[CHANGES OF A TREATMENT PROGRAM FOR AN ACUTE PANCREATITIS].

Pathogenetically substantiated program of complex diagnosis, prophylaxis and treatment of purulent-necrotic complications (PNC) was elaborated for improvement of results of the necrotic pancreatitis treatment. With the objective to study the PNC pathogenesis and a probation of new preparations for local treatment the experimantal simulation of the disease was accomplished. There was proved, that during the disease course the integrity of pancreatic ductal system is disordered . A 42-year experience of treatment of an acute pancreatitis was analyzed. In I period (1970 - 1980) the operative interventions were conducted; in 11 period (1981 - 1991)--a scientifically substantiated conservative therapy; in III period (1992 - 2000)--the diagnostic procedures possibilities were extended, and operative intervention were performed in accordance to severe indications. There was established, that the main cause of PNC is a secondary microbal contamination occurrence on the third-fifth postoperative days, the immediate manipulations on pancreatic gland are forbidden; a one-time surgical processing of the necrosis foci is insufficient; the staged necrsequestrectomy constitutes the optimal operation.

[Peculiarities of operative treatment of complicated forms of abdominal hernias].

The experience of treatment of 150 patients, suffering complicated forms of postoperative abdominal hernias (PAH), was summarized, In majority of patients the large and giant hernias, on a background of associated diseases, were revealed. It was established that complicated forms of PAH are associated with local or systemic infection component, causing the necessity of complex prophylactic measures conduction. Autoplastic and prosthetic methods of operations were applied; the indications for implantation procedures were elaborated. The analysis of lethality and early postoperative complications rate was conducted. Late results were studied up to ten years after the operation. The hernia recurrence had occurred in 12 (7.8%) patients.

[Comparative assessment of hemodynamic parameters in ventricular septal defect, obtained by Doppler echocardiography and catheterization of cardiac cavities]. / Sravnitel'naia otsenka pokazatelei gemodinamiki pri DMZhP, poluchennykh s pomoshch'iu doppleroékhokardiografii i kateterizatsii polosteí serdtsa.

The study was undertaken to assess hemodynamic parameters by Doppler echocardiography in patients with ventricular septal defect (VSD) and pulmonary hypertension. Seventy-two patients aged 5 months to 9 years (mean 2.5 years) who had isolated VSD were examined. The authors conclude that it is possible and necessary to assess hemodynamics in the lesser circulation by using Doppler echocardiography. The method permits monitoring the time course of changes in the right heart, which makes it possible to follow the natural history of disease without applying invasive studies.

[Vagotomy as a simultaneous intervention component in the treatment of duodenal ulcer]. / Vagotomiia kak sostavliaiushchaia simul'tannykh vmeshatel'stv po povodu iazvennoi bolezni dvenadtsatiperstnoi kishki.

For the 1970-1997 yrs. period 1357 patients were operated on for an ulcer disease using vagotomy, in 361 (26%) simultant operations were carried out, including in 340--for the abdominal cavity organs diseases and in 21--for intraoperative complications.

[Prosthesis of the aortic valve by a loose allograft]. / Protezirovanie aortal'nogo klapana beskarkasnym allograftom.

A procedure has been developed to prepare live aortic allografts, which consists in taking a valve early after a donor's death, sterilizing it in antibiotics and freezing it to -190 degrees C in the presence of the cryoprotective agent dimethylsulfoxide. The preservation of valve tissue is evidenced by morphological studies. The first 3 operations for aortic valvular diseases were performed. In two cases, the indication for surgery was infectious endocarditis refractory to antibiotic therapy. Postimplantation complications were not seen. The competence of the allograft was confirmed by intraoperative transesophageal echocardiographical study. The patients examined 4 months postoperation developed no signs of aortic incompetence and infectious endocarditis. Thus, the creation of a bank of live valves allows this prosthesis to be implanted with appropriate indications, one of which is active infectious endocarditis of the aortic valve.

[The effect of lactin on histamine-stimulated gastric secretion and choleresis]. / Vliianie laktina na stimulirovannuiu gistaminom zheludochnuiu sekretsiiu i kholerez.

Lactine was found to depress the level of the histamine secretion of the gastric juice and to reduce the debit of hydrochloric acid in dogs. This peptide suppressed mainly the spontaneous choleresis and alters the compound composition of the bile. Large doses of the hormone obviously suppress the transport of bilirubin into the secret.

[Multi-layer musculo-aponeurotic repair in the treatment of patients with extensive median abdominal hernia]. / Primenenie mnogosloinoi myshechno-aponevroticheskoi gernioplastiki pri lechenii patsientov s obshirnoi sredinnoi gryzhei zhivota.

