[Endoscopic choledochoduodenostomy]. / Endoskopichna kholedokhoduodenostomiia.

Method of endoscopic choledochoduodenostomy was elaborated and introduced in clinical practice. Results of formation of endoscopic biliodigestive anastomosis in 12 patients for 1990-2000 yrs period were analyzed. In 7 (5.8%) patients complications occurred, 1 (0.8%) patient died.

[Fundamentals of complex treatment of acute destructive pancreatitis]. / Osnovnye printsipy kompleksnogo lecheniia ostrogo destruktivnogo pankreatita.

Results of treatment of 240 patients with an acute pancreatitis were analyzed. There were assigned two groups taking into account stage of severity of pancreonecrosis and stage of polyorganic insufficiency. In 147 patients with mild stage and moderate stage conservative treatment was undertaken, in 93 patients with severe course different operative interventions were performed in urgent and emergent order and in period of postnecrotic complications occurrence. Application of such an approach have permitted to lower the postoperative complications frequency in 1.9 the value. Mortality had constituted 22.6%.

[The role of anatomical factors in predicting the probability of the development of an abdominal ischemic syndrome]. / Rol' anatomicheskikh faktorov v prognozirovanii veroiatnosti razvitiia abdominal'nogo ishemicheskogo sindroma.

Anatomo-topographical studies, performed in 100 human corpses established that predispositions to development of the extravasal compressions (EC) of the coeliac trunk (CT) may be observed at high location of the aortal canal mouth, which is usually observed in case of dolichomorphic constitutional type. Complications of not diagnosed coeliac trunk extravasal compressions were the possible reason in 3% of sections. Acute substernal angle (< or = 70 degrees) is an easily determined and significant indicator of dolichomorphic type. This should be taken into account by clinicians in cases of unclear abdominal syndrome.

[Surgical treatment of diseases of operated stomach]. / Khirurgicheskoe lechenie boleznei operirovannogo zheludka.

Surgical treatment of 293 patients with diseases of an operated on stomach is analysed. Relapse of peptic ulcer after closure of a perforation was encountered in 170 patients, the dumping syndrome in 54, peptic ulcer of the anastomosis in 60, the afferent loop syndrome in 6, and a rare type of diseases of an operated on stomach in 3 patients. Classification of diseases of an operated on stomach according to the syndromes and differential diagnosis of functional syndromes are presented. Indications for surgical correction depending on the type and severity of the pathological condition were developed. The late-term results were studied in 266 patients. The results were good in 72%, satisfactory in 21%, and poor in 7% of cases. The late-term results in surgical correction of functional syndromes were good in 29%, satisfactory in 51.6%, and poor in 13.5% of patients. Mortality after all repeated operation was 1.3%.

[Intra-abdominal lavage in the multimodal treatment of patients with acute diffuse peritonitis]. / Vnutribriushnoi lavazh v kompleksnom lechenii bol'nykh s ostrym razlitym peritonitom.

Study showed that the suggested method for appraising the severity of the inflammatory process makes it possible to decide whether peritoneal lavage is necessary in each concrete case. The authors examined 217 patients with acute generalized peritonitis (AGP). Four degrees of the risk of a severe course of AGP were distinguished conditionally. Patients with the first degree of risk do not need intraabdominal lavage. To remove the noted inflammatory changes in the peritoneum it was sufficient to cleanse thoroughly and drain the abdominal cavity and introduce antibiotics into it during complex treatment. Intraabdominal lavage is indicated for patients with the second degree of risk and with marked inflammatory changes in moderate circulatory changes. Abdominal lavage with peritoneostomy is indicated for patients with pronounced inflammatory (N = 3.8 cond. units) and microcirculatory disorders (Y = 0.2 cond. units). Peritoneal lavage is not indicated in patients (third and fourth degrees of risk) with considerable inflammatory (N = 4.04 cond. units) and microcirculatory disorders (Y = 0.4 cond. units).

[Fibrous periarteritis of the retroperitoneal space and mediastinum as a cause of extravasal arterial compression]. / Fibroznyi periarteriit zabriushinnogo prostranstva i sredosteniia kak prichina ékstrvazal'noi kompressii arterii.

Under analysis there were 14 patients operated upon for fibrous periarteritis. In 10 patients there was a retroperitoneal localization of the pathological process, and 4 patients had the mediastinal localization. The both localizations have similar features of etiology, pathogenesis, clinical course and lead to the formation of a stenosing scarry housing around the arteries with an issue into the occlusion. The operation volume for the retroperitoneal and mediastinal localization of the fibrous periarteritis depends on the stage of the disease: decompression and arteriolysis at first stages for stenosis and reconstructive operations for occlusions of the arteries.

[Surgical treatment of diseases of the operated stomach]. / Khirurgicheskoe lechenie boleznei operirovannogo zheludka.

Clinical follow-up results of 876 patients with operated stomach malady, 342 of whom were operated on, were analyzed. In 58% of patients after the perforation closure the ulcer recurrence occurred, in 26% after gastric resection--peptic ulcer, in 26%--functional pathological syndrome. Surgical tactics depended on character of previously conducted procedure, general condition and age of the patient, secretory function of stomach and operative situation. Complications occurred in 6.1% of patients. Mortality was 1.2%.

[The therapeutic measures in acute diffuse peritonitis]. / Lechebnye meropriiatiia pri ostrom razlitom peritonite.

