[Treatment of gastroduodenal bleedings: from surgery to therapy?].

Results of treatment of 2352 patients with gastroduodenal ulcer bleedings were analyzed. Surgical treatment was performed at 495 (21%) of them. Emergency life-saving operation was performed at 78 (15%) patients, urgent operation after primary hemostasis - at 114 (23%), elective operations - at 303 (62%). Various resections were carried out at 78% cases, organ-saving surgeries - at 22%. The main problem in the treatment program of these patients is the prophylaxis of bleeding recurrence. Rational pathogenetic out-patient treatment of ulcer disease, prophylaxis of recurrences and complications are the key points which need close collaboration between surgeons and gastroenterologists.

[Ultrasonic diagnosis of benign diseases of the gallbladder]. / Ul'trazvukovaia diagnostika dobrokachestvennykh zabolevanii zhelchnogo puzyria.

The authors discuss experience in ultrasonic examination (USE) of the biliary tract in 1,068 patients with various benign diseases of the gallbladder; 536 of them were treated by surgery. It is shown that USE is a highly informative and authentic method in the diagnosis of benign diseases of the gallbladder. The article deals with the USE semeiotics of acute destructive cholecystitis, its complications, as well as chronic calculous cholecystitis and various benign acalculous diseases of the gallbladder. Among the existing methods of examination of the biliary tract, the authors claim USE to be most important and the main method in patients with benign diseases of the gallbladder of acalculous genesis.

[Pancreas as one of the targets of "auto-enzyme explosion" in pancreatitis]. / Podzheludochnaia zheleza kak odna is mishenei "autofermentnogo vzryva" pri pankreatite.

The authors consider pancreatitis not as a nosological unity but as a clinical manifestation of enzymatic or autoenzymatic aggression. Based on clinical, histopathomorphological examinations, the authors describe pancreatogenous enzymatic injury of organs and tissues (pancreas, heart, kidneys, liver, gastrointestinal tract, etc). For 4-8 days to 2-10 years the syndrome may damage not only pancreatic parenchyma, but also vascular structures with formation of general vasculitis, lymphangitis and subsequent thrombotic microangiopathy. The authors regard pancreas as one of the target organs--of general disease, in which serious injuries of other organs and tissues may prevail over changes in the primary zone of aggression.

[Combined surgical interventions in gastroduodenal ulcers]. / Sochetannye operatsii pri gastroduodenal'nykh iazvakh.

Diagnosis and treatment of gastroduodenal ulcers combined with abdominal pathology are discussed. The results of combined operations in 158 patients are analysed. Most often gastroduodenal ulcers were combined with hiatal hernia (62%), peritoneal adhesions (17.7%), cholecystitis (17.7%), abdominal wall hernia (10.1%). Good long-term results were achieved in 69.7% of the patients, satisfactory results-in 26.9%, unsatisfactory-in 3.4%. Combined operations are effective in treatment of peptic ulcers and concomitant disorders.

[Rheovasography in the evaluation of conservative treatment methods in obliterating atherosclerosis]. / Reovazografiia v otsenke metodov konservativnogo lecheniia obliteriruiushchego ateroskleroza.

The work discusses the results of treatment of 65 patients for arteriosclerosis obliterans of the lower limb vessels by means of various nonoperative methods. The clinical indices improved within the shortest period of time in the group of patients treated by a complex of measures including reinfusion of blood irradiated by ultraviolet rays. According to the findings of rheovasography, the rheographic index increased to a greater degree (+0.4) in patients who were treated by infusion of their own blood, which had been exposed to ultraviolet light, in combination with intravenous injection of drugs. Application of quantum hemotherapy alone was also effective, which was confirmed by increase of the rheographic index by 0.2. It is pointed out that the therapeutic effect of the method is mainly due to improvement of the blood rheologic properties and provision for the flow of blood along the main channel.

[Diagnosis and treatment of gastrointestinal hemorrhage]. / Diagnostika i lechenie zheludochno-kishechnykh krovotechenii.

The article analyses the results of treatment of 4,430 patients with gastrointestinal bleeding in the last four decades. Two periods, from 1950 to 1969 and from 1970 to 1990, are compared from the standpoint of change of the disease structure, the methods of diagnosis and hemostasis. The number of hemorrhages of ulcer genesis reduced from 80 to 40.3%. Changes in the pattern of the disease is associated with improved diagnostic methods and recognition of pathological processes which were previously inaccessible to radiological examination, such as the Mallory-Weiss syndrome, acute ulcerations of the mucosa. The age composition remains relatively stable. Just like in the previous years, each third patient is over 6.0 years of age. Despite introduction of new methods of treatment, such as endoscopic arrest of bleeding, enteral feeding, a new method for management of penetrating ulcers and others, the mortality rate reduced only from 4.5% (1950-1969) to 3.4% (1970-1990). It is noted, however, that fatal outcomes in the last years prevail among patients aged 65-70 or older.

