[View on the problem of Klatskin tumor].

Klatskin tumor arises from the common hepatic duct and its bifurcation the bile ducts and is the most common primary malignancy of the biliary tree. the location of the tumor and its close relationship with vascular structures at the hepatic hilum have resulted in a low resectability and high morbidity and mortality. Improvement of instrumental diagnostics and operative techniques allows to perform extended resection and complex interventions on the liver, bile ducts and vascular structures at the hepatic hilum. The role of chemoratiotherapy and photodynamic therapy is not fully understood. thus, questions of treatment and prognosis of the disease are remain relevant and require further study.

[BILIARY DECOMPRESSION ASSOCIATED WITH TUMOURS OF PROXIMAL BILE DUCTS].

The treatment of tumours of proximal hepatic ducts (Klatskin tumours) remains a serious challenge because most patients are referred to the clinic at later stages of the disease. Its most common symptom is obstructive jaundice syndrome. Various methods of bile tract decompression have been proposed to resolve manifestations of this syndrome in the course of preoperative preparation for surgery of potentially resectable tumours and palliative treatment of incurable neoplasms. However analysis of the literature shows that the choice of an adequate method for the purpose remains a matter of debate.

DNA-damaging effects of dental bleaching agents.

We studied DNA-damaging effects of dental bleaching systems containing hydrogen peroxide and/or carbamide peroxide by the "comet assay" (alkaline version). Dental bleaching systems in a hydrogen peroxide concentration range from 0.03 to 30 mM produced a genotoxic effect on isolated HeLa cells in vitro comparable with the effects of pharmacopoeial hydrogen peroxide or urea peroxide. Catalase protected the cells against products containing hydrogen peroxide and had no effect on the genotoxicity of samples containing carbamide peroxide.

[Carbohydrate metabolism after pancreatoduodenal resections in patients with chronic pancreatitis].

The carbohydrate metabolism was analyzed in 70 patients with the complicated chronic pancreatitis before and after pylorus-preserving pancreatoduodenal resection (PPDR). Patients were aged 42±1,15 years, of them 64 were men and 6 - women. Bodymass index was 2,2±0,54kg/m2. Patients were divided in groups according to pre- and postoperative glucose metabolism disorders to define the diabetes morbidity by chronic pancreatitis and the influence of surgery on the first. According to the preoperative data, diabetes mellitus of mild severity had 9 of 70 operated patients, 18 patients had medium diabetes. After the operation only one patient demonstrated the aggravation of diabetes. However, the onset of diabetes mellitus was registered in 8 patients postoperatively. The increased glucose blood level in early postoperative period proved to have a high prognostic significance. Therefore, all patients of that category must be strongly recommended to be under the endocrinologist's observation after hospital discharge. That measure would provide a timely diagnose and treatment of the diabetes mellitus. All patients with chronic pancreatitis should be thoroughly investigated concerning glucose metabolism disorders before the operation.

[The distal pancreatic resection with spleen preservation: which collaterals can we rely on?].

The spleen preservation by distal pancreatic resection can be performed either with spleen vessels preservation or with the ligation of the least. The experiment evolved ligation of all gastric arteries but the short gastric arteries in 20 cadaveric organocomplexes, followed by ink perfusion through the left gastric and left gastro-epiploic arteries. The study was amplified with the intraoperative dopplerography of portal arteries of the spleen after crossclamping of the left gastro-epiploic and short gastric arteries. Ten patients after distal pancreatic resection with spleen preservation and splenic vessels ligation had the CT-angiography before and after the surgery. All the conducted studies demonstrated the incapability of short gastric arteries to supply the satisfactory spleen perfusion. The left gastro-epiploic artery proved to be the main source of splenic blood supply after splenic vessels ligation.

[Carbohydrate metabolism disturbances after pancreatoduodenal resection in patients with cancer of the head of pancreas].

Carbohydrate metabolism was explored in 52 patients with cancer of the head of pancreas before and after pylorus-preserving pancreatoduodenal resection. Glycemia, insulin dosage, glucosuria and acetonuria were assessed retrospectively to reveal correlation with postoperative carbohydrate metabolism disturbances. Preoperatively 46.2% of patients had no metabolic problems, whereas postoperatively only 38.5% of patients showed normal sugar metabolism. 9 (17.3%) patients developed disturbed glucose tolerance, 5 (9.6%) patients developed mild diabetes mellitus and 18 (34.6%) patients had diabetes of medium severity. Combination of first diagnosed diabetes mellitus, progressive weight loss and abdominal pain proved to be the negative prognostic set of symptoms and should urge on pancreatic tumor search. Glucose level in early postoperative period is a valuable prognostic criteria for the development of carbohydrate metabolism disturbances in long-term postoperative period.

