[Results of 300 pancreatic duct stenting in acute pancreatitis]. / Rezul'taty 300 stentirovanii virsungova protoka pri ostrom pankreatite.

OBJECTIVE: To analyze the results of pancreatic duct stenting in moderate and severe forms of pancreatitis. MATERIAL AND METHODS: Pancreatic duct stenting in 300 patients with acute pancreatitis was analyzed. Examination and treatment were carried out in accordance with national clinical guidelines for acute pancreatitis (2015). RESULTS: Pancreatic duct stenting was performed in 300 patients with moderate and severe forms of pancreatitis (according to APACHE II) in the first 8-72 hours after the onset of the disease. Plastic stent sizes range from 4 to 7 cm in length and 5 to 7 Fr in diameter. Infection with pancreonecrosis occurred in 22 (7.3%) of 300 patients in the main group, and 20% of 150 patients in the control group. Mortality was 16 (5.3%) in the main group, and 24 (16%) - in the control group. CONCLUSIONS: Pancreatic stenting reduced infection by 3, 2 times, and mortality by 4 times. The dosage of Octreotide was personalized depending on the severity of the disease according to APACHE II.

[New possibilities in antibacterial treatment of intra-abdominal infections caused by multiresistant microflora]. / Novye vozmozhnosti antibakterial'noi terapii intraabdominal'nykh infektsii, vyzvannykh polirezistentnoi mikrobnoi floroi.

AIM: To determine the place of new drugs with activity against multidrug resistant strains of microorganisms in the treatment of complicated intraabdominal infections. MATERIAL AND METHODS: The incidence and distribution of pathogens isolated from intra-abdominal specimens in patients with intra-abdominal infections are analyzed. RESULTS: The current situation on the growth of resistant strains among pathogens causing intra-abdominal infections is rewied. New combined drugs for the treatment of multidrug resistant infections - ceftolozane/tazobactam and ceftazidim/avibactam plus metronidazole, has been suggested. Their potential role in empiric and targeted antibacterial treatment of complicated intraabdominal infections is defined. CONCLUSION: Taking into consideration local monitoring data and risk factors of multi resistant strains Ceftolozane/tazobactam in combination with metronidazole can be used in empiric regime of treatment. Due to the high activity on carbapenem resistant strains of Klebsiella pneumonia and the lack of alternatives, it is advisable to use Ceftazidim/avibactam for the targeted therapy.

[Compression anastomoses with nikelid-titanium rings in peritonitis]. / Kompressionnye anastomozy nikelid-titanovymi kol'tsami pri peritonite.

AIM: To introduce into clinical practice compression anastomosis with nikelid-titanium rings (NTR) with shape memory in advanced peritonitis patients who need for intestinal resections. MATERIAL AND METHODS: Seventy-six procedures of interintestinal anastomoses with NTR (Günter-Ziganshin implant) have been analyzed for the period 2011-2017. Interventions were carried out for widespread peritonitis. In all cases a unified technique of anastomosis was used by applying an implant in the form of a 'clerical clip'. There were following procedures: gastroenterostomy resection for its failure - 5; small intestine resection followed by interntestinal anastomosis - 36; ileotransverso- or colocolostomy - 35. RESULTS: Mean time of enteroenterostomy was 2.6±0.98 min. If elective re-laparomy was supposed, laparostomy was formed followed by sanation within 48 hours. In 55% of patients 3-5-fold elective sanations were performed. Adequacy of compression anastomoses was assessed clinically according to the nature of drainage output and visually during redo surgery. There were 11 (14.5%) deaths: 9 (12%) patients had APACHE-II score over 20. Macro- and microscopic analysis of intestinal specimens and interintestinal anastomoses with nikelid-titanium rings showed complete impermeability and no visual defects. Microscopically neutrophilic leukocyte infiltration and increased number of fibroblasts were observed as the evidence of regenerative processes activation. Implant rejection time was 7.8±1.4 days. CONCLUSION: The use of compression anastomoses in case of advanced peritonitis reduces the risk of anastomosis failure to 3% and decreases time of surgery that reduces intraoperative aggression and improves outcomes in patients with prognostically unfavorable outcomes.

