[Prevention of side effects and complications after operation for partial ileal bypass].

Side effects and complications of the application of partial ileal bypass used for dislipidemia were analyzed in 162 patients with atherosclerosis. It was shown, that the partial ileal bypass operation could lead to the development of series of undesirable side effects such as diarrhea, hypovitaminosis B12, off-state intestine enteritis. The application of modification of partial ileal bypass such as formation of ileo-ileoanastomosis 5-6 cm long near ileocecal valve with the maintenance of its functions disposed the diarrhea and minimized the risk of the development of hypovitaminosis B12 after operation. It is possible to prevent the development of enteritis of off-state loop of the small intestine by using microanastomosis between off-state and functioning iliac intestine. The partial ileal bypass operation didn't influence on body weight, wouldn't increase the risk of stone formation in the gallbladder and kidneys. The risk of the development of hypovitaminosis B12 is minimal after operation.

[Comparative results of various methods of surgical treatment of severe forms of metabolic syndrome].

The data about metabolic syndrome (MS), characteristic for interrelationship of the main pathogenetic factors, are adduced. Along with positive moments, the faults of conservative therapy for MS are described, the indications for surgical treatment performance were substantiated and the results of its application in 220 patients, suffering severe forms of MS, were analyzed.

[25 year experience with using surgical correction of dislipidemia in treatment of patients with atherosclerosis].

An analysis of results of using partial ileoshunting for the treatment of dislipidemia in 159 patients with atherosclerosis has shown that operation of partial ileoshunting has an obligatory, pronounced and lifelong lipidcorrecting effect. An antiatherogenic effect of the operation of partial ileoshunting is manifested as the improvement of the clinical course of the disease caused by atherosclerosis, by less number of thrombotic complications of atherosclerosis and less lethality from cardio-vascular diseases. At a longer follow-up period, the efficiency of partial ileoshunting as a means of secondary prophylactics of atherosclerosis is confirmed but in case of liquidation after operation of dislipoproteidemia.

[Long-term results of dyslipoproteinemia surgical correction in patients with obliterating atherosclerosis of the lower extremity].

An analysis of long-term (up to 20 years) results of performing operations of partial ileoshunting as a method of surgical correction of dislipoproteidemia in 49 patients with obliterating atherosclerosis of the lower extremity vessels has shown that operations of partial ileoshunting have a pronounced and stable lipid correcting effect. Decreased level of atherogenic lipids in blood improved the course of obliterating atherosclerosis of the lower extremity vessels. Worse long-term clinical results after partial ileoshunting were in a considerable degree due to the presence of residual dislipoproteidemia that resulted in additional medicamentous hypolipidemic therapy.

[Surgical treatment of severe forms of metabolic syndrome].

The authors analyze the components of the metabolic syndrome in patients with morbid obesity treated at the surgical department. The effects of a modified operation of jejunal-ileal shunt on the components of the metabolic syndrome were shown in 220 patients operated upon at the clinic of Faculty surgery of the Pavlov Medical Academy in St. Petersburg. The indications to the operative treatment of the metabolic syndrome were substantiated on the basis of etiopathogenesis. The estimation of long-term results of the operation of jejunal-ileal shunt in patients with the metabolic syndrome is given.

[The dynamics of the coronary bed state in patients with ischemic heart disease after surgical correction of dyslipoproteidemia].

The investigation included 85 ischemic heart disease patients with the coexistent dyslipoproteidemia. In 39 of the patients the operation of partial shunting was performed for correction of the impaired lipid metabolism. It was found that the partial ileoshunting was an effective method of correction of dyslipoproteidemia. The effect of the operation was due to lowering the total cholesterol level in blood (at an average by 25.6%) and elevation of the HDL level (at an average by 19.6%). The results of the following angiographic examinations have shown a clear effect of the inhibition of progressing coronary atherosclerosis in patients who underwent surgical correction of dyslipoproteidemia that allows the partial ileoshunting to be considered as an effective method of the secondary prophylactics of atherosclerosis. The HDL level is the main marker of the dynamics of the atherosclerotic process in the coronary arteries.

[Myopathy (terminology, clinical picture, and diagnosis)]. / Miopatii (terminologiia, klinika i diagnostika).

