[Choice of surgical treatment in patients with acute destructive pancreatitis].

Medical and diagnostic algorithm in patients with pancreatic necrosis is developed. It takes into consideration features and expansion of necrotic process in retroperitoneal space, objective severity of patients' condition according to SAPS scale and inflammatory process according to serum procalcitonin concentration. Comparative analysis revealed that the use of developed algorithm improves results of treatment.

[Pathogenesis of visceral functions disorder in diffuse peritonitis].

Clinical and laboratory signs of abdominal sepsis and endotoxicosis were noted in 194 examined patients with diffuse peritonitis. It was stated that pathogenesis of visceral functions mainly expressed as a splanchnic blood circulation disturbance, massive translocation of gut organisms in portal bloodstream and the functional liver insufficiency particularly marked as form of macrophage liver insufficiency. The complex program of liver rehabilitation should be included in standards of treatment of the patients with diffuse peritonitis. It should be based on preventive measures of the enteral detoxication and microbial decontamination of small intestine and at the same time the intraportal transsubilical infusion correcting therapy has to be applied.

[Polymorphic alele variants of eNOS gene in patients with disorders of cardiac conduction].

We studied the role of endothelial nitric oxide synthase gene polymorphism 4a/4b in development of such disturbances of cardiac conduction as atrioventricular (AV) block and sick sinus node syndrome (SSNS). We examined 69 subjects (36 men, 33 women) with AV block and 90 subjects (33 men and 57 women) with SSNS. They were divided into groups in dependence on type of conduction disorder and sex. Probands with pathologies studied composed separate groups. All participants underwent included clinical-instrumental cardiological examination and molecular genetic study of eNOS gene polymorphisms. In all groups we revealed significant predominance of a rare homozygous genotype 4b/4b and tendency to decreased number of carriers of widely spread 4a/4a allele.

[The role of alfa-2-beta-adrenoreceptor in development of ventricular conduction disturbance].

BACKGROUND: The purpose of this study was to investigate association between the genetic polymorphism I/D of gene α2ß-adrenoreceptor (ADRA2B) and hereditary disorders of ventricular conduction. PATIENTS AND METHODS: In this study, 102 people with complete left bundle branch block (45.71 ± 1.852 years)--46 females and 56 males, and 86 people with complete right bundle branch block (34.59 ± 1.86 years)--41 females and 45 males. The study was approved by Ethic Committee of the KrasSMU. All participants were included in the study after written informed consent form. Cardiological examination included clinical examination, electrocardiography, echocardiography, Holter monitoring, stress-test, koronaroangiografy and radionuclide method of a myocardium and molecular and genetic researches. RESULTS: Statistically, significant prevalence of a homozygous genotype of DD on rare allele gene ADRA2B in both groups in comparison with group of control is established. The reliable dominance of the homozygous rare genotypes (D allele) of gene ADRA2B were detected in all groups. CONCLUSION: Polymorphism DD of a gene ADRA2B is a genetic predictor of predisposition to the blockade of the right and left bundle branch block.

[α-2ß-adrenoreceptor gene polymorphism in patients with disorders of cardiac conduction].

The article is devoted to the role of insertion-deletion polymorphism of -2-adrenoreceptor gene in development of hereditary disorders of cardiac conduction. We examined 71 patients with atrioventricular blocks and 92 patients with sick sinus node syndrome. Statistically significant preponderance of homozygous genotype DD of ADRA2B gene was found in both groups. Associations of alleles with male or female gender were also revealed.

[Treatment of ulcer disease by radical duodenoplasty].

Results of radical duodenoplasty for the treatment of ulcer disease in 645 patients were analyzed. Early postoperative complications were registered in 11-12% of patients, of them 2% were jatrogenic. The majority of complications were connected with anatomical difficulties of the operation. Long-term follow-up results revealed ulcer recurrence in 27% of patients, other complications (anastomotic stenosis, reflux gastritis, adhesive ileus, etc) were registered in 17.2%. Unsatisfactory results can be explained by the lack of differential approach to surgical treatment of patients with duodenal ulcers.

[Association of 2B-adrenergic receptor gene polymorphism with disturbances of cardiac conduction].

In this work we for the first time revealed on clinical - genetic material association between hereditary disturbances of cardiac conduction and polymorphism of 2-adrenergic receptor gene.

[Treatment of abdominal sepsis].

129 patients with abdominal sepsis were divided in two groups. Patients of the 1st group (n=68) were treated according to the accepted standard. Patients of the 2nd group received the same treatment, but after germ translocation to the abdominal cavity and blood, immunoglobulin blood titer detection, drugs were administered through the cannulated umbilical vein straight to the portal system. Blood samples from ulnar and portal veins and microbiological samples from gut lumen showed similar results in patients with sepsis, proving the phenomenon of bacterial translocation. Histological analysis of liver biopsy demonstrated affection of both hepatocites and reticuloendothelial system of the liver by sepsis. The use of intraportal drug administration decreased mortality from 27.9% (1st group) to 16.3% (2nd group).

