[Diagnosis and surgical treatment of liver injuries].

Results of surgical treatment of 214 patients with trauma of the liver are analyzed. The diagnostic value of laparoscopy and urgent dynamic ultrasound investigation is emphasized. Prognostic scale ISS was used for assessment of injury severity. Structure of hepatic trauma and posttraumatic complications is analyzed. The ways of optimization of diagnosis and treatment are determined.

[Modern structure of the pancreatic injuries].

Current structure of pancreatic traumas of peace time is considered. The dynamics, mechanism and characteristics of pancreastic injury are described. Surgical treatment of pancreatic injuries and causes of their inadequate management are analysed. This will contribute to improvement of the quality of treatment of pancreatic injuries and of expert evaluation.

[Damage to the major vessels during surgical interventions in patients with cancer]. / Povrezhdeniia magistral'nykh sosudov vo vremia khirurgicheskikh vmeshatel'stv u onkologicheskikh bol'nykh.

The paper discusses causes and outcome of injuries to major arteries and veins observed in 53 surgical cases of cancer of various sites. Radical removal of tumor invading the vascular wall proved the main cause of iatrogenic trauma. Lateral and circular atraumatic sutures were used to restore major circulation in 31 cases; vessels were ligated in 17. Failure to arrest intraoperative bleeding was reported in 5 patients. There were 7 (13.2%) fatalities.

[Disorders of microcirculation in patients with acute surgical diseases of the biliary tract]. / Narusheniia mikrotsirkuliatsii u bol'nykh ostrymi khirurgicheskimi zabolevaniiami zhelchevyvodiashchikh putei.

The authors provide the results of studying the microcirculation in 85 patients with acute cholecystitis and 56 patients with mechanical jaundice caused by choledocholithiasis. The data were obtained with the aid of bulbar capillaroscopy during conservative and surgical treatment. Considerable alterations were detected in all the components of the microcirculation (perivascular, vascular, intravascular), correlating with the gravity of destructive lesions in the gallbladder, duration and degree of jaundice. The times and degree of the normalization of microcirculatory disorders were defined.

[Principles of conservative treatment of trophic leg ulcers]. / Printsipy konservativnogo lecheniia troficheskikh iazv goleni.

Long-term experience gained in the treatment of 647 patients suffering from trophic ulcer of the leg due to chronic venous insufficiency led the author to the conclusion on minimal benefit of chemotherapy in the treatment of the condition. Good therapeutic effect was achieved with enzymes used for cleansing purposes and local elastic compression of the leg with 3% boric acid solution fomentation. Epithelialization ++ of the ulcer occurred in 86.2% of the patients.

[Malignization of trophic leg ulcers]. / Malignizatsiia troficheskikh iazv nizhnikh konechnostei.

The paper treats of the diagnostic and therapeutic results for 40 cases of lower limb trophic ulcers transformed into malignant. The frequency of the malignant transformation and the ulcer site and area are found to correlate. The underlying cause of the ulcer onset and the time from its diagnosis to the first signs of the malignancy have been elucidated. Clinical features of the ulcer malignant transformation, methods of differential diagnosis and therapeutics are described.

[Diagnosis and treatment of rectal melanoma]. / Problemy diagnostiki i lecheniia melanom priamoi kishki.

Rectal melanoma is encountered rarely, is extremely malignant and prone to quick dissemination. The site of the tumor significantly complicates the diagnosis making inexperienced physicians to suspect polyps or hemorrhoids. It is only tumor destruction and ulceration that ascertain cancer. Misdiagnosis of rectal melanoma is responsible for rapid dissemination of malignant cells following undue biopsy. In suspected melanoma it is valid to perform wide electroexcision of the tumor with rapid histological examination. The survival is dependent on melanoma stage, ulceration and destruction, involvement of lymph nodes, histological appearance.

