[A new view on pathochemical mechanisms of prolonged peritoneal dialysis].

New data on etiology, pathogenesis, clinics, quantity estimation, treatment and complications of peritoneal dialysis are observed. The role of aquaporine, nitric oxide, NO-synthase, inflammation and sepsis markers (procalcitonine, C-reactive protein) in pathochemical mechanism of peritoneal dialysis is discussed.

[Defects in conducting case histories in urgent abdominal surgery and their importance].

Information available in case histories is of great importance, e.g. for court examinations on "medical suits". So, we have investigated 472 case histories for the period from 2000 through 2004. It was found that the number of errors and short-comings in case histories still remains rather great. High professional and juridical competence is thought to be the way to avoid the patient's complains and improve effectiveness of treatment.

[Surgical strategy in oncologic diseases of organs of the pancreatobiliary zone complicated by mechanical jaundice]. / Khirurgicheskaia taktika pri onkologicheskikh zabolevaniiakh organov pankreatobiliarnoi zony, oslozhnennykh mekhanicheskoi zheltukhoi.

In patients operated upon for oncological diseases of organs of the pancreatobiliary zone complicated by mechanical jaundice the lethality was decreased in a group of patients with purulent cholangitis and high biliary hypertension by means of using a two-stage method of operative treatment, use of the dosaged decompression of the bile ducts with a gradually increased diameter of the drain from 4 to 7-8 mm being most effective. A good effect of the application of complex antibacterial therapy was also noted when using a direct endolymphatic administration and intracholedochal perfusion of antibiotics. It allowed twice as quick to arrest the inflammatory process in the bile ducts, to normalize the biochemical indices of blood, and to prepare the patient for the main stage of operation.

[The first experience with using high frequency thermo-destruction in patients with metastatic cancer of the liver]. / Pervyi opyt ispol'zovaniia vysokochastotnoi termodestruktsii u bol'nykh s metastaticheskim rakom pecheni.

Thermodestruction of the metastatic cancer of the liver was used in 18 patients. A high frequency induction thermodestructor ELECTROTOM HITT ("Berhtold" Germany) with the working frequency 343 kHz and power 0-60 Wt was used. After the ablation of the main focus the thermodestruction of metastases was performed in the liver. The effects of thermodestruction were estimated by the intraoperative biopsy before and after thermodestruction. The procedure was considered effective if biopsy revealed necrobiotic tissues. A connective tissue scar was formed at the place of thermodestruction. After operation the patients were given polychemotherapy.

[Secondary autoimmune syndrome and immunomodulating lymphotropic therapy in acute pancreatitis]. / Vtorichnyi autoimmunnyi sindrom i immunomoduliruiushchaia limfotropnaia terapiia pri ostrom pankreatite.

Immune status and condition of regional lymphoid tissue were studied in 28 patients with various forms of acute pancreatitis untreated with immunomodulating therapy and in 12 patients receiving combined therapy including lymphotropic regional therapy with T-activin. Acute pancreatitis patients were found to have aquired immunodeficiency, secondary autoimmune syndrome and reaction of toxic immune complexes the severity of which decreased under the action of T-activin therapy.

[Combined treatment of patients with acute cholecystitis complicated by choledocholithiasis and mechanical jaundice]. / Kombinirovannoe lechenie bol'nykh s ostrym kholetsistitom, oslozhnennym kholedokholitiazom i mekhanicheskoi zheltukhoi.

A scheme of combined treatment was used in 72 patients with a complicated form of cholelithiasis. It included retrograde pancreatocholangiography followed by endoscopic papillosphincterotomy, intraoperative cholangiography and drainage of the common bile duct after Pikovsky. There was not a single case of transition to traditional cholecystectomy. Four complications in the postoperative period were obviated during relaparoscopy.

[Intratracheal lymphotropic ozone therapy in erosive-ulcerous tracheitis]. / Intratracheal'naia limfotropnaia ozonoterapiia pri érozivno-iazvennom trakheite.

Under observation there were 452 patients with chronic stenosis of hollow organs of the neck having cannulas during the period from 3 months to several years. During the tracheobronchoscopic examination it was found that 35 patients had trachea ulcers, 46 patients had erosive tracheobronchitis. The ulcers were localized on the anterior wall of the thoracic part of the trachea. Their diameter was from 1 to 2.5 cm. The ulcers were accompanied by diffuse bilateral bronchitis of the II-III degree of the inflammation intensity. 2-3 ml of ozonated sodium chloride solution with the concentration of ozone in it 5 mg/l were introduced into the ulcer edges, i.e. lymphotropically, into the submucous membrane. The same solution (40-60 ml) was used for daily sanitation of the tracheobronchial tree. Complete epithelization of the ulcers and cleansing of the bronchial tree took 3-4 curative bronchoscopies.

[Bronchoscopy in complex examination and treatment of patients with lung abscess]. / Bronkhoskopiia v kompleksnom obsledovanii i lechenii bol'nykh s abstsessami legkikh.

Lung abscess was diagnosed during a complex examination in 115 patients. All the patients had local treatment through the bronchoscope. Cleansing of the abscess cavity takes place 1,3 times quicker in the patients who were given laser irradiation in addition to sanitation bronchoscopy or to whom immunomodulators and antibiotics were introduced lymphotropically intrabronchially, than in those with usual sanitation. The administration of 20 ml of glycerol in the abscess cavity allowed cleansing of the cavity to be 2-3 times quicker.

[Correction of lymph circulation in liver cirrhosis]. / Korrektsiia limfoobrashcheniia pri tsirroze pecheni.

