[Prevention of the development of additional purulent-septic complications in peritonitis of various etiologies, taking into account reduced reactivity]. / Profilaktika razvitiya gnoino-septicheskikh oslozhnenii pri peritonitakh raznoi etiologii s uchetom snizhennoi reaktivnosti organizma.

OBJECTIVE: To evaluate the effectiveness of the drug aminodihydrophthalazinedione sodium (Galavit) for the prevention of the development of additional purulent-septic complications associated with a reduced reactivity in patients with peritonitis. MATERIAL AND METHODS: Patients diagnosed with peritonitis were included in a prospective, non-randomized, single-centre study. Two groups of patients were formed, the main and control, 30 people each. In the main group, patients received aminodihydrophthalazinedione sodium at a dose of 100 mg/day for 10 days, in the control group they did not receive the drug. During 30 days of observation, the development of purulent-septic complications and the number of days of hospitalization were recorded. Biochemical and immunological blood parameters were recorded at the time of inclusion in the study and for 10 days of therapy. Information about adverse events were collected. RESULTS: Each study group included 30 patients (60 in total). The additional complications developed in 3 (10%) patients who received the drug and in 7 (23.3%) in the group that did not receive the drug (p=0.166). The risk ratio is up to 0.556 and the risk ratio is 0.365. The average number of bed-days in the group that received the drug was 5, and in the group that did not receive the drug - 7 days (p=0.108). No statistically significant differences between groups in biochemical parameters were identified. However, there were estimated statistical differences in immunological parameters. Thus, CD3+, CD4+, CD19+, CD16+/CD56+, CD3+/HLA-DR+, IgG were higher in the group taking the drug, and the CIC level was lower than in patients of the group that did not receive the drug. There were no adverse events. CONCLUSION: Aminodihydrophthalazinedione sodium (Galavit) is effective and safe for preventing the development of additional purulent-septic complications associated with a reduced reactivity in patients with peritonitis, decreases the incidence of purulent-septic complications.

[About the signs of malignant pheochromocytoma].

Morphological criteria for malignant pheochromocytoma remain to be developed According to the WHO recommendations, the sole absolute criteria is the presence of metastases in the organs normally containing no chromaffin tissue. Such signs as cellular and nuclear polymorphism, mytotic activity, vascular invasion, capsular ingrowth are not sufficient to describe a pheochromocytoma as malignant. It is equally dfficult to differentiate between malignant and benign tumours based on histological data since histologically mature neoplasms can produce metastases. Based on the results of original studies, the authors believe that such histological features as vascular and capsular invasion do not necessarily suggest unfavourable prognosis. Therefore, the conclusion of malignancy based on such features can not be regarded as absolute. Probably such neoplasms should be called "pheochromocytomas with morphological signs of malignant growths". They should be referred to the tumours with uncertain malignancy potential based on the known discrepancy between morphological structure and biological activity of neoplasms. Comparative studies of clinical and morphological features of pheochromocytomas showed that their histological type (alveolar; solid, dyscomplexed, trabecular) and morphological signs of malignant growth influence both the clinical picture and arterial hypertension. There are no significant relationship between the above morphological signs, timour mass and clinical manifestations of pheochromocytomas.

[Poorly differentiated stomach adenocarcinoma combined with jejunal stromal tumour. Clinical study].

Gastrointestinal stromal tumours (GIST) first described in 1983 are the commonest mesenchymal neoplsams of the digestive tract. The main pathogenetic mechanism is hypersecretion of tyrosin kinase receptor c-kit (CD-117) by GIST cells and its hyperactivation. A rare clinical case of GIST measuring 1.2 CM with concomitant stomach cancer (poorly differentiated carcinoma) is reported. The tumours were discovered intraoperatively. To our knowledge, data on such cases are practically lacking in the literature.

[Delayed results of proximal gastrectomy in patients with esophageal and gastric varices].

An original method of proximal gastrectomy was used to eliminate hemorrhage from gastric and oesophagal varicose veins in 27 patients with portal hypertension. The follow up period varied from 1 to 23 years. The risk of hemorrhage and the degree of vein dilatation were assessed by endoscopy and endoscopic ultrasonography. It is concluded that the method used in the study may be recommended as the first-line surgery for the management of hemorrhage from gastric and oesophagal varicose veins with good functional results in the late postoperative period and rare complications.