[Effect of morphological state of pancreatic parenchyma on the long-term outcome of surgery for chronic pancreatitis]. / Vliyanie morfologicheskogo sostoyaniya parenkhimy podzheludochnoi zhelezy na otdalennye rezul'taty khirurgicheskogo lecheniya khronicheskogo pankreatita.

OBJECTIVE: To determine the effect of baseline morphological state of the pancreas on the long-term outcomes of duodenum-preserving pancreatic head resection (DPPHR). MATERIAL AND METHODS: The study included 104 patients with chronic pancreatitis (CP), who underwent DPPHR in 2014-2019. Pain syndrome, exocrine and endocrine pancreatic insufficiency and quality of life (QoL) were assessed in long-term postoperative period. Patients were stratified depending on CT enhancement of pancreatic parenchyma as an indicator of fibrosis and amount of preserved acinar cells in resected pancreatic tissue. RESULTS. S: Ignificant relief of pain syndrome in long-term period was observed in patients with higher density of pancreatic tissue in venous phase of CT compared to delayed phase. Moreover, these patients needed less additional enzyme intake and had higher QoL. Exocrine insufficiency depended on the number of preserved acinar cells. The percentage of preserved acinar cells also affects the QoL of patients with CP. There were no correlations between endocrine insufficiency and CT-findings, as well as the number of preserved acinar cells. CONCLUSION: Higher CT-density of pancreatic parenchyma in venous phase indicates a lesser degree of fibrosis. It is a favorable prognostic factor for postoperative pain relief and preservation of exocrine function. The percentage of preserved acinar cells in the resected pancreatic tissue is a reliable predictor of exocrine insufficiency.

[Long-term outcomes of pancreatic head resection in chronic pancreatitis]. / Otdalennye rezul'taty rezektsii golovki podzheludochnoi zhelezy pri khronicheskom pankreatite.

OBJECTIVE: To analyze the effect of timing of surgery, quality of resection and removal of MPD-stones on long-term results of duodenum-preserving pancreatic head resection (DPPHR). MATERIAL AND METHODS: The study included 110 patients with chronic pancreatitis (CP) who underwent DPPHR in 2014-2019. Evaluation of long-term outcomes included pain syndrome severity, exocrine and endocrine insufficiency and quality of life (QoL). Patients were stratified depending on duration of disease (within 36 months, >36 months after manifestation), volume of resected pancreatic head tissue according to CT data, removal of MPD-stones. RESULTS: Surgical treatment within 36 months after clinical manifestation was followed by less pain syndrome (VAS score 1.16±1.76 vs. 2.03±1.87, p=0.02), exocrine insufficiency (69.8% vs. 98.5%, p<0.001). Resection of more than 50% of the pancreatic head and removal of MPD-stones were accompanied by pain relief, improved pancreatic secretory function and quality of life. CONCLUSION: Pancreatic head resection in patients with chronic pancreatitis should be performed within 3 years after clinical manifestation. Resection of more than 50% of the pancreatic head with extraction of MPD-stones ensures pain relief, better endocrine and exocrine function, as well as higher QoL in long-term follow-up period.

[Current trends in emergency abdominal surgery in the Russian Federation]. / Sovremennye tendentsii v neotlozhnoi abdominal'noi khirurgii v Rossiiskoi Federatsii.

OBJECTIVE: To analyze morbidity and factors affecting mortality in emergency abdominal surgery in the Russian Federation. MATERIAL AND METHODS: The study included patients with acute abdominal diseases aged 18 years and older. All patients were hospitalized in emergency surgical care departments of 3.194 state healthcare institutions in 84 regions of the Russian Federation in 2018. Morbidity, surgical activity and mortality were analyzed. RESULTS: There were 680.337 cases of hospitalization in emergency surgical department, morbidity rate was 582 cases per 100 000. The most common emergency surgical diseases were acute appendicitis (142.3 cases per 100 000), acute cholecystitis (139.0 cases per 100 000) and acute pancreatitis (131.2 cases per 100 000). Surgery was performed in 399.051 (58.7%) patients. In-hospital mortality rate was 2.4% (16 051 cases). CONCLUSION: There are certain factors affecting mortality rate in acute abdominal diseases. The leading problems in organizing emergency surgical care in Russia are insufficient equipment of rural and small municipal surgical hospitals, different staffing with surgeons in rural areas and large cities and late hospitalization of patients.

