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Antireflux resection of mucous membrane of esophagogastric anastomosis (ARMS) was performed on 6 patients with typical symptoms of gastroesophageal reflux disease (GERD). The patients had a short segment of сolumnar-celled metaplasia (1-2 cm) without radiological and endoscopic signs of hiatal hernia. All the patients received medicamentous therapy by antisecretory agents more than 3 years. The operation included the endoscopic resection of2/3 circle of mucous membrane of esophagogastric anastomosis and resection of the area of columnar-celled metaplasia. The results of treatment were assessed during 3-7 months after ARMS. There was noted an absence of clinical manifestations of GERD, regression of inflammatory signs of mucous coat of esophagus in 4 out of 6 patients. Symptoms of GERD remained in 2 patients, although the intensity of signs significantly decreased.

The abnormalities of myoelectrical activity of gastrointestinal tract were detected in 80 victims with severe combined trauma. There were observed a decrease of total electrical activity and dyscoordination of electrical activity of sections of gastrointestinal tract. An application of substrate antihypoxants should normalize the indices of myoelectrical activity of gastrointestinal tract. This approach allowed elimination of imbalance of total power between superposed (the stomach, the duodenum) and other sections of gastrointestinal tract. This would remove dyscoordination contraction of the jejunum and the ileum.

The article analyzed disadvantages of "Atlanta-92" classification of acute pancreatitis and its two modifications: APCWG-2012 and IAP-2011. The school of Saint-Petersburg pancreatologists suggested the classification AP of Russian Surgical Society (2014), which represented the concept of disease staging.

Gastroesophageal reflux disease is a widespread among population in economically developed countries including Russia. It was analyzed the results of 34 903 endoscopic examinations of upper gastrointestinal tract in ethnically and socially homogeneous population of Leningrad region with symptoms of gastric dispepsia. Procedures were performed for the period 2007-2013. Prevalence of erosive esophagitis was 4.9%. Peptic esophageal strictures due to chronic reflux-associated inflammation were revealed in 0.2% of examined patients (3.7% of patients with erosive esophagitis). Obtained data allow to considergastroesophageal reflux disease as a socially significant problem in Russia requiring close attention and further study.Гастроэзофагеальная рефлюксная болезнь широко распространена среди населения экономически развитых стран, включая Россию. Цель - представить анализ результатов 34 903 эндоскопических исследований верхних отделов пищеварительного тракта у представителей относительно однородной по этническому и социальному составу популяции (жителей Ленинградской области) с симптомами желудочной диспепсии. Материал и методы. Процедуры выполняли в период с 2007 по 2013 г. Распространенность эрозивного эзофагита составила 4,9%. Пептические стриктуры пищевода как исход хронического рефлюкс-ассоциированного воспалительного процесса были выявлены у 0,2% обследованных (3,7% страдающих эрозивным эзофагитом). Результаты. Полученные данные заставляют рассматривать гастроэзофагеальную рефлюксную болезнь как социально значимую для России проблему, требующую пристального внимания и дальнейшего изучения.

The article presents an analysis of 34.903 esophagoscopy results performed for population of Leningrad region at the period from 2007 to 2013. A prevalence of erosive esophagitis was 4.9%, peptic strictures--0.18%, columnar-celled metaplasias--1.43% and esophageal adenocarcinoma--0.645%. The data obtained showed a high prevalence of GERD-associated syndromes with injury of mucous coat of esophagus in the local population of Russians.

The article analyzes the experience of application of polymeric (mesh) implants for hiatal closure in patients with gastroesophageal reflux disease (GERD). The authors showed the main principles of the choice of mesh implants and recommendations to their usage. Principal technical stages of surgery are described. It is noted, that the application of prostheses had the high efficiency and safety in antireflux surgery.

