[Comparison of the results of radical and palliative operations for gastric cancer complicated by an acute hemorrhage].

The results of treatment of 1125 patients, suffering gastric cancer, complicated by an acute hemorrhage, were analyzed. The treatment tactics was elaborated, which have included endoscopic hemostasis conduction in an active tumoral hemorrhage present as well as the measures, directed on prophylaxis of the hemorrhage recurrence, when the signs of the hemorrhage spontaneous arrest and stigmata are present, using miniinvasive methods of endosurgical hemostasis, according to established criteria of their efficacy, and further conduction of clinic-endoscopic monitoring. Introduction into clinical practice of the elaborated algorithm of the treatment tactics have permitted to increase the radical operations performance rate from 66.0 to 75.9%, to lower postoperative lethality index in 4.4 times, to reduce a palliative operations performance rate from 44.0 to 24.1% and to lower lethality after this kind of procedures from 20.3 to 12.8%.

[Application of antiseptic dekasan in urgent abdominal surgery].

Experience in local application of antiseptic Dekasan in the complex treatment of abdominal infections of various origins are presented. The clinical and economic efficacy of the drug application is notice.

[Surgical treatment of Meckel diverticulum complicated by an acute hemorrhage].

Mekkel's diverticulum (MD)--is the inborn anomaly, caused by incomplete yolk duct development, it is present in near 2% of population and in 95% of observations lacks clinical manifestations. Symptoms of the disease manifest while complications occurrence only--in presence of peptic ulcer with possible hemorrhage and perforation occurrence, while ileus, diverticulitis, hernia, umbilicus fistula and tumor development. Eight patients, suffering MD, complicated by gastrointestinal hemorrhage, were treated during 1983-2006 yrs in Kyiv's city center for giving the aid to patients suffering gastrointestinal hemorrhage (GIH). These had constituted 6.6% of general quantity of adult patients, suffering rare causes of GIH occurrence, and 0.03% of all the patients, suffering GIH. For the diagnosis establishing in all the patients colonoscopy, barium enema and abdominal ultrasonography were applied. Definitive diagnosis was established only postoperatively. MD was extirpated in 5 patients, the wedge ileum resection with MD was accomplished in 1 patient and ileum resection with MD--in 2 patients. All the patients are alive.

[Peculiarities of microflora in an acute appendicitis and its impact on the postoperative purulent-inflammatory complications rate].

Bacteriological investigation of processus vermiformis contents was performed in 102 patients suffering an acute appendicitis (AA) and of abdominal cavity exudate--in 82 patients, operated for an AA. The microflora identification was done, as well as probable connection between microorganisms associations, the rate of the AA destructive forms revealing and postoperative purulent-inflammatory complications occurrence.

[Prognosis of disability after performance of operation for complicated gastroduodenal ulcer].

Quality of life of a patient constitutes integrated index of the treatment efficacy. One of parts of the "quality of life" term is a restriction of vital activities - disability. It is for the first time, when the prognostication system was proposed for the risk estimation of disability occurrence in patients, operated on for complicated gastroduodenal ulcer, which was elaborated on background of the step by step discriminant analysis. Application of prognostication system, in particular, its simplified variant, permits to apply it widely for choosing of optimal operative treatment method, which prophylaxes the risk of disability occurrence.

[Application of anticoagulants in patients after operations for gastro-intestinal bleeding].

Our clinical experience witness the necessity of administration of direct anticoagulants in prophylactic dosage to patients, operated on for gastro-intestinal bleeding. The most effective and secure is preparation of the low molecular weight fractionized heparins group--Fraxparin. The summarized data concerning group of patients, in whom Fraxyparin was applied, witness the absence of unfavourable peak of effect after the preparation injection, gradual action and holding on of the interinjection time plato, the absence of significant additive noncontrollable action of Fraxparin after each subsequent injection made.

[Application of synthetic analogue of somatostatin--octrestatin in the treatment of gastroduodenal erosions and acute ulcers complicated by hemorrhage].

