[Predictors of external pancreatic fistulae after pancreatic resection]. / Prediktory vozniknoveniya naruzhnykh pankreaticheskikh svishchei posle rezektsii podzheludochnoi zhelezy.

Despite a significant decrease in postoperative mortality after pancreatic resections in recent years (5.2-15% after pancreatoduodenectomy and about 5% after distal pancreatectomy), incidence of postoperative complications remains high (30-50% and 22-50%, respectively). Postoperative pancreatic fistula is one of the most common and formidable complications. Currently, most authors use the classification proposed by the International Study Group for Pancreatic Fistula (biochemical failure, fistula type B and C). Prediction of the risk of postoperative fistula is still a complex and unresolved problem of modern surgical pancreatology. According to the literature, the main risk factors of postoperative pancreatic fistulae are obesity and high body mass index, concomitant cardiovascular diseases, no neoadjuvant chemo- and radiotherapy, soft pancreatic texture, narrow pancreatic duct, no fibrotic changes in parenchyma, adipose infiltration of the pancreas, advanced intraoperative blood loss, as well as center experience. Most often, magnetic resonance imaging, computed tomography, ultrasound elastography and various multivariate risk assessment systems are used to estimate the risk of pancreatic fistulae. However, a generally accepted technique does not exist. This manuscript is devoted to analysis of risk factors of postoperative pancreatic fistulae and diagnostic methods for assessment of this risk.

[Outcomes of cardiac achalasia grade II-III management]. / Sposoblecheniia akhalazii kardii II-III stadii.

AIM: To analyze early and remote results of the new method of cardiac achalasia grade II-III management. MATERIAL AND METHODS: Original surgical approach was applied in 21 patients with cardiac achalasia grade II-III. RESULTS: There were no any specific postoperative complications and deaths. Exacerbation of chronic pancreatitis, acute stomach ulcer and biliary peritonitis were observed in 3 cases respectively. All patients were followed-up within the period from 1.5 months to 5 years after surgery. Recurrent disease was absent. All employable patients have backed to work. CONCLUSION: According to clinical and instrumental data original surgical repair completely cures the symptoms of cardiac achalasia and restores normal esophageal dimensions and structure early after intervention.

[Functional status of the bile excretion system and upper gastrointestinal tract in patients with duodenal ulcer].

The research of functional condition of biliary tract in 35 patients suffered from gastroduodenal ulcers compared with 30 almost healthy patients was conducted. Disorders of motor function were found out in 13.2% patients in control group. The motor-evacuative function of biliary tract conformed to average scores of healthy patients group in only 8.6% cases. The accelerated gallbladder empting (11.4%), the hypermotoric biliary dyskinesia with the absence of latent period of biliary excretion (17.1%), the hypomotoric dysfunction of biliary tract (34.3%) were found out in the rest cases. The separate group of patients were patients with distortion of biliary excretion that was consisted in periodic increase and decrease of gall bladder volume during the contraction. We concluded that motor-evacuative function of biliary tract doesn't depend on the type of pathological process in the stomach or duodenum but correlates with gastric evacuation contents, the rate of cholagogic meal advancement along the duodenum and acid-productive function of the stomach.

[Transabdominal ultrasonic scanning in evaluation of liver parenchyma: new opportunities].

On suspicion of the diffusive liver lesions 117 patients have been performed a transabdominal ultrasound investigation with a visual estimate of the echogenicity of the structure of the liver's parenchyma in comparison with the echogenicity of the cortical substance of the kidney and with the determination of the homogeneity of the liver's structure on its different areas. For the purpose of the elevation of the self-descriptiveness and precision of diagnostics as well as for the reduction of the subjective estimation the authors carried out the evaluation of the structure of the liver's parenchyma and the cortical substance of the kidneys using the histography on the marked area. The elaboration of the efficient quantitative assessment of the changes of the liver's parenchyma allowed to relieve complications in differential diagnostics and to estimate the damage level of the organ's parenchyma objectively during the investigation.

[Study of gastroduodenal complex wealthy with help of transabdominal ultrasonography].

In the present work we report the results of gastroduodenal complex transabdominal sonography in grayscale mode with Doppler techniques in 237 patients. Sonographic criteria for normal and abnormal intensity of contents outflow from stomach to duodenum were defined, that can be applied in diagnostic algorithm for proximal gastrointestinal tract functional disorders.