[Surgical treatment of desmoid fibroma and sarcoma of the thoracic and abdominal wall].

The article analyses the 17-year (1993-2009 yy) experience of surgical treatment of desmoid fibroma and sarcoma of the thoracic and abdominal wall. 46 operations were analyzed. The radical excision according to the principles of surgical oncology remains the mainstay in the treatment of such patients. The combined technique with the use of polymeric implantates allows to cover large wall defects, thus extending the operability borders and being one of the main factors of the better treatment prognosis.

[Heterotopic urine derivation in females with urinary bladder extrophy].

Fifteen females aged from 17 to 31 years with bladder extrophy (the condition after ureterosygmostomy) have undergone heterotopic urine derivation with creation of a cutaneous urine-retention catheter mechanism. Surgery was indicated in progressive decline of renal function in the presence of renal reflux, total urine incontinence in the failure of pelvic floor muscles and rectal sphyncter apparatus. Creation of cutaneous urine-retention catheter mechanism was made by the following techniques: heterotopic plastic repair from the ileocecal angle by Mainz pouch I (11 patients, 73.4%); heterotopic W ileocystoplasty by Abol-Enein (4 patients, 26.8%). Implantation of both ureters was conducted by Wallace technique in 4 (26.7%) cases. In 7 (46.6%) patients ureteral implantation was performed with antireflux defense by the method of cross dublicate creation. Four (26.7%) patients with small intestinal derivation have undergone extramural implantation of the ureters according to Abol-Enein. The results show that conversion of ureterosygmostomy in heterotopic urine derivation with one-stage genital reconstructive interventions decreases the number of potential complications, improves surgical outcomes and provides much better medico-social rehabilitation. Heterotopic intestinal continent derivation of urine is an operation of choice in women with urinary malformations. In such patients orthotopic urine derivation is impossible.

[Reconstructive surgeries after extensive resections of anterior abdominal and chest walls for tumors].

Experience of reconstructive surgeries after extensive resections of anterior abdominal and chest walls performed on account of tumors is described. Recovery of integrity of anterior abdominal wall was performed by serial grafting with dura mater and polypropylene net implant. The thorax was repaired with special grafts of the ribs and sternum. The integrity of the skin was reestablished with either suturing of the separated flaps or transposition of myodermal flap on vascular pedicle.

[Proliferation of fat cells in lipomas]. / O proliferatsii zhirovykh kletok v lipomakh.

Common lipomas and destructive ones (intramuscular, infiltrating, necrotizing and destroying surrounding tissues) were studied in 9 patients electron-microscopically and radioautographically. The adequacy of necrotizing processes and regeneration was observed: normal fat tissue-lipoma-destructive lipoma. In the latter besides pronounced destruction of tissue (adipocytes, vessels, muscles at the border with tumour), there was accelerated differentiation of preadipocytes from the cells-precursors (fibroblasts and undifferentiated cells of the vascular wall), hypertrophy of preadipocytes (their size and number of nuclei increase) and their proliferation. The process of malignant transformation in a destructive lipoma may be so much pronounced that DNA synthesis may be observed in the mature lipocyte (this has not been described so far).

[Electron-radioautographic study of differential influence of biologically active wound covering on the process of regeneration]. / élektronno-radiographicheskoe issledovanie differentsirovannogo vliianiia biologicheski aktivnykh ranevykh pokrytii ha protsessy regeneratsii.

It is established that local wound treatment with coverings is directed to both suppression of microflora and inflammatory process and stimulation of regeneration at early periods of wound healing, this favouring granulation tissues growth and wound epithelization. Mechanism of biologically active covering influence on the reparative regeneration lies in stimulation of fibroblast, endotheliocyte and pericyte proliferation and stimulation of granulation tissue cells functional activity.

[Development of new biologically active dressings and methodology of their use]. / Razrabotka novykh biologicheski aktivnykh pereviazochnykh sredstv i metodologiia ikh primeneniia.

