[Management of patients with malignant obstructive jaundice using bile examination after external biliary drainage]. / Lechenie bol'nykh mekhanicheskoi zheltukhoi zlokachestvennogo geneza na osnove rezul'tatov issledovaniia zhelchi.

AIM: To determine optimal time of biliary tract decompression and bile reinfusion into gastrointestinal tract in patients with malignant obstructive jaundice. MATERIAL AND METHODS: 179 medical records of patients with obstructive jaundice were analyzed in order to identify risk factors of postoperative complications. Prospective trial included bile examination in 34 patients with malignant obstructive jaundice. The new algorithm of preoperative preparation of patients was proposed using these data. RESULTS: Preoperative hyperbilirubinemia over 50 µmol/l before radical surgery and over 80 µmol/l before palliative surgery is followed by increase of postoperative morbidity from 42.1 to 66.7% and from 11.1 to 37.5%, respectively. The concentration of AST and ALT approaches the norm in 13.63±2.39 days after decompression. Five-day period after external drainage is characterized by the same level of overall bilirubin in the bile while bile reinfusion into gastrointestinal tract after 1-2 days leads to advanced symptoms of intoxication. The proposed tactics allows to reduce postoperative morbidity from 36.9 to 26.5% (p<0.05) and mortality from 5.5 to 2.9%, respectively (p<0.05). CONCLUSION: Duration of biliary decompression should be at least 13.63±2.39 days to reduce postoperative morbidity and mortality. Bile reinfusion into gastrointestinal tract should be started in 5-6 days after decompression.

[Malignant obstructive jaundice management via external biliary drainage followed by bile examination]. / Taktika lecheniia bol'nykh mekhanicheskoi zheltukhoi zlokachestvennogo geneza na osnove issledovaniia zhelchi posle naruzhnogo drenirovaniia biliarnogo trakta (s kommentariem ot redkollegii).

AIM: To determine optimal terms of biliary decompression and bile reinfusion into gastrointestinal tract in patients with malignant obstructive jaundice. MATERIAL AND METHODS: 179 medical records of patients with obstructive jaundice were analyzed to identify risk factors of postoperative complications. Prospective research included bile examination in 34 patients with malignant obstructive jaundice. New algorithm of preoperative management was proposed. RESULTS: Hyperbilirubinemia over 50 µmol/l prior to radical surgery and 80 µmol/l before palliative surgery was followed by postoperative morbidity augmentation from 42.1% to 66.7% and from 11.1% to 37.5%, respectively. Normal AST and ALT concentration after biliary decompression was noted after 13.63±2.39 days. Total bilirubin level in the bile was the same within 5 days after external drainage and bile reinfusion into gastrointestinal tract after 1-2 day was associated with advanced intoxication. New approach is associated with reduced postoperative morbidity from 37.9% to 26.5% (p<0.05) and mortality from 5.5% to 2.9%, respectively (p<0.05). CONCLUSION: Duration of biliary decompression should be at least 13.63±2.39 days to reduce postoperative morbidity and mortality. Bile reinfusion into gastrointestinal tract should be started in 5-6 days after decompression.

[Surgical treatment and different preoperative preparation of patients with malignant tumors of hepatopancreatoduodenal zone].

Different tactical approaches present to optimize surgical treatment of patients with malignant tumors hepatopancreatoduodenal zone. This research based on diagnosis and results of treatment of tumors of this localization, which included 357 analyzed case histories of patients treated in the Chelyabinsk Regional Hospital from 2010 to 2014. During this study was considered the preoperative preparation of patients with malignant obstructive jaundice genesis, and was assessed its impact on the level of postoperative complications and mortality. Farther was found effectiveness of a two-stage surgical treatment of patients with obstructive jaundice malignant etiology for the reduction of postoperative mortality. The complication rate is significantly reduced radically operated patients with bilirubin level below 40 mmol/l, palliative - 80 mmol/l. Also were presented results of treatment of chronic pain.

