[Long-term results of closure of perforated pyloro-duodenal ulcers].

Long-term results of closure of perforated ulcers were analyzed in 91 patients. Excellent and good results were obtained in 70% of the patients, in 12.1% the results were satisfactory. In 18.6% of the cases the results were considered unsatisfactory. Bad long-term results were due to the absence of dispensary follow-up, the absence of repeated courses of anti-ulcer therapy, and not following the recommendations on the treatment. Excellent and good long-term results observed in 70% of the patients allow recommendation of suturing the perforated opening and anti-ulcer therapy in patients with perforated pyloroduodenal ulcers.

[Direct results of endovideosurgical transabdominal adrenalectomy]. / Neposredstvennye rezul'taty énovideokhirurgicheskoi transabdominal'noi adrenaléktomii.

Results of transabdominal adrenalectomy performed in 29 patients with different tumors of the adrenals were estimated. The lower traumaticity of the access due to using a new technology as well as taking prophylactic measures for lower aggressive influence of the pneumoperitoneum allowed performing combined operative interventions in 30% of cases and avoiding serious intra- and postoperative complications.

[Diagnosis and choice of the method of surgical treatment of pancreatic cysts using ultrasonic examination]. / Diagnostika i vybor metoda khirurgicheskogo lecheniia kist podzheludochnoi zhelezy s ispol'zovaniem ul'trazvukovogo issledovaniia.

A more than 10 year experience of using operative interventions under the control of ultrasound has shown that in order to solve the task of improving the results of surgical treatment of cysts of the pancreatic gland it is necessary to improve a number of diagnostic and organizational measures allowing to perform the early and effective diagnosis of the cysts and their timely treatment. The percutaneous puncture-drainage operations with sclerotherapy are indisputably considered to be highly effective in treatment of cysts of the pancreas. In most patients, however, the clinical and ultrasonic signs of pancreatitis are still retained. These patients need permanent dynamic observation and conservative therapy.

[Characteristics of Helicobacter infections in gastroduodenal ulcers and their complications]. / Osobennosti gelikobakaterioza pri gastroduodenal'nykh iazvakh i ikh oslozhneniiakh.

The presence of Helicobacter pylori (HP) was studied in 143 patients with ulcer disease of the stomach and duodenum. The urease test, immunoenzyme analysis, "AEROTEST" and culture of HP in laboratory conditions were used for diagnosis of HP. On the grounds of the culture method three degrees of colonization of the gastroduodenal mucosa were established. It was found that 96.3% of the patients were infected with HP, 86.3% of them having massive colonization. All the patients with complicated ulcers of the duodenum were HP-positive. A severe degree of the HP-infection with the predominant involvement of the antral part was characteristic of patients with bleeding ulcers; in patients with perforative ulcers and stenosis of the pyloric part the HP status is notable for considerably greater variability. Among the patients with gastric ulcers there was less amount of cases with HP (88.2%) as compared with those having duodenal ulcers. All patients with complicated disease were infected with HP, but there was nothing specific in colonization depending on.

[The comparative hemodynamic characteristics in the lower extremities during laparoscopic and traditional interventions on the abdominal cavity organs]. / Sravnitel'naia kharakteristika gemodinamiki v nizhnikh konechnostiakh pri laparoskopicheskikh i traditsionnykh vmeshatel'stvakh na organakh briushnoi polosti.

The plethysmographic methods were used for studying the influence of pneumoperitoneum in hemodynamics in lower extremities. It was proved to cause venous stasis in them and constriction of precapillaries in the venous area predominantly. The degree of such influence depends on the strain of the pneumoperitoneum and its duration. This factor should be taken into consideration for prophylaxis of postoperative complications.

[A methods of laparoscopic suturing of perforated pyloro-bulbar ulcers]. / Tekhnika laparoskopicheskogo ushivaniia perforativnykh pilorobul'barnykh iazv.

The article describes a method of laparoscopic suturing perforated ulcers of the pylorobulbar zone. The elements of all steps of the operation are analyzed including the places of introducing the trocar, the method of putting the intracorporeal stitches, means of sanitation and drainage of the abdominal cavity. The method was successfully used in operations on 43 patients with perforated ulcers without any complications.

[The immediate results of laparoscopic treatment in perforated gastroduodenal ulcers]. / Neposredstvennye rezul'taty laparoskopicheskogo lecheniia pri perforativnykh gastroduodenal'nykh iazvakh.

The article presents an analysis of immediate results of laparoscopic interventions (suturing, vagotomy) in 40 patients with perforated ulcers in the pylorobulbar zone. Postoperative complications were noted in 7.5% of the patients. There were no lethal outcomes. The authors recommend wider introduction of the laparoscopic technology as a method of optimization of surgical treatment for perforated ulcers.

Optimal revascularization of segmental pancreatic transplant.

