Phenylbutyric acid (PBA), which is approved for treatment of urea cycle disorders (UCDs) as sodium phenylbutyrate (NaPBA), mediates waste nitrogen excretion via combination of PBA-derived phenylacetic acid with glutamine to form phenylactylglutamine (PAGN) that is excreted in urine. Glycerol phenylbutyrate (GPB), a liquid triglyceride pro-drug of PBA, containing no sodium and having favorable palatability, is being studied for treatment of hepatic encephalopathy (HE). In vitro and clinical studies have been performed to assess GPB digestion, safety, and pharmacology in healthy adults and individuals with cirrhosis. GPB hydrolysis was measured in vitro by way of pH titration. Twenty-four healthy adults underwent single-dose administration of GPB and NaPBA and eight healthy adults and 24 cirrhotic subjects underwent single-day and multiple-day dosing of GPB, with metabolites measured in blood and urine. Simulations were performed to assess GPB dosing at higher levels. GPB was hydrolyzed by human pancreatic triglyceride lipase, pancreatic lipase-related protein 2, and carboxyl-ester lipase. Clinical safety was satisfactory. Compared with NaPBA, peak metabolite blood levels with GPB occurred later and were lower; urinary PAGN excretion was similar but took longer. Steady state was achieved within 4 days for both NaPBA and GPB; intact GPB was not detected in blood or urine. Cirrhotic subjects converted GPB to PAGN similarly to healthy adults. Simulations suggest that GPB can be administered safely to cirrhotic subjects at levels equivalent to the highest approved NaPBA dose for UCDs. Conclusion GPB exhibits delayed release characteristics, presumably reflecting gradual PBA release by pancreatic lipases, and is well tolerated in adults with cirrhosis, suggesting that further clinical testing for HE is warranted.

Summary. Relaparotomy in the treatment of postoperative complications of abdominal surgery remains a complex problem in modern surgery. Purpose: to study the causes of relaparotomy after surgical operations on the abdominal organs, depending on the nature of the first surgical intervention. Material and Methods: A retrospective analysis of the performance of 74 relaparotomies after surgical treatment of abdominal pathology was performed. The first surgical intervention was performed because of acute cholecystitis (11 patients), choledocholithiasis (4), acute destructive appendicitis (8), perforated stomach or duodenal ulcers (8), strangulated hernia (5), adhesive intestinal obstruction (9), perforation of thin or colon (7), obstruction of the colon of tumor origin (19). Indications for relaparotomy were peritonitis, early adhesive intestinal obstruction, intraperitoneal bleeding. Conclusions: Complications associated with intra-abdominal infection — peritonitis, peritonitis due to insolvency of anastomotic sutures, is the most common cause of relaparotomy after operations on the abdominal organs, requires improvement of both technology of operations and antibacterial therapy. Relaparotomy is a life-saving surgery in the development of intra-abdominal complications, but it is associated with a greater risk of mortality.

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Background: Mirizzi syndrome is a rare complication of longgoing cholelithiasis, commonly accompanied by variety of structural changes in hepatopancreatoduodenal region. Methods: 34 patients underwent surgical treatment. There were 9 (26,4%) male patients and 25 (73,6%) female patients. Median age of 67.3 AE 1,8, ranging from 40 to 83. All patients classified according Beltran and Csendes 2008. Results: Dominant symptom: in 14 cases majority of symptoms indicates on acute cholecystitis , in 18 cases e obstructive jaundice and cholecystitis, in 2 cases eacute small bowel obstruction. Pathological process in patients with initial stages of Mirizzi syndrome (I-II) corrected by cholecystectomy with external drainage of common bile duct, in one case with choledohoduodenoanastomosis . Roux-en-Y hepaticojejunostomy performed in two patients with Mirizzi syndrome III and one -type IV. Optimal treatment for patients with Mirizzi syndrome IV-Va was cholecystectomy with common bile duct repair using gallbladder tissue. Only symptomatic surgery for bowel obstruction performed for patient with Mirizzi syndrome Vb due the severity of patients condition in both cases. Conclusion: With prolongation of disease severity of anatomical changes increases. Surgical treatment of patients with Mirizzi syndromethat requires precise surgical technique and individualized tactics.