RESUMEN
OBJECTIVE: To investigate enteral nutrition as a component of postoperative rehabilitation after reconstructive esophageal and gastric surgeries. MATERIAL AND METHODS: The study included 217 patients who underwent reconstructive esophageal and gastric surgeries between 2010 and 2020. In the main group (n=121), patients underwent postoperative enhanced recovery program (ERAS). Early enteral feeding including micro-jejunostomy and early oral feeding was essential for postoperative management. The control group included 96 patients who were treated in traditional fashion. The primary endpoint was length of hospital-stay (LOS) and ICU-stay. Restoration of gastrointestinal function (peristalsis, stool, oral nutrition), anastomotic leakage rate and other complications comprised secondary endpoints. RESULTS: Both groups did not differ by sex, age, body mass index, diagnosis and comorbidities. There was significant reduction in postoperative LOS in the ERAS group (14 (12; 15.8) and 9 (6.3; 12) days, p<0.0001). In the same group, we observed less in ICU-stay (4.7 (3.6; 5.6) and to 3.5 (2; 4) days, p<0.001), earlier recovery of peristalsis and X-ray control of anastomosis in patients with and without anastomotic leakage. Incidence of respiratory complications was lower in the ERAS group (p=0.034). Overall postoperative morbidity and mortality were similar. CONCLUSION: Early enteral and oral feeding after esophageal and gastric reconstructive surgery reduces hospital-stay and accelerates postoperative rehabilitation.
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Procedimientos Quirúrgicos del Sistema Digestivo , Neoplasias Esofágicas , Procedimientos de Cirugía Plástica , Humanos , Nutrición Enteral/efectos adversos , Fuga Anastomótica/epidemiología , Fuga Anastomótica/etiología , Fuga Anastomótica/prevención & control , Procedimientos de Cirugía Plástica/efectos adversos , Anastomosis Quirúrgica , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Tiempo de Internación , Esofagectomía , Neoplasias Esofágicas/cirugíaRESUMEN
One hundred and one years ago Eduard Nikitich Vantsyan (1921-1989), an outstanding Soviet surgeon, B.V. Petrovsky's pupil, Doctor of Medicine, Professor, Corresponding Member of the USSR Academy of Medical Sciences, was born (Fig. 1). He was the author of more than 120 scientific works and 6 monographs devoted to the study of motor function and surgery of the esophagus, conservative treatment of its constrictions and cardiospasm, diseases of the operated esophagus. He had developed methods of total and segmental plasty of the esophagus, treatment of hernias of the esophageal aperture of the diaphragm and diverticula of the esophagus. He supervised 26 dissertations, including 12 doctoral theses. Eduard Nikitich is considered one of the founders of esophageal and diaphragm surgery.
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Aniversarios y Eventos Especiales , Diafragma , Masculino , HumanosRESUMEN
OBJECTIVE: To analyze the results of thoracoscopic esophagectomy for benign esophageal diseases. MATERIAL AND METHODS: The study included 78 patients who underwent thoracoscopic esophagectomy between 2011 and 2019. Peptic and burn strictures of the esophagus were diagnosed in 53 patients, achalasia - in 24 patients. Minimally invasive esophagectomy and esophagoplasty with isoperistaltic gastric tube and esophagogastrostomy on the neck was performed in 68 patients, Ivor Lewis esophagectomy - in 1 patient, coloesophagoplasty - in 9 patients. We used manual technique of anastomosis in 58 patients, stapling device - in 19 patients. In 1 case, surgery was finished with esophagostomy and gastrostomy. RESULTS: Mean blood loss was 200 ml (10-1200), surgery time - 450 min (265-765 min). Early postoperative complications occurred in 37 patients including anastomotic leakage in 24 cases. In long-term period, anastomotic strictures developed in 9 patients. No mortality was observed. CONCLUSION: Minimally invasive esophagectomy for benign esophageal diseases ensures favorable clinical outcomes. However, no consensus in the choice of surgical approach and indications, as well as small number of these patients cause challenges in implementation of this technique. There are different opinions regarding technique of anastomosis on the neck and surgical access in thoracoscopic esophagectomy.
