[Use of 'Korona' cava filter in oncological patients]. / Primenenie kava-fil'tra 'Korona' u onkologicheskikh bol'nykh.

Using the 'Korona' cava filter in a total of 1345 oncological patients revealed regularity of a change in the shape of the inferior vena cava at the level of implantation. This made it feasible to determine one of the causes of long-term complications following implantation of other models of cava filters. The absence of clinically significant complications in the remote period after using this model of cava filter made it possible to implant it for a longer period, which is of special importance in oncological patients.

[The modification of the M.D. Patsiora's operation by portal hypertension].

The direct transcutaneous transhepatic portography was performed in 85 patients with hystologically confirmed liver cirrhosis, portal hypertension and varices of the esophagus and stomach. It was found out, that the left gastric vein partakes the varicous transformation in 100% of cases. The least had an isolated division in 27% of the studied patients. 68% had the significant dilatation of the posterior gastric vein, whereas 19 (22%) patients had the combined posterior, left and short gastric veins dilatation. The study allowed the modification of the M.D. Patsiora's operation (the azygo-portal disintegration), by supplementing it with the gastric devascularization. The new method increased the 2-years survival from 77 to 97%, improved the hemostatic effect from 51 to 89% and decrease the recurrences from 25 to 5%.

[Optimization of surgical strategy in trauma of the chest: correlation of thoracoscopy and thoracotomy].

The authors analyzed an experience with treatment of 4372 patients. Videothoracoscopy allowed the number of usual drainages of the pleural cavity to be reduced in closed trauma from 16.3% to 2.3%, in wounds--from 3.9% to 0.4%. Persistent hemo- and airstasis were obtained by coagulation of the vessels of the thoracic wall and lung, suturing lung wounds. The coagulated hemothorax was removed, diaphragm wounds were sutured, the pericardium wounds were revised, the character of intrathoracic lesions was reliably determined in 98% of cases. Conversion into thoracotomy was fulfilled in 91 (5.5%) patients. Thoracotomy was fulfilled in 344 (8%) patients with indications to operative interventions and severe condition and unstable hemodynamics. The number of thoracotomies and lethality in patients with penetrating wounds of the chest became 1.5-2 times less, was not considerably changed in closed traumas.

[Pathogenesis of esophageal and gastric varicose veins formation in patients with liver cirrhosis].

RESEARCH OBJECTIVE: studying the features of the collateral venous blood flow and the basic ways of the formation of gastroesophageal varices in patients with cirrhosis and portal hypertension. METHODS: The following analysis is based on the interpretation of results from percutaneous transhepatic splenoportography in 85 patients. It has been established that in all 85 patients the left gastric vein plays a key role in the formation of gastroesophageal varices. RESULTS: It is established that a leading collector in 100% of observations participating in formation gastroesophageal varices, is the left gastric vein. In work the attention is focused on an insufficient estimation of a role of a back gastric vein in a pathogenesis of varicose transformation. From 85 observations its presence is taped in 58 (68%) cases, and, at 19 (22%) patients its expansion isn'ted in a combination to expansion left gastric vein, and at 39 (46%) patients - in a combination with left gastric vein and short veins of a stomach. CONCLUSION: The obtained data on the formation mechanism of varicose expanded veins of an esophagus and a stomach defines necessity of changes for algorithm of inspection of patients for the purpose of diagnostics of features of a venous blood flow of a stomach and an esophagus and definition of surgical tactics concerning volume pre- or intraoperational blockade of the basic venous collectors.

[Temporary cardiac pacing in patients with acute myocardial infarction in the conditions of air medical service].

Temporary electrical cardiac pacing in the conditions of air medical service was used in 183 patients with myocardial infarction complicated with life threatening disturbances of cardiac rhythm and conduction. Immediate results of treatment, complications, and causes of lethal outcomes are presented. Two groups of patients were distinguished: in which traditional and improved by authors methods of temporary electrical pacing were employed. It was established that the use in urgent situations of improved techniques of control of endocardial electrode position, transesophageal, cutaneous, and atrial dependent endocardial ventricular electrical pacing allowed to decrease number of complications 2.6 times, and to lower mortality in acute period of myocardial infarction by 12.8%.

