["Silent" pheochromocytomas]. / "Nemye" feokhromotsitomy.

The results of surgical treatment of 126 patients with "hormonally inactive" and catecholamine secreting tumors of the adrenals were studied. Among them 2 cases (1.6%) of "dumb" pheochromocytoma were diagnosed. The clinical observations have shown the difficulties in the diagnosis of "dumb" pheochromocytoma before operation, risk of performing adrenalectomy and necessity to correct hemodynamic disorders during anesthesia in connection with latent catecholamine activity. The laboratory and instrumental means of examination of patients with suspected "hormonally inactive" tumor of the medullary substance of the adrenal are proposed. The variants of prevention and arrest of hemodynamic disorders during ablation of the "dumb" pheochromocytoma were considered. When the "dumb" pheochromocytoma had the diameter less than 5 cm and the adequate preparation was conducted the authors propose a laparoscopic access for adrenalectomy on the right, and retroperitoneoscopic access on the left. The detection of the catecholamine secreting tumor of more than 5 cm diameter, when problems with the clipping of the central vein of the adrenal take place, open accesses should be preferred--mainly thoracophrenotomy in the X intercostal space. If it was not possible to prove "dumb" pheochromocytoma before operation and it was started with endovideosurgical intervention during which it was not possible to first clip the central vein of the adrenal and the risk of hemodynamic disorders was high, the early transition to open operative intervention is thought to be expedient.

[Ganglionic blockers in abdominal surgery: facts and hypotheses. 2.Clinical, pathophysiological and pharmacological aspects of ganglionic blocker use]. / Ganglioblokatory v abdominal'noi khirurgii: fakty i gipotezy. Soobshchenie 2. Klinicheskie, patofiziologicheskie i farmakologicheskie aspekty primeneniia ganglioblokatorov.

The authors discuss facts and hypotheses on the effects of benzohexonium upon the motor activity of the intestine and the significance of N-cholinolytics for prophylactics and treatment of postoperative pareses of the gastrointestinal tract. The ganglioblockers possess antistress effect, reduce the degree of pathological vegetative reactions and facilitate realization of the mechanisms of selfregulation of functions of the small and large intestine. Using benzohexonium during operation and in the first days after it makes the intestinal pareses less frequent. N-cholinolytics however do not have a considerable stimulating influence on the contracting activity of the gastrointestinal tract that accounts for their not high effectiveness in treatment of early functional motor evacuatory disorders. The points of action of gangliolytics, those at the level of the intestinal wall included, can not be considered to be completely established, as well as the mechanisms of their indirect effect. The ganglionic blockade should be considered as the basic method of prophylactics of the postoperative paresis of the intestine.

[Early diagnosis and intensive care of acute postoperative pancreatitis]. / Ranniaia diagnostika i intensivnaia terapiia ostrogo posleoperatsionnogo pankreatita.

Diagnostic algorithm developed on the basis of multifactorial regression analysis is suggested for more objective diagnosis of acute pancreatitis after operations on the hepatopancreatoduodenal organs. This algorithm helps differentiate the strategy of intensive care in patients with pancreatitis, pancreatic disease, and uneventful postoperative period. It is impossible to single out the specific (pathognomonic) clinical signs of this complication during the immediate postoperative period. Hyperamylasemia and changes in other enzymes are important but not absolute markers of unfavorable course of disease.

[Rendering anesthesiological and resuscitation care to wounded by a medical reinforcement group in an armed conflict]. / Okazanie anesteziologicheskoi i reanimatologicheskoi pomoshchi gruppoi meditsinskogo usileniia ranenym v vooruzhennom konflikte.

The authors describe the aims and content of anesthesiologic and reanimatologic care of the medical reinforcement group in the medical institution of the 1st echelon of specialized care. Basing on the experience of treatment of 825 casualties with gunshot injuries the rational methods of anesthesia and intensive care are shown including the prolonged controlled ventilation, infusion-transfusion therapy, early enteral nutrition. The main causes of lethal outcomes are analyzed. The conclusion was made that during counter-terrorist operations it is reasonable to include anesthesiologists and reanimatologists into the medical reinforcement group.

[Prognostication and prevention of acute postoperative pancreatitis]. / Prognozirovanie i profilaktika ostrogo posleoperatsionnogo pankreatita.

Equations for accurate prediction of the course of postoperative pancreatitis are developed by multifactorial regression analysis for purposeful prevention of this condition. An injury to the pancreas and the "readiness" of hepatoduodenal organs to a degenerative destructive process are significant for the development of pancreatitis. A differentiated strategy is developed for preventing this complication during the post- and intraoperative period by protease inhibitors, cytostatics, and other nonspecific methods.