[Diagnostic and conservative treatment nuances in patients with obstructive jaundice: in the wake of Russian consensus].

The research was performed at the Loginov Moscow Clinical Scientific Center. It is based on Russian obstructive jaundice (OJ) consensus results, considered at the 45th annual Central Research Institute of Gastroenterology Scientific session Oncological issues in the gastroenterologist practice (1 March 2019). The article objective is to note the diagnostic and conservative treatment current issues in patients with OJ. The increase in the number of patients with OJ of different etiology provides problem actuality. In a large number of cases, medical treatment is delayed due to inadequate diagnostic and management, while correct patients routing today can be provided regardless of medical institution level. In this article the examination steps and conservative treatment role in patients with biliary obstruction management are presented.

[Russian consensus on current issues in the diagnosis and treatment of obstructive jaundice syndrome]. / Rossiiskii konsensus po aktual'nym voprosam diagnostiki i lecheniya sindroma mekhanicheskoi zheltukhi.

The Russian consensus document on topical issues of the diagnosis and treatment of obstructive jaundice syndrome was prepared by a group of experts in various fields of surgery, endoscopy, interventional radiology, radiological diagnosis and intensive care. The goal of this document is to clarify and consolidate the opinions of national experts on the following issues: timing of diagnosis of obstructive jaundice, features of diagnostic measures, the need and possibility of conservative measures for obstructive jaundice, and strategy of biliary decompression depending on the cause and level of biliary block.

[The features of opisthorchiasis papillitis diagnosis]. / Osobennosti klinicheskoi diagnostiki opistorkhoznogo papillita.

AIM: To develop an optimal diagnostic algorithm in order to the most reliable decrease of inflammatory changes severity in large duodenal papilla in patients with chronic opisthorchiasis. MATERIAL AND METHODS: Medical reports of 384 patients with opisthorchiasis-induced cholangitis have been analyzed. Diagnostic methods were abdominal ultrasound, endoscopic ultrasound of terminal common bile duct, CT scans, MRI of abdominal organs including magnetic resonance cholangiopancreatography and esophagogastroduodenoscopy with biopsy of the papilla, ERCP and PTHC. Comprehensive general and individual analysis of each of them has determined their advantages and disadvantages. CONCLUSION: Examination should by comprehensive to evaluate visual appearance of large duodenal papilla, lumen dimensions, state of its walls with histological research. Imaging tests are favorable to determine the diagnosis of papillitis due to possible assessment of lumen dimensions and state of the walls. While making a choice the priority should be given to endoscopic ultrasound examination. It allows visual inspection, assessment of the lumen, the walls of papilla and provides biopsy of deep structures.

Russian consensus on exo- and endocrine pancreatic insufficiency after surgical treatment.

The Russian consensus on exo- and endocrine pancreatic insufficiency after surgical treatment was prepared on the initiative of the Russian "Pancreatic Club" on the Delphi method. His goal was to clarify and consolidate the opinions of specialists on the most relevant issues of diagnosis and treatment of exo- and endocrine insufficiency after surgical interventions on the pancreas. An interdisciplinary approach is provided by the participation of leading gastroenterologists and surgeons.

[The Russian consensus on the diagnosis and treatment of chronic pancreatitis: Enzyme replacement therapy]. / Rossiiskii konsensus po diagnostike i lecheniiu khronicheskogo pankreatita: zamestitel'naia fermentnaia terapiia.

