[Modern biochemical markers of acute mesenteric ischemia]. / Sovremennye biokhimicheskie markery ostroi mezenterial'noi ishemii.

OBJECTIVE: To analyze modern literature data on biochemical markers of critical mesenteric ischemia. MATERIAL AND METHODS: We analyzed the most promising, highly specific and sensitive biochemical markers of total and segmental intestinal damage following acute mesenteric ischemia. Analysis included domestic and foreign literature data between 2015 and 2023. RESULTS: We identified the most easy-to-use for any hospitals biochemical markers with at least 90% sensitivity and specificity for further practical research. CONCLUSION: Further prospective research will provide a new step in solving the problem of timely diagnosis of acute mesenteric circulatory disorders.

[Successful treatment of an aortoduodenal fistula after operation on the abdominal portion of the aorta]. / Uspeshnoe lechenie aorto-duodenal'noi fistuly posle operatsii na briushnom otdele aorty.

Gastrointestinal haemorrhage is a common cause of emergency admission of patients to surgical hospitals. Within the structure of nosological entities, not unreasonably referred to the rarest causes of gastrointestinal bleeding is the formation of an aortointestinal fistula whose early diagnosis is of paramount importance. The clinical picture may be different but it is mostly represented by gastrointestinal haemorrhage. The incidence of gastrointestinal fistulas following a surgical intervention ranges from 0.6 to 2.3%. Unless timely diagnosed and with incorrect therapeutic decision-making, the mortality rate amounts to 90%. In this article we present a clinical case report regarding successful treatment of a patient presenting with a secondary aortoduodenal fistula occurring 5 years after previously performed aortofemoral bypass grafting and complicated by relapsing intestinal bleeding and acute ischaemia of the right lower extremity.

[European registry Helicobacter pylori (Hp-EuReg): how has clinical practice changed in Russia from 2013 to 2018 years].

The multicenter prospective observational study initiated by the European Helicobacter and Microbiota Study Group (EHMSG) is conducted in 27 countries in Europe. The data from the Russian part of the European registry for the management of Helicobacter pylori infection (European Registry on the management of Helicobacter pylori infection, protocol: "Hp-EuReg") allows us to analyze the real clinical practice of diagnosis and treatment of H. pylori and compare it with international recommendations. MATERIALS AND METHODS: A comparative analysis of the data entered in the register by the Russian research centers "Hp-EuReg", in the period from 2013 to 2018, was conducted. RESULTS AND DISCUSSION: Invasive diagnostic methods prevail for the primary diagnosis of H. pylori [histology - 20.3% (in 2013 year) - 43.9% (in 2018 year), rapid urease test - 31.7% and 47.8% respectively]. The most popular mode of eradication therapy is a 10-day triple therapy (62.8-76.2%), the effectiveness of which does not exceed 79% (per protocol). Invasive tests (histology) are the leading method for control the effectiveness of therapy, however, there is a tendency towards a wider use of non-invasive methods (H. pylori stool antigen - from 17% in 2013 to 29.3% in 2018 and urea breath test from 6.9 to 18.3%, respectively). Serological test to control the effectiveness of eradication is still used from 8.2% (2013) to 6.1% (2018). Eradication therapy was not performed in 28% of patients throughout the entire observation period. CONCLUSION: In Russia, despite approved domestic and international recommendations, deviations in clinical practice persist, both during eradication therapy and in monitoring the effectiveness of eradication therapy.

European Registry on the management of Helicobacter pylori infection (Hp-EuReg): analysis of 2360 patients receiving first-line therapy in Russia.

