[Surgical treatment of chronic pancreatitis: indications, timing, methods]. / Khirurgicheskoe lechenie khronicheskogo pankreatita: pokazaniya, sroki, metody.

The review is devoted to complex treatment of chronic pancreatitis considering modern data on pathogenesis of this disease. The authors analyze various aspects of endoscopic and surgical interventions in refractory pain syndrome and complications of chronic pancreatitis, as well as positive and negative aspects of each method. Various surgical interventions and indications are analyzed in detail. One of the important points was analysis of the period between disease onset and surgical treatment that affects quality of life in patients with chronic pancreatitis in mid- and long-term period.

[INTEGRAL ASSESSMENT OF RISK AND SEVERITY OF COMPLICATIONS OF SURGICAL TREATMENT FOR ACUTE CHOLECYSTITIS].

Acute cholecystitis (AC) is one of the most common surgical diagnoses in emergency setting. Despite its high incidence, there remains a range of treatment approaches. It is hard to compare different treatment options, and one of the reasons is that reporting of complications is often inconsistent and incomplete. This study aims to develop the Integral Complications Severity Index (ICSI) that takes into account all complications developed during and after surgery. We conducted a multicentric, retrospective cohort study of 754 patients. All of them had surgery for AC at eight hospitals in four cities of Russian Federation (Moscow, Yekaterinburg, Volgograd, and Kislovodsk) during 1-year period. To evaluate results of the surgical treatment we modified Accordion Severity Grading System by adding progressive scores for each grade of complication and taking into account not only all postoperative events but also all complications occurred during surgery and developed the ICSI. The Integral Complications Severity Index (ICSI) is calculated as sum of all complications multiplied by their corresponding scores (mild - 1, moderate -2, severe - 4, death - 8) and then this sum is divided by patients or procedures count. To evaluate surgical treatment schemes that involve multiple procedures (e.g., endoscopic sphincterotomy and laparoscopic cholecystectomy) ICSI of all procedures are summarized. The modified severity grade scale and ICSI can be used to evaluate and compare results and safety of various surgical procedures and their combinations taking into account all complications and their severity developed during and after surgery.

[The comparative analysis of laparoscopic and minilaparotomic techniques in emergency abdominal surgery].

Owing the experience of 16 101 miniinvasive operations by acute diseases of the abdominal cavity, the authors pose that the introduction of polytechnological methods has certain perspectives. The combination of different methods with the use of modern technologies lead to better results.

[Comparative analysis of prognostic value of epileptic encephalopathies and symptomatic epilepsy in children with cerebral palsy].

Cerebral dysfunction due to epilepsy is not currently well-understood and needs to be further investigated. We have observed patients with static encephalopathy (cerebral palsy) of nearly equal severity with epileptic encephalopathy and symptomatic epilepsy and have had carried out comparative analysis of prognosis among these groups. The work is based on the results of investigation of 121 patients admitted to the Center of child neurology and neurorehabilitation during the period 2000-2005. 69 patients with epileptic encephalopathies were included into the study groups according to following criteria: I group -- cases with early starting seizures (before 1 year of life) and II group -- starting seizures after 1 year of life. The control group involved 52 patients with associated cerebral palsy of different severity and symptomatic epilepsy. The study and control groups were compared prognostically. According to our data, prognosis and outcome of epilepsy was closely associated with the time of onset of epilepsy syndromes: early started (within the first year) epileptic encephalopathies display the highest correlation with poor prognosis; the risk of development of epileptic encephalopathies is the highest in patient with cerebral palsy and early starting of seizures.

Prognostic value of gross motor function measure to evaluate the severity of cerebral palsy.

Early adequate evaluation of motor development and prognosis of degree of long-term motor disability is very important not only for parents, but also for correct management of goal oriented rehabilitation treatment and for planning of preventive measures. To estimate the value of Gross Motor Function Measure in evaluation of severity of cerebral palsy, for prognostic counseling with parents and for planning of clinical management. Total of 397 children aged 1 to 12 years at study onset with cerebral palsy were observed for up to 3,5 years during the period from 2002 to 2005. Children were assessed by GMFM-88 (Gross Motor Function Measure), by GMFCS (Gross Motor Function Classification System). Over the course of the study 397 children had a total of 6875 GMFM assessments, or an average of 17,3 observations per child. The study revealed significant differences between developmental limit of each level of gross motor function. Children with lower motor development potential reach their limit more quickly, than children with higher potentials. Children with cerebral palsy reach about 90% of their gross motor function by around age 5 years or younger, depending on their GMFCS level. After this age intervention programs have to address increasing independent activity and to promote participation of children with disabilities.

Importance of correlations of gross motoric functions data and functional independence for management of children with motoric disabilities.

The aim of the rehabilitation therapy is to improve the level of functional independence and decrease degree of disability. The optimization of programs of rehabilitation means functional improvement of the person, and this approach is a basis of effective management. To evaluate the correlation of Gross Motoric Function Data and Functional Independence Measure for children with cerebral palsy. A total of 397 children with cerebral palsy aged 1 to 12 years at the onset of study were observed for up to 3.5 years during the period from 2002 to 2005. Children were assessed by GMFM-88 (Gross Motor Function Measure), by WeeFIM (Functional Independence Measure for Children). Over the course of the study 397 children had a total of 6875 GMFM assessments, or an average of 17.3 observations per child and 1518 -- WeeFIM, or an average of 3.8 observations per child. The values of GMFM-88 and WeeFIM are well correlated (p<0.01). At certain stage of rehabilitation treatment the rate of improvement of gross motoric function slows down and then practically stops. In patients with gross motoric function level IV-V its value remains especially low, and accordingly there is no improvement of functional abilities. This is the main reason of ineffectiveness of rehabilitation treatment and necessity of tertiary care preventive measures.