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Enfermedades del Esófago , Neoplasias Esofágicas , Laparoscopía , Constricción Patológica/cirugía , Enfermedades del Esófago/cirugía , Neoplasias Esofágicas/etiología , Neoplasias Esofágicas/cirugía , Esofagectomía/efectos adversos , Esofagectomía/métodos , Humanos , Laparoscopía/efectos adversos , Laparoscopía/métodos , Estudios RetrospectivosRESUMEN
We evaluated the possibility and effectiveness of transaxillary gas-free approach for minimally invasive Zenker's diverticulectomy. A 64-year-old patient with large Zenker's diverticulum (6 cm) and pathognomonic symptoms is presented. Transaxillary gas-free minimally invasive diverticulectomy was performed using an endoscopic linear stapler. Surgery time was 137 min. There were not any postoperative complications including recurrent laryngeal nerve injury. X-ray examination after 2 postoperative days revealed no signs of anastomotic leakage, so the patient was allowed to drink and consume liquid food from the 3rd day. Patient was discharged on the 7th day. Minimally invasive surgical technology ensures effective and radical transaxillary diverticulectomy in patients with Zenker's diverticulum. The advantages of this method are good and detailed exposition of surgical field, including recurrent laryngeal nerve, more precise and less invasive manipulations and better cosmetic effect. The method may be an alternative to traditional and endoscopic diverticulectomy for a certain group of patients. However, experience accumulation and further prospective studies are required.
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Esofagoscopía/métodos , Divertículo de Zenker , Axila , Humanos , Persona de Mediana Edad , Estudios Prospectivos , Divertículo de Zenker/diagnóstico por imagen , Divertículo de Zenker/cirugíaRESUMEN
OBJECTIVE: To report our initial experience of robot-assisted McKeown esophagectomy with stapled cervical esophagogastrostomy. MATERIAL AND METHODS: There were 5 robot-assisted McKeown esophagectomies in patients with benign end-staged and malignant diseases of the esophagus for the period from October 2019 to February 2020. RESULTS: No conversions and intraoperative complications were observed. Mean surgery time was 406±48 min, total intraoperative blood loss - 108±45 ml. Four patients had minor complications (wound infection, atelectasis, pneumothorax) that required conservative treatment. We have controlled anastomosis in 2-3 postoperative days with water-soluble contrast, none patient had an anastomotic leakage. Mean hospital-stay was 5 days. Complete (R0) resection was accomplished in all patients with malignant neoplasms. CONCLUSIONS: Our first experience showed that robot-assisted McKeown esophagectomy is a safe and feasible surgical option for esophageal diseases. Robot-assisted interventions require advanced endoscopic surgical experience.
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Neoplasias Esofágicas , Esofagectomía/métodos , Esófago/cirugía , Procedimientos Quirúrgicos Mínimamente Invasivos , Procedimientos Quirúrgicos Robotizados , Estómago/cirugía , Anastomosis Quirúrgica/efectos adversos , Anastomosis Quirúrgica/métodos , Cirugía Bariátrica , Enfermedades del Esófago/cirugía , Neoplasias Esofágicas/cirugía , Esofagectomía/efectos adversos , Humanos , Procedimientos Quirúrgicos Mínimamente Invasivos/efectos adversos , Cuello , Estudios Retrospectivos , Procedimientos Quirúrgicos Robotizados/efectos adversos , Resultado del TratamientoRESUMEN
OBJECTIVE: To evaluate an efficiency and safety of perioperative fast track management in reconstructive esophageal surgery. MATERIAL AND METHODS: Perioperative fast track management protocol in reconstructive esophageal surgery has been applied since 2014 at the Department of Thoracoabdominal Surgery and Oncology of the Petrovsky Russian Scientific Center of Surgery. These patients (2017-2020) were included in the main group (n=75). Patients who underwent traditional perioperative care (2010-2013) were enrolled in the control group (n=63). The primary outcome was postoperative hospital-stay. We also evaluated ICU stay, incidence of complications according to Clavien-Dindo grading system with particular registration of respiratory complications, mortality, enteral and oral feeding onset. RESULTS: There were no significant between-group differences in sex, age, ASA grade, body mass index. Fast track management reduced hospital-stay from 14 (12; 17) days in the control group to 11 (8; 22) days in the main group (p=0.008). Mean ICU-stay decreased up to 1 (0.8; 2) day in the main group compared to the control group (4.1 (3.5; 5.6) days, p<0.0001). Pneumonia was noted in 5 patients after fast track recovery and 15 patients in the control group (p=0.004). No patients died in the main group, 3 (4.8%) patients - in the control group (p=1). CONCLUSION: Modern perioperative fast track management protocol is safe and effective for extensive reconstructive esophageal interventions. This approach reduces hospital-stay and ICU stay, as well as the incidence of respiratory complications.
