[The efficacy of the moisture and warmed CO(2) for laparoscopic surgery].

A prospective, randomized study comparing 150 patients undergoing laparoscopic operations (110 patients undergoing laparoscopic cholesystectomy and 40 patients laparoscopic fundoplication) with standard CO2 insufflation vs those receiving warmed, humidified CO2 was performed. All patients were randomized into 2 groups - 84 receiving standard CO2 insufflation (control group) and 66 receiving warmed, humidified CO2 (main group). Main variables included patient core temperature, postoperative pain, analgesic requirements and other postoperative dates. We revaeled that warmed, humidified CO2 has advantages that were statistically significant. Patients undergoing warmed, humidified carbon dioxide (CO2) insufflation for maintain a warmer intraoperative core temperature, and have less postoperative pain and need less analgesic requirements than patients with standard CO2 insufflation.

[The method of biliary tracts drainage of patients with biliodigestive anastomosis at obstructive jaundice and acute cholangitis].

The internal draining of biliary tracts of patients with obstructive jaundice and acute cholangitis is considered most acceptable, but deficiency of this method is anastomosis failure, stricture and purulent-septic complications hazard. The investigations performed on 79 patients with obstructive jaundice, 36 of which were included in control group, 43 - in main group. To patients of main group with internal draining intraoperatively through the nose and biliodigestive anastomosis into the biliary tract transmitted tube with quartz optical monofiber for endocholedocheal laser irradiation in one lumen and hollow other, serve for drainage and irrigation of bile-excreting way with ozonized physiological solution. The application of endocholedocheal laser radiation and ozonetherapy in combination with suggested at biliodigestive anastomosis biliary tract drainage method allowed to earlier elimination of inflammatory process biliary tract, correct the bile lipids per oxidations disturbances and elevate activity of antioxidant protection system, to reduced the time of patients stay at hospital after surgery period from 20,3±1,24 day in control group to 12,7±0,653 day in main group (p<0,001), to prevent purulent-septic and scarry complications in complex treatment of patients with obstructive jaundice and acute cholangitis.

[Some aspects of classification and treatment strategy of iatrogenic bile duct injury].

Iatrogenic bile duct injury continues to be an important clinical problem, resulting in serious morbidity, and occasional mortality, to patients. None of the classification system is universally accepted and worldwide used as each has its own limitation. This article reviews the various classification systems of bile duct injury. Traditionally, biliary injuries have been classified using the Bismuth's classification. This classification does not encompass the whole spectrum of injuries during laparoscopic cholecystectomy. Strasberg's classification made Bismuth's classification much more comprehensive by including various other types of extrahepatic bile duct injuries. Our own classification is simple enough, embraces the majority possible variants of bile duct injuries and convenient in clinical use.

[Surgical treatment of rectovaginal fistulae].

The use of invertation as a surgical treatment of rectovaginal fistulae in 18 adult patients was presented. Operation technique and features of postoperative management were described. Fistula recurrence was observed in one case. Operation was suggested to be a method of choice in surgical treatment of rectovaginal fistulae of large and medium size localized in middle and lower third of vagina.

[Prognostic factors in the treatment of the bile duct injuries and strictures].

To describe the prognostic factors after surgical reconstruction data. were collected prospectively on 60 patients treated at the Scientific Center of Surgery named after M.Topchubashov and N5 City Hospital with major bile duct injuries and postoperative bile duct strictures between 2000 and 2009. Of the 60 patients 21 had bile duct injuries, other 39 had postoperative strictures. In 15 of 53 patients with iatrogenic injury of bile ducts trauma was recognized and repaired intraoperatively. In 22 patients was early, in 16 patients delayed recognition of bile duct injury. Most of patients had undergone a choledocho (8) or hepaticojejunostomy (33) by Roux. External drainage of bile ducts was performed in 24 patients. Of the 60 patients undergoing surgical reconstruction, 47 hud completed treatment. Of patients who had completed treatment, 82,9% were considered to have a successful outcome (24 patients excellent, 15 patients - good results) without the need for follow-up invasive, diagnostic, or therapeutic interventional procedures. Patients with reconstruction after injury or stricture-without external drainage had a better overall outcome (92,9% successful outcome) than patients with drainage of bile ducts (68,4% successful outcome). Number of stents and length of postoperative stenting also were significant predictors of outcome. Type of operation (laparoscopic or open cholecystectomy) had nd significant influence on outcome. At the same time a successful outcome, without the need for biliary stents, was obtained in 87,5% of patients after laparoscopic cholecystectomy versus 71,8% after open cholecystectomy.

[K-ras mutations detection in paraaortic lymph nodes and its prognostic value after the surgical treatment of pancreas cancer].