[Arterial celiac-mesenterial aberrations: comparative analysis of intraoperative data and CT-angiography].

137 CT-angiograms of arterial celiac-mesenterial vessels were pro- and retrospectively analyzed in 120 patients. Radiological data was compared with intraoperative anatomy during standard and extended pancreatoduodenal resections. The analysis showed a considerable variability in architecture of celiac and superior mesenteric artery branches: hereby, a classical arterial anatomy was found only on 55% of the analyzed CT-scans. Intraoperative revision confirmed CT-data in all cases. CT-angiography is a prompt and reliable method of celiac-mesenterial arterial anatomy determination, making surgical treatment of patients with liver and pancreas diseases safer.

[Hilar glissonean access to vascular-secretory elements in anatomical segmental liver resections].

It still remains unclear which patients with hepatic tumors can favour anatomical segmental liver resections instead of major liver resection. Short term results of anatomical segmental liver resection are evaluated and analyzed. Ten patients underwent the anatomical segmental liver resection performed by posterior approach with taping of anterior right hepatic vein. Seven patients had liver metastases of colorectal cancer, one had primary hepatic carcinoma and two had benign lesions, anatomical segmental liver resection were performed without Pringle maneuver. There was no significant difference in blood loss, duration of the procedure, postoperative hospital stay and morbidity in comparison with the segmental liver resection performed by anterior approach. Multiple, large and deep-embedded lesions were removed completely, with tumor-free resection margins. Anatomical segmental liver resection performed by hilar glissonean approach is recommended in patients with compromised liver function "unfavourable" liver anatomy to replace major liver resection provides removal of only affected part of the liver accordingly to its true anatomical borders.

[The chronic pancreatitis caused glucose metabolism disturbances before and after distal pancreatic resections].

Glucose metabolism is evaluated before and after the operation in 51 patients (41--men, 10--women), operated on account of the complicated chronic pancreatitis. The distal pancreatic resection (50% of the gland) was performed in all cases. The middle age of the patients is 41.2+/-7.9. Body mass index (BMI) was 23.7+/-3.4 kg/m2. After distal pancreatic resection 33.33% of patients with chronic pancreatitis didn't have glucose metabolism disturbances. In 27.45% of patients diabetes mellitus was diagnosed for the first time after the operation. At the same time, in 5.8% of cases the worsening from the light to the moderate form of diabetes mellitus was observed. As far as blood glucose level (glycemic control) doesn't have any prognostic value in predicting diabetes mellitus in early postoperative period, it is necessary to recommend regular supervision by the endocrinologist to the patient after discharge. All patients with chronic pancreatitis should be carefully investigated so as to detect glycaemic disorders. It is recommended to determine fasting blood glucose level, glycemia throughout the day, glycated hemoglobin, 24 hours' glucosuria. It is also essential to perform an oral glucose tolerance test (OGTT).

[Median resection of pancreas].

Experience of 16 median resections of pancreas due to serous or mucinous benign cystic tumor (13 patients) or small afunctional neuroendocrine tumor (3 patients) is analyzed. In all the cases the pathologic process was located at the zone of pancreas isthmus. The long-term results were followed-up at 13 patients from 2 to 14 years (mean followed-up - 8 ys). There were no recurrences of tumor. It is concluded that median resection of pancreas is effective and safe surgical operation for the patients with localization of benign tumor at the zone of pancreatic istmus.

[Surgical treatment of chronic pancreatitis in combination with duodenal ulcer disease]. / Khirurgicheskoe lechenie khronicheskogo pankreatita v sochetanii s iazvennoi bolezn'iu dvenadtsatiperstnoi kishki.

Results of two surgeries--total and subtotal resection of pancreatic head in combination with selective proximal vagotomy (SPV)--performed for chronic pancreatitis and duodenal ulcer disease (DUD) are presented. In one case surgery was supplemented with circular resection of the duodenum and fundoplication. Reconstructive stage of both surgeries included creation of pacreato- and biliodigestive anastomosis on Roux intestinal loop. Choledochojejunoanastomosis was created on the same loop of the small intestine either "end-to-side" with supraduodenal part of common bile duct or "side-to-side" with its pancreatic part. The former surgery was finished with duodenoduodenoanastomosis "end-to-end" for recovery of duodenal passage. This surgery was characterized by complete removal of pancreatic head. The latter surgery corresponded to Beger's operation. There were no complications in the nearest postoperative period. Long-term results were favorable and followed up during 17.5 and 7 months, respectively. This experience testifies that resection of pancreatic head with SPV may be considered as alternative to pancreatoduodenal resection in surgical treatment of patients with chronic pancreatitis.

