[Acute pancreatitis (protocols of diagnosis and treatment)].

Protocols of diagnosis and treatment of acute pancreatitis are presented. Definition based on pathogenesis of the disease is given. Phases of acute pancreatitis, features of diagnosis and treatment in each phase are analyzed. Terms of surgical treatment, main principles of postoperative treatment are discussed.

[Prevention of traumatic pancreatitis in injuries of the pancreas]. / Profilaktika travmaticheskogo pankreatita pri povrezhdenii podzheludochnoi zhelezy.

Based on the investigation of results of the treatment of more than 200 patients with various injuries of the pancreas recommendations are given for the prophylactics of traumatic pancreatitis. A combination of different surgical measures on the pancreas and other organs are recommended as well as a purposeful medicamental treatment.

[Acute diseases of the gallbladder and pancreas in patients with severe trauma and shock (characteristics of the diagnosis and treatment)]. / Ostrye zabolevaniia zhelchnogo puzyria i podzheludochnoi zhelezy u postradavshikh s tiazheloi travmoi i shokom (osobennosti diagnostiki i lecheniia).

Under study were 56 observations of posttraumatic cholecystitis and pancreatitis in patients with polytrauma without a direct injury of the gallbladder and pancreas. Diagnostics of posttraumatic cholecystitis and pancreatitis is based on data of laparoscopic and ultrasonic examinations. Treatment of acute cholecystitis in the postshock period of trauma disease is operation, while treatment of posttraumatic pancreatitis must be started with intensive therapy.

[Enzymatic pancreatogenic omental bursitis]. / Fermentativnyi pankreatogennyi omentobursit.

The most common causes of omental sac collections (OSC) are necrotic pancreatitis (90%) and pancreatic trauma (10%). Acute OSC is a form of local peritonitis in acute pancreatitis, subacute OSC are caused by internal pancreatic fistulas. The clinical and radiological signs, enzymatic activity of the exudate, morphological features of peritonitis were investigated. Treatment of acute OSC included conservative measures, of subacute OSC-surgical procedures.

[Patterns in the development of suppurative complications in acute destructive pancreatitis and the means for their prevention]. / Zakonomernosti razvitiia gnoinykh oslozhnenii ostrogo destruktivnogo pankreatita i puti ikh profilaktiki.

Under analysis were the results of conservative and operative treatment of 391 patients. It was shown that purulent complications were more frequent in postoperative and ischemic pancreatitis. Intensive treatment of the enzymatic phase of the disease and reactive phase of severe forms can substantially decrease the frequency of purulent complications and lethality.

[Acute pancreatitis after intraductal occlusion of the pancreas]. / Ostryi pankreatit posle vnutriprotokovoi okkliuzii podzheludochnoi zhelezy.

The clinical and experimental material has shown that curative intraductal occlusion of the pancreas is followed by the development of acute pancreatitis of different degree depending on the viscosity of the polymer mixture used, degree of filling the duct system of the gland, stimulation of the pancreas secretion and other factors. The curative occlusion should be accompanied by a complex of prophylactic measures.

[The concept of abruption of pancreatic necrosis--key to the solution of the problem of destructive pancreatitis]. / Kontseptsiia "obryva" pankreonekroza--kliuch k resheniiu problemy destruktivnogo pankreatita.

The main criterion of severity of acute destructive pancreatitis (ADP) is the volume of pancreatonecrosis formed during the first 24 hours of the disease. A prognostic system is developed allowing to urgently detect the "risk group"--patients with the developing massive pancreatonecrosis by means of the assessment of clinical criteria. In the process of intensive therapy of the "risk group" patients there occurs arresting, "abruption" of the destructive process which greatly improves the results of treatment (the frequency of purulent complications decreases from 32% to 14%, lethality from 45% to 19%). Different methods of "abrupting" therapy are described, the best of them is a combination of curative plasmapheresis with the intraaortal perfusion of the splanchnic area with antienzymes, antihypoxants and antithrombotics. In the group of 17 patients with severe ADP treated by the method described suppuration was noted in 1 (6%) patient, and no lethal outcomes. The pressing problem is to increase the number of patients with severe ODP treated by the method of "abrupting" therapy as early as possible which can be achieved with the help of early hospitalization, with using prognostic systems and creation of a network of specialized pancreatological clinics with the corresponding equipment.

