[Eduard Nikitich Vantsian: to the 100th anniversary of the birth]. / Eduard Nikitich Vantsyan: 101 god so dnya rozhdeniya.

One hundred and one years ago Eduard Nikitich Vantsyan (1921-1989), an outstanding Soviet surgeon, B.V. Petrovsky's pupil, Doctor of Medicine, Professor, Corresponding Member of the USSR Academy of Medical Sciences, was born (Fig. 1). He was the author of more than 120 scientific works and 6 monographs devoted to the study of motor function and surgery of the esophagus, conservative treatment of its constrictions and cardiospasm, diseases of the operated esophagus. He had developed methods of total and segmental plasty of the esophagus, treatment of hernias of the esophageal aperture of the diaphragm and diverticula of the esophagus. He supervised 26 dissertations, including 12 doctoral theses. Eduard Nikitich is considered one of the founders of esophageal and diaphragm surgery.

[Treatment of recurrent traumatic sternomediastinitis after cardiac surgery]. / Lechenie retsidivnogo travmaticheskogo sternomediastenita posle kardiokhirurgicheskikh operatsii.

OBJECTIVE: To assess the possibilities of omentoplasty for prevention of complications after redo sternum osteosynthesis for traumatic rupture. MATERIAL AND METHODS: The study included 53 patients with recurrent sternal diastasis. Greater omentum was additionally implanted in 19 (35.8%) cases to improve healing and reduce the risk of infectious complications. In 34 patients, redo osteosynthesis was carried out using a metal wire and deployment of irrigation-aspiration system. In 19 patients, omentoplasty was additionally used to close the wound. RESULTS: Omentoplasty was characterized by less duration of lavage (7.4±1.5 vs. 4.2±3.3 days, p<0.0001) and no cases of arrosive bleeding (p=0.04). CONCLUSION: Omentoplasty reduces duration of treatment and risk of arrosive bleeding.

[Negative pressure wound therapy for deep sternal wound infections: microbiological characteristics and antibiotic resistance]. / Vliyanie vakuum-assistirovannoi povyazki na lechenie glubokoi infektsii grudiny: bakteriologicheskii analiz i antibiotikorezistentnost'.

OBJECTIVE: To evaluate bacterial flora in patients with deep sternal wound infection and the effect of negative pressure wound therapy on eradication of the pathogen. MATERIAL AND METHODS: There were 102 patients with deep wound infection after cardiac surgery. Mean age was 66.9±9.9 years. Diabetes mellitus was detected in 21 (20.5%) cases, chronic obstructive pulmonary disease - in 15 (14.7%). Wound debridement via daily dressings was performed in 64 patients; vacuum-assisted dressings were applied in 38 patients. Bacteriological analysis of discharge was carried out every week.Results. Mixed infection was observed in 38 (37.3%) patients. S.aureus was the most common pathogen (n=51, 50%), Gram negative bacteria were found in 36 (35.3%) patients. Negative pressure wound therapy ensured eradication of S.aureus within 3 weeks while dressings were associated with only 40% decrease of the incidence of positive analyses (p<0.05). Effectiveness of the method was not obtained for Gram negative bacteria. CONCLUSION: Negative pressure wound therapy accelerates eradication of Gram positive pathogens but does not affect eradication of Gram negative microbes.

[Efficiency of minimally invasive methods in treatment of varicose veins].

It was analyzed the results of studies comparing an efficiency of minimally invasive methods in treatment of varicose veins of lower extremities. Based on presented data similar efficiency of minimally invasive methods and conventional surgical treatment was proved. The graph reflecting remote results was made.

[Permanent vascular accesses in patients with chronic renal failure undergoing hemodialysis].

The article presents an experience of arteriovenous fistulas forming and using in 78 patients with end-stage chronic renal failure undergoing hemodialysis. New methods for permanent vascular accesses forming were suggested. These techniques increased the operation period of arteriovenous fistulas.

[Health care administration for the mass admission of victims to the hospital].

Experience of health care organization at district hospital on the day of armed conflict is discussed. Sixty-six patients with various injuries have been admitted during 5 hours. Optimal organization of health care system permitted to realize all the diagnostic and surgical procedures in time. Overall 98 operations have been performed at 64 patients. Rapid pre-admission care and transportation to specialized hospital allow to decrease hemorrhage volume, shock severity and lethality.

[Erysipelas as the cause of lymphedema].

The results of the treatment of 237 patients with lymphedema and recurrent erysipelas are analyzed. Direct correlation between the number of erysipelas in anamnesis and degree of lymphedema, and also their reciprocal aggravation are demonstrated that permits us to regard erysipelas as the cause of lymphedema.

[Surgical treatment of patients with chronic lower limb venous insufficiency and trophic disorders].

The experience in surgical treatment of 326 patients with IV-VI degree chronic lower limb venous insufficiency (CEAP) is analyzed. Correction of disorders of venous hemodynamics was performed with surgical methods and sclerotherapy. The best clinical and functional results in long-term period were achieved in patients undergone surgery in an early stage of the disease without deep veins valves insufficiency and external trophic disorders. Pathology of deep veins required correction of valves function. It is concluded that these patients require complex approach to the treatment.

[Evaluation of results of surgical treatment of obliterating thrombangiitis in patients living in the North Arctic]. / Otsenka rezul'tatov khirurgicheskogo lecheniia obliteriruiushchego trombangiita u bol'nykh, prozhivaiushchikh v usloviiakh Krainego Severa.