[Diagnostics and treatment approach for abdominal ischemic syndrome].

During 2005-2009 years 150 patients aged between 45-90 years were investigated at the department of general surgery (Rostov medical university) for abdominal ischemic syndrome (AIS). 70 patients were found to have AIS. 4 stages of this syndrome were determined. According to Doppler evaluation of abdominal vessels, an algorithm for the differential treatment approach at various stages of AIS was worked out. The critical level of pathological changes in abdominal vessels and optimal terms for surgical operation were estimated.

[Indications for the lower limb amputation and its level assessment by the diabetic foot syndrome].

Results of the treatment of 639 patients with the complicated diabetic foot syndrome were analyzed. 82 patients were included in the master sample, the rest 557 patient formed the control group. Clinical picture, angiography, computed reovasography of the lower limbs and myoglobin blood level were analyzed. Needle biopsy of tibial and femoral soft tissues were performed in the main group. Algorythm for the surgical treatment volume was worked out, which allowed to decrease postoperative rehabilitation period, amputation and reamputation frequency.

[Postoperative thrombotic complications within a 50-year period]. / Postoperatsionnye tromboticheskie oslozhneniia. Statitsticheskii analiz za 50 let.

24,564 autopsy protocols from the central city hospital and oncology dispensary were analyzed in order to evaluate the rate and dynamics of postoperative thrombotic complications (PTC). The PTC rate was 14.89% and went up two-fold within the recent 20 years. The rate of pulmonary thromboembolism (PTE) was 10.13%; it increased during the recent 20 years from 6.75% to 17.30%. No significant difference was registered between the PTE rates in oncology and other patients (16.01% and 14.10%, respectively). Pelvic vein thrombosis was defined as a source of PTE in 50.11% of cases; deep vein thrombosis was found only in 28.54% of cases. The rate of the in-life PTE diagnosis was 42.8%. Despite refinements and standardization related with the use of anticoagulants, prevention and PTC management, the discussed phenomenon still remains a crucial issue for practitioners.

[Prognosis of outcomes and choice of surgical strategies in general purulent peritonitis]. / Prognozirovanie iskhoda i vybor khirurgicheskoi taktiki pri rasprostranennom gnoinom peritonite.

A comparative analysis of the results of surgical treatment of 233 patients with general peritonitis of different etiology was carried out. It is demonstrated that Manheim's index of peritonitis (MIP) may be used not only for prognosis of outcome, but also as one of main criteria for programmed revisions and sanations of the abdominal cavity, and appliance of laparostomy. Combination of MIP with clinical and laboratory evaluation of endotoxicosis severity permits one to define objectively indications for early preventive methods of enteral and extraorganic detoxication. Differential approach to choice of treatment policy reduced postoperative lethality in general peritonitis from 24.4 to 15.8%.

[Classification and principles of treatment of acute purulent peritonitis]. / Klassifikatsiia i printsipy lecheniia ostrogo gnoinogo peritonita.

State of immune-secretory system of intestinal mucosa, bacterial contamination of the small intestine, peritoneal exudate, portal and systemic venous blood, ultrastructural changes in the liver (electron microscopy) were studied in 167 patients with general acute purulent peritonitis (APP) and clinical-laboratory symptoms of endotoxicosis. It is demonstrated that the main links of APP pathogenesis are disorders of small intestine barrier function, massive bacterial translocation from intestinal lumen to abdominal cavity and portal circulation, damage of reticuloendothelial hepatic barrier manifested as fulminant macrophagal hepatic failure, "bursting" of infectious-toxic agents into systemic circulation with resultant toxico-septic shock and visceral insufficiency. This approach permits to classify three clinical stages of APP and to propose differential surgical policy and detoxication treatment for these patients.

[The role of nurses in psychiatric services]. / Rol' meditsinskikh sester v okazanii psikhiatricheskoi pomoshchi.

Specific features of the nursing process in practical activities of nurses of psychiatric service of the Russian Federation should receive special attention in the system of vocational training. Increase of the volume and improvement of quality of training, reorganization of nurses' work in an inpatient and outpatient setting are the main approaches to improving the quality of medical care and, among other things, mental health of the population.

[Systemic hemodynamics, oxygenating lung function and oxygen transport in patients with acute intestinal obstruction and an endotoxicosis syndrome]. / Sistemnaia gemodinamika, oksigeniruiushchaia funktsiia legkikh i transport kisloroda u bol'nykh s ostroi neprokhodimost'iu kishechnika i sindromom éndotoksikoza.

Systemic hemodynamics, oxygenating function of the lungs, and oxygen budgeting were studied in 32 patients with acute bowel obstruction (ABO) with severe endotoxicosis. Profound disturbances of systemic hemodynamics and blood oxygenation in the lungs underlie the hemostasis changes in this category of patients before and early after operation. These hemostasis changes lead to inadequate oxygen delivery and metabolic requirement of oxygen and are associated with development of oxygen deficiency in tissues. As a rule, patients with ABO with severe endotoxicosis develop acute respiratory failure presenting as adult respiratory distress syndrome on days 2-3 postoperation. Significant differences in the pattern of hemostasis changes and compensatory shifts in survivors and patients dying after ABO are detected at this period, which determine the prognosis and outcome of disease.

