[Surgical hospital endotoxicosis as a problem of clinical gastroenterology].

The original conception of "surgecal endotoxicosis" is presentation in the artical. MATERIALS AND RESEARCH METHODS: 2064 of a patients and results of 320 autopsies was divided into 4 groups in depending with bowel dysfunctions. There is the new classification of surgecal endotoxicosis in this article. Also the authors propose some technologies of detoxication.

[Influence of pectin containing drug on the mucous membrane of digestive tract at the intestinal insufficiency].

There was marked a beneficial effect during using pectin containing drug in the postoperative treatment of intestinal insufficiency, as was confirmed by evaluation of biopsy specimens of gastric mucosa, jejunum and sigmoid colon. Morphologically, it was expressed in chronic inflammation without acute manifestations. Restoration of the morphological structure of the small intestinal mucosa at 7th day of the usual treatment was observed in 50% of patients but during treatment using a modified pectin containing drug at 80%, ie in 1,6 times more often.

[Opportunities of the enterosorption and evolution of the enterosorbent for surgical treatment of endotoxicosis].

In this article was shown the efficiency of enterosorbtion in various departments of medicine. You can find a comparative assessment of different enterosorbents. Were presented results of own using of pectin containing sorbents for enterosorbtion and nutritional support in surgical treatment of endotoxemia on the background of intestinal insufficiency syndrome in 161 patients. Application of the PCD had reduced bed-day in 1,4 times and mortality--a 2.05-times in compare with conventional treatment in the control group of 171 patients of the paired samples.

[Hepato-renal syndrome and problem of protein-energy metabolism correction during urgent surgery of the abdominal organs].

Early connecting of hardware detoxification methods allow more efficient use of amino acid preparations for action. The use of efferent technology provides a full correction of protein and energy metabolism in the immediate surgical patients with complicated diseases of the abdominal cavity. This will reduce bed-day in patient and surgical mortality.

[Role of reconstructive vascular surgery in patients with diabetic angiopathy].

Treatment results were analyzed in 1244 patients with diabetic angiopathy. 882 of them had necrotic suppurative affection of feet. Distal affection predominated among patients with neuroischemic form of diabetic foot syndrome. Combined affection of popliteofemoral and tibial-foot segments was revealed in 46.3% of observations. Stenosis of ileofemoral arterial segment was discovered in 40 (4.9%) patients, occlusion--in 27 (3.3%) patients. Reconstructive operations on aorta and great vessels were carried out to 520 patients; among them: aorto-femoral bifurcational bypass--to 38 patients, proximal popliteofemoral bypass--to 191 patients, distal popliteofemoral bypass--to 195 patients, tibiofemoral bypass--to 96 patients. Thrombosis in reconstruction region was observed in 41% of patients after popliteofemoral bypass including 16% in short-term period and 25% after a year. Low frequency of large amputations amounting 20.4% and low lethality (3.2%) indicated that bypass operations are highly effective in this group of patients.

[Immunocorrection in the treatment of diffuse peritonitis in aged patients].

The results of treatment of 161 patients with diffuse forms of peritonitis with, using of the immunostimulators are analyzed. The algorithm of staged complex immunocorrection for patients with acute pancreatitis, including aged patients, is worked out. The use of it improves the results of treatment and allows decrease the morbidity.

[Diagnostic and management algorithm of acute pancreatitis].

The analysis of diagnostics and treatment of 602 patients with destructive pancreatitis has shown that definition of etiological and pathogenetic forms of pancreatitis defines strategy of treatment. In this way, patients with biliary pancreatitis require emergency operative treatment with use of endoscopic interventions without dependence from a stage of disease. To patients with alcoholic or alimentary pancreatitis in the stage of enzymatic toxemia conservative treatment should be spent only, until shock and/or delirium won't be reduced. Endoscopic retrograde cholangiopancreatography + endoscopic papillosphincterotomy with concrement removal from common bile duct--is the operation of choice in case of acute biliary pancreatitis at the first stage. Laparoscopic cholecystectomy is the operation of choice at the second stage of disease. At destructive pancreatitis of other origin in a stage of the infection or necrotic suppurative inflammation use of open and closed small invasive methods of intervention is most proved. Given tactics of treatment has allowed to lower severity of clinical course, frequency of complications and lethality.

[Evolution of views of the surgical treatment of acute destructive pancreatitis].

