[COMBINATION OF VESSEL EMBOLIZATION AND CRYOTHERAPY IN SURGICAL TREATMENT OF SOFT TISSUE SARCOMAS].

The article analyzed the results of surgical treatment of 153 patients with soft tissue sarcomas. The surgery was complemented by preoperative embolization of vessels, which supplied the tumor, cryotherapy on the tumor and postoperative wound in 72 patients of main group. The control group consisted of 81 patients and there weren't any perioperative actions. It was shown, that more than 80% of soft tissue sarcomas had the main and mixed type of tumor blood supply. Partial and full reduction of blood flow could be obtained by embolization of the tumor in more than 50% patients. Combination of surgical and preoperative embolization of vessels and cryotherapy decreased the rate of local recurrence and increased the quantity of organosafe interventions.

[Influence of nutritive support on surgery outcomes in elderly patients with colon cancer].

The article presents the results of surgery outcomes in 127 elderly patients with colon cancer. The patients were divided into two groups: the main group (prospective, n = 52) and control group (retrospective, n = 75). The combined preoperative nutritive status assessment by BMI and a prognostic hypotrophy index were used. It included the optimization of nutritive support on all stages and an early tube removal, an enteral feeding during postoperative period. It was stated, that it significantly reduced the level of complications, period of intensive care unit stay on 2 days and a hospital stay on 4 days in main group. All the patients of the main group improved the quality of life during 7 days (EORTC QIQ CR29). Proposed nutritive support program allowed improvement of the quality of life and positive treatment outcomes in elderly patients with colon cancer.

[Clinical recommendations on treatment of the elderly colorectal cancer patients].

Colorectal cancer (CRC) is one of the commonest malignancies of Western countries, with approximately half the incidence occurring in patients > 70 years of age. Elderly CRC patients, however, are insufficient to fully examined, therefore, they receive inadequate treatment and underrepresented in clinical trials. The International Society of Geriatric Oncology created a task force with a view to assessing potential for developing guidelines for the treatment of elderly (geriatric) patients. A review of the evidence presented by the task force members confirmed the paucity of clinical trial data in elderly people and the lack of evidence-based guidelines. However, recommendations have been proposed on the basis of the available data and on the emerging evidence that treatment outcomes for fit, elderly CRC patients can be similar to those of younger patients. This gives hoped that such efforts will pave the way for formal treatment guidelines based upon solid scientific evidence in the future.

[Features of hemocomponental therapy in oncological patients].

The authors present an analysis of specific features of transfusions of erythrocyte containing media in oncological patients. Special attention was given to necessary selection of donor erythrocytes in performing operations with massive intraoperative blood loss. It considerably contributes to a decreased number of posttransfusional reactions and complications. For the recent five years transfusions of erythrocyte containing media to more than 15 thousand patients with surgical treatment were analyzed. Among them the individual selection of donor blood was fulfilled in 2047 cases. Compatible erythrocytes could not be selected in five cases only. In these patients infusions of Perftoran were used as an oxygen carrier both during operation and at the postoperative period.

[Immune correction in patients with colostomas and fistulas].

Symptoms of secondary immune deficiency were revealed in 37 out of 84 wounded with colonic fistulas and colostomas. During the preparation of the patients to restorative operations for the improvement of the immune system functions the patients were given transfusions of donor leuko-suspension taken from subjects with high titer of antibody in blood serum to colon bacillus and intravenous infusions of immunoglobulin. Such immunocorrection allowed restoration of immune potential of organism during a short time and improvement of the operation results.

[Frontal resection as a means of decision for surgical treatment of rectum cancer].

The work has been devoted to the improvement of methods of surgical treatment of cancer of the rectum. The possibilities to perform organ-saving operations in treatment of cancer of the rectum are discussed. An analysis of treatment of 351 patients with cancer of the rectum has shown that frontal resection of the rectum is possible in more than 40% of such patients since such interventions save the function of the rectum more completely. New methods of preoperative preparation of the patients are described as well as the application of the improved methods of surgical interventions.

[Treatment of tumoral colonic obstruction].

