[EFFICACY OF SURGICAL TREATMENT OF VARICOSE DISEASE, DEPENDING ON ADSORPTION-RHEOLOGIC PROPERTIES OF BLOOD].

Physico-chemical adsorption-rheological properties of venous blood in patients, suffering varicose disease of the lower extremities, and their impact on efficacy of various methods of surgical treatment were studied. Conduction of endovasal laser coagulation in combination with crossectomy have promoted enhancement of operative treatment efficacy in patients in initial terms of observation (in 1 week), in 1 month a complete occlusion of the vein was noted more rarely. Efficacy of a small--power laser ablation with irradiation power of 10 W and less in 4 weeks postoperatively is higher, than of surgical treatment with a laser irradiation power 15 W. In a varicose disease of the lower extremities there were observed the raising of the blood volume toughness, superficial relaxation and superficial stress on background of reduction of the toughness--elasticity module, superficial toughness and superficial elasticity. Crossectomy conduction did not influence the integral dynamics of adsorption--rheological properties of venous blood, but in 1 month after endovasal laser coagulation a normalization of physicchemical parameters of blood was noted. Application of laser irradiation of the 10 W power and less promotes inhibition of the relaxation properties of venous blood; a prognostic meaning owes initial value of the blood volume toughness.

[The impact of antisecretory therapy on gastroduodenal ulcers healing after acute bleeding].

In this paper we compared the efficacy of proton pump inhibitors (PPIs) and H2 receptor antagonists on the morphogenesis of the marginal zone of gastric and duodenal ulcers in 56 patients withacute gastroduodenal bleeding. It is shown that the antisecretory drugs in the treatment of patients with acute ulcerative bleedingnot only affect on the secretory activity of the glands in gastroduodenal zone, but it also modulates inflammatory reparative process and the status of mucous and bicarbonate barrier. A greater anti-inflammatory effect of PPI in comparison with H2-receptor antagonists has been proved. Appointment of PPIs had more pronounced stimulation of angiogenesis and cell proliferation of the surface epithelium.

[Surgical treatment of an acute non-biliary aseptic necrotizing pancreatitis].

The results of treatment of 345 patients, operated on for an acute nonbiliary aseptic necrotic pancreatitis, are adduced. There was established, that rejection to perform an early open access operations with simultaneous application of modern miniinvasive procedures for peritonitis of the enzyme origin (laparoscopy, laparocentesis), an acute aseptic accumulations of liquid in bursa omentalis and cellular tissue of retroperitoneal space, pancreatic pseudocysts (puncture-drainage interventions under ultrasonographic guidance) and as well as direct operative interventions on pancreatic gland and cellular tissue of retroperitoneal space, using extraperitoneal miniaccesses in presence of sequesters, have permitted to lower postoperative lethality from 15.2 to 4.1%, and to secure a purulent-septic complications prophylaxis in 93.2% of patients. Application of the puncture-drainage interventions under ultrasonographic control, as well as lumbotomy and sequestrectomy, in the environment of aseptic inflammation, have permitted to escape purulent complications occurrence while an acute aseptic accumulations of liquid are present in bursa omentalis in 96.1% of patients and in cellular tissue of retroperitoneal space--in 69.6%.

Dilational rheology of serum albumin and blood serum solutions as studied by oscillating drop tensiometry.

Oscillating drop experiments with a drop profile analysis tensiometer provide the dilational elasticity and viscosity of surface layer. Model experiments for blood serum, composed of HSA and the non-ionic surfactant C(14)EO(8), are used to demonstrate the theoretical approach for calculating the visco-elasticity of mixed adsorption layers from the adsorption characteristics of the single components. Experiments with real serum samples taken from patients choledocholithiasis-based benign obstructive jaundice before and after re-canalisation of the biliary tract demonstrate that the visco-elasticity of the respective adsorption layers is very sensitive of the successful surgery.

[Application of magnetic therapy in acute paraproctitis]. / Primenenie magnitoterapii pri ostrom paraproktite.

There were studied the possibilities and perspectives of application of the magnetically liquefied layer as an instrument for better purulent and putrefactive wounds clearance after intervention for an acute paraproctitis. Together with clinical signs the results of bacteriological investigation were controlled as well. There was established high efficacy of the method proposed and expedience of its application.

[Amoxiklav in the treatment of acute paraproctitis]. / Primenenie amoksiklava v lechenii ostrogo paraproktita.

In 38 patients with an acute paraproctitis a new generation antibiotic Amoxiclave, owing broad spectrum of activity, was applied. While observing the wound clearance and healing process, together with clinical parameters, the results of bacteriological investigation were controlled. High efficacy of the preparation was observed as well as expediency of its application in the purulent wound surgery, for an acute paraproctitis in particular.

[The central hemodynamic indices of patients with ulcerative gastroduodenal hemorrhage]. / Pokazateli tsentral'noi gemodinamiki u bol'nykh s iazvennym gastroduodenal'nym krovotecheniem.

Changes in certain indices for central hemodynamics in the early period after emergency operation were evaluated in 79 patients with helcoid gastroduodenal hemorrhage, the patients' age ranging between 18 to 80 years. At admission all patients demonstrated lowered cardiac and stroke output, cardiac and stroke indices, with the total peripheral vascular resistance being slightly increased. Operation aggravates disturbances in hemodynamics caused by loss of blood. Under the effect of corrective therapy, from day 3 to 5, indices for central hemodynamics tend to slowly return to normal as do those for hepatic bloodflow. The impairment of the function of the circulatory system appear to be greater in cases presenting with deficiency of globular volume of excess of 50%, whose compensatory potential is under too severe a strain. At discharge from the hospital, the percentage of those cases presenting with hypodynamic type circulation amounted to 67.3%, normodynamic having been 32.7%.

