[The efficacy of hand desimpatization after sympatectomy by complex regional pain syndrome].

64 patients operated on the reason of complex regional hand pain syndrome were examined with the use of laser spectral Doppler flowmetry and thermography. 33 patients had thoracoscopic Th3 ganglion clipation; 16 patients had brachial artery and vein perivascular sympathectomy; 15 patients periarterial sympathectomy on the level of brachial artery. Desympathisation (microcirculatory hemodynamic improvement and trophotropic microcirculation regulatory changes) was mostly apparent after thoracoscopic clipation and perivascular desympatisation in comparison with isolated periarterial sympatectomy.

[New facilities in management of complex regional pain upper limb syndrome with thoracoscopic sympathectomy].

26 patients (21 females and 5 males, aged from 40 to 70 years) with complex regional pain syndrome (CRPS) who underwent thoracic sympathectomy at the Th3-4 level on the damaged side, were examined 1,5-2 months since trauma. After an operation all patients showed pain management, improvement of motor and trophic functions, positive dynamics of laser Doppler flowmetry and computer thermography. The given method was demonstrated to be effective and mostly successful at the early stages of CRPS.

[Lymph node dissection in patients with cancer of the proximal part of the stomach]. / Limfodissektsiia u bol'nykh rakom proksimal'nogo otdela zheludka.

The authors describe 694 patients who underwent operation in 1985-1993 for carcinoma of the proximal part of the stomach with various degree of involvement of the adjacent parts of the stomach and esophagus. The tumors differed in histological structure. The main principles of classification of the groups of regional lymph nodes, taking into account the localization of the tumor in the stomach, are shown. These Principles are applied by Japanese surgeons in performing lymph node dissection and were modified in the Clinic od Thoracic Oncology of the Scientific Research Institute, Oncological Center, Russian Academy of medical Sciences. The localization and incidence of metastases in disseminated carcinoma of the proximal stomach with involvement of the esophagus were studied. The sequence of the stages of intraabdominal lymph node dissection in proximal gastric resection and gastrectomy is discussed. The tendency towards improvement on the indices of 3-year survival after expanded operations is noted. Expanded operations with scrupulous morphologic examination of the removed lymph nodes is very important for more precise determination of the stage and individual prognostication of the choice of the postoperative methods of treatment. In palliative interventions the operation is cytoreductive in essence and may create to a certain measure better conditions for chemotherapy.

[The surgical and combined treatments of locally disseminated cardioesophageal cancer]. / Khirurgicheskoe i kombinirovannoe lechenie mestnorasprostranennogo kardioézofageal'nogo raka.

The article deals with the experience in the treatment of more than 1,000 patients with cardioesophageal carcinoma in 1965-1989. The authors note increase of surgical activity and widening of indications for operative treatment at the cost of patients of the old age groups and those with locally-extending forms of the neoplastic process. In distinguishing the term cardioesophageal carcinoma the authors insist on the community of the surgical tactics and operative methods in carcinoma of the cardia extending to the esophagus and in esophageal carcinoma spreading to the stomach. Improvement of the results of tre treatment the authors attribute to the perfection of the methods of lymphodissection and formation of esophageal anastomoses. The authors claim that the development of effective methods of combined treatment underlies the prospects of improving the late-term results. Experience in preoperative hypoxyradiotherapy, adjuvant postoperative chemotherapy, and preoperative regional intraarterial polychemotherapy is analysed.

[Effects of surgical complications on trace element metabolism in patients with cardio-esophageal and esophageal cancer]. / Vliianie khirurgicheskikh ozlozhnenii na obmen mikroélementov u bol'nykh kardioézofageal'nym rakom i rakom pishchevoda.

The homeostatic features of trace elements were studied in 48 patients with cardio-esophageal and esophageal carcinoma in development of incompetence of the anastomosis sutures (17), peritonitis (19), and intestinal fistulas (12). The level of the trace elements was determined in the red cells, blood plasma, and urine by emission plasma spectrometry. With the development of surgical complications after operation on the stomach and esophagus, the metabolism of trace elements was sharply disturbed, catabolic processes prevailed and were manifested by the escape of essential trace elements from the cells and their excretion in the urine. The changes of trace elements metabolism were more profound in peritonitis and intestinal fistulas. Complex intensive therapy including artificial feeding corrected partly the metabolic disorders.

[Substantiation of the expediency of performing extensive lymph node dissection in surgical treatment of esophageal cancer]. / Obosnovanie tselesoobraznosti vypolneniia rasshirennoi limfo- dissektsii pri khirurgicheskom lechenii raka pishchevoda.

The performance of extensive lymph node dissection+ in esophageal carcinoma is substantiated. From their own data the authors conclude that squamous cell carcinoma of the esophagus possesses high lymphatic metastatic activity and point to the statistically significant increase of the incidence of involvement of the superior perigastric lymph nodes in localization of the tumor in its infrathoracic part. At the same time, the frequency of affection of the mediastinal lymph collector does not depend on the localization of the tumor. The authors emphasize that extensive subsequent lymph node dissection+ of the mediastinum and upper part of the abdominal cavity should be an obligatory stage of an operative intervention in esophageal carcinoma.

