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The paper represents data on new potentialities in evaluating a severity of patients with total peritonitis (TP). They are based on the fluorescence analysis of the physical-and-chemical properties of blood albumin. The findings are a result of a multi-center research undertaken by clinics of Moscow and Moscow Region. The properties of albumin-molecule binding sites were investigated by the fluorescence test. The parameter, measured in the test, was named "effective albumin concentration". The study protocol comprised the data of clinical examinations, scales SAPS and MPI as well as laboratory findings and EAC. The subsequent analysis denoted that a combination of 2 parameters, i.e. EAC and serum urea concentration routinely measured, is highly informative in evaluating the TP severity and correlates well with the survival rate in the discussed pathology. The study results could be a basis for an early individual prognostication of TP course made on the 1st postoperative day.

Augmentin was used prophylactically in 25 patients with an account of the infectious complication risk according to 4 regimens: ultrashort-term (1.2 g intravenously with initial narcosis), short-term (1.2 g intravenously with initial narcosis followed by intravenous administration in a dose of 600 mg in 8 and 16 hours), middle-term (1.2 g intravenously with initial narcosis followed by intravenous administration in a dose of 600 mg every 8 hours for 2 days) and long-term (1.2 g intravenously with initial narcosis followed by intravenous administration in a dose of 600 mg every 8 hours for 3 days). One complication episode as wound suppuration was recorded. The routine approach to the use of antibiotics in emergency abdominal surgery, when antibiotics are administered every day for several days after the operation, should be revised.

The authors analyze their experience of 62 video-laparoscopic operations for perforating duodenal ulcer from January 1998 to May 1999. The optimal algorithm of the patients' preoperative examination and substantiation of the used technique are given. Basic steps and technical aspects of the operation are designated. Basic approaches to the postoperative anti-ulcerous treatment are specified. Basic indications and contraindications to video-laparoscopic-closure of duodenum opening in perforating ulcer are indicated.

The results of treatment of 85 patients with trophic ulcers of various origin by leukocytic serum were compared with the results of treatment of 46 patients treated by routine method. The best clinical and aesthetic effect of this treatment was revealed in a group of patients with trophic ulcers due to vein varicosity. From 58 patients epithelization was detected in 49 (84,5%). The relapses of trophic ulcers in a period from 6 months to 1,5 years were revealed in 5 patients. The use of leukocytic serum ensures high percent of closure of the ulcers chiefly of venous etiology.

Study Objective: To evaluate the efficacy of laparoscopy in confirming the diagnosis of acute appendicitis, to distinguish between acute surgical and gynecologic pathology, and to establish indications for surgical intervention., Design: Assessment of 1000 consecutive emergency diagnostic laparoscopies., Setting: A state university hospital in Moscow, Russia., Patients: One thousand women with suspected appendicitis., Interventions: Diagnostic laparoscopies performed under local anesthesia in all 1000 women, followed by open surgery in 405., Measurement and Main Results: Laparoscopy confirmed acute appendicitis in 282 of 1000 women and acute gynecologic diseases in 433. Laparoscopic diagnosis of appendicitis was incorrect in only nine women. The only serious complication of laparoscopy was perforation of the small bowel, which was due to dense adhesions in the abdominal cavity in a woman who had undergone several earlier surgeries., Conclusions: Diagnostic laparoscopy under local anesthesia was very useful in women with acute appendicitis and gynecologic diseases. It was associated with few complications, was inexpensive, and was well tolerated by the patients.

The possibilities of ultrasonic examination in the diagnosis of acute appendicitis are analysed. The ultrasonic parameters are systematized on the basis of examination of 76 patients with various forms of acute inflammation of the vermiform process and of 16 healthy individuals. Exosemeiotics of acute appendicitis is presented. The high significance of USE in complex examination of patients with suspected acute inflammation of the vermiform process difficult for diagnosis is shown. This was confirmed by the results of complex examination of 151 patients with various urgent pathological conditions whose clinical symptomatology was similar to that of acute appendicitis. It was found that USE improves the diagnostics in difficult clinical cases and lessens the number of diagnostic and tactical errors. The wide use of ultrasonic examination in the daily practice of surgical clinics is recommended.

A new method for the formation of an invagination areflux esophago-intestinal anastomosis is suggested. Incompetence of the anastomosis was not encountered in any of the 52 performed operations for gastrectomy. Five patients died, but the cause of death was not connected with the method of anastomosis formation.