AIM: European Registry on the management of Helicobacter pylori infection («Hp-EuReg¼) - a multicenter prospective observational study initiated by the European Helicobacter and Microbiota Study Group, conducted in 27 European countries in order to evaluate the real clinical practice of diagnosis and treatment of H. pylori and its comparison with international recommendations. MATERIALS AND METHODS: The analysis of 2360 patients entered in the register by the Russian centres of «Hp-EuReg¼ in 2013-2017, who were underwent 1st line eradication therapy. RESULTS: The most common methods of primary diagnosis of H. pylori are histological (37.7%), rapid urease test (29.2%) and serology (29.7%). The duration of eradication therapy in 9.4% of cases was 7 days, in 65.3% - 10 days, and in 25.3% - 14 days. To control the effec- tiveness of treatment, H. pylori antigen in feces (31.3%), urea breath test (23.4%) and histological method (23.3%) were used. In 3.6% cases was used serology by mistake. In 17.3% of patients control was not carried out. The effectiveness of triple therapy with a PPI, amoxicillin, clar- ithromycin (per protocol) was 67.6%, with 7-day course, 81.1% at 10-day and 86.7% at 14-day course. Eradication rate of triple therapy with addition of bismuth (per protocol) reached 90,6% in the group receiving 10-day scheme and 93.6% in the group receiving the 14-day treatment. CONCLUSION: Significant deviations of clinical practice from expert recommendations, most pronounced at the stage of monitoring the effectiveness of therapy, were noted. The suboptimal efficacy of triple therapy is shown.

[Tetrahepaticojejunostomy for the treatment of the high biliary strictures].

The article highlights various techniques of biliodigestive anastomises, used for the treatment of high-level blockages of biliary ducts. The novel author method of tetrahepaticojejunostomy, possessing less insufficiency risk and less traumaticity was suggested. 38 patients have been operated on using the hepaticoenterostomy; 5 patients received the described method of tetrahepaticojejunostomy with positive outcome.

[Surgical strategy for juxtapapillary ulcers of the duodenum].

Results of surgical treatment of 89 patients with ulcer of the duodenum with postbulbar localization were studied. A classification of postbulbar ulcers was proposed taking into consideration the degree of involvement of bile-excreting pathways and major duodenal papilla into the periulcerous process. In extrapapillary ulcers without involvement of bile-excreting pathways in the cicatricial-ulcerous process resection of the stomach after Bilroth I is recommended with performing gastroduodenal anastomosis with a single layer suture. Resection of the stomach supplemented with biliodigestive anastomosis is recommended in cases with suprapapillary ulcers with the involvement of choledochus. Mechanical jaundice complicated by juxtapapillary ulcer can be cut off by endoscopic papillosphincterotomy. Fulfillment of pancreatoduodenal resection is possible in cases of deep injury of the pancreatic head.

[Prevalence of ulcer disease complications].

The epidemiology of complications of a peptic ulcer is studied: bleedings, perforations and pylorodudenal stenoses. 1799 patients are included in research that were on hospitalisation in 1995-2009. A frequency of all the complications has declined. Middle age of patients with the complicated ulcer enlarged: in case of an ulcerative bleeding--at the expense of reduction of a share of male at the age of 36-60 years, in case of a perforated ulcer--because of appreciable reduction of a percentage of male at the age of 21-35 years.

[Analysis of classifications of chronic pancreatitis and criteria determining the strategy of surgical treatment].

The authors made an analysis of most widespread classifications of chronic pancreatitis and results of the retrospective distribution of 120 patients in them. A conclusion is made that the volume of surgical interventions in most cases is determined by morphological alterations in the pancreas. The most important of them are thought to be changed pancreas parenchyma (criterion "P"), large cavities (criterion "C") and dilatation of Wirsung's duct (criterion "H"). Such morphology is an indication for transferring the patient to the surgical department. The clinical picture and morphological analysis determine expediency of surgery. The method of surgical treatment depends on the localization and combination of morphological alterations.

[Policy and surgical treatment in malignant tumor of pancreatoduodenal zone].

Experience in the treatment of 65 patients with tumors of pancreatoduodenal zone is analyzed, 36 of them underwent standard and radical pancreatoduadenal resections. Diagnostic value of preoperative examinations is analyzed, type of surgery is substantiated depending of localization and spread of tumor, degree of hepatodepression. Features of pancreatoduodenal resection are described in detail. Lethal outcome was in 1 case. It is concluded that radical surgeries can be more widely used in cancer of periampullar zone and chronic pseudotumoric pancreatitis.

[Surgical treatment of "difficult" duodenal ulcers]. / Khirurgicheskoe lechenie "trudnykh" iazv dvenadtsatiperstnoi kishki.

