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.

[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.

[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.

[Critical conditions as a logical and appropriate series of events in iron methabolism disorders (the summary of experimental studies)].

It is revealed that in all models of critical conditions will activate the free-radical oxidation, decreasing the total antioxidant activity, the concentration of transferrin decreases in the serum of the blood, increase of the concentration of ferritin, the theological properties of the blood are violated and the signs of endothelial dysfunction are identified. Pre-entered deferoxamine in the dose of 80 mg/kg reduced the intensity of free-radical oxidation processes, restoring the antioxidant potential, concentration of the transferrin, and a lower level of ferritin, contributed to the normalization of blood theological properties and a reduction of the extent endothelium destruction as a result of the reduction Fe2+ concentration in blood serum.

[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.

[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.

[Changes in coagulation hemostasis in patients after coronary bypass surgery].

Changes in the coagulation link of hemostasis were studied in 37 patients who had undergone coronary bypass surgery using venous and arterial conduits and in 16 healthy individuals of the same age. The recordings of hemostasiograms were examined before and 14 days after surgery. Prior to coronary bypass surgery, the patients with ischemic heart disease were found to have coagulation hemostatic disorders as moderate hyperfibrinogenemia, fibrinolytic suppression, thrombinemia, and elevated D-dimer concentrations. Postoperatively, hypercoagulation substantially increased with suppressed fibrinolysis and decreased anticoagulants in the protein C system. In this connection, it is necessary to longer use anticoagulants in the postoperative period and to thoroughly monitor hemostasiogram recordings after their discontinuance.

[Impact of postoperative early enteral feeding on hemodynamics, oxygen and nutritive status in patients with colonic malignancies concurrent with type 2 diabetes mellitus].

A hundred and one patients (51 males and 50 females) aged 66.2 +/- 5.0 years who had Stages II-III colonic malignancies concurrent with type 2 diabetes mellitus were examined. Two algorithms of postoperative management using the traditional diet and early enteral feeding were comparatively analyzed. The use of an early enteral feeding protocol improves central hemodynamics, oxygen and nutritive status, prevents moderate protein-energy deficiency in the early postoperative period, and reduces the number of complications and deaths in patients with colonic malignancies concurrent with type 2 diabetes mellitus.

[Treatment for urologic polyneoplasia].

An original method of surgical treatment of synchronous primary-multiple bladder and prostate cancer was used in 10 cases. Ureterocutaneostomy with pelvic-iliac lymphodissection appeared to be the simplest means of urine diversion after cysto-prostate-vesiculoectomy, particularly, in apparent concomitant pathology, basal renal insufficiency or blockade. Urine diversion is best assured via ureterosigmorectoanastomosis which is optimal as far as social rehabilitation of the patient is concerned.

[Peculiarities of lower limb varicosity in patients with various levels of functioning of the cardiovascular system].

Presented herein are the findings of examining a total of 66 patients suffering from lower limb varicosity complicated by trophic ulcers, to have been subdivided into 3 groups depending on the vegetative reaction of the cardiovascular system to the orthostatic test. In each patient group, determined were peculiarities of the parameters of the central and peripheral haemodynamics at rest and while performing active orthostasis, as well as peculiarities of the clinical pattern and course of the disease. Based on the obtained findings, the authors revealed a group of patients suffering from trophic ulcers with the severest clinical course of the disease.

[Iron metabolism in biological systems (biochemical, pathophysiological and clinical aspects)].

Modern concepts concerning iron metabolisms in the body, its circulation, involvement into free radical processes and lipid peroxidation (LP) are reviewed. Spetial attention is paid to cytotoxic effects, Fe2+ influence on lipid peroxidation, its role in multiple organ failure development in critical states. Iron ion can be bound by desferal, which may be effectively used for intensive care of critical states.

[Arrest of the chronic pain syndrome using epidural analgesia in patients with disseminated prostate cancer]. / Vozmozhnosti épidural'noi analgesii pri kupirovanii khronicheskogo bolevogo syndroma u bol'nykh disseminirovannym rakom predstatel'noi zhelezy.

Treatments results of 22 cases of atypical generalized and local carcinoma of the prostate involving different cells and tissues and accompanied by persistent neuropathic pain are described in the paper. The method of continuous epidural analgesia by an opioid agonist ((a 2% morphine hydrochloride solution and a local anesthetic) and by a 0.5% anekain solution provides for a smaller single dose of the preparation and for a less number of injections that should be used; it also eliminates the pain stress and improves the life quality of patients.

[Effect of early post-resuscitation endotoxemia on the myocardial function]. / Vliianie rannei postreanimatsionnoi éndotoksemii na funktsiiu miokarda.

