[Low-temperature sterilization for the surgical infection prophylaxis].

The comparative characteristic of the accepted methods of low-temperature sterilization of medical equipment is given. Special attention is devoted to the surgical infection prophylaxis. The efficacy, expediency and safety of gas sterilization with ethilenoxide is proved. Plasmic methods of sterilization is recommended for use together with other methods of low-temperature sterilization.

[Differential treatment of acute pancreatitis].

Results of examination and treatment of 194 patients with acute pancreatitis were analyzed. It is revealed that the diagnosis of an etiopathogenetic form of acute pancreatitis is a key moment in the choice of the treatment. Patients with acute biliary pancreatitis and alimentary pancreonecrosis with pancreatogenic peritonitis require urgent surgical treatment at early stages of the disease. Laparoscopic cholecystectomy and Haulstad's drainage of the common bile duct are the procedures of choice in acute biliary pancreatitis. Alimentary pancreonecrosis with pancreatogenic peritonitis is the indication for videolaparoscopic drainage procedure and peritoneal dialysis as soon as possible after the disease beginning. This approach decreased lethality, number of complication and hospital stay.

[Reflexotherapy in patients with ischemic angiopathies of the lower extremities]. / Primenenie metodov refleksoterapii u bol'nykh s ishemicheskimi angiopatiiami nizhnikh konechnostei.

Comparative assessment of different methods of reflexotherapy - RT (acupuncture, electroacupuncture, pharmacopuncture and the termopuncture) in treatment of ischemic angiopathies of the lower extremities is presented. One hundred and twenty-four patients with ischemic angiopathies were treated, 86 of them had I - II stage of the disease, 38 - III stage. Diagnosis of the disease and assessment of treatment efficacy were based on clinical, laboratory and special instrumental examinations. Functional examinations revealed equal reaction of peripheral blood flow to different RT methods. Moderate hypocoagulation compared with the baseline was demonstrated. Clinical symptoms (improvement of the general condition, decrease of pain syndrome) and improvement of biochemical and physiological parameters were criteria of successful treatment. The results of the study helped to develop methods of treatment with different variants of RT and to recommend them in clinical practice for combined treatment of this disease.

[Reliability of the sterilization of surgical instruments is a key point in prevention of surgical infection]. / Nadezhnost' sterilizatsii izdelii meditsinskogo naznacheniia.

Occurrence of postoperative purulent-inflammative complications (PPIC), their structure and dynamics after improvement of sterilization are studied. For epidemiological analysis 65,246 medical histories of operated patients were studied, in 404 of them PPIC were revealed. The PPIC rate reduced from 3.05% in 1981 to 0.49 in 2000 though surgical activity increased 12 times after this period. Thus developed measures for improvement of sterilization promoted reduction of the PPIC rate.

[A comparative evaluation of different methods of forming a colonic anastomosis in repeat surgical interventions]. / Sravnitel'naia otsenka razlichnykh sposobov formirovaniia anastomoza obodochnoi kishki pri povtornykh operativnykh vmeshatel'stvakh.

The results of repeated operations on the large intestine, mainly reconstructive operations, are analysed. Surgical interventions with the performance of a triangular anastomosis, including that by a method modified by the authors, were carried out on 50 patients. The operative results, particularly those in the last group of patients, are very promising. The number of complications, such as suppuration of the postoperative wound and incompetence of the anastomosis sutures, reduced from 28.8% to 10%, which allows the method to be recommended for wide application in the clinic.

[The primary postponed radical surgical treatment of acute suppurative paraproctitis]. / Pervichno-otsrochennoe radikal'noe khirurgicheskoe lechenie ostrogo gnoinogo paraproktita.