[Choice of surgical management and methods of detoxication in patients with acute intestinal obstruction]. / Vybor khirurgicheskoi taktiki i metodov dezintoksikatsii pri ostroi neprokhodimosti kishechnika.

A comparative analysis of the results of treatment in 892 patients with various forms of acute bowel obstruction (ABO) of non-tumor genesis has been performed. High informative values of the intraoperative biomicroscopy of bowel wall for evaluation of severity of ischemic damage and viability of the intestine in ABO. The endotoxicosis (ET) in patients with ABO is proposed to be assessed on the basis of integral assessment of clinical and laboratory values of hemostasis. Basic principles of the choice of surgical policy and methods of detoxication in ABO with regard for the grade of ischemic damage of the bowel wall and the ET level are described. The application of the developed methods in patients with ABO allows to avoid mistakes in evaluation of bowel viability, to reduce the rate of development of toxicoseptic shock from 9.8% to 4.7% and to decrease postoperative lethality rate from 12.7% to 6.5%.

[Serum myoglobin as an indicator of endotoxicosis in acute intestinal obstruction]. / Syvorotochnyi mioglobin kak pokazatel' éndotoksikoza pri ostroi neprokhodimosti tonkoi kishki.

To give objective assessmed of endotoxicosis, the authors for the first time have studied blood myoglobin as a marker of tissue hypoxy in 84 patients with acute obstruction of the small bowel. A strong correlation between serum myoglobin level and clinical manifestations of endotoxicosis was established. It enables the authors to recommend the study of myoglobin values in patients for quick and objective evaluation of endotoxicosis. As a result of comparative analysis of the pronouncement of clinical and roentgenological symptoms as well as changes in laboratory findings and among them--myoglobin level in 427 patients with acute intestinal obstruction, the authors demonstrate 5 stages of clinical course of the disease. Th stage of ischemia was in 48.9% patients. In 22% of them manifestations of obstruction were eliminated by conservative means, 26.9% of patients of this stage were operated. The stage of water-electrolyte balance disturbances was detected in 26.2% of patients. The stage of peritonitis was detected in 15.9% of patients. The stage of multiorganic insufficiency was revealed in 8.9% of patients. All of these patients were operated. The stage of rehabilitation took from 2 months to 3 years after the operation. Conservative symptomatic treatment was used in all these patients. It was established that maximal informativevalue of myoglobin study was achieved in patients at the stages of water-electrolyte balance disturbances, in peritonitis and polyorganic insufficiency. The results of the examinations allows evaluation of the stage of endotoxicosis, prediction of the course of the disease and assessment of the effectiveness of detoxication therapy.

[The immuno-microbiological characteristics of the small intestine and the translocation of the enteral microflora in acute intestinal obstruction]. / Immuno-mikrobiologicheskaia kharakteristika tonkoi kishki i translokatsiia énteral'noi mikroflory pri ostroi neprokhodimosti kishechnika.

The complex examination of 72 patients with acute ileus (AI) of nontumor nature with different severity of endotoxicosis was carried out. The study revealed that AI was accompanied by deep suppression of the immunosecretory and motor evacuatory function of the small intestine, as well as by its pronounced bacterial contamination, mainly due to the significant quantitative prevalence of Gram-negative microflora. The combination of these factors played the key role in the increase of the permeability of the enteric barrier for symbiotic microflora and its massive translocation from the intestinal tract to the internal organs of the body (peritoneal exudate, portal bed), which directly correlated with the severity of endotoxicosis in AI patients. The deficiency of the barrier function of the liver was accompanied by the penetration of infective agents into the general blood stream, thus causing the development of endotoxic shock in AI patients. The analysis of the results thus obtained made it possible to determine the main ways for the elimination of intestinogenic intoxication in AI; they should be aimed at the bacterial decontamination of the small intestine, the restoration of its motor evacuatory and protective barrier functions, the liquidation of portal and systemic bacteremia, the correction of the functional deficiency of the liver.

[The prognosis and prevention of the occurrence of acute ulcers and erosions of the stomach and duodenum in surgical patients]. / Prognozirovanie i profilaktika vozniknoveniia ostrykh iazv i érozii zheludka i dvenadtsatiperstnoi kishki u khirurgicheskikh bol'nykh.

Acute ulceration of the gastric and duodenal mucosa was found in 20.3% among 404 patients who died at the surgical department of the hospital. In 89.7% of the patients acute erosive-ulcerous lesions were localized in the gastric mucosa. In 39 patients (9.7%) acute ulcers of the stomach and duodenum complicated by bleedings or perforations were the direct cause of death. Based on results of an analysis of severity of the main and concomitant diseases as well as their complications the authors have determined the factors responsible for the appearance of the ulcers. A complex of prophylactic measures aimed at the main links of the pathogenesis of acute ulcers is proposed.