Results of development of new biologically active dressings and up-to-date methodology of local treatment of wounds (based on their differential application according to phase and features of wound process) are demonstrated. Data about main properties and specific activity of new biologically active dressings based on natural and synthetic polymers with immobilized drugs are presented. Future trends and efficacy of their appliance in complex treatment of purulent and necrotic wounds are demonstrated.

[One-stage formation of urinary bladder, restoration of symphysis with correction of congenital defects of external and internal genital organs]. / Odnomomentnoe formirovanie iskustvennogo mochevogo puzyria, vosstanovlenie lonnogo sochleneniia s ustraneniem vrozhdennykh defektov naruzhnykh i vnutrennikh polovykh organov.

One-stage combined surgery in a female patient with total extrophy of the urinary bladder after uretherosigmostomy was performed for the first time with participation of surgeons, gynecologists and urologists. Corrective surgeries in these patients must be performed for the purpose of creation of isolated urinary reservoir for prophylaxis of pyelonephritis and chronic renal insufficiency. Correction of symphysis defect was carried out with polypropylene endograft. This surgery was performed to provide quality of life and reproductive function of the patient.

[Management of large and giant postoperative ventral hernias]. / Lecheniie bol'shikh i gigantskikh posleoperatsionnykh ventral'nykh gryzh.

The experience of the Department for Plastic Surgery of the A.V. Vishnevsky. Institute of Surgery of RAMS in surgical treatment of 262 patients with postoperative hernias of the anterior abdominal wall has been summarized for the period from 1993 to 1998. 138 patients (test group) had large and giant hernias, 124 (control group)--small and middle-sized postoperative hernias. In large and giant hernias more frequently (46.1%) combined plastic reconstruction of the anterior abdominal wall was used rather than in small and middle-sized hernias (21.5%). In the majority of patients in control group (78.5%) autoplasty of the abdominal wall defect was carried out. In the long term period relapses developed in 9 (7.0%) patients of the test group. In 7 cases the relapse developed after the autoplasty (10.1%), and in 2 cases--after the use of combined method (3.4%). This supports perspectiveness of the method of postoperative hernioplasty by the combined method. Lethality rate after hernioplasty in the test group made up 2.3% (3 patients).

[The classification and surgical correction of postlactation involution of the breasts]. / Klassifikatsiia i khirurgicheskaia korrektsiia postlaktatsionnoi involiutsii molochnykh zhelez.

On the basis of investigations performed a classification is made systematizing postlactational involution according to different parameters and degree. It facilitates objectivization of indications to different correcting operative interventions on mammary glands with postlactational involution and choice of the optimum complex of surgical measures for correction of the mammary gland. It allows prognosis of its contour and esthetic results.

[Neurologic disorders in patients with Madelung's lipomatosis]. / Nevrologicheskie rasstroistva u bol'nykh lipomatozom Madelunga.

The authors had 21 patients with a rare disease, Madelung's lipomatosis. Vegetative disorders of segmental and suprasegmental levels were revealed in all patients. The character of neuropathies in Madelung's lipomatosis is discussed in detail. According to the authors, it is a complex syndrome with peripheral, vegetative, and vascular disorders. The accompanying secondary scalenus syndrome produces a peculiar clinical picture of neuropathy. The existence of neurological disorders dictates the need for complex (surgical and medicamentous) treatment of patients with Madelung's lipomatosis.

[Clinical significance of the determination of protein C dependent disorders of hemostasis in surgical patients]. / Klinicheskoe znachenie opredeleniia protein C-zavisimykh narushenii gemostaza u khirurgicheskikh bol'nykh.

Diagnostic value of protein C measurements was investigated in 159 surgical patients with diseases of the liver, great vessels, and wound infection. Protein C antigen was detected by ELISA with specific antibodies to protein C. The changes of protein C antigenic activity correlated with severity of hepatic disorders. Inhibition of protein C synthetic activity went on in parallel with a fall in pseudocholine esterase concentrations. This suggests feasibility of protein C measurements for examination of protein production by the liver. Characteristics and location of the lesions in great vessels were also related to protein C antigen levels. The fall in this antigen quantity was observed in patients with purulent wound infection. The greater the fall, the more serious the patient's condition became.