[Impact of abdominal cavity open EHF irradiation on activity of adhesive process in peritonitis].

In experiment on 45 rats a purulent peritonitis was simulated. There was established, that on background of a standard therapy for peritonitis application of abdominal cavity open irradiation of extreme high frequency (EHF) have promoted rapid stabilization of the lipid metabolism indices and the blood coagulation system, the reduction of intensity of lipids peroxidal oxidation processes and severity of systemic inflammatory reaction. Under the influence of complex treatment the severity of adhesive process was reduced in 5.4 times, comparing with such in animals, to whom a standard treatment was conducted only. The revealed pathogenetic aspects of the adhesions formation witnesses the expediency to add EHF irradiation to complex therapy of peritonitis.

[Surgical treatment of chronic pancreatitis based on classification of M. Buchler and coworkers].

The results of surgical treatment of 452 patients, suffering chronic pancreatitis (CHP), were analyzed. The CHP classification, elaborated by M. Buchler and coworkers (2009), based on clinical signs, morphological peculiarities and pancreatic function analysis, contains scientifically substantiated recommendations for choice of diagnostic methods and complex treatment of the disease. The classification proposed is simple in application and constitutes an instrument for studying and comparison of the CHP course severity, the patients prognosis and treatment.

[Methabolism of connective tissue in patients with complicated chronic pancreatitis].

A content in the blood serum of a free and connected oxyproline, collagenolytic activity of the blood, the level of glycosaminoglycans and elastase activity was detected in chronic pancreatitis (CHP). There were examined 73 patients (64 men and 9 women). CHP in a stage B (according to M. Buchler et al., 2009) was established in 26 (35.6%) patients, C1 - in 18 (24.6%), C2 - in 17 (23.4%), C3 - in 12 (16.4%). A progress of pancreatic fibrosis in CHP have occurred on a background of a high activity of elastase in neutrophils, a glycosaminoglycans level raising, as well as a free and connected oxyproline. A detection of a neutrophils elastase activity and oxyproline content in the blood serum may be used in a clinical practice as additional diagnostic criteria of estimation of the pancreatic pathology severity. The changes revealed were the same as in CHP of alcoholic and of the other nature.

[Hepatic and the portal vein resection in the surgical treatment of hepatocellular carcinoma].

Modern problems of the portal vein resection while hepatectomy performance are enlighted. Indications for resection of the portal vein bifurcation zone are adduced, various methods of portoplasty are depicted. New methods of the portal vein passability restoration in disparity of its sutured parts diameters are proposed. The results of hepatectomy combined with portal vein resection are studied.

[Portal reconstruction in hepatectomy with resection of portal vein].

Modern issues of the portal vein resection while hepatectomy conduction are enlighten. The indications for resection of region of the portal vein branches confluence were substantiated, various methods of portoplasty were depicted. New methods of the portal tract passability restoration in discrepancy of diameters of the sutured portal vein portions were proposed. The results of hepatectomy with the portal vein resection were studied up.

[The use of Sandostatin in the combined treatment of surgical diseases of the pancreas]. / Primenenie sandostatina v kompleksnom lechenii khirurgicheskikh zabolevanii podzheludochnoi zhelezy.

The paper analyzes experience gained with the use of Sandostatin in patients with a surgical operation-induced pathology of pancreas. Sandostatin is known to be capable of suppressing the exocrine activity of pancreas, which fact made for decline in the recordable postoperative complications and improvement of results of surgical treatment. The maiden experience gained with its use showed high efficacy of Sandostatin in a multimodality treatment of patients presenting with surgical pathology of pancreas.

[Principles of antibacterial therapy of abdominal infections]. / Printsipy antibakterial'noi terapii abdominal'noi infektsii.

The principles of antibacterial therapy of abdominal infection application were analyzed. Most frequent revealed exciters of abdominal infections, information about its sensibility to antibiotics, new approach to antibacterial therapy were presented.

[Surgical treatment of gastroesophageal reflux disease in the presence of coexistent hiatal hernia]. / Khirurgicheskoe lechenie refliuksnoi bolezni pishchevoda pri nalichii soputstvuiushchei gryzhi pishchevodnogo otverstiia diafragmy.

