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Objective: To determine the criteria for choosing surgical access in patients with advanced peritonitis considering its local and general manifestations., Material and Methods: We analyzed treatment outcomes in 588 patients with advanced peritonitis. The most common causes of peritonitis were destructive forms of acute appendicitis (273 cases), perforated gastroduodenal ulcers (165 cases), acute cholecystitis (59 cases). To determine the criteria for choosing surgical access in advanced peritonitis, we analyzed treatment outcomes considering MPI, SPP and WSES SSS score., Results: The choice of surgical access in advanced peritonitis can only symbolically be standardized according to modern scoring systems (MPI, SPP, WSES SSS). Laparotomy is necessary for MPI score ≥30 and SPP score > 10 (WSES SSS score > 8). Regardless of MPI, SPP, WSES SSS scores, the absolute contraindications for laparoscopic surgery are dense non-removable fibrin deposits, interintestinal abscesses, purulent recesses, intra-abdominal pressure > 20 mm Hg or small intestine dilation> 3 cm, sepsis or septic shock (qSOFA score 2-3), previous open abdominal surgery, unstable hemodynamics, technical difficulties. Conversion should be used at any doubt., Conclusion: Careful patient selection, surgical experience and training in laparoscopic technique are decisive factors for wider use of laparoscopic approach in patients undergoing emergency abdominal surgery.

Objective: To create a system for choosing surgical approach and completing laparotomy in advanced secondary peritonitis via combination of clinical, visual intra-abdominal criteria and systems for predicting the outcomes of peritonitis., Material and Methods: The study included 686 patients with peritonitis between May 2015 and December 2022. Age of patients ranged from 16 to 95 years (mean 53.4±8.7). Male-to-female ratio was 1.2:11 (377:309). Destructive appendicitis was the cause of peritonitis in 274 (39.9%) patients, gastroduodenal ulcer perforation - 160 (23.3%) patients, colonic perforation - 188 (27.4%) patients, other causes - 64 (9.4%) patients. At baseline, 481 (70.1%) patients underwent diagnostic laparoscopy, and laparoscopic surgery was possible in 302 (62.8%) cases. Primary median laparotomy was performed in 205 (29.9%) patients. The closed method of completing laparotomy was used in 345 patients (77 - 22.3% died), staged elective surgeries - 28 (18 - 64.3% died), open abdomen technique was used in 11 patients (5 - 45.5% died). Redo laparotomy on demand was performed in 44 patients. Of these, 21 (47.7%) ones died. Overall mortality was 15.0% ( n =103). The main causes of mortality were sepsis/septic shock (67 cases, 65.0%), acute cardiovascular and respiratory failure (15 patients, 14.6%)., Results: The developed index of approach and completion of surgery in secondary peritonitis is valuable to make a decision on access and completion of surgery in patients with widespread peritonitis., Conclusion: Integral systems for assessment of clinical status and choice of treatment strategy are effective in systematizing the results, evaluating treatment outcomes and conducting researches.

To date, mortality in widespread peritonitis is still high (15-20%) and increased up to 70-80% in case of septic shock. Surgeons actively discuss wound closure technique in these patients considering intraoperative findings and severity of illness. The authors present scientific data and opinions of national and foreign surgeons regarding the methods of laparotomy closure. There are still no generally accepted criteria for choosing the method of laparotomy closure in secondary widespread peritonitis. Indications and clinical efficacy of each procedure require additional research.

The review is devoted to the most common general clinical and specific grading systems for peritonitis outcome prediction. Particular attention is paid to methodological approaches, prediction reliability, simplicity of use in clinical practice and their importance in decision-making. It is shown that none of the modern grading systems is universal and absolutely reliable. Combining several systems is quite difficult and will take additional time that is impossible for intraoperative environment. Despite various systems for peritonitis outcome prediction, none of them can completely satisfy surgeons, primarily in choice of surgical access, intervention type and option for its completion.

Objective: To compare the most common prognostic systems in patients with peritonitis., Material and Methods: The study included 352 patients with secondary peritonitis. At admission, sepsis was diagnosed in 15 (4.3%) patients, septic shock - in 4 (1.1%) cases. Mortality was associated with the following main causes: purulent intoxication and/or sepsis - 51 cases (87.9%), cancer-induced intoxication - 4 (6.9%) cases, acute cardiovascular failure - 3 cases (5.2%). We analyzed the efficacy of Manheim Peritoneal Index (MPI), WSES prognostic score, APACHE-II scale, gSOFA score and Peritonitis Prediction System (PPS) developed by the authors., Results: Age of a patient, malignant tumor, exudate nature, sepsis (septic shock) and organ failure not associated with peritonitis are the most important criteria in predicting fatal outcome. ROC analysis was used to assess prognostic value of various prediction systems. Standard error was less than 0.05 for all scales. Therefore, all prediction systems can be considered accurate for prediction of mortality in patients with peritonitis., Conclusion: PPS (AUC 0.942) has the greatest accuracy in predicting fatal outcome in patients with advanced secondary peritonitis, APACHE II (AUC 0.840) - minimum accuracy. MPI had predictive accuracy > 90% too.