[Obturation ileus in cancer of the large intestine]. / Obturatsionnaia kishechnaia neprokhodimost' pri rake tolstoi kishki.

The analysis of treatment and diagnosis is presented for 168 colon cancer patients with occlusive ileus. Late diagnosis is responsible for high percentage of palliative operations (61.9%) with a 26% mortality. Radical surgery involves, as a rule, delayed primary one-stage resection and establishment of a single- or doubled-barreled anus. The mortality in this case reaches 19%. Advances in colon cancer treatment results and ways to reduce mortality in this conditions lie in early diagnosis and better knowledge by general practitioners of occlusive ileus pathogenesis and clinical appearance.

[The surgical treatment of traumatic diaphragmatic hernias]. / Khirurgicheskoe lechenie travmaticheskikh diafragmal'nykh gryzh.

The article discusses experience in treating traumatic diaphragmatic hernias in 68 patients, 63 of them underwent operation. Closed injuries to the diaphragm suffered in falling from a height and in car accidents and knife thoracoabdominal injuries were the main causes of this type of hernia. The principal role in their diagnosis belongs to X-ray examination with obligatory contrast study of the organs of the gastrointestinal tract. Among 41 patients who were operated on for non-strangulated hernia of this localization one died. In a group of 21 patients with a strangulated diaphragmatic hernia 11 died after surgery. Necrosis of the gastric and colonic wall, incompetence of the anastomosis sutures, peritonitis, and pleuritis were causes of death.

[Trauma of the iliac blood vessels]. / Travma podvzdoshnykh sosudov.

The authors generalized experience in the treatment of 32 patients with closed (in 7), puncture-incised (in 8) and iatrogenic (in 17) injuries to the iliac vessels. Three patients had a concurrent acute injury to the main arteries and veins, one patient had a posttraumatic arteriovenous fistula. Operations were performed on 29 persons: restorative operation on the main vessels in 21 and ligation of the vessels in 8 patients. The arterial blood flow was completely restored in 11 patients, the venous blood flow - in 8 patients. The lethality in injuries to the iliac vessels of various genesis was 9.4%.

[Surgery of the major vessels in cancer patients]. / Khirurgiia magistral'nykh sosudov u onkologicheskikh bol'nykh.

The article generalizes 25-year experience in various vascular surgical interventions conducted on 159 oncological patients. Planned operations were conducted after thorough angiographic study in 42 patients (arteriolysis and phlebolysis in 11, thrombectomy in 13, plastics of the vessels in 18). Two patients died after thrombectomy. Embolization of the renal arteries was undertaken in 55 patients with renal carcinoma; there were no fatal outcomes. Various operations for iatrogenic injury to the vessels were carried out in 60 patients (lateral suture in 28, circular suture in 3, ligation of vessels in 18). In this group 11 patients (18.3%) died. The authors claim that large oncological centers should be equipped with the appropriate angiographic apparatuses and have trained angio-surgeons on their staff.

[Injuries of the pancreas]. / Travmy podzheludochnoi zhelezy.

Trauma of the pancreas was studied in 48 patients. It has a typical mechanisms and is characterized by intensity of the exerted force. Due to the last named circumstance, extensive retroperitoneal hematomas, ruptures of the parenchymatous organs, ligaments, veins, and large arteries often occur A severe condition of the patients with fall of arterial pressure and the development of shock is characteristic. It is difficult to establish the diagnosis of trauma of the pancreas before the operation. The most frequent complication is traumatic pancreatitis which is often attended by the development of cysts, fistulas, and peritonitis. The surgeon's tactics is determined by the character of the injury and is individual in each patient.

[The clinical x-ray parallels in traumatic diaphragmatic hernias]. / Kliniko-rentgenologicheskie paralleli pri travmaticheskikh diafragmal'nykh gryzhakh.