An analysis of results of surgical treatment of 468 patients with acute pancreatitis has shown how the views of the diagnosis and treatment of patients with acute pancreatitis have been changing for the recent 10 years. Using the optimized therapy-diagnosis doctrine including the procalcitonin test for diagnosing of the extent and infection of the destruction process in the pancreas and cellular spaces, pathogenetically directed conservative therapy using various methods of extracorporal detoxication, refusal of early wide surgery, using the methods of little invasive surgery and step-by-step sanitations with ultrasonic cavitation resulted in decreased postoperative lethality from 23.9% to 6.7%.

[Prediction of surgical infections severity at elderly and old patients].

Clinical and immunological characteristics of generalized peritonitis in different age group at complicated and non-complicated postoperative period were analyzed at 246 patients with abdominal purulent infection. Prognostic criteria of complicated postoperative period at elderly and old patients have been determined. It is concluded that interpretation of immune characteristics permits to determine the prognostic criteria of disease course and outcome at various age group, and to use the rational immunocorrection.

[Purulent and necrotic complications of diabetic foot syndrome and their reflection in ICD-10 and standards of insurance medicine].

Treatment of 1046 patients with complicated forms of diabetic foot is analyzed. New classification of purulent and necrotic complication of diabetic foot is described. Current medical-economic standards for diabetic foot complicated forms are subjected to criticism. A new concept of the medical-economic standard is discussed.

[Simultaneous operations through mini-approach in patients with multifocal atherosclerosis and cholelithiasis].

The experience with simultaneous operations in 16 patients with multifocal atherosclerosis and cholelithiasis is analyzed. The operations were performed simultaneously through two mini-approaches with original "mini-assistant" devices. Short- and long-term postoperative results are analyzed, indications and surgical techniques through mini-approach in elderly patients are reported.

[Enterosorption and nutritious support with pectin-containing preparation in the treatment of stress immunodeficiency in peritonitis].

Fifty-eight patients aged from 18 to 65 years with peritonitis of different etiology in toxic and terminal phases were treated. Nasoenteral intubation, enterosorption and early nutritious support with pectin-containing preparation (PCP) were carried out in all the patients just after surgery with standard course of 5 days. Baseline data was compared with that after PCP-supported treatment. Powder products of red beet were used as PCP. Immunodeficiency in peritonitis is characterized by imbalance of stress-realizing and stress-limiting mechanisms of immunocompetent cells. Enterosorption and early nutritious support with PCP in peritonitis decrease the level of plasmic cortisol and enhance stress-limiting reception that reduces a harmful effect of cortisol and reestablishes immunity.

[Cost-effect evaluation of different variants of cholecystectomies].

Short-term results of treatment and cost-effect rates were analyzed in three groups of patients undergone traditional cholecystectomy, laparoscopic cholecystectomy and cholecystectomy through minilaparotomy. It was demonstrated that frequency of complications was less after operations through laparoscopy and minilaparotomy. Traditional approach had the most costs due to more number of postoperative complications, hospital stay after surgery and more number of analgesics. Cholecystectomy through minilaparotomy is most cost-effective due to high clinical effectiveness, short hospital stay and rare complications. This procedure does not require expensive devices and can be performed with regional anesthesia only. It is concluded that minimally invasive methods of cholecystectomy must be used more widely.

[Enterosorption with pectin-containing medication in the treatment of peritonitis].

UNLABELLED: One hundred and fifty patients aged 19 to 86 years with general peritonitis mainly in a toxic (85.3%) stage were examined. The leading causes of peritonitis were acute appendicitis (24.0%) and perforation of gastroduodenal ulcers (21.3%). Three groups of patients were formed with a pair samples method for a comparative analysis of treatment RESULTS: The control group of patients was treated conventionally. Entero-sorption was performed through naso-intestinal tube with well-known carbonic sorbent UAO-A and pectin-containing medication made of red beet. The results were compared. A 1.3-fold decrease in entero-paresis naso-intestinal intubation duration, a relief in severity of the patients' condition by SAPS scale as early as on day 2, improvement of immunity indices, faster reduction of toxicity of blood plasma and leukocytic index of intoxication, a 12% decrease in postoperative pneumonia morbidity and postoperative lethality from 14 to 6.6% demonstrated advantages of entero-sorption with pectin-containing medication.

