The aim — to improve infusion therapy for burn shock (BS) for the burn disease acute period course optimizing.

Materials and methods. The treatment results in 390 victims with deep and superficial burns ranging from 15 to 65 % TBSA in the intensive care Burn Clinic were analyzed. The main group consisted of 240 patients, in the treatment of which an optimized infusion therapy (IT) protocol for BS was used during 2007 — 2013. The comparison group consisted of 150 burnt patients’ medical records. Victims’ general condition, terms of shock release and surgical intervention beginning, the infectious complications development, skin recovery time, hospitalization terms were evaluated by clinical methods.

Results and discussion. The different formulas for infusion value calculation and modern drug’s effectiveness in the burn disease acute period treatment were analyzed. The shock course features in different age patients groups were revealed. The use of optimized IT clinical protocols in main patients’ group allowed central hemodynamics restoring, delivery and oxygen consumption quickly. During the BS first days in patients of the main group, an increase in systolic blood pressure by 29 ± 9 %, and oxygen saturation by 8 ± 2 %. The inclusion to BS IT schemes a modern infusion drugs (hydro-ethyl-starches, Reosorbilact, Sorbilactum, soda-buffer etc.) contributed to more efficient recovery of blood circulating volume (BCV) and haemo-concentration reduction, as was evidenced by hematocrit rates at the end of the BS first day treatment. In main group patients this rate was 0.39 ± 0.07, and in comparison group — 0.49 ± 0.09 with the same volume infusion. At the end of the first treatment day in main group’s patients the CVP was 42.5 ± 4.5 mm aq. c., and in comparison group— 37.3 ± 3.5 mm aq.c. All the victims had a positive central and peripheral hemodynamics parameters dynamics during shock stage (systolic and diastolic blood pressure has increased, heart rate and respiratory rate has decreased, oxygen saturation has increased compared with the BS first day) that allowed to start surgery in main group patients on 3.2 ± 0.7 days earlier than in patients in comparison group. The volume of infusion correlated with the severity of the patient status. Significant tissue hypoxia reduction was observed only after the blood volume restoration. Burn disease treatment results in the victims with severe BS were largely depend on the initial anti-shock IT nature.

Conclusions. Improving of anti-shock therapy efficiency can be achieved both by optimizing the transfused fluid volume, and with IT modern infusion drugs within, contributing the more efficient CBV recovery and haemo-concentration reducing. Standard IT formulas should be used only as a guideline for initial IT determining. Real fluid balance should be assessed by clinical and laboratory parameters.

Keywords: infusion therapy, colloid, crystalloid, burn shock, burn disease, plasma.

The aim — to determine the place of anatomic trauma severity scoring (ATS) in patients with spleen injury combined with closed abdominal trauma.

Materials and methods. The study group included 102 patients with splenic injury after combined closed abdominal injury, in which a differentiated approach to the survey and operations scope determination, as well as the hemostasis method choice depending on the injury severity by ATS scale and the spleen damage extent was used. Organ-preserving operations on a spleen were performed with argon plasma coagulations, electric welding and spleen suturing. 126 victims were included in control group in which the full volume of diagnostic and operational actions, not depending on trauma severity were used. Organ-preserving operations were carried out with spleen suturing. Victims with the isolated spleen trauma and advanced cranio-cereberal trauma were not included in groups.

Results and discussion. In the basic group with moderate trauma according to ATS scale were 33 (32.4 %) victims, with severe — 44 (43.1 %), with extremely severe injury— 25 (24.5 %). Medical-diagnostic actions depended on trauma severity and have been executed in the full, reduced and minimum volume accordingly. An inverse relationship between the injury severity and the ability to perform organ-preserving operations on spleen. In the main group this operations were performed in 42.16 % of victims in the control group — in 4.8 %, for non-severe injury their rate was 78.8 %, for severe — 29.5 %, for extremely severe — 16.0 %. In the study group compared with the control the frequency of postoperative complications was lower by 14.7 %, pulmonary — by 18.2 %.

Conclusions. ATS anatomical scale allows to assess the injury severity in victims with spleen damage after closed abdominal injury combined and to justify the examination and surgical treatment amount, as well as the ability to perform organ-preserving operations. Using differentiated tactics based on an injury severity assessment is possible to reduce the total mortality in the main group by 8.6 %: for non-severe injury — 6.1 %, severe — by 13.3 %, with extremely severe — 7.3 % (p <0.05).

