[Endoscopic treatment of gastroduodenal perforations]. / Endoskopicheskoe lechenie gastroduodenal'nykh perforatsii.

A 93-year-old patient underwent endoscopic treatment of perforated duodenal ulcer after previous laparoscopic suturing complicated by failure of sutured defect. A self-expanding nitinol stent with partial polyurethane coating was used. Positive effect of the treatment was noted. Further study of this method and its clinical introduction in case of favorable results can significantly reduce the incidence of complications and mortality in patients with perforated gastroduodenal ulcers.

[Blunt abdominal trauma with intestinal damage]. / Zakrytaia travma zhivota s povrezhdeniem kishechnika, izolirovannaia i sochetannaia.

The last decades are characterized by advanced incidence of injuries with the share of abdominal injuries 1.5-18%. Blunt abdominal trauma is characterized by high incidence of complications and mortality due to severity of injury of internal organs and difficult diagnosis. The article presents 3 case reports of isolated and combined abdominal trauma followed by intestinal injury. Patients were treated at the department of emergency surgical gastroenterology of Sklifosovsky Research Institute for Emergency Care in for the period from August 2017 to February 2018.

[Ileocecal intussusceptions]. / Ileotsekal'naia invaginatsiia kishechnika.

AIM: To present treatment of patients with ileocecal intussusception. MATERIAL AND METHODS: There were 3 patients with ileocecal intussusception for the period from June 2016 to August 2017. CONCLUSION: Abdominal sonography is main diagnostic method for intestinal intussusception. X-ray examination including contrast-enhanced irrigography gives more complete information about suspected intussusception. It is necessary to differentiate intestinal intussusception from other diseases accompanied by abdominal pain, vomiting, bloody discharge from rectum, abdominal neoplasm. Minimally invasive laparoscopic approach is advisable for diagnosis and treatment of intestinal intussusception.

[Minimally invasive treatment of rare forms of mechanical intestinal obstruction]. / Miniinvazivnoe lechenie redkikh form obturatsionnoi kishechnoi neprokhodimosti.

AIM: To develop medical algorithms for reduction of morbidity and mortality in rare forms of mechanical intestinal obstruction. MATERIAL AND METHODS: 17 patients with mechanical intestinal obstruction have been operated in Sklifosovsky Research Institute for Emergency Care for the period 2010 - 2016. There were 13 women and 4 men aged 56 (44,5-74,5) years on the average. Phytobezoar was detected in 7 patients (41.2%), tumor in 7 patients (41.2%) and gallstone ileus in 3 patients (17.6%). RESULTS: There were no complications in group 1. In group 2 postoperative complications occurred in 3 patients: gastrocnemius vein thrombosis followed by successful medication (Clavien-Dindo type II), abdominal abscess drained under ultrasonic control (Clavien-Dindo type IIIa) and 1 (8.3%) death (Clavien-Dindo type V). Postoperative mortality in group 2 was 8.3%. CONCLUSION: Despite small sample size and no statistically reliable results the advantages of minimally invasive access are obvious. However, further trials are required to ensure the reliability of the results.

[The difficulties of diagnosis and treatment of non-occlusive mesenteric circulatory disorders].

AIM: To review one of actual problems of emergency surgery - diagnosis and treatment of patients with non-occlusive mesenteric circulatory disorders. MATERIAL AND METHODS: The article presents the clinical observations showing the ambiguity of clinical picture, features and challenges of diagnosis, treatment of disease and opportunities for positive outcomes. Diagnostic methods are x-ray, abdominal ultrasonography according to which acute abdominal ischemia may be assumed. However, in all unclear cases diagnostic videolaparoscopy is mandatory to determine further tactics. Unfortunately diagnostic videolaparoscopy is not always interpreted comprehensively and not a definitive method of diagnosis. Wide surgical access is usually necessary for non-occlusal acute violation of mesenteric circulation and volume of surgery varies from segmental to subtotal intestinal and colic resection with obligatory enteral intubation and decompression. Thus, complex pre- and postoperative treatment is required.

[Biological implants for hernioplasty].

The combined method of hernioplasty with the use of biologic and sunthetic implants has been worked out. 12 patients have been operated on: the "open" technique was used in 5 patients, the rest 7 have been operated on laparoscopically. The use of dura mater as an implant for hernioplasty allows avoiding tissue tension by muscle sheath plasty. By the combined use of the synthetic implant and dura mater plate, the latter assumes the mechanical load, preventing the hernia recurrence. Besides, the dura mater plate isolates the synthetic implant from the abdominal cavity and subcutaneous fat. No postoperative complications or lethal outcomes were registered.

