[Epidemiologic aspects of echinococcosis]. / Epidemiologicheskie aspekty ékhinokokkoza.

The performed studies showed, that morbidity of the population with echinococcosis substantially varies even within the boundaries of any administrative region and depends on a number of factors. According to climato-geographic conditions it is possible to single out three zones: arid zone (deserts, semi-deserts, salt-marshes) with minimal level of invasion of the population with echinococcosis; zone of semi-deserts and alpines with medium level of invasion; and zone of oases, valleys, middle-mountains and tugays--with high level of invasion. Among the risk group--cattle-breeders--2 subgroups could be singled out: steppe and mountains cattle-breeders, the risk of invasion in the laffer subgroup is substantially higher. It is necessary to include into the risk group also country housewives who are in constant contact with domestic animals, and schoolchildren who an in constant contact with dogs. The significance of aerogenic route of invasion is especially pronounced in children, and frequency of pulmonary form of echinococcosis has reached 50% and more. Besides studying the structure of morbidity and echinococcosis disease in relation to age, sex, occupational activities, for evaluation of epidemiologic conditions on territories it is advisable also to perform mapping of regions according to mass prophylactic examinations data with the use of serological reactions and US examinations, as well as to analyse epidemiologic conditions with the use of such criteria as indices of invasion, morbidity and detectability.

[The surgical procedure in hepatic echinococcosis]. / Khirurgicheskia taktika pri ékhinokokkoze pecheni.

Results of operations on 252 patients with echinococcosis of the liver are analyzed. Closed hydatidectomy was performed in 166 (65.87%) patients, semi-closed one--in 14 (5.56%), pericystectomy--in 16 (6.35%), ideal hydatidectomy--in 12 (4.76%), resection of the liver with removal of the echinococcus cyst--in 9 (3.5%) and percutaneous transhepatic drainage of the cyst--in 7 (2.78%) patients. Postoperative complications were noted in 25 patients; suppurations of the residual cavity--in 17 patients; external bile fistulas--in 5 patients; subdiaphragmatic abscess--in 2, reactive pleurisy--in 1 patient. The least amount of complications followed closed hydatidectomy in 4 patients (2.44%).

[The stimulation of superoxide formation by human neutrophils under the action of blood serum from echinococcosis patients]. / Stimuliatsiia obrazovaniia superoksida neitrofilami cheloveka pod vozdeistviem syvorotki krovi bol'nykh ékhinokokkozom.

The effect of blood serum of patients with liver echinococcosis on the superoxide production by neutrophils of donors was studied. The patients observed were distributed to 2 groups: 1) those with uncomplicated disease and 2) those with festered cyst. Blood serum of patients with echinococcosis was proved to stimulate superoxide production by donor neutrophils by 107-483% in comparison with donor's serum. The serum from patients with festered cyst was shown to have no pronounced effect on superoxide production but a day after echinococcectomy the maximal stimulation was observed, which was 12.03 +/- 0.96 nM/superoxide per 10(6) cells (donor serum 2.49 nM per 10(6) cells). It might be caused by stress effect of the operation. In this group of patients the stimulating effect was gradually decreasing after the operation reaching the control level. In patients with uncomplicated echinococcosis, the stimulation of superoxide production was most profound in the preoperational period (6.70 +/- 0.65 nM per 10(6) cells), and after the operation the stimulating effect gradually disappeared. It is supposed that the phenomenon described is caused by specific antigens which are produced by the helminth.

[Complications after removal of hepatic echinococcal cysts and possibilities of their prevention]. / Oslozhneniia posle ékhinokokkéktomii pecheni i vozmozhnosti ikh profilaktiki.

Operative treatment of hydatid disease is the only radical method at present. According to the data in the literature, the incidence of postoperative complications in patients with hydatid disease of the liver ranges from 14.32 to 64%. The work generalizes the results of operations in 278 patients with hepatic hydatid disease. Closed echinococcectomy was conducted in 168 (65.87%) patients, partly closed--in 34 (12.23%), open echinococcectomy--in 14 (5.04%), pericystectomy--in 21 (7.55%), ideal echinococcectomy--in 17 (6.12%), resection of the liver with removal of the hydatic cyst--in 15 (5.4%), and percutaneous transhepatic drainage of the cyst--in 9 (3.2%) patients. Postoperative complications occurred in 32 (11.51%) cases. Among them were suppuration of the residual cavity in 19, external biliary fistula in 11, and subdiaphragmatic abscess in 2 patients. The least number of complications was encountered after closed echinococcectomy--in 5 (2.97%) patients. One patient died after partly closed echinococcectomy as the result of development of multiple cholangiogenous hepatic abscesses. The results of the authors' observations provide evidence that the character and frequency of postoperative complications are determined by timely diagnosis of echinococcosis of the liver before the development of complicated forms, correct choice of the type of the operation, and the techniques of the operation and the operative approach.

[Diagnosis and treatment of hepatic echinoccosis complicated by rupture into the biliary tract]. / Diagnostika i lechenie ékhinokokkoza pecheni, oslozhnennogo proryvom v zhelchnye puti.