Pancreatology Club Professional Medical Community, 1A.S. Loginov Moscow Clinical Research and Practical Center, Moscow Healthcare Department, Moscow; 2A.I. Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of Russia, Moscow; 3Kazan State Medical University, Ministry of Health of Russia, Kazan; 4Kazan (Volga) Federal University, Kazan; 5Far Eastern State Medical University, Ministry of Health of Russia, Khabarovsk; 6Morozov City Children's Clinical Hospital, Moscow Healthcare Department, Moscow; 7I.I. Mechnikov North-Western State Medical University, Ministry of Health of Russia, Saint Petersburg; 8Siberian State Medical University, Ministry of Health of Russia, Tomsk; 9M.F. Vladimirsky Moscow Regional Research Clinical Institute, Moscow; 10Maimonides State Classical Academy, Moscow; 11V.I. Razumovsky State Medical University, Ministry of Health of Russia, Saratov; 12I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow; 13S.M. Kirov Military Medical Academy, Ministry of Defense of Russia, Saint Petersburg; 14Surgut State Medical University, Ministry of Health of Russia, Surgut; 15City Clinical Hospital Five, Moscow Healthcare Department, Moscow; 16Nizhny Novgorod Medical Academy, Ministry of Health of Russia, Nizhny Novgorod; 17Territorial Clinical Hospital Two, Ministry of Health of the Krasnodar Territory, Krasnodar; 18Saint Petersburg State Pediatric Medical University, Ministry of Health of Russia, Saint Petersburg; 19Rostov State Medical University, Ministry of Health of Russia, Rostov-on-Don; 20Omsk Medical University, Ministry of Health of Russia, Omsk; 21Russian Medical Academy of Postgraduate Education, Ministry of Health of Russia, Moscow; 22Novosibirsk State Medical University, Ministry of Health of Russia, Novosibirsk; 23Stavropol State Medical University, Ministry of Health of Russia, Stavropol; 24Kemerovo State Medical University, Ministry of Health of Russia, Kemerovo; 25N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia, Moscow; 26A.M. Nikiforov All-Russian Center of Emergency and Radiation Medicine, Russian Ministry for Civil Defense, Emergencies and Elimination of Consequences of Natural Disasters, Saint Petersburg; 27Research Institute for Medical Problems of the North, Siberian Branch, Russian Academy of Sciences, Krasnoyarsk; 28S.P. Botkin City Clinical Hospital, Moscow Healthcare Department, Moscow; 29Tver State Medical University, Ministry of Health of Russia, Tver The Russian consensus on the diagnosis and treatment of chronic pancreatitis has been prepared on the initiative of the Russian Pancreatology Club to clarify and consolidate the opinions of Russian specialists (gastroenterologists, surgeons, and pediatricians) on the most significant problems of diagnosis and treatment of chronic pancreatitis. This article continues a series of publications explaining the most significant interdisciplinary consensus statements and deals with enzyme replacement therapy.

[Assessment of the effectiveness of the suture with triclosan coated in emergency surgery]. / Otsenka effektivnosti primeneniya shovnogo materiala s pokrytiem iz triklozana v ekstrennoi khirurgii.

The aim of the study was to evaluate the effectiveness of the suture with a coating of triclosan on the dynamics of postoperative course in emergency surgical patients, comparing the postoperative period in the application of the suture with coating and without it. DESIGN: A prospective cohort with a solid retrospective control group. The efficiency of the application of the suture with a coating of triclosan on the flow dynamics in the early postoperative period 678 emergency surgical patients, comparing the postoperative period when using the coated suture material (292 patients) and without (386 patients). EVALUATION CRITERIA: Time of normalization of body temperature and restore the function of the gastrointestinal tract, the duration of hospital treatment, the need for antibiotic prophylaxis and antibiotic therapy, the incidence of postoperative complications (in general and SSI). It was found a statistically significant effect of the application of the suture with triclosan to reduce the incidence of SSI. The economic effect of using SMT is only by reducing the average duration of hospital treatment amounted to 1 723 238 rubles in one year.

DIAGNOSTICS AND TREATMENT OF OBSTRUCTIVE JAUNDICE AT CHRONIC OPISTHORCHIASIS.

A comparative analysis of possibilities of visual methods of diagnostics was made in order to reveal the causes of obstructive jaundice in chronic opisthorchiasis. There was estimated the possibility of topical diagnostics of rate and character of the bile passages block while conducting MR-imaging cholangiography. Types of architectonics of the bile passages were specified in chronic opisthorchiasis. A differentiated algorithm of treatment was developed and applied in relation to the obtained data.

[Mini-invasive technologies for the acute pancreatitis treatment].

Results of treatment of 2415 patients with acute pancreatitis, including 285 cases of the acute necrotizing pancreatitis, are analyzed. The algorithm of diagnostics and treatment of this category of patients is worked out and successfully applied. The comparative results of the acute pancreatitis treatment before (1995-1999) and after (2000-2005) introducing the algorithm to practice are analyzed. Thus, the rate of postoperative complications decreased from 16,7 to 4,95% and postoperative lethality came down from 25 to 9,1%.

[Endoscopic chromoscopy in diagnosing and treatment of complicated gastroesophageal reflux disease].

The authors describe the results of examination and endoscopic treatment of 278 patients with clinical symptoms of gastroesophageal reflux disease. The method of fibroesophagoduodenoscopy with 3% Lugol aqueous solution chromoscopy was introduced in medical-diagnostic algorithm of the patients. Inclusion of chromoendoscopy in the program of examination and treatment of patients with gastroesophageal reflux disease allowed higher detection of severe epithelial dysplasia (to 10.3%), leukoplakia (to 62.1%) and esophagus cancer (to 3.5%) and improvement of the results of endoscopic treatment.

