PROGNOSIS IN CHRONIC PANCREATITIS AND CANCER WITH A PRIMARY LESION OF THE PANCREATIC HEAD.

Analyzed the results of surgical treatment of 132 patients, including 68 ­ for cancer of the pancreatic head (in 46 ­ with jaundice) and 64 ­ chronic pancreatitis (CP) with a primary lesion of the pancreatic head (16 ­ with jaundice). The distribution of patients into groups was carried out with a maximum value of classification functions calculated by special formulas. Next studied indicators of endothelial dysfunction for differential diagnosis. A certain threshold of VEGF = 346 pg / ml, in which the patients were divid' ed into groups: СP and cancer on the pancreatic head. It was even more accurate indi' cator threshold VEGF = 248 pg / ml. To predict the severity of the pathological process, along with the use of diagnostic data, using the method of classification trees. Pancreatoduodenal resection for Whipple was performed in 23 patients, for Traverso­ Longmire ­ in 8, subtotal right sided pancreatectomy for Fortner ­ in 3, hepaticoje' junostomy by Roux ­ in 8, duodenopreserving resection for Beger ­ in 6, her Bernese option ­ in 7, operation Frey ­ in 51. In 26 (19.7%) patients, minimally invasive inter' vention for removal of bile were spread through the final primary pathological process and severe general state. Postoperative complications occurred in 18 (13.6%) patients, died 3 (2.3%).

[THE STATE OF HEPATIC AND SPLANCHNIC BLOOD FLOW IN VARIOUS TYPES OF COMPLICATED PANCREATIC PSEUDOCYSTS].

Investigations were conducted in 37 patients, suffering complicated pancreatic pseudocysts. In accordance to data of ultrasound Doppler flowmetry for the blood flow along portal vein, a. hepatis communis, a. mesenterica superior in complicated pancreatic pseudocysts compensatory--adaptive reactions on level of hepatic--spanchnic blood flow are directed towards restriction of the blood inflow through the portal vein system. This is accompanied by the common peripheral vascular resistence raising in basin of a. mesenterica superior, which have depended upon the patients' state severity, caused by reduction of the volume blood flow in a certan vascular collector. The oxygen debt of the liver in these patients is compensated by the volume blood flow enhancement along a. hepatis communis.

[DYNAMICS OF CHANGES OF PROINFLAMMATORY AND ANTIINFLAMMATORY CYTOKINES, AS WELL AS SOME INDICES OF THE BLOOD PEROXIDATION SYSTEM, IN THE PATIENTS WITH VARIOUS PANCREATIC PSEUDOCYST TYPES].

The investigation was performed in 47 patients, operated on for pancreatic pseudocysts (PP). The PP type was established in accordance to A. D'Egidio, M. Schein (1991) classification. The blood plasma contents of proinflammatory and antiinflammatory cytokines, including interleukins (IL): IL-6, IL-8, IL-10, IL-18, as well as malonic dialdehyde and activity of glutationperoxidase, were determined for estimation of the immune state disorders. Mostly expressed changes in IL-8 content were registered in complicated PP in 72 h postoperatively, what was have characterized by more expressed raising of its level in systemic blood flow, than in a splanchnic one, in all types of PP and witnessed a hepatic capacity to guarantee a cytokine's clearance in all the patients. The contents of glutationperoxidase and IL-18 in the blood serum in various types of PP have correlated immediately with pancreatitis severity. Close correlative connection between these indices while unfavorable prognosis of postoperative period course was established.

[The role of matrix metalloproteinases and their inhibitors in pathogenesis of pancreatic pseudocysts].

The investigation was conducted in 47 patients, operated on for pancreatic pseudocysts (PP). Activity of matrix metalloproteinases (MMP-9) and content of their tissue inhibitor (TIMP-2) were determined in the blood serum for estimation of inflammatory factors, hypoxia severity and state of the pancreatic tissue reconstruction. High activity of MMP-9 and TIMP-2 in presence of PP types I and II was noted in patients, what, probably, is caused by compensation reaction, directed towards inhibition of the collagen system destruction (predominantly of collagen type IV) and prevention of further reconstruction of pancreatic connective tissue. While progressing of pancreatic fibrosis the MMP-9 activity and the TIMP-2 level have lowered in comparison with these indices while its absence. In PP type III the MMP-9 activity was by 83.6% higher, than in a control group, but, by 51.4 and 35.1% lower, than in PP types I and IV. In all the patients endothelial dysfunction with endothelial injury was observed, witnessed by significant rising of the VEGF content in the blood serum. It have created favorable conditions for pancreatic tissue remodeling while parenchymal defect have been constituted by tissue, owing lower level of organization, including a cicatricial one. In cases of cellular repeated affection more activation of pancreatic stellate cells and enhancement of production of extracellular matrix component were noted.

[Classification of an acute pancreatitis: revision by international consensus in 2012 of classification, adopted in Atlanta].

In 1992 on symposium in Atlanta the general classification of an acute pancreatitis, adopted by world medical society for practical application, was proposed. Due to results of multiple investigations there were enhanced the data about an acute pancreatitis pathophysiology, the organs insufficiency, and improvement of the noninvasive and invasive methods of visualization and treatment, what caused necessity to revise the classification. Web-consultations were conducted in 2007 yr to guarantee a wide participation of pancreatologists. After first meeting the working group have directed the document project to 11 national and international associations of pancreatologists. In 2012 yr the definite conclusions, concerning consensus, were published.

[State of specific and natural immunobiological resistance in patients with colorectal cancer in conditions of obturation of the colon].