The work was devoted to problems of treatment of patients with cancer of the colon complicated by tumoral colonic obstruction. The authors propose an improved clinical classification of disturbances of colonic obstruction with colorectal cancer. The questions discussed are: decision on the strategy of treatment of acute colonic obstruction patients, the possible differential approach to choosing methods of treatment depending on localization of tumor and duration of the period of the development of intestinal obstruction. The results of treatment of 148 patients with colorectal cancer complicated by acute colonic obstruction are analyzed. It was shown that in 20% of patients with the initial stage of obstruction with the tumor localized in the left half of the colon it was possible to resolve the obstruction by conservative measures followed by the preparation of the patients to planned operation.

[Treatment of acute venous thromboses in patients with varicose disease of lower extremity veins].

The work was devoted to surgical methods of treatment of acute venous thromboses of main lower extremity veins for prevention of thromboembolic complications in patients with varicose disease of lower extremities. Possibilities of surgical correction of the venous blood flow are discussed at different variants of the course of acute venous thrombosis. An analysis of treatment of 92 patients with thrombotic lesions of the main lower extremity veins and high danger of thromboembolic complications has shown that more than 40% of patients with venous thromboembolism need treatment with surgical and medicodiagnostic endovascular interventions. Surgical and endovascular methods of prophylactics of thromboembolism of the lesser circle of blood circulation for complicated forms of chronic venous insufficiency are described.

[Minimally-invasive combined radiosurgical interventions in diagnosis and treatment of pulmonary artery thromboembolism]. / Maloinvazivnye kombinirovannye rentgenokhirgicheskie vmeshatel'stva pri diagnostike i lechenii tromboémbolii legochno-arterial'nogo basseina.

Basing on the analysis of results obtained during the investigation and treatment of 38 patients suspected of pulmonary artery thromboembolism (PAT) the algorithm of measures applied in our hospital was developed. Its purpose was to put the PAT diagnosis and treatment in order. In our investigations the leading treatment method was the regional infusion therapy conducted through the transformation of diagnostic catheterization of pulmonary artery trunk into the treatment intervention. With the purpose of embolus hydrodynamic destruction the regional thrombolysis was conducted under conditions of fast high-pressure perfusion. It was preceded by the mechanical recanalization of thrombosis zone by the distal part of probe in order to create more favorable perfusion conditions. To prevent the repeated PAT when the source of thromboembolism was revealed the cava-filter implantation in the infra-renal part of inferior cava was performed.

[Enteral therapy of the syndrome of intestinal insufficiency in patients with peritonitis]. / Enteral'naia terapiia sindroma kishechnoi nedostatochnosti u bol'nykh s peritonitom.

Sixty five patients with peritonitis were examined and divided into two groups. The operative intervention in all the patients included transnasal intubation of the small intestine. The basic enteral therapy used in the first group of patients was made with the glucose-saline solution and transition to a balanced polysubstrate mixture "nutrient standard" with the increasing concentration. For the patients of the second group a special program was developed for enteral therapy in which glutamine and pectine were included in the glucose-saline solution as well as nutrient mixtures containing middle chain triglycerides. Active decompression of the small intestine followed by the enteral administration of the nutrient mixtures facilitated quicker correction of the intestinal insufficiency in patients with severe forms of peritonitis.

[Restorative operations in colostomy patients with short stump of the rectum]. / Vosstanovitel'nye operatsii u kolostomirovannykh bol'nykh s korotkoi kul'tei priamoi kishki.

An analysis of restorative operations on 113 patients with a story of obstructive resection of the colon after Gartman has shown that of special technical difficulty were operations on patients with a short (less than 10 cm) stump of the rectum. In 26 patients an apparatus stitch "to the pitch" with the help of suturing apparatuses AKA-2 and AKA-4 of the firm "Ethicon" was used. In 9 patients a combined hand sewing was used. In the patients in whom the continuity of the colon was restored with the help of a mechanical suture "to the pitch" or by the hand combined sewing there were no incompetent anastomoses. Results of the operations were followed-up during the period from 6 months to 3 years. In 2 patients (5.4%) stricture of the anastomosis was diagnosed following its formation with the help of the apparatus AKA-4.

