METHOD OF OPERATIVE TREATMENT OF POSTNECROTIC CYSTS OF THE PANCREAS.

An analysis of treatment results was made in 26 patients with postnecrotic cysts of different degree of maturity. The laparotomy with trans-gastral cystogastrostomy on the external drainage were performed on 11 patients. A new modified operation underwent 15 patients. This operation was transgastric cystogastrostomy on the external drainage from mini-access, which was developed in 2011. The laparotomy of 4­5 cm was made in pseudocyst projection of the pancreas using a standard set of tools «mini-assistant¼. Postoperative period have passed without complications in all the patients. The drainage was removed on 30­40 days of postoperative period. The terms of hospital stay reduced from (14,4±0,9) bed/ days to (10,8±0,5) bed/days due to application of proposed method of treatment.

[Atrial fibrillation and condition of vegetative nervous system: features of tactics and medical aid rendering at the pre-hospital stage].

Comparative retrospective study of emergency action results for 1051 patients with atrial fibrillation attacks and their management tactics assessment at a pre-hospital stage was done. It was found that occurrence of an attack of atrial fibrillation at a pre-hospital stage is accompanied expressed vegetative imbalance. Antiarrhythmic therapy using diazepam for atrial fibrillation promotes fast decrease of sympathicotonia at a pre-hospital stage and improves treatment efficacy in the first hour of observation of patients.

[Clinical management of disorders hemostasis-related with obstetric complications].

BACKGROUND: The aim of the study was the reduction of adverse pregnancy outcomes in women with gestational and genetically determined changes in the hemostatic system. PATIENTS AND METHODS: The study group comprised 98 patients with obstetric complications on the background of changes in the parameters of coagulation screening. In 63 pregnant women, hemostatic disorders were not corrected, in 35 patients medical tactic defined clinical situation and the results of laboratory and instrumental studies of the hemostatic system. RESULTS: Hereditary thrombophilia detected in 85% of patients with obstetric complications. Carriage of the rare allele of MTHFR-677 2-fold increased risk of adverse pregnancy outcomes; heterozygous carriers of polymorphism PAI-1 - 1.5 times more. The prognostic parameters thrombelastographic (sensitivity 80%, specificity 82%) were higher than in laboratory tests. To determine the most predictive of adverse pregnancy outcome has a density of fibrin clot--the maximum amplitude. CONCLUSIONS: In women with obstetric complications associated with disturbances in the hemostatic system, medical diagnostic tactics using c thrombelastographic evaluates all stages of coagulation and fibrinolysis, allows you to select a reasonable pathogenetic anticoagulant therapy and reduce the number of adverse pregnancy outcomes.

[Clinical effects of packed red blood cells transfusion according to storage life and time of transfusion].

It was studied 66 males aged 39.5±5.3 years with hemorrhagic shock II degree. Gas composition of arterial and venous blood was studied twice (before and after transfusion). It was revealed that succinct transfusion of packed red blood cells (to 2 doses) with storage life to 3 days after bleeding stop and hypovolemia filling is the most effective correction of hemorrhagic shock II degree. Replacement therapy in operating room in condition of stopped bleeding and unrepaired hypovolemia is burdening factor because it does not conducive to transfer of oxygen at the tissue level and inhibits stimulation of bone marrow in response to hypoxia.

[Iron metabolism and its role in traumatic disease].

The article reviews recent studies of iron exchange and its role in a traumatic disease and traumatic shock. The review stresses a relationship of iron metabolism disturbance with free radical oxidation, lipid peroxidation and multiple organ dysfunctions. The article deals with data of unbound iron collect mechanisms, ways of endotoxemia activation, haemostasis and haemodynamics disturbance proving the role of iron in a multiple organ dysfunctions during traumatic disease.

[Problem of intraoperative hemotransfusion].

MATERIALS AND METHODS: We studied 66 patients (males aged 39.5 +/- 5.3) with hemorrhagic shock II. Gas composition of arterial and venous blood and a detailed analysis of the blood were studied twice (before and after hemotransfusion). RESULTS: We found that a low-volume (up to 2 doses) transfusion of erythrocyte mass with terms of storage up to 3 days, held after bleeding stop and hypovolemia correction, is the most effective treatment for hemorrhagic shock II. CONCLUSIONS: Substitution therapy in operating room does not contribute oxygen transfering in tissues and inhibits stimulation of the bone marrow due to hypoxia. Thus the substitution therapy is an aggravating factor when the bleeding stopped, but hypovolemia not eliminated.

[Influence of heptral on the functional-metabolic indices of the liver of rats with necrotizing pancreatitis].