Retrospective analysis of diagnostic and curative processes in Kyiv's city centre of delivering the aid in gastrointestinal hemorrhage for 1131 patients in 1999--2003 yrs period was done. The classification of gastroduodenal erosions and an acute ulcers, complicated by hemorrhage, oriented on etiological factor involved, was proposed. Depending on etiological feature present, there were determined characteristic signs of mucosal affections, their localization and the hemorrhage severity. There was proved the expediency of introduction of the treatment results control, based on investigation of dehydrogenases activity, the intracellular glycogen content and the state of the lipids peroxidal oxidation. Clinical efficacy of synthetic analogue of somatostatin Octrestatin was studied in the treatment of gastroduodenal erosions and an acute ulcers in 26 patients. Application of Octrestatin have promoted the lipids metabolism normalization and acceleration of the mucosal ulcers healing by 2-3 days.

[The clinical and diagnostic characteristics of perforations in acutely bleeding gastroduodenal ulcers]. / Osoblyvost' kliniky ta diahnostyky perforatsiï hostrokrovotochyvykh hastroduodenal'nykh vyrazok.

Over the period 1982-1996 a total of 8822 patients with ulcerorrhagias were treated in a clinical setting. In 122 (1.4%) patients different variants of association of perforation of the bleeding ulcers (PBU) were recordable. Features of development, course, diagnosis and treatment of PBU patients were studied. Two variants of PBU development were identified: concurrently emerging perforation with ulcer bleeding--in 34 (27.9%) patients; when perforation of the ulcer emerged in 88 (72.1%) in--patients one to seven days following a bleeding event, presenting in 48 (54.5%) with bleeding recurrence, and in 40 (45.5%) patients without the above recurrence against the background of varying degrees gravity of loss of blood. As to PBU localization, 92 (75.4%) patients had the same site (in the stomach--18 subjects, pyloroduodenal region--74 ones), 30 (24.6%) patients developed simultaneously one perforating gastric or duodenal ulcer and some other ulcer bleeding. Analysis of symptoms in PBU and in 474 patients presenting with perforating ulcers without bleeding revealed varying degrees atypicalness of PBU course depending on variants of combination. A symptom complex of lesser PBU sign has been singled out, an algorithm proposed for procedures that might be helpful in making early diagnosis and planning surgical treatment to be done in a timely fashion. The suggested approach enabled the postoperative mortality to be reduced 3.5-fold (from 25% to as low as 7.1%).

[Ways for improvement of medical, occupational, and social rehabilitation of patients operated for complicated gastroduodenal ulcer]. / Shliakhy pokrashchannia medychnoï, profesiinoï ta sotsial'noï reabilitatsiï khvorykh, operovanykh z pryvodu uskladnenoï hastroduodenal'noï vyrazky.

Based on the analysis of the early post-operative period in 1588 patients and long-term results in 667 patients having been operated for complicated gastroduodenal ulcers, algorithms are submitted of medical, occupational, and social rehabilitation, which fact permitted improving results of surgical treatment. The proposed rehabilitation project envisages staging and continuity of measures aimed to restore the patients' capacity for work and their social status.

[Complex rehabilitation of patients operated on for complicated peptic ulcer]. / Kompleksna reabilitatsiia khvorykh, operovanykh z pryvodu uskladnenoï vyrazkovoï khvoroby.

Results are submitted of sanatorium-and-health resort treatment of 104 patients operated on with the aid of the organ-sparing and resection techniques for complicated forms of gastroduodenal ulcers. An algorithm of therapeutic measures taking account of sanatorium-and-health resort treatment has been worked out. It allows to lessen considerably the postoperative complications, to shorten duration of temporary disability, to reduce permanent disability after resection of the stomach 3-fold.

[Architectonics of the vessels of small and large intestinal grafts in esophagoplasty]. / Arkhitektonika sosudov tonko- i tolstokishechnykh transplantatov pri ézofagoplastike.

In experiments on 30 cadavers the structure of the small and large bowel vessels with the concern in esophagoplasty was studied. The angiography proved that in case of multiarcade structure of the small bowel vessels, more than in 50% of cases the great bowel showed a trunk type of the division of the vessels. In 70% of cases with a favourable structure of the small bowel vessels good conditions for taking a graft from the large bowel were found. In case of a relatively unfavorable or an unfavorable structure of the small bowel vessels (26.7%) there was the possibility to get a graft from the left side of the large bowel and in 50%--from the right one.

