[Modern surgical tactics in Crohn's disease].

Surgical tactics of Crohn's disease (CD) treatment was elaborated on base of modern information analysis, concerning pathogenesis, peculiarities of clinical course, possibilities of diagnosis, experience in the disease treatment. The tactics provides a timely diagnosis of the disease, prognostication for the recurrence occurrence and postoperative complications, the indications and the method of surgery optimization. Application of the elaborated surgical tactics in CD in 121 patients have permitted to improve the objective estimation of the disease severity, to prognosticate complications, to optimize surgical indications, as well as a choice of the method of a conditionally-radical, restorational, reconstructive-restorational stages of operative intervention, to reduce the disease recurrences rate, postoperative complications, postoperative lethality.

[Method of postcolectomy syndrome prophylaxis].

Method of prophylaxis of postcolectomy syndrome after colectomy and rectum anterior resection at two-stage surgical treatment of severe forms of nonspecific ulcerative colitis and colon diffuse polyposis has been developed and used at 9 patients. Postoperative complications were seen at 2 (22.2%) of them. This method permits to reduce the symptoms of postcolectomy syndrome after radical stage of surgery (colectomy and anterior resection of rectum) and to improve the clinical course of postoperative period after reconstructive stage of surgery.

[Quality of life in patients after restorative operations].

The analysis of the results of the surgical treatment of colon cancer, ulcerative colitis, Crohn's disease, polyposis of colon, diverticular disease of colon on the bases of quality of life scale indexes, questionnaire SF-36 was carried out. The authors have compared the quality of life of patients who underwent surgical treatment using restorative operations after removing functional parts of the colon. The quality of life indexes in 11-12 days after the operation were higher in the first group compared with the second one. Positive influence of laparascopic intervention on quality of life considerably differs from that in the second group in 3 and 6 months and in one and three years after the operation was done.

[Surgical policy in reconstructive surgery on the colon].

Thirty-year experience with 1685 reconstructive operations on the colon is analyzed. Novel surgical policy has increased the rate of primary-reconstructive operations for the last 5 years from 78.8 to 87.9%, decreased the number of postoperative complications from 33 to 21.8%, intestinal anastomosis-dependent complications -- from 22.6 to 8.4%, postoperative lethality -- from 6.9 to 2.4%, raised the rate of good functional results from 64 to 88.2%.

[Application of a one-row everted suture in operations on the colon].

A method of a one-row everted intestinal suture for the formation of terminal-terminal colon-colonic anastomosis was worked out in experiment in 32 dogs. The suture gives a good connection of fragments of the gut by wound surfaces by the type of sensory adaptation. High mechanical strength of the suture, absence of anastomosis stenosis, primary intension healing of the intestine wound were proved on the basis of using the method of pneumocompression, investigation of the stenosis index and histological investigation of the connection zone. The developed suture was used in 27 patients in forming anastomoses after operations on the colon. No complications resulting from the developed suture were noted.

[Abdomino-anal resection in the treatment of low-ampullar cancer of the rectum].

Surgical policy was developed for improvement of functional results and quality of life in patients operated on for low rectal cancer. This policy includes choice of the method of sphincter-saving operation depending on the stage of the tumor, grade of malignancy, distance from a low edge of the tumor to dentate line. Methods of prevention of ischemia and necrosis of brought down colonic transplant and anal incontinence were used. This increased the number of sphincter-saving operations in low location of rectal cancer by 35%, reduced the rate of necrosis of intestinal transplant from 7 to 4.4%, saved continent function and improved significantly quality of life in 89.8% operated patients.

[Method of sphincter-preserving operation for low localization of rectal cancer].

The authors have developed a method and defined indications for sphincter-preserving operation--proctectomy for low localization of rectal cancer. The method of operation suggests ablation of the rectum together with its internal sphincter and preservation of all components of the external sphincter of the rectum that provides realization of voluntary (volitional) component of the anal holding. The operation used in 37 patients gave better functional results of treatment and better quality of their life.

