[Surgical strategy for the treatment of complicated cholelithiasis in elderly and senile patients].

The author summarizes results of the treatment of 140 elderly and senile patients with complicated cholelithiasis divided into 2 groups using scales for the assessment of their clinical condition and prognosis of treatment outcome. Patients of groups 1 and 2 were given single- and multistep treatment respectively. It is concluded that differential approach to the treatment of complicated forms of cholelithiasis in elderly and senile patients permits not only to evaluate their condition but also to use the least invasive procedures for resolution of the biliary obstruction and thereby to reduce the risk of complications and fatal outcome.

[Intralymphatic drug therapy--a pathogenetically substantiated method of treatment in peritonitis].

The method of endolymphatic drug therapy (EDT) suggested by the authors has some advantages over the method of endoarterial therapy (which has proved to be effective in clinical practice) because it is aimed not only at control of the microbial flora, but also at correction of rheologic and microcirculatory disorders, improvement of the processes of tissue respiration and metabolism, stimulation of the intestine, prevention of the damaging effect of enzymes, toxins, and poisons on the organs and tissues of the body, and at correction of disorders of the immune status with promotion of the barrier function of the lymph nodes and the lymphatic system as a whole. EDT may be recommended for wide use in the clinic in the treatment of patients with peritonitis and other serious surgical infections unresponsive to the generally applied methods of management.

[Disputable problems of surgical tactics in acute cholecystitis].

On the grounds of literature data and their own experience, the authors came to the conclusion that clear-cut identification of the character of the pathological process is of principal importance in deciding on the time of operative intervention for acute cholecystitis. Patients with a pronounced clinical picture of acute cholecystitis and those with signs of peritonitis must be operated on as emergencies, "postponed" operations produce poor results. Indications for an emergency operation in patients with acute cholecystitis complicated by obstructive jaundice and other conditions must be considered individually.