Experience of treatment of coexistent hiatal hernia (HH) and gastroesophageal reflux disease (GERD) in 491 patients using simultant hernioplastic and antireflux operation was summarized. Complete fundoplication was performed in 478 (97.4%) patients, noncomplete one--in 13 (2.6%), cruroraphy--in 321 (65.4%), including complex method of hernioplasty--in 80 (16.3%). Postoperative mortality was 0.8% (4 patients). The tactical and methodical principles applied have permitted to guarantee the physiologicity and safety of the coexistent HH and GERD surgical treatment.

[Results of partial shunting in liver cirrhosis]. / Rezul'taty partsial'nogo shuntirovaniia pri tsirroze pecheni.

Complex hemodynamical investigations were conducted in 32 patients before the operation and after performance of partial portosystemic shunting (in 8--mesentericocaval anastomosis was done, in 10--central splenorenal one, in 12--splenorenal side-to-side, in 2--lowermesenterial-renal). The formation of anastomosis 8-10 mm in diameter had promoted the sufficient reduction of pressure in v. porta, preservation in it the hepatopetal blood flow, prophylaxis of uncontrolled occurrence of portosystemic encephalopathy, had secured the stable hepatic function during 36 months.

[Intensive therapy of patients with infected necrotic pancreatitis]. / Intensivnaia terapiia bol'nykh s infitsirovannym nekroticheskim pankreatitom.

In 70 patients the course of infected forms of necrotic pancreatitis was analyzed. Severity degree of the patients conditions was estimated according to APACHE II scale. Practical recommendations about management of such patients were elaborated.

[The role of the intestine in the pathogenesis of the multi-organ dysfunction syndrome in diffuse peritonitis]. / Rol' kishechnika v patogeneze sindroma poliorgannoi disfunktsii pri rasprostranennom peritonite.

Extraction of oxygen (O2), ultrastructural organization of intestinal macrophages and translocation of microorganisms were studied on 50 male rats of Wistar line in 2, 6, 12, 24 and 48 hours after the stimulation operation performance (control group) and modelling of an acute purulent peritonitis (APP)--basic group. Increase of common and lowering of intestinal extraction of O2 in early terms of the APP occurrence, accompanied by intensive reproduction of microorganisms and change of intestinal biocenosis, was noted. These infringements correlated with translocation of microorganisms through mesenteric lymphatic nodes--ductus toracicus--systemic blood flow (basic way) in term up to 24 hours and through portal vein--hepar--systemic blood flow (additional way)--up to 48 hours after the APP beginning.

[Performance of restoration surgeries in postburn stenosis of the esophagus and stomach]. / Vypolnenie vosstanovitel'nykh operatsii pri posleozhogovom stenoze pishchevoda i zheludka.

The thirty-years experience of treatment of 987 patients with postburn stenosis of the gut upper parts was summarized. Of the total amount of restorational operations performed in 431 patients there were: esophagoplasty using colon--in 313 (72.62%), small intestine--in 26 (6.04%), stomach--in 66 (15.32%), segment of colon and ileum on the vascular pedicle--in 10 (2.31%), autotransplantation of jejunal segment--in 2 (0.47%), esophagocardioplasty--in 5 (1.15%), plasty with application of local tissues--in 9 (2.09%). Total mortality had constituted 6.96%, but during last 12 years it had subsided down to 1.91% due to perfection of the operations technique performed, new procedures introduction, the anesthesiological support improvement, wide usage of prophylactic measures for possibly occurring complications.

[Stomach shunting in the surgical treatment of pathologic obesity]. / Shuntirovanie zheludka v khirurgicheskom lechenii patologicheskogo ozhireniia.

Gastric shunting (GS) constitutes one of the most effective surgical methods of treatment of morbid obesity. In USA and European countries GS constitutes standard bariatric intervention, in Ukraine these operations were not performed before. The technique of the most popular GS operations was depicted, own results of their application were presented.

[Re-laparotomy and damage control during surgical treatment of postoperative intra-abdominal purulent-septic complications]. / Relaparotomiia i damage control pri khirurgicheskom lechenii posleoperatsionnykh vnutribriushnykh gnoino-septicheskikh oslozhnenii.

