[Vacuum-therapy for complicated anterior abdominal wall wounds and intestinal fistulas in children].

AIM: To present results of VAC application in children with complicated wounds of anterior abdominal wall combined with intestinal and/or biliary fistulas. MATERIAL AND METHODS: For the last 7 years 8 patients aged from 1.5 months to 15 years with infected postoperative wounds of anterior abdominal wall complicated by intestinal fistulas (6), biliary and intestinal fistulas (1) and biliary fistula (1) have been treated at the surgical department №2 of Russian Children's Clinical Hospital. All patients received complex medical therapy and local VAC-therapy. RESULTS: Granulation and wound's size reduction were observed within first 7 days of VAC-therapy application in 5 (62.5%) children. In 4 (50%) patients at least 1 intestinal fistula has been closed in 15 days after VAC-therapy initiation on the average (range 7--24). Closure of all fistulas and wounds healing were observed in all patients in 28 days (range 16--42) after VAC-therapy initiation on the average. CONCLUSION: VAC-therapy is safe and effective treatment of complicated wounds of anterior abdominal wall combined with intestinal and/or biliary fistulas in children.

[Challenges and opportunities for endoscopic ultrasound in the preoperative diagnosis of topical insulin the pancreas].

Insulinoma in most cases is monohormonal orthoendocrine tumor. This fact limits its searching area by a pancreas. However the insulinoma's clinical picture can be caused by other pathology. Therefore the main task of visual the tumor but also to use all the possibilities of each method for defining type of surgery and avoiding such errors and complications, as pancreatorrhage, damage of bile or pancreatic duct, necrosis of duodenal wall, etc. On the basis of our own experience of endoscopic ultrasound for 61 patients with 66 insulinomas, we have allocated the basic variants of insulinoma ultrasound pictures: hypoechoic, heteroechoic, isoechoic tumor, and also foci without a trustworthy contour. On the basis of the analysis of our own errors we have essentially added the technique, having used multiplane pancreas scanning and biplane tumor scanning. Important points in EUS algorithm are also the following items: detecting tumor relationship to pancreatic surface, distance from the tumor to the ducts, gastrointestinal wall and vessels--for definition of possibility of the tumor enucleation; careful scanning of pancreas even after detecting one tumor--for an exception of multiple tumors, especially at MEN-I; careful scanning of a contour of the gland for an exception of parapancreatic insulinomas; estimation of vascularization not only of the detected tumor and suspicious foci, but also of all the gland--for detection of hypervascularized isoechoic tumors; revealing and the description of focal changes, especially more homoechogeneous in comparison with surrounding parenchyma-- for selection patients for examination by other methods; scanning of zones of possible metastasis. Examination of patients with organic hyperinsulinism demands combined application of two or more techniques. Use of all modern possibilities of endosonography can put this technique on one of the first places in the diagnosis of insulinomas.

[Biologically active myo-inositol phosphates]. / Biologicheski aktivnye fosfaty mio-inozita.

The main problems and results of synthetic studies of biologically important myo-inositol phosphates were discussed. The development of the methods of synthesis was shown, and current trends in the methodology of obtaining myo-inositol phosphates by chemical methods were considered.

[Synthesis of inositol-containing glycophospholipids]. / Sintez inozitsoderzhashchikh glikofosfolipidov.

The results and problems of synthetic studies of natural inositol containing glycophospholipids as well as their biologically active fragments and structural analogs are reviewed.

[Study of complex lipids. Synthesis of diphosphatidylglycerol (cardiolipin) with unsaturated fatty acid residues]. / Issledovaniia v oblasti slozhnykh lipidov. Sintez difosfatidilglitserina (kardiolipina) s nenasyshchennymi zhirnokislotnymi ostatkami.

Diphosphatidylglycerol (cardiolipin) with different fatty acid residues has been synthesised by condensation of 1,2-diacyl-sn-glycero-3-phosphoric acid (obtained, e.g., by the cabbage phospholipase D cleavage of 1,2-dioleyl-sn-glycero-3-phosphocholine or egg phosphatidylcholine) with 2-O-tert-butyldimethylsilylglycerol in the presence of 2,4,6-triisopropylbenzenesulphonylchloride. The synthetic cardiolipins as unsonicated aqueous calcium-free dispersions were shown, by means of 31P NMR spectroscopy, to form aggregates of the bilayer structure.

[Studies in the area of asymmetrically substituted myoinositol derivatives. XXXVIII. Synthesis of phosphatidylinositol glycoside]. / Issledovaniia v oblasti proizvodnykh asimmetrichno zameshchennogo mio-inozita. XXXVIII. Sintez gliukozida fosfatidilinozita.

The total synthesis of 1(3)-O-(rac-1,2-dipalmitoylglycerophospho)-4(6)-O- beta-D-glucopyranosyl-sn-myo-inositol was performed. The major stages of the synthetic route are glycosylation of the substituted myo-inositol derivative by the glycosyl fluoride method and creation of the phosphorus moiety of the target glycolipid by means of the H-phosphonate technique.