[Splenic artery pseudoaneurism as a rare complication of acute and chronic pancreatitis].

Diagnostics and treatment of the splenic artery pseudoaneursm as a complication of acute pancreatitis were highlighted. Literature data is reviewed. Personal results of treatment of 5 such patients were thoroughly analyzed. The effective treatment and diagnostic algorithm was worked out. Technical aspects of visceral arteries' surgery were featured and optimized.

[Surgeon's strategy in forming large intestine anastomoses].

The article includes experience with treatment of 103 patients with the formed different large intestine anastomoses. Primary operations for cancer of the rectum were made on 76 patients, restorative operations--on 27 patients. The following techniques were used: manual formation of the large intestine anastomosis, apparatus anastomoses using AKA-2, "ETHICON CDH" and double apparatuses method using "CONTOUR" and "ETHICON CDH". It was found that the application of stitching apparatuses required shorter time necessary for applying large intestine anastomosis and for operation. When forming the large intestine anastomoses in the abdominal cavity the manual method should be preferred. The formation of anastomosis in the small pelvis cavity is accompanied by technical problems and requires using stitching apparatuses. The method using apparatuses "CONTOUR" and "ETHICON CDH" decreases the number of postoperative complications and can extend the list of indications for performing sphincter-sparing operations.

[Postoperative electrostimulation in abdominal surgery].

A new method of electric stimulation of the gastrointestinal tract in surgical patients is analyzed. The study group consisted of 201 patients after different abdominal surgeries who had undergone electrostimulation procedures in postoperative period. Conventional methods of paresis prophylaxis and treatment were used in 419 similar patients (control group). Electrostimulation was performed during 20-30 min two times a day from the first day after surgery till complete resolution of paresis. It is concluded that direct electrostimulation in postoperative period reduces duration of paresis, number of postoperative pneumonias ( 6-fold and more) and other complications. Postoperative lethality was 3.98% in the study group and 7.87% in the control group.

[The characteristics of the neuropsychotropic activity of bromantane in laboratory animals]. / Kharakteristika neiropsikhotropnoi aktivnosti bromantana u laboratornykh zhivotnykh.

Bromantan [N-2-(para-(bromphenyl)-N-2-(aminoadamantan)] possesses psychostimulating activity in experiments on animals. With LD50 8100 mg/kg (mice, intraperitoneal injection) activates simple and complicated forms of behavior, induces EEG effects typical of psychostimulators, is an antagonist of substances with a deprivationg neuropsychotropic effect. Bromantan is characterized by a positive effect on mnemonic processes and on obtaining the results of complex operant activity in rats.

[The therapeutic efficacy and the effect of gidazepam and fenazepam on the psychophysiological status and on the performance of operators with mental disorders at a neurotic level]. / Terapevticheskaia éffektivnost' i vliianie gidazepama i fenazepama na psikhofiziologicheskoe sostoianie i rezul'tativnost' deiatel'nosti operatorov s psikhicheskimi narusheniiami nevroticheskogo urovnia.

The effect of placebo and gidazepam on the state, psychophysiological predictors of the quality of the operator's performance and its results in individuals with neurotic reactions was studied (test dose 20 mg 7-day course, 40 mg daily, 24 individuals), as well as the effect of gidazepam and phenazepam (42 individuals with neurotic and neurosis-like states; gidazepam test doses 20 and 50 mg, 14-day course, 40 and 100 mg daily; phenazepam test doses 0.5 and 1 mg, 14-day course, daily dose 2 mg). The generally accepted methods of clinical and psychophysiological examination were applied. Gidazepam in the doses under study did not yield to phenazepam in therapeutic activity. A single and a course administration of gidazepam improved the parameters of the psychophysiological state and the efficacy of the operator performance in patients with neurotic reactions and in those with neurotic and neurosis-like states. This makes it possible, whenever necessary, to recommend this drug for the treatment of the indicated disorders in the working operators.