[Endovideosurgical intrascrotal access for diagnosis and treatment of diseases of the scrotum]. / Endovideokhirurgicheskii vnutriskrotal'nyi dostup dlya diagnostiki i lecheniya zabolevanii organov moshonki.

Authors have developed technique of endoscopic inspection of scrotal organs allowing to visualize sufficiently well the poles of testis with head and tail of epididymis, posterior-lateral space behind the epididymis and to perform targeted biopsy of ovarian tissue thus decreasing traumatic effects of the operation. Endoscopy of scrotal organs has been performed in 11 patients with azoospermia of different origin. 18 endoscopic videosurgical examinations have been performed before carrying out Micro-TESE and 10 biopsies of ovarian tissue have been made under visual control with the same patients. Resection of hydatid with its torsion under the condition of artificial hydrocele has been performed in 1 patient with good results.

[Giant complicated duodenal ulcer in patient with diabetes mellitus]. / Gigantskaia oslozhnennaia duodenal'naia iazva u bol'noi sakharnym diabetom.

Treatment of complicated giant duodenal ulcers is one of the most difficult problems in abdominal surgery. Simultaneous course of diabetes mellitus and giant duodenal ulcer has clinical features and requires correction of the treatment. It is presented case report that may be useful regarding accumulation of knowledge about comorbid course of these pathologies. The patient 58-year old was urgently delivered with signs of gastrointestinal bleeding, ulcerative anamnesis for 15 years, diabetes mellitus type 2 for 8 years. Gastroduodenoscopy revealed chronic giant (2.5×3.5 cm) duodenal ulcer complicated by bleeding and subcompensated pyloric stenosis. Endoscopic hemostasis included drug injection and argon-plasma coagulation. Recurrent bleeding occurred after 22 hours. It was performed Billroth II procedure with resection of 2/3 of the stomach and manual formation of 'difficult' duodenal stump. Cicatricial ring was used as a frame for the stump. Postoperative period was uneventful, patient was discharged after 14 days. This clinical case demonstrates the need for more active surgical strategy in patients with diabetes mellitus and reliability of the proposed method of 'difficult' stump forming.

METHOD OF OPERATIVE TREATMENT OF POSTNECROTIC CYSTS OF THE PANCREAS.

An analysis of treatment results was made in 26 patients with postnecrotic cysts of different degree of maturity. The laparotomy with trans-gastral cystogastrostomy on the external drainage were performed on 11 patients. A new modified operation underwent 15 patients. This operation was transgastric cystogastrostomy on the external drainage from mini-access, which was developed in 2011. The laparotomy of 4­5 cm was made in pseudocyst projection of the pancreas using a standard set of tools «mini-assistant¼. Postoperative period have passed without complications in all the patients. The drainage was removed on 30­40 days of postoperative period. The terms of hospital stay reduced from (14,4±0,9) bed/ days to (10,8±0,5) bed/days due to application of proposed method of treatment.

[Immune disturbances in patients with postnecrotic pseudocysts of the pancreas].

The aim of the study was to investigate the role of immune disturbances in development of postnecrotic pseudocysts of the pancreas. 94 patients including 74 with postnecrotic pancreatitis and pseudocysts of the pancreas were observed. The adaptive reactions and subpopulation composition of the peripheral blood lymphocytes were assayed. The percentage of the cells in the state of apoptosis in the cyst content was estimated. The disturbances in the subpopulation composition of the lymphocytes and stress adaptive reactions of the blood system were shown to be some of the main pathogenetic factors in development of postnecrotic complications of pancreatitis. The data are useful in differential diagnosis of pseudocysts and choice of the optimal tactics in the operative treatment of such patients.

[Methods of intraductal pancreatic hypertension elimination].

