[Endoscopic treatment of bleeding due to Mallory-Weiss syndrome]. / Endoskopicheskoe lechenie krovotechenii, obuslovlennykh sindromom Mellori-Veissa.

Experience in diagnosis and treatment of 276 patients with Mallory--Weiss syndrome (MWS) is presented. Definition of the syndrome and brief historical review (from first description of disruption of esophageal-gastric connection to first report of successful hemostasis through endoscope) are given. Particular attention is devoted to etiology and pathogenesis of this syndrome. Clinical material and picture of disease, results of endoscopic diagnosis are analyzed, efficacy of endoscopic hemostasis and prophylaxis of hemorrhage is demonstrated. Indications to various methods of endoscopic hemostasis are regarded, results of treatment and lethal outcomes are analyzed. It is demonstrated that endoscopic procedures are the method of choice in the treatment of this disease reducing emergency surgery rate to 0.4%.

[Surgical treatment of ulcerous pyloroduodenal stenosis]. / Khirurgicheskoe lechenie iazvennogo piloroduodenal'nogo stenoza.

From 1990 to 2001 531 patients underwent surgery for ulcerous pyloroduodenal stenosis, from 1990 to 1995 312 operations were performed with lethality 0.9%, from 1996 to 2001--312 surgeries with one lethal outcome (0.4%). Surgical policy is based on a differential approach to choice of surgical method with consideration of stage of stenosis and level of gastric secretion, and also surgical risk. Organ-saving operations including laparoscopic vagotomy were performed in forming and compensated stenosis. At late stages (sub- and decompensated stenosis) resections (chiefly with vagotomy) were performed. In long-term period excellent and good results were achieved in 91.4% patients.

[Surgical treatment of perforated and bleeding gastroduodenal ulcers]. / Khirurgicheskoe lechenie probodnykh i krovotochashchikh gastroduodenal'nykh iazv.

Twelve-year experience of surgical treatment of gastroduodenal ulcers complicated by perforation and bleeding is analyzed. Modern antisecretion and antihelicobacter drugs have changed conception of pathogenesis and treatment of ulcers. Choice of surgical method is the key moment of surgical policy. Perforation and bleeding in ulcer disease are life-threatening complications especially in elderly patients with concomitant diseases. In these patients technical simplicity and tolerance to surgery are very important.

[Treatment of gastroduodenal ulcer hemorrhages]. / Lechenie iazvennykh gastroduodenal'nykh krovotechenii.

The results of treatment of 901 patients with acute ulcerogenic gastroduodenal bleedings in 1986 to 1997 are analysed. The tactics of the treatment, developed in the clinic, combines active diagnostic and curative measures with differentiated determination of the indications for urgent operative treatment. Improvements of the method for urgent operative treatment, wide implementation of the organ-saving and mini-invasive surgical procedures, usage of new methods for nonoperative (endoscopical) hemostasis, as well as an improvement of the complex for intensive and anti-ulcerogenic therapy enabled in the last group of patients (1994-1997 years) to decrease the postoperative lethality up to 5.9%, and general lethality--to 6.4%.

[Prognosis and daily evaluation of changes in the condition of patients with peritonitis]. / Prognoz i ezhednevnaia otsenka dinamiki sostoianiia bol'nykh s peritonitom.

The authors examined 159 patients with peritonitis (87 with the generalized form and 72 patients with the diffuse form) and conducted a statistical analysis of the findings. Quantitative and some qualitative parameters of the patients were studied. The Student and Wilcoxon criteria and the correlation and discriminant analysis were used in construction of the determinative rules. Two groups of discriminant functions were constructed to obtain the prognosis of the outcome of peritonitis in a patient with daily appraisal of the dynamics of changes in his condition. The first group of prognostic indices was obtained only from the qualitative data. The second group of "simplified" prognostic indices was constructed with the use of parameters which are used most frequently in the wide clinical practice. The quality of both groups of discriminant functions proved to be comparable, i. e. both sets of determinative rules may be used in medical practice to evaluate the condition of a patient with peritonitis and construct the prognosis of the outcome of the disease.

[Etiology of recurrent ulcers after selective proximal vagotomy]. / Prichiny razvitiia retsidivnykh iazv posle selektivnoi proksimalnoi vagotomii.

