[A multidisciplinary approach in the treatment of elderly and senile patients with complications of colon cancer.]

The article presents the results of treatment of elderly and senile patients with complications of colon cancer, in whose perioperative management a multidisciplinary approach was used. The peculiarity of patients in older age groups, caused by polymorbidity, the phenomenon of mutual complication, requires the use of a non-standard approach in the treatment of complicated colon cancer, since the latter is accompanied by negative results. A comparative analysis of the results of treatment of 289 elderly and senile patients with complicated colon cancer by the traditional method and using a multidisciplinary approach was carried out. The patients were divided into two groups: study and control. In addition to the introduction of the principles of a multidisciplinary approach, additional diagnostic methods were used in the main group in order to more specifically determine the type, severity of complications, staging of the window process and determine functional operability. Patients of the main group, taking into account the implementation of a multidisciplinary approach, were operated using endovideosurgical technologies. In the group of patients where a multidisciplinary approach was used using additional diagnostic methods and minimally invasive treatment methods, a more favorable course of the postoperative period was noted with a decrease in postoperative complications (from 44,9 to 27,8%) and mortality (from 8,9 to 5,3%).

[Endoscopic treatment of choledocholithiasis in patients over 80 years old]. / Vozmozhnosti endoskopicheskogo lecheniya kholedokholitiaza u patsientov 80 let i starshe.

OBJECTIVE: To analyze endoscopic treatment of choledocholithiasis in patients over 80 years old. MATERIAL AND METHODS: A single-center retrospective study included 90 consecutive patients aged ≥80 years and 58 patients aged 60-79 years. Early outcomes including efficacy of calculus removal, incidence of complications and their risk factors were evaluated. RESULTS: In 75 patients aged ≥80 years (83.3%), endoscopic treatment was effective definitive single procedure. Between-group differences were insignificant (p=0.163). Patients aged ≥80 years were characterized by higher percentage of ASA classes 2-4 (p<0.001), age-adjusted mean Charlson comorbidity index (p=0.004), and ≥2 calculi (64.4% vs. 32.8%, p<0.001). Postoperative morbidity was similar (7.8% vs. 6.9%, p=0.842). Multivariate logistic regression analysis of potential risk factors did not reveal significant correlations: Chi-square test was 14.94 at 15 degrees of freedom (p=0.463). CONCLUSION: Similar postoperative morbidity determines safety of endoscopic lithoextraction in patients aged over 80 years. We should emphasize higher percentage of advanced age patients with «difficult¼ choledocholithiasis that requires appropriate training of specialists, adequate equipment of hospitals and routing of patients.

[Are hybrid technologies appropriate for revascularization of aortoiliac-femoral segment?] / Opravdano li primenenie gibridnykh tekhnologii pri revaskulyarizatsii aorto-podvzdoshno-bedrennogo segmenta.

OBJECTIVE: To compare various approaches to revascularization of aortoiliac-femoral segment. MATERIAL AND METHODS: Data were collected prospectively for retrospective analysis. There were 192 patients with atherosclerotic lesion of the aortoiliac-femoral segment who underwent reconstructive surgeries. All patients were divided into 3 groups depending on the type of reconstruction: 85 patients underwent open surgical interventions, 63 patients - endovascular interventions, 44 patients - hybrid techniques. Between-group differences were considered significant at p-value <0.05. RESULTS: Hybrid revascularization is characterized by less duration of surgery, blood loss and morbidity. Hybrid interventions ensured favorable primary patency compared to open surgery within the follow-up period. CONCLUSION: Hybrid revascularization of aortoiliac-femoral segment is characterized by less duration of surgery, blood loss and morbidity.

[Improvement of diagnostics and tactics of treatment of patients of elderly and senile age with acute obturational pulpositional obstacle of tumor genesis.]

