[Results of dynamic assessment of melatonin receptor expression in lymphocytes in patients with acute mild and severe pancreatitis].

The authors present results of the investigation of melatonin receptors expression in lymphocytes in dynamics in 102 patients with acute pancreatitis of mild and severe form and in 50 volunteers. A correlated analysis was made between obtained results of laboratory and instrumental researches and clinical course of acute pancreatitis. The decrease of MT1 receptors expression was noted on 25% in patients with acute pancreatitis. The decline of MT2 receptors expression was observed on 40% of patients with acute severe pancreatitis and in a case of acute mild pancreatitis--on 15.5%, respectively. Values of MT1 and MT2 expression were equal between healthy volunteers. The decline of MT2 expression was a prognostic unfavourable sign. Obtained results of dynamic expression assessment of MT-receptors were presented as MT2/MT1 indices. Given index didn't change during disease, because of this, the index could be used as a prognostic development marker of destructive form of acute pancreatitis at the moment of patient's admission to hospital. Mean values of MT2/MT1 were determined for the purpose of universalization of used method (1.13 +/- 0.09 for mild form and 0.81 +/- 0.09 for severe form of acute pancreatitis, respectively).

[Genesis of great saphenous vein obliteration and its clinical manifestations after endovenous laser coagulation combined with crossectomy during the varicose vein treatment].

An analysis of results of the endovenous laser coagulation combined with crossectomy was made in 170 patients with varicose veins of lower extremities (C(VI), C(II)-C(V)). Clinical and ultrasonic data were investigated during a period of 3-5 days (45 lower extremities) and followed up in 1-3 years after operation (194 lower extremities). Three years later the absence of reflux was observed in 95.9% of cases. In 51.1% of cases, 1-2 zones of parietal and segmental hemodynamical insignificant bloodstream were detected. A recanalization of the great saphenous vein along the whole length was revealed in 8 cases out of 194 (4.1%) patients. The bloodstream was provided by affluxes in the area of a shin and a wellhead afflux of the stump of the great suphenous vein. The ultrasonic picture of recanalization was similar to that observed in post-thrombophlebitic occlusion.

[The first experience of endovideosurgical treatment of organic hyperinsulinism].

In connection with the development of endovideosurgical technologies, they are actively used for the treatment of organic hyperinsulinism. The robotized interventions have been applied in the last years. The experience of the laparoscopic and robotized operations performed on 7 patients with established diagnosis of organic hyperinsulinism was shown by the authors. The treatment was effective in all cases. The postoperative period was without complications in majority of patients. An acute postoperative pancreatitis with formation of acute liquid accumulation occurred in one case. This case required the performing of percutaneous puncture interventions using ultrasonics control. Thus, the application of endovideosurgical technologies was accompanied by low percent (14%) of postoperative complications.

[Use of BRAF V600E mutation in the differential diagnosis of follicular and papillary tumors of the thyroid and for the optimization of thearpy].

A possibility of detection of BRAF mutation has been studied by means of polymerase chain reaction in punctate from the thyroid node with the aim of diagnostics of high-differentiated cancer on pre-operative stage. A study includes 94 patients with nodal lesions of the thyroid. According to cytological investigation of material, received by fine-needle aspiration biopsy, papillary thyroid cancer was revealed in 47 patients, follicular tumor-in 35 and nodal colloid goiter in 12 patients. In case of papillary thyroid cancer data of genetic analysis showed the following indices of sensitivity, specificity and diagnostic accuracy: 86%, 100% and 92% correspondingly. Detection of BRAF mutation could be used in pre-operative differential diagnostics of high-differentiated cancer and benign nodal lesions of the thyroid.

[Decision on the strategy of treatment of acute cholecystitis in high operative risk patients].

Based on their personal experience with treatment of 118 patients the authors consider that sanitation-decompression percutaneous-transhepatic punctures of the gallbladder under US control can be used for arresting the inflammation process. The integral scales SAPS-II and POSSUM allow identification of groups of patients with high operative risk. The strategy of treatment depends on both the state of the patient and results of USI. The detection of an obturating concrement in the gallbladder neck requires punctures for decompression of the gallbladder and attempts to reestablish normal bile passage in addition to conservative therapy at early terms.