A modified method for hernioplasty consisting in performance of multi-layer reconstruction of the abdominal wall with transfer and implantation of one of the cuspids of the hernial sac tissues beyond the contralateral musculus rectus abdominis has been suggested. Operated on were 20 patients with extensive, or giant abdominal hernia. Within 2 years after the operation, no hernia recurrence was noted.

[The effect of substance P on histamine-stimulated gastric juice release and bile formation]. / Vliianie veshchestva P na stimulirovannoe gistaminom zheludochnoe sokootdelenie i zhelcheobrazovanie.

The substance P was shown to be able to increase the level of histamine-induced stomach secretion and the debit of free hydrochloric acid in dogs. This peptide increases the volume velocity of the choleresis and the content of bile acids and protein in the bile. The substance P alters the range of the bile acids as well.

Altered sympathetic tone in hypertensives with angina and lowered threshold for pacing ischemia.

To determine the role of the sympathetic nervous system in myocardial ischemia with essential hypertension, plasma norepinephrine, heart rate (HR), blood pressure (BP), and the HR.BP double product at the time of silent ischemia during pacing and exercise treadmill test (ETT) were compared with basal values in 20 patients with sustained essential hypertension and stable angina, 3 to 60 days (12.6 +/- 11.6) after discontinuation of all antihypertensive and coronary vasodilator therapy. Group I (N = 6) had silent ischemia with a higher HR.BP product at ETT than at pacing (ratio = 157 +/- 10.4% [+/- SD] v a value in group II [N = 5] of 102 +/- 18.8 [P less than .01]. Group III (N = 9) had no silent ischemia at ETT or pacing. Group I v group II plasma norepinephrine levels at rest and with pacing silent ischemia were 76 +/- 37 v 138 +/- 36 pg/mL, P less than .02, and 101 +/- 50 v 230 +/- 43 pg/mL, P less than .01, respectively. In groups I and II plasma norepinephrine levels were significantly lower than those of group III. Eleven of 20 patients had ischemia on pacing or ETT. Left ventricular myocardial mass were greater (224 +/- 49 v 180 +/- 28 g, p less than .05), HR (67 +/- 13 v 76 +/- 11 beats/min, P = NS) and plasma norepinephrine levels at rest (104 +/- 47 v 241 +/- 99 pg/mL, P less than .01), pacing (160 +/- 81 v 338 +/- 94 pg/mL, P less than .01), and ETT (758 +/- 268 v 1203 +/- 611 pg/mL, P less than .05), were lower in patients with ischemia (N = 11, group II) than in patients without ischemia (N = 9, group III) on pacing or ETT. Eight patients were on reserpine prestudy; reserpine prestudy was associated with lower basal HR (63 +/- 9 v 76 +/- 12 beats/min, P less than .05) and plasma norepinephrine (106 +/- 48 v 169 +/- pg/mL, P less than .07) and greater ratio of HR.BP double product on ETT/pacing, (141 +/- 33 v 111 +/- 19, P less than .02). The sympathetic nervous tone of group I was low at baseline but there may have been raised alpha/beta-receptor responsiveness to laboratory stresses with concomitant micro/macrovascular constriction at higher oxygen demand.(ABSTRACT TRUNCATED AT 400 WORDS)

Silent myocardial ischemia in patients with essential hypertension.

The aim of this study was to determine the significance of the "coronary factor" in patients with essential hypertension (EH). Electrocardiogram Holter monitoring was performed in 61 patients with EH stage II (according to the World Health Organization criteria). Silent, ie, painless ST-segment depression, was found in 34 patients on whom echocardiography, a treadmill test, and transesophageal pacing were performed. In 21 patients with EH and silent ischemia, the examination included 201Tl stress scintigraphy, coronary angiography, and a platelet aggregation test. In 15 patients, catecholamines and beta-endorphins were obtained in blood samples during silent ischemia. 201Tl scintigraphy showed transient defects of perfusion without clearance abnormalities (group I) and with clearance abnormalities (group II). The patients in group I had more severe left ventricular hypertrophy (LVH) and a significantly higher platelet aggregation response to 0.5 mumol/L adenosine diphosphate; one patient in this group had coronary atherosclerosis. LVH and the platelet aggregation response was less pronounced in the patients in group II, but atherosclerotic lesions of a coronary artery were observed in four patients. In both groups, norepinephrine and beta-endorphin levels were increased during silent episodes of ischemia. The results suggest that there are different pathogenetic mechanisms of coronary insufficiency in patients with EH, a hypertensive heart, and silent ischemia.

[Silent myocardial ischemia in patients with essential hypertension]. / "Nemaia" ishemiia u bol'nykh gipertonicheskoi bolezn'iu.

