[Blood microcirculation disorder in patients with bronchopulmonary diseases and methods of microcirculation study].

AIM: To investigate microhemocirculation in patients with bronchopulmonary pathology with application of Doppler flowmetry (DFM). MATERIAL AND METHODS: Videobronchoscopy (Olimpas or Pentax devices) was performed in 203 patients with bronchitis of different inflammation intensity: Functional activity of microhemocirculation in bronchial mucosa was studied with endobronchial laser Doppler flowmetry (LDF) which was also made in 20 healthy controls. RESULTS: LDF-grams demonstrated that patients with chronic bronchitis and pneumonia have congestive regional microcirculation with low activity of components of microcirculatory bed, venous blood congestion, weak blood flow and tissue ischemia. High informative value of the method and its availability was shown by comparison of LDF-grams on treatment day 7 and 14. CONCLUSION: High informative value of LDF procedure is found in diagnosis of vascular and intravascular microcirculatory disorders in patients with bronchopulmonary pathology.

[Correction of the antioxidative system during ozone therapy in peritonitis].

Clinical studies revealed correlation of changes in anti-oxidative system and lipid peroxidation with peritonitis phases. The assessment of anti-oxidative system was used as an additional diagnostic and prognostic criterion for the disease. Data are presented in proof of efficiency of an ozone physiological solution included in combined treatment of acute peritonitis. Ozone therapy helped to normalize functioning of the anti-oxidative defensive system and thereby decrease the incidence of severe complications and fatal cases among patients with peritonitis.

[Preveation of postoperative venous thromboembolic complications: pharmacoeconomic analysis].

This paper describes the results of a prospective clinicoeconomic <> study at prevention of postoperative venous thromboembolic complications (VTEC) in general surgery and gynecology patients. The patients were distributed into two groups: the basic and control. The basic group were provided pharmacoprophylaxis using fraxiparin. The control group did not receive preventive treatment. The authors examined the effectiveness of VTEC prevention applying duplex scanning of the inferior vena cava and explored the hemostatic system. It has been established that the mean treatment cost accounts for 61186 roubles per patient in terms of the prices recorded in 2005. The main expenses is the cost of the bed day (60% of direct expenses) and of the treatment complications (24%). The main conclusion of the study is that the early anticoagulant prophylaxis provided to patients at moderate and high risk allows minimization of the incidence of thrombotic complications. Besides, it is economically advisable.

[Efficacy of transcutaneous endobiliary procedures in patients with obstructive jaundice].

Transcutaneous endobiliary procedures (TEP) were performed in 378 patients with obstructive jaundice (OJ). External decompression of the biliary ducts was carried out as the first stage of treatment in all the patients with OJ of various etiology. This procedure led to reduction of cholangitis symptoms and hepatic failure, improvement of general condition of the patients before radical surgery. Endoprosthesis of the bile ducts made in 121 patients allowed physiological passage of bile into the intestine and improved quality of life especially in inoperable patients with hepatic and pancreatoduodenal tumors. During external drainage in 27 (7.1%) patients dislocation of drainage of the common bile duct occurred. Postoperative lethality was 8.5%. After open surgeries 2 (1.2%) patients died.

[Minimally invasive methods of surgical treatment for diseases of liver, biliary tract, and pancreas]. / Miniinvazivnye metody khirurgicheskogo lecheniia bol'nykh s zabolevaniiami pecheni, zhelchnykh putei i podzheludochnoi zhelezy.

Results of examination of 324 biopsies from hepatopancreatoduodenal zone were analyzed. The biopsy was performed as roentgentelevision- or US-guided procedure with Pro-Mag 2.2 device. There were no complications. Percutaneous endoprosthesis of biliary ducts was performed in 127 patients (89% of them were older than 65 years) with obstructive jaundice. Roentgen- or gastroscopy-guided hepaticogastroanastomosis was formed in 36 patients with different diseases. The follow-up was to 18 months in malignant tumors, and to 26 months in benign strictures. Video-assisted drainage of gall bladder in acute cholecystitis was performed in 436 patients with cholelithiasis and severe concomitant diseases. Results of many-stage treatment of 207 patients with choledocholithiasis were analyzed, residual disease was revealed in 11 (5.6%) patients.

