[Treatment of hepatic insufficiency in benign mechanical jaundice].

The aim of this work was to estimate hepatic dysfunction and improve treatment of benign mechanical jaundice using an injection hepatoprotector. The study included 124 patients of whom 74 were given remaxol. 50 control subjects received basal therapy. The patients were randomized by the random sampling method. Severity of cholestasis was evaluated from the total and fractional bilirubin content and γ-glutamyl transpeptidase (GGT) level; AST and ALT activities were used to detect cytolysis. Liver synthetic function was estimated from prothrombin index (PTI) and coagulation function from fibrinogen level, PTI and APTT. Endogenous intoxication during biliary tract decompression was assessed by calculating the leukocyte intoxication index from the Kalf-Kalif formula. It was shown that remaxol suppresses cytolysis, reduces total and fractional bilirubin levels, improves bilirubin excretion in bile and decreases activity of hepatocyte excretory enzymes.

[Oxidative stress in patients with mechanical jaundice of different origin and severity].

This randomized clinical study included 118 patients with mechanical jaundice (MJ) of different origin and severity. It highlighted the role of free radical-generation processes (FRP) in the development of the disease within 1 day after its onset. Disbalance of FRP affects oxygen and lipid components of oxidative stress and is especially well pronounced in severe cases and in patients with tumours. It becomes increasingly apparent with time from the onset of jaundice and endotoxicosis. FRP disbalance precedes clinical manifestation of jaundice and persists for a long time even after alleviation of its clinical symptoms. Certain signs have a prognostic values. Therapy with reamberin at a daily dose of 400 ml is shown to effectively correct oxidative stress associated with MJ of tumorous and non-tumorous origin regardless of the severity of the disease. Positive effect of antioxidative therapy is accompanied by the improvement of laboratory characteristics, clinical picture, and outcome of the disease.

[Free radical processes in patients with the acute calculous cholecystitis].

The role of the free radical processes (FRP) is shown and objectified in the development of the acute calculous cholecystitis (ACC). It is revealed on the first day of hospitalization already. In catarrhal and phlegmonic ACC free radical processes changes apply mostly to the oxygen part of the oxidation process. The greatest imbalance of the FRP is registered in the gangrenous ACC. It appeared like decrease of the oxygen and activation of the lipid FRP disregulation. On the first day FRP changes refer to the oxygen part of the oxidation process only. Starts with a second day from the disease début changes in the lipid component of the oxidative stress join the disregulation process. It is proved by the decrease of the antiperoxidant activity of plasma and increase of malondialdehyde. Malondialdehyde level and its rate of rise serve as prognostic criteria of the course and outcome of disease. FRP changes correlate with the clinical presentations of disease. They last till the patient's discharge. The high efficiency of the energetic corrector reamberin in a dose of 400-800 ml was shown in patients with ACC.

[Free radical processes at patients with pathologies of biliary ducts and methods of their correction].

The main objective of a research in the early diagnostics of a functional condition of a liver, is to estimate the degree of the level of its expressiveness and timely pathogenetic correction on the basis of the free radical system processes of studying of patients with mechanical jaundice. Results were carried out among 61 patients with pathologies of bile tracts( biliary ducts) which proved the essential role of free radical processes with strengthening of peroxidation of membrane lipids against the absolute or relative insufficiency of endogenic antioxidants in the mechanism of development of hepatic insufficiency at the given category of patients with the highest degree expressed at the serious conditions of the patients with malignant diseases. It is revealed that the inclusion of energy corrector antioxidants of reamberin to the therapy as a part of standard schemes of treatment promoted positive regressing dynamics of parameters of free radical processes that are correlated with positive clinical symptoms and outcome of diseases.

[Treatment of calculous cholecystitis and its complications]. / Lechenie kal'kuleznogo kholetsistita i ego oslozhnenii.

Results of treatment of 10,724 patients with different forms of acute and chronic cholecystitis are analyzed. Surgical treatment was performed in 7819 (72.9%) patients. Variants of treatment of acute and chronic cholecystitis are presented. Typical cholecystectomy is the basic surgery in patients with acute calculous cholecystitis (63% procedures). Laparoscopic cholecystectomy (LCE) was performed in 37% patients. Two-stage surgeries with previous microcholecystostomy (MCS) and endoscopic papilloshincterotomy (EPST) are indicated in late hospitalization of patients with intoxication and severe concomitant diseases. They permit to prepare patients for cholecystectomy and to decrease scope of surgery. In cholelithiasis and jaundice EPST and MCS are indicated for almost all patients as a preliminary procedure before surgery on the biliary tract and cholecystectomy. This two-stage variant permitted to reduce postoperative lethality from 9.7 to 1.6%. In chronic cholecystitis LCE is the main type of surgery with minimal postoperative lethality. For patients with recurrent calculous cholecystitis, frequent exacerbations, severe concomitant diseases EPST in choledocholithiasis and sanation of gall bladder through fistula are indicated.

[Pathologic changes of major duodenal papilla in biliopancreatic diseases]. / Rol izmenenii bolshogo duodenalnogo sosochka pri zabolevaniiakh organov pankreatobiliarnoi oblasti.

The condition of the major duodenal papilla and the periampullary region was studied in 1,113 patients with diseases of the biliary tract and pancreas. In 88.6% of cases complex examination revealed various pathological changes which were considered to be important etiological factors of the development of the diseases. These changes were found to be particularly significant in patients with the postcholecystectomy syndrome. The authors present the modern methods for correction of pathology of the major duodenal papilla, among which endoscopic interventions are most valuable.