[Psychoneurotic disorders in ineffectively treated patients with first diagnosed destructive pulmonary tuberculosis]. / Evoliutsiia psikhonevroticheskikh rasstroistv u neéffektivno lechennykh bol'nykh s vpervye diagnostirovannym destruktivnym tuberkulezom legkikh.

The evolution and specific features of psychoneurotic symptoms were studied in 270 patients with pulmonary tuberculosis. Four stages of evolution of psychoneurotic disorders were identified. Their pattern and syndromes were described. Their diagnosis and correction were recommended for patients with tuberculosis.

[Social and medical problems of tuberculosis in the Ukraine]. / Sotsial'nye i meditsinskie problemy tuberkuleza v Ukraine.

The paper gives a brief analysis of the existing social and medical problems and factors, which determine poor trends in the development of the tuberculosis epidemic situation in the Ukraine.

[Tuberculin sensitivity in infants and preschool children with pulmonary tuberculosis]. / Tuberkulinovaia chuvstvitel'nost' u bol'nykh tuberkulezom detei rannego i doshkol'nogo vozrasta.

The tuberculin sensitivity of the skin was studied in children with tuberculosis, whose age was under 7 years, in relation to the age, the form of tuberculosis, the phases of a process, its severity, the presence of complications and concomitant disease. It was established that in infants the rate of negative reactions was 13.2 times higher and that of hyperergic reactions was 5.8 times less than those in children aged 3 to 7 years. Negative reactions were most common in the complicated and severe forms of tuberculosis and in comorbidity. Hyperergic reactions were more frequently encountered in ocular tuberculosis (44.5%), helminthic invasion (30.4%), and pulmonary tuberculosis first detected in the phase of resolution (32.4%).

[On grouping the contingents of tuberculosis dispensaries]. / O gruppirovke kontingentov protivotuberkuleznykh dispanserov.

The contingents followed up at the dispensaries in the Ukraine are analyzed. These include as high as 15.42% of patients with tuberculosis, 5.03% with questionable tuberculosis, 67.13% with inactive tuberculosis or infections, and 12.42% of persons contacting with patients. A total of 4.84% of the appropriations are used to follow up the contingents. A new procedure for grouping TB dispensary contingents is proposed.

[Epidemiological value of the efficiency of treatment in patients with tuberculosis]. / Epidemilogicheskoe znachenie éffektivnosti lecheniia bol'nykh tuberkulezom.

The main tuberculosis epidemiological parameters in the Ukraine are analyzed. The present epidemic of tuberculosis has been found to be characterized by the predominance of mortality rates over morbidity ones along less efficiency of treatment and abnormal stabilization of the incidence of recurrent tuberculosis. The efficiency of treatment (ceased bacterial isolation and healed decay cavities and caverns) is of epidemiological value. The range of these parameters, whose achievement may significantly affect immunological parameters is to be defined. It is concluded that it is necessary to make a large-scale epidemiological study of tuberculosis to establish many causal correlations of the present-days epidemic of tuberculosis.

[Tuberculosis in Ukraine: its status, the problems and prognosis (medico-statistical research)]. / Tuberkulez v Ukraine: sostoianie, problemy i prognoz (mediko-statisticheskie issledovaniia).

The tuberculosis epidemiological situation in the Ukraine is analyzed. The causes of its deterioration and outstanding problems in tuberculosis control are presented. A prediction of the epidemiological situation in the coming 10 years is given, ways of improving the tuberculosis epidemiological situation in the Ukraine are outlined.

[Relaparotomy: determination of the indications and results]. / Relaparotomiia: opredelenie pokazanii i rezul'taty.

The indications for relaparotomy in cases of bleeding, peritonitis, acute ileus and abdominal abscess were determined. Using the indications gave a possibility to perform the relaparotomy on 1-st postoperative day right after first signs of those complications. The mortality dropped from 46% to 20.5%.