[Laparoscopic horizontal gastroplasty]. / Laparoskopicheskaia gorizontal'naia gastroplastika.

The analysis of the first 14 operations of horizontal gastroplasty in patients with end-stage alimentary constitutional obesity was carried out, the operations being performed according to standard (9 patients) as well as laparoscopic method (5 patients). The mean body mass made up 133.6 kg, the mean height being 167.8 cm. Patients age was from 22 to 42 years. All the patients operated by laparoscopic method were women. Technique of laparoscopic horizontal gastroplasty is described, indications and contraindications to the operation are established. It is demonstrated, that laparoscopic gastroplasty, as well as previously performed 530 horizontal gastroplasties with the help of fluoric-lausan goffer band, performed in clinic since 1984, in present time is one of the most perspective method of surgical correction of obesity. The application of this method results in substantial and steady decrease of body mass of the operated patients with minimal risk of complications during surgical procedure as well as in postoperative period.

[Effect of fragmin, a low-molecular heparin, on hemostasis in patients with alimentary-constitutional obesity]. / Vliianie nizkomolekuliarnogo geparina fragmina na gemostaz u bol'nykh alimentarno-konstitutsional'nym ozhireniem.

The authors conducted comparative study of the hemostasis indices before and in the immediate period after operation for formation of a small stomach in 31 patients with stage III-IV alimentary-constitutional obesity, in 50 patients without obesity who underwent operation on the stomach, and in 15 volunteers. Nonspecific prevention of thrombogenesis was performed in all patients with normal weight and those with obesity. Patients with obesity were given in addition specific thrombogenesis prevention with nonfractionated heparin (group I) and fractionated low-molecular heparin-fragmin produced by KABI (groups II and III). Study of the parameters of the hemostasis system in the postoperative period showed nonspecific prevention of thrombogenesis to be sufficient to reduce the risk of pulmonary artery phlebothrombosis and embolism in most patients without obesity. In patients with obesity the probability of phlebothrombosis and thromboembolism is much higher, in view of which they must be given heparin in addition to nonspecific prevention. Fragmin, as an agent for thrombosis prevention, has certain advantages over nonfractionated heparin and should be used more frequently in clinical practice in patients of the risk group, e. g. with pathological obesity, in a dose no less than 100 U/kg. With the use of fragmin laboratory control before each injection is not needed. Administration of nonfractionated and fractionated heparins must be combined with bandaging of the lower limbs and other measures of nonspecific prevention of thrombogenesis.

[State of the liver in patients with obesity at distant periods after formation of a "small stomach"]. / Sostoianie pecheni u bol'nykh ozhireniem v otdalennye sroki posle operatsii formirovaniia "malogo zheludka".

Histological study of biopsy specimens taken from the liver of 96 patients during operation for formation of a "small stomach" revealed fatty dystrophy of the liver in 93 patients (96.9%) which was attended by marked inflammatory and fibrous changes in 68 (70.8%) of them and by disturbed lobar structure of the liver (cirrhosis) in 2 patients (2.1%). Biochemical blood tests failed to show the pattern of the pathological changes before the operation. Study of the hepatobiliary system with methionine-75Se was the only method by which protein and pigment metabolism in the liver could be appraised. Examination of patients during 3 postoperative years showed a positive dynamics of changes in biochemical blood tests and improved protein metabolism in the hepatocytes according to the results of scanning of the liver with methionine-75Se. Thirteen repeated studies of the hepatic tissue collected from patients in different periods after operation for the formation of a "small stomach" showed a significant diminution of fatty dystrophy and inflammation of the parenchyma. The level of portal tract inflammation and portal fibrosis did not change. The findings suggest that there is an improved functional and morphological condition of the liver in weight loss caused by operation for the formation of a "small stomach", which allows this type of surgical intervention to be recommended for the treatment of patients with alimentary-constitutional obesity and initially diminished compensatory capacities of the liver.

[Late results of the treatment of patients with the extreme degree of alimentary-constitutional obesity by the method of formation of a small stomach]. / Otdalennye rezul'taty lecheniia bol'nykh s krainymi stepeniami alimentarno-konstitutsional'nogo ozhireniia metodom formirovaniia malogo zheludka.

The work analyses the results of treatment of 311 patients with extreme degrees of alimentary-constitutional obesity by formation of a small stomach. Fatal outcomes (1.9%) were encountered in the period of operative technique mastering. The late-term results were studied in 167 patients in follow-up periods of up to 3 years. The patients' average body weight was 149.4 kg, average height 166.2 cm, average body weight excess as compared to the ideal weight was 125.6%. Study of the late-term results of the operation showed that the postoperative weight loss depends on the initial weight excess and the diameter of the anastomosis formed between the proximal and distal parts of the stomach. The more the initial excess of weight as compared to the ideal value, the more the loss of body weight is. The diameter of the formed anastomosis should be no larger than 15 mm. Besides loss of weight, the activity of vital organs and systems is normalized after the operation, and arterial hypertension, diabetes mellitus, the Pickwickian syndrome, and metabolic polyarthritis take a milder course. The operation for formation of a small stomach made it possible for the patients to resume their customary occupation, freed them of the threat of invalidation, and reduced the duration of the disability period by 4.3 times. After surgical treatment the nature of the patients' life significantly improved; 95.8% of patients appraised the effect of the treatment as excellent and good.

