Relevance. According to the modern realities of hostilities in the East of Ukraine, the medical community has grown a request for information about the nature of the most dangerous defeats of the participants of the Joint Forces Operation (JFO) in Donbass. Objective: analysis and generalization of the nature of heart injuries received during the hostilities in the East of Ukraine, the stages of medical support of such wounded. Materials and methods. Analysis of scientific publications in scientific journals of Ukraine by keywords for the period 2014-2018. Results. The nature of injuries among participants in the JFO has been analyzed. The first place is occupied by injuries of blood vessels with bleeding (60%), 2 - pneumothorax (34%), and 3 - airway obstruction (6%). All this can be combined and supplemented by damage to the nervous system and other organs. In the conditions of the modern war in Donbass, shrapnel injuries (50.5%), bullet wounds (25.3%), and closed injury (20.3%) are considered frequent types of injuries. The classification of heart injuries, clinical symptoms, the levels of support for such a wounded are described: first aid at the prehospital stage ("golden minutes") on the battlefield, qualified medical assistance ("golden hour"), specialized medical care in a hospital. Post-traumatic stress disorders have been described that last from one to 6 months and require complex treatment. Conclusion. According to NATO's new military medical doctrine, "an effective and reliable medical support system contributes to maintaining the trust of the military and the general public in the army and its political leadership".

Relevance. It is relevant to develop new technological solutions for palliative surgical treatment of patients with unresectable pancreatic head cancer (UPHC), since the incidence of postoperative complications in such patients reaches 25 %, and mortality – 20 %. Objective. To improve the diagnosis and immediate results of palliative surgical treatment of patients with UPHC complicated by obstructive jaundice, duodenal obstruction, and carcinomatous pancreatitis. Materials and methods. At the first stage of the study, criteria for the diagnosis of PHC complications, tactics and methods for their surgical correction were evaluated (group I, 159 patients). After analyzing the results, a new technology for the surgical treatment of patients is formulated, the clinical testing of which was carried out in the second stage. An open, prospective, randomized study included 112 patients with UPHC complicated by obstructive jaundice (group II), who underwent palliative surgical treatment using patented surgical procedures. A comparative analysis of the results of surgical treatment of patients of both groups was carried out. Results. The safety and effectiveness of the simultaneous implementation with biliodigestive gastrodigestive shunting has been proven. The advantages of the tactics of two-stage surgical treatment of patients with signs of liver failure are shown. In patients with high anesthetic and surgical risk, the replacement of open surgery with endoscopic prosthetics of the biliary system and duodenal obstruction is justified. In severe forms of carcinomatous pancreatitis with expansion of the main pancreatic duct, a technique for combined bilio- and pancreatodigestive shunting is proposed. When multiple organ dysfunctions with hepatic-renal, hemorrhagic syndromes are formed in patients with obstructive jaundice, decompression of the biliary system by minimally invasive techniques is shown in the first stage, and the main stage of surgical intervention in the second. As a result, the incidence of postoperative complications was 9,8 %, mortality – 3,7 %. Conclusions. In patients with UPHC cancer complicated by obstructive jaundice, performing instead of traditional biliodigestive bypass surgery combined bilioastrodigestive bypass surgery is a safe procedure that does not increase the frequency of postoperative complications, prevents the need for repeated gastro-digestive interventions, improves the quality of life of patients in the long-term postoperative period. The operation of choice in the surgical treatment of patients with UPHC complicated by obstruction of the biliary system and duodenum with high surgical and anesthetic risk is endoscopic interventions with endoscopic prosthetics of the bile ducts and duodenum.

The aim — to improve the diagnostic and surgical palliative treatment results in patients with unresectable pancreatic head cancer, complicated by obstructive jaundice with the canceromatous pancreatitis.Materials and methods. A comparative analysis of the various surgical techniques aimed on the bile duct obstruction syndrome correction by biliodigestive shunting in the palliative surgical treatment of patients with unresectable pancreatic head cancer and mechanical jaundice was done. The analysis of the archival material (1st group, n = 155) was performed at the first stage. It was established that although the pancreatic tumour causes obstruction of both the common bile duct and the main pancreatic duct, however, mechanical jaundice was developed in all patients, and obstructive canceromatous pancreatitis only in 8.8 % of patients. The mild forms of pancreatitis were effectively eliminated by routine methods of intensive care. However, in cases of moderate severe pancreatitis (according to the Atlanta‑92 classification, third revision), the state of patients’ health progressively deteriorated, as the mechanical jaundice background developed a life‑threatening multiorgan failure and the biliodigestive bypassing was not sufficient to avoid a postoperative complications and unsatisfactory results in all cases. Based on the obtained results analysis it was concluded that modernization is need to both surgical tactics and techniques in such patients. Therefore, it was planned and carried out original trial with the optimized treating technology approbation for such patients. To this end, 112 patients with pancreatic head cancer, complicated by mechanical jaundice (Group 2), treated in the surgical department for the period of 2007 — 2018 were included in an open, prospective, randomized study.An approbation of the original algorithm for the carcinomatous pancreatitis verification was performed; the effectiveness evaluation of the proposed tactics and the technique of surgical treatment, including the developed method of combined bilio‑ and pancreaticodigestive bypass surgery was done.Results and discussion. The safety and clinical efficacy of simultaneous with biliodigestive pancreatodigestive bypass was established in patients with locally advanced pancreatic head cancer complicated by obstructive jaundice and carcinomatous pancreatitis. The tactics of a two‑stage surgical treatment was described, which involves first performing external cholangiostomy with minimally invasive techniques or endoscopic transpapillary stenting in patients with signs of liver failure or carcinomatosis pancreatitis, and then the main stage of surgical intervention.Conclusions. The proposed tactics of two‑stage surgical treatment in patients with nonresectable pancreatic head cancer complicated by mechanical jaundice and pancreatic cancer, which includes a two stage technology of surgical interventions with the use of minimally invasive operations in the first stage of treatment and one‑step combined bilio‑ and pancreaticodigestive bypass surgery on the second one, contributes to the reduction of postoperative complications, mortality and improves the patients’ life quality.