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Atención Perioperativa , Complicaciones Posoperatorias , Humanos , Tiempo de Internación , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Periodo Posoperatorio , Federación de RusiaRESUMEN
Significant improvement of treatment outcomes and reduction of postoperative hospital stay can be achieved, provided a multifaceted approach used in the management of patients. The introduction of the enhanced recovery program addressing all possible factors of the perioperative period will contribute to the treatment protocol development for patients after extensive surgery on the esophagus. OBJECTIVE: To improve medical rehabilitation outcomes in patients after extensive surgery for benign and malignant diseases of the esophagus by implementing an enhanced recovery program. MATERIALS AND METHODS: Patients with benign and malignant esophageal diseases underwent radical surgical repair under general balanced anesthesia with mechanical ventilation. With the collaboration of surgery, anesthesiology, and intensive care staff, a proprietary day-by-day enhanced recovery program was developed based on existing guidelines for patient management and systematic reviews on the enhanced recovery protocol after surgical esophageal repair. RESULTS: The developed patient management program was effective due to the reduction of intensive care unit stay and the total postoperative stay in all main group patients. The use of minimally invasive video-endoscopic techniques contributed to the reduction of intensive care unit stay. A less severe surgical stress response was observed in patients in the group of thoracoscopic subtotal esophageal resections. CONCLUSION: The introduction of the enhanced recovery program promotes the reduction of hospital stay and ICU stay in surgical esophageal repair patients. Also, it allows optimizing the postoperative management of patients with complicated and uncomplicated postoperative periods.
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Complicaciones Posoperatorias , Humanos , Tiempo de Internación , Resultado del TratamientoRESUMEN
OBJECTIVE: To compare safety and efficiency of conventional open and laparoscopic surgery in patients with gastrointestinal stromal tumors (GIST) of the stomach. MATERIAL AND METHODS: A retrospective analysis included 42 patients with gastric GIST who were treated at the Moscow City Oncological Hospital #62 for the period from 2006 to 2018. All patients were divided into two groups depending on surgical approach. RESULTS: Laparoscopic surgery is safe and effective in patients with gastric GIST. Short-term results of traditional open and laparoscopic operations in patients with gastric GISTs were compared. CONCLUSION: Laparoscopic resection of gastric GIST is justified for tumors less than 5 cm. Laparoscopic procedure for tumors over 5 cm must be done only in high-volume hospitals.
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Gastrectomía/métodos , Tumores del Estroma Gastrointestinal/cirugía , Neoplasias Gástricas/cirugía , Humanos , Laparoscopía , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
Aorto-esophageal and aorto-bronchial fistulas are rare and life-threatening diseases if emergency treatment is absent. The most of publications devoted to this problem are case reports describing successful treatment of patients with aorto-esophageal and aorto-bronchial fistulas by using of endovascular or open transthoracic surgery. However, we did not find reports of several aortic fistulas in a patient after previous aortic stenting. It is presented case report of patient with aorto-esophago-bronchial and aorto-pulmonary fistulas in postoperative period after thoracic endovascular aortic repair (TEVAR).