[Acute acalculous cholecystitis in emergency surgery]. / Ostryi beskamennyi kholetsistit v neotlozhnoi khirurgii.

The authors discuss their experience in surgical treatment of 297 patients who were operated on for acute acalculous cholecystitis. Pointing out the multifactorial development of the disease, they attribute the principle role to the vascular and enzymatic genesis. From their own clinical experience, they recommend laparoscopic examination in the diagnosis of difficult and uncertain cases. The authors emphasize that active surgical tactics is necessary and that the approach to the management of patients with acute acalculous cholecystitis must be differentiated.

[Surgical treatment of diseases of the small intestine]. / Khirurgicheskoe lechenie zabolevanii tonkoi kishki.

The article deals with experience in surgical treatment of 375 patients with various diseases of the small intestine, rare diseases (tuberculosis, enterolithiasis, tumors, etc.) among others. These diseases were usually manifested clinically in the late stages by ileus, peritonitis or bleeding into the gastrointestinal tract. Most patients with surgical diseases of the small intestine were subjected to operation for emergency indications. Such instrumental methods as laparoscopy, selective endoscopic radiocontrast study of the small intestine, angiography, etc. are important in the diagnosis of the diseases. The authors emphasize the high diagnostic efficacy of a special method of selective endoscopic radiocontrast study, especially in tumors of the small intestine. According to the authors, general mortality rate in diseases of the small intestine is high (13%) and is mainly due to such diseases as disorders of mesenteric blood circulation, incarceration of the intestine in a hernia, adhesive obstruction, volvulus, etc. The authors claim that mortality in diseases of the small intestine can be reduced if early diagnosis, early hospitalization, and adequate surgical interventions are ensured. Among the factors contributing to increase of the efficacy of surgical operations the authors indicate efficacy of surgical operations the authors indicate precision techniques of intestinal suture application with atraumatic suture material, the use of complex biological protection of the anastomosis including treatment with low-frequency ultrasound and subsequent application of collagenic films in which antibacterial agents are deposited, and measures for stimulating reparative regeneration.(ABSTRACT TRUNCATED AT 250 WORDS)

[Diagnostic and therapeutic endoscopy in foreign bodies of the digestive tract]. / Diagnosticheskaia i lechebnaia éndoskopiia pri inorodnykh telakh pishchevaritel'nogo trakta.

The authors observed 45 patients with foreign bodies in different parts of the digestive tract. In all the patients the foreign bodies were extracted with the help of endoscopes without complications. Wide introduction of diagnostic and curative endoscopy in the clinical practice in cases with foreign bodies in the digestive tract allows to avoid operations in most cases. Besides, it considerably shortens the time of staying of such patients in the hospital.

[Diagnosis and treatment of digestive tract obstruction using fiberscopes]. / Diagnostika i lechenie neprokhodimosti pishchevaritel'nogo trakta s pomoshch'iu fibroskopov.

The authors propose indications and contraindications for endoscopy performed in 216 patients. The endoscopic picture of the most frequent causes of obstruction is given. In 113 patients endoscopy of the digestive tract was fulfilled also with curative aims, in 48 patients the phenomena of acute obstruction were resolved or considerably abated. This permitted performing the necessary operations in the planned order.

[Endoscopy in the diagnosis of diseases of the esophagus, stomach and duodenum]. / Endoskopiia v diagnostike zabolevanii pishchevoda, zheludka i dvenadtsatiperstnoi kishki

The results of endoscopic studies in 948 patients with various diseases of the upper digestive tract are reported. It is the author's opinion that esophago-gastrointestinal endoscopy is the most informative method of diagnosing diseases of the esophagus, stomach and duodenum.

[Treatment of gastrointestinal polyps]. / Lechenie polipov zheludochno-kishechnogo trakta

The brief historical information concerning the stages in endoscopic polypectomy development is given. Indications and contraindications to polypectomy by means of modern fiberendoscopes are formulated. The results of 409 polypectomies accomplished by means of endoscopes are analysed. The method of electroexcision of polyps is described, and it is to be emphasized that the former is the most radical one among the currently used technics of polypectomy. Attention is paid not only to great therapeutic efficacy of the operation but also to its economic effectiveness.