[Intensification of the organism detoxification ability under surgical endogenous intoxication]. / Povyshenie detoksikatsionnoi sposobnosti organizma pri khirurgicheskom éndotoksikoze.

The purpose of the study is to establish the effectiveness of remaxol in the correction of endogenous intoxication in patients with acute peritonitis. MATERIAL AND METHODS: The work is based on the results of clinical and laboratory studies. The clinic examined 55 patients with acute moderate peritonitis as complication of various diseases (acute appendicitis, perforated gastric or duodenal ulcer, acute intestinal obstruction, acute destructive cholecystitis). Before surgical operation and in the early postoperative period we evaluated the severity of endogenous intoxication by the level of hydrophilic and hydrophobic toxic products. The content of molecular products of lipids peroxidation - oxidative stress, phospholipase activity were determined in the blood plasma. In the study group (n = 28) in the postoperative therapy additionally included remaxol (400 ml intravenous fluids). RESULTS: Research established that the occurrence of endogenous intoxication syndrome in patients with acute peritonitis associated with the activation of oxidative stress and phospholipases, high intensity of which is maintained even after elimination of the source of peritonitis with manifestation on the 1st day after surgery. Remaxol include leads to a significant reduction in the severity of intoxication syndrome in patients with acute peritonitis. Positive effect of the drug on the correction of endogenous intoxication is largely determined by its ability to significantly reduce oxidative stress and the activity of phospholipases, as the most important membrane destabilizing agents. The greatest detoxication effect of the drug is recorded when it is applied already at the preoperative stage of patients when its ability to reduce the activity of trigger agents of catabolic processes implemented to the greatest extent. CONCLUSION: In acute moderate peritonitis, remaxol use before surgery or in the early postoperative period in complex therapy leads to a significant correction of factors contributing to the development and preservation of the intensification of catabolic processes - one of the sources of endogenous intoxication.

[Pharmacological effects of remaxol on endotoxicosis of peritonitis genesis].

It is found that the drug remaxol, which possesses antioxidant and antihypoxant properties, is also highly effective in correction of metabolism disorders in the kidneys with peritoneal endotoxicosis. The high neuroprotective effect of remaxol is related to its ability to correct the lipid metabolism violated by hypoxia phenomena in tissues, to decrease peroxidation of lipids and activity of phospholipase A2, and to recover intrinsic antioxidant potential of cellular structures of the kidney.

[Decision on the strategy of treatment of acute cholecystitis in high operative risk patients].

Based on their personal experience with treatment of 118 patients the authors consider that sanitation-decompression percutaneous-transhepatic punctures of the gallbladder under US control can be used for arresting the inflammation process. The integral scales SAPS-II and POSSUM allow identification of groups of patients with high operative risk. The strategy of treatment depends on both the state of the patient and results of USI. The detection of an obturating concrement in the gallbladder neck requires punctures for decompression of the gallbladder and attempts to reestablish normal bile passage in addition to conservative therapy at early terms.

[Quality of diagnosis and prophylaxis of HIV-infection in military clinical institutions and related problems in training medical personnel].

The analysis of results of laboratorial diagnostics of HIV-infection in multiprofile treatment institute of the Ministry of Defense of RF, questioning of medical staff on the questions of diagnostics and treatment of HIV-infection discovered several disadvantages in the system of training of the physicians in this sphere. Insufficient level of knowledge of practical aspects of HIV-infection causes baseless quantity of screening laboratorial tests (up to 70%). It leads to grand material inputs of the Ministry of Defense of RF. The authors propose an elaborated guidance manual for teachers, attending physicians and students of academies on studying questions of HIV-infection, based on the principle of "transparent study", on broad engaging of different departments to the process of teaching, on consideration of profiles of cycles of studying, of levels of adoption, types of lessons, volume of study time.

[Infantile hemangiopericytoma: a clinico-morphological study of 10 cases].

Infantile hemangiopericytoma (IH) is a rare mesenchymal tumor of the extremity and trunk soft tissues with medium potential grade. Its clinical course and prognosis on the basis of morphological evidence are unpredictable. IH consists of CD34-positive fibroblasts forming around fissural vessels. Some tumors feature non-hemangiopericytic structures. IH is morphologically identifiable by comparing with other infantile fibroblastic tumors, such as myofibroma and solitary fibrous tumor. Immunomorphological examination is essential to assure proper diagnosis of IH.

[Variants of surgical treatment of acute cholecystitis in high operative risk patients].

Results of surgical treatment of acute cholecystitis were analyzed in 105 patients. Immediate results of laparoscopic cholecystectomy and immediate and long-term results of puncture treatment were estimated. It was shown that in patients with extremely high degree of the operation risk (IV-V degree by ASA) the puncture treatment of acute cholecystitis judged by immediate results proved to be effective in 75% of the patients, and the effect judged by long-term results was 92.5%.

[Testing the procedure for virtual colonoscopy and its possible place in the algorithm of study of colonic diseases].

The paper presents the experience in testing virtual colonoscopy on examining patients with colonic diseases. The potentialities of virtual colonoscopy in imaging tumors, polyps, diverticula, and strictures of the colon are assessed. The place of the procedure in the algorithms of examination of patients is defined. Its advantages and disadvantages are preliminarily estimated.

[Spectrum and coherent characteristics of bioelectric activity of the brain in women with normal and complicated pregnancy]. / Spektral'nye i kogerentnye kharakteristiki bioélektricheskoi aktivnosti mozga zhenshchiny pri normal'noi i oslozhnennoi beremennosti.