The purpose of the work - to study disorders of the liver with pancreatic necrosis and try to reduce them by hepatoprotector ademetionine. Experiments were conducted on 29 inbred male rats. In animals, the study group and comparison group simulated pancreatic necrosis. Animal control group 5 minutes after the simulation pancreonecrosis ademetionine injected in a dose 11.4 mg/kg. The parameters of intensity of free radical oxidation, endotoxemia, cytolysis in the liver, pancreas and blood of the portal and hepatic veins. The study found that pancreatic necrosis accompanied by the development of liver failure, and hepatoprotector ademetionine not only protects the liver, but also the pancreas, reducing their functional and metabolic disorders.

[The participation of matrix metalloproteinases-9 and TIMP-1 in formation of atrial fibrillation paroxisms in patients with metabolic syndrome].

The aim of this study was to estimate the role of matrix metalloproteinases activity (MMP-9, TIMP-1) and gene polymorphism at the patients with metabolic syndrome in combination with paroxysmal form of atrial fibrillation. The 60 patients with metabolic syndrome in combination with paroxysmal form of atrial fibrillation were investigated with estimation of serum levels of MMP-9, TIMP-1 and mutation of genes of angiotenzinogen 1 Thr 174 Met, angiotenzinogen 2 Met 235 Thr and apolipoprorein C3 C3238 G. In patients with metabolic syndrome in combination with paroxysmal form of atrial fibrillation the significant increase synthesis of MMP-9 level can lead to increase of atrial fibrillation paroxysms because of increase synthesis of collagen tissue in myocard and vessel walls. Also the significant high incidence of angiotenzinogen 2 Met 235 Thr mutation was established.

[The clinical significance of matrix metalloproteases in heart and vascular pathology].

The matrix metalloproteases are the big family of endopeptidases that takes part in degradation of extracellular matrix. The investigation of clinical significance of matrix metalloproteases in heart and vascular pathology can organize the pathogenetic treatment of the patients with heart and vascular diseases.

[Immune disturbances in patients with postnecrotic pseudocysts of the pancreas].

The aim of the study was to investigate the role of immune disturbances in development of postnecrotic pseudocysts of the pancreas. 94 patients including 74 with postnecrotic pancreatitis and pseudocysts of the pancreas were observed. The adaptive reactions and subpopulation composition of the peripheral blood lymphocytes were assayed. The percentage of the cells in the state of apoptosis in the cyst content was estimated. The disturbances in the subpopulation composition of the lymphocytes and stress adaptive reactions of the blood system were shown to be some of the main pathogenetic factors in development of postnecrotic complications of pancreatitis. The data are useful in differential diagnosis of pseudocysts and choice of the optimal tactics in the operative treatment of such patients.

[Hemodynamic disorders and myocrdial insufficiency after toxic doses of propranolol].

Results of an experimental study of the toxic action of propranolol on the cardiovascular system are presented. It was shown that i/p injections of propranolol (2 mg/100 g) cause circulatory insufficiency, activate free radical oxidation, and induce cardiac dysfunction.

[Effects of immunocorrective therapy on immunological indices in patients with chronic bacterial prostatitis].

A total of 57 patients with chronic bacterial prostatitis were divided into two groups. The control group (n = 28) received standard treatment, the study group (n = 29) received treatment including immunomodulator likopid. The tests for IgA, IgM, IgG, compliment components C3, C4, circulating immune complexes were made, immunophenotyping of peripheral blood lymphocytes was performed, chemiluminescence parameters of whole blood and plasma, content of IL-10, TNF-alpha, IL-lbeta in seminal fluid were assessed. The detected abnormalities in parameters of systemic and mucose-associated immunity give ground for inclusion of immunomodulators in combined treatment of patients with chronic bacterial prostatitis.

[Study of pathogenesis of Anaprilin toxicological influence in analysis of central hemodynamic indices and myocardial contractility of isolated heart in experiment].

Anaprilin under one-shot intraperitoneal introduction to dose 1 and 2 milligrams to 100 grams of animal's body weight causes depending on dose of the change system hemodynamic, myocardial contractility and biochemical factors shelters rats. Anaprilin under one-shot introduction to dose 2 miligrams to 100 grams of animal's body weight change myocardial contractility of isolated heart which were force evidented in the conditions of hypercalcium perfusion and reperfusion.

[Systemic inflammation complication of acute coronary syndrome with diabetes mellitua type 2].

The basic indicators of systemic inflammatory reaction syndrome, as well as the dynamics of the content of low and medium molecular weight glycopeptides and in biological media in patients with acute coronary syndrome. Analysis of the results showed that the presence of background type 2 diabetes mellitus in patients with acute coronary syndrome is associated with higher non-infective resorbtion of necrotic syndrome. This is the rationale for inclusion in the complex intensive therapy of more active desintocsication activities and metabolically significant effects on myocarde and for type 2 diabetes with acute coronary syndrome.