The work analyses the results of late-term follow-up of 525 patients who underwent selective proximal vagotomy (SPV) in different variants. The results were gained on the basis of long-standing follow-up with the use of the complex dispensary method. The frequency of peptic ulcer recurrences after SPV was 10%. The main causes of the recurrences were: incomplete vagotomy of the parietal cell zone and inadequate selection of patients for this intervention. Finally, the authors demonstrate the clinico-pathogenetical variants of the course of peptic ulcer when SPV cannot correct the existing disorders and the therapeutic effect of the operation is doubtful. All the aforesaid dictates the need for specialization of surgeons-gastroenterologist who are engaged in this problem and for strict determination of the indications for SPV.

[Monitoring and computer control of the status of the central and regional hemodynamics in patients with diffuse forms of peritonitis]. / Monitorno-komp'iuternyi kontrol' sostoianiia tsentral'noi i regionarnoi gemodinamiki u bol'nykh s rasprostranennymi formami peritonita.

Changes in basic central and regional hemodynamic parameters have been studied in 46 patients with diffuse peritonitis using an automated system of constant intensive circulation monitoring. It has been established that the type of circulation did not reflect the severity of the condition in patients with peritonitis, but a characteristic combination of central hemodynamic parameters makes it possible to assess compensatory reserves within each circulation type, as well as to identify unfavourable hemodynamic tendencies. Analysis of changes in the circulation parameters in the course of peritonitis development is necessary to predict the course of the disease and its outcome. There was a considerable difference in circulation parameters patterns of patients who recovered and died of the disease. The principal differences manifested on day 2 postoperatively. Abdominal hemodynamic changes are specific and characterize the severity of peritonitis beginning from the first day of observation.

[The use of decompressive endoscopic operations in the complicated course of cholelithiasis]. / Primenenie dekompressivnykh éndoskopicheskikh operatsii pri oslozhnennom techenii zhelchnokamennoi bolezni.

The article is based on an analysis of observation of 853 patients with complicated forms of cholelithiasis. The average age of patients was 73.5 years, two thirds of them had critical coexistent diseases. The system of treatment proposed by the authors allowed achievement of good results (lethality is less than 5%) while the methods of treatment generally accepted in surgical practice is followed by higher lethality achieving 40%. The work analyzes errors and complications of endoscopic decompressing operations and gives recommendations for their prevention.

[Endoscopic nerve block of the acid-producing area of the stomach in the treatment of duodenal ulcer]. / Endoskopicheskaia medikamentoznaia blokada kislotoprodutsiruiushchei zony zheludka v lechenii iazvennoi bolezni dvenadtsatiperstnoi kishki.

The work describes the method of endoscopic medicamentous++ block of the acid-producing zone of the stomach (EMB AZS) and the results of its use in the treatment of 135 patients with duodenal ulcer. It is shown that EMB AZS leads to a significant reduction of acid production and does not disturb the motor-evacuation activity of the stomach and duodenum, which allows it to be considered a pathogenetically substantiated method of nonoperative management of chronic duodenal ulcer. The authors evaluate the clinical efficacy of EMB AZS in recurrent ulcer after operation on the stomach caused by a high level of acid production and ulcerative gastroduodenal bleeding. A conclusion is made on the expediency of including EMB AZS in the complex of therapeutic measures for these diseases.

[Therapeutic tactics in acute obstruction of the terminal part of the common bile duct]. / Lechebnaia taktika pri ostroi blokade terminal'nogo otdela kholedokha.

The authors had 158 patients with acute block of the terminal part of the choledochus under observation. According to the clinical course, a biliary, pancreatic, and mixed forms were distinguished. The emergency diagnostic program was made up of ultrasonic examination, esophagogastroduodenoscopy, ERCP, and laparoscopy. The cause of the block of the terminal choledochus was choledocholithiasis in 104 patients, papillitis and microcholedocholithiasis in 36, and ++choledocholithiasis and stenosis of the major duodenal papilla in 18 patients. Acute block of the major duodenal papilla was found in 76 and acute block of the intramural part of the choledochus in 76 patients. The mixed form prevailed in the first and the biliary form of hypertension in the second. Operations (cholecystectomy, choledocholithotomy with external or internal drainage of the choledochus) were performed on 42 patients, the postoperative fatality rate was 9.7%. Emergency EPST and extraction of concrements was undertaken in 116 patients. Increase in the clinical picture of acute cholecystitis and destructive pancreatitis after EPST called for operative interventions on 21 patients. The lethality rate after EPST performed for acute block of the terminal choledochus was 6.1%.

