[Evaluation of intestinal viability on a simulation model of a small ileus based on determination of dielectric parameters].

Interrelationship between dielectric parameters and level of ATPH before and during ischemia, as well as with indices of survival after elimination of strangulation, was estimated on a simulation model of strangulation ileus in rats. The data obtained permit to suppose, that parameter tg δm may be used as effective noninvasive criterion of diagnosis in real time for estimation of the intestinal wall state in strangulation. Resection of the infringed intestine without elimination of strangulation is necessary in tg δm less than 2.20, in tg δm more than 2.36 the elimination of infringement is indicated, because there exist possibility to restore intestinal function after ischemic-reperfusion injury. Tactics of treatment in intermediate meanings of tg δm is not determined, but its measurement before reperfusion may help in estimation of a small intestine viability and choice of surgical tactics in its ischemia.

[Surgical treatment of chronic pancreatitis based on classification of M. Buchler and coworkers].

The results of surgical treatment of 452 patients, suffering chronic pancreatitis (CHP), were analyzed. The CHP classification, elaborated by M. Buchler and coworkers (2009), based on clinical signs, morphological peculiarities and pancreatic function analysis, contains scientifically substantiated recommendations for choice of diagnostic methods and complex treatment of the disease. The classification proposed is simple in application and constitutes an instrument for studying and comparison of the CHP course severity, the patients prognosis and treatment.

[Methabolism of connective tissue in patients with complicated chronic pancreatitis].

A content in the blood serum of a free and connected oxyproline, collagenolytic activity of the blood, the level of glycosaminoglycans and elastase activity was detected in chronic pancreatitis (CHP). There were examined 73 patients (64 men and 9 women). CHP in a stage B (according to M. Buchler et al., 2009) was established in 26 (35.6%) patients, C1 - in 18 (24.6%), C2 - in 17 (23.4%), C3 - in 12 (16.4%). A progress of pancreatic fibrosis in CHP have occurred on a background of a high activity of elastase in neutrophils, a glycosaminoglycans level raising, as well as a free and connected oxyproline. A detection of a neutrophils elastase activity and oxyproline content in the blood serum may be used in a clinical practice as additional diagnostic criteria of estimation of the pancreatic pathology severity. The changes revealed were the same as in CHP of alcoholic and of the other nature.

[Surgical tactic in patients with high risk of occurrence of the intestinal anastomoses sutures insufficiency].

The prognosis criteria for development of the intestinal anastomoses sutures insufficiency were elaborated, basing on analysis of the risk factors occurrence. Surgical tactic of treatment of the patients was substantiated, depending on the risk grade presence. In presence of high or moderate risk of the sutures insufficiency occurrence the methods of the deferred intestinal anastomoses formation were elaborated, excluding necessity of multistage intraabdominal operative interventions performance. Introduction of curative-diagnostic approach proposed promotes lowering of postoperative complications rate and lethality.

[Using tactics of damage control in complex treatment of the abdominal cavity organ injuries and pancreatitis complicated by severe bleeding and vasodilatation shock].

The results of surgical treatment analysis was conducted in 39 injured persons, aged 16-74 yrs, who suffered severe trauma and pancreatitis and in whom the Damage Control tactics (DCT) was applied for massive bleeding and vasodilatation shock occurrence. According to TRISS scale for injured persons, suffering severe trauma, operated on using the DCT principles, the primary "approximate" prognosis of the death ("blunt") had constituted (37.4 +/- 24.7)% at average (range, 10.7-89.7%, mediana 31.7%); the primary "accurate" ("penetrating") prognosis--(39.56 +/- 22.14)% (range, 12-91.3%, mediana 39.65%); the severity of general state according to APACHE II scale was estimated as (19.54 +/- 7.65) points at average (range, 12-36 points, mediana 16 points). The characteristic for main principles of operation performance, using the DCT, was suggested. Of the total of 39 injured persons 12 (30.8%) did not survive. Postoperative complications had occurred in 18 (46.2%) of patients.

[Role of nitric oxide and lipid peroxidation in pathogenesis of acute experimental pancreatitis].

In experiment, conducted on 130 Wistar line rats, there was studied up the influence of nitric oxide on the peroxidal oxidation of lipids intensity, activity of enzymes of the antioxidant defense system and morphological changes in acute pancreatitis. Modern suggestions about the influence of the nitric oxide system on pathogenetic mechanisms of an acute pancreatitis and possibilities of correcting therapy were scrutinized. It was established, that the nitrates and the nitrites content in the blood serum of experimental animals correlates positively with the pancreatic oedema index and severity of its morphological changes as well. Intraperitoneal injection of 20% water solution of L-arginine in dosage 200 mg per 100 g of an animal body mass have had aggravated an acute pancreatitis course; intravenous injection of 1% water solution of methylene blue in dosage 1 mg per 100 g of an animal body mass caused pancreatoprotective effect.

