[Delayed complication of surgical treatment of duodenal atresia in neonatal period]. / Pozdnee oslozhnenie khirurgicheskogo lecheniya atrezii dvenadtsatiperstnoi kishki v neonatal'nom periode.

We report a 48-year-old woman who underwent surgery in early neonatal period for duodenal atresia and developed subsequent diseases of the upper gastrointestinal tract. Symptoms of gastric outlet obstruction, gastrointestinal bleeding and malnutrition developed over the past 5 years. Inflammatory and cicatricial lesions of gastrojejunostomy formed for congenital duodenal obstruction following annular pancreas required reconstructive surgery.

[DIFFERENTIAL MANAGEMENT AT THE SPHINCTER OF ODDI DYSFUNCTION AFTER CHOLECYSTECTOMY].

Aim: Develop a differential management at the patients with suspected sphincter of Oddi dysfunction after cholecystectomy. Materials and methods: 169 patients after cholecystectomy, divided into 2 groups. 1st group - 60 patients after repeated surgery formed as a comparison group. They multivariate analysis of clinical, laboratory and ultrasonic data revealed the most significant signs of organic causes of cholestasis, expressed in scores. 2nd group - 109 patients with a suspected sphincter of Oddi dysfunction, who did not have symptoms of organic pathology. Types of bile outflow were assessed by hepatobiliary scintigraphy (GBSG). In cases of doubtful diagnoses computer tomography, magnetic resonance cholangiopancreatography, and/or retrograde cholangiopancreatography are performed. Results: According to the scoring system, patients 1st group scored 4 or more (8,7 ± 3,87) points. GBSG performed only in 7 (11.6%) patients, and in all cases the cholestatic type of bile outflow was detected. The amount of estimated points in the 2nd group was 2-3 points (2,43 ± 0,34; p < 0.05). GBSG performed in all patients and three types of bile outflow were revealed: normal - in 21 (19.2%) patients, cholestatic in 8 (7.3%), and accelerated - in 80 (73.3%) patients. When refining the diagnosis in 10 (9%) patients had hidden organic disorders of bile outflow, served as an indication for surgery. Conclusion: Scoring system for the assessment of the suspected sphincter of Oddi dysfunction allows to differentiate of patients for invasive research and surgery. In our study group of 109 patients received less than 4 points, they have dominated the functional disorders, but the results of a detailed examination, 9% of patients had latent organic changes that have become indications for surgical treatment.

[Diagnosis of sphincter of Oddi dysfunction in patients with postcholecystectomy syndrome from hepatobiliary scintigraphic findings].

OBJECTIVE: to diagnose and estimate the clinical value of postcholecystectomy sphincter of Oddi dysfunction in patients. MATERIAL AND METHODS: Examinations were made in 100 postcholecystectomy patients without signs of cholestasis; of them 14 postpapillotomy patients formed a comparison group. Hepatobiliary scintigraphy using the radiotracer 99mTC-bromeside was performed for 90 minutes with cholagogue breakfast at 45 minutes. Common bile duct and duodenal functions and duodenogastric reflux (DGR) were evaluated comparing them with clinical, laboratory, and instrumental findings. RESULTS: Two patient groups were identified according to bile outflow changes. In Group I consisting of 20 (23.2%) patients, the time of maximum accumulation (Tmax) of the radiopharmaceutical in the projection of the choledochus coincided with that in the cholagogue test (46.0 1.8 min) and in Group 2 including 66 (76.8%) patients that was shorter than in the cholagogue test (32.9 +/- 6.8 min) (p<0.05). In Group 2, Tmax was similar to that in the comparison group (30.9 +/- 7.5 min; p > 0.05) and there was no significant difference in intestinal imaging time (18.6 +/- 6.0 min versus 17.6 +/- 0.8) either, which could be indicative of sphincter of Oddi dysfunction. Diarrhea was observed in 73% of the patients with sphincter of Oddi dysfunction and in 86% of the patients in the comparison group versus 10% of the patients with normal bile passage (p<0.01). Statistical data processing showed a correlation of the indicators of sphincter of Oddi dysfunction with those of duodenal evacuator function (r = 0.57; p < 0.0005) and DGR (r = 0.74; p < 0.009). CONCLUSION: Postcholecystectomy sphincter of Oddi dysfunction assumes the greatest clinical value in patients with duodenal motor-evacuator dysfunction, which should be hepatobiliamy scintigraphic, kept in mind when choossphincter of Oddi dysfunction ing a treatment policy.

