[Cardiovascular disorders in case of acute gastrointestinal bleeding in patients with arterial hypertension].

AIM: To investigate the blood pressure changes and electrocardiogram parameters for the 1st day after acute gastrointestinal bleeding in patients with arterial hypertension. MATERIAL AND METHODS: Indexes of blood pressure monitoring and electrocardiogram in case of acute gastrointestinal bleeding in patients with arterial hypertension were studied. 45 patients with arterial hypertension and acute gastrointestinal bleeding, 63 patients in acute stage of bleeding without hypertension and 48 patients suffering from hypertension without gastrointestinal bleeding were studied. Parallel simple open controlled investigation included blood pressure monitoring and Holter monitoring. RESULTS: Circadian dynamics of blood pressure in patients with arterial hypertension on the background of gastrointestinal bleeding was noted by reduced variability and insufficient reduction of pressure at night. Diastolic pressure decreased in accordance with severity of blood loss. Holter monitoring revealed high incidence of supraventricular ectopic activity, sinus arrhythmia and significant elongation of the ventricular electrical systole.

[Choice of the operation for perforated ulcers of the stomach and duodenum].

Actual questions of diagnostics and treatment of 776 patients with perforated gastroduodenal ulcers are discussed. The most informative method of the diagnosis, particularly covered perforation, is laparoscopy. Decision on the operation must be individually grounded. Radical operations were performed in 599 patients with 2% postoperative lethality. Lethality after suturing of the perforation was 10.3%, after resection operations--4.1%, after suturing the perforation in combination with selective proximal vagotomy--0.3%.

[Surgical tactics and causes of death in ulcer gastroduodenal bleedings].

4212 patients with ulcer gastrointestinal bleedings were treated during 1990-2007 years. 364 patients had gastric ulcers, other patients had duodenal ulcers. 1819 patients (43.2%) were operated. 418 patients (23%) were operated due to ineffective endoscopic hemostasis and recurrent bleedings. 409 patients (22.5%) underwent urgent operations because of risk for recurrent bleeding. Elective operations were carried out to 1358 patients (74.7%). Postoperative lethality amounted 5.8% including 19.1% lethality after emergency operations, 4.2% lethality - after urgent operations and 0.8% lethality - after delayed operations. The general hospital lethality amounted 3.3%. Lethality can be decreased by extension of indications for urgent operations, preventing recurrent bleedings.

[Experience with using a one-layer uninterrupted suture in abdominal surgery].

The authors made an analysis of using a one-layer uninterrupted suture with a synthetic absorbable thread in forming gastrointestinal, intestinal, duodenojejunal and pancreatojejunal anastomoses. The operation technique and early complications are described showing advantages of the one-layer uninterrupted suture with a synthetic thread.

[Surgical treatment of ulcer disease in arterio-mesenterial compression of the duodenum]. / Khirurgicheskoe lechenie iazvennoi bolezni pri arteromezenterial'noi kompressii dvenadtsatiperstnoi kishki.

Experience in surgical treatment of 124 patients with gastric and duodenal ulcers associated with chronic duodenal obstruction due to arterio-mesenterial compression of the duodenum is analyzed. This combination occurred in 12% of all patients with ulcers over 20-year period. Special methods of examination were used for diagnosis: probe duodenography with duodeno-manometry, hepato-bili-scintigraphy. Differential approach to choice of surgical method was developed, and two original methods of surgery are presented: selective proximal vagotomy and resection of the stomach in combination with duodeno-jejuno-anastomosis. Long-term results were studied in 75 patients, and in 93% of them they were assessed as excellent and good. Quality of life of patients after surgery depends on severity of chronic duodenal insufficiency.

[Enteral tube feeding early after surgery on the stomach and the duodenum]. / Enteral'noe zondovoe pitanie v rannem periode posle operatsii na zheludke i dvenadtsatiperstnoi kishke.

Experience in enteral tube feeding (ETF) early after stomach resection, gastrectomy, reconstructive surgeries for chronic duodenal obstructions and postgastroresection disorders in 1716 patients is presented. Irrigators were installed in the jejunum during surgery, more rarely--through gastroscope below distal anastomosis. During the first day saline solutions were administered, further--nutritional cocktails. Period of ETF was 5.8 +/- 0.8 days in uncomplicated postoperative period and from 9 to 73 days in postoperative complications. ETF stimulates motor, resorption, synthetic, barrier functions of the small intestine. ETF permits to improve immediate results of stomach and duodenum surgery and to reduce cost of treatment.

[Gastrectomy with creation of small intestinal reservoir]. / Gastréktomiia s sozdaniem tonkokishechnogo rezervuara.

