PREVENTIVE NEPHROPEXY AS A PREVENTION OF COMPLICATED NEPHROPTOSIS

The article show the efficiency of Doppler ultrasonography for the determination of hemodynamic criteria, which determine tactics of treatment of patients with, uncomplicated nephroptosis. Survey design included ultrasonic Doppler ultrasonography of kidneys' vessels in sitting and standing positions. The degree of disorder of hemodynamics in renal artery was determined in orthostasis in comparison with clinostasis. The indications for the operative treatment of uncomplicated nephroptosis were the disorders of hemodynamics in orthostasis more than 30 % in comparison with clinostasis. All operated patients had. laparoscopic nephropexy. Blood flow in renal artery in postoperative period restored in all operated patients with uncomplicated nephroptosis. The research of renal blood flow shows objective idea of the degree of change of hemodynamics in pathologically movable kidney. Patients with uncomplicated nephroptosis and. disorders of hemodynamics in orthostasis more than 30 % need operative treatment for the prevention of the complications of the desease

LOW RECTUM RESECTION SYNDROME AND ITS CORRECTION

First stratification scheme of the anorectal dysfunction after low rectum, resection was described and its appliance was shown in 32 cases with "ileoascendocecalneorectum" creation. It was shown that this method, of neorectum, creation allowed, to get good, functional results and high quality of life quality in early postoperative period. Described, stratification, scheme of anorectal dysfunction, was approved, to be good, tool to unify objective clinical information, about patients' anorectal functions after the low rectal surgery

CLINICAL AND FUNCTIONAL SUBSTANTIATION OF FORMING OF “NEORECTUM” WITH USE OF ILEOASCENDOCECAL COMPLEX

Clinical and functional results of the "low" resection with foring of "neorectum" by ileoascendocecal complex tmnsposition and reveron were studied, in 32 patients. It was shown that this method, permits to get good functional results and. to prevent "low anterior resection syndrome" development

PREOPERATIVE CORRECTION OF ENDOGENOUS INTOXICATION AND RESPIRATORY DISORDERS IN PATIENTS WITH COLORECTAL CANCER

The detection of the symptoms of endogenous intoxication in patients colorectal cancer patients is a difficult problem and should include not only evaluation of quantitative changes of blood clinical analysis but otheг standard methods. It was shown that adequate preoperative preparation of patients with eespieatory disorders con:ection let us to decrease the risk of perioperative complications in descnbed cases

Diagnosis and treatment of the irritable bowel syndrome: clinical guidelines of the Russian gastroenterological association and Russian association of coloproctology

Aim of publication. To present recent RGA evidencebased medicine centered guidelines on diagnosis, rational pharmacotherapy and management of irritable bowel syndrome (IBS). Summary. IBS - is a functional bowel disorder is manifested by recurrent abdominal pain that develops at least once per week and characterized by at least two of the following signs: it is related to bowel movements, associated to the change in stool frequency and/ or shape. These symptoms should be present in the patient for the last 3 months at overall duration of observation for six months or more. Similar to other functional gastrointestinal disorders, the diagnosis of IBS can be established at compliance of symptoms to Rome IV criteria and the absence of organic gastrointestinal diseases that could cause patient’s symptoms. Due to complexity of differential diagnostics, IBS should be considered as diagnosis by exclusion that require following investigations: clinical and biochemical blood tests; IgA or IgG anti-tissue transglutaminase antibodies; thyroid hormone levels; fecal occult blood test; glucose or lactulose hydrogen breath test for bacterial overgrowth syndrome; stool test for coliform bacteria, stool test for Clostridium difficile toxins A and B; fecal calprotectin level; abdominal ultrasound; upper and lower endoscopies, at indications - with biopsies. IBS treatment requires diet and lifestyle modifications, intake of pharmacological agents and psychotherapy. Antispasmodic medications (e.g.: hyoscine butylbromide, pinaverium bromide, mebeverine) are recommended for abdominal pain relief. For diarrhea-predominant IBS such medications as loperamide hydrochloride, dioctaedric smectite, non-absorbable antibiotic rifaximin and probiotics may be prescribed. For treatment of IBS with constipation use of bulking agents (psyllium), osmotic laxatives (macrogol 4000, lactulose), laxatives stimulating intestinal motility (bisacodyl) may be applied. Enterokinetic agent prucalopride may be prescribed at inefficacy of laxatives. Peripheral opioid agonists (trimebutine maleate) normalizing intestinal motor activity via action on different subtypes of peripheral opioid receptors, combined plant-derived medication STW 5 are applied as well. Conclusion. Implementation of clinical guidelines can determine timely diagnosis and treatment of various IBS types. The IBS is characterized by scalloping course with relapse periods that are provoked by psychoemotional stress and remissions. The risk of organic bowel diseases IBS patients is not higher, than in total population