[Effectiveness of various approaches for acute malignant colonic obstruction]. / Sravnitel'naia otsenka éffektivnosti razlichnykh sposobov lecheniia bol'nykh ostroi tolstokishechnoi neprokhodimost'iu opukholevogo geneza.

AIM: To determine optimal treatment strategy for acute malignant colonic obstruction. MATERIAL AND METHODS: 349 patients with acute malignant colonic obstruction were retrospectively analyzed for the period 2005-2017. All patients were divided into two groups depending on surgical approach. Surgical group comprised 259 patients, endoscopic group - 90 patients. Both groups were comparable by gender, age, level of intestinal obstruction and duration of the disease. However, morbidity and mortality rate were significantly different. RESULTS: In surgical group incidence of complications was 63.3%, mortality - 19.7%. In group of endoscopic stenting the same values were 8.9% and 6.7%, respectively. Significant differences of morbidity and mortality were observed between groups (p<0.05). CONCLUSION: Endoscopic stenting should be preferred over surgery to eliminate colonic obstruction in patients with acute malignant ileus.

[Combined trauma of the abdomen and pelvis]. / Sochetannaia travma zhivota i taza.

Experience in treatment of 164 patients with combined trauma of abdomen and pelvis is analyzed. Mean age of the patients was 40.1+/-17 years, 94 patients were male, 70 -- female. ISS was 28.6+/-11 points. Lethality was 44.5%, during first day -- 61.6%. High lethality may be associated with mistakes in surgical and traumatological policy. Abdominal surgery was performed in 64 (39%) patients, only in 24 (14.6%) of them laparotomy was curative, the rest 40 (85.4%) patients underwent diagnostic laparotomy. It is demonstrated that diagnostic laparotomy has negative influence on prognosis of combined trauma of the abdomen and pelvis. Adequate traumatological policy has also great influence on lethality, particularly during the first day. Overall lethality of patients with rotary-vertical instability of the pelvis was lower in the group with fixation of the pelvis than in conservatively treated patients (41.7 and 56.6%). Lethality during day 1 in patients with fixed pelvis was 0, without fixation of the pelvis -- 82%. It is concluded that verified indications for laparotomy and active traumatological policy improve treatment results in patients with combined trauma of abdomen and pelvis.

[Diagnosis and treatment policy in trauma of duodenum]. / Diagnosticheskaia i lechebnaia taktika pri travme dvenadtsatiperstnoi kishki.

Experience of treatment of 70 patients aged from 17 to 71 years with trauma of duodenum (TD) was analyzed. Majority of them was men -- 57 (81.4%). Open TD were seen in 61.4% cases, closed -- in 38.6%. There were no pathognomonic symptoms. X-ray examination of abdominal cavity is the important procedure permitted to suspect TD. Diagnostic algorithm in abdominal trauma for exclusion of TD before surgery was developed. Yellow-green imbibition, mass of air vesicles in retro-abdominal space, hematomas in duodenal zone were the indications for revision of duodenum during surgery. Hematoma of duodenal wall was indication for it revision for exclusion of penetrating wound. In 55 (77.1%) patients with wounds penetrating into duodenum (or disruption of duodenum) suture of defects was performed. "Exclusion" of duodenum was performed in 20 (28.6%) patients when there was threat of sutures insufficiency. Lethal outcome was seen in 20 (28.6%) patients including 13 (18.6%) cases during first day due to combined injuries and massive blood loss. Developed algorithm and treatment policy permitted to improve results of this severe variant of abdominal trauma.

[Laparoscopy in diagnosis of abdominal injuries in patients with combined trauma]. / Laparoskopiia v diagnostike povrezhdenii zhivota u patsientov s sochetannoi travmoi.

Importance of laparoscopy (LS) in diagnosis of intraabdominal catastrophe in patients with combined trauma (CT) is determined. Based on analysis of treatment results in 1,118 patients with CT it was revealed that real LS requirement does not exceed 10%, and it may influence negatively trauma outcome. Low diagnostic value of this method was revealed: sensitivity 98.4%, specificity 51%, accuracy 69.2%. It is concluded that LS is not a method of choice in diagnosis of intraabdominal injuries in patients with CT.

[Diagnosis of abdominal injuries in combined injury]. / Diagnostika povrezhdenii zhivota pri sochetannoi travme.

Diagnostic value of verification methods for abdominal injuries in patients with combined trauma (CT) was analyzed, severity of injuries by Injuries Severity Scale (ISS) was specified. From 503 patients with CT (ISS = 17.6 +/- 9) diagnostic laparocentesis (DLC) was used in 224 (44.6%), USI--in 204 (40.4%), diagnostic laparoscopy (DLS)--in 49 (9.8%). Diagnostic value of each method is not optimal as they do not confirm or exclude injuries of abdominal organs requiring emergency surgery. Absence of clear criteria of diagnosis of intraabdominal catastrophe leads to significant number of unnecessary laparotomies (DLC--39%, USI--43%, DLS--48.6%) that makes graver state of patients with CT and prognosis.

[Thrombophilia, venous thromboses and their treatment]. / Trombofilii, venoznye trombozy i ikh lechenie.

Thromboses are leading among causes of death worldwide. Arterial thromboses--the underlying cause of myocardial infarctions, strokes and acute ischemia--develop due to a defect of atherosclerotic plaque. Venous thromboses and associated venous thromboembolism killing one of 1000 world population develop in unaffected vascular wall. Recent data show that 70% cases of venous thromboembolism can be prevented by identification of thrombophilia markers--inheritable conditions associated with thromb formation. Current information on variants and prevalence of thrombophilia is given as well as recommendations on venous thromboembolism prevention.