A new variety of the esophago-intestinal anastomosis in gastrectomy is presented. The application of the anastomosis begins with formation of the cuff around the esophagus by the usage of the afferent and efferent loops, which then being joined together in a shape f reservoir. A total of 113 patients with cancer of the stomach (83), cancer of the gastric stump (10), giant ulcers of the cardial part of the stomach complicated by bleeding (15), and Zollinger-Ellison (5) syndrome have been operated on. Insufficiency of the anastomosis was revealed in 2 patients (1.8%). 6 patients (5.1%) died, 1 patient with insufficiency of the esophageal anastomosis included. There were no clinical manifestations and objective features of reflux-esophagitis after the usage of the suggested method for anastomosis, the reservoir function after the resection of the stomach was for the most part compensated.

[Surgical treatment of patients with perforating gastroduodenal ulcers]. / Khirurgicheskoe lechenie bol'nykh s perforativnymi gastroduodenal'nymi iazvami.

Under analysis were the results of treatment of 267 patients with perforating gastroduodenal ulcers for the period from 1992 till 1997. Radical operations were fulfilled in 86% of the patients. Suture of the perforation and selective proximal vagotomy were performed in 118 patients with ulcers of the duodenum having no intraoperative signs of duodenostasis, in the others resection of the stomach was used. Palliative operations (suturing the perforation) were performed in 15% of the patients. General lethality was 3.7%, postoperative--3%. Excellent and good results were obtained in 95.5% of the patients.

[Surgical policy in gastrointestinal tract foreign bodies]. / Khirurgicheskaia taktika pri inorodnikh telakh zheludochno-kishechnogo trakta.

66 patients (45 males and 21 females) who have swallowed 157 foreign bodies (fragments of wire, nails, needles, hafts of spoons, et were treated). If the objects were located in the stomach and the duodenum in the absence of complications endoscopic method of treatment was preferable, with the help of which 31 objects were successfully removed and the terms of treatment were significantly decreased. Conservative treatment (diet rich in fiber and protective substances, barium sulfate administration) resulted in elimination of 58 objects by vias naturals, 53 from which were not more that 8 cm long. Evacuation of the foreign bodies was carried out only during the first 3 weeks after the swallowing. Operative treatment was carried out in 21 patients, in whom 68 foreign bodies were extracted. An urgent operation in the first 6 hours in complications due to foreign bodies (perforation, incarceration, gastrointestinal bleeding) was carried out in 13 patients. An urgent operation in terms from 6 to 24 hours of hospitalization was carried out in 6 patients with large (more that 8 cm) swallowed objects, conglomerates and bunches of foreign bodies. Early removal of these objects prevented development of complications. Elective operation was carried out in failure of conservative treatment as was in 2 patients. No lethality was registered.

[The surgical treatment of chronic duodenal obstruction]. / Khirurgicheskoe lechenie khronicheskoi duodenal'noi neprokhodimosti.

An analysis of indications to operative treatment has been made on the basis of clinical examinations of 162 patients with chronic disturbances of duodenal patency. The operation is indicated to patients with mechanical forms with any stage and to all the patients with the stage of subcompensation and decompensation. Operations were performed on 98 patients. In patients with the stage of subcompensation the operations were most effective which excluded the duodenal passage, especially antrumectomy after Roux with the elimination of the mechanical obstacles at the level of the duodenojejunal passage. At the stage of decompensation only such combined operations are thought to be effective which include additional drainage of the excluded duodenum.

[Surgical treatment of chronic duodenal obstruction after radical operations on the stomach in peptic ulcer]. / Operativnoe lechenie khronicheskoi neprokhodimosti dvenadtsati- perstnoi kishki posle radika'lnykh operatsii na zheludke pri iazvennoi bolezni.

The authors operated on 138 patients with impaired duodenal patency after gastric resection and selective proximal vagotomy. The most substantiated operation is the Roux-en-Y reconstruction. In possible elimination of mechanical obstacles and normal tonicity of the duodenum, the passage through it was restored by means of isoperistaltic jejunal segment. Good long-term results were noted in 83.2%, satisfactory--in 13.6%, bad (ulcer recurrence)--in 3.2% of the patients.

[Complex treatment of complicated forms of paronychia]. / Kompleksnoe lechenie oslozhnennykh form panaritsiia.

Results of the treatment of 100 patients with bony, bony-articular panaritium, thecal whitlow and pandactylitis are described. Expediency of the complex treatment including surgery, regional administration of antibiotics and immunotherapy is shown.

Enzymatic detoxication of superoxide anion-radicals and lipoperoxides in intima and media of atherosclerotic aorta.

Unusually high activities of the "antioxidative" enzymes (superoxide dismutase, glutathione peroxidase) have been found in the cells isolated from the intima and media of normal human aorta. The activities of "antioxidative" enzymes of the intima and media of the human aorta in different types of atherosclerotic lesions (lipid spots, fibrous plaques) have been demonstrated to be greatly lowered.

[Immunotherapy in the complex treatment of acute suppurative diseases of soft tissues and the hand under ambulatory conditions]. / Immunoterapiia v kompleksnom lechenii ostrykh zabolevanii miagkikh tkanei i kisti v ambulatornykh usloviiakh.

On the basis of clinical experiences with the surgical treatment of 145 patients the authors recommend using active immunization with staphylococcal anatoxin after operation. It is found to shorten the time of treatment.