Association of the HindIII Lipoprotein Lipase Gene Polymorphism with the Development of the Non-Biliary Acute Pancreatitis: a Pilot Study.

We studied the relationship between lipoprotein lipase (LPL) gene HindIII polymorphism and the development of acute pancreatitis in the Russian population. Whole blood samples were collected from 145 patients with acute non-biliary pancreatitis and 191 healthy individuals. Genotyping of LPL gene HindIII (rs320) polymorphism was performed by PCR with TaqMan assay. It was found that allele H+ (OR=0.63, 95%CI 0.41-0.96, p=0.03) and genotype H+/H+ (OR=1.79, 95%CI 1.06-3.04, p=0.03) were associated with the risk of acute non-biliary pancreatitis only in males. In this study, the relationship between HindIII polymorphism of LPL gene with the risk of acute non-biliary pancreatitis was revealed.

[State of duodenal patency in patients with postgastrectomy syndromes].

It was analyzed the examination and treatment results of 100 patients who underwent resection of stomach by Billroth-I in case of peptic ulcer. Chronic disorders of duodenal patency were diagnosed in 86% of patients. The main role of chronic disorders of duodenal patency in postgastrectomy syndromes development was proved. There were a combination of reflux gastritis with dumping syndrome in 66.3% of patients, a combination of reflux gastritis with recurrent ulcer in 8.1% of patients. Correction of chronic disorders of duodenal patency is necessary stage in conservative and surgical treatment of postgastrectomy syndromes.

[The association study of the promoter polymorphism -308G>A of tumor necrosis factor gene with the development and severity of acute pancreatitis in Russian population of Kursk region].

The aim of this study was to investigate the relationship between the polymorphism -308G>A of tumor necrosis factor (TNF) gene and the risk and severity of acute pancreatitis (AP) in unrelated Russians from Kursk region. DNA samples were obtained from 190 AP patients and 217 healthy controls for genotyping the polymorphism through a TaqMan allelic discrimination assay. Although -308G>A genotypes did not show a significant association with disease risk, the genotype -308GA was found to be associated only with non-severe type of acute alcohol-related pancreatitis (odds ratio 1.81 (95% CI 1.02-3.23 p=0.04).

[The role of chronically disordered duodenal patency in the development of post-gastroresection syndrome].

We assessed results of examination and treatment of 100 patients with ulcer disease who had undergone Bilroth-1 stomach resection. Chronic disorder of duodenal patency was revealed in 86% of the patients. This condition was shown to play the leading role in the development of post-gastric resection syndrome. Reflux-gastritis was associated with damping syndrome in 66.3% of the patients and with recurrent ulcer in 8.1%. It is concluded that conservative and surgical treatment of post-gastric resection syndrome should be aimed at correction of chronic disorders of duodenal patency.

[Improvement of endoscopic treatment of the acute cholecystitis].

Treatment results of 763 patients with acute cholecystitis were analyzed. Destructive forms of the disease was diagnosed by the ultrasound examination in all cases. Choledocholithiasis was diagnosed in 35 (4.6%), choledocholithiasis with papilla Vatery stricture was in 9 (1.2%) patients and isolated papilla Vatery stricture was registered in 5 (0.7%) patients. All patients were attempted to treat laparoscopically with the use of original "Device for antegrade papillotomy" and "Method of antegrade bipolar papillosphincterotomy". Authors state, that a final decision about the possibility of endoscopic treatment of the acute cholecystitis can be made after detection of anatomical structures of the Calo triangle. By complicated forms of the disease a one-stage laparoscopic treatment should be preferred. Endoscopic papillosphincterotomy should be performed only by the enblocked concrement of the papilla Vatery.

[Technology for sclerosurgical treatment of upper veno-venous reflux of the large subcutaneous vein in varicose vein patients]. / Tekhnologiia sklerokhirurgicheskogo lecheniia vysokogo veno-venoznogo refliuksa po bol'shoi podkozhnoi vene u bol'nykh varikoznoi bolezn'iu.