The role of the bacterial factor in the development of acute pancreatitis and its purulent-septic complicationsIntroduction. A feature of acute pancreatitis is the high risk of developing complications (occurring in 50% of patients), the total mortality of which reaches 15%, and in severe cases it varies within 40-70%.The aim of the study was to determine the role of Helicobacter pylori as an etiological factor of acute pancreatitis and a marker of the development of its purulent-septic complications.Materials and methods. The results of treatment of 280 patients with acute pancreatitis were analyzed, which were divided into two groups: the main group (n=187) -patients with severe acute pancreatitis and the comparison group (n=93) -patients with a mild and moderate course of the disease. In addition, in order to determine prognostic criteria for the development of purulent-septic complications, the patients of the main group were divided into two subgroups. The first subgroup included patients with a severe course and the development of purulentseptic complications (n=59), the second (n=128) -with a severe course without the development of purulent-septic complications of acute pancreatitis.Results. When screening patients for Helicobacter pylori, the results of the express test were positive in 232 patients (82.9%), while in the main group 165 (88.2%) patients, in the comparison group -75 (80.6%) patients (χ2= 2.9, 95% CI -1. 1-17.6, p=0.08). An increase in the content of immunoglobulin M to Helicobacter pylori was also determined in patients with a severe course of acute pancreatitis after 7 and 14 days from the moment of hospitalization, which indicates the acute phase of the disease. The correlation between immunoglobulin M and procalcitonin was strong (r=0.87; p=0.0001), but the relationship between these indicators was not linear, but closer to exponential (y=1.1543-2.7292*x +2.1604*x^2).Conclusions. The results of a screening study of Helicobacter pylori in patients with acute pancreatitis allow us to consider this microorganism as one of the factors in the pathogenesis of this disease (82.9% of cases). For patients with severe acute pancreatitis, the content of immunoglobulin M to Helicobacter pylori in blood serum ≥1.24 IU/ml can be considered as a likely predictor of the development of purulent-septic complications (sensitivity 86.4%, specificity 100.0%).

Generalized forms of peritonitis are a major factor leading to non-traumatic mortality in all cases of emergency care and the second leading cause of sepsis in critically ill patients. Objective of this study was to evaluate the efficacy and safety of multicomponent infusion solution Reosorbilact in the treatment of patients diagnosed with purulent peritonitis. An international multicenter randomized study included 181 patients aged from 18 to 60 years with a diagnosis of purulent peritonitis. Patients received therapy with Reosorbilact according to the prescribing information for use. The primary endpoint of the effectiveness was change in SOFA scale on day 3 of therapy. Changes in APACHE II, SAPS II, MODS, and MPI scores as well as changes in endogenous intoxication markers on day 3 of therapy were considered as secondary endpoints. Safety was assessed by analysis of adverse events (AE) and vital signs after 3 days of therapy. On day 3 of treatment with Reosorbilact statistically significant changes were observed in SOFA (1.80 ± 0.91 points), MODS (1.45 ± 0.76 points) and MPI (1.84 ± 5.03 points) scales. There was a statistically significant improvement in markers of endogenous intoxication (creatinine, bilirubin, white blood cell count, C-reactive protein, neutrophil to lymphocyte ratio) on day 3 of treatment. The majority of AE (98.99 %) were mild. No AE were associated with the study preparation and did not result in the patient’s withdrawal from the study. According to the results of RheoSTAT-CP0691, Rheosorbilact is an effective and safe drug for the treatment of patients with purulent peritonitis. It is advisable to include Rheosorbilact in routine treatment algorithms for patients with purulent peritonitis.