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Factors of the inborn immunity in patients, suffering hepatocellular carcinoma of large size, were studied. Preoperatively the raising of metabolic activity of neutrophils in spontaneous NST-test, the neutrophils reserve reduction in NST-test, weak activation of the neutrophils absorption function in a phagocytosis reaction were noted. On the 7-8th postoperative day a reduction of quantity of formazan--positive neutrophils in spontaneous NST--test, raising of reserve of the neutrophils metabolic activity, comparing with initial values, were observed.

There were examined 198 patients, in whom immunodeficient (inflammatory, infectious and viral) diseases were revealed, as well as 10 healthy persons--for investigation of sensitivity of the blood neutrophils to immunomodulators (timalin, immunofan, polyoxidonium, timogen, erbisol). Most active one, in accordance to the investigation data, have evolved a synthetic preparation polyoxidonium, action mechanism of which is caused by direct activating impact on phagocytosis. Absence of sensitivity of the blood neutrophils towards activating stimuli (immunomodulators) in some patients was caused by a phenomenon, according to which the blood neutrophils, persisting durably in a preactivated state, further (while examining of the patients) have a reduced capacity for answering to stimulation. Such factors, as persisting in organism components of cellular wall of microorganisms or viruses, as well as antiinflammatory citokines, which are secreted in answer to the infectious agent introduction, are altogether promote the blood neutrophils preactivated state persistence. In patients, suffering viral infections, the blood neutrophils are mostly sensitive to immunofan and timalin. Immunologic preparations must be selected individually, taking into account the data of tests for sensitivity.

The method for individual selection of immunocorrector in surgical treatment of patients, suffering obliterating atherosclerosis of abdominal aorta and its branches, was proposed. There were examined 69 patients, suffering affection of abdominal aorta and its branches. Inhibition of phagocytic function of neutrophils was observed; on background of activation of the oxygen-dependent metabolism; decompensation of the phagocytic cells function, not depending from the disease stage present. Introduction of the proposed method for the immunocorrector selection secures rising of the diagnosis accuracy and the immunotherapy efficacy.

In patients, suffering an acute pancreatitis with purulent-septic complications, there are observed: the blood neutrophils metabolic activity raising in spontaneous NST--test, the reserve index of the blood neutrophils metabolic activity is secured, but the phagocytic number is lowered, raised or normal. In patients, who have died, the blood neutrophils metabolic activity in stimulated NST--test is raised, but preservation reserve of their metabolic activity is lowered, in comparison with such in a control group. Trustworthy raising of the blood neutrophils metabolic activity in stimulated NST--test was observed in patients, suffering infected pancreonecrosis, in comparison with such in aseptic necrosis, the phagocytic number in them was trustworthy reduced. In patients, suffering an acute pancreatitis, who have died, there was established the reversed correlation dependence between the formazanpositive blood neutrophils quantity in spontaneous NST--test and preservation reserve.

The indices of local and the system immunity were studied up in the patients, suffering gastroduodenal ulcer disease. The local immunity peculiarities were noted, characterizing the lowering of the reparative processes activity and gastric ulcers refractivity to conservative treatment, thus confirming the necessity of active surgical tactics application in such patients.

Examination and treatment of 32 patients was done, in whom an acute necrotic pancreatitis was diagnosed. In 16 patients (the main group) ozonotherapy, according to scheme, elaborated in the clinic, was added to conventional treatment. The ozonotherapy application had permitted to reduce the rate of performance of "open" operative interventions. The cellular, humoral and local immunity improvement and biochemical indices normalization were noted. The stationary treatment duration was 21.4 days at average in the main group and 34.5 -- in a control one. The relaparotomy performance rate in the main group was lesser than in a control one.

In 81.25% patients with an acute necrotic pancreatitis and in 50% of healthy persons the blood neutrophils are sensitive to cerulloplasmin in metabolic activity. In 62.5% of patients the phagocytic index have had reduced in addition of cerulloplasmin. Phagocytic number in addition of cerulloplasmin have constituted over 1,5 conditional units, in 75% of patients, without such addition - in 84%. The conclusion was made about necessity of individual selection of immunomodulators in patients with an acute necrotic pancreatitis.