[Decompression of the gallbladder in acute cholecystitis in middle-aged and elderly patients]. / Dekompressiia zhelchnogo puzyria pri ostrom kholetsistite u bol'nykh pozhilogo i starcheskogo vozrasta.

The authors showed that operations for decompression of the gallbladder may improve the results of surgical treatment of acute cholecystitis in elderly and senile patients at a high anesthesiological risk. Decompression operations reduced postoperative fatality among patients of the most "threatened" group to 3.5%.

[Laparoscopic microcholecystostomy in the treatment of acute cholecystitis]. / Laparoskopicheskaia mikrokholetsistostomiia v lechenii ostrogo kholetsistita.

Laparoscopic microcholecystostomy is recommended by the authors for nonarrested attack of acute cholecystitis in patients with high operative-anesthesiological risk as the first step of treatment. Delayed operations are performed after arrest of the inflammatory process in the gallbladder and correction of the coexistent pathology. The use of laparoscopic microcholecystostomy considerably decreased lethality in most dangerous contingent of patients.

[Surgical treatment of acute cholecystitis complicated by peritonitis in middle-aged and elderly patients]. / Khirurgicheskoe lechenie ostrogo kholetsistita, oslozhnennogo peritonitom, u bol'nykh pozhilogo i starcheskogo vozrasta.

Peritonitis is among the severe complications of acute cholocystitis; the authors encountered its generalized forms in 10.9% of the patients who were operated on as being critically ill. Gangrenous or perforating cholecystitis was the most frequent cause of peritonitis. The high postoperative death rate (22.4%) caused among elderly and old-aged patients by generalized peritonitis and the necessity of an emergency operation requires intensive preoperative management and complex postoperative treatment with the application of modern detoxification methods in an intensity care department. In view of the high operative-anesthetic risk in patients of the old-age groups, the authors undertook sparing operations for decompression of the gallbladder in generalized peritonitis with the subsequent performance of a radical sanitizing operation in a postponed or planned order. This allowed the postoperative death rate to be reduced to 7.7% in the recent years.

[Ultrasonic and x-ray parallels in the diagnosis of cholelithiasis]. / Ul'trazvukovye i rentgenologicheskie paralleli v diagnostike kholelitiaza.

The sensitivity and specificity of ultrasound investigation (USI) and x-ray methods of indirect and direct contrast studies of the biliary system in the diagnosis of cholecysto- and choledocholithiasis were compared by a blind control method. USI was shown to be superior over all x-ray contrast methods in the diagnosis of cholecystolithiasis. The diagnosis of choledocholithiasis usually requires the use of x-ray methods among which preference should be given to endoscopic retrograde cholangiography as the most informative method permitting simultaneous intervention on the major duodenal papilla.

[Prognosis of recurrence of peptic ulcer after isolated selective proximal vagotomy]. / Prognozirovanie retsidiva iazvennoi bolezni posle izolirovannoi selektivnoi proksima'lnoi vagotomii.

The joint work of doctors and mathematicians is based upon their 20-years experience with performing vagotomy in the clinic. Prognosis of recurrence of ulcer disease was elaborated on materials of 141 operations of isolated selective proximal vagotomy for chronic duodenal ulcer. The dispensary principle of managing the patients after operation allowed obtaining objective data both in the nearest and remote (over 10 years) periods. A group of 20 patients with recurrent ulcers and 13 patients with hypersecretion gastroduodenitis was considered to have unfavorable postoperative status. The prognosis developed may be used to make the indications to isolated selective proximal vagotomy more exact. The prognosis was correct in 80% of the observations.

[Results of truncal and selective proximal vagotomies combined with stomach-draining surgery in ulcer-related pyloro-duodenal stenosis]. / Rezu'ltaty stvolovoi i selektivnoi proksima'lnoi vagotomii v sochetanii s dreniruiushchimi zheludok operatsiiami pri iazvennom piloroduodena'lnom stenoze.

The authors have shown that remote results of draining operations in combination with truncal vagotomy in ulcerous pyloroduodenal stenosis proved to be similar to results of their combination with selective proximal vagotomy in practically all the parameters. Advantages of the selective proximal vagotomy due to somewhat less amount and less degree of postoperative functional disorders observed after this intervention become practically levelled down by a considerably greater amount of recurrences of ulcers after it as compared with truncal vagotomy and drainage of the stomach.