Keywords: polytrauma, spleen trauma, trauma severity, organ-preserving operation.

The aim — to develop bio-mechanical based protocols of the surgical treatment for traumatic mandibular fractures on the ground of a differentiated approach to the fixation choice devise and to determine their clinical efficacy.

Materials and methods. Results of the surgical treatment of 269 patients with 359 mandibular fractures were analyzed. Patients were divided into two groups: in the main group (47.6 %), the differentiated approach to the surgical treatment choice was used according to developed protocols. In the control group (52.4 %) osteosynthesis methods not in accordance to these protocols has been applied. All patients were analyzed for immediate and long-term treatment results based on clinical examination and X-ray control. The accuracy of mandible anatomical shape reconstruction, its movements and chewing function, pain syndrome presence, malocclusion, and postoperative complications were taking into consideration.

Results and discussion. Osteosynthesis results analysis has showed that satisfactory restoration of the mandibular anatomic shape (residual displacement less than 2 mm) in the early postoperative period in the main group was 1.7 times higher — nearly 90 %. Stabile fixation of the bone fragments during consolidation period was noted in 76.5 % of all operated patients. The risk of secondary displacement depended on the applied method of treatment: in the study group, their frequency was 7 % compared to 37.5 % in the control group. Frequency of occlusal disorders, in patients treated according to developed protocols decreased by 3.52 times, and the frequency of temporomandibular joint functional disorders by 1.5 — 3.3 times.

Conclusions. Developed surgical treatment protocols for mandible fractures based on a differentiated choice of the fixation method and functional load modes, considering the type and location of fracture enable to increase significantly the effectiveness of surgical treatment by reducing the rate of secondary displacement, occlusion and articulation disorders.

Keywords: mandibular fractures, surgical tactics, osteosynthesis.

The aim — to determine evidence-based ways to reduce operational and anesthetic risk when performing bariatric operations through the new approaches introduction to the preoperative preparation in patients with morbid obesity (MO).

Materials and methods. 20 patients with morbid obesity (MO) were examined and treated. All of them underwent the gastric balloon BIB (BioEnterics Corp.) installation as preoperative preparation. Medical history, clinical, laboratory, instrumental and statistical methods were used.

Results and discussion. In 6 months after intragastric balloon installation body mass index decreased from 69.78 ± 3.20 kg/m2 to 61.20 ± 3.54 kg/m2, that contributed to positive changes in metabolic, cardiovascular and respiratory systems parameters, particularly the increase in left ventricular ejection fraction on the background of the trend towards normalization of left atrial size as a risk factor for atrial fibrillation. Positive trend in fasting glycaemia dynamic, systolic and diastolic blood pressure indices, FVC, FEV, and others were registered.

Conclusions. One way to reduce operational and anesthetic risk when performing bariatric operations is to install the gastric balloon as a first stage of MO treatment. This reduces the body mass index and blood glucose levels, as well as improve the functioning of the cardiovascular system and respiratory system performance

Keywords: intragastric balloon, operational and anesthetic risk, morbid obesity.

The aim — to analyze prehospital symptom’s complex and identify clinical and diagnostic features of acute bleeding colorectal cancer (ACRC).

Materials and methods. From 2002 to 2013 in city GI-bleeding care center 241 patients with colorectal cancer acute bleeding were hospitalized. Patients’ age ranged from 41 to 94 years. 126 were men (52.3 %) with age ranging from 41 to 94 years, mean age was 66.9 ± 11.8 years. 115 were women (47.7 %), age range from 50 to 89 years, mean age was 69.0 ± 8.4 years. Elderly and senile patients prevailed — 81.3 %. Polymorbidity index was 4.7 for men and 5.3 for women. In 63 (26.1 %) patients disease was diagnosed previously in other medical institutions. First revealed colorectal cancer was detected in 178 (73.9 %) patients. According to the AJCC Cancer Staging TNM — 7, stage І was set in 13 (5.4 %) patients, stage ІІ — in 142 (58.9 %), stage ІІІ — 41 (17.0 %), stage ІV — in 45 (18.7 %). Moderate hemorrhage severity was in 99 (41.1 %) patients, mild — in 49 (20.3 %), severe — in 93 (38.6 %).