[Determination of melatonin receptors in human blood mononuclear cells: clinical and experimental rationale].

Melatonin is a mammalian hormone that has a great variety of effects. At present there is evidence that this hormone considerably reduces the manifestations of many gastrointestinal inflammatory diseases. The biological effects of melatonin are realized through the receptors located on the membranes of different animal cells. Three types of melatonin receptors are now known; of them two (MT1 and MT2) receptors were detected in mammals. Varying clinical forms of gastrointestinal diseases may be pathogenetically caused by the quality and amount of MT1 and MT2 receptors, their ratio, and endogenous melatonin activation. The purpose of this study was to develop a procedure for measuring the human blood cell levels of MT1 and MT2 receptors. For this, specific antibodies to MT1 and MT2 receptors were experimentally obtained; then indirect immunofluorescence was used to determine the content and ratio of blood mononuclear cells having these receptors onto the surface in 23 volunteers. The findings are an initial stage of this study and provide considerable opportunity to study a role of melatonin and its receptors in the pathogenesis of many diseases of the human digestive system.

[Galectin-3 in diagnosis of thyroid cancer].

Fourty patients with thyroid nodules were examined. Benchmarking study of FNA results, histology reports and immunohistochemistry of Galectin-3 expression were performed. Galectin-3 is a highly sensitive oncomarker for papillary carcinoma of thyroid gland: sensitivity--100%, specificity--71%, diagnostic value--85%.

[Long-term results of closure of perforated pyloro-duodenal ulcers].

Long-term results of closure of perforated ulcers were analyzed in 91 patients. Excellent and good results were obtained in 70% of the patients, in 12.1% the results were satisfactory. In 18.6% of the cases the results were considered unsatisfactory. Bad long-term results were due to the absence of dispensary follow-up, the absence of repeated courses of anti-ulcer therapy, and not following the recommendations on the treatment. Excellent and good long-term results observed in 70% of the patients allow recommendation of suturing the perforated opening and anti-ulcer therapy in patients with perforated pyloroduodenal ulcers.

[Decision for the method of surgical treatment of acute destructive pancreatitis]. / Vybor metoda khirurgicheskogo lecheniia ostrogo destruktivnogo pankreatita.

The work presents results of treatment of 375 patients with acute pancreatitis, 93 patients with destructive pancreatitis were operated upon. Minimally invasive and traditional technologies were used. Postoperative lethality was 6.5%. The method of lumboscopic extraperitoneal drainage of the destruction focus under the control of laparoscopy and USI is described. The percutaneous paracenthetic-draining interventions under the control of USI and endovideosurgical technologies were shown to be highly effective in treatment of patients with acute destructive pancreatitis and its complications.

[Direct results of endovideosurgical transabdominal adrenalectomy]. / Neposredstvennye rezul'taty énovideokhirurgicheskoi transabdominal'noi adrenaléktomii.

Results of transabdominal adrenalectomy performed in 29 patients with different tumors of the adrenals were estimated. The lower traumaticity of the access due to using a new technology as well as taking prophylactic measures for lower aggressive influence of the pneumoperitoneum allowed performing combined operative interventions in 30% of cases and avoiding serious intra- and postoperative complications.

[Clinical experience with low- and minimal-flow isoflurane in extensive resections of the liver and liver transplantation]. / Klinicheskii opyt ispol'zovaniia izofliurana v rezhimakh low- i minimal-flow pri obshirnykh rezektsiiakh i transplantatsii pecheni.

A comparative study was performed of general balanced anesthesia on the basis of neuroleptic analgesia (NLA) and inhalation low- and minimal-flow anesthesia with isoflurane in anesthesiological management of extensive operations on the liver. A total of 75 anesthesias were conducted. Because of low hepatotoxicity, absence of its metabolites' pharmacological activity, fast elimination from the body unchanged, isoflurane is effective in long and traumatic operations on the liver. Low-flow isoflurane significantly lowers pharmacological load with opiates, myorelaxants which is essential in patients with hepatic diseases. This leads to more rapid recovery of adequate spontaneous respiration and activation of the patient in low risk of postoperative iatrogenic complications.

