Effect of lornoxicam therapy on expression of TLR2 and TLR4 mRNA during systemic complications of acute pancreatitis.

Primary pancreatic injury that occurs in acute pancreatitis leads to necrosis of pancreatic cells and is accompanied by the development systemic inflammatory response of varying severity. Systemic inflammatory response, in turn, can lead to the development of multiple organ dysfunction syndrome and death of patients. The release of damage-associated molecular patterns into the extracellular space is the trigger pathological mechanism underlying these processes. The released patterns exert their effects via Toll-like receptors (TLR). These findings suggest that TLR can be considered a new target for therapeutic intervention in acute pancreatitis. We studied mRNA expression of TLR2 and TLR4 in the peripheral blood mononuclear cells from the patients with acute pancreatitis and showed a decrease in the examined parameters associated with lornoxicam treatment. Anti-mediator therapy decreased mortality in these patients.

[The use of fibrin-collagen substance in case of spleen injuries].

Spleen damage is one of the most common injuries of the abdomen. Thus, splenectomy is one of the most common embodiments of the surgical procedure. Justified by the desire of surgeons to perform organ save surgery, which was made possible by the emergence of new hemostatic agents. In this paper, an experimental and clinical study of the effectiveness of fibrin-collagen substance (FCC) "Tachocomb" to hemostasis of spleen injuries was submitted.

[Application of a glue substance in operations on the colon].

The incompetent intestinal suture in the colon is one of the most frequent complications in emergency surgery. A great number of studies have found that the main way to improve the immediate postoperative result is to create optimal conditions for healing the intestinal wall. The results of clinical and experimental research of the drug "Tachocomb" for strengthening the intestinal anastomosis are described. It was shown that this technique allowed the mechanical strength of the anastomosis to be increased by stimulation of reparative processes in the intestinal suture and the microbial contamination to be reduced.

[The systemic inflammatory response syndrome correction in acute destructive pancreatitis].

Acute pancreatitis is a disease of variable severity. In which some patients experience mild, self-limited attacks while others manifest a severe, highly morbid, and frequently lethal attack. The exact mechanisms by which diverse etiological factors induce an attack are still unclear. Recent studies have established the role played by inflammatory mediators in the pathogenesis of acute pancreatitis. In our research we have estimated influence of not steroid anti-inflammatory preparation on synthesis pro-and anti-inflammatory Cytokines at healthy donors and at patients with Acute pancreatitis.

[Corrective effect of cyclooxygenase inhibitor on functional status of mononuclear cells expressing Toll-like receptors].

AIM: To study the influence of the COX inhibitor--lornoxicam (LX)--on Toll-like receptor (TLR)-mediated production of proinflammatory and anti-inflammatory cytokines by peripheral blood mononuclear cells (PBMC) from healthy subjects and patients with acute pancreatitis (AP) in vitro. MATERIALS AND METHODS: Cytokine production by PBMC of healthy donors was stimulated by TLR1/2 ligand peptidoglycan (PG) and TLR4 ligand lypopolysaccharide (LPS) in presence of LX. Levels of cyotokines (IL-1beta, IL-6, IL-8, IL-10, IL-12, and TNFalpha) were measured by ELISA. Group of patients with acute pancreatitis of toxic etiology included 11 subjects: patients from main group received combined therapy supplemented with NSAID from the oxicam class--LX; patients who received only standard basic treatment formed comparison group. RESULTS: It was found that in vitro LX inhibits production of both proinflammatory and anti-inflammatory cytokines by PBMC of healthy subjects mediated by ligands of TLR1/2 and TLR4. Maximal inhibitory effect of LX was observed when cytokine production was induced through TLR1/2. Patients with AP demonstrated increased production of TNFalpha induced by TLR1/2 and TLR4 ligands. CONCLUSION: LX inhibits TLR-mediated production of both proinflammatory (IL-1, IL-6, IL-8, IL-12, TNFalpha) and anti-inflammatory (IL-10) cytokinesby PBMC of healthy subjects in vitro. Treatment with LX in patients with AP results in diminished effector function of TLR1/2 and TLR4 already during 1st day of the illness and normalization of these indices by 6th day.

[Causes of the formation of hernias after laparoscopic cholecystectomy].

The authors made an analysis of postoperative hernias in 32 patients. General and local causes are considered. The proposed technical methods used for exclusion of local causes allowed the frequency of postoperative hernias to be reduced from 1.9% to 0.5%.

[Surgical aspects of the treatment of generalized peritonitis].

Advantages and disadvantages of different methods of surgery termination at generalized peritonitis are discussed. Drainage of abdominal cavity can not guarantee adequate sanation. Disadvantages of peritoneal lavage exceed the clinical value of this method. Active influence on infectious process during postoperative period can be realized with laparostomy, programmed revisions and sanations of abdominal cavity. These methods lead to recovery of more 80% patients with generalized peritonitis. Laparoscopic sanation is effective when bacterial contamination of peritoneal exudation doesn't exceed 10(5) mb/g.