[Curative-tactical approaches in patients with pancreatic pseudocyst]. / Lechebno-takticheskie podkhody u bol'nykh s psevdokistoi podzheludochnoi zhelezy.

Experience of treatment in the clinic of 162 patients with pancreatic pseudocyst was analyzed. Modern principles of diagnosis and treatment of patients were adduced. Operation before the cyst capsule formation is compulsory, caused by the complications occurrence and the pancreonecrosis progression. External drainage of an acute pancreatic pseudocyst was performed in 61 patients, internal drainage--in 72. After external drainage the cyst recurrence was noted in 17, the pancreatic fistula formation--in 7 patients. The poorest results were noted in patients with infected pancreonecrosis and in pseudocyst formation.

[Re-laparotomy and damage control during surgical treatment of postoperative intra-abdominal purulent-septic complications]. / Relaparotomiia i damage control pri khirurgicheskom lechenii posleoperatsionnykh vnutribriushnykh gnoino-septicheskikh oslozhnenii.

The issues of pathophysiology, diagnosis and surgical treatment of postoperative intraabdominal purulent-septic complications were suggested. Noncontrolled abortion of mediators with subsequent development of inflammation and damage in the organs, localized far from primary focus, constitutes the main factor of the postoperative intraabdominal purulent-septic complications occurrence. In such a situation the intraabdominal hypertension and abdominal compartment syndrome also promote the deepening of multiple dysfunctions of organs due to mechanical failure of functions in respiratory, hemodynamical, excretional systems of the organism, what promotes the development of vicious circles and the cascade reactions, leading to exitus lethalis. The modern strategy and tactics of complex treatment of such patients is enlighted.

[The role of endothelin-1 in the pathogenesis of septic shock in the abdominal sepsis]. / Rol' éndotelina-1 v patogeneze septicheskogo shoka pri abdominal'nom sepsise.

Role of endoteline-1 (ET-1) in pathogenesis of septic shock (SS) was studied in 22 patients in the age from 34 to 58 years. There was shown, that ET-1 content in plasma depends on functional level of the adaptation-compensation reaction of organism as an answer on occurrence of SS in patients with abdominal sepsis. This is demonstrated by more high concentration of the index studied in the patients survived and also presence of correlative connection between ET-1 level in plasma of blood, indexes of middle arterial pressure and general peripheral resistance of vessels. There were received preliminary data, witnessing, that circulating cytokines, in particular, interleukin-8, stimulate the heightened production of ET-1 by endothelial cells, what probably in early terms the SS course constitutes the compensatory reaction, directed on elimination of pathogenic microorganisms, securing of reparative processes and maintenance of homeostasis.

[Assessment of risk of thromboembolism in patients undergoing surgery]. / Otsenka riska vozniknoveniia venoznogo tromboza i émbolii u khirurgicheskikh bol'nykh.

The risk factors of venous thromboembolism (VTE) in 1146 patients who were underwent operated for the diseases of digestive organs, for obliterating atherosclerosis of abdominal aorta and peripheral arteries, diseases of bones and joints were studied. The methods of VTE prevention in these patients were studied. To evaluate the risk of VTE we designed the special chart. Three levels of risk of VTE: low, moderate and high were distinguished. The specific prophylaxis of the VTE using low molecular weight heparin fraxiparine was given to the patients moderate (90.7%) and high (93.3%) risk degree.

[Prognosis of postoperative period outcome in patients with critical ischemia of lower extremities after reconstructive surgery of aorta and arteries of lower extremities, using synthetic transplant]. / Prognozirovanie techeniia posleoperatsionnogo perioda u bol'nykh s kriticheskoi ishemiei nizhnikh konechnostei posle vyupolneniia rekonstruktivnoi operatsii na aorte i arteriiakh nizhnikh konechnostei s primeneniem sinteticheskogo transplantata.

Basing on results of retrospective analysis of 596 case record were detailed prognostically significant signs as a table was elaborated, allowing to prognosticate the late follow up results of treatment in patients with critical ischemia of lower extremities.

[The role of immune disorders in formation of local and systemic complications of severe acute pancreatitis]. / Rol' immunnykh narushenii v formirovanii lokal'nykh i sistemnykh oslozhnenii pri tiazhelom ostrom pankreatite.