For today, it is necessary to recognize, that treatment of patients with abdominal sepsis remains the basic problem in urgent surgery due to the invariably high mortality. Early diagnostics and targeted therapy are the key points for improving of sepsis outcome. At present, researchers around the world have proposed a large number of biological markers for diagnosing sepsis and predicting mortality. Ideally, doctors can use biomarkers for risk stratification, diagnosing, monitoring of treatment effectiveness and outcome prediction. The biomarker is a laboratory parameter that can be objectively measured and characterized as an indicator of normal and pathological biological processes. The article presents the modern concept of the sepsis pathogenesis for understanding the role of various biomarkers and inflammatory indicators in its development. We have analyzed literature data and summarized information on the possible use of biological markers and their combinations in the early detection of sepsis, for monitoring sepsis and predicting its outcome.

Aim: To evaluate an efficacy of endovascular hemostasis in patients with gastric ulcerative bleeding and high risk of recurrent bleeding and death., Material and Methods: The work is based on a study of the results in 30 patients with gastric ulcerative bleeding, high risk of recurrent bleeding (rebleeding forecast system (RFS) score over 17) and high risk of death (SAPS II score over 30). We attempted transcatheter embolization of left gastric artery to prevent rebleeding. The control group consisted of 60 patients with gastric ulcerative bleeding and the same RFS and SAPS II values in whom angiography and endovascular hemostasis were not performed., Results: Technical success of endovascular hemostasis was achieved in 25 (83.3%) cases. In 5 cases embolization was not performed. Complications after transcatheter angiography and embolization were absent. Recurrent bleeding after technically successful embolization was observed in 3 (12.0%) patients. In all cases PVA microemboli were used. Mortality was 11.1% (3 patients)., Conclusion: Endovascular hemostasis in patients with severe comorbidities (SAPS II score over 30) and high risk of rebleeding (RFS score over 17) reduced incidence of recurrent bleeding from 36.7% to 11.1%.

Aim: To create a reliable system for assessing of severity and prediction of the outcome of peritonitis., Material and Methods: Critical analysis of the systems for peritonitis severity assessment is presented. The study included outcomes of 347 patients who admitted at the Department of Faculty Surgery of Peoples' Friendship University of Russia in 2015-2016. The cause of peritonitis were destructive forms of acute appendicitis, cholecystitis, perforated gastroduodenal ulcer, various perforation of small and large intestines (including tumor)., Results: Combined forecasting system for peritonitis severity assessment is created. The system includes clinical, laboratory data, assessment of systemic inflammatory response (SIRS) and severity of organ failure (qSOFA). The authors focused on easily identifiable parameters which are available in virtually any surgical hospital. Threshold value (lethal outcome probability over 50%) is 8 scores in this system. Sensitivity, specificity and accuracy were 93.3, 99.7 and 98.9%, respectively according to ROC-curve that exceeds those parameters of MPI and APACHE II.

Aim: To define the role of endoscopic hemostasis in treatment of gastroduodenal ulcers complicated by bleeding., Material and Methods: The results of endoscopic hemostasis in 770 patients with peptic ulcers were analyzed., Results: Injection hemostasis had the highest efficacy in case of recurrent bleeding. No other method showed significant advantage in its efficiency. The efficacy of injection method was 52%, argon-plasma coagulation - 83.3%, radiowave technique - 78%, combined endoscopic method  - 96%. In case of recurrent bleeding endoscopic hemostasis is effective alternative to surgery especially in high-risk patients. Repeated endoscopic hemostasis significantly decreases mortality from 45% to 23% in case of recurrent bleeding.

500 patients with cancer of biliopancreaticoduodenal area who underwent treatment and survey in the hospital at the period from 1986 to December 2011 years were included in the study. There were 212 (42.4%) males and 288 (57.6%) females. It was analyzed the long-term results of palliative surgical interventions in 72 (40.2%) patients and endoscopic interventions in 107 (65.2%) patients. It was done a comparative analysis of palliative interventions results. It was concluded that both methods have high efficiency for resolution of obstructive jaundice. Average survival rate of patients depends on the biliary decompression method (8 months after surgical interventions and 7 months after endoscopic interventions). It was analyzed the long-term results of radical surgery in 55 (78.5%) patients. It was concluded that the best 5-years survival rate was in patients with major papilla cancer without invasion into mesenterical vessels (54.2%). 5-years survival rate was observed only in 2 patients in case of pancreatic head and terminal bile duct cancer. And lifetime of the majority did not exceed 3 years.