The results of providing care to 346 elderly and senile patients with acute obstructive intestinal obstruction of tumor Genesis were analyzed. In the diagnosis of acute intestinal obstruction, along with traditional diagnostic methods, the dynamics of intra-abdominal pressure and hemodynamic parameters in the visceral arteries of the abdominal aorta were evaluated. Based on the study, it was shown that acute obstructive intestinal obstruction is accompanied by an increase in intra-abdominal pressure and a reduction in blood flow in the visceral arteries of the abdominal aorta. Moreover, the greater the degree of intestinal obstruction, the more pronounced these changes are. The use of these studies made it possible to improve the diagnosis of acute intestinal obstruction of tumor Genesis. In addition, the assessment of these indicators in the dynamics indicated the effectiveness of conservative measures and gave reason to establish more timely indications for performing surgery. A comprehensive approach to timely diagnosis of acute intestinal obstruction of tumor origin allowed us to identify a group of patients who can perform surgical interventions using endovideosurgical technologies. The use of minimally invasive technologies in the treatment of colon cancer complicated by acute intestinal obstruction has reduced the number of postoperative complications and the level of postoperative mortality.

[Choice of the revascularization method for patients of elderly age with infraeinguvinal arterial disease.]

The aim of the study was to perform a comparative evaluation of the use of various methods of reconstructive assistance in the defeat of the femoral-tibial segment in elderly patients with peripheral arterial disease. 253 patients over 60 years old (60-74 years and more than 75 years) with atherosclerotic lesions of arteries below the inguinal ligament were examined and revascularized. According to the type of reconstruction performed, the patients were divided into 3 groups: 98 patients underwent open surgical interventions; 116 patients underwent endovascular interventions; 39 people performed hybrid reconstructions. The shorter duration of each stage of hybrid interventions, minor blood loss, and stability of hemodynamics during the perioperative period positively characterize hybrid effects. It was found that there was a shorter stay in the intensive care unit and shorter hospitalization of patients after hybrid revascularization methods compared to open methods. The absence of dangerous complications and the primary patency of the operated segment in the early postoperative period, approaching 100%, characterize hybrid techniques as an effective method of treating patients with infraganginal arterial disease. Conclusion: Hybrid reconstructions are promising in elderly patients who have severe comorbidity due to less operational blood loss, shorter duration of intervention and the minimum number of postoperative complications.

[Immediate results of surgical treatment of complicated colorectal cancer in elderly and senile patients.]

The work analyzes the results of surgical treatment of 545 elderly and senile patients with complicated forms of colon cancer. Among colon cancer complications frequently encountered acute intestinal obstruction (AIO) - 413 (75,8%), less likely to have been identified - perifocal inflammation (PPV) with abscess - 80 (14,7%), bleeding - 30 (5,5 %) and tumor perforation - 22 (4%). Operations on the colon were performed as a traditional method - 408 (74,9%) and with the use of endovideosurgical technologies - 137 (25,1%). 335 (61,5%) of radical, 50 (9,2%) palliative, 160 (29,3%) symptomatic operations were performed. Operations on the colon, performed for the development of cancer complications, were accompanied by a high mortality rate (22,9%) and a high incidence of postoperative complications (37,1%). The most frequent wound complications were 105 (19,3%) and pneumonia 67 (12,3%). The highest postoperative mortality was observed after operations for tumor perforation of colon cancer (59,1%). Endomedosurgical operations on the large intestine were accompanied by fewer postoperative complications (17,5%) and postoperative lethality (2,2%).

TREATMENT OF PATIENTS WITH COMPLICATIONS OF COLON CANCER IN CONDITIONS OF MULTIFIELD GERONTOLOGICAL HOSPITAL.

The article analyzes treatment results of 482 patients of elderly and senile age with complicated colon cancer forms who were in the hospital for war veterans at the period from 2008 to 2014. The more frequent complication of colon cancer was an acute intestinal obstruction (76,8%). Peritumorous inflammation with abscess formation was noted in 13,5% cases, hemorrhage - in 5,6% tumor perforation - in 4,1% cases. The operations were performed by conventional methods and using endovideosurgical technologies in case of complication of colon cancer. Laparoscopic operations had less volume of intraoperative hemorrhage, lower rate of postoperative complications and reduction of the level of postoperative lethality. The rate of lethality was 31,18% after conventional operations and it consisted of 1,81% after laparoscopic surgery. Total postoperative lethality was 24,5%. The maximal level of postoperative lethality was noted in cases of colon cancer complications and it had an ultimate rate (100%) in cases of perforation of locally advanced tumor.

[THE CHOICE OF SURGICAL TREATMENT OF OBSTRUCTIVE ILEUS IN ELDERLY AND SENILE PATIENTS].

The article presents results of treatment of 100 patients with elderly colon cancer complicated by obstructive ileus. Patients were divided into two groups of 50 people. Main group patients for colon surgery performed using laparoscopic techniques. The efficiency of operations on the colon laparoscopically - fewer postoperative complications, length of postoperative hospital stay days. Deaths in the study group was not (control - 6 %).