Spectrum and coherent EEG analysis was performed in 86 pregnant women on the 35-36th week of gestation. It was shown that functional interhemispheric brain asymmetry is a sensitive index of normal and complicated gestation. It was found out that activation prevailing in the central and temporal brain areas contralateral to the side of placenta localization in the uterus was characteristic of the normal pregnancy. The development of gestation complications was accompanied by the inversion of interhemispheric asymmetry of EEG activation. It was suggested that correlative properties of bioelectric brain activity in women with normal gestation are an indicator of the left-hemispheric dominance of brain centers in the integration process.

[Decision for the method of surgical treatment of acute destructive pancreatitis]. / Vybor metoda khirurgicheskogo lecheniia ostrogo destruktivnogo pankreatita.

The work presents results of treatment of 375 patients with acute pancreatitis, 93 patients with destructive pancreatitis were operated upon. Minimally invasive and traditional technologies were used. Postoperative lethality was 6.5%. The method of lumboscopic extraperitoneal drainage of the destruction focus under the control of laparoscopy and USI is described. The percutaneous paracenthetic-draining interventions under the control of USI and endovideosurgical technologies were shown to be highly effective in treatment of patients with acute destructive pancreatitis and its complications.

[Direct results of endovideosurgical transabdominal adrenalectomy]. / Neposredstvennye rezul'taty énovideokhirurgicheskoi transabdominal'noi adrenaléktomii.

Results of transabdominal adrenalectomy performed in 29 patients with different tumors of the adrenals were estimated. The lower traumaticity of the access due to using a new technology as well as taking prophylactic measures for lower aggressive influence of the pneumoperitoneum allowed performing combined operative interventions in 30% of cases and avoiding serious intra- and postoperative complications.

[Diagnosis and choice of the method of surgical treatment of pancreatic cysts using ultrasonic examination]. / Diagnostika i vybor metoda khirurgicheskogo lecheniia kist podzheludochnoi zhelezy s ispol'zovaniem ul'trazvukovogo issledovaniia.

A more than 10 year experience of using operative interventions under the control of ultrasound has shown that in order to solve the task of improving the results of surgical treatment of cysts of the pancreatic gland it is necessary to improve a number of diagnostic and organizational measures allowing to perform the early and effective diagnosis of the cysts and their timely treatment. The percutaneous puncture-drainage operations with sclerotherapy are indisputably considered to be highly effective in treatment of cysts of the pancreas. In most patients, however, the clinical and ultrasonic signs of pancreatitis are still retained. These patients need permanent dynamic observation and conservative therapy.

[Evaluation of the functional state and working capacity of patients with chronic toxoplasmosis]. / Otsenka funktsional'nogo sostoianiia i rabotosposobnosti bol'nykh khronicheskim toksoplazmozom.

Operator's main functions were studied in 78 patients with chronic toxoplasmosis during the period of disease aggravation and during the following 6 months. It was revealed that marked disorders in higher nervous activity and psychomotor system are observed in the patients during the period of aggravation, significantly more expressed during disease recurring course. It is reasonable to examine servicemen with chronic toxoplasmosis using psychologic and psychophysiologic methods before treatment and in 6 months after its completion. Without clear tendency towards improvement of professionally significant qualities in 6 months after treatment (level of neurotization, psychopathyzation, comparative number of mistakes in attention test and during reckon in head, delayed memory, positive tapping-test) it is not recommended to use servicemen at the posts having operator's profile and connected with long staying in secluded small collectives.

[The current objective criteria for the adequacy of general anesthesia in children]. / Sovremennye ob''ektivnye kriterii adekvatnosti obshchei anestezii u detei.

Auditory evoked potentials (AEP) were recorded and analyzed in 12 children during general halothane and ketamine anesthesia. Ketamine suppressed the amplitude of primary negative component and eliminated secondary AEP components with latencies more than 60 ms, including N-200 and P-300 waves. By contrast, halothane did not affect primary components with less than 95 ms latencies and suppressed the latest components. Hence, ketamine suppresses the nonspecific afferent pathways and the brain structures responsible for memory and emotional functions, while halothane does not affect the afferent pulsation and partially suppresses emotional and mnemonic functions.

[A methods of laparoscopic suturing of perforated pyloro-bulbar ulcers]. / Tekhnika laparoskopicheskogo ushivaniia perforativnykh pilorobul'barnykh iazv.

The article describes a method of laparoscopic suturing perforated ulcers of the pylorobulbar zone. The elements of all steps of the operation are analyzed including the places of introducing the trocar, the method of putting the intracorporeal stitches, means of sanitation and drainage of the abdominal cavity. The method was successfully used in operations on 43 patients with perforated ulcers without any complications.

[The immediate results of laparoscopic treatment in perforated gastroduodenal ulcers]. / Neposredstvennye rezul'taty laparoskopicheskogo lecheniia pri perforativnykh gastroduodenal'nykh iazvakh.

The article presents an analysis of immediate results of laparoscopic interventions (suturing, vagotomy) in 40 patients with perforated ulcers in the pylorobulbar zone. Postoperative complications were noted in 7.5% of the patients. There were no lethal outcomes. The authors recommend wider introduction of the laparoscopic technology as a method of optimization of surgical treatment for perforated ulcers.

[Use of laparoscopic methods in combined surgery]. / Ispol'zovanie laparoskopicheskikh metodov pri sochetannykh operatsiiakh.

The authors have made a comparative analysis of the effectiveness of isolated and combined laparoscopic cholecystectomies. The control group consisted of 246 patients subjected to isolated cholecystectomies. The group under study included 22 patients in whom combined cholecystectomies were performed. The comparative analysis included the following clinical data: duration of the operation, number of postoperative days in the hospital, amount of postoperative complications. It was concluded that the little-invasive laparoscopic technique used in one of the steps of the combined operation allowed traumatism of the surgery to be decreased which in its turn allowed wider indications to combined operations.