[Surgical treatment of pancreaticoduodenal artery aneurysm combined with celiac trunk occlusion]. / Opyt uspeshnogo khirurgicheskogo lecheniya anevrizmy pankreatoduodenal'noi arterii v sochetanii s okklyuziei chrevnogo stvola.

We report successful surgical treatment of inferior pancreaticoduodenal artery aneurysm combined with celiac trunk occlusion. Considering angioarchitectonics of the afferent and efferent arteries (significant tortuosity), possible liver ischemia during endovascular occlusion of pancreaticoduodenal artery and expected low efficiency of embolization, the patient underwent open surgery (celiac trunk replacement and resection of pancreaticoduodenal artery aneurysm). Postoperative period was uneventful. The first and subsequent postoperative controls showed an adequate function of the prosthesis and no contrast enhancement of the aneurysm. We concluded that rational surgical approach ensured optimal solution of the problem, i.e. surgical treatment of pancreaticoduodenal artery aneurysm was the most radical and functional.

[Specific complications of liver resection and their prevention]. / Rezektsiia pecheni. Spetsificheskie oslozhneniia i ikh profilaktika.

AIM: To improve the results of treatment of patients with focal liver formations by preventing the development of postoperative complications after liver resections. METHODS: The study included 304 patients with benign and malignant liver lesions. In 196 (64.4%) patients, resections were performed for malignant liver damage, in 108 (35.6%) - for a benign process. To assess the impact of ongoing measures to prevent the development of postoperative complications, patients were divided into two time periods: from 2007 to 2012 and from 2013 to 2018. RESULTS: The introduction of a protocol of preoperative examination of patients for whom resection of 3 or more liver segments is planned, with the inclusion of SPECT/CT, which allows determining the volume of the remaining functioning liver parenchyma, allowed to reduce the percentage of development of acute post-resection liver failure from 11.6% to 3.6% during the second time period (p=0.0064). The use of modern suture material, surgical binocular loops, as well as the use of the concept of predominantly performing parenchyma-saving resections, reduced the number of biliary complications from 8.1% to 5.7% (p=0.1). The use of a proprietary dissection algorithm for the liver parenchyma significantly reduced hemorrhagic complications from 5.3% to 1.04% (p=0.0074). CONCLUSION: The use of modern pre- and intraoperative technologies has reduced the number of postoperative complications after liver resections from 38.3% to 20.9% (p=0.018) and mortality from 2.6% to 0.5% (p=0.004), thereby improving the results of liver resections.

[The influence of 'potassium orotate' on neocollagenogenesis in implantation of polypropylene endoprosthesis and polypropylene combined with polylactic acid endoprosthesis]. / Vliyanie orotata kaliya na neokollagenogenez pri implantatsii polipropilenovogo endoproteza i endoproteza iz polipropilena s polimolochnoi kislotoi v eksperimente.

AIM: To study neocollagenogenesis after implantation of polypropylene endoprosthesis and polypropylene combined with polylactic acid endoprosthesis on background of «potassium orotate¼ administration. MATERIAL AND METHODS: We used two different types of endoprosthesis in the experiment. The first type was made of just polypropylene, the second type was made of polypropylene combined with polylactic acid. Histological examination was performed using polarizing microscopy. Collagen types I and III ratio in connective tissue around the prosthesis was analyzed according to the color that was individual for each type. RESULTS: The results were significantly better in case of collagenogenesis stimulation with Potassium orotate within 30 days and later for one type of endoprosthesis. Also we revealed that collagenogenesis and paraprosthesis capsule formation were more active in case of combined endoprosthesis. We revealed stimulating action of «Potassium Orotate¼ for collegenogenesis process, this fact was proved by increased collagen I/III ratio. CONCLUSION: Optimization of collagenogenesis was based on persistent 1,37-fold increase of collagen I/III ratio in case of combined endoprosthesis after 90 days. It was manifested by accelerated formation of connective tissue capsule and facilitated early isolation of the implant from surrounding tissues.

[Prediction of acute biliary pancreatitis].

Authors propose mathematical model for prediction of acute biliary pancreatitis in patients with strangulated concrements of papilla Vateri. Values of α-amylase and lipase in blood and bile are used as main prognostic signs. It is estimated that blood lipase, bile α-amylase and lipase are main prognostic signs for development of acute biliary pancreatitis.

[Endoscopic transmural and transpapillar procedures for the treatment of chronic pancreatitis].

93 patients with chronic pancreatitis were treated endoscopically: 44 had transpapillar procedures and 49 patients had transmural operations. The transmural procedures were applied in case of pancreatic pseudicysts, whereas transpapillar endoscopic operations were applied in cases of the obstructive jaundice, pseudocyst, connected of the main pancreatic duct, virsungolithyasis or ductal pancreatitis with pain syndrome. The endoscopic procedures by chronic pancreatitis proved to be the reliable alternative to the traditional surgery.

[Clinical approaches to the treatment of postnecrotic cysts of pancreatic head].

A total of 110 surgical interventions were undertaken to treat 98 patients with pseudocysts of the head of pancreas. Internal drainage was performed in 72 patients including 43 laparatomies and 30 endoscopic procedures for the construction of cystodigestive anastomoses. Surgery with paracentesis drainage was practiced in 35 patients largely for the management of acute immature or suppurative cysts. Two patients underwent gastropancreatoduoudenal resection. Assessment of immediate and late outcomes of different methods of internal drainage demonstrated that endoscopic technique has an advantage over other modalities.

[Endoscopic drainage of postnecrotic pancreatic cysts]. / Endoskopicheskoe drenirovanie postnekroticheskikh kist podzheludochnoi zhelezy.

Results of endoscopic drainage of postnecrotic pancreatic cysts in 12 patients were analyzed. Possibilities of the method are limited by location of the cysts in pancreatic head and corpus. Clear visualization of the cysts on the gastric or duodenal wall is the main condition for this procedures feasibility. Surgery must be started with point burning in the wall that is safe and permits the surgeon to stop procedure when cyst is not found. When the cyst is drained through the duodenal lumen, it is necessary to visualize Veter's papilla and perform the procedure below it to prevent lesion of a distal part of the common bile duct. Section of the cyst with wall thickness to 3-4 mm from the duodenal lumen and the ikness to 6-7 mm from the stomach is safe enough. Endoscopic procedures are not indicated in hypertension in the bile ducts.

[Equipment for blood detoxication in critical care of patients]. / Apparat dlia detoksikatsii krovi pri kriticheskikh sostoianiiakh bol'nykh.

The paper deals with the development of a new more improved blood detoxicating system in critical patients. Based on the design of a [symbol: see text]-0.5 plasmapheresis device, the authors have designed a new [symbol: see text] 2-0.5 system, by including into the extracorporeal circuit the second rotor which cultures biologically active agents (hepatocytes, fragments of splenic and placental tissue) enhancing a patient's detoxification. The paper also outlines the operating principles of the [symbol: see text] K 2-0.5 device, its operational preparation and procedure.