[Minimally invasive method in the treatment of liver trauma complications]. / Miniinvazivnyi metod v lechenii oslozhnenii travm pecheni.

78 patients aged from 14 to 73 years (57 men, 21 women) with complications after trauma of the liver were studied. Minimally invasive operations (puncture, drainage, puncture + drainage) were performed in 62 (79%) patients. 8 patients with small bilema received conservative treatment under visual follow-up. 8 patients with middle and big posttraumatic lesions not treated with minimally invasive surgery entered control group. Intracavitary prolonged proteolysis with immobilized proteinases (imosimase Literum, Novosibirsk) was used. Imosimase injection led to lysis of thick inflammation products, intensified sanation of focus. There were neither complications nor lethal outcomes. 2 (2.6%) patients were operated. Tissue sequestrum and bleeding were indications for surgery. Efficacy of minimally invasive treatment of posttraumatic lesion of the iver was 96%.

[Puncture-drainage sanation of abdominal abscesses: is it sufficient treatment?]. / Punktsionno-dreniruiushchaia sanatsiia gnoinikov briushnoi polosti: ischerpyvaiushchii li metod lecheniia?.

Some anatomical grounds of postoperative extravisceral abscess formation, methods and results of their treatment, therapeutic policy in abscesses of parenchymatous organs are presented. 681 patients with abdominal abscess of various location were examined. Detailed analysis of ultrasonic and computed tomographic semiotics of postoperative extravisceral suppurative focus was carried out in 164 patients. The risk zones of extravisceral abscess formation in the conditions of changed visceral syntopy and destroyed ligamentic structures were determined. The efficiency of puncture-drainage treatment in different variants of subdiaphragmatic abscess was 89.4%, in abscess of omental bursa--83.3%. Intracavital prolonged proteolysis by immobilized proteinases (imosimase) was applied. The injection of imosimase in abscess cavity led to its content lysis, including the thick products of inflammation, improving their secretion through the drainage. In the majority of the patients, the puncture-drainage treatment of abscesses of various etiology and pathogenesis is an adequate method of sanation.

Immobilized proteinases in the treatment of diffuse purulent peritonitis.

In vitro experiments on fibrin films using purulent exudate from the abdominal cavity of rats with experimental peritonitis demonstrate the fibrinolytic effect of bacterial proteinases immobilized on a polymeric matrix. The application of Imozimaza in the complex treatment of experimental peritonitis by the way of intraperitoneal lavage resulted in reliable lowering of mortality, due to the lysis of fibrinopurulent abdominal contents and better contact between antibacterial agents and peritonitis pathogens. In the clinic, prolonged abdominal proteolysis was applied to 44 patients with postoperative diffuse purulent peritonitis of >24 h duration. Under the conditions of programmable relaparotomy, intraperitoneal Imozimaza infusion led (as in in vitro tests) to the lysis of fibrinopurulent masses, which contained micro-organisms of an order higher than exudate. It was accompanied by increase in the drainage efficacy, absence of fragmentation of abdominal contents and absence of secondary abscesses. The use of Imozimaza on the background of complex antibacterial treatment and combined homeostatic therapy resulted in lowering of mortality from 65.8% to 27.3%. Complications and contra-indications for Imozimaza use in diffuse purulent peritonitis were not registered.

[Cerebral, central and intracardiac hemodynamics in patients with progressive arterial hypertension following the surgical suppression of adrenal hyperfunction]. / Sostoianie tserebral'noi, tsentral'noi i vnutriserdechnoi gemodinamiki u bol'nykh progressiruiushchei arterial'noi gipertenziei posle khirurgicheskogo podavleniia giperfunktsii nadpochechnikov.

Forty-eight patients with progressive (malignant) arterial hypertension resistant to conservative therapy were subjected to surgical portalization of the adrenal blood stream in order to metabolize excessively produced aldosterone in the liver of the patients. Cerebral hemodynamics was studied before by tetra- and bipolar rheoencephalography, central hemodynamics was studied by tetrapolar transthoracic rheography, and intracardiac hemodynamics by echocardiography before and after surgery; blood plasma aldosterone and hydrocortisone concentrations and plasma renin activity were measured. A significant reduction of arterial pressure, elimination or alleviation of subjective and objective manifestations of chronic hypertensive encephalopathy were seen in the majority of patients after surgery. Cerebral blood flow improved, blood plasma aldosterone and renin activity reduced, myocardial hypertrophy decreased, and a trend to normalization of intracardiac hemodynamics was observed.

[Use of immozymase in the treatment of suppurative wounds]. / Primenenie immozimazy dlia lecheniia gnoinykh ran.

The authors discuss the results of application of proteinase preparations immobilized on a water soluble carrier (Immozymase) and a water insoluble carrier (Profezyme) in the management of ++pyo-necrotic processes of various etiology and localization in 1,059 patients. The wounds were cleansed 1.5-2 times quicker than with the traditional methods of treatment. Immobilized proteinases possessing a prolonged therapeutic effect were found to stimulate the regeneration process. The authors believe the use of Immozymase to be promising in the treatment of purulent foci which are drained with difficulty and in intracavitary administration for treating purulent processes in the thoracic or abdominal cavity.

[The indications for the suppression of adrenal hyperfunction in a progressive course of hypertension]. / Pokazaniia k podavleniiu giperfunktsii nadpochechnikov pri progressiruiushchem techenii gipertonicheskoi bolezni.

The authors analyze the results of the surgical treatment of patients with progressive essential hypertension (PEN). The treatment involved cryodestruction (adrenalectomy) of the right adrenal and autotransplantation of the left adrenal on the vascular peduncle into the transverse mesentery. Before the operation the data on water-salt homeostasis, central and cerebral hemodynamics and on the renin-angiotensin-aldosterone system attested to PEH. 1 to 3 years after the operation natriuresis was revealed (210% of the initial value), as were a decrease of the total peripheral vascular resistance, amelioration of the cerebral blood flow and peripheral blood aldosterone lowering from 246 +/- 17 to 90 +/- 14 sh/ml.

[Methods of suppression of adrenal hyperfunction]. / Sposoby podavleniia giperfunktsii nadpochechnikov.

Evolution of the methods for suppression of adrenal hyperfunction has now made it possible to give up bilateral adrenalectomy in favour of portalization of the adrenal blood flow from the left adrenal by its autotransplantation with maintained blood supply into the transverse mesocolon and cryodestruction of the right adrenal. Analysis of the mortality showed two-stage suppression of adrenal hyperfunction to be advisable.

[Non-extirpation methods of suppressing adrenal gland hyperfunction in severe course of arterial hypertension]. / Neekstirpatsionnye metody podavleniia giperfunktsii nadpochechnikov pri tiazhelom techenii arterial'noi gipertenzii.

The authors report on using cryodestruction of the adrenals in 30 patients. Four patients died during the postoperative period. The operation of cryodestruction of the adrenals is considered by the authors to be technically simpler than resection of the adrenals.

[Differential diagnosis of jaundice based on antipyrine metabolism]. / Differentsial'naia diagnostika zheltukh po metabolizmu antipirina.

The investigation of detoxicating function of the liver in 85 patients has shown that the indices of antipyrine clearance in patients with one-month-long parenchymatous jaundice and obstructive cholestasis were reliably different. However, longer terms of mechanical jaundice with concomitant pronounced cholangiohepatitis made the liver metabolism progressively worse. The authors recommend using antipyrine tests in differential diagnostics of parenchymatous and mechanical jaundice.