[Intestinal obstruction in disseminated malignant tumors of the female genitalia: the surgical procedure and combined operations]. / Kishechnaia neprokhodimost' pri rasprostranennykh zlokachestvennykh opukholiakh zhenskikh polovykh organov: khirurgicheskaia taktika i kombinirovannye operatsii.

Results of surgical treatment of 103 patients are presented who had spread malignant tumors of the female genitalia with the involvement of different segments of the intestine and urinary tract, and damaged intestinal passage. Combined operations were performed on 57 patients (55.3%), palliative--46 patients (44.7%) 54 patients were operated on urgently. For the last 10 years resectability has been increased 8.5 times owing to active surgical policy. Immediate lethality after combined operations was 10.5%. Cumulative indices of 3- and 5-year survival were 66% and 53.3% respectively. Lethality and 5-year survival after palliative operations were 30.4% and 13.8% respectively. Combined operations for cancer of female genitalia (both primary and recurrent ones and metastases) are quite reasonable in order to provide the optimum volume of cytoreduction and perform chemo- and radiation treatment.

[Extensive hepatic resections and reconstruction of bile ducts in patients with tumors and parasitic cysts]. / Obshirnye rezektsii pecheni i rekonstruktsiia zhelchevyvodiashchikh putei pri opukholiakh i parazitarnykh kistakh.

The short-term and end results of hemihepatoectomies (36) associated with malignant (31) and benign (2) hepatic tumors and parasitic cysts (3) are presented (total right-side hemihepatectomy-7, subtotal-9, left-side hemihepatectomy-15, extended left-side hemihepatectomy-5). In 14 cases, due to considerable invasion of tumor from other sites or because of distant metastases, the liver was resected alongside with removal of primary tumor. In such patients, gastric extirpation was carried out simultaneously with resection of the esophagus and pancreas (4), colon and rectum (8) and gastropancreatoduodenal area (1). Liver resection was associated with surgical correction of biliary tracts (6). Post-operative lethality was 11.1%. The end results are quite satisfactory: out of 27 patients treated for primary (10) and secondary (17) hepatic malignancies, 15 survived 2 years, 8-4 years and more; there are 10 survivors at the time of reporting.

[General and local antibiotic treatment with ceftriaxone of suppurative-septic diseases and complications]. / Obshchaia i mestnaia antibiotikoterapiia tseftriaksonom gnoino-septicheskikh zabolevanii i oslozhnenii.

A third-generation cephalosporin, Ceftriaxone, was used in intensive care of patients subjected to elective and urgent surgery in the Regional Clinical Hospital, St. Petersburg. A total of 105 patients were divided in 4 groups: 1) a course of ceftriaxone in combination with aminoglycosides started before the intervention; 2) the same, with the disease course complicated by peritonitis; 3) patients with neurosurgical diseases and brain injuries complicated by secondary meningoencephalitis; and 4) abdominal surgical patients in whom the severity of illness was determined by the abdominal process of different localization. The treatment included general and local use of ceftriaxone under ultrasonic control. The results indicate that ceftriaxone is a broad-spectrum drug effective in the treatment of nosocomial infections and neuroinfections; it can be applied locally and is economic.

[Current trends in the diagnosis and therapy of colorectal cancer]. / Sovremennye napravleniia v diagnostike i lechenii kolorektal'nogo raka.

The report deals with the 30-year experience gained by the Department in the treatment of nearly 5,500 cases of tumors of large bowel. Radical surgery for colonic tumor was followed by lethality in 3.0 and 5-year survival-80.8%; rectal tumor resection-5.3 and 58.2%, respectively. Individually-tailored modalities have been devised for a spectrum of cases of colonic wall invasion and metastatic lesions in regional lymph nodes. A choice of sparing, extended and combined surgical procedures vis-a-vis these factors has been developed, the latter offering most advantage. Therapeutic strategies for hepatic metastasis have been worked out on individual basis.