[Comparative study of properties of temperate erwiniophages 49 and 59]. / Sravnitel'noe izuchenie svoistv umerennykh érviniofagov 49 i 59.

Molecular-biological properties of two relative temperate erwiniophages 49 and 59 have been comparatively studied. The both phages are highly specific with respect to sensitive bacteria and lyse only inconsiderable quantity of amylovora-like strains of Erwinia horticola. It has been established that erwiniophages are distinguished by the basic parameters of a single reproduction cycle in the cells of common host E. horticola 450. Considerable differences between phages have been also found in the areas of genomes responsible for the establishment and maintenance of lysogenic state in the cells of the bacterium-host. Study of structure polypeptides has confirmed the identity of capsids and tails of phages 49 and 59. It has been shown that phage 49 has another, as compared to phage 59, basal plate, which availability destabilises the phage tail and leads to virion destruction under various physical effects. Virion DNA of phages 49 and 59 are of the same size--47.9 kbp, but differ as to GC-content. Using the restriction analysis it has been shown that genome of phage 49, as well as the genome of phage 59, is permuted, but its permutation is of discrete character. The fact of recombination interaction between erwiniophages 49 and 59 has been established. It is supposed that phage 49 is the recombination (hybrid) derivative of phage 59 and unknown phage, or prophage, genetic module. The given recombination, probably, took place under the persistence of different phages in the general polylysogenic system of E. horticola.

[The interaction of Bradyrhizobium japonicum with clay minerals]. / Vzaimodeistvie Bradyrhizobium japonicum s glinistymi mineralami.

It is shown that such clay minerals as palygorskite and montmorillonite stimulate growth activity of Bradyrhizobium japonicum. The bacteria come into contact with the above minerals. Granulated preparations of rhizobia have been developed on the basis of the results obtained. These preparations are characterized by the high yield of viable cells and a possibility of long-term storage. The use of montmorillonite in production of granulated preparations provides the higher yield of viable bacteria in the preparations and stability of their composition under long-term storage.

[Recurrent profuse hemorrhage in gastric angiodysplasia]. / Retsidiviruiushchie profuznye krovotecheniia pri angiodisplazii zheludka.

Dieulafoy's disease--i.e. arteriovenous malformation--is a rare cause of gastric bleedings, which makes up 1.5-3% of all sources of hemorrhage. All the armory of diagnostic modalities may require to reveal arteriovenous malformations. Angiography of the stomach appeared to be the most informative method for diagnosis of this disease in 2 patients. Radical treatment of patients with Dieulafoy's disease implies resection of the proximal part of the stomach or gastrectomy. Endoscopic hemostasis (with the use of coagulation and injections of sclerogenous preparations around the diseased area) results in temporary effect.

[Roentgenological examination of stomach after pancreatoduodenectomy]. / Rentgenologicheskoe issledovanie zheludka posle pankreatoduodenal'noi rezektsii.

High frequency of complications after pancreatoduodenal resections dictates the necessity to study causes of their origin. This paper provides the results of roentgenologic examinations in early and late postoperative periods in 24 patients who underwent classic pancreatoduodenal resection by Whipple and in 23 patients after pylorus saving pancreatoduodenal resection--operation by Traverzo-Longmire. Conventional method of roentgenologic examination of the operated stomach was used. In early postoperative period disturbances of motor-evacuatory function of upper parts of gastrointestinal tract were revealed in 50% of patients in any modification of pancreatoduodenal resection. In most cases slowering down of the evacuation up to complete gastrostasis was observed. But in long-term follow-up functional results after pancreatoduodenal resection according to x-ray examination data were much better after operation by Traverzo-Longmire (75% patients) than after classic version by Whipple (37% patients). Thus, the results of roentgenologic examination showed that pylorus saving version of pancreatoduodenal resection provides optimal conditions for normal activities of the saved organ.

[A retrospective examination of a hepatitis focus in plasma donors]. / Retrospektivnoe obsledovanie ochaga gepatita u donorov plazmy.

Data are presented on the retrospective epidemiological serological investigation of episodes of hepatitis-like diseases among plasma donors in Krasnoyarsk. A mixed structure of the focus was established with prevalence of B- and non-A-, non-B hepatitides. Markers of recent infection with HB virus were recorded in 43.6% of sick donors, at the same time no donors had IgM antibodies to hepatitis A evidencing the acute stage or early convalescence. The use of the insufficiently sensitive passive hemagglutination test for HBsAg identification has resulted in incomplete detection of donors-carriers of HB virus.