[Prevention and treatment of post-traumatic pancreatic necrosis in patients with blunt abdominal trauma].

INTRODUCTION: High incidence of necrotic and suppurative complications is feature of acute post-traumatic pancreatitis. Severe trauma of the pancreas and post-traumatic pancreatitis lead to depressurization of ductal system that requires adequate drainage of damaged area and retroperitoneal fat. MATERIAL AND METHODS: 95 patients in group 1 received standardized treatment. The victims of the 2nd group (44 patients) were treated using immunoreactive therapy (roncoleukin) and octreotide (the dose depended on the severity of pancreatitis) at early stages. The efficacy of treatment was assessed based on clinical, laboratory and instrumental parameters. RESULTS: Regardless severity of pancreatic injury overall mortality in groups 1 and 2 was 41% and 20.5% respectively. The main causes of adverse outcomes are severe destructive pancreatitis, postnecrotic suppurative complications. CONCLUSION: Adequacy rather radicalism of surgery should be preferred for blunt pancreatic trauma management. Minimally invasive surgical techniques and new methods of biological hemostasis may be applied. Timely use of anti-enzymatic and immunoactive therapy reduces the risk of severe post-traumatic pancreatitis, suppurative complications and improves outcomes in patients with blunt pancreatic trauma.

[The results of combined ozone therapy using in complex treatment of soft tissues infections in patients with diabetes mellitus type II].

Levels of interleukins-6, 8, 10, TNF-alpha and basic fibroblast growth factor (bFGF) were examined in peripheral blood of 60 patients with diabetes mellitus type II and soft tissues infections. It was revealed the elevated levels of proinflammatory (IL-6, 8), anti-inflammatory (IL-10) cytokines and basic fibroblast growth factor at the time of admission. Application of combined ozone therapy including ozonated autohemotherapy and superficial management of wounds with ozone-oxygen mixture resulted in significant decrease of IL-6, 8, 10 production and high level of bFGF on blood serum. Thus effective local bactericidal impact of ozone in combination with normalization of proinflammatory cytokines levels and preserved high level of bFGF in peripheral blood provide better results of wound healing process in patients with diabetes mellitus type II.

[The remote results of treatment of patients with postoperative abdominal hernias depending on surgical access].

The modern concept of life quality research in herniology is applied in the work. 202 patients with postoperative abdominal hernias who underwent making a prosthetic appliance hernioplasties for the period from 2000 to 2010 were included in the study. 105 patients (studied group) and 97 patients were operated by using of laparoscopic and conventional techniques, respectively. Quality of life was evaluated by using of standardized russified questionnaire SF-36 which allowed to make idea about two main components of health - physical and mental. Laparoscopic plasty has certain advantages in comparison with conventional techniques. Also it increases quality of life of patients in terms more than 1 year after surgery.

[Dynamics of local expression of connexin-43 and basic fibroblast growth factor receptors in patients with skin and soft-tissue infections against the background of diabetes mellitus type II].

Clinical results of wound healing dynamics were studied in 60 patients with soft-tissue infection against the background of diabetes mellitus type II. At the same time the study considered indices of intercellular contacts protein tissue expression such as connexin 43 (Cx43) and basic fibroblast growth factor receptors (bFGFR). The basic therapy of biopsy material of wound borders was applied. The reduction of bFGFR expression and the minor growth of Cx43 expression were observed. The pain syndrome proceeded for a long time and there were signs of perifocal inflammation, retard wound healing with granulation tissue. The application of combined method of ozone therapy which included autohemotherapy with ozone and an external management of wound by ozone-oxygen mixture facilitated to considerable shortening of inflammatory phase and regeneration. It was associated with increased Cx43 expression (in 1.9 times) in comparison with initial level and bFGFR was enlarged in 1.7 times to eighth day of postoperative period.

[Effects of immunotropic therapy on the structure of system-forming indices in patients with urgent surgical pathology].