Results and discussion. After the analysis of pre-hospital symptom’s complex patients with newly diagnosed ACRC were divided into 3 groups: 69 (38.8 %) patients had subclinical disease prior to the intestinal bleeding development, 40 (22.4 %) — oligosymptomatic disease, 69 (38.8 %) — manifest disease. in 204 (84.6 %) patients the instrumental methods of examination were submitted. The diagnosis was established by the RRS obtained data in 86 (42.1 %) patients, by IS —in 85 (41.7 %), by FCS — in 33 (16.2 %). In 124 (60.8 %) patients a combination of different instrumental diagnostic methods was used. In the right half of the colon the process was located in 58 (24.1 %) cases, in the left half of the colon — in 85 (35.3 %), in the rectum — in 92 (38.1 %). In 6 (2.5 %) patients a primary multiple cancer was identified: in 129 (53.5 %) — exophytic forms, in 112 (46.5 %) — endophytic. six major clinical variants of colorectal cancer course, depended on Intestinal bleeding combination with other complications were identified

Conclusions. 38.8 % patients had asymptomatic illness before intestinal bleeding development. A physical examination may reveal symptoms of malignant colon neoplastic lesions in 37.8 % cases. Intestinal bleeding clinical picture with an isolated variant was present in 64.3 % patients, and in the remaining patients, the intestinal bleeding clinical signs coexisted with partial intestinal obstruction, perifocal inflammation, tumor perforation.

Keywords: acute bleeding colorectal cancer, pre-hospital symptoms’ complex, endoscopic diagnosis, clinical signs.

The aim — to improve the comprehensive treatment results and to reduce the mortality in patients with Fournier’s gangrene.

Materials and methods. A retrospective analysis of treatment results in 12 patients with Fournier’s gangrene treated in surgery department of Kyiv City Clinical Hospital N 15 during 2007 — 2013 was conducted. Middle age of patient was 54 years. Three main directions in FG treatment were used: Early active surgical treatment (necrectomy, the formation of double-barreled sigmoid stoma for hanging off the rectal passage); detoxification therapy, normalization of homeostasis, antibiotic therapy, correction of comorbidities; reconstructive surgical interventions aimed on affected areas defects plastic.

Results and discussion. One (8.3 %) patient died. On the background of extensive soft tissue necrosis, 5 (41.7 %) patients had a complete or partial exposure of testicular tissue and the spermatic cord, with the spread on hip (1 (8.3 %) case). Vacuum wounds therapy has reduced the average length of hospital stay from 31 to 20 days, and to perform reconstructive surgery in a short time — on average by the 12th day from the time of hospitalization.

Conclusions. Fournier’s gangrene has severe course with putrid defeat over a large soft tissue area and can be the cause of fulminant surgical sepsis and deaths. If the Fournier’s disease occurs as a complication of putrid anaerobic paraproctitis, the mandatory imposition of the surgical treatment is suspended double-barreled sigmoid stoma. Application of the suggested tactics possible to reduce mortality and to perform reconstructive surgery.

Keywords: Fournier’s gangrene, putrid abscess, sepsis.

The aim — to examine the biliary decompression open and mini-invasive methods effectiveness in obstructive jaundice in elderly patients.

Materials and methods. From 2002 to 2013, 73 patients with obstructive jaundice were treated in the surgical clinic. The age of patients ranged from 70 to 89 years. Two-stage surgical tactics were used in 39 (53.4 %) cases, in 34 (46.6 %) — one-stage surgery.

Results and discussion. In 39 (53.4 %) patients with bilirubin level more than 100 umol/l, jaundice durations more than 14 days and cardiopulmonary insufficiency III were used two-stage surgical intervention. Complications were in 3 (7.7 %) patients. Mortality were not. In 34 (46.6 %) patients with bilirubin level lower than 100 umol/l, jaundice duration not exceeded 14 days, compensated comorbidity and in the absence of suppurative cholangitis one-stage surgery was performed. Complications were diagnosed in six (17.6 %) cases, mortality were one (2.9 %).

Conclusions. The use of mini-invasive methods of biliary decompression in elderly patients reduces the postoperative complications incidence in two times. Two-stage surgical tactics in obstructive jaundice in this age group of patients are priority.

Keywords: obstructive jaundice, laparoscopic and open cholecystectomy, endoscopic papilosphincterotomy.

