[Early cancer of stomach].

Results of surgical treatment of 170 patients with early cancer of the stomach are analyzed. There were 113 patients with tumor invasion within the bounds of the mucous membrane (m -- 113), the others had invasion within the bounds of the submucous membrane (sm -- 57 patients). Impressed and ulcered macroscopic types of early cancer (IIc + III) were diagnosed most often: 57% m+sm (97 of 170), 58.4% m+sm (97 of 170), 54.4% sm (31 of 57), respectively. Poorly differentiated tumors prevailed over moderate- and well-differentiated tumors - 68.8% (117 of 170) and 31.2 (53 of 170) patients, respectively. Subtotal distal resection of the stomach has been performed in 118 (69,4%) patients, subtotal proximal resection -- in 13 (7.7%), gastrectomy -- in 22 (12.9%), resection of 2/3 stomach -- in 14 (8.2%), resection of the cardia - in 3 (1,8%). Lymphadenectomy has been performed in 156 patients including 1 (0.6%) patient with D0-lymphadenectomy, 88 (56.4%) - D1, 62 (39.7%) -- D2, and 5 (3.2%) -- D3. Metastases to the regional lymph nodes have been revealed in 8 (5%) cases -- 2 m and 6 sm. Extended lymphodissections (D2 and D3) have improved significantly long-term results. Five-year survival among the patients who had undergone extended operations with D2 and D3 lymphadenectomies was higher compared with patients after limited and standard operations (D0 and D1) -- 96.0+/-2.5 and 87.0+/-3.5%, respectively.

[Short and long-term results of surgical correction of the aortal valve dysplasia]. / Blizhaishie i otdalennye rezul'taty khirurgicheskoi korrektsii displazii aortal'nogo klapana.

Nearest and long-term results of surgical treatment of 108 patients with dysplasia of aortal valve were analyzed. Necessity of individual approach to choice of method of surgical correction (prosthesis or valvuloplasty of aortal valve) depending on degree of dysplasia and/or secondary valvular pathology, it anatomic variants, presence of concomitant infectious endocarditis and age of patients is noted. This permitted to reduce hospital lethality from 8.8 to 3.9%. Survival in 1, 5 and 10 years after prosthesis and valvuloplasty of aortal valve was 92.3 +/- 3.3, 86.8 +/- 4.8 and 85.7 +/- 5.7% versus 100, 94.1 +/- 4.1, 94.1 +/- 4.1% respectively. Quality life in remote period was evaluated as good in 80.3% operated patients, as satisfactory--in 11.1% and unsatisfactory--in 8.6%.

[Perioperative myocardial infarct during the surgical treatment of IHD]. / Perioperatsionnyi infarkt miokarda pri khirurgicheskom lechenii IBS.

Perioperative myocardial infarction is one of the most frequent causes of death in patients subjected to surgery for coronary disease. Study of the pathogenesis of this complication may become an approach to decreasing the postoperative mortality. Forty-seven case histories and autopsy protocols of patients who died after surgery on the coronary arteries and 241 intraoperative biopsy specimens of autovenous shunts are analyzed. The mechanisms underlying the cardiomyocyte necrosis in surgical treatment of coronary disease are based on various pathological processes, the leading of which is thrombosis of the shunts and coronary arteries. The principal factors were intraoperative ischemia of autovein endothelium and shunting of coronary artery with a narrow distal bed.

[Arterial pulmonary thromboembolism as a cause of mortality in thoracic surgery]. / Tromboémboliia lëgochnoi arterii kak prichina letalnosti v torakalnoi khirurgii.

Analysis of hospital mortality showed that thromboembolism of the pulmonary artery was a cause of lethal outcomes in thoracic surgery in 0.4% of hospitalized patients, in 0.7% of those who underwent operation, in 14.8% of all patients who died, and in 15.6% of those who died in the postoperative period. The principal causes of death in thromboembolism of the pulmonary artery were various diagnostic errors (79.5%), severity of the patient's initial condition (14.1%), and defective treatment (6.4%). Prevention of thromboembolism of the pulmonary artery is based on timely detection of its sources by wider use of ultrasonic and radionuclide methods, rarer application of invasive diagnostic methods, and the use of anticoagulant therapy after operations in the risk groups.

[Surgical treatment of lung cancer in patients with preoperative radiation therapy]. / Khirurgiia raka legkogo u bolnykh s predoperatsionnym oblucheniem.

Combined treatment (radiotherapy--operation) was conducted in 378 patients with lung carcinoma in 1963-1991. Retrospective analysis of the immediate and late-term results of treatment showed that preoperative radiotherapy does not complicate the operative intervention. The incidence of postoperative complications is a little higher than among nonirradiated patients. Pyoinflammatory complications prevailed. Marked postradiation damage of the tumor occurred approximately in 1/3 of the patients and depended on the total largest dose of radiotherapy. Adenocarcinoma of the lung was most resistant to radiotherapy, squamous cell carcinoma and undifferentiated carcinoma were most sensitive. Total 5-year survival of patients with lung carcinoma was 35.8% after combined treatment and 42.9% after radical operations. Among patients with complete regression of the tumor after preoperative radiotherapy 63.2% of patients who underwent operation had a survival period of over 5 years.

[Bleeding as a cause of mortality in thoracic surgery]. / Krovotechenie kak prichina letalnosti v torakalnoi khirurgii.

Analysis of hospital lethality showed that hemorrhage was the cause of lethal outcomes in thoracic surgery among 0.5% of all hospitalized patients, 0.8% of those who underwent operation, and 17.3% of all patients who died. Among all fatal hemorrhages 28.6% were surgical and 71.4% were erosional. Surgical hemorrhage was due to injury inflicted to the large vessels (atria) during the operation. Erosional hemorrhages were caused by postoperative infectious-septic complications, progressive malignant tumors and pyo-purulent diseases, and exacerbation of peptic ulcer or the formation of an acute gastric ulcer. Among the principal causes of fatal hemorrhages are defective treatment (32.9% of cases), methodical and technical errors during the operation (28.6%), erroneous diagnosis (25.3%), initially severe condition of patients (6.6%), and progressive malignant tumor (6.6%). Intraoperative prevention of fatal surgical hemorrhage is based on personal experience, knowledge and skill of surgeons, and the use of modern technology in the control of blood loss. The prevention of erosional hemorrhage in patients who are not operated on consists in timely surgical treatment and early diagnosis in the postoperative period and active treatment of infectious-septic complications.

[Heart valve dysplasia as a cause of valvular insufficiency in cardiac surgery (clinico-morphological correlations)]. / Displaziia klapanov serdtsa kak prichina klapannoi nedostatochnosti v kardiokhirurgii (kliniko-morfologicheskie sopostavleniia).

Dysplasias underlying the mitral and aortic valve diseases in the presence of valvular incompetence were identified in 110 patients with a history of valve replacement. The morphological and electron microscopy evidence together with combinations of valvular changes with Marfan's syndrome and Erdheim's disease, and in some cases with minimal changes in the aorta and peripheral vessels, which followed the type of idiopathic cystic medionecrosis without aneurysm formation support the idea of the dysplastic etiology of the detected abnormalities. The occurrence of a heart disease in the presence of dysplasia is determined by the extent of a valvular process and attending complications, such as chordal rupture or septic endocarditis.