[X-ray-negative pancreatic dust stones in patients with chronic pancreatiti]. / Rentgenonegativnyi virsungolitiaz u bol'nykh khronicheskim pankreatitom.

Diagnosis of chronic pancreatitis is not associated with any difficulties in patients with CT signs of pancreatic duct stones as a rule. However, 'classical' picture of chronic pancreatitis is usually absent in case of predominant protein matrix in the calculi. Two cases of X-ray-negative pancreatic dust stones in patients with protein stones of the pancreatic duct are reported.

[Quality of life as an efficiency index of surgical treatment of chronic pancreatitis]. / Kachestvo zhizni kak pokazatel' éffektivnosti khirurgicheskogo lecheniia khronicheskogo pankreatita.

OBJECTIVE: To evaluate quality of life in long-term postoperative period in patients with chronic pancreatitis. MATERIAL AND METHODS: There were 31 (21 males and 10 females) patients with complicated forms of chronic pancreatitis who underwent surgery in 2015-2017. Mean age was 49 (44; 53) years, body mass index - 22.4 (20.4; 24) kg/m2. HR-QOL was determined using the questionnaires SF-36, QLQ EORTS C30, VAS. Postoperative control was made no earlier than 6 months after surgery. Median follow-up 11.5 months. The data were analyzed using non-parametric methods. Quantitative data are shown as median with interquartile range. Differences between quantitative values were determined using the Mann-Whitney test. RESULTS: Physical status value (SF-36) before surgery was 30.5 (24.8; 37.5), after surgery - 50.8 (46.7; 56.5). Mental status value was 30.2 (26.7; 36.4) prior to surgery and 53.8 (48.7; 57.3) after operation. Improvement of QoL (QLQ C30) from 29.17 (0; 50.0) before surgery to 75.0 (54.2; 83.3) after operation was observed. VAS-score of pain severity was 8 (8; 10) prior to surgery and 3 (2; 5) after surgery. Differences were significant (p<0.05). CONCLUSION: Surgical treatment of complicated chronic pancreatitis significantly reduces pain and improves HR-QoL. However, recurrent symptoms of chronic pancreatitis in long-term period cannot be excluded due to short follow-up period (median less than one year). The further investigation is needed.

[Fatty degeneration of upper tarsal muscle as etiological factor of acquired upper eyelid ptosis]. / Zhirovaia distrofiia verkhnei tarzal'noi myshtsy kak étiologicheskii faktor priobretennogo ptoza verkhnego veka.

PURPOSE: To study the histological structure of the upper tarsal muscle (Müller's muscle of the upper eyelid) in patients with acquired ptosis and to confirm the presence of its fatty degeneration as an understudied etiological factor of upper eyelid ptosis. MATERIAL AND METHODS: A retrospective analysis was performed covering 79 biopsy samples of Müller's muscle of the upper eyelid obtained intraoperatively. Histological examination was performed with samples prepared by waxing. Planning the surgery included determination of basic parameters and the 'transparency' symptom; the Müller's muscle projection area was examined in the inverted upper eyelid, and ultrasound biomicroscopy (UBM) of the upper eyelid structures was performed. RESULTS: Among the study subjects, a group of 11 patients with isolated fatty infiltration of the upper tarsal muscle was identified. At the preoperative stage, in the group of patients with upper eyelid eversion, visibly thickened Müller's muscle advancing on the tarsus could be observed, as well as negative 'transparency' symptom; UBM showed thickened 'conjunctiva - Müller's muscle' complex, and a large number of hypoechogenic inclusions in the muscle in comparison with the intact eye. The removed muscle was thickened, yellow, with increased density and rigidity. Microsection of the histological preparations revealed fat cells located among bundles of smooth muscle fibers of the upper tarsal muscle and dispersion of smooth myocytes on the background of fat infiltration. CONCLUSION: The presence of dystrophic changes in the upper tarsal muscle is proved with clinical, macromorphological and pathohistological methods; they can be one of the independent causes of acquired upper eyelid ptosis.

[The mistakes in diagnosis of pancreatic intraductal papillary mucinous tumor]. / Oshibki diagnostiki vnutriprotokovoi papilliarno-mutsinoznoi opukholi podzheludochnoi zhelezy.