[Comparative evaluation of remote results of surgical treatment of complicated gastroduodenal ulcer]. / Porivnial'na otsinka viddalenykh rezul'tativ khirurhichnoho likuvannia uskladnenoï hastroduodenal'noï vyrazky.

Results of operative treatment of 1588 patients with complicated gastroduodenal ulcer in immediate and of 667--in late postoperative period were analyzed. Best results were obtained after performance of organ preserving operations in combination with proper full complex medical rehabilitation of operated patients.

[Surgical treatment of acute peptic hemorrhage associated with perforation of gastroduodenal ulcer]. / Khirurhichne likuvannia hostroï vyrazkovoï krovotechi, poiednanoï z perforatsiieiu hastroduodenal'noï vyrazki.

In 1982-1996 yrs of 8822 patients with ulcer bleeding in 122 (1.4%) it was concurrent with gastroduodenal ulcer perforation. In 34 (27.9%) simultaneous perforation and bleeding were observed, in 88 (72.1%) perforation occurred in 1-7 days after bleeding, in 48 (54.5%) it was concurrent with recurrent bleeding. Postoperative mortality lowered from 25 to 7.1% due to application of the principles elaborated.

[Emergency diagnosis and surgical treatment of acute gastric hemorrhage in the Mallory-Weiss syndrome]. / Ekstrennaia diagnostika i khirurgicheskoe lechenie ostrykh zheludochnykh krovotechenii pri sindrome Mallori-Veisa.

The Mallory-Weiss syndrome was observed in 4.5% of 4154 patients with gastrointestinal bleedings. In 113 patients with arrest of the bleeding the conservative drug therapy was performed, in patients with continuing bleedings (76 patients)-endoscopic diathermic coagulation was fulfilled with complete and perfect hemostasis without complications and lethal outcomes.

[Treatment of patients with acute gastrointestinal hemorrhages at a specialized center]. / Lechenie bol'nykh s ostrymi zheludochno-kishechnymi krovotecheniiami vspetsializirovannom tsentre.

The work has shown that concentrating the patients with acute gastro-intestinal bleedings at surgical hospitals having qualified surgeons, auxiliary services and necessary equipment can give a considerable improvement of differential diagnosis of the source of bleeding in the acute period, higher surgical activity in the ulcer on cancer nature of the bleeding, better results of both the operative and conservative methods of treatment.

[Internal ligatures of the pyloro-duodenal region after surgical treatment of bleeding ulcers]. / Vnutrennie ligatury piloroduodenal'noi zony posle operativnogo lecheniia krovotochashchikh iazv.

1886 fibrogastroduodenoscopic examinations were performed in 820 patients within 7 years after operative treatment of bleeding pyloroduodenal ulcers. Catgut was used in 589 patients for internal sutures in pyloroplasty, the unresolving suture material--capron--was used in 221 patients. Clinico-endoscopic investigations have shown that the application of catgut is followed in the early postoperative period by the development of inflammatory reactions in the tissues along the suture line, while the use of the unresolving suture material is followed by inflammations of less degree, the rejection of internal ligatures was slow with episodes of bleedings, ulcerations, formation of granulomas. The article gives grounds for expedience of removal of internal ligatures during the endoscopic examination of organs in the zone of the operative intervention.

[Effectiveness of the use of solcoseryl after surgery of acute hemorrhage in gastroduodenal ulcer]. / Effektivnost' primeneniia solkoserila posle operatsii po povodu ostrogo krovotecheniia iz gastroduodenal'noi iazvy.

The experience of solcoseryl application in 70 patients, operated on for an acute hemorrhage from gastroduodenal ulcer, was summarized. The preparation was injected intravenously in the dose of 10 ml in 5% solution of glucose every other day during 6 days and then in the dose of 5 ml intramuscularly during 4-5 days. High efficacy of solcoseryl, manifesting by more earlier elimination of pain and oedema, healing of mucosa by first intention, shortening of the treatment duration in stationary by 3-5 days, was established.