It was analyzed the treatment results of 1341 patients with diagnosed ulcerative bleeding. The data shows that at present time mortality rate in case of ulcerative bleeding is determined by bleeding outcomes in patients with severe concomitant diseases including elderly patients. It was not observed significant advantages in any methods of endoscopic hemostasis for stop and prevention of recurrence ulcerative bleeding. All techniques are equivalent alternatives. None prognosis scale of recurrence ulcerative bleeding probability has high specificity and sensitivity.

The work is based on the analysis of the palliative treatment of 66 patients with malignant upper digestive tract obstruction who underwent implantation of 75 self-expanding metallic stents in the period of 2003-2012 yy. Early postoperative complications developed in 10 (15.2%) cases. Procedure-related complications were observed in 8 (12.1%) patients, non-specific complications occurred in 2 (3.0%) patients. In-hospital lethality was 4.5% (3 patients). 51 patients were followed until death. Symptomatic relapse of obstruction was observed in 4 cases. Median survival was 97 days. Stenting with self-expanding metal stents was concluded to be an effective and safe method of palliation of malignant upper digestive tract stenosis.

229 patients with ulcerous gastroduodenal bleeding were included in the study. Prognostic scales of the bleeding recurrence by Rockall, Blatchford, Vinokurov and System of Prognosing of Bleeding Recurrence (SPBR) I and II were comparatively analyzed. The SPBR II proved to be statistically relevant and the most accurate in prognosing the bleeding recurrence, then other scales.

900 patients with gastrointestinal bleedings were included in the study. Basing on the endoscopic findings, prognosis for recurrent bleeding and clinical evaluation of the patients, diagnostic algorithm and treatment protocol were worked out. Use of forecasting system concerning the bleeding risk and clinical evaluation of the patients applying SAPS II for medical tactics choice allowed decreasing lethality from acute hemorrhage from 6.1 to 0.9%, in case of conservative treatment--from 4.5 to 1.0%, postoperative lethality--from 14.5% to 0.

Treatment results were studied in 542 patients with ulcerous gastroduodenal hemorrhage. Authors offer to use index of bleeding relapse and forecasting system of bleeding relapse for definition of ulcerous bleeding relapse probability. It provides quick and objective appraisal of relapse probability and allows making a proper choice of therapeutic approach reasoning from the patient's status.

Results of treatment of 458 patients with ulcerous gastroduodenal bleedings are analyzed. It is demonstrated that argon-plasma coagulation (APC) is the most effective at primary endoscopic hemostasis and amounts to 92.5% compared with 87.5% at radio-wave coagulation and 79.7% at injection method. Treatment and diagnostic algorithm based on patients state severity assessment (by SAPS scale) and risk of bleeding (by Forrest) was developed. Use of this algorithm led to decrease of lethality due to acute blood less from 6.1 to 2.7% (including at conservative treatment from 4.5 to 2.2%) and postoperative lethality from 14.5 to 5.6%.

Results of treatment of 164 patients with combined abdominal trauma were analyzed. It makes sense to evaluate severity of trauma and severity of the patient condition by scales VPKh-MT and VPKh-SP. These scales permit to standardize severity of damages and choose optimum diagnostic and curative algorithm. The emphasis is on early ultrasonic examination of the abdomen in combined trauma. In obscure ultrasonic diagnosis laparoscopy is recommended, in severe or extremely severe condition of patients (over 31 points by scale VPKh-SP)--laparocentesis. Choice and time of surgical interventions must be determined by priority of severity of damage.

Glutamic acid decarboxylase (GAD) is considered as target antigen in pancreatic beta cell autoimmunity. Two isoforms of GAD (islet and brain GAD) were detected recently. In circulation of approximately 80% of recently detected patients with insulin-dependent diabetes mellitus (IDDM) autoantibodies to brain GAD (bGAD) have been demonstrated. To detect autoantibodies to bGAD blood sera of 48 children aged 1 to 14, 36 of these with newly diagnosed IDDM, 2 with impaired glucose tolerance (IGT), 10 healthy controls, were tested. Indirect immunofluorescent staining of rat cerebellum cryoslices was carried out. The results were assessed using fluorescent microscopy and processed by statistical methods. Autoantibodies to bGAD were found in 30 out of 36 patients with IDDM: 83.3 +/- 12.4% (p = 95%), in 1 with IGT, and in none of controls. The fact that all controls were antibody-negative proves a high specificity of this immunological marker of IDDM. Family history or a younger age by the moment of diabetes onset were conductive to a higher prevalence of autoantibodies to GAD, each of these factors being unrelated to the other.