[The anesthesiological support of liver transplantation]. / Anesteziologicheskoe obespechenie transplantatsii pecheni.

The choice of anesthesia for a high risk operation, orthotopic transplantation of the liver (OTL), is discussed. The authors propose a protocol of anesthesia for OTL. For induction anesthesia, intravenous drugs should be preferred; the liver-free stage of the operation is carried out under anesthesia with a closed isoflurane contour, and the initial metabolic disorders of patients are corrected. When the bloodflow is let in the transplanted organ, intravenous drugs (ketamine, phentanyl, and benzodiazepines) should be administered in order to reduce the vasodilating effect of isoflurane and vasopressors for preventing relative hypovolemia. At the final stage of anesthesia, isoflurane is used. Before transporting the patient into intensive care ward, phentanyl in a dose of 1.5-3 micrograms/kg was injected, because of rapid elimination of isoflurane and awakening of the patient. This protocol maintained the hemodynamics and the major metabolic parameters at the optimal level.

[The comparative hemodynamic characteristics in the lower extremities during laparoscopic and traditional interventions on the abdominal cavity organs]. / Sravnitel'naia kharakteristika gemodinamiki v nizhnikh konechnostiakh pri laparoskopicheskikh i traditsionnykh vmeshatel'stvakh na organakh briushnoi polosti.

The plethysmographic methods were used for studying the influence of pneumoperitoneum in hemodynamics in lower extremities. It was proved to cause venous stasis in them and constriction of precapillaries in the venous area predominantly. The degree of such influence depends on the strain of the pneumoperitoneum and its duration. This factor should be taken into consideration for prophylaxis of postoperative complications.

[A methods of laparoscopic suturing of perforated pyloro-bulbar ulcers]. / Tekhnika laparoskopicheskogo ushivaniia perforativnykh pilorobul'barnykh iazv.

The article describes a method of laparoscopic suturing perforated ulcers of the pylorobulbar zone. The elements of all steps of the operation are analyzed including the places of introducing the trocar, the method of putting the intracorporeal stitches, means of sanitation and drainage of the abdominal cavity. The method was successfully used in operations on 43 patients with perforated ulcers without any complications.

[The immediate results of laparoscopic treatment in perforated gastroduodenal ulcers]. / Neposredstvennye rezul'taty laparoskopicheskogo lecheniia pri perforativnykh gastroduodenal'nykh iazvakh.

The article presents an analysis of immediate results of laparoscopic interventions (suturing, vagotomy) in 40 patients with perforated ulcers in the pylorobulbar zone. Postoperative complications were noted in 7.5% of the patients. There were no lethal outcomes. The authors recommend wider introduction of the laparoscopic technology as a method of optimization of surgical treatment for perforated ulcers.

[Orthotopic liver transplantation]. / Ortotopicheskaia transplantatsiia pecheni.

Orthotopic liver transplantation is the only method of choice for many severe liver diseases with poor prognosis. The development of liver transplantation programmes is based on medical science achievements and high technology in surgery, anesthesiology and perfusiology. The experience of the Surgery Research Center, Russian Academy of Medical Sciences, made it possible to obtain positive results of liver transplantation and posttransplantation management. This in turn provided longer survival for 80% of recipients. At the same time the mortality of potential recipients was 60.4%, which is due to the greater shortage of donor organs and which is the main problem in the development of organ grafting in Russia. The fact that there is a high proportion of children who are recipients for the donor's liver requires that liver transplantation from living related donors should be developed.

[Use of laparoscopic methods in combined surgery]. / Ispol'zovanie laparoskopicheskikh metodov pri sochetannykh operatsiiakh.

The authors have made a comparative analysis of the effectiveness of isolated and combined laparoscopic cholecystectomies. The control group consisted of 246 patients subjected to isolated cholecystectomies. The group under study included 22 patients in whom combined cholecystectomies were performed. The comparative analysis included the following clinical data: duration of the operation, number of postoperative days in the hospital, amount of postoperative complications. It was concluded that the little-invasive laparoscopic technique used in one of the steps of the combined operation allowed traumatism of the surgery to be decreased which in its turn allowed wider indications to combined operations.