[Rapid dicentric assay of human blood lymphocytes after exposure to low doses of ionizing radiation].

The probability of losses of different chromosome aberrations during the dicentric chromosome assay of metaphase cells with incomplete sets of chromosome centromeres was estimated using a mathematical model for low doses of ionizing radiation. A dicentric assay of human blood lymphocytes without determination of the total amount of chromosome centromeres in cells without chromosome aberrations (rapid dicentric assay) has been proposed. The rapid dicentric analysis allows to register chromosome aberrations in full compliance with the conventional classification. The experimental data have shown no statistically significant difference between the frequencies of dicentric chromosomes detected by rapid and classical dicentric chromosome assays of human lymphocytes exposed to 0.5 Gy of 60Co gamma-rays. The rate of the rapid dicentric assay was almost twice as high as that of the classical dicentric assay.

[Experience with using a one-layer uninterrupted suture in abdominal surgery].

The authors made an analysis of using a one-layer uninterrupted suture with a synthetic absorbable thread in forming gastrointestinal, intestinal, duodenojejunal and pancreatojejunal anastomoses. The operation technique and early complications are described showing advantages of the one-layer uninterrupted suture with a synthetic thread.

[Cytogenetic characteristics of human blood lymphocytes in vivo in a 120-day bedrest study].

Effects of 120-d bed rest on chromosomal aberration rate were studied in lymphocytes of human peripheral blood in vivo. Chromosomal analysis revealed statistically significant increases in dicentrics and paired acentric fragments in blood lymphocytes of human test-subjects.

[Cytogenetic studies of human blood lymphocytes in vivo in a 7-day experiment with immersion].

The investigation had the goal to fulfill in vivo cytogenetic studies of blood lymphocytes of human subjects in a 7-d experiment with "dry immersion". Blood was sampled from 10 subjects prior to and on completion of the experiment. Analysis of chromosomal aberrations in blood lymphocytes after exposure to simulated microgravity did not reveal statistically reliable chromosomal alterations in comparison with spontaneous levels.

[Dynamic hepatobiliary scintigraphy in the evaluation of the efficiency of reconstructive surgery in patients after gastrectomy].

The study was aimed at defining the informative value of dynamic hepatobiliary scintigraphy (HBSG) in the evaluation of duodenal reflux in patients with postgastrectomic disorders after reconstructive surgery. HBSG was performed in 23 patients. After intravenous injection of 99mTc bromeside in a dose of 74-80 MBq, the areas concerned were identified in the projection of the liver, gallbladder, hepaticocholedochus, duodenum, and stomach for 120 minutes with 60-min cholagogic breakfast. Histrograms were plotted in the activity-time coordinates; hepatic function, gallbladder contractility, and hepaticocholedochal patency were evaluated; the duodenal motor function index and the gastroduodenal reflux were estimated. HBSG is physiological, which makes it possible to reveal duodenal motor-and-evacuation disorders, to specify the reason for poor outcomes of gastrectomy, to objectively evaluate the severity of postgastrectomic disorders, and to determine further treatment policy for this difficult group of patients.

[Surgical treatment of ulcer disease in arterio-mesenterial compression of the duodenum]. / Khirurgicheskoe lechenie iazvennoi bolezni pri arteromezenterial'noi kompressii dvenadtsatiperstnoi kishki.

Experience in surgical treatment of 124 patients with gastric and duodenal ulcers associated with chronic duodenal obstruction due to arterio-mesenterial compression of the duodenum is analyzed. This combination occurred in 12% of all patients with ulcers over 20-year period. Special methods of examination were used for diagnosis: probe duodenography with duodeno-manometry, hepato-bili-scintigraphy. Differential approach to choice of surgical method was developed, and two original methods of surgery are presented: selective proximal vagotomy and resection of the stomach in combination with duodeno-jejuno-anastomosis. Long-term results were studied in 75 patients, and in 93% of them they were assessed as excellent and good. Quality of life of patients after surgery depends on severity of chronic duodenal insufficiency.