[Effect of the anesthesia method on the immune status of gerontological patients during abdominal operations]. / Vliianie vida obezbolivaniia na immunnyi status gerontologicheskikh bol'nykh pri abdominal'nykh operatsiiakh.

As a rule, gerontological patients have a combination of senile physiological immunodeficiency and secondary immunodeficiency caused by various diseases. These states of the immune system are aggravated by stress immunodeficiency formed as a result of operative traumas and anesthesia. The immunodeficiency state (IDS) of such patients in many respects is determined by their interleukine status. Patients operated on abdominal cavity organs by the life-saving indication according to a delayed or scheduled procedure under conditions of epidural anesthesia (45 patients), spinal anesthesia (43 patients) and general anesthesia (41 patients) were examined. When generalizing the obtained results, it is necessary to mention that various types of anesthesia have a different effect on the immune and interleukine status of gerontological patients.

[The impact of the type of anesthesia on stress-realizing and stress-limiting mechanisms of the immune system in gerontological patients at abdominal surgeries]. / Vliianie vida obezbolivaniia na stress-realiziruiushchie i stress-limitiruiushchie mekhanizmy immunnoi sistemy u gerontologicheskikh bol'nykh pri abdominal'nykh operatsiiakh.

Surgical stress resulting from the operative morbidity and narcosis aggravates the associated age-related and secondary immunodeficiency of gerontological patients at surgeries. Stress hormones have a strong depressing effect on the immunity by forming stress immunodeficiency. Not only high blood level determines the damaging effect of stress hormones but also the activity of stress-limiting mechanisms of the immune system protect it from the damaging effect of stress hormones. In this connection, the impact of operative morbidity and anesthetic aggression on the activity of stress-realizing and, in particular, stress-limiting mechanisms plays an important role because of the frequency of postoperative complications in gerontological patients namely. We observed patients operated on the abdominal cavity by urgent indications with a delay or based on a schedule under conditions of epidural anesthesia (45 patients), spinal anesthesia (43 patients) and general anesthesia (41 patients). The analysis of data obtained shows that different types of anesthesia have different effect on the plasmic cortisol level and activity of stress-realizing and stress-limiting systems. Thus, in case of epidural anesthesia of gerontological patients it was possible to observe the reduction of the high plasmic cortisol level and activation of stress-limiting reception of immunocompetent cells contributing to the preservation of the immune function. The increased plasmic cortisol level accompanied spinal anesthesia applied to such patients. However, it did not suppress the stress-limiting reception protecting the immunity against the damaging action of cortisol. In case of general anesthesia of gerontological patients it was possible to observe the increased blood cortisol level and decreased activity of protective stress-limiting receptors contributing to the formation of glucocorticoid immunosuppression.

[Laser doppler flowmetry for assessment of acute pancreatitis treatment efficacy]. / Ispol'zovanie lazernoi dopplerovskoi floumetrii dlia otsenki éffektivnosti lecheniia ostrogo pankreatita.

Microcirculation was studied with laser doppler flowmetry in 226 patients with acute destructive pancreatitis treated with standard detoxication, antiinflammatory, antibacterial and surgical methods. The examination was performed on the unit LAKK-01 (NPP 'Lazma', Russia) by original methods based on the study of microcirculation in biologically active points. Based on analysis of 2500 dopplerograms, criteria of assessment of organic and systemic capillary circulation and also laser doppler flowmetric characteristics of 4 degree microcirculation's insufficiency were developed. The proposed scheme was effectively applied for assessment of each medical procedure and of all curative complex in general.

[Use of millimeter wave therapy in treatment of acute pancreatitis]. / Ispol'zovanie millimetrovoi volnovoi terapii v lechenii ostrogo pankreatita.

The observations were performed in 226 patients with acute destructive pancreatitis. In 152 patients the medical complex was supplemented with a program of photo-millimeter-wave therapy in which the electromagnetic radiation of the millimeter diapason combined with red and green light was used with due regard for the disease stage. The inclusion of photo-millimeter-wave therapy in the complex of treatment starting from the 2-3 days of disease promoted a decrease of the systemic inflammatory reaction, rapidly improved the general condition of the patients, reduced the occurrence of infectious forms of pancreanecrosis, lethality and time of hospital staying of the patients. The inclusion of photo-millimeter-wave therapy since the 10-15th day did not influence the duration of hospitalization but resulted in more favorable course of the disease and less lethality.