[Analysis of the short and long-term results of traditional duodenum-saving resections of the pancreas head and the original resection-draining method of treatment of chronic pancreatitis]. / Analiz blizhaishikh i otdalennykh rezul'tatov traditsionnykh duodenumsokhranyayushchikh rezektsii golovki podzheludochnoi zhelezy i original'noi rezektsionno-dreniruyushchei metodiki pri khronicheskom pankreatite.

AIM: Compare the short and long-term results of traditional duodenum-saving resections of the pancreas head and the original resection-draining method of the surgery of chronic pancreatitis. MATERIALS AND METHODS: There has been the analysis of the immediate and long-term results of various types of duodenum-saving operations in 48 patients with chronic pancreatitis since 2011 to 2020. The patients were divided into two groups: the control group (n=26) where typical duodenum-saving operations were performed, and the study group (n=22) - the original resection-draining method of surgery. RESULTS: The groups had no difference in gender, age, clinical manifestations. After typical duodenum-saving operations, the number of postoperative complications was higher than after original resection-draining method (31 [14; 52]% and 23 [8; 45]% respectively). In the control group the incidence of pancreatic fistula 19% [7; 39], hemorrhagic complications 12% [2; 30] was higher. In both groups, one patient died in the early postoperative period. However, these differences were statistically insignificant. 12 (52% [31; 73]; p<0.001) patients have died in the control group for the 9-year observation period, mainly (7 cases) as a result of the progression of chronic pancreatitis against the background of alcoholism. The groups had no difference in the level of pain reduction, development of dyspeptic syndrome and diabetes mellitus. CONCLUSIONS: The proposed original technique of subtotal resection of the head, ventral part of the body and tail of the pancreas with longitudinal pancreatojejunoanastomosis made it possible to improve the short-term results and reduce the incidence of pancreatic fistula formation. Taking into account the level of compliance the selection of patients permitted to achieve a better quality of life according to the results of the SF - 36 questionnaire and to reduce the lethality to 5 [0; 25]% (p<0.001) in the long-term period. Statistically significant difference was obtained for three of the five criteria, the total value of the physical (PCS, p=0.033) and mental (MCS, p=0.032) health components.

[Analysis of the short-term and long-term results in surgical treatment of the chronic cystic pancreatitis].

INTRODUCTION: In recent years, the practice of abdominal surgery marked increase in the number of patients with pancreatic cysts. Tactics of treatment of this disease is still disputable. MATERIAL AND METHODS: The article analyzes the treatment of 128 patients with formed pancreatic cysts. They were divided into three groups: 1) external drainage - 44 (34.4%); 2) internal drainage - 41 (32.0%); 3) resection surgery - 43 (33.6%). RESULTS: The duodenum resections were introduced for the treatment of the pancreatic head cysts - 21 (48.8%). Resection methods in the number of postoperative complications (23.3%) could be compared with the operations of the internal drainage of pancreatic cysts (19.5%), although the resection methods are technically more difficult and traumatic. 66 (51.6%) patients were observed in the long-term period. The number of postoperated disease recurrences was more in group 1 (28.6%). Quality of life indicators (SF-36) were higher in group 3. We marked the best results after resection operations. CONCLUSION: So this type of operation can be recommended for the treatment of patients with formed pancreatic cysts as the most radical method.

[THE INDICATORS OF COAGULATION HEMOSTASIS AFTER CRIO-RESECTION OF LIVER].

The article presents results of comparative evaluation of indicators of coagulation hemostasis in 24 patients with focal parasitic and non-parasitic pathology of liver before and after resection of organ with and without frigotherapy. The analysis of condition of coagulation hemostasis was implemented on the basis of results of blood clotting tests and immune enzyme technique of detection of content of factors V, Xl, XII in blood plasma. It is demonstrated that after crio-resection of liver the tendency to normalization of content of factors V and XI is more expressed than in case of common resection of organ. At that, in patients with non-parasitic diseases of liver after crio-resection initially decreased concentration of factor Xl is normalized and content of factor XII keeps to be in limits of normality under its decreasing in patients after resection without frigotherapy. The plasma concentration of fibrinogen corresponds to standard. The most significant departures of international normalized ratio (increasing higher than reference values) and activated partial thromboplastin time (decreasing up to reference values) in patients with parasitic and non-parasitic diseases of liver are observed at 5th day after resection independently of technique applied (with of without frigotherapy).