The principles of antibioticoprophylaxis and antibacterial therapy in abdominal surgery were expounded. There are adduced the most frequently revealed pathogenic microorganisms, inducing intraabdominal infection, the ways of lowering of the antibacterial therapy expenses, new approaches to application of immunocorrection and directed transport of antibiotics in surgery as well as empirical and etiotropic treatment, basing on the taking account of the spread and antibioticosensitivity of pathogenic microorganisms of nosocomial infections. There was shown, that concentration of interleucin-1beta and tumor necrosis factor-alpha in the blood serum is connected with the severity of patient state. Significant rising of this cytokines concentration constitutes the trustworthy criterion of the ineffective therapy and mortality risk. The influence of microorganisms and some antibiotics on induction of interferons was studied. Amoxicyllin, polymixin, vancomycin, cephalosporins and fluconazol are the most active inductors of gamma-interferon. Maximal efficacy of antibacterial therapy is possible only if an adequate surgical intervention was performed.

Analysis of efficacy of the immunomodulators application, thymalin in particular, in complex treatment algorhythm in 18 patients with an acute necrotic pancreatitis was conducted. Efficacy of immunocorrecting therapy in the immune state improvement, purulent-septic complications prophylaxis, the abortive course of the disease promotion was established In 12 (66.7) patients the disease regression was noted, in 2 (11.1%)--the inflammatory process delineation with pancreatic pseudocyst formation was observed, 4 (22.2%) patients were operated on. All the patients survived.

Cystic transformation of biliary ducts (CTBD) is a rare inborn anomaly of the biliary system development. For the patients with CTBD quite high metabolic activity of neutrophils according to data of spontaneous test with nitroblue tetrazolium (NBT-test), reduction of IgA content in the initial period, significant raising of interleukin-6 (IL-6) level on the first postoperative day are characteristic. Quantity of active neutrophils of type II in the blood of patients with CTBD depends on antigenic load. Neutrophils in the bile restore the NBT according to type I. Local concentration of IL-6 and IL-8, and also the functional activity of neutrophils in ductal bile in patients with CTBD are the sensitive indexes of clinical state and immunological reactivity.

Results of treatment of 160 patients, operated on for nontumoral biliary ducts impassibility, complicated by purulent cholangitis, were analyzed. In 60 patients intraoperatively and after the operation in complex of treatment laferon solution was injected into biliary ducts in dosage 500,000--1 million IU a day, permitting to reduce the frequency of the postoperative complications occurrence from 62.2 to 36% and of postoperative mortality--from 13 to 6%. Regional immune therapy using laferon stimulates the factors of organism inflammatory reaction and hepatocytes functional state restoration.

There were examined 19 patients with nontumoral disease and 13--with hepatopancreatoduodenal zone organs tumor. In nontumoral disease interleukin-6 (IL-6) was revealed in 83.3% of patients in the blood serum and in 88.9%--in ductal bile; in nontumoral impassability of biliary ducts IL-6 was revealed in the blood serum in 53.8% of patients, in ductal bile--in 87.5%. It was established, that bilirubinemia degree did not correlate with IL-6 content in the blood serum, but was directly influenced by its concentration in ductal bile.

The interleukin-6 (IL-6) contents in the blood serum and in bile from the gallbladder was studied in 25 patients with uncomplicated cholelithic disease and with that, complicated by chronic biliary pancreatitis. Laparoscopic cholecystectomy was done in all the patients. In uncomplicated cholelithic disease IL-6 was not revealed in the blood serum and in majority of observations--in bile from gallbladder. Direct dependence was established between duration of cholelithic disease existence, complicated by chronic biliary pancreatitis, and concentration of IL-6 in bile from gallbladder.

20 patients with peptic ulcer disease of duodenum were studied. We found that metabolic activity of neutrophils in peripheral blood and in mucosa is the same in patients with complicated peptic ulcer. The absorption activity of tissue neutrophils is higher than in blood. During operation we observed an increase of neutrophils' activity both in blood and mucosa. On the 6th day after operation the response of neutrophils recovered. In patients who undergo conservative treatment for peptic ulcer of duodenum the activity of neutrophils decreased significantly. This emphasizes that immunocorrection treatment is indicated to all patients that receive conservative treatment for peptic ulcer.

It was established that while incubation of the blood leucocytes of a healthy person with duodenal bile of a patient, suffering chronical purulent cholangitis, the leucocytes life span enhances. In a patient's bile the leucocytes survival is higher than in healthy person's.

A comparative evaluation was done of factors of the local and systemic immunity in 18 patients with diffuse pyoperitonitis. Morphological (neutrophiles from the abdominal cavity in patients with peritonitis retrieve NBT in a diffuse-dotted fashion whereas neutrophiles of blood give a diffuse pattern and by granules) and functional (reduced metabolic activity of abdominal neutrophiles in a spontaneous NBT-test and an augmented index for the reserve versus metabolic activity of blood neutrophiles) differences in local and systemic factors of immune defence were noted. It is shown that the content of all classes of immunoglobulins is significantly lower in the peritoneal exudate than it is in blood serum. The above facts are to be considered in treatment of patients with generalized purulent peritonitis.