The article is devoted to the choice of antireflux procedure in surgery of gastroesophageal reflux disease. The mechanisms of the most popular antireflux operations are described. The criteria for selecting options of reconstructions gastroesophageal junction are presented in the article. The theoretical propositions are supported by the results of clinical observations.

This article presents the analysis of 24384 endoscopic investigations of the upper gastrointestinal tract in population of Leningrad region with symptoms of dyspepsia during the period 2007-2011.The results revealed erosive esophagitis in 5.4%, peptic strictures of the esophagus--0.2%, the columnar-lining esophagus (Barrett's esophagus)--1.1%, and esophageal adenocarcinoma--0.045%. This data shows a high prevalence of esophageal complications of GERD in a local population of Russians.

The article presents an analysis of results of 24 384 endoscopic examinations of the upper gastrointestinal tract in population of the Leningrad oblast with symptoms of gastric dyspepsia during the period from 2007 to 2011. The detection of the columnar-celled metaplasia was 1.1%, adenocarcinoma of the esophagus--0.045%. Esophageal adenocarcinoma occurred in 3.95% of cases of the column-celled esophagus. Barrett's esophagus was revealed in males more often than in women (56.5% and 54.5% respectively). The peak incidence of esophageal adenocarcinoma in males was at the age from 46 to 60 years (36.4% of patients), in females--from 61 to 75 years (27.3% of patients). Intestinal metaplasia was detected in 72.7% of cases with esophageal adenocarcinoma: The diagnosis of long and short segment of column-celled esophagus revealed no significant difference in the development of esophageal adenocarcinoma.

In order to improve radicalism of emergency surgical interventions an appropriate method of total mesocolonectomy and D3-lymph node dissection in the medial-lateral direction and the principle of "no-touch technique" were used in 14 patients. This technique is safe, effective, does not prolong the duration of operation and postoperative period, is not followed by increased number of complications and lethality.

The examination and treatment of 64 patients have shown that inclusion of complex antioxidant cytoflavin in intensive therapy at the postoperative period of diffuse peritonitis allows the hypoxia degree to be decreased that in its turn results in quicker recovery of the antioxidant system and decreased activity of peroxidation and endotoxicosis level. The clinical course of the postoperative period of diffuse peritonitis with cytoflavin included in intensive therapy is characterized by shorter terms of artificial lung ventilation, shorter time of staying in critical condition, more favorable course of complications.

Operations of transplantation of kidneys taken from donors with expanded criteria with satisfactory results were made on 27 recipients of the older age group (from 60 through 76 years). Standard transplantation of the kidney was made to 20 recipients, and dual renal transplantation to 7 recipients. Mean level of creatinine in elderly patients on the 21st day was (340.9 +/- 49.3) microM/l, on the 90th day (124.6 +/- 6.9) microMl/l.

The authors have analyzed experience with treatment of pain syndrome in 45 patients, in 31 of them thoracoscopic sympathsplanchnectomy was fulfilled. The operation was shown to give a pronounced analgetic effect and improved quality of life of patients.

The author reports results of clinical assessment of cytoflavin for injections in the treatment of different pathological condition including critical ones. It was shown that therapy reduces mortality among patients with acute disturbances of cerebral circulation to 4.8-9.6% compared with 11.7-17.1% in controls. Positive dynamic of neurologic status was documented in 79% of the patients with dyscirculatory encephalopathy versus 25% in control. Duration of comatose state decreased 1,7-fold, length of stay in resuscitation and intensive therapy wards 1.8-fold, and frequency of internal complications secondary to the effect of neurotropic poisons 2-fold. Cytoflavin corrected the level of metalloproteides and stabilized antioxidative potential of sera and cerebrospinal liquid in patient with meningitis including that of zoonotic etiology. In the period of post-narcosis rehabilitation cytoflavin restored conscience in 77% of the patients within 20 min. The drug also inhibited pathological alcohol addiction within 5 days after the onset of therapy as apparent from the improvement of intellectual-mnestic status and activization of attention. The frequency of infectious complications in patients with acute surgical abdominal pathology decreased by 5.1% and lethality by 3.6% compared with placebo group. Cytoflavin exhibited cardioprotective action in patients with myocardial infarction, during cardiosurgical intervention, and chronic brucellosis. It had hepatoprotective effect in iatrogenic hepatic conditions as well as ophthalmo- and oto-protective activity.