Analysis of the observations of 431 patient with acute diffuse peritonitis is presented. Use of intraabdominal flowing lavage is recommended in patients with inflammatory phenomena against the background of moderately pronounced changes in microcirculation in the parietal peritoneum. The maximum clinical effect of hemosorption and lymphosorption was noted at the first 3 days after the operation in cathepsin-D activity in the blood equal to 14-17 activity units/(min.mg) and lymphorrhea over 700 ml/day. Lethality was 18.8%.

[Disorders of immune status in duodenal ulcer complicated by perforation and peritonitis]. / Narushenie immunnogo statusa pri iazvennoi bolezni dvenadtsatiperstnoi kishki, oslozhnënnoi perforatsiei i peritonitom.

The chemotaxic activity of neutrophil granulocytes was studied in 112 patients with duodenal ulcer disease complicated by perforation and peritonitis with a different degree of spreading. Sharp decrease in spontaneous migration of leukocytes (SML) was revealed in generalized peritonitis. In diffuse peritonitis, the index didn't differ from that in normal subjects. In patients with the complicated course of the postoperative period, SML stimulation under the influence of the own serum was noted. At day 3-9 after the operation, the stimulating activity of the humoral factors of immunity was gradually decreasing. Use of the stimulators of migrative activity of phagocytes contributes to normalization of their function. In patients who had the immunocorrigative agents been prescribed, aggravation of peritonitis and purulent-septic complications were noted 1.4-fold less often than in absence of such treatment.

[Prevention of early inflammatory complications after transthoracic interventions and estimation of the degree of immunologic deficiency]. / Profilaktika rannikh vospalitel'nykh oslozhnenii posle trans- torakal'nykh vmeshatel'stv s uchetom vyrazhennosti immunodefitsita.

An analysis of the results of the examination and treatment of 379 patients undergoing transthoracic interventions showed that the use of the target-aimed selective immunomodulation, short-term antibacterial prophylaxis, inhibitors of arachidonic acid metabolites, active elimination of the circulating immune complexes and medium-weight molecular peptides and adequate local analgesia after the interventions providing normalization of the laryngeal reflex and early activation of the patients permitted the incidence of the pulmonary complications to be decreased by 2.5 times, pleural complications by 1.7 times, suppuration of the postoperative wound by 1.8 times and the total expenses by 25.6 per cent.

[The use of cholesorption in the treatment of patients with acute cholecystitis complicated by cholangitis]. / Primenenie kholesorbtsii v lechenii bol'nykh s ostrym kholetsistitom, oslozhnennym kholangitom.

The results of treatment of 137 patients with acute cholecystitis complicated by cholangitis are presented. The causes and clinical signs, and tactics for operative treatment of the disease are described. Progressive hepatic failure is one of the causes of lethality. Use of the developed method of cholesorption permitted to reduce the incidence of hepatic failure development, decrease postoperative lethality to 9.5%.

[New approaches in diagnosis and therapy of the thoracic outlet syndrome]. / Novye podkhody k diagnostike i lecheniiu sindroma grudnogo vykhoda.

The results of diagnosis and treatment of the thoracic outlet syndrome (TOS) in 35 patients have been analysed. Compression of the subclavicular neurovascular bundle at the site of its outlet from the thoracic cavity was most frequent cause of TOS development. A degree of compression was assessed quantitatively by the data of a modified functional dynamic test. The modified operation, including resection of the I rib (and of a cervical one in its presence), scalene muscle, musculus pectoralis minor, periarterial sympathectomy of the subclavicular artery, was performed. In narrow (less than 1.5 cm) costoclavicular space, the II rib was additionally resected. An excellent long-term result is indicative of the effectiveness of the method.

[Combined antibacterial therapy in acute lactation mastitis]. / Kombinirovannaia antibakterial'naia terapiia pri ostrom laktatsionnom mastite.

The results of treatment of 129 patients with acute suppurative lactic mastitis are presented. In severe forms of the disease, the use of combined antibiotic therapy+ permits to shorten the duration of in-patient treatment from 13.5 to 10.3 days, prevent the disease recurrence.

[Use of external drainage of the thoracic duct and lymphosorption in the complex treatment of acute diffuse peritonitis]. / Primenenie naruzhnogo drenirovaniia grudnogo protoka i limfosorbtsii v kompleksnom lechenii ostrogo razlitogo peritonita.

In 47 patients with acute generalized peritonitis in the complex of therapeutic measures, the external drainage of the thoracic duct (EDTD) with subsequent lymphosorption (LS) was used. The effectiveness of treatment was judged about by the lymph and blood toxicity, and as well by contents of peptides with the molecular mass of from 300 to 1000 dalton. In favourable course of the postoperative period, the increase in lymph debit and decrease in proteolytic enzyme activity in the lymph and blood were noted. The use of EDTD and LS in the complex with the other methods of treatment permitted to achieve a clinical effect in 76.6% of cases.

[Clinico-morphological characteristics of acute pancreatitis and its complications]. / Kliniko-morfologicheskaia kharakteristika ostrogo pankreatita i ego oslozhnenii.

The results of treatment of 6681 patients with acute pancreatitis (AP) were analysed. Operated on were 554 patients with AP, among them, 260-with acute destructive pancreatitis (ADP). Total lethality was 1.6%, the postoperative one-20.2%. In ADP, the postoperative lethality was 28%. Mild forms of the AP course were characterized by constancy of the clinical symptoms and their rapid involution, severe forms of the disease (destructive pancreatitis)--by progressive periodicity and intensity of clinical signs. A morphologic pattern of the different forms of AP is described. It was established that at the early period of the disease, patients died mainly from posthemorrhagic anemia, anemia with intoxication, at the late period--predominantly from different purulent and necrotic complications.