The method of primarily postponed radical surgical treatment of acute purulent paraproctitis consists in puncture of the abscess, introduction of a double-channel drain, and continuous drop irrigation of the cavity for 1-2 days with antiseptic solutions and active aspiration for preoperative management. When the inflammatory process abates, fistulochromography is conducted and a radical operation is carried out on the same day with excision of the inner opening of rectal fistula. The method makes it possible to combine two operations in one stage which are undertaken in one third of patients in routine surgical treatment of acute paraproctitis. The described method shortens the period of treatment to 14-15 days and improves the immediate and long-term results. Eight patients were operated on with a good outcome.

[Experience in the use of laser instruments in surgery of the anorectal region]. / Opyt primeneniia lazernykh instrumentov v khirugii anorektal'noi oblasti.

The article discusses experience in surgical treatment of 480 patients with the most common diseases of the anorectal region (acute and chronic haemorrhoids, acute and chronic paraproctitis, polyps, chronic fissures of the anal canal) in which special laser tools were used. The carbonic acid laser Skalpel-1 with a wave length of 10.6 microns and power of 30 W was used as the source of laser radiation. Methods of operations with the use of these tools are described in detail. The advantages of laser instruments in the treatment of patients with the above listed diseases are shown on a rich clinical material.

[Determination of the viability of a patient's intestine by using laser doppler flowmetry during surgery]. / Opredelenie zhiznesposobnosti kishechnika u bol'nogo vo vremia operatsii s pomoshch'iu lazernoi dopplerovskoi floumetrii.

Intraoperative determination of the viability of the intestine by means of laser Doppler flow measurement was conducted in 26 patients. The method proved to be highly effective, made it possible to judge most objectively the degree of changes in blood flow in various parts of the intestine in a short time and correct them subsequently during the operation, and considerably reduced the possibility of the development of postoperative complications due to inadequate appraisal of the degree of vascularization of the mobilized segments of the small and large intestine which are prepared for the formation of the anastomosis.

[Experience in the use of a pneumo-obturator in patients with colostomy]. / Opyt primeneniia pnevmoobturatora u bol'nykh s kolostomoi.

The authors were able to prevent uncontrollable discharge of intestinal contents in 70 patients with colostomy by means of a pneumo-obturator of an original design. Its advantages over magnetic obturating devices were revealed: the simple and light design, hygienic properties, short adaptation period, and no need for implantation of a foreign body into the tissues surrounding the colostomy. Sixty-four patients use the device regularly and are able to retain feces of any consistency. No complications have been noted. The pneumo-obturator may therefore be used for creating a new method for controllable evacuation of the intestine.

[Place of carbohydrate antigens in the spectrum of protein tumor markers in patients with tumors at different sites]. / Mesto karbogidratnykh antigenov v spektre belkovykh onkomarkerov u bol'nykh s opukholiami razlichnykh lokalizatsii.

Carbohydrate antigens (CA-19.9 and CA-125) levels were assayed in patients suffering rectal, ovarian, breast and hepatic carcinoma, severe recurrent hepatitis A, chronic persistent hepatitis B, hepatic cirrhosis and in cases of normal pregnancy. Patients with early-stage cancer usually failed to reveal the said antigens. This was also the case in some patients with clinically manifest tumor. Clinical application of said assay may improve postoperative monitoring cancer patients. Cancer was more frequently associated with increased level of CA-19.9 than with that of CA-125.

[Clinical and morphological comparative correlations in rectal cancer and their prognostic importance]. / Nekotorye korreliativnye kliniko-morfologicheskie sopostavlneiia pri rake priamoi kishki i ikh prognosticheskoe znachenie.

Besides generally accepted tests for prognostication of the results of radical surgical treatment for rectal cancer, great practical importance is attached to the complex of accessory tests such as the combined intensity of immune lymphocytic infiltrates, the tumor and adjacent tissues, the amount of pathological mitoses, the degree of vascularization and the absolute number of lymphocytes in peripheral blood. An estimation of different combinations of the tests concerned makes it possible to prognosticate the results of radical treatment for rectal cancer in each particular case.