[Enteral tube feeding early after surgery on the stomach and the duodenum]. / Enteral'noe zondovoe pitanie v rannem periode posle operatsii na zheludke i dvenadtsatiperstnoi kishke.

Experience in enteral tube feeding (ETF) early after stomach resection, gastrectomy, reconstructive surgeries for chronic duodenal obstructions and postgastroresection disorders in 1716 patients is presented. Irrigators were installed in the jejunum during surgery, more rarely--through gastroscope below distal anastomosis. During the first day saline solutions were administered, further--nutritional cocktails. Period of ETF was 5.8 +/- 0.8 days in uncomplicated postoperative period and from 9 to 73 days in postoperative complications. ETF stimulates motor, resorption, synthetic, barrier functions of the small intestine. ETF permits to improve immediate results of stomach and duodenum surgery and to reduce cost of treatment.

[Gastrectomy with creation of small intestinal reservoir]. / Gastréktomiia s sozdaniem tonkokishechnogo rezervuara.

A new variety of the esophago-intestinal anastomosis in gastrectomy is presented. The application of the anastomosis begins with formation of the cuff around the esophagus by the usage of the afferent and efferent loops, which then being joined together in a shape f reservoir. A total of 113 patients with cancer of the stomach (83), cancer of the gastric stump (10), giant ulcers of the cardial part of the stomach complicated by bleeding (15), and Zollinger-Ellison (5) syndrome have been operated on. Insufficiency of the anastomosis was revealed in 2 patients (1.8%). 6 patients (5.1%) died, 1 patient with insufficiency of the esophageal anastomosis included. There were no clinical manifestations and objective features of reflux-esophagitis after the usage of the suggested method for anastomosis, the reservoir function after the resection of the stomach was for the most part compensated.

[Stable and unstable chromosome aberrations in human blood lymphocytes in vitro after gamma irradiation]. / Stabil'nye i nestabil'nye khromosomnye aberratsii v limfotsitakh krovi cheloveka in vitro posle gamma-oblucheniia.

Radiation-induced (137Cs-gamma-rays) aberrations in the first chromosome in human peripheral lymphocytes were investigated using FISH technique. It was shown that the most of detectable aberrations were translocations (about one half) often appearing with deletions: about 1/3 of the number of translocations were dicentrics; rings and insertions were rare.

[The surgical treatment of chronic duodenal obstruction]. / Khirurgicheskoe lechenie khronicheskoi duodenal'noi neprokhodimosti.

An analysis of indications to operative treatment has been made on the basis of clinical examinations of 162 patients with chronic disturbances of duodenal patency. The operation is indicated to patients with mechanical forms with any stage and to all the patients with the stage of subcompensation and decompensation. Operations were performed on 98 patients. In patients with the stage of subcompensation the operations were most effective which excluded the duodenal passage, especially antrumectomy after Roux with the elimination of the mechanical obstacles at the level of the duodenojejunal passage. At the stage of decompensation only such combined operations are thought to be effective which include additional drainage of the excluded duodenum.

[Surgical treatment of chronic duodenal obstruction after radical operations on the stomach in peptic ulcer]. / Operativnoe lechenie khronicheskoi neprokhodimosti dvenadtsati- perstnoi kishki posle radika'lnykh operatsii na zheludke pri iazvennoi bolezni.

The authors operated on 138 patients with impaired duodenal patency after gastric resection and selective proximal vagotomy. The most substantiated operation is the Roux-en-Y reconstruction. In possible elimination of mechanical obstacles and normal tonicity of the duodenum, the passage through it was restored by means of isoperistaltic jejunal segment. Good long-term results were noted in 83.2%, satisfactory--in 13.6%, bad (ulcer recurrence)--in 3.2% of the patients.