[The complicated forms of Meckel diverticulum].

20 patients with the complicated forms of Meckel diverticulum are treated. The nosological forms were: acute diverticulitis (n=16), acute ileus (n=2), intestinal bleeding (n=1) and perforation of diverticular wall with foreign body n=1). All cases were diagnosed only intraoperatively. The majority of patients with the acute diverticulitis presented a clinical picture of an acute appendicitis, on the cause of which they were operated on. Meckel diverticulum was found 40-140 sm from the ileocecal angle. Surgical treatment consisted of the wedge ileal resection and, in 6 patients, appendectomy. There were no deaths.

[The acute small-bowel obstruction caused by periappendicular abscess].

The diagnostic modes and results of treatment 7 patients with periappendicular abscess, complicated by the acute short-bowel obstruction are discussed. Age varied from 19 to 76 years. 4 of them were hospitalized with ileus symptoms, the rest 5 developed the obstruction during the hospital stay. 2 patients had an urgent operation, 4 patients were operated after 2-4 days and 1 after 9 days after admission. The correlation between the obstruction symptoms and appendicular inflammation was supposed in 3 patients. The cause of small-bowel obstruction was twist of the intestine loop, matted to the appendicular abscess. The surgery consisted of abscess sanation, appendectomy, small-bowel decompression and extrication. One patients died postoperatively of pulmonary embolism.

[Traumatic injuries of the inferior vena cava].

The authors analyse the results of surgical treatment of 21 patients with injury of the inferior vena cava seen at the Hospital of General Surgery. The mean age of patients was 33.7 years. Venous injuries were induced by cut wounds (14 casualties), gunshot wounds (5 patients) and blunt trauma (2 patients). The majority of patients were transported in a state of severe hemorrhagic shock which required intensive resuscitation measures. On laparotomy all the patients were found to have retroperitoneal hematomas. The infrarenal segment of the inferior vena cava was damaged in 17 patients, the renal segment in two and the suprarenal segment also in two patients. Seven patients presented with perforating wound of the vein. In 19 cases, injuries of the inferior vena cava were coupled with injury of other organs whereas in four casualties, they were associated with trauma of the visceral vessels. Vascular suture was applied in 17 casualties with trauma of the inferior vena cava, two patients underwent the replacement of its wall using an autogenous vein patch, and two patients were provided venous ligation. Nineteen patients underwent simultaneous rations on the involved caval and parenchymatous organs, visceral vessels. The postoperative lethality accounted for 38%. The causes of lethal outcomes are analyzed. The data obtained allow the conclusion casualties with injury of the inferior vena cava can be operated on successfully at the hospitals of general surgery. The pledge of success is the necessity of the training of general surgeons in the technologies of vascular reconstructive operations.

[Cholelithic small bowel obstruction].

Results of treatment of 18 patients with cholelithic small bowel obstruction are analyzed. All of them were female aged 62 to 84 years with severe concomitant diseases. Different variants of clinical manifestation of small bowel obstruction, significance of diagnostic methods, the causes of delayed hospitalization and operation are analyzed in details. Fourteen patients have been operated with diagnosis of intestinal obstruction but only at 3 of them the true cause of disease has been assumed before surgery. Enterolithotomy was performed at 15 patients, resection of small intestine together with gallstone - at 3 patients. Recurrence of cholelithic obstruction was seen at one patient on 8th day after surgery. Postoperative lethality was 27.7%, but only at one case the purulent complications and multiple organ failure was the cause of lethality. Recommendations for improvement of treatment results and prophylaxis of cholelithic small bowel obstruction are given.

[Clinical masks of torsion of omental appendices of sigmoid colon].

Twelve cases of torsion of colon's epiploic appendices (EA) are analyzed. The most often localization of the disease was sigmoid colon, female overweight patients of middle age were prevalent. As usual, this disease was masked by other acute surgical abdominal diseases, mainly by acute appendicitis. Clinical symptoms suspected for torsion of EA are analyzed, importance of diagnostic laparoscopy is discussed. The necessity of urgent surgery is emphasized. Some aspects of endoscopic surgery for these patients are also discussed.

[Acute inflammation of greater omentum].

Results of treatment of 9 patients (3 male, 6 female) with acute omentitis are analyzed. Omentitis was primary in 8 patients, and secondary -- in 1 patient. Right-sided abdominal localization of pains was the cause of incorrect entrance diagnosis (acute appendicitis and acute cholecystitis). All the patients were operated, the resection of affected parts of great omentum was performed; in 3 cases it was supplemented with appendectomy. Problems of pre-operative diagnosis of acute omentitis and the choice of optimal variant of surgery are discussed.

[Acute inflammation of omental processes of the colon].