[Alpha-fetoprotein immunotherapy as a stage of combined treatment of cancer patients].

The paper discusses the preliminary findings on alpha-feto-protein (AFP) treatment of 58 patients with stage III-IV malignancies of different localizations. No influence on neoplastic processes was registered in poorly differentiated cell tumors, nor were any immunological mechanisms of antitumor action triggered on. However, in moderately- and well-differentiated cell tumors, several foci of acute immune inflammation were induced. It is suggested that AFP is responsible for tumor cell apoptosis by freeing antigenic determinants from shielding antibodies via elimination of <> of tumor growth.

[A device for performing drainage into common bile duct].

A new original instrument is proposed for draining the cystic duct into the common bile duct through the stump. The device combines a reliable fixation of the drainage tube in the stump of a narrow (less than 3 mm) or scared altered cystic duct and the not traumatically embedded cannula into the common bile duct.

[Selection of protection regimen of dual-chamber cardiac pacing against paroxysmal supraventricular tachycardia]. / Vybor rezhima zashchity dvukhkamernoi élektrostimuliatsii serdtsa ot paroksizmal'nykh nadzheludochkovykh takhikardii.

Criteria of selection of a type of protection against paroxysmal supraventricular tachycardia were studied in 38 patients with permanent dual-chamber cardiac pacing. Three types of protection were distinguished. Criteria for their selection were presence of "pacemaker syndrome", state of chronotropic function of the heart, frequency of attacks of supraventricular tachycardia, results of modeling of pathological atrial activity. During follow-up after programming of optimal type of protection of dual-chamber pacing (mean duration 5.1 years) chronic supraventricular tachycardia developed in 13.5% of patients, survival was 89.2%.

[Embolization of gastric veins in patients with esophageal hemorrhage during laparotomy]. / Embolizatsiia zheludochnykh ven u bol'nykh pishchevodnymi krovotecheniiami pri laparotomii.

The authors discuss the possibility of a laparotomy approach for endovascular embolization of the gastric veins in patients with portal hypertension and gastroesophageal bleeding. This approach was used in four patients in whom transhepatic catheterization of the portal channel was impossible. After laparotomy, catheterization of the portal vein system was conducted through one of the veins of the small intestine. The effect of embolization in two of three patients who were subjected to the operation consisted in correction of esophagitis and complete cessation of esophageal bleeding. In view of the danger of the development of operative and postoperative complications due to the specific features of the pathological condition, the authors recommend using laparotomy endovascular embolization of the gastric veins only in the presence of strict indications.

[X-ray intravascular reduction of blood flow along the hepatic artery in patients with portal hypertension and resistant ascites]. / Rentgenoéndovaskuliarnaia reduktsiia krovotoka po pechenochnoi arterii u bol'nykh portal'noi gipertenziei i rezistentnym astsitom.

After studying the results of embolization of the hepatic artery in 14 patients with portal hypertension and resistant ascites the authors came to the conclusion that this operation often leads to the development of hepatic insufficiency and a fatal outcome and produces a clinical effect only in a small number of patients. Celiac- and mesenteric angiography and transhepatic portography were carried out for pathogenetic substantiation of the intervention. Pressure in the portal vein, hepatic veins and arteries, and in the inferior vena cava was measured during the examination. The space velocity of the portal and arterial hepatic blood flow was determined. Clinico-angiographic examination of the patients failed to reveal criteria for predicting the efficacy of embolization of the hepatic artery. A positive result may be expected in cases in which embolization leads to a reduction in portal pressure. Embolization of the hepatic artery produced no clinical effect in initial reduction of the blood flow in the liver.

