[Influence of early surgery and endoscopic interventions on the risk of infection in patients with pancreatic necrosis]. / Vliyanie rannikh operativnykh i endoskopicheskikh vmeshatel'stv na risk infitsirovaniya u patsientov s pankreonekrozom.

OBJECTIVE: To prevent purulent-septic complications in patients with destructive pancreatitis. MATERIAL AND METHODS: A cohort study included 488 patients with pancreatic necrosis: group 1 (n=331) - active surgical strategy, group 2 (n=157) - follow-up and therapy. We used binary logistic regression to predict purulent-septic complications. RESULTS: Original model of independent variables significantly (p<0.001) revealed 5.3 times higher risk of infectious complications after laparotomy within the first week after hospitalization. Incidence of these events increased by 2.8 times in patients biliary pancreatitis compared to alcohol-alimentary pancreatitis. Complication rate was higher in older patients (by 2.1% for each year). Risk of purulent-septic complications decreased by 57.4% in women compared to men. There was no significant correlation between risk of infectious complications and endoscopic procedures. Specificity and sensitivity of the model was 74.2 and 72.6%, respectively. CONCLUSION: Original model significantly predicts the risk of purulent-septic complications within the first week after hospitalization. Refusal of early active surgical strategy in these patients will significantly reduce the likelihood of purulent-septic complications.

[Prediction and diagnosis of pancreatogenic encephalopathy in patients with destructive pancreatitis]. / Diagnostika i prognozirovanie pankreatogennoi entsefalopatii u bol'nykh destruktivnym pankreatitom (obzor literatury).

OBJECTIVE: To study the literature data on pancreatogenic encephalopathy in patients with destructive pancreatitis. MATERIAL AND METHODS: Searching for Russian- and English-language literature data was carried out in electronic databases: elibrary, PubMed, the Cochrane Library. We planned a systematic review if studies with evidence level 1 and 2 were available. If these trials were absent, descriptive review was considered. RESULTS: No studies with evidence level 1 and 2 were found in available literature. Therefore, a descriptive review was carried out. Analysis of primary sources showed that the incidence of pancreatogenic encephalopathy is 9-35% and has no direct correlation with etiology of destructive pancreatitis. Major factors of pathogenesis are high serum enzymes, activation of proinflammatory cytokines and hypoxemia, which are accompanied by damage to myelin sheath of the white matter and cytotoxic brain edema. Clinical manifestation of pancreatogenic encephalopathy occurs within two weeks. Acute onset and various symptoms are typical. Possible laboratory predictors of encephalopathy are persistent hyperglycemia, increased hematocrit, fibrinogen-like protein 2 (FPB-2), proinflammatory cytokines TNF-αand interleukin-1-beta. Pancreatogenic encephalopathy is a factor of unfavorable prognosis of treatment. Mortality in patients with pancreatogenic encephalopathy is 57-70%. Favorable course of pancreatic necrosis is followed by regression of cerebral disorders in most cases while residual cognitive disorders are possible in elderly patients. CONCLUSION: Pancreatogenic encephalopathy accompanies severe destructive pancreatitis. It is an unfavorable factor for treatment outcomes requiring further research.

[Evolution of approaches to surgical treatment of complicated cholecystitis]. / Evoliutsiia podkhodov k khirurgicheskomu lecheniiu oslozhnennogo kholetsistita.

More than 17 thousand surgeries for calculous cholecystitis and its complications including 560 repeated surgeries on the major bile ducts were performed. Based on this experience three stages in treatment of complicated cholecystitis are distinguished. Principal changes of surgical policy are the criteria of this division. From 1993 a tendency towards mini-invasive surgery in complicated cholecystitis was developing. Optimal terms of surgery, adequate scope improved technique improve significantly results of surgical treatment of complicated cholelithiasis.

[Papillovirsungocystoduodenoplasty in the treatment of cysts of the pancreatic head]. / Papillovirsungotsistoduodenoplastika v lechenii kist golovki podzheludochnoi zhelezy.

Experience in the treatment of cystic lesions of the pancreatic head is analyzed. The method of internal drainage of the pancreatic head cyst with transduodenal approach is described. This methods includes three stages: papillosphincteroplasty, deep virsungotomy with virsungoplasty and cystovirsungoplasty through ducts. The method is named papillovirsungocystoduodenoplasty (PVCDP). Results of 6 successful PVCDP are presented. There were neither recurrence of the cyst nor lethal outcomes.

[Contact dissolution of gallstones]. / Kontaktnoe rastvorenie kamnei zhelchnogo puzyria.

The techniques and results of contact dissolution of stones in the gallbladder of 27 patients subjected to laparoscopic cholecystostomy for acute cholecystitis were analysed. It was found that the main factors impeding effective dissolution were: the size of the stones over 1.5 cm and admixture of pigment in the concrements. The first Soviet produced litholytic preparation Oktalgin, synthesized by the authors jointly with the Zelinsky IOCh, AMS USSR, was used as the main solvent. The principal possibility of dissolving multiple stones of the gallbladder through laparoscopic cholecystostomy is proved.