[Treatment of the patients with complications of colon malignant tumors].

Results of surgical treatment of 106 patients with complications of colon malignant tumors are analyzed. Diagnostic and treatment algorithm for these patients has been developed and used in clinical practice. Standardization and use of this algorithm permitted to increase the rate of radical operations from 48.9 to 62.6%, to reduce the rate of purulent complications more in 2 times and postoperative lethality - in 1.6 times.

[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.

[Prophylactics of complications of operations on the colon (experimental-clinical investigation)].

One of important aspects influencing the results of surgical treatment of patients with diseases of the colon is thought to be stepwise diagnostic and treatment measures. A retrospective analysis of treatment of 171 patients with pathology of the colon has been made. A medical-diagnostic algorithm has been developed and introduced which allowed improvement of effectiveness of medical aid in the group under study. Of importance was also modernization of certain technical aspects of operation. Efficiency of the developed method of the formation of colonic anastomosis with strengthening the line connection with a plate "Tahokomb" was proved in experiment and confirmed in clinical practice. The application of the medical-diagnostic algorithm allowed unification and standardization of approaches to treatment of patients with a pathology of the colon and better results were obtained with 3 times less number of complications.

[Evaluation of results of surgical treatment of peptic ulcer associated with Helicobacter pylori]. / Otsenka rezul'tatov khirurgicheskogo lecheniia iazvennoi bolezni, assotsiirovannoi s Helicobacter pylori.

Under observation there were 82 patients operated on for ulcer disease of the stomach and duodenum. Dissemination of the mucosa with Helicobacter pylori (HP) was studied by means of using the urease test. Before the operation the positive result of the study was obtained in 73 patients (89%). In 1-6 months after the operation the HP infection was found in 29 patients (39.7%). The HP persistence retained in 39.7% of the patients subjected to resection of the stomach in spite of the preoperative treatment including De-nol and Metronidazole. Post-resectional reflux-gastritis and anastomositis were more pronounced in HP carriers. The antireflux variants of anastomoses (transversal, terminolateral gastroduodenal anastomosis and gastrojejunal anastomosis by Roux) were followed by much less HP persistence and less frequent cases of anastomositis and gastritis of the gastric stump.

[Stomach injury]. / Povrezhdenie zheludka.

The results of treatment of 221 patients with injury to a stomach (IS), whose age range was from 3.5 to 71 years, have been analysed. Closed IS was noted in 9 (4.1%), open--in 212 (95,9%), isolated--38.5%. The main method of operative treatment (in 92.8% of sufferers) was the organ closure. Surgical errors were made in 9.5% of the patients. The postoperative complications occurred in 75 (33.9%) sufferers. Total lethality was 11.8%. A good long-term result of treatment was noted in 48.0%, a satisfactory one--in 45.2%, an unsatisfactory one--6.8% patients.

[Prevention of incompetence of sutures of the colon in its injuries]. / Profilaktika nesostoiatel'nosti shvov obodochnoi kishki pri ee povrezhdeniiakh.

The authors analysed 242 clinical cases of open and closed injury to the colon and the results of experiments on 120 animals. Incompetence of the sutures of the colon was encountered in 12 (4.9%) patients: in 10 (5.2%) with punctured-incised injuries, in one (3.3%) with subcutaneous rupture, and in one (5.5%) with gunshot injury. Clinico-experimental studies allowed 2 groups of pathogenetic factors (predisposing and resolving) in the development of incompetence of colonic sutures to be distinguished. The pathogenetic approach forms the basis of the developed complex program of the prevention of incompetence of the sutures of the colon in its injuries. Introduction of the suggested program into clinical practice made it possible to reduce the incidence of incompetence of colonic sutures from 6.6 to 2.0%.

[Surgical treatment of injuries of the colon]. / Khirurgiia povrezhdenii obodochnoi kishki.

Having analyzed results of treatment of 214 patients with an injury of the colon and its mesentery the authors have made a conclusion that most typical errors are related with problems of diagnostics in closed and associated trauma of the colon and the absence of single tactical recommendations in choice of the optimum operation volume. The primary suture of the gut was performed in 165 patients, in 9 patients suturing was supplemented by proximal colostomy. Resection of the intestine with a one-lumen anus was performed in 9 patients, and resection with primary anastomosis--in 6 patients more. In 2 patients the injured loop was brought onto the anterior abdominal wall. For decompression of the gut lumen after its resection or suturing the wound the authors propose a method of the duct decompression lavage of colonic anastomoses which was used in 7 patients. Pyo-septic complications were noted in 79 patients, 23 patients died (10.7%).