Under analysis were results of a complex ultrasound examination and the following treatment of 101 patients with varicose disease which had developed due to a high veno-venous ejection. The decision on the method of treatment depended on the variant of reflux spread and the degree of dilatation of the large subcutaneous vein. Four variants of spreading the reflux were established: in the inguinal area only (3.8%), along the femur to the level of the knee articulation (13.6%), femur and the upper third of the shin (66.8%), from the groin to the malleolus (15.8%). Selective interventions consisting in scleroobliteration or removal of the large subcutaneous vein within the limits of the femur or upper third of the shin were fulfilled in 84.2% of the patients. Sclerotherapy was used in veins having the diameter from 5 to 7 mm, sclerosurgery--with the diameter from 8 to 10 mm, surgical treatment in veins with the diameter more than 10 mm. The effectiveness of liquidation of the reflux was 95.2%.

[Mechanisms of the development of venous hypertension in patients with varicose disease]. / Mekhanismy razvitiia venoznoi gipertenzii u bol'nykh varikoznoi bolezn'iu.

The examination of 539 patients with varicose disease was fulfilled with the help of ultrasonic (dopplerography, angioscanning), rentgenological (phlebography, lymphography), functional (rheovasography, photoplethysmography) methods. Two forms of venous hypertension were established: superficial and deep. Hemodynamic disorders in patients with the superficial form result from the formation of isolated blood refluxes in the superficial, perforant and profound veins. In patients with this form the muscular-venous pump has mild disturbance and is clinically manifested as a slowly progressing course of the disease. The basis for the development of the deep form is a severe valve incompetence of the profound veins with the formation of associated blood refluxes in all the elements of the muscular-venous pump. The latter completely looses its function which leads to a rapid lympho-venous decompensation.

[The pathogenesis and surgical treatment of trophic ulcers of the lower extremities against a background of varicose veins]. / Patogenez i khirurgicheskoe lechenie pri troficheskikh iazvakh nizhnikh konechnostei na pochve varikoznoi bolezni.

The state of the musculo-venous pump of lower extremities was studied in 72 patients with trophic ulcers caused by varicose disease. The methods used were: phlebotonometry, phleboplethysmography, US dopplerography, distal ascending and retrograde-femoral, popliteal and talocrural phlebography. It was established that ectasia and/or valve incompetence of deep and muscle veins of the lower extremities with the formation of blood refluxes along the profound, communicating and superficial veins underlie the disturbances of venous hemodynamics. The authors propose a scheme of pathogenesis of the varicose disease trophic ulcers and recommend to perform pathogenetically justified operations.

[The mechanisms of the development of decompensated forms of varicose veins]. / Mekhanizmy razvitiia dekompensirovannykh form varikoznoi bolezni.

The functional (rheovasography, photoplethysmography), ultrasonic (dopplerography) and roentgenological (distal ascending and retrograde popliteal and talocrural phlebography) methods of investigation were used for studying the state of the musculo-venous pump of the crus in 50 patients with the varicose disease in the stage of trophic disorders. It was established that the formation of pathological capacities in the crural muscular veins and leakage of blood from the posterior tibial into deep plantar veins was responsible for the development of the decompensated course of this disease.

[The pathogenetic validation of the volume and the technology for the surgical correction of disorders in the musculo-venous pump of the lower extremities in patients with decompensated forms of varicose veins]. / Patogeneticheskoe obosnovanie ob''ema i tekhnologiia khirurgicheskoi korrektsii narushenii myshechno-venoznoi pompy nizhnikh konechnostei u bol'nykh s dekompensirovannymi formami varikoznoi bolezni.

The state of the venous, capillary blood circulation and lymph flow was studied in 70 patients with varicose disease at the stage of trophic disorders with the help of photoplethysmography, rheovasography, dopplerography, distal ascending and retrograde femoral, popliteal, talocrural phlebography, lymphography. It was established that a sharp disturbance of the musculo-venous pump function caused decompensation of not only the venous blood circulation but also the lymph flow, while the removal of the subcutaneous veins of the crus is not possible without deterioration of the lymphatic drainage. The authors propose not to ablate the main trunks of the subcutaneous veins on the crus but to perform occlusion of the autovein ablated from the femur. A technology of resection of the pathologically altered vein of the soleus and gastrocnemius muscles and retrograde occlusion of the posterior tibial veins is developed for improving the work of the musculo-venous pump of the leg. Good results of treatment were obtained in 84.3% of the patients.

