[Prevention of side effects and complications after operation for partial ileal bypass].

Side effects and complications of the application of partial ileal bypass used for dislipidemia were analyzed in 162 patients with atherosclerosis. It was shown, that the partial ileal bypass operation could lead to the development of series of undesirable side effects such as diarrhea, hypovitaminosis B12, off-state intestine enteritis. The application of modification of partial ileal bypass such as formation of ileo-ileoanastomosis 5-6 cm long near ileocecal valve with the maintenance of its functions disposed the diarrhea and minimized the risk of the development of hypovitaminosis B12 after operation. It is possible to prevent the development of enteritis of off-state loop of the small intestine by using microanastomosis between off-state and functioning iliac intestine. The partial ileal bypass operation didn't influence on body weight, wouldn't increase the risk of stone formation in the gallbladder and kidneys. The risk of the development of hypovitaminosis B12 is minimal after operation.

[Surgical correction of dislipodemia in patients with obesity].

The results of surgical treatment of 139 patients with metabolic syndrome, obesity and dislipodemia were analyzed. Modern bariatric operations (4 types) were performed by using laparoscopic method. There were regulated bandages of the stomach (RBS), lengthwise gastric resections (LGR), biliopancreatic and stomach bypass surgeries (BBS, SBS). Results of five-year follow-up indicated that restrictive operations on the stomach (RBS, LGR) aimed to correct overweight and dislipodemia had some limitations to application in a varying degree. The RBS operation should be appropriate to use for women of the young age group, when an initial body-weight index wasn't more than 43 kg/m2. The LGR operation was effective for men of the young age group and women in case of moderately expressed dislipodemia and in case when the initial body-weight index didn't exceed more than 45 kg/m2. Combined bariatric operations (BBS, SBS) were most likely effective on body weight and dislipodemia.

[25 year experience with using surgical correction of dislipidemia in treatment of patients with atherosclerosis].

An analysis of results of using partial ileoshunting for the treatment of dislipidemia in 159 patients with atherosclerosis has shown that operation of partial ileoshunting has an obligatory, pronounced and lifelong lipidcorrecting effect. An antiatherogenic effect of the operation of partial ileoshunting is manifested as the improvement of the clinical course of the disease caused by atherosclerosis, by less number of thrombotic complications of atherosclerosis and less lethality from cardio-vascular diseases. At a longer follow-up period, the efficiency of partial ileoshunting as a means of secondary prophylactics of atherosclerosis is confirmed but in case of liquidation after operation of dislipoproteidemia.

[Long-term results of dyslipoproteinemia surgical correction in patients with obliterating atherosclerosis of the lower extremity].

An analysis of long-term (up to 20 years) results of performing operations of partial ileoshunting as a method of surgical correction of dislipoproteidemia in 49 patients with obliterating atherosclerosis of the lower extremity vessels has shown that operations of partial ileoshunting have a pronounced and stable lipid correcting effect. Decreased level of atherogenic lipids in blood improved the course of obliterating atherosclerosis of the lower extremity vessels. Worse long-term clinical results after partial ileoshunting were in a considerable degree due to the presence of residual dislipoproteidemia that resulted in additional medicamentous hypolipidemic therapy.

[The dynamics of the coronary bed state in patients with ischemic heart disease after surgical correction of dyslipoproteidemia].

The investigation included 85 ischemic heart disease patients with the coexistent dyslipoproteidemia. In 39 of the patients the operation of partial shunting was performed for correction of the impaired lipid metabolism. It was found that the partial ileoshunting was an effective method of correction of dyslipoproteidemia. The effect of the operation was due to lowering the total cholesterol level in blood (at an average by 25.6%) and elevation of the HDL level (at an average by 19.6%). The results of the following angiographic examinations have shown a clear effect of the inhibition of progressing coronary atherosclerosis in patients who underwent surgical correction of dyslipoproteidemia that allows the partial ileoshunting to be considered as an effective method of the secondary prophylactics of atherosclerosis. The HDL level is the main marker of the dynamics of the atherosclerotic process in the coronary arteries.