The aim — to improve the aesthetic deformities treatment results of upper facial part by developing new and improving existing surgical methods

Materials and methods. 158 patients aged from 30 to 65 years were included in the study. Patients were divided into a control group and three experimental groups according to the surgical intervention characteristics. Surgical intervention results were evaluated in the early postoperative period on the 10th day and on the target dates — after 1 month and 1 year

Results and discussion. In the early postoperative period the «traditional» surgical methods on upper face part provide a high frequency of good results (81.9 ± 4.9 %). In the postoperative period dynamics, a gradual decrease in the good results proportion is noted: in 1 year — 64.0 ± 6.1 %. The main reasons for this are recurrent brow ptosis associated with the activity of the circular eyes muscles, and scalp sensitivity disorders, which occurs as aggressive interventions, result on the facial muscles. The developed endoscopic lifting methods of the upper facial part with preliminary chemical denervation of the facial muscles and tissue fixation, improve the results in the late postoperative period by 73.1 % relative to the comparison group, and can reduce the incision number and length, and in 1.5 times the surgery duration length.

Conclusions. Comparative analysis of early and late surgical treatment results for aesthetic deformities of the upper facial part revealed that the operation of choice is endoscopic front-temporal lifting with preliminary chemical muscles denervation, as well as displaced tissue fixation by polyurethane adhesive composition with folic acid. This helps to improve the surgical interventions results in the late postoperative period from 64.0 ± 6.1 to 90.3 ± 5.3 %.

Keywords: tissues fixation, facial muscles chemical denervation, endoscopic front-temporal lifting, polyurethane adhesive composition, folic acid, upper part of the face.

The aim — to study the gelatinase’s activity at wound healing in patients with purulent wound.

Materials and methods. A complex assessment of wound healing process in 35 patients with purulent wounds of the skin and subcutaneous tissue was performed. Among them were 18 men and 17 women. The average age of patients — 30.0 ± 2.3 years. All patients underwent surgical treatment — adequate disclosure and sanitation with purulent focus drainage. During healing process, the conventional bacteriological and cytological indexes were monitored and matrix metalloproteinases (MMPs) activity levels in the wound surface tissues were evaluated.

Results and discussion. The study found that patients with purulent skin diseases gradually healing took place, as evidenced by the cytological and microbiological studies’ results. However, along with changes in the bacterial wound landscape and cytological picture, the MMP activity’s changes has been happened corresponding to healing period.

Conclusions. It was established that the features of the MMP activity dynamics change is typical for certain phases of healing. MMP activity may serve as a sensitive marker of reparative processes occurring in skin wound and can be used as a prognostic criterion during their treatment.

Keywords: wound healing, matrix metalloproteinase, zymography, cytograms.

The aim — to analyze the effectiveness of empirical combined antibiotic therapy (cefepime and metronidazole) in the treatment of complicated intra-abdominal infections.

Materials and methods. The study included 53 patients with community-acquired secondary peritonitis (in the reactive stage — in 32 (60.4%), and toxic — in 21 (39.6%)) who were treated at the hospital during the period from 2012 to 2014; there were 36 men (67.9%), women — 17 (32.1%). Average age was 37.3 ± 7.2 years. Cefepime (Aurobindo Pharma Limited., India) was administered at a dose of 1000 mg twice daily intravenously for peritonitis in the reactive phase and a dose of 2000 mg twice a day — for peritonitis in the toxic stage. After 3 — 4 days switched to intramuscular injection. The duration of treatment ranged from 5 to 9 days, on average — 7.2 ± 0.8 days. The drug was administered for 30 — 60 minutes before the surgery start, at a dose of 2 g was administered after the operation an additional 500 mg of metronidazole. Further metronidazole was administered at a dose of 500 mg intravenously three times a day throughout the period of application of cefepime.

Results and discussion. From the contents of the abdominal cavity isolated 102 strains of microorganisms. Gram-negative microflora prevailed — in 66 (64.7%) patients. Monocultures were obtained in 32 (31.4%) patients, microbial associations — in 70 (68.6%). Among the gram-negative flora dominated by Escherichia coli (37.4%), among gram-positive microorganisms — Enterococcus spp. (12.8%) and Streptococcus spp. (8.8%). The sensitivity of microorganisms to cefepime and metronidazole in most cases was 100.0%, with the exception of fungi of the genus Candida, Bacteroides spp., Pseudomonas aeruginosa and Enterococcus spp. In the perioperative period, positive bacteriological effect was achieved in 52 (98.1%) patients. Complete pathogens elimination was established in 42 (79.2%) patients. In 10 (18.9%) patients due to drainage lack and high clinical efficacy was assessed as the estimated elimination effect. In 1 (1.9%) patients had persistent pathogen (Bacteroides spp.). Positive clinical efficacy was established in 52 (98.1%) patients: 46 (86.8%) — recovery in 6 (11.3%) — an improvement. During antibiotic therapy (cefepime and metronidazole) was no cases of drug intollerance. In-hospital stay terms ranged from 6 to 16 days on average — 9.4 ± 0.6 days.