[Study of asymmetrically substituted myo-inositols. XXXIX. The synthesis of conjugate of 2',3'-didehydro-3'-dehydroxythymidine with phosphatidylinositol: a new nucleoside phospholipid with potential anti-HIV activity]. / Issledovaniia v oblasti proizvodnykh asimmetrichno zameshchennogo mio-inozita. XXXIX. Sintez kon''iugata 2',3'-didegidro-3'-dezoksitimidina s fosfatidilinozitom, novogo nukleozidfosfolipida s potentsial'noi anti-VICh-aktivnost'iu.

A partially protected phosphatidylinositol with a free hydroxyl group in the cyclitol moiety was synthesized by phosphorylation of a tetrasubstituted myo-inositol using the H-phosphonate and phosphoamidite methods. The H-phosphonate method was advantageous for the synthesis of selectively protected monophosphoinositide due to a lesser number of stages. Two schemes for the conjugation of 2',3'-didehydro-3'-dehydroxythymidine with phosphatidylinositol using succinic acid as a linker were tested in the synthesis of the target nucleoside phospholipid.

[Liposomal forms of cytostatics in oncology]. / Liposomal'nye formy tsitostatikov v onkologii.

The current state and prospects of using the liposomal forms of anthracyclinic antibiotics, fluoroucil agents, and platinum compounds are discussed as potential drugs for chemotherapy of tumors. Comparative studies of standard and liposomal forms of the above groups of compounds were made to determine their therapeutical effects.

[Biotechnological approaches to the development of therapeutic and diagnostic preparations of lipid nature]. / Biotekhnologicheskie napravleniia v sozdanii lekarstvennykh i diagnosticheskikh preparatov.

The paper summarizes own results of studies on phospholipids and glycolipids from natural biological sources. New approaches for synthesis of inositol-containing sphingophospholipids, glycophosphatidylinositols, semisynthetic synthesis of phosphoglycerols have been introduced. New industrial method of phosphjatidylcholine isolation and production of number of lipid preparations were developed. Incorporation of DOPA into liposomes increases efficacy of its action in the medication of MPTP-induced parkinsonism in mice.

[The choice of the sequence of operations on the periodontal tissues]. / Vybor posledovatel'nosti operatsii na tkaniakh parodonta.

Operations on periodontal tissues and accessory operations, such as frenulo- or vestibuloplasty, have always been difficult for beginning practitioners. Analysis of 8-year practical work of a periodontologist--296 operations (57 accessory operations and 239 operations on periodontal tissues) disclosed the regularities in such interventions, related to patient's age and sex and the percent ratio of each operation, determined the rational order of operations, and demonstrated the prophylactic efficacy of accessory operations (frenuloplasty or vestibuloplasty).

[The characteristics of the choice by each of 6 periodontists of the site to be operated on on periodontal tissues]. / Osobennosti vybora operiruemogo uchastka na tkaniakh parodonta kazhdym iz shesti parodontologov.

Periodontal pockets deeper than 4-5 mm require surgical treatment. Records of surgical journals of a periodontology room over 6 years are reviewed and 2183 operations performed by six periodontologists are analyzed. The results of surgery are determined by patient's status, site of anesthesia, type of secondary adentia, convenience of surgical access, terms between operations. Individual features of surgical technique of each of the six surgeons are shown.

[The determination of the extent of a surgical intervention on periodontal tissues]. / Opredelenie ob''ema khirurgicheskogo vmeshatel'stva na tkaniakh parodonta.

A surgical intervention is needed in patients with periodontal pouches deeper than 4-5 mm. The results of 239 operations in 182 patients are analyzed. Optimal variants of the operations are described, depending on the patient's status, analgesia, types of secondary adentia, surgical access, and intervals between the operations.

[Prevention of suppurative complications after closure of formed intestinal fistulas in children]. / Profilaktika gnoinykh oslozhnenii pri zakrytii formirovannykh kishechnykh svishchei u detei.

The problem of prophylactics of postoperative infectious complications in the surgery of digestive tract is discussed. A comparative analysis of efficiency of two methods of antibacterial prophylactics during operations of closing the formed intestinal fistulas in children is given. High efficiency of the method of preoperative subtotal decontamination of the intestine according to individually selected schemes is shown.

[Formation of antireflux small-to-large intestinal anastomoses in resection of the ileocecal angle]. / Formirovanie antirefliuksnykh tonkotolstokishechnykh anastomozov pri resektsii ileotsekal'nogo ugla.

The results of the resection of the ileocecal angle and creation of the different types of small-to-large intestinal anastomoses in 52 children at the age of from 5 mos to 14 yrs were analysed. The authors have developed in the experiment and employed in 9 children the modification of the invagination anastomosis according to Ya. D. Vitebsky with the use of a silicone tube. This permitted to reduce the incidence of postoperative complications.