The study is devoted to the surgical treatment of benign pancreatic cysts. Results of the internal drainage of pancreatic duct ul system in 76 patients were analyzed. Pancreaticoenterostomy combined with partial pancreatic resection in 21 cases, was performed in 53 patients. The rest 23 patients required no enterostomy of the main pancreatic duct. The lateral pancreaticojejunostomy was performed in 48 patients, of whom 32 patients had an original reconstructive circulation of the intestinal loop applied. By the width of the pancreatic duct less then 5 mm, the original method of resection of the front surface of the pancreas was applied (n=5). The bilateral pancreaticojejunostomy was performed in 3 patients with the pancreatic duct width less then 5 mm and diastasis of the latter. There was no postoperative lethality; complicated postoperative period required reoperation in 5,3%. Long-term results were considered good in 74,6%, satisfactory in 16,4% and unsatisfactory in 9% of patients.

[An original method of the recovery period after medial resection of the pancreas].

A method of rehabilitating stage after medial resection of the pancreas was developed with the width of the main pancreatic duct from 3 to 5 mm, allowing widening the area of the anastomozing surface. The method was used in practice with good nearest results.

[Virtual colonoscopy in the evaluation of colorectal cancer].

548 patients, aged 32-78 years, underwent virtual colonoscopy followed by common optical colonoscopy, which served as a reference standard. 21 tumors were diagnosed, in 2 cases the lesion was identified in segments of colon, where optical colonoscope failed to pass. Thus, sensitivity of the virtual colonoscopy for colorectal cancer was 100% and specificity comprised 92%.

[Method of pancreaticoduodenal resection].

Immediate results of 59 pancreaticoduodenal resections for cancer of the pancreas and 7 - for chronic pancreatitis were analyzed. An original method of pancreaticoduodenal resection was developed consisting in optimization of the recovery phase by making a pancreatogastroanastomosis on the posterior wall of the stomach, subsequent pancreatojejunostomy and then gastrojejunostomy with the gastric stump and circularly enteroenteroanastomosis closed loop of the small intestine with disconnection of them by the machine stitch. Using the new technique operations were performed on 12 patients without complications although total postoperative lethality due to incompetence of the pancreaticodigestive anatomoses after PDR was 6%.

[Prophylaxis of acute pancreatitis during resection of the stomach for "difficult" complicated of duodenal ulcers].

The authors have performed 407 resections of the stomach for duodenal ulcers. In 9 cases the major duodenal papilla was found to be involved into the zone of ulcer destruction. It was noted that operations for "difficult" complicated ulcers of the duodenum with the involvement into the zone of destruction of the major duodenal papilla required a delicate surgical strategy directed to minimization of trauma and blockade of the main factors of the development of acute postoperative pancreatitis, the proximal duodenojejunoanastomosis being the operation of choice for "difficult" complicated ulcers of the duodenum.

[Invagination vasoepididymoanastomosis with application of microsurgical tools].

A variant of microsurgical invagination vasoepididymostomy (patent of the Russian Federation N 2195205, 2002) was developed in 2001-2004 in experiment on 21 mongrel dogs. Fourteen dogs have undergone 22 vasoepididymostomies according to the novel technique and 5 control vasoepididymoanastomoses side-to-side. The proposed operation implies deep antegrade submersion and fixation of the stump of the epididymis duct in the lumen of the deferent duct through a small slit wound of the latter. Duration of the operation is 62 +/- 3 min. Passability of the anastomosis was assessed 6 months after the operation with ejaculate microscopy, retrograde staining of the deferent ducts on the preparations and with microscopy of stained histological sections. Spermatozoa were detected in ejaculate of all the operated on dogs. By microscopy, 20 anastomoses were capable. This operation technique was introduced into clinical practice: 3 patients with epididymic obstruction were operated on. Passability recovered 1.5-2 months after the operation in two of them. Thus, this variant of invagination vasoepididymostomy is perspective for wide clinical practice.

[Drainage of the pancreatic duct].

An original drainage was used for preventing acute postoperative pancreatitis which had a construction providing preventive decompression of the pancreatic duct system acting on the pathogenetic mechanisms of its development, i.e. intraduct hypertension. The principal distinction of the proposed drainage construction is the duct system decompression with the saved physiological way of outflow of the pancreas secretion that eliminates the shortcomings of the external drainage. The drainage described was used in 6 patients after operations on the major duodenal papilla, cicatricial stricture of the papilla, choledocholithiasis. High clinical effectiveness of the method of the pancreatic duct system decompression is shown.

