[Predictors of external pancreatic fistulae after pancreatic resection]. / Prediktory vozniknoveniya naruzhnykh pankreaticheskikh svishchei posle rezektsii podzheludochnoi zhelezy.

Despite a significant decrease in postoperative mortality after pancreatic resections in recent years (5.2-15% after pancreatoduodenectomy and about 5% after distal pancreatectomy), incidence of postoperative complications remains high (30-50% and 22-50%, respectively). Postoperative pancreatic fistula is one of the most common and formidable complications. Currently, most authors use the classification proposed by the International Study Group for Pancreatic Fistula (biochemical failure, fistula type B and C). Prediction of the risk of postoperative fistula is still a complex and unresolved problem of modern surgical pancreatology. According to the literature, the main risk factors of postoperative pancreatic fistulae are obesity and high body mass index, concomitant cardiovascular diseases, no neoadjuvant chemo- and radiotherapy, soft pancreatic texture, narrow pancreatic duct, no fibrotic changes in parenchyma, adipose infiltration of the pancreas, advanced intraoperative blood loss, as well as center experience. Most often, magnetic resonance imaging, computed tomography, ultrasound elastography and various multivariate risk assessment systems are used to estimate the risk of pancreatic fistulae. However, a generally accepted technique does not exist. This manuscript is devoted to analysis of risk factors of postoperative pancreatic fistulae and diagnostic methods for assessment of this risk.

[Experience of Pneumo 23 vaccine in patients with combination of COLD with pneumoconiosis].

The most well-studied, but not single factor of COLD development is smoking. Occupational hazards as organic and inorganic dust are underevaluated risk factor of COLD. Smoking increased unfavorable effects of occupational hazards. Interesting for the study are the patients with combination of pneumoconiosis and COLD, severe concomitant diseases and decompensated complications--chronic cardiac failure and chronic lung failure. These patients have lower life quality, more frequent infectious exacerbations of COLD and pneumonias--that remains a significant medical and social problem. At present, pneumonia occupies 4-5th place in lethal outcomes structure. Pneumo 23--polysaccharide 23-valent vaccine--covers main serotypes of pneumococcus causing diseases of severe clinical course. In the study, the patients were injected with Pneumo 23 along with basic COLD therapy, were observed over 5 years and demonstrated reliable decrease of acute respiratory infections, COLD exacerbations and pneumonias. Those exacerbations and pneumonias had less severe course. Number of the exacerbations requiring hospitalization also decreased.

[Adaptation mechanisms in the formation of the Corynebacterium diphtheriae carrier state]. / Adaptatsionnye mekhanizmy formirovaniia bakterionositel'stva Corynebacterium diphtheriae.

The complex clinico-laboratory examination of 92 children aged 3-14 years with the localized form of stomatopharyngeal diphtheria and toxigenic C. diphtheriae (TCD) carrier state was carried out. The children were hospitalized in the clinic of drop infections during the period of 1996-1998. The hydrophobic properties, adhesive, lysozyme, antilysozyme and DNAase activities of 92 TCD strains, as well as the levels of the specific and nonspecific immunity of the macroorganism, were studied. The study revealed that the character of the infectious process in TCD carrier state was determined by the degree of the colonization activity of the infective agent. Direct correlation between the time of the persistence of TCD in the body and their hydrophobic properties, adhesive and antilysozyme activities (with r = 0.89-0.93) was established. The duration of TCD carrier state was found to be inversely related to the electrophysiological state of epithelial cells of the mucosa, the level of humoral specific antibacterial immunity and the content of local antidiphtheria IgA.