[Abnormalities in stomach and duodenal ulcer immunoregulation].

The effect of the immunity state on the clinical course of stomach ulcer was studied. The study involved 50 patients (38 men and 12 women being 17-67 years old) with stomach ulcer (n = 14) and duodenal ulcer (n = 36) in the acute condition and 25 healthy blood donors. Twenty-seven patients underwent an immunology study. It was revealed that the evident increase of circulatory lymphocyte apoptosis (> 10), which is associated with the depression of their proliferative activity in vitro culture, is recorded with 40.7% of patients (11/27). It was also revealed that a high level of circulatory lymphocyte apoptosis and apoptosis-associated dysfunctions are found more frequently in people with long-term and complicated clinical course.

[Toxicity of mushrooms Paxillus involutus and Paxillus atrotomentosus]. / K voprosu o toksichnosti gribov vida svinushka tonkaia i tolstaia.

Thirty-eight patients with mushroom (Paxillus involutus and Paxillus atrotomentosus) poisoning were treated. Slight poisoning (acute gastroenteritis) was diagnosed in 17 patients, medium-severe in 13, severe in 6, and extremely severe in 2 patients. Changes in the LPO-AOD system correlated with the severity of hepatorenal involvement. The treatment included hepatotropic therapy; patients with acute renal failure were treated by hemodialysis. Paxillus mushrooms induced functional evacuatory disorders in the small intestine. Eleven patients with adhesions in the abdominal cavity developed ileus. Two patients died: a man aged 26 years after eating fried (not boiled) mushrooms and a woman aged 76 years with ileus with symptoms of multiple organ dysfunction. The rest patients were discharged from hospital in satisfactory condition. Clinical course of poisoning with Paxillus mushrooms is discussed.

[Lipid peroxidation and antioxidant system functions in patients with gastroduodenal ulcerous hemorrhages undergoing conservative and surgical treatment]. / Sostoianie perekisnogo okisleniia lipidov i antioksidantnoi sistemy u bol'nykh s gastroduodenal'nymi iazvennymi krovotecheniiami pri konservativnom i operativnom lechenii.

The results of examination of 53 patients have shown that greater intensity of lipid peroxidation and less activity of the antioxidant system of blood are more pronounced in the operated patients. The authors recommend to include antioxidants in the complex of medical measures.

[Postoperative treatment of retroperitoneal fat suppuration in patients with gastrointestinal injuries]. / Posleoperatsionnoe lechenie nagnoenii zabriushinnoi kletchatki u bol'nykh s travmoi zheludochno-kishechnogo trakta.

Early diagnosis of retroperitoneal festering is possible if methodologically strictly carrying out of succession of radiation methods (US, computed tomography, roentgenological examination) is applied and used in complex. Extraperitoneal approach to phlegmon of retroperitoneal cellular tissue provides good visualization and is less traumatic. Infusional and enteral therapy in postoperative period promote effective elimination of volemic disturbances, stabilization of hemodynamic indices, and provides stable curative effect.

[Use of ultravist to examine the gastrointestinal tract in patients with emergency abdominal pathology]. / Ispolzovanie ultravista dlia issledovaniia ZhKT u bolnykh s ékstrennoi abdominalnoi patologiei.

The paper deals with the results of using the nonionic water soluble contrast agents ultravist 300 and ultravist 370 (Schoring, Germany) to examine the gastrointestinal tract (GIT) in 21 patients with acute abdominal abnormality. GIT contrasting was made in 9 patients in the early postoperative period and in 12 patients on their admission to the Institute. The examinations revealed the high contrast rate of the above agent when administered into the stomach and upper small intestine, which excluded failure of gastroenteroanastomic sutures and the sutured gastric wall in 2 patients, established, in terms of gastric displacement and deformity, left-sided subdiaphragmatic abscess, and in terms of transposition of a portion of the gastric fornix into the pleural cavity, rupture of the left diaphragm, and to exclude diaphragmatic rupture with closed abdominal injury. The revealed important quality of ultravist within a short time (1-2 hours) to contrast the small intestine and enter the colon enabled differential diagnosis to be made between complete and partial small intestinal ileus and between early comissural small intestinal ileus and postoperative intestinal paresis. Ultravist contrast studies allowed the authors to avoid an emergency operative intervention and to follow up the resolution of ileus during medical therapy.