[The treatment in ulcerative hemorrhages in patients with liver cirrhosis and portal hypertension]. / Lechenie pri iazvennykh krovotecheniiakh u bol'nykh s tsirrozom pecheni i portal'noi gipertenziei.

Treatment of 34 patients with bleedings from chronic gastroduodenal ulcers associated with cirrhosis of the liver and portal hypertension was analysed. Overall lethality was 41.2%, postoperative lethality was 41.7%. Temporary hemostasis due to a solution of Caprofen used during fibrogastroduodenoscopy allows the operation to be delayed and complex intensive therapy can be performed in patients with hepatic insufficiency. Control medical endoscopic investigations should be performed 4 and 12 hours after admission to the hospital of patients with sub- and decompensated cirrhosis of the liver with portal hypertension and symptoms of unstable hemostasis. The emergency and delayed operative treatment of patients with subcompensated hepatic insufficiency should include organ-saving operations such as vagotomy with pyloroplasty and/or dissection of the ulcer. Operation is indicated to patients with cirrhosis of the liver at the stage of decompensation but if they have evident reappearance of bleeding and in minimal volume. The attainment of final endoscopic hemostasis will allow to avoid surgical interventions intolerable for this category of patients.

[Use of leukocytic suspension in the treatment of diffuse peritonitis]. / Primenenie leikotsitnoi vzvesi pri lechenii razlitogo peritonita.

Immunocorrection by means of transfusions of donor leukocytes was performed in 64 patients. Transfusions of the leukocytic suspensions in short courses (2-3 transfusions to one patient or 300-500 ml per a course) during the first three days after operation allowed the immune status of organism to be improved and increased the effectiveness of the antibacterial and infusion-detoxication therapy. The greatest medical effect was obtained when using the leukosuspension from donors with natural high (from 1:160 and higher) titers of antibodies to E. coli.

[Use of an artificial carrier of oxygen on the base of modified hemoglobin in patients with gastroduodenal hemorrhage]. / Primenenie iskusstvennogo perenoschika kisloroda na osnove modifitsirovannogo gemoglobina u bol'nykh s gastroduodenal'nymi krovotecheniiami.

Infusions of Helenpole used in 23 patients allowed for a short time to stabilize hemodynamics and to considerably improve the gas-transporting function of blood. The best curative effect in patients with hemorrhagic shock was obtained by means of intravenous jet infusions of the medicine, after stabilization of the hemodynamic indices with the help of an intravenous dropper (80-90 drops/min). The dose of the 1% solution of the medicine was 25-30 ml/kg of the patient's body weight.

The small intestine as the origin of bacteremia in acute diffuse peritonitis.

Studies have demonstrated the failure of gut barrier function in all cases of experimental acute diffuse peritonitis. Histobacterioscopy and electron microscopy showed the occurrence of bacteria under the basal membrane, in lymphatic and blood capillaries of the small intestinal villi. Experimental and clinical trials with blood sampling from different regions of the circulation have demonstrated the gut origin polymicrobial bacteremia in 66% of patients and in 75% of experimental animals with acute diffuse peritonitis.

[An erythrocyte suspension in Modegel in the treatment of acute gastrointestinal hemorrhages]. / Vzves' éritrotsitov v "Modezhele" pri lechenii ostrykh gastroduodenal'nykh krovotechenii.

The effectiveness of a suspension of erythrocytes in the new colloid preservative "Modegel" (in 1:1 ratio) was studied in the complex treatment of 31 patients with severe gastroduodenal bleedings. It was established that the hemodynamic, antianemic action of the suspension was not inferior (and even excels) to the action of the whole preserved blood and the erythrocytic mass. The suspension transfusion has a favorable effect upon functions of the liver and kidneys, corrects the acidic-alkaline state of the recipients' blood, decreases the lipid peroxidation and has detoxicating properties. During transfusion of the suspension hypocoagulation of blood doesn't take place. The temperature reactions following the suspension transfusion are rare. The suspension of erythrocytes "Modegel" deserves wide introduction to clinical practice.