[Hepatolithiasis].

The authors present an analysis of treatment results in 14 patients with hepatolithiasis. An influence of chronic opisthorchosis invasion on the frequency was determined. Hepatolithiasis was detected in 8 (0.14%) out of 5757 patients, who underwent the operation for cholelithiasis and its complications. The disease was found out in 6 (0.31%) patients out of 1965, who had cholelithiasis and accompanying chronic opisthorchosis. It was 2,2 times more frequent due to proliferative sclerotic changes of biliary system. The trasdermal teanshepatic cholangiography was contraindicated for opisthorchiasis injuries, because of the danger of subcapsular cholangioectates damage. The endoscopic retrograde cholangiopancreatography and the endopapillosphincterotomy were complicated due to extensive structures of the large duodenal papilla and distal section of the general bile duct. The patients were treated by using the cholecystectomy, extraction of stones from ducts, reconstruction of liver passage. Choledochoduodenostomy was performed with compulsory external drainage for ducts sanation from infections and helminthes in the case of the opisthorchiasis. Interportal infusions were carried out. The surgical, conservative and endoscopic treatment was required for multiple colangiolithiasis. The lethality consisted of 7.1%.

[Internal biliary fistulas as a complication of cholelithiasis].

The authors made an analysis of observations of 46 patients. They describe algorithm and problems of clinico-instrumental and X-ray diagnostics, strategy of operative treatment and postoperative complications.

[Relaparotomy and laparostomy in treatment of early postoperative complications].

The cause-and-effect analysis of early (within 3 weeks after the initial surgery) relaparotomy was made, using the experience of 5286 laparotomized patients, of whom 82 (1,55%) had relaparotomy. The main reason of intraabdominal complications was the initial generalized peritonitis in emergency patients (85,4%). In comparison with data of 30 years prescription, the portion of postoperative peritonitis and bleeding had increased, though the number of eventrations and postoperative ileus, on the contrary, decreased. The introduction of laparoscopy eliminated the necessity of diagnostic relaparotomies. The mortality rate after the repeated surgery had decreased from 38,0% to 30,5%.

[The repeated operations for focal liver lesions].

Repeated operations for focal liver lesions were analyzed. 75 patients with parasitic liver lesions (alveococcosis, echinococcosis), 14 patients with liver tumors, 15 patients with cysts and abscesses were included in the study. For the first time patients underwent palliative operations or diagnostic laparotomy. In some patients relapse was observed after radical surgery in postoperative period. Ultrasound study was the main diagnostic method for detecting localization and extent of the lesion. 91 patients underwent radical surgery, including hemihepatectomy carried out to 26 patients, segmental and bisegmental liver resections carried out to 35 patients. Transparenchymatous Tung ligation was used in liver resections. Resection line was covered by hemostatic sutures according to B.I. Alperovich technique. Intraparenchymatous processing of Glisson pedicle according to E.I. Galperin method was applied in extensive liver resections. Cryodestruction was used for prophylaxis of relapses in parasitic and tumor lesions. Liver failure (4) and bleedings (2) were the most life-threatening postoperative complications. 4 patients died due to liver failure (2) and bleedings (2). Among 97 patients good results were observed in 73 (75,3%) patients, satisfactory - in 22 (22,7%), poor - in 2 (2,1%) with relapse of hepatocellular carcinoma.

[Ten years experience with using directed laparostomy in treatment of diffuse purulent peritonitis].