The paper deals with a description of the clinical picture and diagnosis of the main types of myodystrophies taking into account formes of muscular damages and a trend of generalization of a pathological process at the early phase of the disease. The clinical picture of endocrine myopathies was also studied. The authors revealed almost the same formula of muscular damages. Muscles of the pelvic girdle and femurs mainly suffered and to a lesser degree--muscles of the shoulder girdle and shoulders. According to the data of the clinical picture, histopathology and electromyography endocrinic myopathies are phenocopies of hereditary myodystrophies.

[New approaches to the surgical treatment of coronary arteriosclerosis]. / Novye podkhody k khirurgicheskomu lecheniiu ateroskleroza koronarnykh arterii.

A new combined approach to surgical treatment of coronary heart disease is recommended: direct myocardial revascularization (mammary-coronary and aorto-coronary bypass) to recover coronary flow; partial ileo-shunting to control hyperlipoproteinemia, and Arnulf's plexectomy (heart denervation) to eliminate vasospastic component. The sequence of operations can be altered depending on the diagnostic findings. Each operation can be performed independently or in combination with others. Operations were performed in 315 patients. The follow-up covered up to 8 years. Long-term patency of mammary-coronary shunts was 93.5%, and that of autovenous shunts was 65%. Lipid composition showed a stable normalization and signs of coronary spasm disappeared.

[Surgical correction of hyperlipoproteinemia in patients with ischemic heart disease]. / Khirurgicheskaia korrektsiia giperlipoproteidemii u bol'nykh ishemicheskoi bolezn'iu serdtsa.

The experimental results obtained in 102 animals showing a beneficial effect of partial ileac bypass on hyperlipoproteinemia and experimentally-induced atherosclerosis prompted the authors to perform this surgical intervention in 34 patients with coronary heart disease (CHD) and attendant hyperlipoproteinemia resistant to therapeutic agents. The follow up period was up to five years. The patients exhibited a persistent and substantial decrease in blood lipids and atherogenic lipoproteins, a reduced incidence of angina attacks and an improved CHD course. Furthermore, the surgery resulted in a considerable and stable elevation of the cholesterol levels of antiatherogenic high density lipoproteins (by an average of 85,3%) and in a 45.8% decrease of the cholesterol coefficient of atherogenicity which contributes to atherosclerosis regression.

[Level of lipids and apolipoproteins in obesity]. / Uroven' lipidov i apolipoproteinov pri ozhirenii.

The level of lipids and apolipoproteins was studied in the serum of patients with various degrees of obesity without hormonal impairments in order to find interrelationship between obesity and atherosclerosis development. 14 men and 42 women aged 19-59 years were examined. Concentration of triglycerides and very low density lipoprotein (VLDL) cholesterol was distinctly higher in obese patients of both sexes than in normal weight persons. However, content of apo A-I and apo B was similar in blood of both obese and normal persons, while concentration of apo E was higher in obesity. In obesity, the ratio HDL cholesterol/A-I was decreased, thus indicating that the HDL3/HDL2 ratio was altered, showing a decreased content of the latter subfraction. The findings suggest that impairment in metabolism of mainly HDL and VLDL subfractions occurred in patients with obesity. These impairments were atherogenic and may be responsible for a high risk for atherosclerosis and heart ischemic disease in obese patients.

[Jejunoileal bypass in the prevention and treatment of clinical manifestations of atherosclerosis in patients with morbid obesity]. / Eiunoileoshuntirovanie v profilaktike i lechenii klinicheskikh proiavlenii ateroskleroza u bol'nykh s rezko izbytochnoi massoi tela.

Jejunoileostomy effects on blood lipids and cardiovascular system were investigated in obese patients. They were found to lose 30% of their body mass within 6 postoperative months with parallel reduction in concentrations of total cholesterol, triglycerides, LDL and VLDL cholesterol and apoprotein B. These changes persisted for 4.5 years of the follow-up. The surgery in males has a more pronounced effect on blood lipids than in females. Significant changes were not registered in post- and preoperative levels of HDL cholesterol and apolipoprotein A-1. Jejunoileostomy promoted a fall in blood pressure, a rise in exercise tolerance, alleviation of atherosclerosis symptoms.

[Work capacity and the factors limiting it in patients with III- to IV-degree obesity]. / Rabotosposobnost' i faktory, ee limitiruiushchie, u bol'nykh ozhireniem III--IV stepeni.