[Pancreatitis predominantly affecting the caudal part of the pancreas]. / Pankreatit s preimushchestvennym porazheniem khvostovogo otdela podzheludochnoi zhelezy.

The characteristics of specific features of acute and chronic processes in the caudal pancreatis and surrounding retroperitoneal fat is given on the basis of an analysis of 273 cases of pancreatitis with the predominant lesion of this portion. It was established that acute caudal pancreonecrosis at an early period had atypical symptoms and more favourable course than that of the proximal parts of the pancreas. Later periods of the development of this variant of the disease are characterized by great frequency and spread of pyo-necrotic lesion of the retroperitoneal fat. Specific features of the clinical course, diagnosis and treatment were formulated and their being taken into account allowed to reduce lethality of patients with caudal pancreatitis from 39.0% to 25.0%.

[Comparative characteristics of octreotide and famotidine in the treatment of acute pancreatitis]. / Sravnitel'naia kharakteristika oktreotida i famotidina pri lechenii ostrogo pankreatita.

Antisecretory therapy is an important and integral component of complex therapy of acute pancreatitis. The clinical estimation of efficiency of various antisecterory preparations, sandostatin and famotidin (quamatel) was made in treatment of acute pancreatitis at an early stage of the disease. The results of the research have shown that the efficiency of sandostatin and famotidin (quamatel) in treatment of not severe (mild and medium) forms of acute pancreatitis is approximately identical. But the application of famotidin (quamatel) is economically more favorable (8.3 times cheaper than sandostatin). In treatment of severe acute pancreatitis of paramount importance are the terms of the beginning of antisecretory therapy, the optimum term being the first day of the disease. The preparation of choice is sandostatin, the preparation of reserve--famotidin (quamotel). The duration of a medical course of treatment is the first three days from the beginning of the disease. The application of antisecretory preparations in question is less effective when used in later terms.

[Characteristics of the local pathological changes in acute pancreatitis and therapeutic procedural problems]. / Osobennosti mestnykh patologicheksikh izmenii pri ostrom pankreatite i nekotorye voprosy lechebnoi taktiki.

On the basis of great clinical material (804 patients with pancreatonecrosis) the authors give clinico-morphological characteristics of main components of local pathological changes connected with acute pancreatitis. Debatable questions of the curative methods are described. More exact indications for early surgical interventions are considered in detail.

[Traumatic suppurative-necrotic pancreatitis]. / Travmaticheskii gnoino-nekroticheskii pankreatit.

Among 105 patients with traumatic pancreatitis there were 32 patients with pyo-necrotic pancreatitis. The diagnosis and treatment of pyo-necrotic pancreatitis are described.

[2-Component silicone compounds in the emergency surgery of gastrointestinal hemorrhages]. / Dvukhkomponentnye silikonovye kompozitsii v neotlozhnoi khirurgii zheludochno-kishechnykh krovotechenii.

Based upon their clinico-experimental investigations the authors prove advantages of the two-component silicon compositions over oil preparations for the arrest of gastro-intestinal bleedings. Such compositions are recommended for patients whose treatment by traditional methods of hemostasis proved to be ineffective due to some causes which is often observed in elderly and senile patients.

[Minimally invasive technologies in the treatment of severe forms of acute pancreatitis at various periods of the disease]. / Maloinvazivnye tekhnologii v lechenii tiazhelykh form ostrogo pankreatita v razlichnye periody zabolevaniia.

The choice of the optimum technique of the sanitation procedure in treatment of acute necrotizing pancreatitis (ANP) is now one of the most disputable problems. Clinical estimation of the efficiency of various operative techniques of treatment of ANP at various stages of disease has been made. In the aseptic phase laparoscopic decompression of the pancreas is indicated when the patient has evident hemorrhagic parapancreatitis. In the phase of septic sequestration of ANP the optimum method of minimally invasive surgical intervention is considered to be minilaparotomy which is expedient for abscesses of small volume, lipid abscesses of any volume with the minimal content of necrotizing tissues as the first step of sanitation in critical patient. High quantity of the necrotizing tissues in the zone of the destructive focus requires traditional laparotomy of the abscess under conditions of preventive maintenance of the endotoxic shock.