In the period from 1980 to 1990 operations were carried out on 412 patients with echinococcosis of the liver. Complicated forms were encountered in 108 patients. Rupture of the hydatid cyst into the biliary tract occurred in 72 patients. Among the patients with this complication 14 had changes of the bile ducts with the development of obstructive jaundice, 14 had a history of short-term jaundice, in 35 patients the cystobiliary fistula was discovered only during the operation. Percutaneous transhepatic and retrograde cholangiography proved to be the most informative diagnostic methods in rupture of the hydatid cyst into the biliary tract with the development of obstructive jaundice. Echinococcectomy with one-stage operative intervention on the biliary tract was conducted in 14 patients. Along with echinococcectomy, 7 underwent cholecystectomy and drainage of the common bile duct, 2 were subjected to choledochoduodenostomy, 1 to papillosphincterotomy, in 4 patients echinococcectomy was preceded by percutaneous transhepatic cholangiostomy.

[Surgical tactics in associated echinococcosis of the liver and lung]. / Khirurgicheskaia taktika pri sochetannom ékhinokokkoze pecheni i legkih.

Over 10 years operations were conducted in 28 patients with hydatid disease with concurrent involvement of the liver and lungs, which accounted for 5.76% of all patients with hydatid disease of the thoracic and abdominal organs. The following variants were encountered: uncomplicated echinococcosis of the right lung and right hepatic lobe (13 patients); uncomplicated echinococcosis of the left lung and liver (3); suppurative hydatid cyst of the liver with rupture into the pleural cavity and the development of pyothorax (9); rupture of a hepatic hydatid cyst into the bronchial tree of the right lung with the development of a cysto-bronchial fistula (3 patients). In the group of 28 patients with concurrent involvement of the liver and lung 18 were operated on through a thoraco-phreno-laparotomic approach, 9 through a transpleural approach, and one patient underwent a two-stage operation. The success of the treatment is determined by early recognition of the concurrent echinococcosis and the choice of the optimal surgical tactics. One-stage echinococcotomy from the liver and lung is the operation of choice in concurrent affection of the liver and right lung.

[Mechanisms of the pathogenetic prevention of acute pancreatitis in an experiment]. / Mekhanizmy patogeneticheskoi profilaktiki ostrogo pankreatita v éksperimente.

The work was aimed at the elucidation of mechanisms of pathogenetic prevention of acute experimental pancreatitis induced according to the method of Arai. Pathological and biochemical examinations have shown that the application of PNA synthesis inhibitor 5-FU and cellular and intracellular membrane stabilizer-intralipid, infused at the beginning of the experiment, prevented the development of acute purulent pancreatitis.

[Morphology of experimental pancreonecrosis following treatment with 5-fluorouracil]. / Morfologiia éksperimental'nogo pankreonekroza pri vozdeistvii 5-ftorouratsila.

Histological and electron microscopic study of the pancreas and biochemical determination of pancreatic enzymes in blood serum were performed in animals with experimental pancreonecrosis and after the treatment with 5-fluorouracil. The treatment resulted in the decreased secretion of pancreatic acinus tissue, diminution of destructive and inflammatory lesions and the decreased levels of trypsin, alpha-amylase and transamidinase. It is suggested that 5-fluorouracil may be used in the combined treatment of acute pancreonecrosis.

[Dynamics of morphologic changes during treatment of experimental acute pancreatitis with 5-fluorouracil and intralipid]. / Dinamika morfologicheskikh izmenenii pri terapii éksperimental'nogo ostrogo pankreatita 5-ftoruratsilom i intralipidom.

In experimental pancreatitis induced by the modified Agai technique, the combined administration of 5-fluorouracil and intralipid produced an appreciable therapeutic effect, preventing the development of acinus necrosis and suppurative melting of the gland tissue. It is suggested that the effect of the pharmacological combination is consequent on the inhibitory action of 5-fluorouracil on DNA and RNA synthesis by exocrine cells of the pancreas and on the stabilizing action on the cellular and capillary membranes of unsaturated fatty acids constituting intralipid.

[Effect of 5-fluorouracil on the enzymatic activity of the pancreas and blood serum of rats with acute pancreatitis]. / Vliianie 5-ftoruratsila na aktivnost' nekotorykhfermentov podzheludochnoi zhelezy i syvorotki krovi krys pri ostrom pankreatite.

The effect of 5-fluorouracil on the activity of pancreatic enzymes was studied in rats with acute pancreatitis. 5-Fluorouracil was injected intraperitoneally in a dose of 4.5 mg per 100 g body weight. Pancreatic transaminidase as well as serum alpha-amylase and trypsin levels decreased starting from 3--6h after the induction of acute pancreatitis. 5-Fluorouracil inhibited RNA and DNA synthesis and blocked the synthesis of pancreatic enzymes.

[Morphology of experimental acute pancreatitis during treatment with 5-fluorouracil]. / Morfologiia éksperimental'nogo ostrogo pankreatita pri lechenii 5-ftoruratsilom.

Application of 5-fluorouracil exerts a noticeable therapeutic effect in experimental pancreatitis induced according to the modified technique. It prevents the development of acinus necrosis and suppurative lysis of the gland tissue. A suggestion is made that the therapeutic effect of 5-fluorouracil is related to its inhibitory action on RNA synthesis and to the blockade of secretion release from the exocrine part of the gland.