CHANGES OF MICROCIRCULATION AND IMMUNE STATUS IN LATER POSTOPERATIVE PERIOD AFTER SURGERY ON THE TRAUMATIZED SPLEEN

The state of wall thomboresistance, hemocoagulation, rheologic properties of blood and immune status have been investigated in patients after various surgeries on spleen in later postoperative period. It has been estimated that the best results are obtained after organpreserving operations on spleen. Somewhat worse results have been observed after splenectomy and autospleentransplantation. The worst results have been revealed in the group of patients after splenectomy

The dynamics of main indicators for the treatment of ulcerative gastroduodenal bleedings — the analysis of several years studies

The research goal is evaluation of influence of changes in diagnostic & treatment possibilities and surgical approach on the results of treatment of patients with ulcerative gastro-duodenal bleedings (GDB). Material and methods: An analysis of the treatment results of 1885 patients suffering from ulcerative GDB, which have been treated in the surgery department of the "State clinical hospital No.6" in Saratov has been done. The information about the patients suffering from GDB has been retrieved from the digital archives, which were filed from 1991 to 2009. The patients have been divided into five groups according to five periods of work, each one differ by its own diagnostic & treatment possibilities and approaches. The evaluation was based the amount of operations, the number of different types of operations, the efficiency of endohemostasis, the amount of bleeding relapses and the lethality. Results: The introduction of computer prognosis for bleeding relapse, the increase in the number of endoscopic hemostatic methods, the application of Laser Doppler Flowmetry (LDF) for the evaluation of reliability of hemostasis, the use of dynamic endoscopy and testing probe for bleeding relapse in the state of prerelapse syndrome with the combination of preventive measures on the source of bleeding and antisecretory therapy have led to the decrease of overall lethality from 6,5% to 1,9%, and the postoperative lethality from 9,1% to 1,7%. Conclusion: The analysis of treatment results by periods made it possible to have an overview on different factors as they undergo changes during these periods, evaluate weak points in the current treatment tactic and set a direction for further investigations

Experimental and clinical application of laser doppler flowmetry in gastric and duodenal ulcerative bleedings

The research goal is to develop a new objective diagnostic method of prerecurrence syndrome that will prognose bleeding recurrence from gastroduodenal ulcers. Materials and methods. Method of laser Doppler flowmetry (LDF) of the regional perfusion of tissue has been used. The experimental part has been done on 30 white laboratory rats. Characteristics of regional tissue perfusion in the simulation and laser hemostasis of bleeding have been studied. Gastroduodenal endoscopy has been performed with laser Doppler flowmetry (ELDF) in clinical conditions to predict the recurrence of ulcerative bleeding. The prognostic method of gastroduodenal ulcerative bleeding was used in 58 patients hospitalized with such pathology and activity of bleeding Forrest II. Results. The study of microcirculation parameters and experimental hemostasis has showed the possibility of using LDF to measure its performance. Effective hemostasis has been accompanied by a significant decrease in perfusion. On the basis of microcirculation parameters in ulcerative bleeding, medical adrenaline test has been proposed for an objective verification pre-recurrence syndrome. To evaluate the effectiveness of endoscopic hemostasis perfusion has been measured before and after its implementation. Conclusion. ELDF has objectified the prognosis of ulcerative bleeding recurrence, verified pre-recurrence syndrome and evaluated the efficacy of endoscopic hemostasi

Modern issues on the treatment of peptic ulcer bleedings

Despite the success of therapeutic treatment of peptic ulcer and the introduction of endoscopic technologies, the problem of peptic ulcer hemorrhage remains valid. A large number of publications in foreign literature are dedicated to epidemiology and prevention of bleeding, evaluation of modern tactics and search for new methods of treatment. The works relating to organization of aid to patients with peptic ulcer bleeding are of particular interest. According to the recent data not all clinics even in economically developed countries manage to follow the recommendations of an international consensus-2010 for non-variceal bleeding treatment of upper gastrointestinal tract. Among the causes of non-compliance of international recommendations there are subjective and objective factors, the understanding of which can significantly affect the optimization of aid to patients with peptic ulcer bleeding