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Aneurisma de la Aorta Torácica/cirugía , Fístula Bronquial/etiología , Procedimientos Endovasculares/efectos adversos , Fístula Esofágica/etiología , Enfermedades Pulmonares/etiología , Fístula Vascular/etiología , Aneurisma de la Aorta Torácica/complicaciones , Enfermedades de la Aorta/etiología , Enfermedades de la Aorta/cirugía , Fístula Bronquial/cirugía , Procedimientos Endovasculares/métodos , Fístula Esofágica/cirugía , Humanos , Enfermedades Pulmonares/cirugía , Fístula del Sistema Respiratorio/etiología , Fístula del Sistema Respiratorio/cirugía , Fístula Vascular/cirugíaRESUMEN
AIM: To investigate the role of video-assisted subtotal esophageal resection in treatment of patients with benign esophageal diseases. MATERIAL AND METHODS: Fifty-one patients with benign esophageal diseases have undergone subtotal esophageal resection in our department for the period 2010-2017. Thoracoscopic technique was applied in 25 cases, open approach - in 26 patients. Total surgery time, thoracoscopic stage duration, length of hospital-stay (LOS), ICU-stay, Clavien-Dindo morbidity rates with separate registration of respiratory complications, mortality have been considered. RESULTS: Groups were similar in terms of age, gender, ASA status. Thoracoscopic stage duration gradually decreased from 175 to 65 min with average time of 102 (75; 123) min. Total surgery time was 390 (270; 495) min in group 1 and 465 (341; 561) min in the control group (Ñ=0.035). Mean ICU-stay decreased up to 2 (1.25; 3.75) days compared with the control group (5 (3.92; 5.85) days, Ñ<0.0001). Conversion rate was 8%. In the main group complications Clavien-Dindo grade 2 were detected in 10 (40%) patients compared with 20 (69%) cases in the control group (Ñ=0.009). Respiratory complications occurred in 5 patients in group 1 and in 13 cases of the control group (Ñ=0.039). Mortality was absent. CONCLUSION: Thoracoscopic subtotal esophageal resection may be advisable alternative to open surgery for patients with benign esophageal diseases due to lower postoperative morbidity and earlier rehabilitation followed by improved outcomes.
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Enfermedades del Esófago , Esofagectomía , Enfermedades del Esófago/cirugía , Humanos , Complicaciones Posoperatorias , Estudios Retrospectivos , Cirugía Torácica Asistida por Video , Resultado del TratamientoRESUMEN
AIM: To improve surgical and complex treatment of patients with gastrointestinal stromal tumors (GIST). MATERIAL AND METHODS: Our analysis included 97 GIST patients who were at Petrovsky Russian Research Center of Surgery and Moscow City Oncological Hospital #62 from January 2006 to September 2016. RESULTS: Advisability of surgery for GIST patients was confirmed. We have assessed surgical outcomes, defined the indications for adjuvant targeted therapy depending on GIST prognostic risk and additional factors for unfavorable course of disease. CONCLUSION: It was concluded that surgical treatment is preferred for patients with resectable GISTs. Adjuvant therapy is indicated in patients with high risk of progression if mutations indicating tumor sensitivity to the drugs are revealed. Adjuvant targeted therapy is not indicated in patients with low and very low risk of progression.
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Procedimientos Quirúrgicos del Sistema Digestivo , Neoplasias Gastrointestinales , Tumores del Estroma Gastrointestinal , Mesilato de Imatinib/administración & dosificación , Complicaciones Posoperatorias , Quimioterapia Adyuvante/métodos , Procedimientos Quirúrgicos de Citorreducción/métodos , Procedimientos Quirúrgicos del Sistema Digestivo/efectos adversos , Procedimientos Quirúrgicos del Sistema Digestivo/clasificación , Procedimientos Quirúrgicos del Sistema Digestivo/métodos , Femenino , Neoplasias Gastrointestinales/tratamiento farmacológico , Neoplasias Gastrointestinales/patología , Neoplasias Gastrointestinales/cirugía , Tumores del Estroma Gastrointestinal/tratamiento farmacológico , Tumores del Estroma Gastrointestinal/patología , Tumores del Estroma Gastrointestinal/cirugía , Humanos , Masculino , Persona de Mediana Edad , Terapia Molecular Dirigida/métodos , Moscú , Invasividad Neoplásica , Metástasis de la Neoplasia , Estadificación de Neoplasias , Evaluación de Procesos y Resultados en Atención de Salud , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/terapia , Inhibidores de Proteínas Quinasas/administración & dosificaciónRESUMEN
INTRODUCTION: At present, no doubt enhanced by the attention of clinicians to monitor blood glucose and methods of its correction in ICU patients. Evidence of the effect of the expressed glycemic balance disorders on the results of treatment of such patients determine of the problem. Attempts to create a computer algorithm to determine the rate of insulin. The aim of the study was to investigate the efficacy and safety of the module Space glycemic control (SGC, "BBraun Germany) with intravenous insulin therapy in patients with thoracoabdominal surgery. MATERIAL AND METHODS: Single-center prospective observational study was conducted in the ICU in 50 patients in the early period after operations on the abdominal and thoracic cavity, mediastinum. RESULTS: The average duration of the monitoring group with SGC was 57 hours (17 to 280 hours). The average length of the period during which the patients were recorded in the target range glycemia was 80.4% of the total time of SGC monitoring. The average value of glucose in capillary blood proved to 7,6?1,58 mmol/l. The incidence of severe hypoglycemia was 2% (1 patient). CONCLUSION: Application module SGC should expedient be used in patients after extensive thoracoabdiminal surgical procedures in which recorded postoperative hyperglycemia.
