[Diagnostic and management algorithm of acute pancreatitis].

The analysis of diagnostics and treatment of 602 patients with destructive pancreatitis has shown that definition of etiological and pathogenetic forms of pancreatitis defines strategy of treatment. In this way, patients with biliary pancreatitis require emergency operative treatment with use of endoscopic interventions without dependence from a stage of disease. To patients with alcoholic or alimentary pancreatitis in the stage of enzymatic toxemia conservative treatment should be spent only, until shock and/or delirium won't be reduced. Endoscopic retrograde cholangiopancreatography + endoscopic papillosphincterotomy with concrement removal from common bile duct--is the operation of choice in case of acute biliary pancreatitis at the first stage. Laparoscopic cholecystectomy is the operation of choice at the second stage of disease. At destructive pancreatitis of other origin in a stage of the infection or necrotic suppurative inflammation use of open and closed small invasive methods of intervention is most proved. Given tactics of treatment has allowed to lower severity of clinical course, frequency of complications and lethality.

[Possibilities of x-ray computed tomography in the diagnosis and treatment of suppurative complications of acute pancreatitis]. / Vozmozhnosti rentgenovskoi komp'iuternoi tomografii v diagnostike i lechenii gnoinykh oslozhnenii ostrogo pankreatita.

The authors have analyzed results of the roentgen computed examination of 73 patients with acute pancreatitis and its complications. The potentialities of roentgen computed tomography (RCT) in diagnosing are shown as well as computed semiotics of acute pancreatitis and its complications. The authors consider that RCT makes the diagnosis substantially more exact and enables the complications to be detected much earlier. Systematization of the signs detected by RCT in acute pancreatitis in combination with the clinical symptoms gives the information necessary for correct strategy of surgical treatment.

[Immune and enzyme disorders in patients with acute pancreatitis]. / Immunnye i fermentnye narusheniia u bol'nykh ostrym pankreatitom.

Analysis of immune and enzyme disorders in 85 patients with acute pancreatitis shows that persistent imbalance of immunoregulatory T-lymphocytes with suppression predominance; reduction of all immunoglobulines number, imbalance in phagocytic immunity with height of absorbing activity of neutropils and stimultaneous decrease of their digestive capacity are prognostically unfavourable for high risk of pyonecrotic complications and lethal outcome. It is necessary to include immunocorrectors in combined therapy. Direct assessment of leukocytic elastase activity and alpha-IP level in blood plasma permits to evaluate spreading of inflammatory process and it severity, efficacy and prognosis of treatment.

[Enteral correction of homeostasis in acute pancreatitis]. / Enteral'naia korrektsiia gomeostaza pri ostrom pankreatite.

The experiments showed that heart and liver functional abnormalities will take place even before changes of blood amylase is occurred. It was shown that Dalargin in a dose of 50 micrograms/kg will stimulate the intestinal absorption.

[Leukinferon in immunological correction of acute inflammatory diseases of the abdominal organs]. / Immunokorrektsiia leikinferonom pri ostrykh vospalitel'nykh zabolevaniiakh organov briushnoi polosti.

Addition of (intramuscular+intravenous) leukinferon (LF) to the schemes for the treatment of acute peritonitis promoted a more rapid positive development of the time course of clinical signs and decreasing of leukocytosis in the presence of a pronounced tendency to normalization of the main immunological indices i. e. the counts of differential T-lymphocytes and T-helper cells. There was also activation of neutrophil phagocytic function. A rapid decrease in objective signs of endotoxicosis was recorded: the intoxication leukocytic index and the level of medium-mass molecules. In parallel with the decrease in the intoxication leukocytic index, there was a decrease in cytosis of the peritoneal exudate. The use of LF in the treatment of elderly patients with acute cholecystitis eliminated the clinical signs and normalized the main laboratory indices without surgical interventions which allowed one to make a planned operation with the minimum risk.

[Treatment of patients with late thrombosis after reconstructive surgery of the terminal segment of the aorta and its branches]. / Lechenie bol'nykh s pozdnim yrombozom posle rekonstruktivnykh operatsii na terminal'nom otdele aorty i ee vetvakh.

An analysis of personal clinical observations (339 patients) has been performed. In 45 of the patients (13.3%) late thromboses developed within the period from 3 months to 5 years. Under analysis were results of the investigation of rheological properties of blood in the regional and peripheral blood flow by stages of the disease, methods of detoxication and correction of hemorheology. Results of the treatment are described.