[Improvement in the diagnosis, therapy, and prevention of complications in patients with rectal cancer].

The goal of this study was to assess the informative yield of modem radiology diagnostic (endorectal and intraoperative sonography, spiral computed tomography and magnetic resonance imaging) and three-dimensional modeling methods in patients with rectal cancer. The effectiveness of postoperative immune-modulating therapy (Neovir and Betaleukin) was also evaluated. The aforementioned techniques contributed to an adequate preoperative selection of surgical treatment and allowed reducing the incidence of postoperative complications.

[Resources of modern methods of radiodiagnostics in optimization of surgical treatment of patients with rectum cancer].

An investigation of the information value of modern radial methods of diagnostics (endorectal and intraoperative sonography, spiral computed and magnetic resonance imaging) and Power Shape program for three- dimensional modeling in 150 patients with rectum cancer has shown their significance in the assessment of prevalence of the tumor process, invasion of the tumor into the rectum wall, its spreading in the intestinal wall, involvement in the tumor process of the pararectal fat and adjacent to the rectum organs of the small pelvis, the presence of signs of metastases to the regional lymph nodes. These methods of X-ray analyses and three- dimensional computed modeling of the tumor process of the rectum facilitate preoperative decision on the adequate volume of surgery.

[Possibilities of ultrasonography in diagnostics and treatment of nonparasitic cysts and abscesses of the liver].

The results of ultrasound diagnostics of focal fluid lesions of the liver in 132 patients are presented. Echographic semiotics of abscesses and nonparasitic cycts of the liver is described. The possibilities of using transcutaneous minimally invasive puncture and drainage methods in 80 patients under ultrasound control were analyzed. We formulated indications and contraindications to puncture-aspiration and puncture-drainage operations, methods of sclerotherapy of cysts and techniques of drainage and sanitation of the abscess cavities. The results of treatment of focal fluid lesions of the liver by minimally invasive methods of surgery under ultrasound control were thoroughly analyzed. These techniques permit achieving good results with few complications and minimal lethality. The methods can be recommended for wider use in practical work.

[Intermittent pneumatic compression of the lower extremity muscles in complex prophylactics of postoperative venous thromboses in elderly and senile patients].

An analysis of frequency of venous thrombitic complications after different operations on 69 patients aged from 69 through 87 was made. The greatest number of venous thromboses was noted after amputations of the femur. Intermittent pneumatic compression of the lower extremities in addition to standard methods of prophylactics reduced the number of postoperative thromboses from 12.8% to 3.3%.

[Disturbances of bone tissue metabolism in elderly and senile patients after stomach resection].

The authors have examined 104 elderly patients after one of operations on the stomach. The mineral metabolism, biochemical and X-ray findings were investigated. Osteoporosis was observed more often in patients after Billroth-II resection of the stomach, rarer after Billroth-I operation and more rarely in patients after pylorus-saving resection of the stomach.

[Results of minilaparotomies in treatment of cholelithiasis in elderly and senile patients].

The authors have analyzed results of surgical treatment of 79 patients with cholelithiasis using a mini-access. The method can be widely used in patients with high operative risk. It is minimally traumatic, has less lethality and a fewer number of early and late postoperative complications. It also considerably decreases stay of the patients at the hospital.

[Intraductal photo-irradiation of bile in complex treatment of patients with cholangitis].

The authors have analyzed results of complex treatment of cholangitis patients by the application of intraductal photoirradiation. This method of treatment was shown to give more favorable course of the postoperative period.

[The efficacy of Neovir in the combined treatment of patients with operable tumors of the gastrointestinal tract]. / Effektivnost' Neovira v kompleksnom lechenii bol'nykh s operabel'nymi opukholiami zheludochno-kishechnogo trakta.

Under observation there were 32 patients with operable tumors of the gastro-intestinal tract. The average age of the patients was (64.8 +/- 7.5) years. Patients of the control group (18 patients were given the routine complex treatment. The main group (14 patients) were additionally given the interferonogenic immunomodulator "Neovir" which resulted in lower risk of the appearance of pyo-septic complications. It was confirmed by positive dynamics of the indices of cellular immunity, intensified production of proinflammatory cytokines and interferon-alpha.