The approach to surgical correction of lymph circulation in hepatic cirrhosis is described. The main criteria in the choice of operations draining neck lymphatic duct were hyperkinetic central hemodynamics with high functional pressure in thoracic lymphatic duct and lymphovenous pressure gradient, central or mixed type of intrahepatic lymph flow. All the 26 patients underwent transvenous external-internal drainage of thoracic duct as a temporal measure for stabilization of patients state. Reinfusion of lymph after lymphosorption promoted detoxication in hepatic failure in patients with cirrhosis, complicated by resistant ascites. Low pressure indices of central lymphodynamics and mixed intrahepatic lymph flow are indications for anastomosis creation between right lumbar vein and right lymphatic duct. In this case it is possible to save the behind-hepatic portion of cava inferior in potential recipients of liver transplants.

[Surgical correction of blood and lymph circulation in liver cirrhosis]. / Khirurgicheskaia korrektsiia gemo- i limfoobrashcheniia pri tsirroze pecheni.

After modeling cirrhosis of the liver in experimental dogs the gastroesophagolienal hemo- and lymphocirculation and that of the greater omentum were transferred into the system of the vena cava inferior, the mesenterial outflow being preserved through the liver. The dynamic observation of the experimental animals has shown the intervention performed to be valid. In 6 patients the gastroesophagolienal circulation and that of the greater omentum were transferred into the system of the vena cava inferior. The proposed method of surgical correction leads to lower portal pressure, to saved hepatopetal blood flow along the portal vein. The reestablished absorbing capacity of the greater omentum and the developed collateral lymph circulation decrease the transudation of the lymph into the abdominal cavity and increase its reabsorption.

[Method of medicamentous saturation of lymphatic system]. / Metod lekarstvennogo nasyshcheniia limfaticheskoi sistemy.

Data of experimental study in 18 mongrel dogs followed by clinical trial in 96 patients are represented, which concerns a method of indirect medicamentous saturation of lymphatic system, consisted in creation of medicamentous subcutaneous infiltration in the thighs followed by pneumocompression. Gentamycin contents in blood lymphatics and organs of experimental animals was studied in various periods of time. The obtained data have determined identity of the effect with the method of introduction of the antibiotics together with the media, which possess hyaluronidaze-like action, and followed by 2 hours duration phlebohypertension (by V.M.Buyanov, 1991). It promotes reduction of time for the procedure more than 3 times and gives possibility to avoid introduction of additional preparations, which are unnecessary load to the procedure. Gentamycin contents in blood serum of patients in various time intervals are demonstrated.

[The rapid diagnosis of the toxicity of biological media in surgical patients]. / Ekspress-diagnostika toksichnosti biologicheskikh sred u khirurgicheskikh bol'nykh.

A simple and objective rapid method for assessing serum and plasma toxicity is proposed, based on registration of the frog cardiac contractions. The method permits assessment of disease severity and monitoring the time course of pathological process after surgery and plasmapheresis. The level of toxemia and disease severity did not correlate in 20% of cases. Causes of this disagreement are discussed.

[New methods for assessing the severity of endogenous intoxication in surgical patients]. / Novye metody otsenki tiazhesti éndogennoi intoksikatsii u khirurgicheskikh bol'nykh.

New methods (a reticulocytic test, inhibition of erythrocyte sedimentation, registration of the frog's heart rate) were used in studying the toxicity of the serum, blood plasma and urine of surgical patients. The most informative methods for the assessment of the toxemia degree are thought to be the reticulocytic test and registration of the frog's heart rate. The maximum time for the determination of endotoxicity is 15 minutes. The pathological process severity can be estimated not only by the toxemia degree but also by its dynamics. The determination of endotoxicity is of value for choosing the methods for the individual detoxication therapy.

[Endoscopic gastroduodenal lymphography with opacification in the diagnosis of penetrating ulcers]. / Endoskopicheskaia gastroduodenolimfografiia s rentgenokontrastirovaniem v diagnostike penetriruiushchikh iazv.

The authors describe the method of endoscopic gastroduodenal lymphography with opacification and its results obtained after treatment of 79 patients with peptic ulcers. The method of diagnosing penetrating ulcers is thought to be highly informative and reliable. It should not be followed by repeated roentgenological examinations, so it decreases the X-ray load both on the patients and on medical personnel and allows the optimal methods of treatment of patients with chronic gastroduodenal ulcers to be chosen.

[Prevention of errors and complications of laparoscopic cholecystectomy]. / O profilaktike oshibok i oslozhnenii laparoskopicheskoi kholetsistéktomii.

Great experience with performing laparoscopic cholecystectomies enabled the authors to work out a classification of failures, errors and complications appearing during preparation, in the process or after such operative interventions. Recommendations are given on prevention of them and for their less frequency.

[Hemostatic therapy of gastroduodenal hemorrhage of non-ulcer genesis by the use of reserve mechanisms of hemostasis]. / Gemostaticheskaia terapiia gastroduodenal'nykh krovotechenii neiazvennogo geneza s ispol'zovaniem rezervnykh mekhanizmov gemostaza.

The article presents summarized results of treatment and examinations of 216 patients with gastro-intestinal bleedings due to acute errosive hemorrhagic gastritis and gastroduodenitis, cancer and polyposis of the stomach, liver cirrhosis and portal hypertension, hemorrhage against the background of atherosclerosis and arterial hypertension by administration of hemostatic medicine into the lymphatic system for activation and reinforcement of the reserve monocyte-macrophage mechanism of hemocoagulation. The results obtained confirm the expedience of this method of influencing the monocyte-macrophage hemostasis, having no complications and giving better medical effects.