[Surgical correction of vertical reflux of blood in musculo-venous pump of the lower limbs and pelvis in patients with varicose veins]. / Khirurgicheskaia korrektsiia vertikal'nogo refliuksa krovi v myshechno-venoznoi pompe nizhnikh konechnostei i taza u bol'nykh varikoznoi bolezn'iu.

The authors have made an analysis of results of treatment of 469 patients with the varicose disease. During operations on them surgical correction of vertical reflux of blood was performed by means of extravasal correction of incompetent valves of the femoral, popliteal and tibial veins, resection or obturation of the posterior tibial veins. Traditional methods (frame spiral and fascioplication) and original ones (three ligatures and tension of the valve cusps through the frame spiral coil) were used. Elimination of the vertical reflux of blood in each of the four pumps (abdomino-caval and femoral ones, those of the leg and foot) forming the musculo-venous pump, results in getting 7% greater amount of excellent and good results, bad results were obtained in 3.4% less number of cases. The period of temporary loss of working ability becomes shorter.

[Clinical and X-ray diagnosis of vertical blood reflux in muscle-venous pump of lower extremities and pelvis in varicosity]. / Kliniko-rentgenologicheskaia diagnostika vertikal'nogo refluksa krovi v myshechno-venoznoi pompe nizhnikh konechnostei i taza pri varikoznoi bolezni.

Four hundred and twenty three patients with varicosity were comprehensively examined and surgically treated. X-ray diagnosis of vertical blood reflux was made in each of 4 musculovenous pumps (the abdominocaval pump, the punps of the hip, shin, foot). The first pump was studied by retrograde pelvic phlebography through the contralateral leg, the second one was examined by retrograde contrast administration into the onset of the external iliac vein as the second stage of retrograde pelvic phlebography or by its direct puncture, the third pump was explored by retrograde saphenous phlebography with pneumocompression of deep veins of the hip proximalo the site of puncture. The vertical reflux in the foot pump was determined by retrograde talocrural phlebography by contrast administration into the accompanying rectal vein above 4 cm of the foot along the Lington line. At surgery, vertical blood reflux was removed in each area of the musculovenous pump by extravasal correction of failing deep venous valves. Analyzing the outcomes of treatment in the patients and controls who underwent routine superficial and accompanying vein surgery without removing vertical blood reflux showed that the application of the new approaches to X-ray diagnosis and treatment of varicosity yielded excellent and good treatment outcomes by 10.6%, reduced poor ones by 10.8%, shortened the mean disability duration by 15.6 + 2.3 days, prevented disability.

[Hemodynamic characteristics of the state of musculo-venous pump of the lower limbs and pelvis in patients with varicose veins]. / Gemodinamicheskaia kharakteristika sostoianiia myshechno-venoznoi pompy nizhnikh konechnostei i taza u bol'nykh s varikoznoi bolezn'iu.

The method of phlebotonometry developed by the authors was used in an analysis of results of the state of musculo-venous pump of lower extremities and pelvis in 106 patients with varicose disease. The dynamics of phlebotonogram indices was studied during isolated functional exercises of the muscles of prelum abdominale, femur, leg and foot. In the first and second stages of the disease the function of both the single pumps and the whole pump system is disturbed but mildly and has no stage distinctions. Their pronounced impairment appears but in cases of a complicated course of the disease. In valvular incompetence of deep veins the musculo-venous pump looses its function: the greater the degree of valvular incompetence, the worse the functioning of this structure.

[The hemodynamic significance of normal vertical blood reflux based on dopplerographic data and in patients with primary varicose veins of the lower extremities]. / Gemodinamicheskaia znachimost' vertikal'nogo refliuksa krovi po dannym dopplerografii v norme i u bol'nykh s pervichnym varikoznym rasshireniem ven nizhnikh konechnostei.

