[Gastroesophageal reflux after laparoscopic hiatal hernia repair in patients with axial hiatal hernia]. / Prichiny patologicheskogo gastroezofageal'nogo reflyuksa posle videolaparoskopicheskoi korrektsii zamykatel'noi funktsii kardii u bol'nykh aksial'noi gryzhei pishchevodnogo otverstiya diafragmy.

OBJECTIVE: To find out significance of the main locking mechanisms of lower esophageal sphincter in the relapse of GERD in patients with axial hiatal hernia after previous antireflux laparoscopic surgery. MATERIAL AND METHODS: There were 103 patients with GERD and axial hiatal hernia who underwent original circular laparoscopic esophagofundoplication with correction of hiatal opening dimensions by crural and hiatal repair. Depending on generalized DeMeester index (within the normal range or its excess), all patients were divided into two groups - without relapse (group 1, n=88) and with recurrent GERD (group 2, n=15). Both groups were comparable by the main characteristics and postoperative follow-up period (mean - 6 years). Antireflux function was investigated by X-ray examination and endoscopy, manometry of the esophageal-gastric passage, intra-esophageal 24-hour pH-monitoring. Processing and graphical presentation of data was carried out using Statistica v.10.0 Rus software (StatSoft, USA) and Microsoft Office Excel 2013 (USA). RESULTS: Abnormal gastroesophageal reflux was detected in 14.56±3.48% of patients after laparoscopic anti-reflux surgery. Recurrent hiatal hernia occurred in 20±10.33% of these patients, malfunction of lower esophageal sphincter - in 80±10.33%. Failure of cardia was caused by shortening of its length by 30.43% and decrease of tone by 6.78% with significantly (61.09%) increased tone of the stomach. Failure of cardia was manifested by increase of generalized DeMeester index in the lower third of the esophagus by 3.2 times, acidic gastroesophageal refluxes, reflux index and index reflux values. Preserved esophageal motility combined with shortening of time of esophageal clearance in patient's lying position was associated with reduced incidence of reflux-esophagitis by 77.26% even in case of recurrent GERD. CONCLUSION: Abnormal reflux after antireflux laparoscopic surgery due to GERD with axial hiatal hernia is caused by recurrent hiatal hernia in every fifth patient while the main reason is failure of LES cuff with increased intragastric pressure.

[Endoscopic surgery for benign diseases and injuries of the esophagus (with commentary)]. / Endokhirurgiya dobrokachestvennykh zabolevanii i povrezhdenii pishchevoda (s kommentariem).

AIM: To analyze the results of surgical treatment of patients with benign diseases and injuries of the esophagus. MATERIAL AND METHODS: We summarized the experience of different endoscopic interventions in 159 patients with various benign diseases and perforation of the esophagus. Patients with achalasia (72 cases) underwent videolaparoscopic Geller's esophagomyotomy with anterior hemiesophagofundoplication by Dor. Video-assisted thoracoscopic extirpation of the esophagus with simultaneous or delayed esophagocolo/gastroplasty was performed in 56 patients with post-ambustial cicatricial stenosis of the esophagus. Patients with esophageal perforation (14 cases) underwent videolaparoscopic transhiatal mediastinal drainage. Esophageal leiomyoma has been excised through thoracoscopic (9 cases) or laparoscopic access (4 cases). Removal of esophageal diverticulum was made via VATS-access in 4 patients. RESULTS: Satisfactory early and remote results were achieved in all patients with achalasia. Mortality rate was 5.4% (3 out of 56 patients) and 14.3% (2 out of 14 patients) in groups of cicatricial esophageal stenosis and esophageal perforation respectively. Sutures failure after removal of the diverticulum and leiomyoma occurred in 2 and 1 patient respectively and has been successfully cured. CONCLUSION: Endoscopic technologies allow to perform successfully complex reconstructive interventions for dysphagia in patients with cicatricial esophageal stenosis and achalasia even at late stages, to remove benign tumors and diverticula of thoracic esophagus and provide adequate drainage of posterior mediastinum in case of esophageal perforation.

[Endosurgery of benign diseases and injuries of esophagus].