[The combined endoscopic surgery of gallstones complicated by diseases of the terminal common bile duct]. / Kombinirovannaia éndoskopicheskaia khirurgiia zhelchnokamennoi bolezni, oslozhnennoi zabolevaniiami terminal'nogo otdela obshchego zhelchnogo protoka.

The article deals with combined endoscopic treatment of cholelithiasis complicated by pathological changes of the terminal part of the common bile duct in 104 patients: in 81 of them there was choledocholithiasis (5 of them had the Mirizzi syndrome). 15 patients had choledocholithiasis and papillostenosis, 8 patients had papillostenosis. Papillosphincterotomy with laparoscopic cholecystectomy was performed in 50 patients, in 4 senile patients only papillosphincterotomy was performed. Laparoscopic cholecystectomy and interventions on the common bile duct were fulfilled in 46 patients; in 27 cases the duct was drained by the method of Holsted-Pikovskii, in 13 cases--after Kehr, in 3--after Vishnevskii. In 2 cases the concrements were removed through the cystic duct, the common bile duct was not drained. The supraduodenal choledochoduodenoanastomosis was made in one patient. The open operation was performed in 4 cases (3.9%). One patient died (1%). The experience shows that the modern endoscopic technique allows the whole program of intraoperative revision and sanitation of the hepaticocholedochus and its drainage to be realized. Advantages of the combined endoscopic treatment of the cholelithic disease complicated by a lesion of the terminal part of the common bile duct as compared with traditional surgery are evident. They are: decreased postoperative pain syndrome, less amount of complications, good cosmetic affect, shorter period of reconvalescence, high economic effect.

[The quality of medical care given to patients with esophageal cancer in St. Petersburg and the Leningrad region]. / Sostoianie lechebnoi pomoshchi bol'nym rakom pishchevoda v Sankt-Peterburge i Leningradskoi oblasti.

The data on the morbidity, time of diagnosis and results of treatment of esophageal cancer in St. Petersburg and Leningrad Region (1992-1994) were analyzed. The morbidity rates were higher in women than in men, the predominant age being over 60. Morphological verification data were not available in almost half the cases. Stage I-II tumors were detected in 15.7-26.5%. Specialized treatment was given to 25%, combination one-to nearly 2%. To raise the standards of medical aid, it is suggested that measures be taken to ensure stable operation of the Cancer Register, St. Petersburg, and to offer treatment to esophageal cancer patients at specialized medical facilities.

[Specifics of metabolic disorders in patients with "hormone-associated neoplastic" syndromes]. / Osobennosti metabolicheskikh narushenii y bol'nykh novoobrazovaniiami, formiruiushchimi sindrom "gormon-assotsiirovannykh rakov".

Overweight, lipidemia features, glucose tolerance and insulinemia were studied in 642 females suffering tumors of the corpus uteri, breast, ovary and large bowel, i.e. types of neoplasia which often occur and correspond to the syndrome of primary multiple "hormone-related" cancers. Beside certain obvious similarities in the said parameters established among patients with the said pathologies, the distinctions related, first of all, to degree of pernicious tumor process and, possibly, preoperative weight loss. Since no differences were found in manifestations of hormono-metabolic disturbances between cases of solitary and primary multiple neoplasms of the same localizations, it is suggested that carcinogenesis of both types might be caused by the same factors.

[Specifics of reproductive disorders and hormonal sensitivity of tumors in patients with "hormone-related neoplastic syndrome"]. / Osobennosti narushenii v reproduktivnoi sisteme i gormonochuvstvitel'nosti opukholei u bol'nykh novoobrazovaniiami, formiruiushchimi sindrom "gormon-assotsiirovannykh rakov".