Immediate and long-term results of surgical treatment of patients with obliterating thrombangiitis in patients living in Arctic North are analyzed. It is revealed that course of disease depends on length of patient's stay in Arctic North. These patients were younger, demonstrated more intensive progression of disease and more distal type of arterial lesion. Surgical treatment permitted to save 75.9% extremities in patients living in Arctic North with thrombangiitis and critical ischemia during 5 years after surgery that is worse than in patients living in Moscow region -- control group (86.1%). In long-term period more stable positive result was achieved after indirect revascularisation (save of extremity 78.3%).

[Organization of treating patients with major vessel injuries at stages of evacuation]. / Organizatsiia lecheniia postradavshikh s raneniiami magistral'nykh sosudov na étapakh évakuatsii.

The experience in treatment of 236 patients with primary injuries of major vessels is presented. A pressure dressing and tense surgical pack of the wound were used in a prehospital treatment. Use of a hemostatic tourniquet (37.3%) led to increased ischemia of injured extremity tissues. Maximal shortening of evacuation time is another important factor. Time to qualified surgical care was 3.2 +/- 0.4 hrs from injury moment, specialized--5.5 +/- 0.7 hrs. Shock was seen in 94.9% wounded. It is necessary to begin anti-shock treatment immediately after injury. Surgery was started only after shock compensation. If shock was caused by continued bleeding, surgery was started at the same time with anti-shock treatment (5.7%). Temporary shunt was used in field conditions in 35.9% wounded. In 11 (19.7%) cases endoprosthesis of original construction (two-lumen tube with microirrigator) was used. If this device was used there were no cases of arterial or venous thrombosis at the stage of specialized treatment. Since using of temporary endoprosthesis leads to delay of evacuation for specialized care it was performed only in cases of gangrene's threat when arrest of bleeding could not be performed with other methods.

Surgical treatment of patients with renovascular hypertension secondary to aneurysmal lesions of the renal arteries.

The paper analyzes the results of examination and surgical treatment of 71 patients with renal artery (RA) aneurysms which constituted 3% among all the subjects treated and examined at the Russian Scientific Centre of Surgery, Russian Academy of Medical Sciences (RSCS RAMS). Fibromuscular dysplasia caused RA aneurysm most frequently (60%). Contrast radioangiography was the basic modality used in the diagnosis of RA aneurysms. While making decision as to whether the surgical treatment is feasible, preference was given to reconstructions on the renal arteries in order to reduce systemic arterial pressure and to maintain renal function. Resection of the aneurysmal renal artery was resorted to most frequently, followed by establishment of an end-to-end anastomosis (38.2%). Lateral resection of RA aneurysm was employed only in the event of its eccentric bulging and when its diameter did not exceed 15-20 mm (22.1 %). There were no lethal outcomes. The positive results could be obtained in 93.6% of patients. In the long-term postoperative period, the stable positive results were recorded in 60.9% of patients with a history of reconstructions on the renal arteries for their aneurysmal lesion.

[Reconstructive surgeries on deep femoral artery in chronic critical limb ischemia]. / Rekonstruktivnye operatsii na glubokoi arterii bedra pri khronicheskoi kriticheskoi ishemii konechnostei.

Possibilities of revascularisation of the lower extremity through the deep femoral artery in elderly and aged patients with chronic critical limb ischemia were evaluated. Forty-nine patients with high surgical risk were studied. Safety of the extremity, decrease of ischemia degree and level of amputation were the main problems in surgical treatment. Deep-femoral-popliteal index was very important. If this index was less 0.3 surgeries on deep femoral artery were effective. If index was 0.3-0.5 results of surgery were questionable. Index more than 0.5 is the factor of unsuccessful revascularisation through the deep femoral artery.

[Surgical policy in patients with diffuse arterial lesion of lower extremities]. / Taktika khirurgicheskogo lecheniia bol'nykh s diffuznym porazheniem arterii nizhnikh konechnostei.

In spite of the achievements of contemporary surgery the rate of unfavoutable outcomes of reconstructive operations is keeping on to be high. Early postoperative complications because of inadequate choice of method for surgical treatment mount to 25%. Classification of the lesions of arteries of lower limbs is developed with due regards to functional and angiographic data. Simultaneous stenotic total lesions of the aorta, iliac, femoral, popliteal and tibial arteries lesions were considered as diffuse ones. The kind of surgical intervention is such lesions was determined according to functional reserve of collateral blood flow of the lower extremity. In such cases reconstructions only of aorto-iliac segment or multilevel reconstruction is possible (two-stage or one-stage reconstruction). The operation of choice was one-stage reconstruction.

[Complex approach to diagnosis and surgical treatment of patients with abdominal aortic aneurysm (classification)]. / Kompleksnyi podkhod k diagnostike i khirurgicheskomu lecheniiu bol'nykh anevrizmami briushnogo otdela aorty (klassifikatsiia).

The problem of management of abdominal aortic aneurysm (AAA) is becoming urgent due to growing AAA incidence. Most often concomitant disease in them is coronary artery disease (CAD) which itself is a risk factor for life. The study was performed in 249 patients, who underwent. Surgery for AAA in RAMS Research Center for Surgery in 1975-1997. 142 (57%) of them had associated CAD. The use of complex approach to the diagnosis in this category of patients has made in possible last years to increase detection of CAD by more than 75%. In surgical management the principle of dominant in lesion of one of these regions was used. In critical conditions of both regions one stage regions was used. In critical conductions of both regions one stage reconstruction was performed. This technique is well developed now. The proposed classification helps to assess completely concomitant diseases in patients with AA and to determine policy of surgical treatment individual for each patients.