Data of echophlebodopplerography on "ULTRA-PVD" (USA) were used for studying the frequency and hemodynamic significance of vertical reflux of blood in the deep veins of lower extremities in varicose patients. A group of 50 healthy men and women and 80 patients with different stage of varicose disease were studied. A comparison of the data obtained allowed determining a reliable static criterion of the retrograde wave duration when performing a test with proximal compression. It was shown that under normal conditions it should not exceed 1.5 sec. Three degrees of the retrograde blood flow were distinguished. Indications for surgical correction of the relative valve deficiency of the deep lower extremity veins must be established in each concrete case. Since 1993 200 patients with primary varicose veins have been examined and operated upon. Good and excellent results (96%) testify to the effectiveness of the correction of deep vein hemodynamics which can improve surgical treatment of this pathological condition.

[Significance of retrograde blood flow in the posterior tibial and deep plantar veins of the foot in the pathogenesis of decompensated varicose disease]. / Znachenie retrogradnogo krovotoka po zadnim bol'shebertsovym i glubokim plantarnym venam stopy v patogeneze dekompensirovannykh form varikoznoibolezni.

An examination of 91 patients with varicosities of the lower extremity veins at different stages of the disease was carried out in order to find out the retrograde blood flow in deep veins of the shin and foot by means of the retrograde popliteal and talocrural phlebography. The investigation performed allowed a conclusion of an important pathogenetical role of the retrograde blood flow in deep veins of the shin and foot in genesis of trophic cutaneous disorders. Endovascular occlusion of the posterior tibial veins after A.N. Vedensky was fulfilled in 32 patients with trophic cutaneous disorders along with a correction of the pathological blood flow along the superficial veins. An analysis of long-term results of the treatment has shown that this kind of operative interventions is an adequate method for correction of the hemodynamic disorders in question at the decompensation stage of the disease.

[Use of a domestic hydrogel as an occlusive agent of varicose veins of the lower limbs]. / Primenenie gidrogelia otechestvennogo proizvodstva v kachestve okkliuzanta varikozno-izmenennykh ven nizhnikh konechnostei.

The authors propose experimental grounds of the method of surgical correction of the pathological blood flow along varicose subcutaneous veins and the endovasal catheter obliteration of them. The method was used in operations on 70 patients with varicosities of the lower extremity veins at the I and II stages of the disease. No complications or recurrences were noted in the following 1-3 years of observation.

[Noninvasive diagnosis of pathological reflux of blood in the musculo-venous pump of the lower limbs and pelvis in varicose disease]. / Neinvazivnaia diagnostika patologicheskikh refliuksov krovi v myshechno-venoznoi pompe nizhnikh konechnostei i taza pri varikoznoi bolezni.

An examination and following treatment of 469 patients with varicose disease were carried out on the basis of a three-steps noninvasive diagnostic complex developed by the authors of the article. The first step is intended for examining the patients in order to detect injuries of each of the four pumps (the abdomino-caval pump, femur, shin and foot) involved in the venous return. The functional tests developed by the authors were used. The second step included the determination of the degree of injury of the pumps under study with the help of functional rheovasography of the femur, shin and foot. Methods of ultrasonic dopplerography were used at the third step for detecting the causes of the developing blood refluxes.

[Surgical treatment of acute biliary pancreatitis]. / Khirurgicheskoe lechenie ostrogo biliarnogo pankreatita.

The analysis of surgical treatment of 126 patients with acute biliary pancreatitis is made. The authors follow an active surgical policy in patients with justified risk of surgery. The operation is carried out in two stages: 1st-radical elimination of pathologic changes of extrahepatic bile ducts, restoration of the passage through the large duodenal papilla (LDP), and 2nd stage is the operation on the pancreas. The indications and contraindications for transduodenal intervention in acute biliary pancreatitis have been determined. The authors think it necessary in destructive forms of acute pancreatitis accompanied by extensive fermentative damage of parapancreatic and retroperitoneal cellular tissue to remove it thoroughly and to drain it widely. The reoperation should be performed not earlier that 12-21 days after the initial operation. Postoperative lethality was 8.7%.