Conclusions. The combination of antimicrobials cefepime and metronidazole has a broad spectrum of activity against gram-positive cocci, gram-negative bacteria and anaerobes; good tolerance, high positive bacteriological and clinical efficacy in patients with communityacquired peritonitis secondary complications (98.1%).

Keywords: intra-abdominal infections, surgical treatment, antibiotic therapy, cefepime.

The aim — to improve the treatment results of advanced purulent peritonitis, to develop measures set for its complications prevention, to optimize postoperative therapy, to develop criteria for the optimal drug selection for pharmacological microcirculation and metabolism disorders correction in advanced purulent peritonitis.

Materials and methods. The study was conducted on white Wistar rats with an average body weight 185 ± 15 g and 25 out-bred rabbits with an average body weight 2.2 ± 0.5 kg. The animals were divided into two groups. To correct the micro-circulation and metabolism disorders In second animals’ group the drug Сitoflavin in 150 mg/kg body weight per day dosage was used. The analysis of treatment results in 117 patients from 2000 to 2012 was also done. For the efficiency analysis of treatment methods the patients were divided into two groups: control (57 patient) and the main (60 patients). In the study group the pharmacologic correction of hypoxia, metabolic disturbances and microcirculatory processes, enteral insufficiency syndrom were performed, early enteral nutrition was applied.

Results and discussion. On the 2nd day in the animals of the second group the lactate levels reduction from 3.80 ± 0.57 to 2.54 ± 0.47 mg/dL (normal — 1.40 ± 0.24 mmol/l) was noted, whereas in the first group the lactate level remained high (3.52 ± 0.48 mg/dL), indicating the preservation of metabolic disorders in animals of the 1st group. On the 4th day the tendency to lactate level decrease remained (2.15 ± 0.47 mmol/l whereas in first group the lactate level was increased and has made 3.12 ± 0.45 mmol/l. Using the proposed method of peritonitis treatment with the Citoflavin drug application in the postoperative period has reduced the postoperative mortality to 16.67 %.

Conclusions. The complex substrate antihypoxant Сitoflavin for free radical oxidation and endotoxemia disorders correction use allows to reduce hypoxia, improve oxygen utilization by tissues that have experienced hypoxia, reduces peroxidation activity, which contributes to the rapid recovery of the antioxidant and anti-peroxidation protection, reduce endogenous intoxication, artificial ventilation duration.

Keywords: peritonitis, hypoxia, Сitoflavin, complex treatment of peritonitis.

The aim — to improve outcomes in patients with generalized peritonitis (GP).

Materials and methods. 103 patients were divided into 2 groups, which were differed by the abdominal cavity lavage during surgery: 1st (81 patients) laparostomy as the primary method of treatment in conjunction with VAC-therapy, the abdomen was washed with a solution to the «pure» with conventional filling manually; 2nd (22) — pulsating lavage with Cleanest apparatus were intraoperative performed and completed by laporostomy with VAC-therapy.

Results and discussion. The efficacy of laparostomy in conjunction with conventional abdominal lavage and subsequent VAC-therapy is due to active, continuous pathological secretions removal from maximal peritoneal surface and to local positive hemodynamic effect. Abdominal pulsating lavage with Cleanest apparatus allows to wash and remove pathological secretion at a high washing solution feed rate under pressure, making it possible to achieve significant bacterial contamination reduction of the peritoneal cavity in all patients after 1 — 2 lavages, and to increase efficacy of toxic products removing from the peritoneal cavity. Total number of lavages of the abdominal cavity using a Cleanest decreased on the average from seven to four (on 45 %).

Conclusions. Laparostomy with abdominal lavage and VAC therapy is the main method of GP treating. Peritoneal cavity pulsating lavage with Cleanest apparatus reduces the intervention terms and the total lavages number (on 45 %), increasing the treatment efficiency. Laparostomy with abdominal pulsating lavage with y Cleanest and VAC therapy allowed reducing the postoperative mortality from 11.1 to 9.1 % in patients with GP.

