[Percutaneous endoscopic gastrostomy for long-term artificial enteral nutrition of seriously ill and trauma patients].

Percutaneous endoscopic gastrostomy was performed on 55 patients of anaesthesiology resuscitation clinic of Military Medical Academy during the last 5 years. A surgery duration was about 13.7 ± 0.5 minutes. The following complications were observed: postoperative wound infections (3 cases), uncontrolled removals of the feeding tube (2 cases), bleeding was noted in 1 patient. The authors recommend the method of percutaneous endoscopic gastrostomy for widespread adoption in patient care institutions according to their experience. The enteral feeding could be used when patients would have the swallowing malfunction during more than 3 weeks.

[The diagnostic algorithm in patients with severe chronic constipaton without aganglionosis of the large intestine].

The algorithm of special study in patients with severe chronic constipations includes the chronometry of passage of sulphate barium along the gastric tract with the assessment of evacuation function of each part of the large intestine, the irrigoscopy, the fibrocolonoscopy, the investigation of motor function of sigmoid colon. The proposed diagnostic algorithm allows the determination of part or parts of the large intestine with incompetent motor and evacuation functions and decision on the necessary extent of resection of the colon.

[The role of tumor markers in diagnostics of gastric cancer metastases. Part II: postoperative monitoring].

Complex examination of 32 patients with gastric cancer in terms of more than 6 months after radical operations included endoscopic, radial and laboratory methods with the determination of indices of the carcinoembryonic antigen and carbohydrate antigens 19-1 and 72-4 every six months. It was established that normal concentration of all the three tumor markers within 12 months after surgery was a practically reliable sign of the absence of metastases and recurrence of gastric cancer. The increased level of one or two oncomarkers within 12 months after radical operation points to progression of gastric cancer with probability of 57.1% or the development of other surgical pathology (cholecystolithiasis, gastric stump polyps and others) in 28.6% of observations. In all cases of progressing gastric cancer in terms of more than 6 months after operation there was a more that 1.5 times elevation of any one or two tumor markers.

[The role of tumor markers in diagnosing metastases of gastric cancer: preoperative diagnostics (part I)].

Preoperative indices of cancer embryonic antigen (CEA), carbohydrate antigens 19-9(CA)19-9, 72-4(CA)72-4, and alfa-fetaprotein (AFP) in 60 patients with gastric cancer were compared with the results of postoperative staging of the malignant process. It was found that increased concentration of one of the tumor markers were not a significant diagnostic sign of the metastases of gastric cancer. CEA is considered as an exception since its more than one and a half elevation (more than 3.75 ng/ml) suggests the presence of metastases with 80% probability. An increased concentration of any two oncomarkers (CEA, CA19-9, CA 72-4) points to the metastases of gastric cancer with 83.3% probability and usually coincides with the presence of distant metastases. A simultaneous elevation of indices of three tumor markers does not occur in gastric cancer. AFP is not informative in cases of gastric cancer and its dissemination.

[Ganglionic blockers in abdominal surgery: facts and hypotheses. I. Benzohexonium and motor function of the gastrointestinal system in the early postoperative period]. / Ganglioblokatory v abdominal'noi khirurgii: fakty i gipotezy. Soobshchenie I. Benzogeksonii i motornaia funktsiia zheludochno-kishechnogo trakta v rannem posleoperatsionnom periode.

The method of registration of the intraluminal pressure was used to study the function of the stomach, small intestine and sigmoid colon under conditions of partial ganglionic blockade in the first days after truncal vagotomy and resection of the stomach. It was found that benzohexonium in doses 0.1-0.3 mg/kg failed to substantially decrease the frequency of early functional motor-evacuation disorders of the "operated" stomach, but the results of using N-cholinolytic was better after truncal vagotomy than after resection of the stomach. Benzohexonium in doses 0.1-0.2 mg/kg failed to considerably stimulate the motor function of the small intestine while the doses of 0.3-0.4 mg/kg resulted in a decrease of its contractile activity. No reliable changes in the qualitative and quantitative parameters of the sigmoid colon motor function were found against the background of ganglionic blockade. So, for prevention and correction of early postoperative motor-evacuation disorders of the gastrointestinal tract the ganglionic blockade with N-cholinolytics should not be taken as a method of choice or a variant of monotherapy.

[Ganglionic blockers in abdominal surgery: facts and hypotheses. 2.Clinical, pathophysiological and pharmacological aspects of ganglionic blocker use]. / Ganglioblokatory v abdominal'noi khirurgii: fakty i gipotezy. Soobshchenie 2. Klinicheskie, patofiziologicheskie i farmakologicheskie aspekty primeneniia ganglioblokatorov.

The authors discuss facts and hypotheses on the effects of benzohexonium upon the motor activity of the intestine and the significance of N-cholinolytics for prophylactics and treatment of postoperative pareses of the gastrointestinal tract. The ganglioblockers possess antistress effect, reduce the degree of pathological vegetative reactions and facilitate realization of the mechanisms of selfregulation of functions of the small and large intestine. Using benzohexonium during operation and in the first days after it makes the intestinal pareses less frequent. N-cholinolytics however do not have a considerable stimulating influence on the contracting activity of the gastrointestinal tract that accounts for their not high effectiveness in treatment of early functional motor evacuatory disorders. The points of action of gangliolytics, those at the level of the intestinal wall included, can not be considered to be completely established, as well as the mechanisms of their indirect effect. The ganglionic blockade should be considered as the basic method of prophylactics of the postoperative paresis of the intestine.