[Oxygen transporting function of blood in patients with gastroduodenal hemorrhage in enteral treatment]. / Kislorodtransportnye funktsii krovi u bolnykh s gastroduodenalnymi krovotecheniiami pri énteralnoi korrektsii.

The authors had 32 patients with gastroduodenal hemorrhage of ulcerous etiology under observation. Enteral correction of the blood loss with an electrolyte-monomer solution in such patients increases systemic oxygen transport (SOT) through improvement of central hemodynamics in the posthemorrhagic and postoperative periods. In respect of percentage SOT increased equally both in enteral correction and in the traditional infusion-transfusion therapy, oxygen consumption did not reduce in the periods of examination (1st, 3rd, 7th day). Enteral correction allows the volume of infusion-transfusion therapy to be significantly reduced, the amount of stored blood needed is 3.9 time less.

[Changes in hemostasis indices in patients with gastrointestinal hemorrhages depending on treatment methods]. / Izmenenie pokazateleil gemostaza u bol'nykh s zheludochno-kishechnymi krovotecheniiami v zavisimosti ot metoda lecheniia.

The dynamics of changes in some values of the hemostatic system was studied on days 1, 3, and 7 after gastrointestinal hemorrhage (GIH) of ulcerous etiology during enteral (administration of an electrolyte-monomer solution through a tube) and parenteral (traditional administration of infusion solutions) treatment. In operated on patients with enteral correction marked hyperfibrinogenemia was revealed, as well as diminished blood fibrinolytic activity, prolonged thrombin time, and a positive ethanol test, which indicates the predominance of hypercoagulation changes in the blood. Patients who were not subjected to operation but were given enteral correction had marked thrombocytopenia, reduced tolerance of plasma to heparin in all test periods tendency towards reduction of the fibrinogen content during the whole week after the hemorrhage in normal values of fibrinolytic activity, positive ethanol and protamine sulfate tests, which is evidence of hypocoagulation shifts in the hemostatic system. Reduction of the 4th thrombocytic factor, a tendency towards diminution of plasma tolerance to heparin, normal fibrinogen level, reduced blood fibrinolytic activity, and negative ethanol and protamine sulfate tests were revealed in patients who did not undergo operation and were given the traditional parenteral treatment, which reflects the compensatory character of the blood coagulation system response to rapidly developing blood loss. Disorders of the hemostatic system were more marked in patients with GIH who were not operated on and were given enteral correction, who require additional therapy.

[Enteral correction in gastroduodenal hemorrhage of peptic ulcer etiology]. / Enteral'naia korrektsiia pri gastroduodenal'nykh krovotecheniiakh iazvennoi étiologii.

Among 115 patients with gastroduodenal hemorrhage 60 received nonoperative treatment, 30 of them underwent enteral correction with a monomer electrolyte solution. Emergency operation was carried out on 55 patients, 35 of them were subjected to enteral correction in the postoperative period. Enteral administration of the monomer electrolyte solution in the early posthemorrhagic and postoperative periods promoted filling up of the blood circulation volume and its components and stabilization of the values of central hemodynamics. It was established on grounds of the clinical data, studies of the volemic indices and central hemodynamics that enteral correction does not yield to the traditional intravenous infusion-transfusion therapy in efficacy.

[Hormonal interrelations in the hypophyseal-ovarian system in heifers during prostaglandin F2-alpha-induced estrus]. / Gormonal'nye vzaimootnosheniia v sisteme gipofiz-iaichniki u telok v period éstrusa, indutsirovannogo prostaglandinom F2 alpha.

Study of prostaglandin F2 alpha action, synchronizing the estrus, in experiments on heifers demonstrated that Estrumeit (made by ICI, Great Britain), rostaglandin F2 alpha drug, in a dose of 500 micrograms was an active luteolytic factor, leading to the corpus luteum regress, determined by a fall in the progesteron level in the peripheral blood. During the estrus induction there was a short-term elevation in production and excretion of testosterone, this pointing to the prostoglandins participation in the activation of the androgenic ovarian function. Prolactin hyposecretion was shown to be a necessary condition for the realization of general biological processes for the occurrence of estrus.