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The studies conducted in 27 patients with disseminated suppurative peritonitis and multiorgan failure made it possible to optimize the basic technical parameters of hemofiltration. It has been shown that the volume of replacement of 20-25 1 with postdilution is the optimal. To prevent hemodynamic reactions during hemofiltration, hemodynamic monitoring using impedance plethysmography should be conducted and the speed of the procedure should be changed with the appearance of preclinical signs of chill. When there is no vascular response and blood cortisol level is not increased, the adrenal cortex function depletion should be considered and hormones should be preventively administered.

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A procedure of transcutaneous draining of bile ducts through a guided replaceable drain using the gallbladder and formation of cholecystostomy and cholecystohepatico-, gastro entero- and enteroenteroanastomoses is suggested for palliation of pancreatic cancer patients. The procedure offers a good clinical effect assuring a significantly longer survival as compared to standard palliative operations used for pancreatic cancer treatment.

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Hemofiltration (HF) potentials are presented in complex treatment of 12 patients with disseminated suppurative peritonitis in the phase of polyorgan failure with signs of adult respiratory distress syndrome (ARDS). It has been shown that HF reduces the amount of extravascular fluid in the lungs, increases right-to-left pulmonary shunt, eliminates mediators causing higher permeability of pulmonary vessels, and other medium-molecular toxins. Death was recorded in 6 out of 12 patients. In 3 of the dead patients HF had an obvious positive effect, and death was caused by acute hepatorenal failure. Thus, HF seems promising for the treatment of ARDS in patients with peritonitis.

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The influence of the cascade filtration exchange plasmapheresis on the central and organ haemodynamics was studied in 15 patients in the terminal phase of diffuse purulent peritonitis. The procedure was found to be followed by the activation of the cardio-vascular system function if it was initially depressed and by its weakening in cases of excessive strain. The worse functional state of haemodynamics 1 day after plasmapheresis is the earliest symptom of progressing endotoxemia and is though to be an indication for redetoxication.

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Activated clotting time was determined during cascade filtration exchange plasmapheresis (CFEP) in 24 patients with generalized suppurative peritonitis. A modified method of activated clotting time determination, using a home-made infusorial earth substitute of the type of "Kieselguhr" was used. A gradual decrease in activated clotting time during CFEP has been observed, which required additional heparin administration. By the end of the procedure, when the removed plasma volume reached 1500 ml, activated clotting time values returned practically to baseline.

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Central, cerebral, pulmonary and peripheral hemodynamics has been studied using impedance plethysmography in 36 terminally ill patients with pyogenic generalized peritonitis. It has been shown that direct dependence of changes in the cardiac output on its cerebral fraction, as well as impedance findings of brain and lung hydration may be considered as prognostically unfavourable. The onset of hypoperfusion of the vital organs which accompanies peripheral vasodilation and decreased hemodynamic activity is associated with unfavourable vital prognosis.

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The results of the application of exchange plasmapheresis in 51 patients with suppurative peritonitis have been processed statistically using "MEDSTAT-85" software. 2-3 exchange plasmapheresis procedures at an up to 2-day interval, with exfusion of 1000-1200 ml plasma and adequate replacement of plasma loss by freshly frozen donor plasma and specific hyperimmune plasma were shown to be an optimum regimen. Blood toxicity, concentration of medium molecular toxins and leukocytic index of intoxication were the most informative criteria of the efficacy of exchange plasmapheresis.

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The report is based on the results of treatment of 116 patients with severe purulent-destructive abdominal cavity diseases and 320 patients with liver failure due to bile ducts obturation. Along with surgical operations, methods of organism extracorporeal detoxication-haemosorption, exchange plasmapheresis, autoblood ultraviolet irradiation--were used in all patients either in isolation or in combination with each other. Toxical metabolites concentration, blood integral toxicity, peptids with mean molecular weight concentration, liver profile enzimes activity, lipid metabolism indices, general and liver haemodynamics and electroencephalogram were studied. On the basis of correlations between indices obtained by the method of extreme grouping factors-syndromes were formed, and then in accordance with a special program summary evaluation of detoxication was calculated in marks. A drop in lethality by 28.3% was ensured, as well as a drop in postoperatyonal liver failure by 51.4%.

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Hemofiltration was for the first time used in multiple-modality treatment of 26 patients with peritonitis in the terminal phase with symptoms of organic and multi-organ insufficiency. Indications to and contraindications against this treatment modality were developed, as was the optimal scheme of hemofiltration in peritonitis patients. This method was found the most effective in patients with symptoms of multi-organ insufficiency (respiratory distress syndrome, nephropathy, hypodynamic syndrome, toxic and hypotoxic edema of the brain). Inclusion of this method into the complex of therapeutic measures has helped prolong the intensive care of peritonitis patients in the terminal phase in the majority of cases. Fourteen patients died, the death rate has made up 53.8 percent.

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An experience of using discrete exchange plasmapheresis (DEP), filtration exchange plasmapheresis (FEP), hemofiltration (HF) and plasmafiltration (PF) in combination with ultraviolet (UV) irradiation of autoblood has been reviewed in 92 patients with pyogenic peritonitis. It has been shown that HF (PF) is an effective and pathogenetically grounded method of detoxication in patients with disseminated pyogenic peritonitis at a stage of polyorgan failure. FEP must be a method of choice during complex therapy at terminal phases of disseminated pyogenic peritonitis. The mechanisms of FEP therapeutic effect are based on elimination of a wide range of toxic substances, correction of severe metabolic disturbances, improvement of central and liver hemodynamics and, in combination with UV irradiation of autoblood, on bacteriocide and antihypoxic effect. The use of DEP is restricted to local pyogenic processes in the abdominal cavity.

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Changes in the liver structure and morphology have been examined by means of light optic and transmissive electron microscopy in 12 patients with obstructive jaundice before and after blood purification. The findings permit a conclusion that in mechanical jaundice the methods for extracorporeal purification of the blood do not directly influence the pattern of the underlying condition of the liver, though promote a stabilization of the structural changes in the hepatocytes and prevent their augmentation; this recommends an earlier employment of extracorporeal purification of the blood in this condition.

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