Vascular anastomotic thrombosis is one of the most frequent complications after segmental transplantation of the pancreas (STP). We propose a new type of vascular anastomosis to reduce the rate of vascular thrombosis following STP. For this purpose we used double arterial-double venous anastomosis (DADVA). Four different types of vascular anastomosis used for STP were studied and compared. The rate of vascular anastomotic thrombosis was evaluated in correlation with the type of vascular anastomosis used. Traditional vascular anastomosis (TVA) was complicated by vascular thrombosis in 51.9% of cases. DADVA reduced rate of vascular thrombosis to 2.6% (P < 0.01).

Blood flow in the pancreatic segment before and after transplantation.

BACKGROUND: Blood flow in the pancreas before and after transplantation has not been studied sufficiently. Blood flow in the pancreatic transplant as a function of type vascular anastomosis used has not been explored. AIM: The objective of our study was to study blood flow in the intact pancreas prior to harvesting and at different time periods after transplantation. Two different types of vascular anastomosis were used for segmental transplantation of the pancreas. Blood flow in the transplanted pancreas was compared in this two experimental groups. METHODS: Study was conducted on 61 mongrel dogs. Autotransplantation of a pancreatic segment was performed to the left iliac vessels. There were two randomized experimental groups. In the first group (26 animals) traditional vascular anastomosis was used to revascularize pancreatic graft. Proximal end of splenic artery was anastomosed to iliac artery in "end to side" manner. Portal end of splenic vein was anastomosed to iliac vein in "end to side" manner as well. Splenic ends of splenic artery and vein were ligated. In the second group (35 animals) double arterial double venous anastomosis was used. For this purpose, after completing traditional vascular anastomosis, second arterial anastomosis was created distal to the first one between distal end of splenic artery and iliac artery in "end to side" fashion. Second venous anastomosis was performed distal to the first one between splenic end of splenic vein and iliac vein in "end to side" fashion. Blood flow in the pancreatic segment was measured using direct blood flow measurement method and electromagnetic flowmetry. After transplantation of pancreatic segment, blood flow was measured in the pancreatic graft 3 min, 1 h, 1 and 6 months following transplantation. RESULTS: Blood flow in the pancreas before harvesting was 0.69 +/- 0.01 ml/min/g. Blood flow in the pancreatic transplant in traditional vascular anastomosis group was higher than blood flow in the normal pancreas (1.13 +/- 0.05 ml/min/g after one month and 1.00 +/- 0.05 ml/min/g after six months (p < 0.01)). Blood flow in the double arterial double venous anastomosis group was not statistically significantly different from blood flow in the normal pancreas at 1 and 6 months after transplantation (0.70 +/- 0.02 and 0.67 +/- 0.02 ml/min/g accordingly). CONCLUSION: Double arterial double venous anastomosis provided more physiological blood flow to the graft, than traditional vascular anastomosis.

[The pathophysiological basis of vagotomy in perforated duodenal ulcers]. / Patofiziologicheskoe obosnovanie vagotomii pri perforativnykh duodenal'nykh iazvakh.

Fractional intubation, intragastric pH-metry and other methods were used in complex examination of 107 patients who had perforated duodenal ulcers. The influence of surgical vagotomy upon the state of tissue blood flow was determined by means of polarography with a medicamentous vagotomy test. The medicamentous denervation was found to result in decreased blood supply of the acid-producing area and increased blood filling of the duodenum mucose. A conclusion is made that performing vagotomy is expedient after suturing the ulcer defect in patients having no diffuse purulent peritonitis.

[Use of laparoscopic methods in combined surgery]. / Ispol'zovanie laparoskopicheskikh metodov pri sochetannykh operatsiiakh.

The authors have made a comparative analysis of the effectiveness of isolated and combined laparoscopic cholecystectomies. The control group consisted of 246 patients subjected to isolated cholecystectomies. The group under study included 22 patients in whom combined cholecystectomies were performed. The comparative analysis included the following clinical data: duration of the operation, number of postoperative days in the hospital, amount of postoperative complications. It was concluded that the little-invasive laparoscopic technique used in one of the steps of the combined operation allowed traumatism of the surgery to be decreased which in its turn allowed wider indications to combined operations.

[The HLA phenotype and duodenal ulcers in patients following kidney transplantation]. / HLA-fenotip i duodenal'nye iazvy u bol'nykh posle transplantatsii pochki.