Keywords: generalized peritonitis, laparostomy, VAC-therapy, pulsing lavage, Cleanest apparatus.

The aim — to study the laparoscopic treatment possibility for peritonitis in urgent surgery.

Materials and methods. The analysis of 105 emergency laparoscopic surgery in patients with acute abdominal pathology and associated peritonitis was done. Men were 38 (36.2 %), women — 67 (63.8 %). Patients were aged from 17 to 77 years. Acute appendicitis was diagnosed in 28 (27.3 %) patients, pyosalpigs, salpingitis — in 18 (16.9 %), destructive cholecystitis — in 35 (33.2 %), perforated duodenal ulcer — in 17 (16.1 %), acute intestinal obstruction — in 7 (6.5 %).

Results and discussion. The main stages of secondary peritonitis laparoscopic treatment are the elimination or maximum restriction of the peritonitis source; the most adequate intraoperative abdominal cavity sanitation; postoperative peritonitis prevention or early treatment. The need in the conversion has arisen in three (2.9 %) patients. Adequate abdominal laparoscopic sanitation in them was considered impossible due to the dense massive fibrin layers presence and gelatinous purulent exudate with a tendency to the intra-loop abscesses formation and enteroparesis requiring intestinal intubation.

Conclusions. Adequate laparoscopic abdominal cavity sanitation for diffuse peritonitis is possible in the absence of paralytic ileus and bacterial exudate contamination less than critical level lg 5 CFU/ml. This is reliable and safe treatment of diffuse peritonitis in case of acute surgical abdominal pathology.

Keywords: emergency surgery, peritonitis, laparoscopy.

The aim — to improve the quality of patients’ treatment for acute appendicitis based on comparative evaluation of the laparoscopic appendectomy methods’ effectiveness.

Materials and methods. According to the surgical treatment results of 335 patients with acute appendicitis the comparative assessment of the laparoscopic techniques efficacy was done.

Results and discussion. It was established that the use of laparoscopic techniques versus open appendectomy allows reducing hospital stay in two times, and reducing the number of postoperative complications in four times.

Conclusions. Among the laparoscopic methods for acute appendicitis treatment, the single-port appendectomy is the most efficient.

Keywords: acute appendicitis, laparoscopy, appendectomy.

The aim — to improve the treatment results of lower extremities varicose disease by possibility of outpatient patients’ surgical treatment substantiation.

Materials and methods. The 238 patients’ treatment results for lower limbs varicose disease during the period from 2009 to 2014 were analyzed. In 212 (89.08 %) patients the intraoperative catheter micro-foam trunk phlebo-sclero-obliterations after proactive crossectomy was performed, in 26 (10.92 %) patients — without proactive one. The horizontal reflux elimination for in the trophic disorders in insufficient perforating veins area (clinical classes C4—C6) was performed by insufficient perforating veins micro-foam echo-scleroobliteration method.

Results and discussion. According to the ultrasound duplex angioscaning (USDAS) the 16 hemodynamic disorders variants depending on the venous system various segments involvement in the pathological process were revealed. In the 1 — 3 years interval after intraoperative catheter micro-foam trunk phlebo-sclero-obliterations, according ultrasound control, the complete fibrous transformation was observed in 138 (97.18 %) of 142 patients, insufficient perforating veins complete occlusion after echo-sclero-obliteration was achieved in 29 (85.29 %) patients from 34. In all patients with functional class C6 in 1 — 3 months’ term the complete venous ulcers healing was achieved.

Conclusions. USDAS allows performing minimally invasive intervention only on changed veins’ segments, thus minimizing surgical trauma so that varicose disease surgical treatment can be performed in an outpatient conditions.

Keywords: varicose veins, ambulatory surgery, ultrasound diagnostics, mini-invasive technology.

The aim — to evaluate the nature, frequency, risk factors and morphological substrate of liver pathology after various types of pancreatic resections.

Materials and methods. 96 patients (male — 57, female — 39) aged from 22 to 76 years in which the pancreatic resection was performed between 2003 and 2012 were included in the study. Total pancreatectomy (TPE) was done in 8, pancreato-duodenal resection (PDR) — in 69, distal pancreatic resection (DPR) — in 19 patients. To assess the liver pathology nature the native computer tomography (CT) (evaluating the coefficient of hepatic/splenic attenuation (HSA) and the difference between hepatic (HA) and the splenic (SA) attenuation), which was performed through 6, 12, 24 month. after operation, have been used. Morphological study of liver tissue was carried out with histological and histochemical methods.