Ultrasonic model of acute pancreatitis.

Acute pancreatitis was modeled in outbred albino rats by contact exposure of the pancreatic lobes to low-frequency ultrasound. This method induces focal destruction of the pancreas not accompanied by damage to the adjacent intact tissues. Morphological study showed microcirculatory disorders, parenchymatous edema, plethoric vessels with diapedetic and focal hemorrhages, and small foci of hemorrhagic impregnation and steatonecrosis in zones locally exposed to low-frequency ultrasound.

[Morphological characteristics of colon polyps]. / Morfologicheskaia kharakteristika polipoza tolstoi kishki.

The most widespread method of removal of the polyps was polypectomy through colonoscope with electrocoagulation of polyp leg or basis. The survey morphological study of 123 bioptates, received from the patients with polyposis, was carried out. For histological study of bioptates, preparations were painted with hematoxylin and cosine. It was determined, that adenomatous polyps were revealed in 66.7 +/- 4.2% of cases, fibrous polyps in 3.3 +/- 1.6% of cases. The results of comparative research of adenomatous polyps have shown, that common tubular polyps were revealed much more onen among adenomatous polyps--in 74.4 +/- 4.8% of cases. Tubular-papillar-villiferous polyps are revealed only in 25.6 +/- 4.8% of cases. Tubular polyps in the majority of cases (62 5.3%) had the expressed degree of dysplasia. The received data correspond the literary data, which shows that glandular T)olvDS concern to the most eood-cmalitv colonal tumours.

[Local sorption-detoxication therapy in combined treatment of acute purulent paraproctitis]. / Mestnaia sorbtsionno-detoksikatsionnaia terapiia v kompleksnom lechenii ostrogo gnoinogo paraproktita.

Efficacy of sorption-detoxication therapy (sorbent SUMS-1) in combined treatment of acute purulent paraproctitis was evaluated. Degree of endotoxication, state of postoperative wound, structural and morphological state of mucosous membrane of the rectum (light, electron microscopy, morphometry of biopsies) were studied. It was found that local use of sorbent increases efficacy of treatment of severe paraproctitis: endotoxicosis eliminates, regional hemo- and lympho-circulation improves, wound regeneration activates.

[Immune and nonimmune variants of acute pancreatitis]. / Immunnyi i neimmunnyi varianty ostrogo pankreatita.

The article gives an analysis of humoral immunity to structural and secretory components of the pancreas in acute pancreatitis. Based on the distinctions revealed the authors determined two variants of the disease--the immune and nonimmune variants which is of great significance in diagnostics and treatment of acute pancreatitis, for the administration of immunocorrecting medicines in particular.

[Humoral immunity and antigens of HLA system in acute pancreatitis]. / Sostoianie gumoral'nogo immuniteta i antigeny sistemy HLA pri ostrom pankreatite.

In the authors investigations patients with acute pancreatitis had antibodies to endogenic antigens: to o-DNA--in 58.5%, to d-DNA--in 53.7%, to n-DNA in 51.2%, to trypsin--in 42.7%, to insulin--in 28.1% and to the tissue antigen of the pancreas--in 19.5%. A rise of serum immunoglobulins' and circulating immune complexes' levels were established. Alterations of humoral immunity in connection with high frequency of antigens HLA A1, B8, B18 associated with disregulation among T- and B-links of immune system detected in patients with acute pancreatitis, represent genetic and humoral mechanisms which mediate the development of autoimmune reactions in this disease.

[Endoscopic and immunomorphological changes in the mucosa of the operated stomach]. / Endoskopicheskie i immunomorfologicheskie izmeneniia slizistoi obolochki operirovannogo zheludka.

The method of dynamic endoscopic observation was used in examination of 288 patients after resections of the stomach. Four types of the inflammatory reaction of the gastric stump mucosa and of the anastomosed intestine were found out depending on the degree and spread of the inflammatory alterations during the postoperative period. A correlation was established between the type of inflammatory and immunomorphological changes and the probability of the appearance of peptic ulcer of the anastomosis.