An investigation of system-forming indices of severity of the state and intoxication in 276 patients with urgent surgical pathology depending on using immunotropic medicines has revealed differences in the significance of factors of system-forming indices and functional load on the inflammation mechanisms depending on the inclusion of immunotropic medicines in the complex treatment.

[The results of the practical use of the destructive peritonitis' standartized treatment].

The results of inspection and treatment 117 patients with an acute destructive pancreatitis from 1998 to 2010 are presented. Distinguishing features of management approach of the patients, which was hospitalized in clinic from 2005 to 2010, were high frequency of octreotide use, de-escalated orientation of antibacterial therapy, without early laparotomy interventions and expansion of indications to program sanitation by development of widespread forms of infected pancreatic necrosis. Achievements of intensive therapy of last years and change of surgical tactics have allowed to reduce postoperative mortality by sterile necrosis from 21.1 to 11.8%, to reduce frequency of infected pancreatic necrosis from 68.3 to 40.4%. Development of the infected pancreatic necrosis accompanied by statistically significant growth of frequency of local purulent complications and the tendency to increase--extended.

[Improvement of differential diagnostics and prognostication of the course of destructive forms of acute pancreatitis].

A complex dynamic investigation of the state of oxidative homeostasis in patients with different forms of acute pancreatitis has shown that a reliable reduction of the indices of maximal intensity of chemiluminescence and the coefficient of blood serum antioxidative activity can be considered as an additional criterion for early diagnosis of infected pancreatonecrosis. The absence of a tendency to increased peroxide erythrocyte resistance in the postoperative period in pancreatonecrosis patients speaks of unfavorable prognosis of the disease. Improvement of differential diagnostics allows optimization of the surgical strategy and minimization of the number of early traumatizing surgical interventions.

[Application of cryogenic stimulation in treatment of chronic wounds].

The authors have studied alterations occurring both in the ultrastructure of the cell matrix and in the microcirculatory bed of the chronic wound after local exposure to cryoagent. The up-to-date effective methods including laser Doppler flowmetry were used followed by correct statistical processing of the data obtained. The cryogenic stimulation of the wound was shown to result in considerably improved perfusion of the microcirculatory bed, epithelization and remodeling of the scar. It allowed transformation of a chronic process into acute and thus led to considerably accelerated process of regeneration. The developed method of cryogenic treatment of the chronic wound was used in 35 patients, allowed quicker healing of the chronic wounds and made ambulatory treatment of the patients 3 weeks shorter.

[Vascular component in the pathogenesis of lung failure in acute pancreatitis patients]. / Sosudistyi komponent v patogeneze legochnoi nedostatochnosti u bol'nykh ostrym pankreatitom.

The blood circulation was studied in 61 patients with acute pancreatitis by the method of rheopulmonography. Considerable disorders were revealed both in the systemic hemodynamics and organic blood flow in the lungs during the development of pulmonary hypertension and venous congestion in the small blood circle. Positive influence of the infusion therapy upon the pulmonary blood flow is noted.

[Disorders of gastric secretion in the early stages of acute pancreatitis]. / Narusheniia sekretsii zheludka v rannikh stadiiakh ostrogo pankreatita.

The elevated secretory and fermentative function of the stomach was found by examining 32 patients with acute pancreatitis within 15 days after the onset of the disease. Continuous aspiration of the gastric content and antacid therapy are recommended in order to decrease the acidity of the duodenal content.

[Postoperative anesthesia by the extrapulmonary administration of cycloporpane]. / Posleoperatsionnoe obezbolivanie vnelegochnym vvedeniem tsiklopropana

According to the author's data postoperatively in patients receiving cyclopropane a much more early restoration of the renal excretory function was noted, postoperative intestinal paresis is liquidated more rapidly, the number of complications on the part of the respiratory and cardiovascular systems is diminished up to a minimum. There was less degree of postoperative metabolic alkalosis under the influence of cyclopropane, and it was also more rapidly eliminated.