The impact made by serum (which was obtained in 30 minutes after resuscitation) on the cardiovascular system was studied in experiments with the total body as well as with isolated and isovolumetrically contracting hearts of white outbred male rats. A 5-minute clinical death was provoked by a severe blood loss. The "toxic" serum, when administered to the intact animals with the macrophage system blocked by trypan blue, was found to reduce the stroke and minute hearts volumes and to increase the general resistance of peripheral vessels. Lower force and velocity indices of the myocardium contractility, a higher consumption of glucose by the heart per a unit of a performed function, disassociation of the oxidation phosphorylation, activation of anaerobic glycolysis and increased discharges of cardiachystiocyte, lactate, pyruvate and of enzymes of different ultrasound localizations were detected in perfusion of the hearts isolated by Krebs-Henzelight solution containing the "toxic" serum.

[Use of plasmapheresis for correction of metabolic disorders in patients with surgical sepsis]. / Ispol'zovanie plazmafereza dlia korrektsii metabolicheskikh narushenii u bol'nykh s khirurgicheskom sepsisom.

Twenty-four patients aged 16-67 years with surgical sepsis developing as a result of pancreonecrosis, gynecological diseases, urological sepsis. closed abdominal injury, and suppurative inflammation of soft tissues were examined. Endotoxemia caused pronounced disorders in metabolism, particularly purine metabolism, and the associated lipid peroxidation processes. Plasmapheresis exerted a positive effect in patients with high concentration of medium molecular-weight polypeptides (more than 0.32 arb. units) in the blood, decreasing the mortality by 40.5%. At lower concentrations of these polypeptides in the blood (less than 0.32 arb. units) plasmapheresis is inefficient.

[Complex prevention of thrombotic complications in patients with colorectal cancer during different stages of surgical treatment]. / Kompleksnaia profilaktika tromboticheskikh oslozhenenii u bol'nykh kolorektal'nym rakom na étapakh khirurgicheskogo lecheniia.

Time course of parameters characterizing vascular platelet and coagulation hemostasis was studied in 83 patients with colorectal cancer before, during, and for 7 days after surgery. Before the intervention the disorders in regulation of the blood aggregate state present as chronic disseminated intravascular coagulation (DIC) syndrome. The intervention induces the development of subacute DIC syndrome. During the postoperative period disorders in hemostasis system manifest by chronic hypercompensated DIC syndrome. Thrombotic complications during the postoperative period were prevented by fraxiparin 2 h before the intervention and then during 5 days of the postoperative period in a daily dose of 7500 units anti-Ca (about 100 units/kg) and verapamil starting from day 1 after surgery in a dose of 0.2-0.3 mg/kg for 3 days.

[The use of sodium gamma-oxybutyrate and gutimine for decreasing metabolic disorders in the heart, caused by exotoxic shock in acetic acid poisoning]. / Primenenie gamm-oksibutirata natriia i gutimina dlia umen'sheniia metabolicheskikh narushenii v serdtse, vyzvannykh ékzotoksicheskim shokom pri otravlenii ukusnoi kislotoi.

Exotoxic shock was simulated in non-linear rat males anesthetized with barbital after intragastric administration of 70% acetic acid at a dose of 4 ml/kg using a gastric tube. Energy metabolism and the rate of lipid peroxidation were studied in heart muscle during the decompensated and terminal periods of exotoxic shock. Sodium hydroxybutyrate (200 mg/kg) and gutimine (75 mg/kg), administered alone within 30 min after the poisoning, prolonged the period before manifestation of the decompensated and terminal steps of the shock; these drugs decreased the rate of metabolic impairments in the myocardium by decreasing the rates of adenine nucleotide catabolism, of glycolysis, lipolysis and lipid peroxidation.

[Total sequestration of the labyrinth]. / Total'naia sekvestratsiia labirintov.

At present total sequestration of the labyrinth in the case of purulent epitympanitis and cholesteatoma is a rare pathology. This paper describes data from the literature and two observations by the present authors. They offer an efficient method for arresting labyrinthectomy-induced liquorrhea by means of a flap of the lip mucous membrane. They maintain that computer tomography combined with traditional tomography is an informative method for diagnosing labyrinth destruction. They assert that continuous destruction of the labyrinth during prolonged pyorrhea and progressive development of cholesteatoma can be stimulated by functional changes of the body, e.g. pregnancy. They also suggest that the vestibular apparatus has high compensatory potentials under the conditions of a complete destruction of the vestibule and semicircular canals as a result of extended inflammation of the middle and internal ear.