[Transpopliteal phlebography in the diagnosis of chronic diseases of the veins of the lower extremities]. / Chrespodkolennaia flebografiia v diagnostike khronicheskikh zabolevanii ven nizhnikh konechnostei.

From experience in 98 studies the authors claim that transpopliteal phlebography yields information on the condition of the popliteal and the tibial veins and the ostial valve of the small saphenous vein in retrograde, and on the condition of the femoral vein in antegrade administration of the radiocontrast medium. It is indicated for patients suffering from varicosity in ectasia of the popliteal and tibial veins, as well as when the results of clinical tests for competence of the valves of the small saphenous vein are doubtful. The absence of visualization of the femoral vein in ascending distal or retrograde femoral phlebography in patients with congenital venous dysplasia or with phlebothrombosis sequelae is an indication for antegrade transpopliteal phlebography.

[Biophysical properties of bile and urine in patients with cholelithiasis]. / Biofizicheskie svoistva zhelchi i mochi u bol'nykh kholelitiazom.

The electric conductivity of the hepatic bile received during and 24 hours after surgery from the drainage introduced into the common hepatic duct was studied in 94 patients with cholelithiasis. It is demonstrated that conductivity increases in cholestasis, inflammatory process in the biliary tract and depends on the hepatic morphofunctional status. The specific electric conductivity of intraoperative bile that is more than 192 S/m is considered to be criteria for the diagnosis of cholangitis. The electric conductivity of urine before and in first 4 days after surgery decreases in inflammation of the biliary tract and depends on the degree of concomitant renal dysfunction and electrolyte disturbances. There was a decrease in the conductivity of bile and urine in all studied groups. Detection of biophysical parameters of biological fluids may objectively control the postoperative period and correct treatment policy.

[Endovascular embolization of the gastric veins in portal hypertension complicated by esophagogastric hemorrhages]. / Endovaskuliarnaia émbolizatsiia ven zheludka pri portal'noi gipertenzii, oslozhnennoi ézofagogastral'nymi krovotecheniiami.

Through a period from 1981 to 1996 127 roentgen-endovascular embolization of gastric veins were carried out in 95 patients for portal hypertension complicated by esophagogastric bleeding or in its threatening relapse. Group 1 consisted of 73 patients, to whom endovascular treatment was carried out urgently at the background of continuing hemorrhage, in 52 patients--it was delayed and in 21 patients in the nearest posthemorrhagic period. In 73 patients bleeding resulting from embolization was stopped. In the earliest postembolization period recurrence of hemorrhage developed in 6 patients, thus initial hemostatic effect of embolization made up 91.8%, and survival rate--74% (54 from 73 patients of the 1-st group were discharged from the clinic). Group 2 consisted of 22 patients to whom embolization of gastric veins was carried out as an elective procedure. There were bleedings in the anamnesis in the patients of the latter group, and varicose veins of the esophagus with trophic disturbances in esophageal mucosa manifested real treat of the hemorrhage. The survival rate in this group of patients made up 95.5%. The analysis of the results of elective endovascular embolization of gastric veins revealed more favourable results in the nearest postembolization period, than in urgent procedures. Far off results of embolization of gastric veins were followed up in 61 patients (43 patients of the 1st group and 18 patients of the 2nd group). Index of survival up to 6 months made up 87.8%, up to 12 months--80.5%, up to 3 years--57.5% and up to 6 years--19.6%. Hemostatic effect up to 6 months made up 100%, to 12 months--84.6%, to 3 years--54.9%, to 6 years--15.6%.

[Effectiveness of external drainage of the common bile duct]. / Otsenka éffektivnosti naruzhnogo drenirovaniia obshchego zhelchnogo protoka.

Influence of different methods of external drainage of the biliary tract on dynamics of inflammation in the biliary tracts was evaluated based on the data examination of bioimpedance, specific electric conductivity and general microbial number of bile received during surgery and from drainage of the common bile duct during 9 days after surgery in 197 patients with cholelithiasis complicated by bile outflow disturbances. It is demonstrated that each type of external drainage has own indications depending on the degree of bacterial contamination, macroscopic structure, biophysical parameters of bile, and planned treatment policy after surgery. Right fixation of the drainage tube in the common bile duct improves immediate results of surgical treatment of patients with cholelithiasis.

