[The significance of respiratory and orthostatic tests in duplex scanning in diagnostics of celiac artery compression syndrome].

The preoperative transabdominal ultrasonics duplex scanning (UDS) of celiac artery was made in quiet breathing, in inspiration, in expiration, using vertical position in 180 patients. As well as the intra-abdominal UDS was made before the decompression of the celiac artery using the pulmonary ventilation during narcosis and relaxation. Peak systolic blood velocity, degree of stenosis, arterial pressure gradient in the celiac artery and volume blood velocity were hemodynamically significant in quiet breathing, in expiration and intraoperatively, reliably lower in inspiration in vertical position. It is important to use respiratory and orthostatic tests in diagnostics of compressive stenosis of the celiac artery. The data, which were obtained in quiet breathing using vertical position, should be taken into account in order to distinguish the compressive stenosis from atherosclerotic stenosis or other origin.

[Results of combined reconstructions of the renal arteries, abdominal aorta and its other branches in patients with atherosclerosis].

A comparative analysis was made of clinical indices and long-term survival in 20 patients (13 men and 7 women of mean age 62 +/- 2 years), having multifocal atherosclerosis of the renal arteries (RA), abdominal aorta and arteries of lower extremities (LE) (11 aneurysms, 7 occlusive lesions of the aorta and 3 of its unpaired branches) who underwent combined reconstructions, with patients having similar lesions, but not operated (12) or operated only on RA or on the arteries of LE (45). The groups of patients had no great differences except more pronounced renal dysfunction (RD) in the first of them. In spite of high postoperative lethality (20%) mainly due to acute renal failure (3), long-term survival proved to be significantly higher (14 from 16), than in not operated (3 from 12) (p = 0.00001) and had better tendency than in those operated on the same basin (35 from 45). In addition, the patients after combined operations had substantially decreased systolic and diastolic arterial pressure (159 +/- 13 vs. 132 +/- 9, p = 0.00001; 91 +/- 5 vs. 83 +/- 7, p = 0.010) and also stabilized renal function.

[Intraoperative ultrasound duplex scanning in the diagnosis and assessment of results of surgical treatment of patients with celiac compression syndrome].

The authors have performed an analysis of main indicators of celiac duplex scanning in 180 patients with celiac compression syndrome before operation, during decompression and at the postoperative period. All the patients underwent surgical celiac trunk decompression. The indicators of the intraoperative celiac duplex scanning (stenosis degree, linear peak systolic circulation rate) of the celiac trunk shower hemodynamic reliable stenosis and were sufficiently different from preoperative findings. The stenosis degree and linear peak systolic circulation rate were less during intraoperative examination than before the operation. Intraoperative, duplex canning allowed compressive stenosis of the seliac trunk to be differentatied in some patients from intravasal one (atherosclerosis and arteritis), and its adequate decompression to be performed. When performing the celiac trunk decompression it is thought to be necessary to fulfill its intraoperative ultrasound duplex scanning before and after elimination of the compression.

[Postprandial hypotension in patients with compression of the celiac trunk].

One of the causes of the development of postprandial hypotension is thought to be impaired vegetative nervous regulation of arterial pressure. Patients with the syndrome of the celiac trunk compression also have signs of dysautonomy. The investigation performed has shown that syndrome of the celiac trunk compression is often combined with postprandial hypotension. Patients with such combination much more often have complains associated with asthenia and dysfunction of the autonomous nervous system. After operative treatment of patients with the celiac trunk compression (decompression of the celiac trunk) the frequency of symptoms of postprandial hypotension and clinical manifestations of asthenia and dysautonomy become less often in such patients.

[Surgical treatment of fibromuscular dysplasia of renal arteries in adults].

The authors have analyzed an experience with treatment of 16 patients. All the patients had renovascular hypertension (RVH) and 3 of them had renal dysfunction. Revascularization of the kidneys (RK) was fulfilled in 11 patients by shunting (9) or prosthesis (2) of the renal arteries. In 7 patients percutaneous endovascular angioplasty (PEA) was used. There were neither complications nor lethal outcomes. Arterial pressure normalized in 7 patients and in 9 RVH was better. In the long-term period (at the average within 21 months) 14 patients were followed-up. In 3 patients having perimedial and intimal fibroplasty of RA after PEA restenoses were diagnosed. They had repeated RK. Renal function became better in 1 patient, in 2 patients there was no substantial dynamics. All shunts were passable. The analysis of the data has shown that liquidation of RVH in patients with FMD of RA has inverse dependence on its duration, and decision on the method of RK depends on the type of RA, experience of the specialists, the patients desire included.

[Aneurysmatic and occlusive lesions of the aorto-iliac segment in combination with cancer of the lungs and organs of the abdominal cavity].