[Characteristics of the development of respiratory insufficiency in the early postoperative period following surgery of cancer of the esophagus and the cardia]. / Osobennosti razvitiia dykhatel'noi nedostatochnosti v rannem posleoperatsionnom periode posle operatsii po povodu raka pishchevoda i kardii.

Acute respiratory failure (ARF) in the earliest postoperative period after radical surgery for esophageal cancer is characterized by staged development. Its severity is determined by the degree of ventilation-perfusion disorders and the accompanying diffusion disturbances. The following factors are considered to be ARF-provoking: postaggressive circulation centralization, predominant administration of crystalloid plasma substitutes, persistence of hypoproteinemia in the earliest postoperative period, as well as extended lymph dissection involving cardiopulmonary plexus located in the area of bifurcation. The latter factor is the peculiarity of surgery caused by oncological considerations, while three former factors should be taken into account during management of patients in the intra- and postoperative periods.

[Disorders of trace element metabolism and their correction using artificial nutrition in patients with cancer of the esophagus in the preoperative period]. / Narusheniia obmena mikroélementov i ikh korrektsiia s pomoshch'iu iskusstvennogo pitaniia u bol'nykh rakom pishchevoda v predoperatsionnom periode.

Findings of research into disorders of the micronutrient exchange in esophageal carcinoma patients are overviewed. The micronutrient level in the plasma, erythrocytes, and urea was estimated by means of emission plasma spectroscopy. Patients with esophageal carcinoma were found to have pronounced changes in the micronutrient exchange on their admission into the clinic. These changes were corrected by means of artificial nutrition, which included preparations with directed action and micronutrients. After the course of therapy a tendency towards normalization of the micronutrient exchange was observed.

[Garlock's operation in cancer of the esophagus]. / Operatsiia Garloka pri rake pishchevoda.

Experience in 88 Garlock-type operations carried out in carcinoma of the esophagus allows a certain opinion to be formed on the advantages and shortcomings of this surgical intervention. In esophageal carcinoma with its proximal boundary within the range of the retropericardial segment of the esophagus, a left abdominothoracic approach (Garlock's operation) is adequate in resection of the esophagus in conformity with the oncological principles and allows the formation of the esophagogastric anastomosis at the level of the arch of the aorta without particular technical difficulties. Reduction of the time needed for the operation, determination of the resectability of the esophageal tumor before mobilization of the stomach are obvious advantages of the abdominothoracic approach.

[The effect of parenteral feeding on the metabolism of arachidonic acid in patients with cancer of the esophagus and the stomach]. / Vliianie parenteral'nogo pitaniia na metabolizm arakhidonovoi kisloty u bol'nykh rakom pishchevoda i zheludka.

Blood plasma and erythrocyte level of arachidonic acid (C20:4) and blood plasma level of its two metabolites (6-keto-PGF1 alpha and TXB2) have been investigated in 24 patients with esophageal and gastric cancer. In the preoperative period and during 8-10 days postoperatively 12 patients were on "glucose" energy supply (group I) and 12 patients were on "lipid" energy supply (group II). Daily calorie intake was 30-35 kcal/kg. In the preoperative period Lipofundin-S infusions produced a significant increase in C20:4 blood plasma and erythrocyte levels. An increase in TXB2 concentration was accompanied by a certain increase in 6-keto-PGF1 alpha content. At the same time in group I parenteral feeding caused no significant changes in the above parameters. Surgical trauma and anesthesia caused a considerable increase in 6-keto-PGF1 alpha blood plasma level in both groups (P less than 0.05), with a certain decrease in TXB2 level (P greater than 0.05). In the postoperative period, unlike "glucose", "lipid" energy supply stabilized C20:4 content in the erythrocyte membrane and favourably affected 6-keto-PGF1 alpha/TXB2 ratio. This is confirmed by a considerable increase in 6-keto-PGF1 alpha/TXB2 ratio, which in the course of the postoperative period was significantly higher in group II than in group I.

[Some peculiarities of pyrimidine isoplyth methylation of newly synthesized DNA from human blood lymphocytes in normal conditions and chronic lymphoycytic leukemia]. / Osobennosti metilirovaniia pirimidinovykh izoplitov vnov' sintezirovannoi DNK limfotsitov krovi cheloveka v norme i pri khronicheskom limfoleikoze.

Methylation of pyrimidine isoplythes of newly synthesized DNA from activated human blood lymphocytes was studied under normal conditions and in chronic lymphocytic leukemia. The analysis of distribution of labelled 5-methylcytosine in DNA pyrimidine oligonucleotides, differing in their lengths, showed a considerable increase in the methylation of pyrimidine oligonucleotide fragments of DNA from lymphocytic leukemia lymphocytes as compared to normal. The greatest differences were observed in methylation with respect to longer fragments, e.g. under chronic lymphocytic leukemia the level of methylation of the cytosine residues of DNA in isoplythes I and II, as well as in the fraction of isoplyth III and in longer fragments exceeded that of the normal DNA isoplythes, 3.7-, 2.1- and 8.3-fold respectively.