[Diagnosis, treatment and prophylaxis of postoperative recurrent nodular goiter]. / Diagnostika, lechenie i profilaktika posleoperatsionnogo retsidivnogo uzlovogo zoba.

Results of surgical treatment of 81 patients with recurrent goiter and 79 patients with benign nodular forms of goiter are analyzed. Based on clinical data, results of ultrasonic and histological examinations, it was determined that recurrence of goiter does not depend on volume of surgery. It is seen in patients with subclinical forms of postoperative hypothyreosis and in half of cases with lymphoid infiltration of I - IV degree. Dispensary observation and timely prescription of suppressive therapy, if it is necessary, permit to reduce number of goiter recurrences from 8.2 to 2.5%.

[Complications of the transcutaneous transhepatic catheterization of the portal vein and their prevention]. / Oslozhneniia chreskozhnoi chrespechenochnoi kateterizatsii vorotnoi veny i ikh profilaktika.

An analysis of complications after performing a transhepatic catheterization of the portal vein in 117 patients with different diseases has shown that all of them were associated with mechanical traumas of the liver parenchyma, vascular structures or bile ducts and may be considered to be a direct consequence of technical problems and errors. The most severe complication of the procedure was bleeding into the abdominal cavity. Certain technical means facilitating the examination and improving its safety are discussed as well as methods to prevent bleedings into the abdominal cavity.

[The results of endovascular embolization of the gastric veins in patients with portal hypertension complicated by esophagogastric hemorrhage]. / Rezul'taty éndovaskuliarnoi émbolizatsii ven zheludka u bol'nykh portal'noi gipertenziei, oslozhnennoi ézofagogastral'nym krovotecheniem.

An experience with using endovascular venous embolization in 53 patients with bleeding from varices of esophageal veins is presented. Transhepatic, transsplenic and laparotomic accesses were used. Embolization of the gastric veins was fulfilled with nonlysing materials--teflon velour in combination with metallic spirals. The results obtained proved to be better than those known from the literature.

[The problem of posttraumatic fat embolism]. / K voprosu o posttravmaticheskoi zhirovoi émbolii.

The article is devoted to the problem of fat embolism. In 63 patients with combined and isolated traumas the maximum frequency of fat embolism was diagnosed in the investigation of blood serum from the femoral artery. It can be supposed that no isolated injury of the lesser circulation circuit can occur in fat embolism. An investigation of the venous-arterial difference of fat globulemia has shown the main role of the so-called theory of shunting for fat embolism to be doubtful.

[Diagnostics of traumatic fat embolism]. / O diagnostike travmaticheskoi zhirovoi émbolii.

The article deals with diagnosis and treatment of fat embolism concomitant with trauma. A new term is suggested, i.e. liqoroglobulism, which is concomitant with the cerebral form of fat embolism. The results of investigations of patients, who endured fat embolism, are presented. A new method is suggested for the treatment of fat embolism, i.e. a combination of hemosorption and liquosorption. A thesis on that the blood-brain barrier is damaged in the cerebral form of fat embolism is formulated.

[Cerebrospinal fluid fat globules in traumatic fat embolism]. / Zhirovaia likvoroglobuliia pri travmaticheskoi zhirovoi émbolii.

The article is devoted to the problem of diagnosis and treatment of 28 patients with cranio-cerebral injury with posttraumatic fat embolism. In 15 of them fat liquoroglobulia was diagnosed which is a reliable symptom of the cerebral form of fat embolism. The method of detection of fat liquoroglobulia is described. A new method--liquorosorption--was used in treatment of patients with the cerebral form of fat embolism. A disturbance of the hematoencephalic barrier is thought by the authors to be possible in such embolism.