[Improvement of extracorporeal shockwave cholelithotripsy in the comprehensive treatment of cholelithiasis].

The method of shockwave distant lithotripsy (DL) has been used since 1985. However, many facets of this problem have not been solved yet, because large fragments of the stone remain after its destruction, and focused shock waves (FSW) damage the gallbladder (GB). The aim of this study was to determine possibilities of effective distant destruction of gall stones, to reveal negative consequences of the effects of FSW on the gallbladder (GB) and the surrounding tissues, as well as development and perfection of DL technique. The established parameters of FSW were used to develop the new Lithotriptor Compact. By now, 53 patients with cholelithiasis aged 18 to 55 have been treated by DC. The procedure was performed without general anesthesia. A thousand to 3500 shockwave impulses were applied to each stone. All patients had received litholytic therapy and treatment directed towards metabolic normalization, the functional state of the GB, and prevention of recurrent stone formation, prior to DL. In total, 116 DL sessions (2.2 sessions per a patient) were performed. A positive effect as a result of the complex treatment of cholelithiasis using DL method was achieved in 47 (88.7%) of the patients. There were no complications. In 3 patients (5.7%) recurrence of gallstones was found two years after DL sessions. Correctly selected parameters of FSW and DL technology allow for effective destruction of GB stones, while conservative therapy favors their passage through the biliary tract and fast litholysis of remaining stone fragments.

[Diagnostics, treatment and expert evaluation of air crew members with polypoid growth in the gallbladder].

The article discusses results of diagnosing and treatment of various forms of gallbladder polypoid growth (GBPG) in air crew members in the past 10 yr. period. Growth of polyps was detected in 12.1% of pilots with gallbladder pathologies. Timely and correct diagnostics with the use of radiologic visualization may prevent unwarranted surgery of the hepatobilizry system and thus extend the flying longevity. Ultrasound Doppler investigation is particularly effective in diagnosing early GBPG. High quality of visual differentiation attainable with these techniques made it possible to diagnose the nonneoplastic nature of GBPG in 75% of cases that did not require operational treatment. In most cases the authors' diagnostic and treatment algorithm reduced the amount of surgical activity and prolonged ace careers.

[Hemostasis disorders after resection of liver and approaches to their prevention and correction]. / Narusheniia sistemy gemostasa posle rezektsii pecheni, ikh profilaktika i korrektsiia.

Second- or third-degree dysfunction of hepatocytes was the most frequent (47.9%) disorder in the hemostasis system on the first-second days after extensive resection of the liver, whereas after economic resection this disorder was observed in only 5.5% patients. Intraoperative blood loss of more than 3 liters is fraught with hemorrhages and hepatorenal insufficiency in the postoperative period. Such blood loss is complicated by coagulopathic states presenting as 1) hepatocyte dysfunction of the second-third degree, 2) hypoxia and decreased production of blood clotting factors, and 3) variants of the DIC syndrome. Study of the genesis of postoperative coagulopathies after resection of the liver and development of pathogenetically-based methods of drug correction, together with introduction of novel instrumental methods affecting the intensity of local and total hemostatic reaction, helped reduce 2.5 to 3 times the total blood loss.

[Synthesis and biological activity of new analogs of beta-casomorphine-5]. / Sintez i biologicheskaia aktivnost' novykh analogov beta-kazomorfina-5.

Four new analogues of beta-cazomorphine-5 modified at the C-end with ethylenediamine- and glycine-containing derivatives were synthesized by the standard method of peptide chemistry (mixed anhydrides, carbodiimide, activated esters): H-Tyr-Pro-Phe-Pro-Gly-EtDA-Gly-II (I) H-Tyr-Pro-Phe-Pro-Gly-EtDA-Gly-Gly-II (II) H-Tyr-Pro-Phe-Pro-Gly-EtDA-Gly-Gly-CO-CH3 (III) H-Tyr-Pro-Phe-Pro-Gly-EtDA-Gly-Gly-CO-CH2-CH2-COOH (IV) The level of affinity and the degree of selectivity of the peptides towards the mu- and delta-opioid receptors of the rat brain lyophilized membranes were studied by the radioreceptor method. All the new peptides displayed analgetic activity, largely depending upon their structure.