There is a marked decrement in physical performance of those patients with III to IV grade obesity as compared to apparently healthy volunteers going into training. Deficient reserve capabilities of the system for utilization of oxygen and oxygen transport appear to be those factors determining and limiting physical fitness of obese individuals. Exercise testing involving recording of indices for gas exchange in real time appears to be a valuable method of diagnosis of particular features of oxygen supply in patients with III to IV grade obesity, providing a very helpful information.

[The dynamic electrocardiogram in the late period after the surgical treatment of obesity patients]. / Dinamika élektrokardiogrammy v otdalennye sroki posle khirurgicheskogo lecheniia bol'nykh ozhireniem.

An analysis is presented of ECG of 68 patients with obesity (grade III-IV) before the operation of jejunoileal shunting and 1-2, 3-5 and 6-10 years after surgery. It was found that the main changes in the cardiovascular system occur during the first 2 years, i.e. during the period of body mass reduction. The importance of ECG in the diagnosis of hypertrophy of different compartments of the heart in obesity of grade III-IV.

[Surgical treatment of chronic ischemic heart disease]. / Khirurgicheskoe lechenie khronicheskoi ishemicheskoi bolezni serdtsa.

The authors suggest a new complex approach to the surgical treatment of ischemic heart disease. Operation of coronary shunting for the restoration of the coronary blood flow, operation of partial ileoshunting for correction of hyperlipoproteinemia, plexotomy for removal of the vasospastic component. The sequence of the operations may vary, each one can also be undertaken independently. The operations were conducted on 315 patients. The follow-up period is up to 8 years. Patency of the mammary-coronary shunts was 93.5%, of autologous veins shunt--65%. Disappearance of the signs of coronary spasm++ and stable normalization of the lipid spectrum are noted.

[Effect of partial ileoshunting on hyperlipoproteinemia in patients with atherosclerosis]. / Vliianie chastichnogo ileoshuntirovaniia na giperlipoproteidemiiu u bol'nykh aterosklerozom.

In 57 atherosclerotic patients with concomitant hyperlipoproteinemia operations of partial ileoshunts were performed consisting in shunting the distal third of the small intestine. The follow-up observation was up to 6 years. A persistent decrease of the elevated level of lipids and cholesterol of atherogenic LDL and VLDL was noted as well as a considerable and stable increase of the level of cholesterol of antiatherogenic very high density lipoproteins and a lower atherogeneity coefficient. It facilitates stabilization and regression of atherosclerosis.

[Surgery of patients with toxic goiter]. / Khirurgicheskoe lechenie bol'nykh s toksicheskim zobom.

Some peculiarities of the toxic goiter found in patients in the republic of Afghanistan are considered. The results of surgical treatment of 68 cases are set forth. The advantage of beta-blockators over the antithyroid drugs for the preoperative management of these cases is shown.

[Predicting weight loss in patients with massive obesity after jejunoileal shunting]. / Prognozirovanie poteri massy tela u bol'nykh massivnym ozhireniem posle operatsii eiunoileoshuntirovaniia.

Postoperative decrease of the body mass was studied in 105 patients with massive obesity subjected to operation of jejunoileoshunting. Loss of the body mass was proportional to its initial value, inversely proportional to the length of the functioning portion of the ileum. In men the degree of postoperative loss of the body mass was more considerable than in women.

[Method of surgical treatment of patients with hyperlipoproteinemia]. / Metodika operativnogo vmeshatel'stva u bol'nykh giperlipoproteidemiei.

In 200 operations of partial shunts of the small intestine in patients with hyperlipoproteinemia the authors have used their modification of the technique of partial ileoshunts in patients with normal weight and jejuno-ileoshunts in patients with morbid obesity. The modification has considerably reduced the amount of postoperative complications. The authors recommend using the procedure at the hospitals dealing with problems of metabolic surgery.

[Effect of combined anesthesia with ketalar on cardiohemodynamics in obese patients]. / Vliianie kombinirovannogo obezbolivaniia ketalarom na kardiogemodinamiku bol'nykh ozhireniem.

Ketalar was used as the main anesthetic drug in operations of jejuno-ileo-shunting and partial ileo-shunting in 30 obese patients (mainly with concomitant arterial hypertension and ischemic heart disease). To prevent the hypertensive effect of Ketalar an intravenous injection of seduxen and droperidol was made.