Results of the first using of abdominal prolonged normothermal perfusion with transmembrane oxigenation and removal of leukocytes from the perfusion contour in situ are presented. The investigation included 6 asystolic donors with primary thermal ischemia from 49 to 90 minutes and transplantation of their kidneys to recipients. In half of the patients there was immediate function of the transplant. This protocol is the method of choice in getting transplants from donors with a sudden irreversible arrest of blood circulation and prolonged 90 min primary thermal ischemia.

Based on an experience with treatment of 269 patients with complicated peptic ulcer the authors came to a conclusion that the most sparing and radical operation was subdiaphragmatic truncal vagotomy with Finney pyloroplasty with lethality of 6.8%. Resection of the stomach and forced palliative interventions such as suturing of perforated and bleeding ulcers resulted in lethal outcomes in more than 50% of them.

The article presents the data on frequency of disrupted pelvic ring in fertile women on the basis of the Djanelidze Research Institute of Emergency Medicine database from 2000 to 2005. Strategy of treatment, target dates of the pelvis fixation and removal of fixators are described depending on planning the pregnancy terms. In addition, approaches to childbirth, indications and contraindications to Caesarian section were studied on the basis of the Snegiryov maternity hospital database for the period from 2000 to 2006.

The article describes organizational grounds of the system of organization of emergency care to victims of traffic accidents (TA) under conditions of a megapolis at the stages of evacuation. The principles of rendering emergency medical care in TA are considered in detail. The succession of actions at each stage is stressed. Organization of trauma centers is recommended which will be able to render specialized medical care to the victims. Special attention should be paid to the conception of trauma disease. Correct organization of rendering specialized medical care to TA victims substantially reduces lethality.

Analysis of results of treatment of 51 patients with diffuse peritonitis has shown effectiveness of correction of disturbed microcirculation in the intestine by means of administration of oxygenic perftoran.

The distinctions and interrelationship were established between acute cholangitis and biliary sepsis. Patients with hyperbilirubinemia were divided into four groups according to the developed criteria of inclusion and of using a new strategy of treatment for each group. It determined the result of treatment, i.e. resulted in lower lethality, shorter stay at hospital, less cost of treatment. One of the main criteria for the inclusion into a certain group was considered to be the index of blood plasma procalcitonin.

The authors presented materials on treatment of acute adhesive obstruction in the St. Petersburg Research Institute of Emergency Medicine for 8 years. Operations were performed on 54 patients. A conclusion was made that laparoscopic adhesiolysis had advantages over open surgery methods but with due regard for the selection of patients for the procedure, and for better rehabilitation after operation.

The authors consider actuality of using apparatus perfusion of renal transplants for the distension of the door pool and improvement of quality of transplantation. The article contains the results of the first in Russia clinical application of apparatus perfusion in the work with asystolic donors. The data are presented on possibility of using the apparatus perfusion of renal transplants for their testing, selection and improving results of transplantation.

An analysis of experimental investigations carried out in 32 dogs and 30 rabbits and laboratory data of 242 patients has shown that the application of antioxidant and antihypoxic medicines decrease reperfusion lesions and endotoxicosis in operative treatment of acute intestinal obstruction.

For the period from 2000 through 2007 there were 27 patients treated for lesions of extrahepatic bile ducts of different genesis. Since all the lesions were high, we have formed biliodigestive anastomoses on the exchangeable transhepatic drains by the method of Groetz-Saypol-Kurian. In a month after the operation and a standard management of the exchangeable transhepatic drains we departed from the classical technique and applied nonperforated drains. Using the nonperforated exchangeable transhepatic drains in patients after reconstructive operations on the extrahepatioc bile ducts gave good immediate results of operations and substantially improved quality of life of the patients in the postoperative period.