There were studied the factors, which initiate the immune response in severe acute pancreatitis, in 57 patients of both gender ageing from 16 to 66 years, in whom the acute pancreatitis severity had constituted 3 marks and more (according to the Ranson criterions). In majority of the patients the combined type of the immune disorders had prevailed. The first stage of the disease was characteristic for metabolic hyperactivity occurrence with raising of HLA-DR+ level as well as of immunoregulating coefficient at the expense of the T-helpers quantity increase. In 47.1% of the patients with aseptic pancreonecrosis also the HLA-DR1 leukocytic antigens were revealed in combination with normal phagocytic activity of neutrophils present in 85.3% of them. In these patients also most frequently were revealed such antigens as HLA-A1 (in 20.6% of observations), HLA-A9 (in 29.4%), HLA-B13 (in 30.4%), HLA-B16 (in 20.6%). In 51.2% of patients, suffering infectionized pancreonecrosis, there was revealed HLA-DR2 lymphocytic phenotype. In them there were noted high suppressive activity of T-lymphocytes, lowering of phagocytic activity of neutrophils, activation of the aberrant adhesion molecules (ICAM-1, ICAM-3) on the background of higher concentration of interleukin-8 present in the blood serum in comparison with such in patients, suffering aseptic pancreatic necrosis.

[Surgical treatment of integumentary tissues of foot and shin using adhesive dermal tension and cryotherapy]. / Khirurgicheskoe lechenie defektov pokrovnykh tkanei stopy i goleni s ispol'zovaniem adgezivnoi dermotenzii i krioterapii.

The first experience of performance of plasty for nonhealing wounds and ulcers of foot and shin, based on grafting of the surrounding skin on the defect region, using stimulating atraumatical adhesive dermotension independently and in combination with cryotherapy, was presented. The methods proposed were applied in 21 patients for restoration of bearing and other tissues of foot and shin, when defect was up to 110 cm2, since 1996. Positive result of treatment was noted.

[Chlamydiosis of the upper sections of the digestive tract]. / Khlamidioz verkhnikh otdelov pishchevaritel'nogo kanala.

The experience is submitted gained with the diagnosis and treatment of Chlamydia trachomatis-associated esophagitis. Used in the study were laboratory and instrumental methods of diagnosis, with their merits and demerits outlined. It is pointed out that complex diagnosis of Chlamydia trachomatis-produced esophagitis is important, the treatment involving institution of anti-bacterial and immunomodulating therapies.

[Modern aspects of diagnosis and treatment of acute pancreatitis]. / Sovremennye aspekty diagnostiki i lecheniia ostrogo pankreatita.

Problems of pathophysiology, diagnosis and main principles of treatment of an acute pancreatitis were considered. An early accurate diagnosis, taking into account form of the disease, prognostication of his course, application of modern intensive therapy, obligatory prophylaxis and treatment of systemic inflammatory reaction and the early (noninfectional) and late (infectional) syndrome of polyorganic dysfunction, conduction of endoscopic intervention in systemic-toxic phase of the disease, adequate choice of operative method in presence of pancreatic infection are promoting the reduction of the disease course severity and the mortality lowering.

[Clinical value of determination of the blood elastase activity as a marker of postoperative pancreatitis]. / Klinicheskaia tsennost' opredeliniia aktivnosti élastazy v krovi kak markera posleoperatsionnogo pankreatita.

For diagnosis of postoperative pancreatitis 50 patients were examined after performance of organ-preserving operation for gastroduodenal ulcer disease. In 15 patients various postvagotomy symptoms occurred. In 12 of them the elastase activity in blood was increased already in 12 h after operation, lowering gradually under the influence of specific therapy. On 2-3 days in these patients the amylase activity increase in blood and urine was revealed, testifying the postoperative pancreatitis presence. Under the influence of the treatment conducted the postvagotomy syndromes severity had reduced in accordance with the elastase activity normalization in blood.

[Regulation of regeneration processes by synchronous cellular response to the wound cryo-application distance and its influence on wound healing]. / Regulirovanie protsessa regeneratsii sinkhronnym otvetom kletok na okoloranevuiu krioapplikatsiiu i ego vliianie na zazhivlenie rany.

Possibility of correcting regulation of regeneration while timely adjusted answer of cells on cryoaffection was established in experiment. In such a situation a small elastic, not protruding cicatrix arises, the healing duration of the wound reduces by 15%.

[Persisting viral infection, serum antibodies and chromosome instability in myasthenia]. / Persistiruiushchaia virusnaia infektsiia, syvorotochnye antitela i khromosomnaia nestabil'nost' pri miastenii.

There were examined 94 patients, aged from 22 to 68 years, with myasthenia, in whom morphological changes of thymic gland were revealed. In 89% of observations there was established the infectioning by cytomegalovirus, in 10%--hepatitis B, in 9%--hepatitis C. In 5% of patients there were observed coexistence of cytomegaloviral infection and hepatitis. In all the patients the trustworthy increase of the chromosomal aberrations frequency in comparison with spontaneous level of mutation was revealed. High diagnostic validity of chain reaction with polymerase in the viruses persistence determination was noted. The results of investigation of serous immunoglobulins to the virus neutralizing antibodies ratio may be applied for the indications elaboration in the lymphosorption and immunocorrection application in patients with myasthenia more than 4 years in course.