[The laparoscopic treatment of varicocele]. / Laparoskopicheskoe lechenie varikotsele.

Laparoscopic treatment of varicocele is described for 37 patients. The operation was performed under endotracheal, epidural and intravenous anesthesia with ligation of the testicular vein in 18 patients. Ligation with the dissection was conducted in 19 patients. On the first postoperative day 2 patients were given promedol (2%, 1.0 ml), the rest were injected baralgin (2-3 injections). The patients were discharged after 1-2 days of hospital stay and resumed their usual way of life 2-7 days after the discharge. One month later varicocele disappeared in 29 patients, diminished in size in 7 patients, pain relief occurred in 15 patients. Due to its advantages (simple performance, good visualization of the testicular vein, minimal use of narcotic drugs, short hospital stay, absence of serious complications) laparoscopic treatment may be considered as a method of choice.

[The antibacterial and immunocorrective action of ozone therapy in peritonitis]. / Antibakterial'noe i immunokorrigiruiushchee deistvie ozonoterapii pri peritonite.

Ozone therapy was used in 74 patients with diffuse forms of purulent peritonitis. It allowed to make postoperative lethality 1.7 times less and the amount of complications 1.8 times less as compared with a group of 62 patients where ozone was not used.

[The prognostic significance of the level of the blood antiproteinase potential in peritonitis]. / Prognosticheskoe znachenie urovnia antiproteinaznogo potentsiala krovi pri peritonite.

It was shown that the level of proteinase alpha 1-inhibitor (alpha 1-i.p.) in the toxic phase of peritonitis was reduced. In transition of the toxic phase to the terminal one the level of alpha 1-i.p. increases which suggests the preserved function of the liver. The terminal phase proper is accompanied by a considerably decreased level of the inhibitor. For this phase proteinase inhibitors should be administered. The level of activity of alpha 1-i.p. can serve as a prognostic criterion of the peritonitis course.

[A comparison of different methods for quantum hemotherapy in treating complicated forms of acute cholecystitis in middle-aged and elderly patients]. / Sravnenie razlichnykh metodov kvantovoi gemoterapii pri lechenii oslozhnennykh form ostrogo kholetsistita u bol'nykh pozhilogo i starcheskogo vozrasta.

Quantum hemotherapy (QH) was used in complex treatment of elderly and senile patients operated upon for complicated forms of acute cholecystitis. Under examination there were 75 patients. Transfusion of UV irradiated donor plasma was found to be most effective of the QH methods used by us in the complex treatment of acute cholecystitis in elderly and senile patients.

[X-ray irradiation of donor blood in the complex treatment of suppurative diseases]. / Rentgenovskoe obluchenie donorskoi krovi v kompleksnom lechenii gnoinykh zabolevanii.

The authors discuss the use of donor blood after isolated exposure to X-rays in the complex treatment of 65 patients with various suppurative diseases. The therapeutic complex included in all cases transfusion of 250 ml of irradiated blood and subsequent antibiotic therapy. Study of antibiotic (penicillin) pharmacokinetics showed increase of its biological activity and prolongation of its presence in the blood in therapeutic concentrations for 24-48 hours. A scheme of antibiotic therapy in transfusion of irradiated blood is suggested. A formula for calculating the optimal irradiation dose is given. It is concluded that transfusion of irradiated blood followed by injection of an antibiotic raises the efficacy of antibiotic therapy, reduces the term of treatment, and increases the effect of postoperative management.

[Endoscopic treatment of cicatricial stenosis of the esophagus]. / Endoskopicheskoe lechenie rubtsovykh suzhenii pishchevoda.

On the basis of experience in the examination and treatment of 118 patients with cicatricial stenoses of the esophagus the authors came to the conclusion that endoscopic examination is the main method for identifying the character of the narrowing and that esophagoscopy should be performed in all cases of recognized or suspected cicatricial stenosis of the esophagus. Endoscopic methods of treatment were also applied: removal of foreign bodies from the cicatricially changed esophagus, the advancement of a guiding string during esophagoscopy for therapeutic bougienage, cutting the cicatricial tissue with an electric knife.