Blood-serum levels of gonadotrophins and estradiol were assayed alongside with those of estradiol and progesterone receptors in the tissue of tumors of the breast, uterus, ovary and large bowel to establish general regularities of reproductive homeostasis in patients. The study was based on the assumption that risk of secondary tumor development is considerable in a patient who bears one of said malignancies. The effect of estrogen hormones was shown to be one of general causes of tumorigenesis. This is corroborated by enhanced hyperestrinism observed in cases of carcinoma of the corpus uteri as well as by certain data pointing to a reliable correlation between estrogen-stimulated synthesis of progesterone receptors and prognosis in patients with tumors of the breast, uterus and ovary. No estrogen dependence, however, was registered in patients with tumors of the bowel. Pathogenetic features shared by tumors of the large bowel and those of the reproductive system should probably be accounted for by disorders in metabolism.

[Radiation-induced multiple tumors]. / Radioindutsirovannye polineoplazii.

Multiple primary tumors have been detected in 192 (5.0%) cases out of 3,812 patients with primary cervical malignancies, 100 (2.6%) cases having been traced to radiation-related origin. The peculiarities of the syndrome of radiation-induced multiple tumors of the rectum, vagina and corpus uteri, duration of their development, histological patterns, degree of cell differentiation, depth of invasion and patterns of metastasis spreading have been identified. Relative cumulative risk of secondary tumor development and causal factors have been established.

[One-step transpleural or transmediastinal esophagogastroplasty in resection of the esophagus for cancer]. / Odnomomentnaia transplevral'naia ili transmediastinal'naia ézofagogastroplastika pri

An experience with 139 radical one-step surgeries for esophagus cancer using transpleural or transmediastinal plasty with a gastric tube is presented. This type of surgery is a method of choice for malignant tumours of the esophagus since it provides the best radical operation and good functional results. The standardized approach to the anesthesiological maintenance of these surgeries and to postoperative intensive therapy is substantiated. The total postoperative mortality made up 26.2%; mortality from surgical complications-20.9%; 3-years survival was 24.5%; 102 patients (73.3%) were discharged from the clinic with good functional results.

[The characteristics of bile acid excretion in patients with cancer of the large intestine]. / Osobennosti ékskretsii zhelchnykh kislot u bol'nykh rakom tolstoi kishki.

Marked difference in bile acids excretion (on the same diet) was observed between patients with large bowel cancer and healthy controls. The peak level of the bile acids in feces was registered in female patients 46-59 years of age suffering right-sided cancer. It is suggested that bile acid excretion in man is determined both by nutritional factors and hormonal-metabolic peculiarities of the body. High excretion of the bile acids is associated with risk for colon cancer.

[Primary-multiple malignant tumors of the colon, uterus and breast]. / Pervichno-mnozhestvennye zlokachestvennye opukholi tolstoi kishki, matki i molochnoi zhelezy.

A study of 94 case histories of primary multiple tumors of the large bowel, uterus and breast showed relative risk of development of uterine body cancer in patients with colonic cancer to be 37 times that for a general population of healthy females over 40 years of age. Post-treatment risk of breast cancer in cases of large bowel cancer increases 17-fold, uterine body--15-fold and cervix uteri--10-fold. Risk for large bowel cancer increases 179-fold in patients treated for uterine body tumors. On the whole, it serves as a confirmation of a possible role of endocrine-metabolic disorders played in the pathogenesis of primary multiple tumors of the large bowel and uterus. Radiation is the key factor of induction of rectal and rectosigmoidal tumors as a result of radiotherapy for cancer of the uterus. The results of the study make the case for timely diagnosis of primary multiple tumors of the large bowel, uterus and breast and adequate follow-up, no matter at what site the first tumor was found.

[Intestinal obstruction in the early postoperative period in patients with gastrointestinal tumors]. / Kishechnaia neprokhodimost' v rannem posleoperatsionnom periode u bol'nykh opukholiami zheludochno-kishechnogo trakta.

Data on the clinical course and medical tactics in mechanical small intestine ileus developing in the early postoperative period in patients with carcinoma of the gastrointestinal tract are given. The mechanical intestinal ileus was responsible for relaparotomies in 22 patients (5 of them died). An early repeated operation is stressed to be necessary which is less dangerous for the patient than a continuous waiting.