[Effects of dyslipoproteinemia on long-term results of surgical treatment of patients with obliterating atherosclerosis of the lower extremity vessels]. / Vliianie dislipoproteidemii na otdalennye rezul'taty khirurgicheskogo lecheniia bol'nykh obliteriruiushchim aterosklerozom sosudov nizhnikh konechnostei.

The investigation included 120 patients who had undergone different revascularizing operations more than 10 years ago for obliterating atherosclerosis of the lower extremity vessels. Dyslipoproteidemia was diagnosed in 88 of them. It was established that in patients with dyslipoproteidemia the symptoms of ischemia of lower extremities were developed in younger age. Within 5 years after the first revascularizing operations there appear reliable differences in the course of the disease in patients with dyslipoproteidemia and normal levels of lipids in blood. More than 90% of patients with dyslipoproteidemia in the distant period of time have symptoms of generalized atherosclerosis, and the survival is mainly predetermined by cardiac and cerebral complications of atherosclerosis. The life of dyslipoproteidemia patients operated upon is 8 years shorter than of subjects with the normal-level of lipids in blood.

[Dyslipoproteinemia and prognosis of the course of ischemic heart disease after coronary bypass]. / Dislipoproteinemiia i prognoz techeniia ishemicheskoi bolezni serdtsa posle koronarnogo shuntirovaniia.

The article deals with the observation of 88 patients with ischemic heart disease, 62 of them had coexistent dyslipoproteidemia. More pronounced atherosclerotic lesions of the coronary artery were found to develop in patients with dyslipoproteidemia influencing the degree of ischemic heart disease before coronary bypass. Within the period of 10 years after operation dyslipoproteidemia patients have 3.5 times higher risk of the development of myocardial infarction, more than 2 times higher risk of reappearance of stenocardia and death from cardiovascular diseases. Patients with dyslipoproteidemia have 2 times higher probability of generalization of the atherosclerotic process in patients with is chemic heart disease at later terms after coronary bypass.

[Long-term results of the use of different modifications of the partial ileal shunt operation in the treatment of patients with atherogenic dyslipoproteinemias]. / Otdalennye rezul'taty primeneniia razlichnykh modifikatsii operatsii chastichnogo ileoshuntirovaniia dlia lecheniia bol'nykh s aterogennymi dislipoproteidemiiami.

The article presents long-term (up to 20 years) results of performing the classical H. Buchwald operations and its various modifications in 145 patients. Creation of ileoileoanastomoses 5 cm from the ileocecal valve and a standard shunt of 250 cm of the ileum allowed to obtain a necessary and considerable (27% at an average) hypocholesterolemic effect and to eliminate diarrhea at the postoperative period.

[20 years' experience of treating patients with extreme forms of obesity]. / Dvadtsatiletnii opyt lecheniia bol'nykh s krainimi formami ozhireniia.

During 20 years 356 patients with morbid obesity of the III-IV degrees were operated on, 339 of them being subjected to jejunoileal shunting in the authors' modification. The developed measures for the selection of patients, preoperative preparation, anesthesia and operation technique allowed the amount of postoperative complications to be reduced from 15 to 5%. Long-term results were followed-up in 220 patients during 3-17 years. Stable loss of the body mass, regression of the diseases resulting from obesity were noted in 187 of these patients (85%). Electrolytic disorders were found in 16.8% of the patients. The reconstruction of the small intestine because of progressing hepatic insufficiency was performed in 16 patients. Less than 20% loss of the body mass was noted in 18 patients.

[Combined operations in extreme forms of obesity]. / Sochetannye operatsii pri lechenii krainykh form ozhireniia.