An analysis of retrospective data has shown that 34 (14.4%) out of 236 patients with aneurysm of the abdominal aorta and iliac arteries and in 62 (5.1%) out of 1214 patients with occlusion or stenosis of these vessels mainly had cancer of the lungs (52%) and stomach (17.7%) with almost similar incidence in both groups. Colorectal cancer (8.3%) and cancer of other organs of the abdominal cavity were detected more rarely. Aneurysmatic (12 patients) and occlusive-stenosing (17 patients) lesions of the aorto-iliac segment were noted in 29 (0.4%) among 6834 patients with lung cancer or organs of the abdominal cavity. There were three subgroups of patients: (1) first cancer was diagnosed, and then aneurysm, stenosis or occlusion of these arteries (12-12.5%); (2) diseases of the arteries and cancer were diagnosed simultaneously (60-62.5%) and (3) first lesions of the arteries and later cancer (24-25%). Two-stage operative interventions for these diseases were made in 30 (31.2%) patients.

[Bypass grafting of the celiac trunk of superior mesenteric artery in treatment of patients with chronic ischemia of digestive organs].

In the period from 1984 to 2010 operations were made on 41 patients aged from 36 to 76 years with chronic ischemia of digestive organs (CIDO), infarction of the small intestine was determined in 7 of them mainly due to atherosclerotic injury of the celiac trunk (CT) and/or superior mesenteric artery (SMA). In 41 patients antegrade (15) or retrograde (26) shunting of CT and/or SMA were fulfilled with synthetic prostheses in combination with resection of the small intestine in 7 patients, with lethal outcome in 2 of them only. No prosthesis infection was noted. Lethality in early terms was 17.1% mainly at the early stage of the work. Observations during the period from one month to 24 years were followed up in 26 (63.4%) patients. Their state remains satisfactory, the shunts are patent. In treatment of patients with CIDO the antegrade and retrograde shunting of CT and/or SMA are shown to be effective methods.

[Percutaneous angioplasty and stenting in treatment of chronic occlusions of renal arteries].

The article presents results of examination and treatment of 14 patients aged from 46 through 79 years with chronic occlusion of one of the renal arteries in each of them and subocclusion of the contralateral renal artery in 13 patients due to atherosclerosis. At first percutaneous intraluminal angioplasty and stenting were performed in 13 out of 14 patients with stenosis of the renal artery. Then at once only percutaneous intraluminal angioplasty of the occlused renal artery was performed in 10 out of 14 patients and within 36 hours on average the implantation of stents in case of patency of the renal artery proper and its branches, according to the findings of control angiography, in these arteries with the optimal result. The percutaneous intraluminal angioplasty and stenting are relatively safe and effective methods of reestablishment of patency of the renal arteries after their chronic occlusion.

[Celiac trunk compression syndrome associated with primary mitral valve prolapse].

A prospective study included 106 patients with celiac trunk compression syndrome (CTCS). Duplex scanning of the celiac trunk and superior mesenteric artery and echocardiography were performed during their examination. The investigation revealed primary mitral valve prolapse (PMVP) in 78 (74%) patients. Operations of decompression of the celiac trunk were made on 101 patients. After operation the symptoms (neurovegetative included) were found to disappear. No authentic distinctions were revealed in the clinical semiology and postoperative course of patients with CTCS and with a combination of CTCS and PMVP.

[Syndrome of compression of the celiac trunk of the abdominal aorta in adults].

The article presents results of examinations and surgical treatment of 300 patients aged from 19 through 72 years with the syndrome of compression of the celiac trunk of the abdominal aorta. Under study were the symptoms and features of the clinical course as well as the possibilities of diagnosis with the help of ultrasonic duplex scanning and aortography. The principal method of treatment of this syndrome is thought to be operative decompression of the celiac trunk resulting in the reestablished hemodynamics in this vessel and in recovery of the greatest part of the patients.

[Aneurysms of the pancreaticoduodenal artery in association with stenosis or occlusion of the celiac trunk].

On the basis of an analysis of 69 patients including 2 personal observations the authors discuss the questions of pathogenesis, clinical picture, diagnosis and treatment of aneurysms of the pancreaticoduodenal artery in association with stenosis or occlusion of the celiac trunk (CT). A description of 2 cases with a true not broken aneurysms of the inferior pancreaticoduodenal artery and subocclusion of the celiac trunk is given which was caused by compression of the latter by the median arcuate ligament of the diaphragm and neurofibrous tissue of the celiac plexus. These patients were detected as a result of examinations and operative treatment of 556 patients with compressive stenosis of the celiac trunk for the period from 1982 through 2002. In one case a transcatheter embolization of the aneurysm was fulfilled followed in 3 months by a compression of the celiac trunk, in the other case a compression of the celiac trunk was made first and then in 5 months it was followed by resection of the aneurysm with a favorable outcome.

[The role of an objective assessment of the heart right vientricle function for the anesthesiological maintenance and intensive therapy of surgical patients].