[Surgical treatment of ulcer complicated with severe hemorrhage]. / Khirurgicheskoe lechenie iazvennoi bolezni, oslozhnennoi tiazhëloi krovopoterei.

The results of treatment of 380 patients with the globular volume deficiency of 40% and more, operated in urgency for ulcer gastroduodenal bleeding. In 124 (32.6%) of them ulcer was localized in the stomach, in 224 (64.2%)--in pyloroduodenal region, in 12 (3.2%)--the combined ulcers were revealed. Cause of the death was an acute cardiovascular insufficiency in 11.1% of patients, thromboembolia of the pulmonary artery--in 1.3%, bleeding ulcer or erosion--in 1.6%. Suture insufficiency of the duodenal stump and anastomoses occurred in 5.8%, pneumonia--in 12.6%, purulent complications--in 6.3%. The conduction of proposed surgical tactics permitted to lower the mortality after operations for persistent bleeding down to 12.5%, the prevalence of recurrent bleeding occurrence--to 12.5%. The prevalence of operations accomplishment in the patients with high risk of bleeding recurrence have increased up to 78.7%, radical intervention--to 70.7%. The authors make a conclusion about perspectivity of the proposed elaborated an active-rational therapeutical tactics in the patients with severe gastroduodenal bleeding.

[A treatment method for patients with a local suppurative infection]. / Metod lecheniia bol'nykh s mestnoi gnoinoi infektsiei.

To treat patients with the post-injection abscess and mastitis, suspension of alveolar porcine macrophages was periodically introduced via a drainage tube into the cavity formed after sparing opening of an abscess and removal of necrotic tissues. Local use of the substance permitted to shorten by 30-50% the duration of hospital stay of the patients as compared to that in use of conventional methods.

[The diagnosis and treatment of a closed abdominal injury]]. / Diagnostika i lechenie zakrytogo povrezhdeniia zhivota.

The experience with diagnosis and treatment of 216 sufferers with closed injury to the abdomen, including 186 who were operated on, has been summarized. The main methods for diagnosis of closed abdominal injury are laparoscopy and laparocentesis, the operation of choice--laparotomy.

[The surgical procedure in patients with hemorrhaging perforating gastroduodenal ulcers]. / Khirurgicheskaia taktika u bol'nykh s krovotochashchimi penetriruiushchimi gastroduodenal'nymi iazvami.

The paper presented the results of surgical treatment of 277 patients with bleeding penetrating gastroduodenal ulcers. Gastric location of the ulcer was revealed in 52 patients and duodenal location in 225 ones. More commonly used resections of the stomach according to a Billroth-I method or suprapyloric resections versus the resection of the stomach according to method Billroth-II when used in the patients with gastric location of the ulcers helped to reduce the mortality from 23.1 to 0%. The wide usage of organ-sparing operations combined with vagotomy reduced the lethal outcomes of the disease from 13 to 5.5% versus the resection of the stomach. The rate of bleeding relapses in the early postoperative period which followed the suture of penetrating gastroduodenal ulcers was 25.9%. The dissection of ulcers or their elimination from the alimentary tract could be regarded as the methods of choice in case of palliative treatment. Surgical treatment of penetrating gastroduodenal ulcers should be performed prior to bleedings. Planned operative intervention should be performed in patients with deep gastric ulcer with diameter of 1.5 cm and more and pyloroduodenal ulcers with diameter of more than 1 cm.

[Several aspects of improvement in the training of surgeons at medical institutes]. / Nekotorye aspekty povysheniia kachestva podgotovki spetsialistov-khirurgov v meditsinskom vuze.

This paper summarizes the experience gained in the training of surgery specialists at a medical institute and determines the main shortcomings of undergraduate and postgraduate specialization. A sociological survey carried out in the groups of subinterns indicated low effectiveness of preinstitute and intrainstitute professional orientation. Great emphasis is being placed on increasing the quality of training on fundamental sciences and preclinical disciplines. A positive appreciation is being given to the long application of the unified methodological system of specialists training, the use of the syndrome method of training at the graduate year, which is based on maximum activation of clinical thinking, motivated approach to the development of practical knowledge and skills. The important role of continuity in the training of surgeons in the subinternship and internship is stressed.

[The acid-base status and oxygen-transport function of the blood in patients in the early period after surgical interventions for ulcerative gastroduodenal hemorrhage]. / Kislotno-osnovnoe sostoianie i kislorodtransportnaia funktsiia krovi u bol'nykh v rannem periode posle operativnykh vmeshatel'stv po povodu iazvennogo gastroduodenal'nogo krovotecheniia.

Changes in the acid-base state and acid-transport function of blood were studied in 59 patients with gastroduodenal ulcer bleedings. More than 50% of the changes were more pronounced in patients with a deficient globular volume and its recovery was somewhat slower. In spite of reduced values of the concentration of hemoglobin in blood, 2,3-DPH and ATP of erythrocytes, most patients were found to have satisfactory compensation of the acid-transport function and balanced oxygen affinity for hemoglobin during the whole postoperative period.