Survival after surgery of pancreas carcinoma is still poor. Despite an apparently curative resection, tumor rapidly recur. Thus, the arsenal of diagnostic means should be enriched by sensitive methods to detect the minimal residual disease. The frequency of micrometastases in corresponding paraortic lymph nodes after an apparently curative operation was detected using routine histological, immunohistological and polymerase chain reaction for mutated K-ras methods. Tumor tissue was used for the control. 3 cases out of 69 revealed a positive tumor histological reaction, and 5--immunohistological staining. K-ras mutations are detected in 42 (61%) patients, 12 (17%) of those revealed a positive tumor reaction. Only one patient of a control group showed K-ras mutation. All K-ras positive patients revealed a poor survival prognosis and had a tumor relapse after resection.

[Dynamics of glycosylated hemoglobin and malondialdehyde contents in experimental diabetes mellitus]. / Dinamika soderzhaniia glikozilirovannogo gemoglobina i malonovogo dial'degida pri éksperimental'nom sakharnom diabete.

The levels of HbAIc, malonic dialdehyde (MDA), sugar and insulin were measured in the blood of dogs with experimental diabetes mellitus. HbAIc increased from postoperative week 4 to week 8 of the observation period. MDA levels stood high for postoperative week 1, returned to the baseline, rerose on week 4 and remained high till week 8. Hyperglycemia was observed through the whole experiment.

[A model of diabetes mellitus in dogs: combination of pancreas resection with intra-arterial administration of alloxan]. / Model' sakharnogo diabeta u sobak: kombinatsiia rezektsii podzheludochnoi zhelezy s vnutriarterial'nym vvedeniem alloksana.

A study was made of the indices of blood sugar on an empty stomach, GTT, blood insulin, body mass and the general status in 17 mongrels during one month after various types of resection of the pancreas: the 1st group--resection (80%), the 2nd group--resection (68%), the 3rd group--resection combined with intraarterial administration of alloxan. Insulin was determined using a standard kit RIO-INS-PG-125I by a radioimmunoassay. Alloxan was injected during operation at a dose of 250 mg (5% solution) in the upper pancreatoduodenal artery. Stable hyperglycemia, diabetogenic disturbances in GTT, a decrease in the blood level of insulin, and a clinical picture of diabetes mellitus were observed after operation in the 1st and 3rd groups. A new model of experimental diabetes mellitus in dogs (a combination of pancreas resection with intraarterial administration of alloxan) was recommended.

[Perfection of the method of selective proximal vagotomy and improvement of late-term results of the surgical treatment of duodenal ulcer]. / Sovershenstvovanie metodiki selektivnoi proksimal'noi vagotomii i uluchshenie otdalennykh rezul'tatov operativnogo lecheniia duodenal'nykh iazv.

In the period from 1985 to Sept. 1990 operations were conducted on 288 patients with duodenal ulcer; 165 of these patients (group I) were treated by selective proximal vagotomy (SPV) by the old method--without extensive mobilization of the cardia, esophagus, and fundus of the stomach; draining operations were used in 97% of patients. A perfected operative method was applied in 123 patients (group II)--besides extensive dissection of the zone of the esophagogastric junction all of them underwent circular esophagomyotomy 2 cm above the cardia and modified fundoplication. The indications for draining operations were limited (51.2% of patients). The results studied in 2.3 patients in follow-up periods of 6 months to 5 years confirmed the advantages of the perfected method of SPV: the number of recurrent ulcers reduced from 11.8% to 1.7%, that of the dumping syndrome from 9.2% to 4.5%, and the incidence of diarrhea from 7.8% to 3.3%. In groups I and II the results were excellent and good in 66.7% and 88.3% of patients, satisfactory in 21.6% and 10.0% of patients, and poor in 11.8% and 1.7% of cases, respectively. Perfection of the SPV method is directly reflected in its results which must be studied in follow-up periods of over 5-10 years for the evaluation to be more objective.

[Immunologic reactivity of patients with obstructive jaundice of non-neoplastic etiology]. / Immunoreaktivnos't u bo'lnykh s mekhanicheskoi zheltukhoi neopukholevogo geneza.

Immunity values were studied in patients with obstructive jaundice of cholelithic etiology. The number of immune cells was reduced and the formation of antibodies was deficient in these patients in the preoperative period. The degree of immunodeficiency correlated with the duration of jaundice and the degree of bilirubinemia. The level of autoantigens was also increased. An operation promotes still greater suppression of immunity. The values of immunity were normalized earlier in patients who had received immunomodulation therapy.

[Percutaneous transhepatic cholangiostomy in malignant tumors of the proximal sections of the extrahepatic bile ducts]. / Chreskozhnaia chrespechenochnaia kholangiostomiia pri zlokachestvennykh opukholiakh proksimal'nykh otdelov vnepechenochnykh zhelchnykh protokov.

The results of the use of percutaneous transhepatic cholangiostomy (PTCS) in 21 patient with obstructive jaundice, caused by tumour obstruction of the proximal bile ducts were studied. PTCS in 15 patients was a definitive intervention, which adequately substituted palliative bile-diverting operations, and in 6--served as an effective method of preoperative preparation. In 3 patients, the PTCS was used for combined internal-external bile diversion.