The authors make an analysis of their experiences with combined operations for extreme forms of obesity in 93 patients. Indications to such operations were considered to be only the diseases which could cause complications of the early and late postoperative period. In spite of more pronounced signs of aggression the combined operations do not enhance frequency and severity of postoperative complications. Recommendations are given for the selection of anesthesia, the access and sequence of operation steps. Measures are proposed which allow the frequency of postoperative complications to be decreased from 59.8 to 29.8%.

[Work capacity and the factors limiting it in patients with III- to IV-degree obesity]. / Rabotosposobnost' i faktory, ee limitiruiushchie, u bol'nykh ozhireniem III--IV stepeni.

There is a marked decrement in physical performance of those patients with III to IV grade obesity as compared to apparently healthy volunteers going into training. Deficient reserve capabilities of the system for utilization of oxygen and oxygen transport appear to be those factors determining and limiting physical fitness of obese individuals. Exercise testing involving recording of indices for gas exchange in real time appears to be a valuable method of diagnosis of particular features of oxygen supply in patients with III to IV grade obesity, providing a very helpful information.

[The partial ileal bypass in the treatment of familial hypercholesterolemia]. / Chastichnoe ileoshuntirovanie v lechenii semeinoi giperkholesterinemii.

Data on the influence of a partial ileal bypass on the level of lipids in 8 patients with a heterozygous variant of familial hypercholesterolemia are presented. The operation was followed by a decreased concentration of circulating cholesterol at the expense of cholesterol of low density lipoproteins, but the normalization of the lipid level in blood took place in 1 case only. To improve the results of treatment it is expedient to administer inhibitors of cholesterol synthesis in the postoperative period.

[Level of lipids and apolipoproteins in obesity]. / Uroven' lipidov i apolipoproteinov pri ozhirenii.

The level of lipids and apolipoproteins was studied in the serum of patients with various degrees of obesity without hormonal impairments in order to find interrelationship between obesity and atherosclerosis development. 14 men and 42 women aged 19-59 years were examined. Concentration of triglycerides and very low density lipoprotein (VLDL) cholesterol was distinctly higher in obese patients of both sexes than in normal weight persons. However, content of apo A-I and apo B was similar in blood of both obese and normal persons, while concentration of apo E was higher in obesity. In obesity, the ratio HDL cholesterol/A-I was decreased, thus indicating that the HDL3/HDL2 ratio was altered, showing a decreased content of the latter subfraction. The findings suggest that impairment in metabolism of mainly HDL and VLDL subfractions occurred in patients with obesity. These impairments were atherogenic and may be responsible for a high risk for atherosclerosis and heart ischemic disease in obese patients.

[Surgical treatment of ischemic heart disease using internal thoracic artery and partial ileal bypass]. / Khirurgicheskoe lechenie ishemicheskoi bolezni serdtsa s primeneniem vnutrennei grudnoi arterii i chastichnogo ileoshuntirovaniia.

The authors recommend complex two-stage treatment of ischemic heart disease, including a reconstructive operation on the coronary arteries and an operation for correcting the disturbed plasma lipid spectrum (partial ileal bypass). The results of operative treatment of 150 patients with the use of the internal thoracic artery were studied. The authors emphasize the advantages of this operation over one using an autovein graft. Complex operative treatment was conducted in the clinic in 60 patients with a good clinical effect. The authors also recommend operation for partial ileal bypass as an independent intervention in dyslipoproteinemia and diffuse affection of the coronary arteries.

[The immune status of patients with obesity]. / Immunnyi status u bol'nykh ozhireniem.

The immune status was studied in 30 patients with adiposity of grades III-IV. Evaluation of the number of T-, B-lymphocytes, phagocytosis, circulating immune complexes, complement, migration of leucocytes, level of A, M, G, immunoglobulins revealed disorders in the T-system, unspecific cellular and unspecific humoral immunity with a tendency of immunity deterioration as the grade of obesity advanced. There was correlation between the ratio of blood plasma atherogenicity and level of circulating immune complexes, complement.