[Results of surgical formation of small stomach in patients with morbid obesity]. / Rezul'taty operatsii formirovaniia malogo zheludochka u bol'nykh so sverkhozhireniem.

The authors conducted a comparative analysis of the results of surgical treatment of patients with alimentary-constitutional adiposity (ACA) of extreme degrees. Operation for the formation of a small stomach (SSF) was carried out in 41 patients. The results in the same patients were analysed in postoperative periods of more than 2 years. The patients were divided into 2 groups. The first group was composed of 22 patients with morbid obesity and an average body weight of 140.2 +/- 4.47 kg (101.4 +/- 3.83% excess weight). The second group was made up of 19 patients with an average body weight of 170.2 +/- 6.5 kg (average excess weight 169.8 +/- 7.03%). The average weight loss in the first group was 41.9 kg (59.9% loss of excessive weight), the average weight loss in patients with hyperadiposis (second group) was 62.9 kg (99.4% loss of excessive weight). The results of operation for SSF for reducing body weight in patients with adiposity are better than those of vertical gastroplasty.

[Results of the operation for creating "miniature stomach" in the treatment of alimentary-constitutional obesity]. / Rezul'taty operatsii formirovaniia "malogo zheludochka" v lechenii alimentarno-konstitutsional'nogo ozhireniia.

The article analyses the results of surgical treatment of alimentary-constitutional obesity in 207 patients by means of operation for formation of a "miniature stomach". Total postoperative mortality was 2.4%. This index was 4.2% in the period when the method was mastered and 0.89% for the next 112 operations. It is shown that the operation for formation of a "miniature stomach" leads to a significant and stable loss of body weight, recovery from concomitant diseases or essential diminution of their severity, it alters the patients' life for the better and makes it possible for many of them to resume work.

[Hematologic indicators in patients with morbid obesity after surgical creation of the miniature stomach]. / Gematologicheskie pokazateli u bo'lnykh s krainei stepe'niu alimentarno-konstitutsiona'lnogo ozhireniia posle operatsii formirovaniia malogo zheludka.

Surgical establishment of miniature stomach was conducted in 28 patients with severe alimentary-constitutional obesity (mean body weight 155.7 kg). After a 18-36-month follow-up the patients underwent hematological examination. It was found that a 134% excess of body weight registered preoperatively dropped to 54%. Reduced levels of blood red cells, hemoglobin, serum iron were not registered. Neither was anemia. This shows that physiological function of the whole gastrointestinal tract was not damaged, the blood loss appeared insignificant. Substitution therapy with hemostimulants during the following two years may be avoided.

[Syndrome of premature ventricular repolarization]. / Sindrom prezhdevremennoi repoliarizatsii zheludochkov.

ECG abnormalities are described in 71 persons with the syndrome of premature repolarization of the ventricles. The syndrome of premature ventricular repolarization is considered a benign, most probably congenital, change of the electro-physiological state of the heart which due to its morphological peculiarities, however, leads to hyperdiagnosis of ischemic heart disease. In the discussion of the pathogenesis of this syndrome, the main attention is focused on the increased effect of the vagus nerve and the possible existence of anomalous additional pathways of atrioventricular conduction.

[Differential diagnosis of supraventricular rhythm disorders and the tactics in the treatment with cardiac glycosides]. / Differentsial'naia diagnostika supraventrikuliarnykh narushenii ritma i taktika lecheniia serdechnymi glikozidami.

The article discusses the possibilities of differential diagnosis of supraventricular arrhythmians by means of carotid zone stimulation, atrial VCG and ECG recorded from right-bronchial leads. Atrial VCG can reveal the character of the ectopic P-wave and thus helps in the diagnosis of arrhythmias with conspicuous atrial activity. ECG recorded from bronchial leade makes it possible to obtain a large atrial wave and determine elements of decisive importances in the diagnosis of many rhythm disorders: junctional and combined contractions, various types of ectopic P-waves, the character of antero- and retrograde conduction. The tactics of treatment with cardiac glycosides is determined by precise diagnosis of the arrhythmia and its connection with digitalis toxicosis.

[Partial atrioventricular dissociation caused by paroxysmal nodal tachycardia with outlet tract block]. / Nepolnaia atrio-ventrikuliarnaia dissotsiatsiia, obuslovlennaia paroksizmal'noi uzlovoi takhikardiei s blokadoi vykhoda.

Two cases of partial atrioventricular dissociation caused by paroxysmal nodal tachycardia with outlet track block are described. One of the episodes was discovered with the aid of ECG bronchial leads that permit distinct determination of atrial and ventricular "trapped" contractions, as well as combination complexes.