[Efficacy of ivabradine in combination therapy for complicated acute coronary syndrome in patients with type 2 diabetes mellitus].

AIM: To study the effect of ivabradine (coraxan, Servier) as part of combination therapy on the clinical manifestations of acute left ventricular failure (ALVF) in Braunwald class II-IIIB unstable angina in patients with type 2 diabetes mellitus (T2DM). SUBJECTS AND METHODS: Thirty-six T2DM patients (mean age 56 + 4.3 years) with a diagnosis of acute coronary syndrome were examined. Eighteen healthy individuals were examined as an age- and gender-matched control group. Metabolic, hemodynamic, and electrophysiological parameters were studied in all the patients on hospital stay days I and S. RESULTS: Ivabradine used in combination therapy for unstable angina caused reductions in the clinical manifestations of ALVF, heart rate, the number of myocardial ischemic episodes. In the ivabradine-treated patients, left ventricular ejection fraction showed a significant trend for increase. No adverse reactions were recorded. CONCLUSION: Ivabradine therapy demonstrated antiischemic and antianginal efficiencies and a good tolerability, without leading to the development of tolerance and without being followed by the development of the withdrawal syndrome.

[The matrix metalloproteinase 9 (MMP-9) and TIMP-1 activities in patients with chronic and recurrent pancreatitis].

UNLABELLED: The aim of study was to estimate the role of metalloproteinases 9 and TIMP-1 in the pathogenesis of chronic recurrent pancreatitis. MATERIALS AND METHODS: The 63 patients with chronic recurrent pancreatitis were investigated with estimation of serum levels of MMP-9, TIMP-1, TNO-alpha and IL-1beta. RESULTS: In patients with chronic recurrent pancreatitis the increase synthesis of proinflammatory cytokines and metalloproteinase 9 was estimated with a strong correlation between TNO-alpha and MMP-9 (r = 0.87, p = 0.001), and IL-1beta and MMP-9 (r = 0.81, p = 0.001). CONCLUSION: In aggravation mechanisms of chronic recurrent pancreatitis take part the increase synthesis of MMP-9 after TNOalpha and IL-1beta activation. Addition to therapy of pancreatitis the Mexidol helps to decrease MMP-9 level and to increase the synthesis of MMP-9 antagonist - TIMP-1.

Experimental model of heart contusion.

The proposed experimental model reproduces the mechanism of isolated contusion of the heart resultant from the chest stroke against the steering wheel prop in a car accident. The conditions of experiment rule out the additional pathogenetic factors occurring in clinical practice (extracardiac injuries, alcohol intoxication, blood loss, pain, etc.) and hence, it is possible to study the mechanisms of developing myocardial dysfunction proper and its contribution to the course and outcome of the posttraumatic period. Clinical, hemodynamic, and pathomorphological equivalents of this kind of blunt injury of the heart were obtained.

[Preventive strategy for atrial fibrillation in arterial hypertension].

The aim of the study was to evaluate effectiveness and safety of angiotensin II receptor blockers and inhibitors of angiotensin-converting enzyme (ECE) for protective therapy following medicamentous cardioversion with propafen at a loading dose of 600 mg in patients with paroxysmal atrial fibrillation and arterial hypertension. 101 patients were divided in 2 groups. Group 1 included 75 patients who received ACE inhibitor lisinopril (10 mg BID) after recovery of sinus rhythm by propanorm. 26 patients of group 2 were treated with angiotensin II receptor blocker candesartan (8 mg daily). Combined treatment with angiotensin II receptor blocker and propafenone leads to cardioversion faster than therapy with ACR inhibitor. It is concluded that alternative approach to the maintenance of sinus rhythm using angiotensin II receptor blockers has advantages over traditional anti-arrhythmic therapy; it is well tolerated by the patients and produced no serious side effects.

[Prophylaxis of acute pancreatitis during resection of the stomach for "difficult" complicated of duodenal ulcers].

The authors have performed 407 resections of the stomach for duodenal ulcers. In 9 cases the major duodenal papilla was found to be involved into the zone of ulcer destruction. It was noted that operations for "difficult" complicated ulcers of the duodenum with the involvement into the zone of destruction of the major duodenal papilla required a delicate surgical strategy directed to minimization of trauma and blockade of the main factors of the development of acute postoperative pancreatitis, the proximal duodenojejunoanastomosis being the operation of choice for "difficult" complicated ulcers of the duodenum.