It is presented surgical treatment of the patient with pancreatic intraductal papillary mucinous tumor who was under observation with diagnosis of chronic pancreatitis for a long time. Recurrent tumor with possible malignant transformation to carcinoma was suspected in 5 years after pancreaticoduodenectomy. It was supposed to perform pancreatic stump extirpation. Redo surgery did not reveal any tumor. The cause of recurrent pain was pancreatic duct obliteration at the level of anastomosis.

[Complex treatment of patient with chronic pancreatitis]. / Kompleksnoe lechenie bol'nogo khronicheskim pankreatitom.

Chronic pancreatitis complicated by pancreatic duct stones and pancreatic hypertension, post-necrotic cysts and fistulas requires surgical treatment. There are various procedures from minimally invasive to advanced pancreatectomy. Endoscopic interventions and radical open surgery allow to achieve good results. Successful complex treatment of patient with chronic pancreatitis is presented in this report.

[Current issues in pancreatic surgery]. / Aktual'nye voprosy khirurgii podzheludochnoi zhelezy.

AIM: To present own experience of pancreatic surgery and to analyze literature data for this issue. MATERIAL AND METHODS: We have analyzed work of abdominal surgery department over the last 5 years. Moreover, MEDLINE and RSCI databases regarding surgical treatment of pancreatic diseases were assessed. RESULTS: There were 456 pancreatectomies. Postoperative complications arose in 176 (38.6%) patients, 11 patients died (2.4%). According to world data, mortality after pancreatectomy reaches 10%. Only creation of specialized centers is proven way to improve the outcomes. CONCLUSION: Current medical assistance for pancreatic disease may be only achieved in specialized centers with large number of various pancreatic procedures. The organization of such centers is required throughout the country and certain accreditation criteria should be developed for this purpose. Targeted routing of patients to specialized pancreatology centers will be able to reduce incidence of diagnostic, tactical and technical errors.

[Wirsungorrhagia in cystic mucinous pancreasic tumor]. / Virsungorragiia pri kistoznoi mutsinoznoi opukholi podzheludochnoi zhelezy.

A rare case of virsungorrhagia in a 65 y/o patient with a mucinous tumor of the tail of the pancreas is presented. Recurrent gastrointestinal bleeding was associated with an arrosis of the splenic artery adjacent to the tumor, which required a two-step treatment - endovascular occlusion of the splenic artery and distal resection of the pancreas.

[Ultrasonography in normal eyelids assessment].

The article presents the results of a complex study on ultrasonography which included high-resolution grey scale B-scan, color Doppler imaging, and ultrasonic density measurement of eyelids and periorbital tissues. A total of 48 patients were enrolled. Echographic anatomy of eyelid layers, i.e. skin, orbicularis oculi muscle, tarsus, and orbital fat, is described in detail. Depth and ultrasonic density values for all layers are provided. The authors suggest performing an ultrasound examination of eyelids prior to reconstructive and plastic surgery in order to facilitate the choice of surgical tactics.

[About experience of producing city health profile as a part of the international who healthy cities project].

The article presents information about the international project "Healthy cities", knowledge about principles and axioms of the project. The authors have analyzed the experience of producing the "City Health Profile" under the project WHO "Healthy cities". The authors believe that the "Health Profile" of each individual city varies depending on specific conditions, both physical (the size of the territory, the state of the environment, its location) and political, and socio-economic. However, the formation of the "City Health Profile" is universally, regardless of geographical location or structure. It was noted that the "City Health Profile" has reflected all aspects of the life of the city, facilitates or barriers the promotion of inhabitants' health and their well-being. For producing of "City Health Profile" additional data are needed: survey, sociological polls of the city population (self-assessment of their health status, lifestyle and quality of life). The advantage of these researches, carried out in the framework of the project "Healthy Cities", is implementation of complex sociological survey with a focused multi-purpose monitoring, covering all spheres of life in the city, to present a versatile, complete and objective evidences to illustrate the city as a territory of health and make up the holistic picture and the centre of which is the citizen and his/her health according to the WHO recommendations.

[Posterior approach for foreign body removal from optic nerve head. Case report].