[Radiofrequency ablation in comprehensive surgical treatment of patients with varicose veins of lower limbs]. / Radiochastotnaia obliteratsiia v kompleksnom khirurgicheskom lechenii bol'nykh s varikoznoi bolezn'iu nizhnikh konechnostei.

Analysed herein are the results of using radiofrequency ablation (RFA) in comprehensive surgical treatment of patients presenting with varicose veins of the lower extremities. The study included a series of ninety-eight 28-to-60-year-old patients (with a total of 105 operations performed) suffering from varicose veins of the lower limbs. Of these, there were 10 men (10.3%) and 88 women (89.7%). Venous disease of clinical class C2 according to the CEAP classification was diagnosed in 80 patients, that of class C3 in 17, and that of class C4a in 1 patient. The procedure of RFA was performed by means of the VNUS device model RF62. The impact was exerted in an automatic mode, maintaining the catheter's temperature at 120° C during a 20-second treatment cycle for each 7 cm of the vein's length. In all cases, each 7-cm-long venous segment to be treated was acted upon 4 times. Forty-five patients after RFA underwent ultrasonographic monitoring performed first on POD 7 and then at 3, 6, 12 and 24 months. Recanalization of the trunk of the great saphenous vein (GSV) was registered in 3 (2.8%) cases at terms up to 3 months after the operation. In 2 cases recanalization turned out to be provoked by an incompetent perforant vein in the lower third of the femur. Seven (6.6%) patients with a large diameter of the great saphenous vein were found to develop post-closure hyperpigmentation which resolved spontaneously 8 months later. The remaining patients, with strict adherence to the indications for RFA, demonstrated complete obliteration of the vessel treated, with no recanalization observed ultrasonographically 10-12 months after the procedure. An additional experimental study with a morphological analysis confirmed appropriateness of carrying out four 20-second treatment cycles of RFA in each segment of the vein. A conclusion was made that RFA used in comprehensive surgical treatment for varicose veins of the lower limbs makes it possible to attain good therapeutic and cosmetic results that persist over time, if conducted in compliance with the mentioned fundamentally essential peculiarities of performing the procedure.

[Principles «cliff¼ pancreatic necrosis in a first-aid hospital]. / Printsipy «obryva¼ pankreonekroza v skoropomoshchnoi bol'nitse.

INTRODUCTION: Pancreatic necrosis - acute surgical disease accompanying high rates of mortality and complications. MATERIAL AND METHODS: The analysis of the treatment of 256 patients with pancreatic necrosis moderate and severe degrees. In the control group was conducted basic therapy, the main (n=158), which further were administered high doses of octreotide and endoscopic stenting of the main pancreatic duct to decrease the intraductal pressure, prevention and treatment of internal pancreatic fistula. RESULTS AND DISCUSSION: In the main group in contrast to the control is marked by a more rapid decline in the level of amylase, lipase and leukocyte index of intoxication. The infection occurred in the basic - 11%, control 20% died in the study group - 3%, control - 9%.

[Analysis of the clinical application of epidermal growth factor ("Heberprot-P") and bioplastic material ("Collost") in treatment of skin and soft tissues defects in patients with diabetic foot syndrome].

RELEVANCE: Currently, there is increasing the number of diabetic foot patients with tissues defects. The local treatment of this pathology against the backdrop of diabetic angiopathy and polyneuropathy is a topical issue. AIM: Treatment of wound defects in patients with neuroischemic form of diabetic foot syndrome; study of the effectiveness of collagen implants and gene-therapy technologies in wound closure. MATERIAL AND METHODS: The comparative study was conducted for analyzing clinical effects of "Heberprot-P" and bioplastic material "Collost" on wound healing process in patients with verified diagnosis "diabetic foot syndrome" on the base of City Clinical Hospital №81(Moscow) and "Diabetic Foot" center (Kazan). RESULTS: The article shows the availability, methodology, results of combination treatment of wound defects of lower limbs in DFS patients with gen-therapy methods and bioplastic materials based on native type I collagen. CONCLUSION: The use of bioplastic materials based on native type I collagen for treatment of tissue defects in patients with diabetic foot is preferably than the use of epidermal growth factor.

