[Features of diagnostics and surgical strategy of diaphragmatic rupture in patients with closed chest and abdominal polytrauma].

The article presents results of diagnostics and surgical treatment of diaphragmatic rupture in 32 victims with an estimation of diagnostic value of different instrumental methods of investigation and the efficacy of surgical approach. The correct interpretation of typical clinical and instrumental signs in consideration with trauma mechanogenesis allowed diagnostics of diaphragmatic rupture before the operation in 17 (53.1%) cases. It was observed that an undiagnosed rupture of the left hemidiaphragm caused a formation of posttraumatic diaphragmatic hernia in 2 (6.2%) patients. The laparotomy was applied in 28 patients as a surgical approach and thoracotomy--in 2patients. The laparotomy and after that thoracotomy were performed on one patient. The thoracotomy and laparotomy were carried out on the second patient in turn. The authors consider the laparotomy as optimal variant of surgical approach in acute period of trauma. The postoperative lethality was 15.6%.

[Comparative characteristic of preoperative magnetic resonance and intraoperative cholangiography in diagnostics of the common biliary duct disorder].

The investigation objective have had constituted comparative characteristic of the magnet resonance cholangiography (MRCHG) and intraoperative cholangiography (IOCHG), which were applied in 186 patients, suffering biliary calculous disease. Basing on results of the performed standard operational investigations, three groups of the general biliary duct (GBD) risk affection were delineated: high, middle and low. In the high risk group were included 82 patients, in whom in GBD its widening and echopositive mass presence were revealed, as well as cholangitis, pancreatitis, obturation jaundice and raising of the cholestatic enzymes activity. The middle risk group was presented by 41 patients, in whom the ultrasound investigations data did not show the changes, but nonspecific raising of the hepatic enzymes activity was registered or they have had jaundice and pancreatitis in anamnesis. In the low risk groups were included 63 patients, in whom preoperative investigations did not show pathologic changes. The GBD affection was diagnosed in 82 patients. The investigation results have shown, that along with lowering of the GBD risk affection revealing, the MRCHG sensitivity lowers (in the groups--93.1, 80 and 57.1%, accordingly), and specificity is raising (90, 96.7 and 98.2%). Conduction of intraoperative cholangiography is indicated to all patients in high and middle risk of GBD affection, in low risk--in necessity. In a distal affection of GBD MRCHG owes low sensitivity and specificity.

[Laparoscopic choledochoduodenostomy].

The article presents the results of laparoscopic choledoch-duodenostomy (CDS) applied to 23 patients with benign strictures of distal part of common bile duct (CBD). 21 patients had cholelithiasis in combination with the CBD stricture. The rest 2 patients had acalculous postcholecystectomy stricture. The laparoscopic CDS was executed by 5 trocars: 4 were placed in standard cholecystectomy positions and the 5th was placed by the right pararectal line at the umbilicus level and was used for traction of duodenum and continuous aspiration. 2 sm long side-to-side CDS was performed with interrupted sutures. The mean operative time was 128±36 (90-205) min. There was no conversion. The mean hospital stay was 4.5 (3-9) days. There was no mortality. 2 patients developed an anastomosis bile leakage: one received the relaparoscopy and T-draining of the CDS, in another patient the leakage seased spontaneously. 82.7% of patients showed excellent and good long term results. 3 patients reported bad outcome and very bad result was registered in 1 patient. In conclusion, the laparoscopic CDS gives good outcomes in experienced hands and could be considered as an alternative to endoscopic sphincterotomy in patients with distal CBD stenosis.

[Effects of intravascular laser irradiation of blood on the state of the immune system of patients with chronic osteomyelitis]. / Vliianie vnutrisosudistogo lazernogo oblucheniia krovi na sostoianie immunnoi sistemy bol'nykh khronicheskim osteomielitom.

The authors discuss the results of study of the immune status in 55 patients with chronic osteomyelitis, it was found that the condition of the patients' immune system reflects the duration and severity of the disease and the individual reactivity of the organism. The inclusion of laser treatment in the complex of therapeutic measures should be based on appraisal of the condition of the immune system and conducted under dynamic immunological control. In deficiency of the thymus-dependent immunity the sessions of blood intravascular laser irradiation activate the organism's defence forces and facilitate correction of the imbalance in the system of the regulating cells. Laser irradiation of blood in mild changes of the immunological status is expedient because it may lead to negative dynamics of the immune system. Attainment of an optimal immunological condition in the preoperative period is conductive to a favourable course of the postoperative period and a favourable outcome of the disease.