Estimation of the immune state was performed in 57 patients, suffering colorectal cancer (CRC) with impassability of large bowel (ILB) in compensated stage (in 30) and subcompensated (in 27). In all the patients immunosuppression was revealed, in ILB in a compensation stage activation of proinflammatory and antiinflammatory citokines--mediators of immune system, while in LIL in a subcompensation stage and in progressing of CRC--inhibition of antiblastomic mediators on background of significant rising of the problastomic citokines, what may have a prognostic significance for optimization of pathogenetic therapy in such patients.

[Surgical treatment of patients for abdominal sepsis].

Results of surgical treatment of 201 patients, suffering abdominal sepsis (AS), which have occurred after operations on abdominal organs, were analyzed. Expediency of application of modern scales for the patients state severity estimation, prognostic sign-posts and dynamic of the pathological process course in every patient was substantiated. Existing systems of prognostication (APACHE II, SOFA, MODS) are applied restrictedly for diagnosis of infection in patients, what demands relaparotomy performance in presence of clinical signs of intraabdominal infection, which persists. For prognostication of the treatment result and determination of indications for relaparotomy conduction in patients, suffering severe AS and infectious-toxic shock (ITSH), the most informative is application of the Manheim's index of peritonitis together with analysis of clinico-laboratory indices for formation of groups of patients in risk, to whom reoperation is indicated. Advantages of relaparotomy "on demand" conduction were proved in comparison with "programmed" relaparotomy during the staged surgical treatment of patients, suffering severe AS and ITSH. Complex surgical treatment with substantiation of indications and choice of adequate method of intervention secures improvement of the treatment results in these severely ill patients.

[Prognostic significance of indices of endogenous intoxication and of a monooxygenase system on the stages of surgical treatment in patients, suffering abdominal sepsis].

Some indices of endogenous intoxication and lymphocytic monooxygenase activity in the blood of patients, suffering abdominal sepsis (AS), were investigated, their prognostic significance was determined. In 28 patients the signs of AS were revealed, in 14 of a severe sepsis, in 11--of a septic shock. For peritoneal AS there were operated 37 patients, and for a pancreatogenic one--15. Relaparotomy "on demand" was performed in 12, and "the programmed" one--in 15 patients. A 30-days lethality in AS was 10.7%, in severe shock--28.6%, and in a septic one--63.6%. While AS occurrence a rising of metabolic activity of the monooxygenase system were registered in certain terms, and significant inhibition of this index--while severe state of the patients in a refractory shock occurrence. A safety correlational connections of indices in the blood and the lymphocytic monooxygenase system activity were determined in patients, who died.

[Intraabdominal hypertension syndrome in patients with abdominal sepsis].

Investigations were conducted in 53 patients, operated on in 2013 yr for abdominal sepsis (AS). The patients state severity was determined in accordance to the systemic inflammatory reaction and the polyorgan insufficiency severity. In 28 patients (group I) AS was diagnosed, in 14 (group II)--severe AS, in 11 (group III)--a septic shock. Tactics of surgical management of the patients have included two main measures: the infection origin control (source control), and control of the affected organ function and systemic defense mechanisms (damage control). In all the patients in AS the intraabdominal pressure rising was revealed. Syndrome of intraabdominal hypertension was noted in 10 (18.9%) patients (in 4--while presence of severe AS, and in 6--in septic shock). Lethality was the highest in intraabdominal hypertension degrees III and IV (11 of 25 patients have died).

[Time of surgical treatment performance in patients with acute necrotic pancreatitis complicated by secondary pancreatic infection].

Retrospective and prospective analysis of the surgical treatment results was conducted in 445 patients, suffering secondary pancreatic infection, ageing 18-83 yrs. Correlation connection was established between the terms of the operative intervention conduction and the patients mortality (r = -0.95, t = -18.7, P = 0.000). After the operation in 30 days from the admittance to the hospital the patients mortality was lesser.

[Application of mini-invasive methods of elimination of horizontal reflux in patients with varicose disease of the lower extremities complicated by active trophic ulcers].

The results of surgical treatment of 153 patients for varicose disease of the lower extremities, complicated by trophic ulcers of the feet, were summarized. Miniinvasive methods were applied in patients of the main group for elimination of horizontal reflux, causing the increase of the favorable (excellent and good) results of treatment rate by 36.22% and the reduction of unfavorable results rate--by 15.29%. Introduction of the individualized methods of surgical treatment, using modern technologies of diagnosis and treatment, the choice of optimal variant of operation, applying miniinvasive methods, have permitted to reduce an early postoperative complications rate, a recurrence rate of trophic ulcer of the lower extremities, duration of the patients stationary treatment, as well as to achieve good and satisfactory results in 94.4% of patients during three years after performance of the operation.

[Peculiarities and results of reconstruction-plastic operations in patients with locally spread forms of the thyroid gland cancer].

The work is devoted to problem of differentiated application of reconstruction-plastic operations in patients with locally spread forms of the thyroid gland cancer with affection of cervical trachea, esophagus, main cervical vessels and mediastinum. For substantiation of choice of tactics and the operative intervention volume there was elaborated and introducted the technology of estimation of the tumoral expansion degree according to diagnostic algorhythm elaborated. The treatment doctrine was formulated, which substantiate the expediency of performance of radical interventions and of reconstruction-plastic operation. Its efficacy is proved by available postoperative complications rate (21.6%), by mortality (3.9%), the patients survival indexes during 3 years (77.8%) and 5 years (64.6%).