An experience with diagnosing and treatment of traumatic diaphragmatic hernias in 68 patients (63 of them operated upon) is discussed. The leading role belongs to roentgenological examination of organs of the gastrointestinal tract. Lethality in free diaphragmatic hernias was 2.4%, in incarcerated hernias--52.4%.

[Indications for sclerosing theraph of superficial varicose veins and its possibilities]. / Pokazaniia skleroziruiushchei terapii varikoznogo rasshireniia poverkhnostnykh ven i ef vozmozhnosti.

17 years experience with the use of sclerosing preparations for the treatment in varicosis of the superficial veins of various genesis in 1477 patients is set forth. The studies of the long-term results (2 to 15 years) have shown good and fair cosmetic and functional results in 82.6% of cases. Recurrence has been found in 17.4%.

[Trigger mechanisms in the etiology of varicose and post-thrombophlebitic crural ulcers]. / Puskovye mekhanizmy v geneze varikoznykh i posttromboflebiticheskikh iazv goleni.

The results of clinical study of 247 cases suffering from trophic crural ulcer are set forth in this paper. Their occurrence is mainly due to various diseases of deep, communicant and superficial veins (236 cases 95%). Venous hypertension in the deep veins, while the patient is standing, is the leading cause of the microcirculation disorders, occurrence of interstitial edema, and opening of arterio-venous shunts. Tissue hypoxia and an infection, arising against this background, lead to the expansion of necrobiosis and to the occurrence of trophic ulcers. The therapeutic principles grounded upon the results of the presented study are brought about in this work.

[Vascular trauma in children]. / Travma sosudov u detei.

Results of the treatment of injuries of vessels in 29 children are described. Associated injuries of arteries, veins, nerves, tendons and bones were predominant (in 18 children). Most of the patients were subjected to restorative operations on main arteries: end-to-end anastomoses (7), lateral suture (6), autovenous prosthesis and shunting (7). Ligation of the small-diameter vessels was performed in 6 patients. In 3 patients the primary amputation of the extremity was fulfilled. Unfavourable results were noted mainly following the associated trauma of arteries and nerves. The authors believe that children with injuries of the vascular-nervous bundle should be observed in dispensaries.

[Injuries of the major blood vessels in joint dislocations]. / Povrezhdeniia magistral'nykh krovenosnykh sosudov pri vyvikhakh v sustavakh.

Experience with the treatment of 12 patients with injuries of major vessels resulting from dislocations of joints is generalized. In 5 of the patients an associated injury of nerve trunks was diagnosed, in 4 patients there were injuries of major veins. Reconstructive operations were made in 11 patients. In 8 patients full recovery was stated, three patients were subjected to amputation of the extremity. The main cause of the failure was late diagnosis of the closed trauma of the artery and progressing ischemia of the extremity.

[Gunshot pellet wounds of the major blood vessels]. / Ognestrel'nye drobovye raneniia magistral'nykh krovenosnykh sosudov.

The treatment of 14 patients with small-shot wounds of large blood vessels is analyzed. The specific features of such injuries are described and reasons of diagnostic errors at the stage of evacuation to a specialized department are found out. The use of reconstructive operations favoured the recovery of adequate arterial flow in 10 patients. Two patients were subjected to amputation of the extremities and one patient died due to a great small-shot injuries of vessels and nerves from a close distance.

[Gallbladder injuries]. / Povrezhdeniia zhelchnogo puzyria.

Injuries of the gall bladder were studied in 16 patients. Typical mechanisms of the trauma, clinical picture of the abruption, rupture of the bladder and knife wounds are established. Errors in the surgeon's actions are analyzed. Recommendations are given.

[Surgical treatment of arteriovenous fistulas and aneurysms]. / Khirurgicheskoe lechenie arteriovenoznykh svishchei i anevrizm.

An experience with the treatment of 31 patients with posttraumatic arteriovenous aneurysms and fistulas is presented. The blood flow was re-established in 28 patients, in 8 patients the ligature method was used. The functioning of the extremity was repaired.