The existence of autonomous system of the biliary ducts local immunity was established. The contents of the antibodies and C3-component complement in intraductal bile in patients with purulent cholangitis (PC) is normalizing during an early postoperative period. In a common biliary duct bile while PC a polymorphonuclear neutrophils are regularly revealed, which restore nitroblue tetrazolium (NBT) diffusely. The NBT test application in PC diagnosis is substantiated.

Study of the functional activity of blood and biliary neutrophils in patients with purulent cholangitis revealed different patterns of blood neutrophil reaction in the NBT test. The share of type 1 cells (with diffuse staining of the cytoplasm) in spontaneous and stimulated NBT test is a constant value in the studied patient population. The count of active blood neutrophils (type 2, with formasane granules) depends on the antigen dose in the test. A more grave form (with strictures of the bile duct) is associated with a decreased count of formasane-positive type 2 cells in comparison with that in patients with choledocholithiasis. An accurate and rapid method for the diagnosis of purulent cholangitis has been developed, based on measuring the functional activity of A bile neutrophils collected during surgery. The C bile neutrophils differ from blood neutrophils of patients with purulent cholangitis by morphology and function. Biliary neutrophils reduce the NBT after the diffuse punctuate type. The detected differences are presumably due to specific features of the environment.

It has been found out for the first time that in 55% of cases presenting with purulent cholangitis, there are antibodies to a clinical strain of E. coli in the bile taken intraoperatively from major bile duct whereas museum specimens of E. coli strain are free from the above antibodies. Immune complexes were identified in the bile of all examined patients (0.316 +/- 0.085 arbitrary units). In the blood serum of patients with purulent cholangitis, antibodies to the clinical strain E. coli are not detectable, while there are great counts of circulating immune complexes (0.928 +/- 0.242 arbitrary units). Based on the findings obtained a conclusion was reached about relative independence of local immunity of the biliary tract.

The indexes of the loading rosetteforming tests were studied up in vitro in 10 healthy persons and in 12 patients with peritonitis. In the patients the hyporeactive type of reactivity and multidirectional reaction on immunomodulators was revealed more frequently by comparison with such in a healthy persons. The individual option of the immunocorrecting agents is mandatory in patients with an acute peritonitis.

Injection implantation of polyacrylamide gel "Interfall" in soft tissues was conducted in 110 patients in 1992-1997 yrs. In 17 patients the mammary glands prosthesis was conducted using biogel. Biogel did not influence the cell subpopulations of the immunity T- and B-systems, the immunoglobulins level and did not cause the organism sensibilization.

The experience with combined treatment of 122 patients with pancreatic cancer in the clinic of the Institute of Clinical & Experimental Surgery for the period of from 1988 to 1990 is summarized. Radical operations were performed in 54 patients, the palliative ones--in 68. After performance of a palliative operation, the patients underwent polychemotherapy, 5--in combination with UHF-hyperthermia. To study the effect of chemotherapy on the immune system, the immunologic monitoring was carried out. It was established that under the influence of chemotherapy and hyperthermia, the indices of immunity in patients with pancreatic cancer improved. In cancer of the pancreatic head with involvement of pancreatic body, the performance of subtotal pancreatoduodenal resection with subsequent regional chemotherapy is expedient. Chemotherapy and hyperthermia in combination with creation of a shunt permit to improve the results of treatment of inoperable tumors. The use of regional chemotherapy in subtotal resection contributed to increase in 2-year survival of the patients.

Having substantiated the results of treatment of 425 patients with purulent cholangitis caused by benign obstruction of the bile ducts, the authors suggest their definition of "purulent cholangitis". The two-stage operative interventions were used. At the first stage, the sparing decompression of the bile ducts, and as well rational regional antibacterial therapy were performed. The lethality reduced from 3 to 1.3%, purulent cholangitis was cupped off in 98.7% of the patients. The indications, methods for performance of endoscopic papillotomy, and as well of closed interventions in obstruction of the bile ducts with the use of a transcutaneous transhepatic approach are presented.

A study of the systemic and local immunity was carried out in patients with mechanical jaundice and purulent cholangitis. It was established that this category of patients revealed more rapid changes of local immunity values that may be of importance for evaluating the efficiency of operative interventions.