Results and discussion. Morphological substrate of liver pathology was steatosis, variants of which depend on the type of resection and period after the operation. Reduction of HA CT-indices over 6 months after surgery there was in 78 (81.25 %) patients, though not all these indices meet the criteria of liver steatosis. The steatosis frequency was 48.96 % (TPE — 100 %, PDR — 56.5 %, DPR — 0 %). After PDR, the SA rates remained unchanged in all patients with steatosis, difference between HA and SA have been substantially reduced. After PDR during the CT on 12 and 24th month the disappearance of steatosis was not revealed, and new cases were detected in 8 and 14 patients respectively. In all patients after TPE HA rate was declining significantly over 6 months, which has progressed over time. After DPR, this index stayed within the normal through the 6, 12 and 24 month. Factors influencing on steatosis development were pancreatic adenocarcinoma (p < 0.01), rapid reduction in body weight (p < 0.01), the diarrhea syndrome presence (p < 0.01).

Conclusions. Patients with pancreatic adenocarcinoma, diarrhea syndrome and rapid reduction in weight after operation are risk group for the nonalcoholic steatosis/steatohepatitis development. It is necessary to perform liver parenchyma monitoring, to use hepatoprotectors and hyperalimentation therapy. While planning a liver resection in this group of patients the pre-operative native CT and liver biopsy to assess the steatosis degree and nature should be performed, and to determine the resection feasibility and extension, the ablation technology ability.

Keywords: pancreatic resection, liver steatosis.

The specificity of the clinical data and conventional diagnostic methods in differential diagnosis and verification of duodenal diverticulum ulcer perforation in combination with malrotation remains very low, especially in adults. Most practitioners are not well informed about possible complications of this disease, its clinical course characteristics, so a correct diagnosis in complicated forms is set in a few cases. It belongs to the casuistic. This explains the high frequency of diagnostic and tactical errors that cause late surgical interventions and high postoperative mortality (8.3 — 18.0 %). A successful treatment case in patients 53 years old with perforated duodenal diverticulum in combination with intestinal malrotation, which was treated in the surgical department, is described. Resection of the duodenal part with diverticulum and the imposition of entero-enteric anastomosis «end to end», appendectomy, sanitation and drainage of the abdominal cavity were performed.

Keywords: diverticulum, duodenum, perforation, complications, intestinal malrotation.

The successful treatment case of acute intestinal bleeding (AIB) from neurofibromatous node of small intestines in patient with generalized neurofibromatosis type I who were treated in the surgical department is described in the article. Ultrasound of the abdomen, fibrogastroduodenoscopy, fibrocolonoscopy, chest radiography, histopathological study for diagnostics were executed. Patients underwent surgery — laparotomy, small intestine with neurofibromatous node resection. The patient was discharged with recovery on the 10th day. Analysis of pathological process all the features made it possible to in-time diagnose and successfully cure of acute intestinal bleeding in a patient with neurofibromatosis type I.

Keywords: neurofibromatosis type I, acute intestinal bleeding.

The analysis of suppurating urachus cysts clinical observations with mistakes in diagnosis and treatment was done. Urinary duct cysts are formed in case of incomplete cleft. Infection of the cyst occurs by bladder fistula and lymphogenous and hematogenous route. Urachus cysts suppuration can simulate any acute surgical diseases of the abdominal cavity.

Keywords: urachus, urinary duct cyst.

The article presents the clinical case of a unique complication of cholelithiasis — antecolic-cholecysto-jejunal fistula complicated with acute small bowel obstruction (with gallstone). According to the literature, the most common biliodigestive fistulas are cholecystoduodenal fistulas, due to the peculiarities of topographic-anatomical relations of these organs. 3.4 % of cases are cholecystotransversae fistulas, 3.3 % — cholecystogastric. According to world literature, there are described isolated cases of cholecysto-jejunal fistula. Despite the fact that these complications of cholelithiasis is extremely rare, it is important to remember and be careful with patients with cholelithiasis and acute intestinal obstruction.

Keywords: cholelithiasis, antecoliccholecystojejunal fistula, acute intestinal obstruction.