[Prospects of combined anterior prosthetic hernia repair in treatment of large and giant ventral hernias]. / Peredniaia proteziruiushchaia gernioplastika kombinirovannym sposobom pri bol'shikh i gigantskikh ventral'nykh gryzhakh.

AIM: To evaluate clinical efficacy of combined anterior prosthetic hernia repair in treatment of large and giant ventral hernias. MATERIAL AND METHODS: Patients with large and giant hernias have been analyzed. In the main group (n=675) combined methods of hernia gates repair were applied, in control group (n=257) - stretching repair including prosthesis deployment. Surgeons (n=22) were interviewed for learning curve, safety, limitations and reliability of combined methods. RESULTS: Combined method of hernia repair in patients with large and giant hernias reduces overall postoperative morbidity (p<0.001), wound complications (p<0.05) and incidence of recurrent hernia (p<0.001). Questionnaire data showed the possibility of learning for the method by the most of surgeons to treat these patients. As a result, some practical recommendations are presented for successful procedures and satisfactory results of treatment.

[Nutrition support in complications after bariatric surgery].

Obesity is a disease, requiring timely operative intervention frequently. To the testimonies it is necessary to befit very carefully in connection with possible complications as violation of a digestive-transport function of gastrointestinal tract.

[Cachexia and multiorgan insufficiency in a patient with small intestine carcinoid].

Carcinoid of the thin bowel is difficult to diagnose pathology. Complications diagnosticians with that doctors clash on ambulatory and hospital the stages, including at offtype clinical presentation of disease, result in late recognition of carcinoid and belated operative intervention. In taken apart case a diagnosis was set at pathomorphologic research. One of typical displays of carcinoid syndrome is a cachexy. Treatment of carcinoid is surgical, a conservative correction is sent mainly to the decline of hormones activity of this tumours type.

[Recurrent hernia of the esophageal diaphragm heatus at patients with postoperative ventral hernia (some features of surgical tactics)].

A clinical observation of patients with recurrent hernia of the esophageal diaphragm heatus and postoperative ventral hernia. We described some features of surgical treatment, the need to perform simultaneous operations.

[The diagnostic significance of ultrasound elastometry in evaluation of fibrosis in chronic diffuse liver diseases].

THE PURPOSE OF THE STUDY: Determination of the diagnostic value of ultrasound elastometry of liver (UEL) in the assessment of liver fibrosis in patients with chronic diffuse liver diseases (CDLD). MATERIAL AND METHODS: The study involved 316 patients with various etiologies of the CDLD, with the underwent both liver biopsy, the UEL, and evaluation of fibrosis (F) according to the Metavir classification. RESULTS: The maximum diagnostic accuracy of the UEL was obtained in determining of the 4-th stage of fibrosis according to the Metavir. The accuracy of the method was 91% with a sensitivity of 100%. The lowest sensitivity of the UEL determined in patients with nonalcoholic fatty liver disease (NAFLD): F1 - 25%, F2 - 33%, F3 and F4 - 50%. The High body mass index (BMI = 30,1 +/- 3,8 kg/m2) is a factor which is limiting the use of elastometry for patients NAFLD. The low sensitivity for F1 and F2 - 14,3% and 10%, respectively, 100% for F4, with a BMI = 24,4 +/- 5,1 kg/m2 was obtained in primary biliary cirrhosis (PBC). In the alcoholic liver disease (ALD) obtained high sensitivity (100%) for F2 and F4. In the CDLD of viral etiology the sensitivity of UEL was 33-71,4% in the early stages of fibrosis (F1 and F2) with high specificity - 100% and 93.5% respectively. CONCLUSION: The use of the UEL allows the diagnosis of fibrosis in chronic liver diseases of different etiologies as an alternative to needle biopsy of the liver.

[Features of clinical finding, tactics and surgical treatment of patients with injuries of left subdiaphragmatic space organs].

Results of treatment of 208 patients with injuries of left subdiaphragmatic space organs are analyzed. At 130 (52.5%) patients injuries of spleen, stomach, left curve of colon, pancreas were isolated, at 78 (37.5%)--combined. Features of clinical finding depending on combination of organs injuries were revealed. In clinical finding of abdominal trauma the pancreatogenic syndrome is emphasized which does not prove itself just after trauma. At isolated trauma 2 (0.96%) patients died, at combined trauma--12 (5.77%).