Therapeutic-diagnostic videothoracoscopy was used in complex treatment of hemothorax in 86 patients for isolated and combined stab-slash wounds and closed traumas of the chest. Thoracoscopy was not used in 321 patients with the same pathology taken as control. It was found that videothoracoscopy used for medium and big hemothorax always allowed the doctors to make the precise topical diagnosis of chest injury and due to medicinal endosurgical manipulations the thoracotomies were made 2.1 times more rarely, the duration of pleural drainage was 2.2 times shorter. Complications of the traumatic disease were 1.6 times less often, the time of in-patient treatment and lethality 1.3 times less.

Results of realization of the protocols of organization of the medico-diagnostic care to patients with bleedings from chronic gastric and duodenal ulcers since 2002 have been analyzed. A simplified scale of the assessment of severity of ulcerous bleedings (UB) at admission including 8 criteria is proposed. Protocols of medical strategy for "severe UB" under conditions of the resuscitation unit are discussed. The principles of rendering the medico-diagnostic care for UB allowed stabilization of total lethality among these patients at the level of 3.4-3.7% at operative activity 27%. The possibility to improve results of the treatment of this pathology in future is associated by the authors with the available and high quality elements of conservative treatment.

The authors describe specific features of the diagnosis and emergency medical care at the prehospital period developed on the basis of treatment of more than 5000 patients with isolated and combined injuries of the chest and abdomen. The importance of using the resuscitation-surgical teams, the syndrome diagnostics and stabilization of vital functions at the place of the accident is stressed as well as admittance of the casualties as quickly as possible to an up-to-date specialized multitype traumatology center.

The condition of organ donation and organ transplantation is extremely unsatisfactory in Russia. The main reason for that is the rules and professionals forms regulating the Russian organ donation activities have become logically and morally outdated. As a way to improve the situation there is the first effort to establish the institute of transplant coordination in Russia in order to avoid the conflict between different groups of medical staff and the public.

The main problem of transplantology is deficit of organs. A renewal interest to using non heart beating (as too as marginal) donors is connected with the ischemic-reperfusion injury complications. Circumstances of explantation restrict the opportunities of using this kind of transplants because there are initial defects caused by ischemic damages. Using the machine perfusion enables to maximize the acceptance of marginal kidneys as the result of summarizing the processes of diagnoses, selection, treatment of kidney transplants during conservation.

The authors propose a system of assessment of the state of blood circulation in lower extremities which allows planning a more effective method of treatment of patients with obliterating diseases in the stage of critical ischemia.

The microcirculation in the intestinal wall was evaluated in 42 women in the postoperative period using contact biomicroscopy in laparoscopy with a microhysteroscope. The dynamic contact biomicroscopy unlike other clinico-laboratory data allowed prognosis of the development or progress of peritonitis and choice of the strategy of treatment.

The topicality of a study is determined by high mortality rates in victims with concomitant shockogenic injuries. A large proportion of victims die in the acute period of traumatic disease (TD). At this time, major changes are observed in the circulatory system. For optimization of intensive care, the authors have changed a clinical classification of the acute period of TD, by applying the principles of general pathology, the data on altered hemodynamics and microcirculation. The stages of infusing-transfusion therapy considering the specific features of changes during each period, which are characteristic for victims with reversible and irreversible shock, are described. Implementation of the infusion-transfusion therapy program proposed by the authors could reduce mortality in victims with concomitant mechanical shockogenic trauma.

Protocols of diagnosis and treatment of acute pancreatitis are presented. Definition based on pathogenesis of the disease is given. Phases of acute pancreatitis, features of diagnosis and treatment in each phase are analyzed. Terms of surgical treatment, main principles of postoperative treatment are discussed.