[Intraoperative use of Xefocam at laparoscopic cholecystectomy].

Xefocam was used in patients with calculous cholecystitis during laparoscopic cholecystectomy to prolong anesthesia and to reduce an inflammatory process in an area under operation. The agent was injected into the round ligament of the liver in a dose of 16 mg intraoperatively and in a dose of 8 mg postoperatively. The proposed method was applied to 52 patients operated on for acute and chronic calculous cholecystitis. Fifty patients receiving the conventional anesthesia with the narcotic analgesic promedol were examined to evaluate the efficiency of the new procedure of anesthesia; the later being effective in 96.2% of the patients. The findings indicated the high efficiency of the proposed procedure without side effects observing in the use of narcotic analgesics. Furthermore, the nonspecific anti-inflammatory activity of Xefocam promotes a reduction in the number of postoperative local inflammatory complications.

[Fibrin-collagen substance as a vehicle for local application of antibacterial agents]. / Fibrin-kollagenovaia substantsiia kak sredstvo lokal'nogo naneseniia antibakterial'nykh preparatov.

Inhibitory activity of fibrin-collagen substance (FCS) impregnated by various antibacterial agents against various microorganisms was investigated. It was demonstrated that antibacterials bind well with FCS, providing its sufficient antibacterial activity. Determination of growth-inhibition zones showed that antibacterial agents diffuse into medium well and demonstrated the same activity as discs with antibiotics. For clinical practice it is recommended to use for impregnation the following drugs: gentamycin, meropenem, cefriaxone and ciprofloxacin.

[Ciprofloxacin and other antimicrobial drugs in the treatment of disseminated peritonitis]. / Primenenie tsiprofloksatsina i drugikh antimikrobnykh preparatov pri lechenii rasprostranennogo peritonita.

Forty two patients with general peritonitis were treated with ciprofloxacin and combinations of various antimicrobial drugs. Ciprofloxacin had the highest effect on aerobic and anaerobic microbes in the peritoneal cavity which defined the favourable clinical results in all the patients. Moreover, there were observed no disorders in the composition of the normal intestinal microflora which in the end promoted a decrease in the number of the patients with suppuration of the surgical wound.

[Treatment of peritonitis of appendicular etiology]. / Lechenie peritonita appendikuliarnogo proiskhozhdeniia.

The authors had 475 patients with appendicular peritonitis under observation. All of them underwent emergency operation and were given antibacterial therapy with metronidazole and agents of the aminoglycoside series. Among 223 patients, the operation on whom was completed by traditional drainage of the abdominal cavity and complete closure of the operative wound, 148 patients developed postoperative complications. Five patients died. In 252 patients, primarily delayed sutures were applied to the wound and drainage of the abdominal cavity was limited. The abdominal cavity was inspected repeatedly in 24 patients with generalized peritonitis and clinical signs of anaerobic nonclostridial infection. Postoperative complications occurred in 87 patients and were limited to suppuration of the wound. One patient died.

[Diagnosis and treatment of acute adhesive small intestine obstruction]. / Diagnostika i lechenie ostroi spaechnoi tonkokishechnoi neprokhodimosti.

Experience of treatment of 162 patients with acute adhesive intestinal obstruction (AAIO) is described. These patients had most often (23.3%) appendectomy in anamnesis. Conservative treatment was effective in 23 (14.2%) patients only. Surgical treatment was performed in 139 (85.8%) patients including traditional open operation in 79 (56.8%) patients, laparoscopic and laparoscopy-assisted in 60 (43.2%). Advanced adhesive process with formation of single intestinal conglomerate, neglected forms of AAIO with paralytic ileus were indications to open operations; lethality in these operations was 17.7%. Laparoscopic operation was indicated in AAIO due to isolated commissure as well as in early adhesive obstruction; lethality was 1.7%. If diagnostic laparoscopy showed that AAIO is caused by intestinal deformation in small intestinal conglomerate or intestinal resection is required, laparoscopy-assisted operations were performed.

[Intraabdominal cholerrhea after cholecystectomy]. / Vnutribriushnoe zhelcheistechenie posle kholetsistéktomii.

Cholecystectomy (CE) was performed in 2303 patients with cholelithiasis and its complications. Cholerrhea (CR) after operation was in 31 (1.34%) patients: after laparoscopic CE (1425 patients)--in 18 (1.26%), after open CE (878 patients)--in 13 (1.48%). Source of CR was not found in 21 patients, CR from gall bladder bed was revealed in 7, from cystic duct stump--in 2, from hepaticojejunoanastomosis--in 1 patient. Ultrasonic examination, endoscopic retrograde pancreatocholangiography, laparoscopy were used for diagnosis of this complication. CR stopped spontaneously in 19, after endoscopic papillosphincterotomy--in 4 patients. Spread of bile in abdominal cavity was revealed in 6 patients, 4 of them underwent laparoscopic operations, 2--open operations. Infrahepatic encapsulated bile clumps were in 2 patients, they underwent ultrasonic-assisted drainage.