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Glucemia/análisis , Quimioterapia Asistida por Computador/métodos , Hiperglucemia/prevención & control , Monitoreo Fisiológico/métodos , Apoyo Nutricional/métodos , Cuidados Posoperatorios/métodos , Algoritmos , Femenino , Humanos , Hiperglucemia/diagnóstico , Hipoglucemiantes/administración & dosificación , Hipoglucemiantes/uso terapéutico , Infusiones Intravenosas , Insulina/administración & dosificación , Insulina/uso terapéutico , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Periodo Posoperatorio , Estudios ProspectivosRESUMEN
Treatment results of 207 patients with the benign diseases of the esophagus, operated on during 2009-2012 yy, were analyzed. The diseases included the burn stricture of esophagus, cardiospasm, esophageal achalasia, hiatal hernias and diverticles. Indications to different treatment algorithms were substantiated. Postoperative complications were registered in 22 (10.6%) patients; the postoperative lethality was 1.6%. The authors concluded the high efficacy of the used methods of treatment.
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Enfermedades del Esófago/cirugía , Esofagectomía , Esofagoplastia , Complicaciones Posoperatorias , Adulto , Anciano , Enfermedades del Esófago/clasificación , Enfermedades del Esófago/etiología , Esofagectomía/efectos adversos , Esofagectomía/métodos , Esofagoplastia/efectos adversos , Esofagoplastia/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud , Complicaciones Posoperatorias/clasificación , Complicaciones Posoperatorias/epidemiología , Factores de Riesgo , Resultado del TratamientoAsunto(s)
Adenocarcinoma , Gastrectomía/métodos , Hepatectomía/métodos , Neoplasias Hepáticas , Neoplasias Pulmonares , Neumonectomía/métodos , Neoplasias Gástricas , Adenocarcinoma/patología , Adenocarcinoma/fisiopatología , Adenocarcinoma/cirugía , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Humanos , Neoplasias Hepáticas/tratamiento farmacológico , Neoplasias Hepáticas/patología , Neoplasias Hepáticas/secundario , Neoplasias Hepáticas/cirugía , Neoplasias Pulmonares/tratamiento farmacológico , Neoplasias Pulmonares/patología , Neoplasias Pulmonares/secundario , Neoplasias Pulmonares/cirugía , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Neoplasias Gástricas/patología , Neoplasias Gástricas/fisiopatología , Neoplasias Gástricas/cirugía , Resultado del TratamientoAsunto(s)
Quemaduras Químicas/complicaciones , Colon/trasplante , Estenosis Esofágica , Esofagoplastia , Procedimientos de Cirugía Plástica/métodos , Complicaciones Posoperatorias , Estenosis Traqueal , Traqueostomía , Anciano , Estenosis Esofágica/inducido químicamente , Estenosis Esofágica/diagnóstico , Estenosis Esofágica/fisiopatología , Estenosis Esofágica/cirugía , Esofagoplastia/efectos adversos , Esofagoplastia/métodos , Esófago/diagnóstico por imagen , Esófago/cirugía , Femenino , Humanos , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/fisiopatología , Complicaciones Posoperatorias/cirugía , Radiografía/métodos , Reoperación/métodos , Tráquea/diagnóstico por imagen , Tráquea/cirugía , Estenosis Traqueal/inducido químicamente , Estenosis Traqueal/diagnóstico , Estenosis Traqueal/fisiopatología , Estenosis Traqueal/cirugía , Traqueostomía/efectos adversos , Traqueostomía/métodos , Resultado del TratamientoAsunto(s)
Adenocarcinoma , Aneurisma de la Aorta Abdominal , Implantación de Prótesis Vascular/métodos , Enfermedad de la Arteria Coronaria , Gastrectomía/métodos , Revascularización Miocárdica/métodos , Neoplasias Gástricas , Adenocarcinoma/complicaciones , Adenocarcinoma/patología , Adenocarcinoma/cirugía , Aorta Abdominal/diagnóstico por imagen , Aneurisma de la Aorta Abdominal/complicaciones , Aneurisma de la Aorta Abdominal/diagnóstico , Aneurisma de la Aorta Abdominal/cirugía , Angiografía Coronaria/métodos , Enfermedad de la Arteria Coronaria/complicaciones , Enfermedad de la Arteria Coronaria/diagnóstico , Enfermedad de la Arteria Coronaria/cirugía , Humanos , Masculino , Persona de Mediana Edad , Neoplasias Gástricas/complicaciones , Neoplasias Gástricas/patología , Neoplasias Gástricas/cirugía , Resultado del TratamientoRESUMEN
