[Perforated peptic ulcer in patients with cancer: prediction of postoperative morbidity and mortality]. / Probodnaya yazva u patsientov s onkologicheskimi zabolevaniyami: prognozirovanie posleoperatsionnykh oslozhnenii i letal'nogo iskhoda.

OBJECTIVE: To analyze treatment outcomes and approaches to predicting the postoperative morbidity and mortality in patients with perforated ulcers and cancer. MATERIAL AND METHODS: A non-randomized trial included 194 patients. The first group enrolled 45 (23%) patients with perforated ulcers and concomitant cancer who underwent at the oncology center; the second group included 149 (77%) patients with perforated ulcers and no cancer who underwent surgery in general surgical hospitals. Organ-sparing procedures prevailed (40 (88.9%) and 138 (92.6%) cases, respectively). Resections were performed in 5 (11.1%) and 11 (7.4%) patients respectively. Analyzing the factors affecting treatment outcomes, we studied crude (COR) and adjusted (AOR) odds ratios. ROC-analysis was used to assess diagnostic significance of the models for prognosis of morbidity and mortality. RESULTS: Length of hospital-stay was 10 (range 9-14) and 8 (range 7-9) days respectively. Postoperative complications (Clavien-Dindo grading system) occurred in 18 (40%) in 37 (24.8%) patients, respectively. According to multivariate analysis, predictors of complications in patients of the first group were treatment with NSAIDs/glucocorticoids and Charlson-Deyo index >3. Sensitivity of this model was 82.4%, specificity - 75.0%. Postoperative mortality was 15.6% (n=7) and 7.4% (n=11) respectively. According to multivariate analysis, predictors of mortality were age over 65 years and more than 5 chemotherapeutic courses. Sensitivity of the model was 85.7%, specificity - 97.4%. CONCLUSION: The stratified approach makes it possible to improve prediction of postoperative morbidity and mortality in patients with perforated ulcers.

[Incidence of peptic ulcers accompanied by gastrointestinal bleeding after surgery for critical lower limb ischemia]. / Vstrechaemost' erozivno-yazvennykh porazhenii zheludochno-kishechnogo trakta i krovotechenii u bol'nykh, operirovannykh na arteriyakh nizhnikh konechnostei po povodu kriticheskoi ishemii.

OBJECTIVE: To study the incidence of peptic ulcers accompanied by gastrointestinal bleeding after surgery for critical lower limb ischemia and their relationship with the factors predisposing to mucous membrane damage. MATERIAL AND METHODS: The study involved 94 patients with critical lower limb ischemia who were eligible for open bypass surgery. All patients underwent preoperative gastro- and duodenoscopy. The patients were followed up for 1 year, while the relationship between the nature of the lesion of the proximal gastrointestinal tract mucosa and the duration of pain syndrome against the background of ischemia, painkiller consumption and redo surgery. RESULTS: All study participants had lesions of the mucous membrane of the stomach and duodenum: inflammatory changes were identified in 92.6% of patients, ulcerative defects in 7.4%. When conducting a correlation analysis, we obtained a weak and moderate strength of the relationship between the duration of rest pain and severity of mucous membrane lesion and strong correlation between painkiller consumption and endoscopic data. Postoperative gastrointestinal bleeding was more common after redo reconstructive surgery or amputation compared to one intervention (7.7% and 1.8%, respectively). CONCLUSION: Various lesions of gastrointestinal mucous membrane are diagnosed in all patients with critical lower limb ischemia. It is associated with the underlying disease and painkiller consumption. Risk of bleeding is higher after redo surgery and amputations. Prevention of lesions requires comprehensive examination of patients and individual approach.

[Pathogenesis and prevention of venous and arterial thromboembolic events in patients after deep vein thrombosis of lower extremities]. / Patogenez i profilaktika venoznykh i arterial'nykh tromboémbolii u bol'nykh, perenesshikh tromboz glubokikh ven nizhnikh konechnostei.

AIM: To define the role of thrombophilic and other procoagulant conditions in pathogenesis of deep vein thrombosis and the effectiveness of pathogenetic secondary prevention of venous and arterial thromboembolic events. MATERIAL AND METHODS: The study included 107 patients for the period 2007-2016 who were divided into 3 groups. The main group (n=40) - lifelong individual antithrombotic therapy with warfarin predominantly; the second (control) group (n=39) - warfarin administration for 3-6 months; the third (additional) group (n=28) - specific life-long therapy depending on procoagulant status which was assessed according to original scale. The main anticoagulants were rivoroxaban or dabigatran etexilate. Recurrent venous thromboembolic complications (RVTE) were observed in one (2.5%) patient of the first group and in 8 (20.5%) cases of the second group. In the third group RVTE were absent (significant differences, p<0.03 and 0.001, respectively). Arterial thromboembolic diseases were noted in 1 (2.5%) patient of the first group, in 4 (10.25%) cases of the second group and in none of the third group (significantly only for group II vs. group III, p<0.01). RESULTS: Individual antithrombotic therapy reduces the incidence of recurrent venous and arterial thromboembolic events in patients with idiopathic deep vein thrombosis.

[Aneurysms of the aorta and its visceral branches as a cause of gastrointestinal hemorrhage]. / Anevrizma aorty i ee vistseral'nykh vetvei kak prichina zheludochno-kishechnykh krovotechenii.

From 1993 till 1999 6 patients with aneurysmointestinal fistulas complicated by bleedings were operated. In 4 cases the aneurysmointestinal fistulas were primary, in 2 cases--secondary. Gastroduodenoscopy, ultrasonic examination of abdominal organs, retroperitoneal space and duplex scanning of main vessels were used. Correct diagnosis before operation was made in 5 patients. The following operations on the vessels were performed: suturing of defect of central anastomosis (1), aortobifemoral grafting (1), abdominal aorta grafting (2), suturing of aortal defect (1), resection of peripheral aneurysm (1). Thrombosis of prosthesis branch (1) and suppuration of prosthesis bed with arrhosive bleeding (2) were early postoperative complications. Immediate postoperative lethality was 33.3%. Long-term results are followed in 3 patients. There were no repeated signs of graft infection in remote period. Basic methods of clinical and instrumental examination including ultrasound permit to make correct diagnosis before operation. Active surgical policy saves the life in the majority of patients, but it is necessary to use carefully the synthetic grafts for arterial vessels repair.