[Postoperative complications in patients with peritonitis]. / Posleoperatsionnye oslozhneniia u bol'nykh s peritonitom.

One thousand three hundred and ten patients with peritonitis have undergone surgery: local limited peritonitis was in 230 patients, local unlimited--in 342, general--in 738 patients. After surgery suppuration of the wound was seen in 92 (7.1%) patients, phlegmons of the abdominal wall--in 16 (1.3%), progressive peritonitis--in 40 (3.1%), abscesses of abdominal cavity--in 13 (1.0%), eventration--in 19 (1.5%), adhesive intestinal obstruction--in 17 (1.3%). Laparoscopy was used for diagnosis of intraabdominal complications in 47 patients. This allowed to avoid unjustified laparotomies in 20 patients. Application of laparoscopy is limited by degree of bacterial contamination of peritoneal exudates. Early adhesive intestinal obstruction in 7 patients was treated with endoscopic procedure. Sonography is effective in diagnosis of intraabdominal complications, detection of site of safe puncture before postoperative laparoscopy and drainage of abscesses.

[Results and prospects of treatment of general forms of peritonitis]. / Rezul'taty i perspektivy lecheniia rasprostranennykh form peritonita.

956 patients with general peritonitis were operated: 596 patients--for diffuse peritonitis, 360--for general peritonitis. The causes of peritonitis were: perforating gastroduodenal ulcers (454), acute destructive appendicitis (190), acute destructive cholecystitis (82), perforation of small intestine and colon (96), postoperative peritonitis (80), other diseases (54). In low degree of bacterial contamination of abdominal cavity (not more Ig 5 CFU/g) operations were completed without abdominal drainage, laparoscopic variant of the operation being optimal. In postoperative period, out of 691 patients with low degree of bacterial contamination wound infection was in 7.9%, intraabdominal infection--in 2.5%, polyorganic insufficiency--in 1.0%; lethality was 5.9%. In high degree of bacterial contamination (more Ig 5 CFU/g) and massive unremovable fibrinous patch on the peritoneum the programmed revisions and sanations of abdominal cavity were performed, sometimes--control laparoscopic revisions. In postoperative period of 256 patients with high degree of bacterial contamination wound infection arose in 6.0%, intraabdominal infection--in 4.2%, polyorganic insufficiency [symbol: see text] in 42.6%; lethality was 18.1%.

[Mode of surgery completion in peritonitis]. / Sposoby zaversheniia operatsii pri peritonite.

1310 patients with various forms of peritonitis were operated during 1989-1998. The tactics of the treatment was determined depending on bacterial contamination of the abdominal cavity. In abscesses of the abdominal cavity with massive bacterial contamination (6-7 CFU/g) drainage procedure was used. Mortality rate made up 4.8%. In local extended and diffuse peritonitis with a slight bacterial contamination of the abdominal cavity (3-5 CFU/g) and in absence of fibrinous deposition fixed on peritoneum, the drainage of the abdominal cavity was not used, and laparoscopy was performed in postoperative period for the control of the course of infectious process. Mortality rate was 0.6%. In extended peritonitis with massive bacterial contamination (6-8 CFU/g) the method of repeated explorations and sanitations of the abdominal cavity was used, mortality rate being 17.8%. The overall lethality made up 7.8%. Postoperative wound infection occurred in 6.7%, intraabdominal infection as abscesses or progressing peritonitis--in 2.1% of cases.

[Technical aspects of nasointestinal intubation]. / Tekhnicheskie aspekty nazointestinal'noi intubatsii.

According to the authors' opinion nasointestinal intubation have some advantages over "open" methods of decompression of the small bowel in paralytic intestinal obstruction resulted from peritonitis and mechanical obstruction of the small bowel. The authors' experience with more than 500 their own cases indicates, that application of nasointestinal intubation is not only necessary, but safe as well if keeping strictly to the established technique. Technical aspects of the method, possible errors which could occur during the performance of nasointestinal intubation and introduction of the probe are described. Complications which made up 2.6% are analysed.

[Use of fibrin-collagen plates in abdominal surgery]. / Ispol'zovanie fibrin-kollagenovykh plastin v abdominal'noi khirurgii.

The article presents results of experimental substantiation and clinical use of fibrin-collagen plates Tachocomb. They were used in clinical practice in 28 patients with different bleedings under conditions of open and little invasive surgery. The preparation not only increases the mechanical strength of the surgical suture, but also has a stimulating effect on reparative processes. The author proposes to use Tachocomb for strengthening the sutures and anastomoses in peritonitis, intestinal obstruction and interventions in the area of the tissues altered due to infiltration.