Latent dysfunction of the heart right ventricle and hypovolemia were assessed in 50 patients divided into 4 groups, operated on the heart, abdominal aorta and lungs. It was found that after revascularization of the myocardium the diastolic disorders prevailed. In patients operated for the heart valve (mitral and aortal) diseases prevailing were the systolic and pump dysfunction of the right ventricle. Insufficiency of the right ventricle in these groups was 13% and 22% respectively. After operations on the abdominal aorta a combination of the systolic and diastolic impairments of the right ventricle were observed. After extended resections of the lungs there was a characteristic combination of systolic, diastolic and pump dysfunctions. When the operation was followed by a decreased minute volume of circulation, its cause was hypovolemia in 29% of cases in the examined surgical patients. The investigation of the right ventricle functions with the help of pulmonary arterial volumetry can reveal their latent dysfunctions as well as hypovolemia in a considerable part of surgical patients.

[Compression stenosis of the celiac trunk in children and adolescents]. / Kompessionnyi stenoz chrevnogo stvola u detei i podrostkov.

Operations for compression stenosis of the celiac trunk (CSCT) were made on 97 patients aged 5.5-18 years (56 women and 41 men). Three basic clinical syndromes were observed: pain abdominal, dyspeptic and neurovegetative. The appearance or intensification of abdominal pains observed in 71.3% of the patients were connected with meal, in 59.69% of them it was simultaneous with physical exercise. The diagnosis of OSCT was based mainly on findings of ultrasonic duplex scanning. The indications to decompression of the celiac trunk were: clinical manifestations of CSCT, the stenosis degree at the maximal expiration more than 50%, peak systolic velocity of the blood flow more than 2 m/s and a gradient of arterial pressure more than 15 mm Hg. The decompression of the celiac trunk consisted in the dissection of a median arcuate ligament of the diaphragm, its interior crura and celiac ganglion fibers. Convalescence and recovery was stated in 87 of 97 patients in the nearest and long-term follow-up.

[Role of the tumor markers CA 19-9 and carcinoembryonic antigen (CEA) in diagnosis, treatment and prognosis of pancreatic cancer]. / Znachenie opukholevogo markera CA 19-9 i kartsino-émbrional'nogo antigena (KEA) v diagnostike, vybore lechebnoi taktiki i prognozirovanii raka podzheludochnoi zhelezy.

The investigation was concerned with diagnostic sensitivity, specificity and effectiveness of assay of CA 19-9 and carcinoembryonic antigen (CEA) in the choice of treatment modality and evaluation of therapy pancreatic carcinoma (PC). Either marker has been studied in 685 examinations for PC, 68--chronic pseudotumorous pancreatitis and 24--intestinal cancer at other sites since 1995. Tumor resection for PC was carried out in 31; conservative treatment--67; chemotherapy--56 and radiotherapy--in 29 cases. In CA 19-9 examinations, diagnostic sensitivity was 90.2; specificity--72.1 and effectiveness--85.3%, while in CEA determinations, 82.5; 30.9 and 68.5%, respectively. CA 19-9 and CEA levels proved to be prognostic factors of survival. An inverse correlation was observed between median survival and tumor marker concentrations: higher basal (preoperative) level of marker in blood was matched by lower median survival. A similar relationship was identified for CEA: 5-10--14.2 months; 10.1-20 ng/ml--8.0 months; 20.1-30 ng/ml--3.9 months, and more than 30 ng/ml--4.8 months. There was a direct correlation between CA 19-9 level and tumor stage. The dynamics of tumor markers, particularly, CA 19-9 correlated with treatment effectiveness during its course.

[Results of radiotherapy and combined, comprehensive treatment of pancreatic cancer]. / Rezul'taty luchevogo, kombinirovannogo i kompleksnogo lecheniia raka podzheludochnoi zhelezy.

The results of irradiation, combined and complex treatment of pancreatic cancer have been evaluated versus stage, site and extent of surgery. Radiotherapy was carried out in 63 patients (1988-1999): prior to gastropancreaticoduodenectomy (GPDE)--7; after GPDE--12; for local recurrence after GPDE--4, before and after left-sided resection--4, before and after conservative surgery--19, and after diagnostic verification (exploratory laparotomy or ultrasound-controlled fine-needle biopsy)--17. Diagnosis was established on the basis of clinical data and case histories, ultrasonographic, CT, histological, cytological, biopsy, blood serum-marker CA 19-9 and CEA findings. Two months after treatment, complete remission was registered in 5 (13%), partial response--5 (13%), stabilization--13 (33%), tumor progression--16 (41%). Before and after GPDE, tolerance to radiotherapy was sufficient. Median survival in this group was 12.9 months, controls--8.1 months; for conservative surgery--7.3 and 4.1 months, respectively; radiotherapy + exploratory laparotomy alone--16.8 and 4.3 months, respectively. Irradiation of locally-advanced tumors of the body and/or tail of pancreas proved effective: median survival was 7.3 months, control--2.2 months. Hence, radiotherapy made an important contribution to treatment of locally-advanced and resectable pancreatic tumors and longer survival.