During the recent ten years operations were made on 331 patients with diffuse purulent peritonitis, 214 of them had traditional management of the postoperative period, 117 were managed using directed laparostomy by the method developed in the clinic. Toxic phase of peritonitis was noted in 66.76%, with the terminal phase--33.24% of patients, in the group of patients with laparostomy their number being 10% more than in the group of comparison (with a traditional method of management at the postoperative period). In cases with using directed laparostomy with programmed sanitation of the abdominal cavity the number of postoperative complications was 29.9%, 21.36% of patients died. In the group of patients with traditional management of the postoperative period there were 68.2% of complications, 80 patients (37.4) required relapatotomy, 55.6% died.

[Preparation of rabbit antiserum to Ebola virus]. / Poluchenie krolich'ikh antisyvorotok v virusu ébola.

Humoral immunity of rabbits insusceptible to Ebola virus infection were studied after challenge with infectious Ebola virus and inactivated antigen of this virus. Administration of Ebola virus antigen induced the production of specific antibodies in proportion with the antigen dose injected.

[Development and application of an immunoenzyme test system for diagnosing Ebola fever]. / Razrabotka i primenenie immunofermentnykh test-sistem dlia diagnostiki likhoradki ébola.

Enzyme immunoassay (EIA) test systems for the detection of antigens of and antibodies to Ebola virus were developed and tried. The test system for the detection of Ebola virus antigens based on direct solid-phase EIA detects viral antigens in culture fluid of infected Vero cells, in the blood sera, and in homogenates of infected tissues. Use of this test system allows detection of at least 10 ng of viral proteins or 5.0 x 10(3) to 1.0 x 10(4) PFU/ml in infectious material. The test system is prepared on the basis of protein A - horseradish peroxidase conjugate. It is universal for the testing of animal and human sera and is characterized by high resolution and reproducibility of results. It allows detection of antibodies to Ebola virus starting from days 8-9 of infection. A higher sensitivity of direct solid-phase EIA in comparison with complement fixation or indirect immunofluorescence tests is demonstrated.

[Change in biochemical and hemostatic indicators in guinea pigs upon administering Ebola virus preparations]. / Izmenenie biokhimicheskikh i gemostaticheskikh pokazatelei u morskikh svinok pri vvedenii preparatov virusa Ebola.

The biochemical and hemostatic parameters were compared in guinea pigs after inoculation of Ebola virus strains lethal and nonlethal for them and of inactivated antigen of this virus. The time course of the main hemostatic and biochemical parameters in animals challenged with the lethal strain of Ebola virus differed much from that in other groups. This permits us to hypothesize that modification of the virus in the course of adaptation to the host results in the appearance of properties boosting the enzymatic processes and, hence, in depletion and failure of antioxidant and hemostatic defence, which aggravates the pathological process.

[Comparative study of methods for determining antibodies to measles virus]. / Sravnitel'noe izuchenie metodov opredeleniia antitel k virusu kori.

The authors have developed enzyme immunoassay (EIA) for detecting antimeasles antibodies in the serum and compared it to routine methods. Preparation and purification of measles virus antigen used in EIA and optimal conditions of the reaction are described. Results of the routine methods and those of EIA correlated. EIA was used to determine titers of antimeasles antibodies in the sera of vaccinated children. 3-4 years after the vaccination the antibodies were undetectable in the sera of 23% of children.

[Isolation of purified Ebola virus]. / Poluchenie ochishchennogo virusa ébola.

Purified concentrates of Ebola virus were prepared by two methods, adsorption on polyethylenglycol-600 followed by ultracentrifugation in sucrose density gradient and ultrafiltration. The ultrafiltration method permits preparation of concentrated Ebola virus with better preserved virion structure and infective activity than the traditional method.

[Repeat surgery of hepatic neoplasms]. / Povtornye operatsii pri novoobrazovaniiakh pecheni.