The authors have performed an investigation of the association between ulcer disease of the duodenum and bleedings from the ulcers in 204 patients after transplantations of the kidney with the antigen of HLA system histocompatibility. Duodenal ulcers were found in 25 patients (12.9%), in 11 of them the ulcers were complicated by bleedings which was 5.4% of the total number of the patients with the transplanted kidney. The evaluation of the HLA antigen distribution has revealed an association of duodenal ulcers with A2 and B13 antigens which took place significantly more often than in a group of practically healthy people (RR = 1.85 and 1.9 correspondingly). In patients with the transplanted kidney and following ulcerous bleedings this association was more obvious (RR = 2.32 and 3.74 correspondingly). According to the calculated etiological fraction 40% of the patients can be supposed to have the etiological association of the disease with A2 antigen and 20% of the patients with B13 antigen. A typical feature was the presence of possible "protective" A9 antigen which was found in the group under study two times more seldom than in the control group (RR = 0.25). A comparison of the distribution of HLA antigens in the patients in whom there developed bleeding duodenal ulcers with those who had no such complications has also established the association of the disease with HLA A2 and B13 antigens. The probable "protective" A9 antigen was also found. Since the kidney transplantation is preceded by determination of the recipient's HLA phenotype, these data can be used as prognostic criteria as well as the indications to performing preventive antiulcerous therapy in patients with high risk of the development of ulcerous lesions of the gastrointestinal tract.

[The diagnosis of Helicobacter infections in patients with gastric and duodenal peptic ulcers]. / Diagnostika khelikobakternoi infektsii u bol'nykh iazvennoi bolezn'iu zheludka i dvenadtsatiperstnoi kishki.

The results of the study of 33 patients having gastroduodenal peptic ulcer, with 9 of them subjected to surgical treatment, are presented. The diagnostics of Helicobacter infection was made with the use of bacteriological and biochemical assays. The study revealed that in the overwhelming majority of cases peptic ulcer was associated with the presence of H.pylori, and the most informative method for the diagnostics of H.pylori infection was the bacteriological study of biopsies from the pyloric antrum characterized by the highest degree of massive contamination. The determination of ammonia concentration by biochemical assay with the use of Aerotest was most suitable for the diagnostics of H.pylori infection in patients with a short history of peptic ulcer.

[Detection of Helicobacter pylori in stomach cancer]. / Vyiavlenie Helicobacter pylori pri rake zheludka.

Helicobacter pylori (HP) infection was detected in different segments of the gastric mucosa in 13 patients with stomach tumors. Twenty five patients suffering from stomach ulcers were used as controls. HP infection was diagnosed by means of urease and microbiological testing. HP was identified in all cases of stomach cancer, the rates of dissemination in the mucosa in such patients being higher than in those with stomach ulcers.

[Patient Helicobacter pylori infectivity after gastric resection]. / Infitsirovannost' Helicobacter pylori bol'nykh posle rezektsii zheludka.

The article is devoted to investigation of the Helicobacter pylori (HP) infection in 14 patients after resection of the stomach for ulcers of the gastroduodenal zone. Different methods were used for the assessment of the state of the gastric stump and gastroenteric anastomosis in the postoperative period. In most cases different degree of inflammatory alterations of the gastric mucosa were detected. In 2 cases (14.3%) peptic ulcers of the anastomosis developed. Changes to the gastric stump of 11 patients were associated with the HP infection which involved the mucosa of the anastomosed intestine in 8 patients. The data obtained point to possible participation of HP pathogenesis of the alterations detected after the stomach resection. The question of the expediency of a specific antibacterial therapy in the postoperative period and in treatment of certain kinds of postgastroresectional syndromes is raised.

[Blood flow and free radical oxidation of lipids in gastric and duodenal mucosa in complicated duodenal ulcers]. / Krovotok i svobodno-radikal'noe okislenie lipidov v slizistoi zheludka i dvenadtsatiperstnoi kishki pri oslozhnennom techenii duodenal'noi iazvy.

38 patients with complicated duodenal ulcer were examined with polarographic method. The significant decrease of tissue blood flow was revealed in all segments of gastroduodenal zone. The increased level of free-radical oxidation of lipids was determined in duodenal mucosa and ulcer edges. Disorders of blood supply and activation of free-radical lipid oxidation play an important role in the mechanism of ulcer formation. The drugs improving blood supply and antioxidants should be used in combined therapy and preoperative preparation.

[The association of HLA antigens with gastric and duodenal peptic ulcer]. / Assotsiatsiia antigenov sistemy HLA s iazvennoi bolezn'iu zheludka i dvenadtsatiperstnoi kishki.

The association of duodenal ulcers with antigens AIO and combinations of antigens B18B40, B35B40, A10B5, A10B40 and others and the association of gastric ulcer with antigens A3B7, A3B40, B14B15 were revealed by an investigation of HLA antigens in 46 patients with ulcer disease of the duodenum and 25 patients with ulcer disease of the stomach. It was concluded that the ulcer disease had a hereditary predisposition characterized by genetic heterogeneity with different etiopathogenetic mechanisms of the development of ulcers of different localizations. The HLA antigens may be used as immunogenic markers of ulcer disease if observing the population method in the investigations.

[Extracorporeal shockwave lithotripsy in cholelithiasis]. / Ekstrakorporal'naia udarno-volnovaia litotripsiia pri zhelchnokamennoi bolezni.

The authors describe their experiences with using stroke-wave lithotripsy in 102 patients with cholelithiasis. Positive results were obtained in 68% of the patients. Indications to lithotripsy are formulated. A description of specific features of the method is given.