Results of treatment of 17 patients aged from 27 to 82 years with acute inflammation of omental processes (OP) are analyzed. The majority of them were hospitalized on day 1-3 from the beginning of the disease. In 9 cases inflammation was in the right half of the colon, in 7 -- in sigmoid colon (which in 3 patients was located in the right iliac area). In right-sided location of inflammation clinical picture looks like acute appendicitis. In some patients mainly in left-sided location of the inflammation the disease looks like renal colic, perforation of colon or peritonitis. Acute pathology of OP was suspected only in one case. All the patients underwent surgery. In 8 of them necrosis was revealed, in 7 -- phlegmonous inflammation of one OP, in 2 -- inflammatory infiltration without destruction. Surgery comes to removing of affected OP, which was supplemented with appendectomy in 9 cases. There were no complications and lethal outcomes. Problems of diagnosis and surgical treatment of acute inflammation of OP are discussed.

[On omentum torsion].

Results of treatment of 10 patients aged from 16 to 62 years with omentum torsion were analyzed. The majority of them were hospitalized 1.5 -- 3 days after disease beginning. The main symptom was pains in the right half of the abdomen. Clinical picture was characterized by slow progress and late manifestation of peritoneal symptoms. All the patients underwent surgery under general anesthesia. Eight of them were suspected for acute appendicitis, 2 -- for acute cholecystitis. Five patients were operated during the first 2 hours, others -- from 6 hrs 40 min to 20 hrs after hospitalization. In all the patients segmental torsion of the right side of the omentum on 360-720 degrees was revealed. Nine patients had abdominal hemorrhagic effusion. Resection of the affected part of the omentum with additional appendectomy in 5 cases was performed. Destruction in the appendix was revealed only in one patient. There were no complications and lethal outcomes. Problems of diagnostic and surgical policy are discussed.

[Primary infarction of the greater omentum].

Results of treatment of 10 patients with primary infarction of the greater omentum were analyzed. Young and middle-aged persons prevailed. Majority of the patients were hospitalized from 27 to 72 hours after disease manifestation. The cause of disease was not revealed in all the patients. Pains in right half of the abdomen were the main symptoms of primary infarction of the greater omentum. There were no specific clinical or laboratory signs. Seven patients were operated for suspected acute appendicitis, and 3 patients - for suspected acute cholecystitis. Pathology of the greater omentum was combined with hemorrhagic effusion in 8 of 10 patients. Resection of affected part of the greater omentum was performed in all the patients, 6 patients underwent simultaneous appendectomies. There were no postoperative complications. All the patients recovered. Mistakes leading to incorrect diagnosis are analyzed.

[Diagnosis and treatment of Helicobacter infections in patients with stomach ulcer associated with hemorrhage]. / Diagnostika i lechenie khelikobakterial'noi infektsii u bol'nykh iazvennoi bolezn'iu, oslozhnennoi krovotecheniem.

Diagnosis and treatment of stomach ulcer associated with helicoid-bacterial infection and with hemorrhage are discussed in the paper. The many-year observations show that the risk of relapsing hemorrhage is high in patients with the above diagnosis. Eradication of the causative agent by using the modern therapeutic schemes cuts significantly the rate of such relapses. The most effective method of monitoring the infection and eradication results is suggested, i.e. urease test combined with microbiological diagnosis involving the method of polymerase chain reaction.

[Bezoars as a cause for acute small intestinal obstruction]. / Bezoary kak prichina ostroi kishechnoi neprokhodimosti.

Results of treatment of 12 patients with acute small intestinal obstruction due to bezoars were analyzed. Mean age of the patients was 67,5+/-3,7 years. In 9 of them bezoars were localized in the ileum, in 3 -- in the jejunum. Mechanisms of bezoars formation are analyzed. Clinical symptoms of intestinal obstruction due to bezoars are regarded. Necessity of surgical treatment of these patients is noted. Bezoars were removed with enterotomy in 10 patients, in 2 -- with fragmentation and transposition in the cecum. Recommendations on surgical techniques are presented. All operated patients have recovered. There were no complications.

[Changes in microcirculation and their correction in patients with varicose veins and post-thrombotic syndrome]. / Izmeneniia mikrotsirkuliatsii i vozmozhnosti ikh korrektsii u liudei pri varikoznoi bolezni i s posttromboticheskim sindromom.

Variety of disturbances of microcirculation can be stipulated by vasomotorial disfunction's of blood circulation in terminal vascular bed, changes of rheologic and coagulative characteristics of blood as well as morphological changes of structure of tissue and vessels of microcirculatory bed of destructed lower limb. In case of a varicose disease without complications changes of microvessels are considered to be compensatory adaptation. Patients suffering from a complicated type of varicose disease and post-thrombotic syndrome have "failure" of compensatory adaptation reaction. It results from significant functional disturbances of microcirculation and sudden morphological changes of structure of blood and lymphatic capillaries and tissue of a destructed lower limb. Correlative dependence can be found between degree of clinical evidences and a level of structural changes of microcirculatory bed. They are mostly significant in groups of patients having complicated varicose disease and post-thrombotic syndrome. It was shown that functional and morphological states of microcirculatory bed are of prognostic importance for estimation of effectiveness of operative interferences during diseases being analysed.