[Role of correction of the syndrome of intestinal failure and abdominal hypertension in the prevention of infection of pancreatic necrosis]. / Rol' korrektsii sindromov kishechnoi nedostatochnosti i vnutribryushnoi gipertenzii v profilaktike infitsirovaniya pankreonekroza.

UNLABELLED: The number of patients with acute pancreatitis and pancreatic necrosis has been steadily increasing. Mortality in infected pancreatic necrosis remains high. AIM: To develop measures to prevent infection of pancreatic necrosis by timely correction of intra-abdominal hypertension and the syndrome of intestinal failure. MATERIAL AND METHODS: Developed a package of measures, consisting of early intestinal lavage and enterosorption, intravenous highdoses of octreotide, epidural blockade, adequate detox and the start of effective antimicrobial therapy. Comparative evaluation of clinical, laboratory and instrumental data in the primary (n=50) and control (n=50) groups. RESULTS: In the main group pancreatogenic sepsis occurred in 10%, control 18%. Mortality, respectively, was 8 and 16%.

[Metabolic therapy with Actovegin in case of ischemic syndrome of limbs].

Actovegin was used in complex conservative and surgical treatment of lower limb chronic ischemia and diabetic foot syndrome in 200 patients. In 120 patients Actovegin was used in combination with reconstructive operations, angioplasty and stenting for preparation for surgery. In 80 patients Actovegin was used as independent method of treatment. In severe cases the medicine was injected intravenously 1000-2000 mg №10-15, and in mild degrees (IIA-IIB) - 400-800 mg intramuscularly with conversion on the tablet form in the future. Clinical picture, dopplerographic and microcirculatory data evidence about absolute safety, efficiency and comparative cheapness of the parenteral and enteral forms of Actovegine.

[The prophylaxis and treatment of renal dysfunction by pancreatogenic endotoxicosis].

The treatment of 386 patients with the acute pancreatitis of various etiology was analyzed. Renal dysfunction was revealed in 243 (63%) of them. The prognostic factors of renal dysfunction were carried out. The timely application of the treatment scheme, including early extracorporal detoxification, permit the significant improvement of the treatment results of the acute pancreatitis.

[Modern aspects of surgical treatment of combined gallstone disease and multifocal atherosclerosis aorta and its branches].

Lipidic metabolism infringements in the organism according with pathology of hepatocyts generates plural associated diseases. On prevalence and weight of metabolic damages the first place occupy cholelithiasis and atherosclerosis. Results of treatment of 752 patients with an atherosclerosis and cholelithiasis after surgical intervention was analysed. Basing on studying pathophysiological shifts at simultaneous cholelithiasis and atherosclerosis the algorithm of examination and tactics of the surgical treatment (simultaneouse or stage operations) are optimised, criteria for application of miniaccesses operations are specified.

[Prevention and treatment of hepatorenal syndrome by acute intestinal obstruction].

Results of treatment were analyzed in 358 patients with acute bowel obstruction resulted from a variety of causes. Algorithm for control of liver and renal function disturbances in dynamics was estimated basing on the markers for hepatorenal failure. It is shown that differentiated approach to extracorporal detoxification combined with enterosorbtion and complex therapy allows preventing hepatorenal failure and decreasing lethality and terms of hospitalization.

[Outcomes of reconstructive operations in gerontological patients with diabetic foot syndrome].

The authors share herein their experience in treating a total of two hundred and forty-six patients presenting with an ischaemic form of diabetic foot syndrome on the background of secondary to occlusion ofmajor arteries. The patients'average age amounted to 74 years. According to the findings of ultrasonographic angioscanning and radiopaque aorto- arteriography, 62.3 % of the patients were diagnosed as having bilateral lesions of the arterial bed and only 37.7 % of the patients had lesions of the major vessels on one side. Reconstructive operations on the aortoiliac-femoral zone were performed in sixty-nine (28 %) patients, distal reconstruction in one hundred and twenty-seven (52 %) patients, multi-storey reconstructions in eighteen (7 %), and prolundoplasty in thirty-two (13 %) patients. Direct revascularization of lower extremities made it possible to save the supporting foot in 89 % of the patients undergoing proximal reconstructions and in 83 % of the patients subjected to distal reconstructions, as well as to decrease the rate of high amputations to 11 %.