Low-invasive interventions have now become the usual practice of a surgical unit. Nowadays operations on abdominal and small pelvic organs can be made by using the Russian equipment. In all, more than half the patients with cholelithiasis and its complications, chronic appendicitis, inguinal hernias were operated on by employing video endoscopic equipment (Endomedium, Kazan) and miniaccess-intervention instruments (SAN, Yekaterinburg). The outcomes of surgical treatment are summarized in the paper. The benefits and drawbacks of low-invasive intervention procedures, the advantages of various operation in different groups of patients are dealt with. The feasibility of combined operations and treatment in patients with cholelithiasis is discussed.
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Abdomen/cirugía , Laparoscopía , Apendicitis/cirugía , Colelitiasis/cirugía , Estudios de Factibilidad , Femenino , Hernia Inguinal/cirugía , Humanos , Masculino , Persona de Mediana Edad , Resultado del Tratamiento , Grabación en VideoRESUMEN
Reflux-esophagitis is wide-spread and frequently diagnosed disease, which is found in persons of young and adult age. The main kind of treatment is conservative one, however sometimes reflux-esophagitis is accompanied by complications, dangerous for life, which require surgical treatment. Experience of surgical treatment of 720 patients is available. Fundoplication procedure in RCS modification combined with SPV is main and optimal operation. This operation is possible in more than 2/3 cases of surgical treatment of reflux-esophagitis and peptic stricture of the esophagus. If it is found to be impossible to carry out organ saving procedure in severe reflux-esophagitis and irreversible peptic stricture of the esophagus the operation of choice should be extirpation of the esophagus and gastroplasty with gastric tube or large bowel and simultaneous creation of anastomosis in the neck. This was carried out in 38 patients with favourable outcomes.
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Úlcera Duodenal/complicaciones , Estenosis Esofágica/cirugía , Esofagitis Péptica/cirugía , Fundoplicación , Vagotomía Gástrica Proximal , Adulto , Úlcera Duodenal/cirugía , Estenosis Esofágica/etiología , Estudios de Seguimiento , Humanos , Complicaciones Posoperatorias , Estudios RetrospectivosRESUMEN
The authors examined a group of 42 patients with neuromuscular diseases of the esophagus. They distinguished a group of patients who were not treated previously, a group with recurrent neuromuscular diseases of the esophagus in high tonues of the cardia, and a group of patients with a recurrence in normal or low tonus of the cardia. All patients underwent roentgenoscopy of the esophagus and stomach, esophagogastroscopy, and esophagomanometry, as well as clinico-psycho-diagnostic examination. Polymorphism of psychic reactions with predominance of anxiety and depression was revealed in the group of untreated patients, tendency to develop static forms of psychic and somatic responses and mild excitability were encountered in the group of patients with a recurrence in increased cardiac tonus. In patients with a recurrence in low tonus of physiological cardia the condition was determined by hystero-hypochondriac, alarming-depressive disorders. Clinocopsycho-diagnostic examination made it possible to develop averaged schemes of psychotropic therapy according to the groups of patients.