So-called "difficult" ulcers have a significant occurrence among complicated duodenal ulcers. Scar process and anatomic disturbances in the zone of duodenal bulb lead to technical difficulties during resection of the stomach with Gofmeister-Finsterer method. Eighty-nine resections of the stomach by Bilrot-I with creation of end-to-end one-row gastro-duodeno-anastomosis were performed under conditions of "difficult" duodenal ulcer with good early and long-term results.

[Clinical peculiarities of optic neuritis and alterations of local immune response in patients with multiple sclerosis]. / Klinicheskie osobennosti techeniia opticheskogo nevrita i izmeneniia lokal'nogo immunnogo otveta u bol'nykh rasseiannym sklerozom.

Multiple sclerosis (MS) is a severe organic disease of the central nervous system (CNS) affecting mostly young people. Optic neuritis (ON) is one of the first manifestations of the disease in approximately 75% of cases. The autoimmune reactions to myelin antigens play a key role in ON pathogenesis of MS. The pro- and anti-inflammatory unbalance is the most important factor of the origin, development and stabilization of CNS changes. Presented are the data on alterations of the levels of pro- and anti-inflammatory cytokines TNF-alpha, IF-gamma and antibodies to MBP and anti DNA in patient's tears. The clinical peculiarities of ON in MS correlating with immunological alterations are established.

[Electrochemical detoxication of the lymph in the treatment of patients with suppurative-resorptive endotoxicosis]. / Elektrokhimicheskaia detoksikatsiia limfy v lechenii bol'nykh s gnoino-rezorbtivnym éndotoksikozom.

A new method for lymph detoxication in patients with pyoresorptive endotoxicosis is proposed. The method is based on electrochemical oxidation of the lymph, is simple and cheap. After 4-h exposure of the lymph with 0.04% sodium hypochlorite the concentration of the main toxic metabolites appreciably decreased, while the levels of total protein and leukocytes changed negligibly. Electrochemical detoxication of the lymph was used in the treatment of 13 patients with pyoresorptive endotoxicosis and led to improvement of the clinical status and rapid decrease in the levels of the major toxic metabolites, which was particularly expressed 3 days after the treatment. No negative effects were observed. Hence, electrochemical detoxication of the lymph appreciably improved the results of treatment of patients with cholestatic endotoxicosis.

[A new method for detoxifying the lymph in patients with cholestatic endotoxicosis]. / Novyi metod detoksikatsii limfy u bol'nykh s kholestaticheskim éndotoksikozom.

A method is proposed for lymph detoxication in patients with cholestatic endotoxicosis by indirect electrochemical oxidation. The method is simple and cheap. After the treatment of the toxic lymph with the solution of sodium chloride during 4 hours the concentration of main toxic metabolites in it was substantially decreased while the total protein content was practically not changed. Under study were the results of using electrochemical lymph detoxication in 11 patients with cholestatic endotoxicosis which was followed by better condition of the patients and by faster dynamics of lowering the level of the main toxic metabolites.

[Morphologic characteristics of the RPDI neuron in the pond snail and its participation in the processing of multimodality sensory information]. / Morfologicheskie osobennosti neirona RPDI prudovnika i ego uchastie v pererabotke raznomodal'noi sensornoi informatsii.

The morphology of giant neuron RPDI in right parietal ganglia of Lymnaea stagnalis (Mollusca, Gastropoda) was studied by intracellular injection of the Lucifer Yellow. The branches of RPDI were found in nerves of right parietal, visceral, cerebral and pedal ganglia. Concentration of branches was revealed in visceral, right parietal and pleural ganglia. The branches of RPDI were observed also along peripheral nerves. Responses of the neuron to the adequate stimulation of various sensory structures (tentacles, lips, mantle, etc.) were studied by electrophysiological methods. It was shown that RPDI had a wide polymodal sensory input and responded to the adequate stimulation of mechano-, chemo- and photoreceptors in the head skin and mantle. Applied stimuli caused either subthreshold EPSP or spike response in the neuron. Neuron responses of the neuron conditions of chemical synapses blockade are discussed.