The problem of sepsis and septic shock (SSH) is known to be very actual due to peak-shaped growth of the number of such patients and unsatisfactory results of treatment. The occurrence of SSH is different--from 10% in the structure of infectious complications after polytrauma to 50% in patients with gram-negative sepsis in patients with burn disease. An analysis of treatment of 165 patients with SSH developed against the background of peritonitis has revealed high level of lethality (64%). In the pathogenesis of SSH an important role is played by immune disorders resulting in the development of generalized inflammation and polyorganic insufficiency. Treatment of patients with SSH must be necessarily supplemented with immuno-correcting techniques: use of medicines of nonspecific anti-cytokine action (pentoxyphillin) and regulators of the immune response (ronkoleukin, blood perfusion through the donor porcine spleen). The timely performed immunomodulating therapy allowed lethality of patients with SSH to be reduced to 32%.

The authors consider actual problems of transplantation of organs associated with using donors. Special attention is given to current methods of preservation and obtaining donor kidneys from irreversible cardiac arrest donors. The authors propose to use a standard protocol of measures aimed at obtaining high quality transplants in every day practice of surgical teams dealing with taking off donor organs. First positive results of using the proposed method are described.

The specific character of emergency surgical care requires a concentration of highly skilled specialists of various profiles on the basis of multi-type hospitals and using expensive modern, highly informative and less invasive methods of diagnosis and treatment. The using of multi-type hospitals for emergency medical care will allow the intensification of treatment, wide application of less invasive technologies that will result in the appearance of incentives and conditions to shorten the number of bed-days, restriction of groundless hospitalization and to improve the tariff politics in the system of compulsory medical insurance.

The investigations performed allowed the authors to make a conclusion that in female patients with pyo-inflammatory processes in the small pelvis organ-saving operations can be fulfilled in most cases, but the choice of surgical strategy and the volume of operative treatment in particular must depend on many factors: general state of the patients, spread of the infectious process, patient's age, realization of the reproductive function, parameters of intoxication, data of laparoscopic and ultrasonic examinations.

The authors made an analysis of aspects of using the diagnostic and operative hysteroscopy in diagnosis and treatment of urgent nongravidary metarrhagias (UNM) under conditions of the department of urgent gynecology of the multiprophile hospital. The authors have analyzed the causes of the development of UNM, revealed high incidence of adenomyosis (44.3%).

A retrospective analysis of treatment of 450 injured with traumas of the extremity vessels was made. These patients were subjected to reconstructive operations. In a considerable part of the patients there appeared thrombosis of the operated vessel. Experiments in dogs have shown that prophylactics of temporary prosthesis and injured artery should be based on the method of active treatment in order to eliminate the posttraumatic spasm of the arteries.

The choice of the optimum technique of the sanitation procedure in treatment of acute necrotizing pancreatitis (ANP) is now one of the most disputable problems. Clinical estimation of the efficiency of various operative techniques of treatment of ANP at various stages of disease has been made. In the aseptic phase laparoscopic decompression of the pancreas is indicated when the patient has evident hemorrhagic parapancreatitis. In the phase of septic sequestration of ANP the optimum method of minimally invasive surgical intervention is considered to be minilaparotomy which is expedient for abscesses of small volume, lipid abscesses of any volume with the minimal content of necrotizing tissues as the first step of sanitation in critical patient. High quantity of the necrotizing tissues in the zone of the destructive focus requires traditional laparotomy of the abscess under conditions of preventive maintenance of the endotoxic shock.

Using minimally invasive methods of sanitation of bile ducts in 456 patients with high operative risk reduced the number of postoperative complications to 11%, lethality to 1.3%. Two-stage treatment with surgical intervention by means of laparotomy was necessary in 124 patients. In this group of patients the frequency of complications was 32.3%, and lethality--4.8%.