A technique of foreign body removal from optic nerve head performing an external approach and optic nerve transection is described. After 3 months of follow-up cosmetic result is satisfactory and there are no surgery related complications.

[The effect of foridon on the cerebral circulation in non-narcotized animals]. / Vliianie foridona na mozgovoe krovoobrashchenie u nenarkotizirovannykh zhivotnykh.

In chronic experiments in rabbits, foridone, 0.3 mg/kg, i.v., caused a significant increase in overall and local cerebral circulation and pO2 in various brain regions. In conscious rats, foridone given in the same dose under 30-min carotid occlusion resulted in a less profound decrease in brain blood supply to the baseline level during recirculation and prevented disturbances in oxidative processes in brain tissue and development of brain edema.

[Experimental and clinical studies of the action of verapamil (finoptin) on the cerebral circulation in transient cerebral ischemia]. / Eksperimental'noe i klinicheskoe issledovanie deistviia verapamila (finoptina) na mozgovoe krovoobrashchenie pri tranzitornoi tserebral'noi ishemii.

The experiments on unanesthetized rats have established that the intravenous injection of verapamil in a dose of 0.6 mg/kg during 30-minute carotid occlusion with subsequent recirculation prevents postischemic hypoperfusion, normalized oxidative processes and prevents brain tissue edema. In patients with transient cerebral circulatory disorders, a single injection of verapamil in a dose of 10 mg enhances the pulse filling of cerebral vessels. During a course therapy, the drug decreases minor and middle vessel tone, increases the REG amplitude, lowers the interhemispheric asymmetric blood filling rate, and enhances the functional resistance of cerebral vessels.

[Attitude of hysterical patients to an experimental situation]. / Otnoshenie k éksperimental'noi situatsii bol'nykh isteriei.

The article analyses the way in which hysterical patients' attitude to an experimental situation affects the results of an experiment. It has been assumed that depending on the nature of an experiment and the motivational content of the stimulating material the patients' attitude toward the experiment will also change. Comparison of the above attitudes in different variants of technique denoted as "the level of claims" has made it possible to characterize the specificity of hysterical patients' motivation expressed in excessively high claims and maintenance of inadequate self-assessment. The data obtained in the course of the experiment allow certain conclusions while determining the means to study the psychological syndrome in this group of patients.

Adaptation to laboratory and wild animals of the haemorrhagic fever with renal syndrome virus present in the foci of European U.S.S.R. Brief report.

Four strains of haemorrhagic fever with renal syndrome virus (HFRSV) from rodents or patients in European U.S.S.R. foci of HFRS were isolated in laboratory bred C. glareolus. The sensitivity of these animals to HFRSV was compared with that of five other laboratory and wild animals.

[Demonstration of the virus of hemorrhagic fever with renal syndrome in the organs of rodents from natural foci of the infection in the USSR and the serodiagnosis of the diseases]. / Indikatsiia virusa gemorragicheskoi likhoradki s pochechnym sindromom v organakh gryzunov iz prirodnykh ochagov infektsii v SSSR i serodiagnostika zabolevanii.

An indirect fluorescent antibody test (IFAT) and an enzyme-immunological test (ELISA) were used for the detection of HFRS virus in organs of rodents from HFRS foci in the USSR. The virus was found in 115 out of 1120 bank voles, 9 out of 92 redbacked voles, and 2 field voles examined. Spontaneous infection-rate of bank voles in population varied from 1.3 to 100% correlating with the epidemiological situation in foci. IFAT and ELISA were successfully used for serodiagnosis of HFRS. Examinations of 335 paired sera from 157 patients by the IFAT demonstrated seroconversion. Retrospective diagnosis and diagnosis of subclinical forms of the disease were also made.

Detection of hemorrhagic fever with renal syndrome (HFRS) virus in the lungs of bank voles Clethrionomys glareolus and redbacked voles Clethrionomys rutilus trapped in HFRS foci in the European part of U.S.S.R., and serodiagnosis of this infection in man.

The antigen of HFRS virus was demonstrated by means of the indirect fluorescent antibody procedure in the lung tissue of bank and redbacked voles (Clethrionomys glareolus, Cl. rutilus) trapped in HFRS foci in the European part of USSR. This antigen has been used satisfactorily for serodiagnosis of HFRS in several European and Asian regions of the USSR where HFRS had been found to be endemic.