[Cholelitiasis and age: tactic of surgical treatment].

MATERIAL AND METHODS: We examined the resultants of treatment of 268 old patients. RESULTATES: The global demographic transition to an older population effects developing as well as developed coutries. Cganges in mitochondria with age, in body composition, in biliary tract gives to start for many diseases such as cholelitiasis. It has recommended the special surgic tactict of treatment such situations.

[Role of reconstructive vascular surgery in patients with diabetic angiopathy].

Treatment results were analyzed in 1244 patients with diabetic angiopathy. 882 of them had necrotic suppurative affection of feet. Distal affection predominated among patients with neuroischemic form of diabetic foot syndrome. Combined affection of popliteofemoral and tibial-foot segments was revealed in 46.3% of observations. Stenosis of ileofemoral arterial segment was discovered in 40 (4.9%) patients, occlusion--in 27 (3.3%) patients. Reconstructive operations on aorta and great vessels were carried out to 520 patients; among them: aorto-femoral bifurcational bypass--to 38 patients, proximal popliteofemoral bypass--to 191 patients, distal popliteofemoral bypass--to 195 patients, tibiofemoral bypass--to 96 patients. Thrombosis in reconstruction region was observed in 41% of patients after popliteofemoral bypass including 16% in short-term period and 25% after a year. Low frequency of large amputations amounting 20.4% and low lethality (3.2%) indicated that bypass operations are highly effective in this group of patients.

[Distal reconstructions under critical lower limb ischemia in elderly patients].

Performong reconstructive operations on arteriae is the only way to avoid limb amputation in patients with critical limb ischemia. Whereas reconstructive manipulations on distal arteriae, especially in patients older then 75 years, are often entailed by thrombotic complications. High peripheric vessel resistance is considered to be the crucial factor of the bypass thrombosis. The conducted study demonstrated the efficacy of the use of vena saphena magna collateral tributaries as bypass unload collectors. Femoral distal autovenous in situ reconstruction decreases vessel resistance. Due to the arterial reconstruction with bypass unload using unligated autovenous tributaries the cumulative bypass patency was 75,1% a year after the procedure. 5-year cumulative bypass patency was 53,8%. 5 - year lethality was 28,6%.

[Correction of protein-energy metabolism in hepatorenal failure in surgical patients].

Infringements of a protein-energetic metabolism in hepatorenal complications are an actual problem in urgent surgery. 358 patients with a acute surgical pathology of intestines were analyzed, in 27.4% of patients infringements of functions of a liver and kidneys were revealed, necessity for normalization of the protein-energetic metabolism was noted in 47-70% of cases. As a result the scheme for protein-energetic metabolism correction was specified in depending of a kind of intestinal impassability and a degree of severity of surgical disease. The early correction of a protein-energetic metabolism in complex with the extracorporeal support methods of a detoxication has provided the expressed positive clinical effect.

[Hepato-renal syndrome and problem of protein-energy metabolism correction during urgent surgery of the abdominal organs].

Early connecting of hardware detoxification methods allow more efficient use of amino acid preparations for action. The use of efferent technology provides a full correction of protein and energy metabolism in the immediate surgical patients with complicated diseases of the abdominal cavity. This will reduce bed-day in patient and surgical mortality.

[Diagnostic and management algorithm of acute pancreatitis].

The analysis of diagnostics and treatment of 602 patients with destructive pancreatitis has shown that definition of etiological and pathogenetic forms of pancreatitis defines strategy of treatment. In this way, patients with biliary pancreatitis require emergency operative treatment with use of endoscopic interventions without dependence from a stage of disease. To patients with alcoholic or alimentary pancreatitis in the stage of enzymatic toxemia conservative treatment should be spent only, until shock and/or delirium won't be reduced. Endoscopic retrograde cholangiopancreatography + endoscopic papillosphincterotomy with concrement removal from common bile duct--is the operation of choice in case of acute biliary pancreatitis at the first stage. Laparoscopic cholecystectomy is the operation of choice at the second stage of disease. At destructive pancreatitis of other origin in a stage of the infection or necrotic suppurative inflammation use of open and closed small invasive methods of intervention is most proved. Given tactics of treatment has allowed to lower severity of clinical course, frequency of complications and lethality.