The work analyses the results of emergency laparoscopy in 4,730 patients with acute surgical pathology of the abdominal organs. There were 26.3% of males and 73.7% of females; 26.5% of patients were of an elderly age. Laparoscopy was undertaken in all cases in which the diagnosis was questionable but the clinical picture was that of "acute abdomen" and in patients with an established diagnosis for conducting therapeutic manipulations: microcholecystostomy, drainage of the abdominal cavity. The authors show differential endoscopic signs of some acute surgical diseases of the abdominal organs. Laparoscopy confirmed the clinical diagnosis in 45.5% of cases and revealed indications for an emergency operation in 896 patients (33.8%). Laparoscopic microcholecystostomy was performed 137 times and drainage of the abdominal cavity 398 times. The diagnostic value of laparoscopy came to 97.1% on the average.

A new mode of forming an invaginational areflux esophagus-stomach-intestinal anastomosis was proposed. Seven patients were operated on by the proposed procedure. No cases of incompetence of anastomotic sutures were observed. The analysis of long-term outcomes suggests that there were no complications such as reflux-esophagitis and cicatricial strictures, which is accounted for by anatomical and surgical features of this mode of anastomosis.

The article deals with the experience in surgical treatment of 157 patients with chronic venous insufficiency complicated by trophic ulcers of the leg. Purposeful study of the method of two-stage operative treatment of trophic ulcers of the lower extremities of venous origin was conducted. The expediency of dividing the operation into two stages is substantiated on basis of analysis of the results. One-stage operation was carried out in 77 and two-stage operation in 80 patients. In the group of patients treated by one-stage operation 7 (9.8%) had suppuration of the postoperative wounds. No suppuration of wounds was encountered in patients who were operated on in 2 stages. Among 51 patients who underwent one-stage operation 4, (7.8%) had a recurrence of the disease. A recurrence of the disease (trophic ulcer) was not revealed in 57 patients treated by two-stage operation.

The results of a comprehensive examination of 44 patients with duodenal ulcer are analyzed. Reflux gastritis was detected in almost 50% of the patients. X-ray method, gastroduodenoscopy, and radiologic method for measuring the duodenal reflux in gastric contents portions were employed to diagnose duodenogastric reflux and reflux gastritis. The radiologic method was found the most informative. Reflux gastritis was finally diagnosed after histologic examination of gastric mucosa biopsy specimens. Increased count of IgE cells in these specimens may be considered as the marker of reflux gastritis. The authors come to a conclusion that reflux gastritis degree should be taken into consideration when choosing a method for conservative and radical treatment of duodenal ulcers.

The article deals with general information on the immediate and late-term results of operations with vagotomy for perforating and bleeding duodenal ulcers in 670 patients. Indications for economical operative interventions in emergency situations were determined. The immediate and late-term results of economical operations with vagotomy allow them to be recommended for introduction into wide surgical practice.

The article discusses the results of treatment of 256 patients with gastroduodenal hemorrhages. The routine actively temporizing strategy was employed in the treatment of the first group of patients. The total mortality in the group was 13%, postoperative one, 33%. In the second group active surgical strategy was based on the results of recurrent hemorrhage prognosis. The total mortality was 6%, postoperative one, 6.5%. It is concluded that active surgical strategy which is based on prediction of recurrent hemorrhage yields better results of management of patients with ulcerative hemorrhages.

In order to prognoze recurrent bleedings during the nearest time after admission to the hospital the authors have analyzed the most frequently used objective data on patients with gastro-duodenal hemorrhages (the activity and intensity of bleeding, size and character of the ulcer, duration and severity of blood loss). A rule for prognozing recurrent bleedings is proposed.

Among 240 patients with perforated duodenal ulcers this complication was associated with hemorrhage in 4. In all these patients organ-preserving operations on the stomach associated with trunk vagotomy were successfully performed. In large callous perforated bleeding ulcers gastroduodenotomy and suturing of the bleeding ulcer was employed followed by Finney gastroduodenostomy.

The article deals with the problem of the functional status of the cardia in duodenal ulcer. The cardial function was studied in 27 patients with complicated duodenal ulcer. The results make it possible to judge about the degree of manifestation of cardia insufficiency. While tackling the problem of a character of surgical intervention upon the duodenal ulcer cases it is necessary, in author's opinion, to take into consideration the results of the functional examination of the cardia.