The issues of pathophysiology, diagnosis and surgical treatment of postoperative intraabdominal purulent-septic complications were suggested. Noncontrolled abortion of mediators with subsequent development of inflammation and damage in the organs, localized far from primary focus, constitutes the main factor of the postoperative intraabdominal purulent-septic complications occurrence. In such a situation the intraabdominal hypertension and abdominal compartment syndrome also promote the deepening of multiple dysfunctions of organs due to mechanical failure of functions in respiratory, hemodynamical, excretional systems of the organism, what promotes the development of vicious circles and the cascade reactions, leading to exitus lethalis. The modern strategy and tactics of complex treatment of such patients is enlighted.

[The role of endothelin-1 in the pathogenesis of septic shock in the abdominal sepsis]. / Rol' éndotelina-1 v patogeneze septicheskogo shoka pri abdominal'nom sepsise.

Role of endoteline-1 (ET-1) in pathogenesis of septic shock (SS) was studied in 22 patients in the age from 34 to 58 years. There was shown, that ET-1 content in plasma depends on functional level of the adaptation-compensation reaction of organism as an answer on occurrence of SS in patients with abdominal sepsis. This is demonstrated by more high concentration of the index studied in the patients survived and also presence of correlative connection between ET-1 level in plasma of blood, indexes of middle arterial pressure and general peripheral resistance of vessels. There were received preliminary data, witnessing, that circulating cytokines, in particular, interleukin-8, stimulate the heightened production of ET-1 by endothelial cells, what probably in early terms the SS course constitutes the compensatory reaction, directed on elimination of pathogenic microorganisms, securing of reparative processes and maintenance of homeostasis.

[Acute biliary pancreatitis. Diagnosis and course of treatment]. / Ostryi biliarnyi pankreatit. Diagnostika i taktika lecheniia.

The results of surgical treatment of 320 patients with an acute biliary pancreatitis are analysed. The therapeutic-tactical algorythm, using miniinvasive endoscopical interventions, is elaborated. Mortality for pancreatitis in systemic-toxical phase have constituted 10.1%, and in septical one--33.3%.

[Splanchnic circulation after distal splenorenal anastomosis in hepatic cirrhosis]. / Splankhnicheskoe krovoobrashchenie posle nalozheniia distal'nogo splenorenal'nogo anastomoza pri tsirroze pecheni.

While the result estimation of the distal splenorenal anastomosis formation operation, done in 12 patients according to the W. D. Warren method and in another 12 patients--according to the method, modified by K. Inokuchi, it was established that the hepatic portal perfusion loss causes compensational enhancement of blood flow in a. hepatica, including while the standard method application--by 22% and the modified one--by 8%. Doing the splenorenal venous disconnection improves the patients' quality of life due to the incidence rate of portosystemic encephalopathy reduction by 8.3%, and in this circumstances the life span and the hemorrhage recurrency rate do not differ with such while using the standard method.

[Antibacterial therapy of patients with inflammatory necrotic pancreatitis]. / Antibakterial'naia terapiia bol'nykh s infitsirovannym nekroticheskim pankreatitom.

The infectionized necrotic pancreatitis (NP) course, complicated by localized and diffusive peritonitis, abscess and retroperitoneal phlegmon in 86 patients, was analyzed. Severity of state of patients according to the APACHE II scale was estimated. Recommendations for application of empirical and purposeful antibacterial therapy was elaborated. Total mortality for infectionized NP with complicated course was 25.5%.

[Diagnosis and surgical treatment of secondary gastroesophageal reflux disease]. / Diagnostika i khirurgicheskoe lechenie vtorichnoi refliuksnoi bolezni pishchevoda.

Examination and treatment was performed in 69 patients with secondary gastroesophageal reflux disease (GERD), 61 (88.4%) of whom were primarily operated on for achalasia of cardia and GERD. The choice of the operation method was based on complex examination of the patients. Due to conduction of preoperative preparation it was possible to perform the most physiological antireflux fundoplication operations in the patients.

[First experience of laparoscopic esophagocardiomyotomy for achalasia of the cardia]. / Pervyi opyt laparoskopicheskoi ézofagokardiomiotomii pri akhalazii kardii.

The first experience of extramucosal laparoscopic esophagocardiomyotomy performance in 12 patients for achalasia of cardia was summarized. There were presented main technical stages of the operation, indications, early and immediate results of its application as well.