[Pressing problems of gastric and duodenal ulcer surgery]. / Aktyal'nye voprosy khirurgii iazvennoi bolezni zheludka i dvenadtsatiperstnoi kishki.

Main types of surgical operations for the treatment of ulcer disease were elaborated towards the end of XIX century and improved constantly for the better by surgeons. Vagotomy is the outstanding achievement of the XX century. It enabled lowering of mortality, and frequency of postresection syndromes and improved patients' quality of life. The discovery of Helicobacter pylori (Hp) has changed our knowledge about ulcer disease pathophysiology. Eradication of Hp with omeprasol and antibiotics sharply improved the treatment, decreased the relapses. In this connection number of elective surgical operations decreased, but number of emergency increased. Importance of Hp in pathophysiology of ulcer disease is overestimated. Chronic Hp gastritis, destroying protective mucosal barrier clear the way for destructive action ofacidopeptic component of gastric juice and ulcer formation. The comparative evaluation of different surgical operations is given and optimal methods for the treatment of complicated and uncomplicated duodenal and gastric ulcers are recommended.

[Estimation of stomach surgery results]. / K metodike otsenki rezul'tatov operatsii na zheludke.

Operations on the stomach make up about 2-5% of all operations performed in clinics of general surgery. In evaluation of the efficacy and quality of treatment the quantitative indices are used: intraoperative and postoperative complications, frequency of relapses of the basic disease, frequency and degree of severity of developing functional manifestations of the diseases of postoperative stomach and metabolic disturbances. However, contemporary trends to standardization of surgical technique and to high rank of technological equipment of the operation unit predetermine related or identical results after various operations on the stomach. Differences in outcomes of surgical treatment are best of all revealed in the study of qualitative results. The qualitative evaluation of various operative procedures with the use of integrale scales of Johnston and Visick has some substantial disadvantages. WHO recommends to use "adequacy of treatment", i.e. achievement of the adequate quality of life for each patient as a criteria for evaluation of the efficacy of treatment. The authors suggest that, until the influence of particular operation on the level of the quality of life of patients in postoperative period (in comparison with the initial ones before the operation and in healthy people) is not studied, it is impossible to judge about its advantages and shortcomings. The quality of surgical operation--the choice of the procedure and its technical realisation--predetermines quality of life of patients in postoperative period.

[Plastic surgery in patients with obesity late after horizontal banded gastroplasty]. / Plasticheskie operatsii u bol'nykh ozhireniem v otdalennye sroki posle gorizontal'nli gastroplastiki.

The results of 361 plastic operations in 296 patients with morbid obesity late after horizontal gastroplasty were analyzed. Plastic and corrective operations aimed at removal of redundant lipocutaneous "aprons" at the anterior abdominal wall, thighs, thoracic wall, gluteal region and the arms, represent a final stage of surgical treatment of patients with morbid obesity. The indications, technique and the results of plastic operations performed from 1985 to 1998, are thoroughly elucidated. The analysis of early postoperative complications has established, that it a reasonable to perform such operations 1-3 years after gastroplasty when body weight stabilizes and there are no vitamin deficiency, iron deficient anemia, hypoproteinemia, hydroionic disturbances or other complications of the later period. Complex prophylactic measures for prevention of pyoseptic and thromboembolic complications in patients with obesity late after gastroplasty permits to avoid severe complications and lethal outcomes in patients after plastic operations.

[Spectro-fluorescence analysis of ALA-induced protoporphyrin IX in differential diagnosis of stomach disease]. / Spektral'no-fliuorestsentnyi analiz ALA-indutsirovannogo protoporfirina IX v differentsial'noi diagnostike zabolevanii zheludka.

The results of examination of 47 patients with confirmed diagnosis of cancer of the stomach (21 patients) or 26 suspects were analyzed. 2-4 hours after oral taking of Alasence in the dose 5-10 mg/kg, gastroscopy with spectrofluorescence analysis of ALA-induced protoporphyrin IX was performed. There were no toxic complications due to Alasence taking. The standard spectrodetector LESA-7 was used for fluorescence record registration. The fluorescence spectra were recorded in the range of 650-850 nm. The specific for protoporphyrin IX peak at 700 nm wavelength was analyzed. Fluorescent endoscopic diagnosis allowed to confirm stomach cancer in 21 patients, and to detect cancer in 7 patients, including 2 cases of cancer in situ. The contrast of protoporphyrin IX accumulation (tumor/norm ratio) ranged from 2.5 to 18, that was enough for differential diagnosis in the majority of cases. In analysis of spectrograms for correct contrast calculation it is necessary to take into account the own fluorescence, with was high in some cases.

[Intraoperative instrumental examination in stomach cancer]. / Intraoperatsionnye instrumental'nye issledovaniia pri rake zheludka.

Ultrasound examination and laser autofluorescent spectroscopy were used intraoperatively for evaluation of gastric cancer dissemination. These methods were efficient in differentiation of cancer and benign tumors, estimation of cancer dissemination, revealing of metastases in the liver and lymph nodes. The use of these methods made it possible to increase sensitivity and specificity of estimation of cancer infiltration to 100% and of revealing lymph nodes metastases to 90% and 76%, respectively.

[Laser fluorescence spectroscopy in intraoperative diagnosis and staging of lung cancer]. / Lazernaia fluorestsentnaia spektroskopiia v intraoperatsionnoi diagnostike i otsenke rasprostranennosti raka lëgkogo.

67 patients with different kind of lung diseases have been evaluated by intraoperative laser spectroscopy. 49 of them had lung cancer and 18 patients had nonmalignant tumors, tuberculomas and chronic abscess. Helium-neon laser has been used to study spectral parameters of a normal lung tissue and lungs with malignant and benign tumors intraoperatively. It was found that intensity of autofluorescence will increase in cancer tissue. This phenomenon may be used for differential diagnosis of a lung cancer with benign tumors and chronic pulmonary diseases. It was also shown that autofluorescence of metastatic lymph nodes is higher compared to their hyperplasia. That may be used for rapid diagnosis of metastases in mediastinal lymph nodes and intraoperative staging of lung cancer.

[Topical problems in classification and treatment of disseminated purulent peritonitis]. / Aktual'nye voprosy klassifikatsii i lecheniia rasprostranennogo gnoinogo peritonita.

A critical analysis of modern classifications of peritonitis has been done. The article is based on the analyses of 347 patients with peritonitis in the phase of subcompensation and decompensation (polyorganic failure). The author suggests to differentiate peritonitis according to the character of inflammation and rate of dissemination: diffuse peritonitis (local, disseminated and general) and localized (abscesses and infiltrates). The term "general peritonitis" should not be used because it combines the definition of "diffuse" and "disseminated" peritonitis. The programmed staged peritoneal lavage (cleaning and revision of peritoneum) is advocated as a method of choice in the treatment of residual infection. Nasointestinal drainage of small intestine should be used in treatment of paralytic ileus.