The paper discusses resection and repeat resection of the liver for tumor carried out at a specialized institution. Combination of resection and cryotherapy for hepatic tumor prevents dissemination of cells thereby improving ablasticity of surgery.

[Ultrasonic diagnosis of complications in repeated surgery of the liver]. / Ul'trazvukovaia diagnostika oslozhnenii pri povtornykh operatsiikh na pecheni.

Ultrasonic examination is an effective noninvasive method in the diagnosis of complications in reoperations on the liver. With the application of the method the cavity of disintegration and sequestration were diagnosed in 86% of patients with complicated alveococcosis. Affection of the elements of the porta hepatis and inferior vena cava was revealed in 82% of patients, which was very important in determining the operability of the process and was of essential significance in planning the volume of liver resection. Right pleuritis, the formation of a residual cavity, and sequestration of the parasitic and hepatic tissue are also diagnosed adequately in the postoperative period by means of ultrasonic examination.

[Cryosurgery of focal lesions of the liver in patients requiring reoperation]. / Kriokhirurgiia ochagovykh porazhenii pecheni u povtorno operirovannykh bol'nykh.

Cryosurgery ++ (cryoresection and cryodestruction) was carried out in 21 of a group of 43 patients (48.8%) during resection and +re-resection of the liver in repeated operations. One patient died. It was found that cryodestruction combined with radical and palliative resections of the liver in reoperations improved the late-term results of the operation significantly. With the use of cryotechniques, blood loss is reduced and intraoperative dissemination of the tumour cells and alveococcus and recurrences in the postoperative period are prevented.

[Hepatectomy in repeated operations on patients with parasitic diseases of the liver]. / Rezektsiia pecheni pri povtornoi operatsii u bol'nykh s parazitarnymi zabolevaniiami pecheni.

The results of resection of the liver in repeated operations on patients with parasitic disease of the liver are discussed. Operations were conducted on 22 patients with alveococcosis and 7 patients with echinococcosis. By means of the method of atypical liver resection radical operations were performed on 20 patients (69%) and palliative resections of the liver in 9 patients (31%). The palliative resections were combined with cryodestruction of the remaining parasitic tissue, which improved the therapeutic effect significantly and prolonged the patients' survival. The volume of the resection ranged from a segment to one half of the liver. The fatality rate was 6.8%.

[The late results of liver resection in repeat operations]. / Otdalennye rezul'taty rezektsii pecheni pri povtornykh operatsiiakh.

Long-term results after resections of the liver in reoperated patients are described. The operations were performed on 48 patients. Four of them died (8.4%). The patients were followed-up during 1-15 years. The volume of the operations was from segment resections up to wide hemihepatectomies. Good long-term results were obtained in 82.7% of the patients, satisfactory--in 13.9%, unsatisfactory--in 3.4%. The use of cryosurgical methods in palliative resections gives better long-term results of the operations. Recurrences were noted in 17.2% of the patients. Labor rehabilitation after vast resections of the liver in reoperated patients takes place within 1.5-2.5 years.

[Complications after reoperation hepatectomy]. / Oslozhneniia posle rezektsii pecheni pri povtornoi operatsii.

The main cause of lethal outcomes after resection of the liver in reoperations is hemorrhage and hepatic insufficiency. Among most frequent specific complications are right-side pleurisy, formation of the residual cavity and sequestration. Complications are often observed in combinations and require active therapy. Ultrasonic scanning is a leading method of diagnosing complications after resection of the liver.

[The classification of cryosurgical resections of the liver in reoperated patients]. / Klassifikatsiia kriokhirugicheskikh rezektsii pecheni u povtorno operirovannykh bol'nykh.

The authors present a classification of cryosurgical operations in resection of the liver in reoperated patients. The basis of this classification is different combination of usual and cryosurgical (cryoresection and cryodestruction) methods, which allow to increase the radicality of the operations. Ten kinds of cryointerventions (5 radical and 5 palliative) were established. The classification proposed allows the operative volume for resection of the liver in reoperated patients to be correctly planned.