Holter monitoring was performed in 61 patients with essential hypertension. Painless, silent ST segment depression was found in 34 patients. Exercise myocardial scintigraphy indicated the occurrence of transient perfusion defects without abnormal clearance (Group 1) and those with abnormal clearance (Group 2). The patients from Group 1 showed more severe myocardial hypertrophy, higher platelet aggregation, coronary atherosclerosis was detected in 1 case. The patients from Group 2 exhibited less myocardial hypertrophy, lower platelet aggregation. Coronary atherosclerosis was revealed in 4 cases. The patients from the two groups had elevated plasma norepinephrine levels at the onset of silent myocardial ischemia.

[Annuloplasty of the tricuspid valve with a controllable semi-ring under the control of transesophageal echocardiography]. / Annuloplastika trikuspidal'nogo klapana reguliruemym polukol'tsom pod kontrolem chrespishchevodnoi ékhokardiografii.

The paper analyzes the first clinical experience with a novel procedure of tricuspid annuloplasty with a controllable semiring under the control of transesophageal echocardiography in 6 patients with tricuspid dysfunction and those with mitral and tricuspid valvular diseases. The application of intraoperative transesophageal echocardiography makes it possible to control both the degree of mitral regurgitation and the severity of right atrioventricular stenosis. This echocardiography may serve a method for plastic correction of the tricuspid valve.

[Role of the hypothalamo-hypophyseal neurosecretory system in the accomplishment of the antistress effect of substance P]. / Uchastie gipotalamo-gipofizarnoi neirosekretornoi sistemy v osushchestvlenii antistressornogo vliianiia substantsii P.

Light and electron microscopy and spectrophotometry were employed in study of the morphofunctional condition of the hypothalamo-hypophyseal neurosecretory system (HHNS) of intact rats after exposure to stress in injection of substance P. Injection of 12.5 mcg/100g of substance P decelerates the outflow of the neurosecretory substance in intact animals and inhibits the processes of biosynthesis in the neurocytes of the hypothalamic supraoptic nucleus. Injection of substance P prior to exposure of the organism to the stress effects leads to diminution of the HHNS response of them and prevents the development of dystrophic changes in the gastric mucosa.

[Morpho-functional analysis of median-sector approach in abdominal surgery]. / Morfofunktsional'nyi analiz medianno-kulisnogo dostupa v abdominal'noi khirurgii.

The article presents comparative analysis of original median-link access in abdominal surgery under various surgical interventions on the abdominal cavity organs. On the vast experimental material including 60 rabbits and data of clinical observation of 426 patients with different surgical diseases the authors showed the advantages of median-link access.

[A painless decrease in the ST segment during the 24-hour ECG monitoring of hypertensive patients]. / Bezbolevoe snizhenie segmenta ST pri sutochnom monitorirovanii EKG u bol'nykh gipertonicheskoi bolezn'iu.

The daily Holter ECG monitoring and echocardiography were conducted in 61 men aged on the average 50.5...1.2 years with a diagnosis of stage II essential hypertension. 55.7% of the patients manifested episodes of painless depression of the ST segment. Such parameters as the patients' age, duration and intensity of arterial hypertension, the painful syndrome pattern did not afford revealing persons at high risk for instability of the ST segment of the ECG. Only initial disorders of the repolarization phase of the ECG at rest, so-called ECG with the signs of left ventricle hypertrophy with "strain" were in this respect of prognostic importance. 2/3 of the patients with the left ventricle mass exceeding 200 g manifested episodes of "silent" depression of the ST segment, with those episodes being encountered more frequently in left ventricle hypertrophy with an asymmetry index greater than or equal to 1.5.

[The morphofunctional status of the hypothalamo-hypophyseal neurosecretory system and the energy processes in the gastric tissues following electromagnetic irradiation in the millimeter wave range]. / Morfofunktsional'noe sostoianie gipotalamo-gipofizarnoi neirosekretornoi sistemy i énergeticheskikh protsessov v tkaniakh zheludka posle vozdeistviia élektromagnitnogo izlucheniia millimetrovogo diapazona voln.

A single and double 15 and 30 min exposure to electromagnetic waves of millimetric range (60 GGz, 3 mW/cm2) of a biological active point (acupuncture point) EIII36 of intact male rats and those subjected to stress inhibits the functional activity of hypothalamo-hypophysis neurosecretory system, thyroid gland and cell elements of gastric glands the inhibition being mostly pronounced in animals under stress.

[The role of oxytocin in realizing hypothalamic effects on the motor function of the digestive tract]. / Rol' oksitotsina v realizatsii gipotalamicheskikh vliianii na motornuiu funktsiiu pishchevaritel'nogo trakta.

Chronic experiments in dogs showed that, after i.v. injection of oxytocin, the latency of activation of gastrointestinal motility by the stimulation of median hypothalamic structures was increased and inhibitory effects of posterior hypothalamic structures on the contractile activity of the digestive tract were intensified. The data obtained suggests that oxytocin facilitates the manifestation of inhibitory effects of the hypothalamus on the motor function of gastrointestinal tract.