[Delayed results of proximal gastrectomy in patients with esophageal and gastric varices].

An original method of proximal gastrectomy was used to eliminate hemorrhage from gastric and oesophagal varicose veins in 27 patients with portal hypertension. The follow up period varied from 1 to 23 years. The risk of hemorrhage and the degree of vein dilatation were assessed by endoscopy and endoscopic ultrasonography. It is concluded that the method used in the study may be recommended as the first-line surgery for the management of hemorrhage from gastric and oesophagal varicose veins with good functional results in the late postoperative period and rare complications.

[Transabdominal ultrasonic scanning in evaluation of liver parenchyma: new opportunities].

On suspicion of the diffusive liver lesions 117 patients have been performed a transabdominal ultrasound investigation with a visual estimate of the echogenicity of the structure of the liver's parenchyma in comparison with the echogenicity of the cortical substance of the kidney and with the determination of the homogeneity of the liver's structure on its different areas. For the purpose of the elevation of the self-descriptiveness and precision of diagnostics as well as for the reduction of the subjective estimation the authors carried out the evaluation of the structure of the liver's parenchyma and the cortical substance of the kidneys using the histography on the marked area. The elaboration of the efficient quantitative assessment of the changes of the liver's parenchyma allowed to relieve complications in differential diagnostics and to estimate the damage level of the organ's parenchyma objectively during the investigation.

[The potential for endoscopic dissection of the leg perforating veins].

This paper describes the results of endoscopic dissection of the leg perforating veins in patients suffering from different forms of chronic venous insufficiency of the lower limbs. Varicosity was present in 54 (88.4%) and postthrombophlebitis in 7 (11.6%) patients. Before operation the patients were provided ultrasound Doppler and duplex scanning. Microcirculation was examined by laser Doppler flowmetry. The study evidences decreased perfusion of the superficial skin layers during the growth of arteriolo-venular blood shunting that occurs because of phlebohypertension. For endoscopic dissection of the leg perforating veins an original titanium nickelide clips was employed, which allowed ligation of the veins measuring over 5 mm via a standard endoscopic canal. The use of the given technique made it possible to minimize the time of operation, to decrease traumatic injury of intervention due to the exclusion of incisions in the area of trophic disorders. The mean time required for ulcerous defect healing accounted for 32.3+/-1.7 days. Regulation of lower limb microcirculation was restored 3 months after surgical treatment.

[Optimization of prognosis and surgical prophylaxis of bleedings from esophageal varicose veins].

New methods of prediction of bleeding from the esophageal varicose veins improve treatment outcomes. These methods consist of endoscopic assessment of varicose vein and mucous membrane with determination of thickness of the vein wall and mucosa, and also assessment of reflux-esophagitis with endoscopic ultrasonography. Original operation of azigoportal disconnection was performed in 13 patients followed-up after surgery from 1 to 4 years. The results obtained demonstrate high efficacy of this surgery for prophylaxis of repeated bleedings from esophageal varicose veins.

[Prevention of dumping syndrome after distal gastrectomy in peptic ulcer]. / Profilaktika demping-sindroma posle distal'noi rezektsii zheludka po povodu iazvennoi bolezni.

Operations were performed on 386 patients with peptic ulcer by a method suggested by the authors for gastric resection with formation of a sphincter in the region of the anastomosis. In 18 patients a Billroth II anastomosis was reconstructed into a Billroth I anastomosis by the authors' modification in severe dumping syndrome. Complex examination was conducted in late-term postoperative periods in 324 patients after primary resection and in 18 after reconstructive operation. A mild dumping syndrome was found in 9 (2.8%) and 3 patients, respectively. The results of the study show that if the authors' requirements regarding the volume and method of gastric resection are abided by, there is no doubt that the suggested method has advantages over the classical method in that the reservoir function of the stomach is maintained, hydrochloric acid secretion reduces to a state of hypo- or normoacidity, and the peristaltic component of evacuation is preserved due to the formed functionally active anastomosis.

[Surgical treatment of stomach ulcer]. / Khirurgicheskoe lechenie iazvennoi bolezni zheludka.

Operated on were 168 patients with gastric ulcer disease. The preference was given to Billroth-I gastric resection with the artificial sphincter formation at the site of anastomosis and proximal gastric resection with the antireflux gastroesophageal anastomosis creation. The introduction of the developed techniques of gastric resection permitted to improve considerably the long-term functional results of treatment.