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The authors present common bile duct reconstruction using the Kehr drainage.

Purpose: elaboration of algorithm for selection of patients with resistant arterial hypertension (AH) for Catheter-Based Renal Sympathetic Denervation (CBRSD)., Materials and Methods: We examined 284 patients with resistant AH. On stage 1 we excluded most frequent causes of secondary AH. In 247 patients (86.9 %) we established secondary character of AH, in 37 patients (13.1 %) AH was found to be essential. On stage 2 patients with essential AH were given 3-5 component hypotensive therapy. At the background of this therapy we conducted 24‑hour ambulatory blood pressure monitoring (ABPM). CBRSD procedure was considered indicated if according to ABPM average 24‑hour blood pressure (BP) was above 150 and 100 mm Hg, and 24‑hour elevated BP load exceeded 60 %. In 13 of 37 patients (35 %) BP level satisfied these conditions. For CBRSD we used high frequency generator. Ablation was performed using the Symplicity Catheter. Results were assessed in 1, 2, 9, 12, and 28 months., Results: Target BP level at the background of minimal doses of hypotensive drugs was achieved in 11 patients (85 %), what was confirmed by ABPM data. Levels of mean 24-4 hour systolic and diastolic BP significantly decreased from 173.9±14.9 to 143±21.3, р<0.05, and from 108.2±8.7 to 91.4±13.8 mm Hg., р<0.05, respectively. Index of elevated systolic BP time decreased from 78.2±14.6 to 49.8±29.6 %, р<0.05. Best effect was achieved in patients with AH duration before the procedure less than 7 years. None of the patients had episodes of cerebral vascular insufficiency or heart failure progression., Conclusion: While determining indications to bilateral CBRSD one should be governed by such criteria as exclusion of symptomatic AH and objective proofs of AH resistance (according to ABPM at the background of hypotensive therapy).

Peritonitis due to perforated duodenal ulcer was taken as a model. Patients were conditionally divided into three groups depending on the time after perforation: 6-12, 13-24 and over 24 hours. Analysis of microflora and pH of abdominal exudate was performed immediately after laparotomy. AIM: simple and reproducible method for determining the aggressiveness of peritonitis was developed. The authors believe that the diagnostic test is useful to individualize surgical approach in patient with advanced. peritonitis regardless time after perforation.

Treatment tactics of patients with duodenal ulcer bleeding were analyzed. Criteria of recurrent ulcer bleeding were defined. The importance of consideration of thrombocyte hemostasis component in treatment of such conditions was studied.

This article is devoted choosing the optimal time of operation at patients with stopped ulcerative duodenal bleeding. It has been shown that surgical treatment during the first two days at patients with a high probability of recurrence of bleeding leads to statistically significant mortality reduction in compared with patients who were operated upon within the time frame 3-12 days after stopping bleeding. It is concluded that active surgical tactics at patients with a high probability of recurrence of bleeding at the current stage of modern medicine is more justified than waiting tactic.

Results of treatment of 308 patients under 60 years of age with verified stopped ulcer duodenal bleeding were analyzed retrospectively. The number of recurrent bleedings among 85 women was less than among 223 men with similar location of ulcer, severity of blood loss and methods of treatment. Basing on the results of treatment of 99 patients who received no transfusions of blood components it was demonstrated that the velocity of erythrocytes and hemoglobin natural recovery after blood loss was significantly higher among women than among men.

The treatment of patients with bleeding duodenal ulcers is still one of the most complicated and discussable problems in surgery. The aim of this study was an attempt to predict the relapse of bleeding from ulcer of the duodenum on the basis of the experience in the treatment of 539 patients with this disease, 101 of whom underwent surgery. Diagnostic criteria for prognosis of repeated bleeding have been developed and the role of each of them in reliability of hemostasis in ecores was determined. It was established that indication for urgent operations for unreliable hemostasis is determined by the sum of 11 scores and more, as probability of bleeding recurrence in this situation in 90.2%.

Available are the results of treatment of 493 patients with duodenal ulcer complicated by bleeding in the center of gastro-intestinal bleedings at N. I. Pirogov City Hospital No. 1 in 1995-1996 years. 74 patients were operated. Overall lethality made up 1.8%, postoperative lethality rate--8.1%. In ulcer of posterior wall of the duodenum, 10 mm and more in diameter with blood loss of medium and high degree, the number of relapses made up 57.1%. In cases of urgent operations (n = 30); carried out on the first day of admittance to the hospital, 1 patient died. Expectant policy in treatment of patients with ulcer of posterior wall of the duodenum results in poor effect of the treatment and complications (4.1%). The advantages of active individual approach in treatment of patients with acute duodenal bleeding are outlined.