AIM: To analyze the results of endoscopic interventions for benign diseases and injuries of the esophagus. MATERIAL AND METHODS: 159 patients with benign diseases and perforation of the esophagus were operated. There were 72 (45.3%) cases of achalasia, 56 (35.2%) with post-ambustial stenosis of esophagus, 14 (8.8%) with esophageal perforation, 13 (8.2%) with leuomyoma of esophagus and 4 (2.5%) with diverticulum of thoracic esophagus. RESULTS AND DISCUSSION: In long-term period 56 patients with achalasia were followed-up after laparoscopic Heller cardiomyotomy with Dor fundoplication. Good results were observed in all cases. Three patients died in early postoperative period after thoracoscopic extirpation of esophagus with esophagoplasty via laparotomy at the stage of development of the technique. There were no deaths after thoracoscopic extirpation of esophagus with simultaneous laparoscopic gastroplasty. Postoperative period was significantly less after thoracoscopic extirpation of esophagus with simultaneous laparoscopic esophagogastroplasty using whole stomach compared with esophagogastroplasty and esophagocoloplasty via laparotomy. In long-term postoperative period different complications occurred in 17 cases. Two patients with esophageal perforation died after video-assisted laparotranshiatal drainage of posterior mediastinum. Scarring of esophageal defect was observed in others. Seam failure after esophageal leuomyoma removal was diagnosed in 2 patients that required video-assisted laparotranshiatal drainage of posterior mediastinum and Maydl jejunostomy. Seam failure in thoracic esophagus after thoracoscopic removal of diverticulum was observed in 1 case. The complication was cured by video-assisted laparotranshiatal drainage of posterior mediastinum.

[Effect of solubilization by methylethylketone of rat liver mitochondrial monoamine oxidase on inhibition by clorgyline and deprenyl of the enzyme activity]. / Vliianie soliubilizatsii mitokhondrial'noi monoaminoksidazy pecheni krysy metilétilketonom na tormozhenie khlorgilinom i deprenilom aktivnosti fermenta.

A comparative study of the inhibitory effect of clorgyline and deprenyl on serotonin, beta-phenylethylamine and tyramine deamination by intact mitochondria as well as by solubilized with methylethylketone and partially purified monoamine oxidase (MAO) from rat liver was carried out. The effect of 4-ethylpyridine on this process was investigated. After solubilization of MAO by methylethylketone 7% of mitochondrial activity passes into solution and the rate of deamination of serotonin, tyramine and beta-phenylethylamine by soluble MAO preparation is selectively decreased. The corresponding residual activities are equal to 29, 63, 86 and 92%. The inhibitory effect of clorgyline on serotonin deamination by soluble MAO preparations is considerably lower than that by mitochondrial suspensions at the concentrations of the inhibitor from 1 x 10(-4) to 1 x 10(-7) M, while the inhibitory action of clorgyline on tyramine deamination after MAO solubilization by methylethylketone is increased at 10(-4) and 10(-5) M, but decreased insignificantly at 10(-6) and 10(-7) M. When solubilized MAO preparations are used, 4-ethylpyridine introduced into the sample before or after preincubation of the enzyme with clorgyline (30 min, 23 degrees) eliminates the inhibitory action of the latter on serotonin and tyramine deamination, thus suggesting the reversibility of the inhibitory effect of clorgyline. In similar experiments with mitochondrial suspensions the inhibition by clorgyline of deamination of these amines is irreversible. Similar experiments on mitochondrial suspensions showed that clorgyline irreversibly inhibits the deamination of these amines. The rate of inhibition by deprenyl of beta-phenylethylamine oxidation due to MAO solubilization by methylethylketone is not changed. 4-Ethylpyridine added to the samples before or after preincubation of deprenyl with the enzyme (30 min, 23 degrees) abolishes the inhibiting effect of the former both in soluble MOA and in mitochondrial suspensions. This suggests that under the given experimental conditions the inhibiting effect of deprenyl is reversible. Possible nature of MAO forms A and B is discussed.

[Sorbent for purification of diamine oxidase by the method of affinity chromatography]. / Sorbent dlia ochistki diaminooksidazy metodom affinnoi khromatografii

A substrate of diamine oxidase hexamethylene diamine was covalently bound through adipinic acid dihydrazide to Sepharose 4B in order to prepare a sorbent for the purification of diamine oxidase by means of biospecific (affinity) chromatography. A method was developed to purify diamine oxidase from pig kidney cortex using the sorbent. The method, comprising three steps, yielded enzyme preparations with specific activity 2 000-fold higher than that of kidney homogenate.