[Plasma lipids oxidation in patients with occlusive atherosclerosis of lower extremities and ischemic heart disease].

Dynamics of lipoprotein oxidation in blood plasma was studied by Cu-induced plasma oxidation in 114 patients with atherosclerosis of lower extremities of various severity with and without ischemic heart disease. Preparedness of plasma lipoproteins to oxidation in patients was higher than in healthy subjects. Degree of oxidizeability increased with increase of severity and extent of atherosclerosis and was highest in patients with atherosclerosis of lower extremities and ischemic heart disease. There were no significant differences between groups of patients with various severity and extent of atherosclerosis in levels of total cholesterol and triglycerides as well as in other parameters of lipid spectrum. Correlation analysis revealed no relationship between age of patients and degree of plasma oxidizeability.

[Ultrasound investigation and mini-invasive ultrasound-assisted technologies in diagnosis and treatment of extra-organ separate fluid formations in abdominal cavity]. / Ul'trazvukovoe issledovanie i maloinvazivnye tekhnologii pod kontrolem UZI v diagnostike i lechenii vneorgannykh otgranichennykh skoplenii zhidkosti v briushnoi polosti.

The authors discuss the use of ultrasound-assisted percutaneous puncture and drainage for diagnosis and treatment of extraorganic separate fluid formations in abdominal cavity (abscess, limited non-infected fluid formation, hematoma with clotted blood), determination of their sizes and obtaining material for laboratory study. 307 patients with various extraorganic separate fluid in formations in abdominal cavity were examined. Ultrasonic symptoms of abscess were described in 54 patients, of limited non-infected fluid formation--in 234, of hematoma with clotted blood in 19 patients. 146 patients were cured conservatively, 75 patients underwent US-assisted puncture, 76--US-assisted drainage. Mean time of drainage was 14 days (ranged from 10 to 20). There were neither complications nor lethal outcomes. Ultrasound examination and US-assisted mini-invasive surgery permit to detect precisely the nature of fluid formation, to perform timely and low-traumatic treatment.

[Obliterating arteriosclerosis of lower limb arteries and ischemic heart disease clinico-pathogenetic correlations]. / Obliteriruiushchii ateroskleroz arterii nizhnikh konechnostei i ishemicheskaia bolezn' serdtsa: kliniko-patogeneticheskie sootnosheniia.

To study clinical and pathogenetic correlations between different stages of arterial deficiency in obliterating atherosclerosis of lower limbs arteries (OALLA) and various clinical forms of ischemic heart disease (IHD) as well as the influence of different risk factors on OALLA clinical course in different arterial territories. The study included 76 OALLA patients (73 men and 3 women, mean age 56 years). The diagnosis was made on the basis of typical complaints, physical and device examinations. IHD was diagnosed on the basis of typical clinical symptoms and/or findings of the device examinations. OALLA and IHD differ by some risk factors. One of them--chronic alcoholism--is responsible for OALLA progression. This was shown by the analysis of chronic alcoholism prevalence in two groups of patients: with OALLA alone and OALLA in combination with IHD. In the former group alcoholics prevailed (61 vs 24.1%). Chronic alcoholism may be considered as an independent risk factor of OALLA development.

[Immunomorphologic detection of apoprotein B antigenic determinants in the gallbladder wall in cholesterosis and cholelithiasis]. / Immunomorfologicheskoe vyiavlenie otdel'nykh antigennykh determinant apoproteina B v stenke zhelzhnogo puzyria pri kholesteroze i zhelchnokamennoi bolezni.

The presence and location of apoprotein B (Apo B) antigenic determinants in cholesterosis and cholelithiasis in gall bladder wall were detected for elaboration of modified Apo B role in pathogenesis of these diseases. Macroscopically changed parts of gall bladder (GB) wall of patients with gall bladder cholesterosis (GBC), and also macroscopically unchanged parts of GB wall of patients with cholelithiasis (CL) after cholecystectomy were studied. Macroscopically unchanged parts of GB wall obtained during autopsy of persons without symptoms of GB pathology were used as a control. Apo B location was studied with monoclonal (MAB 5F8 to Apo B) and polyclonal (PAB) antibodies; Apo B modified by malonic dialdehyde and oxidized by Cu2+ (4C11), Apo A with MAB1C5. Antibodies to CD 68 (specific marker of macrophages) was positive control, antibodies to trichinella--negative control. The most intensive accumulation of modified Apo B was revealed in foam cells region with accumulate lipids and form polyps that testifies to connection of apoproteins with lipids and foam cells and suggests their role in pathogenesis of GBC. More intensive staining of GB epithelial cells, particularly on GB peripheral parts by antibodies to apoproteins compared with surrounding tissues shows that bile is the source of detected modified apoproteins. Increase of absorption and accumulation of apoproteins in GB wall were also revealed in CL but these processes are less intensive than in GBS.

[Use of regulated silicone bandage in horizontal gastroplasty in patients with morbid obesity]. / Ispol'zovanie reguliruemogo silikonovogo bandazha pri gorizontal'noi gastroplastike u bol'nykh morbidnym ozhireniem.

From 1984 in N.N. Burdenko Surgical clinic of I.M. Sechenov MMA more than 500 horizontal gastroplasties (HGP) were performed for the treatment of patients with extreme degree of alimentary-constitutional obesity. In 1996 for the first time in our country HGP was performed, including laparoscopic method, with use of regulated silicon bandage "Lap-Band" (LB) made by "Bioenterics", USA. Laparoscopic HGP was performed in 29 patients (7 males, 22 females), aged from 23 to 60 years, mean age was 34.2 +/- 10 years. Minimal body weight was 85 kg, maximal--180 kg, mean--131 +/- 27.2 kg. Mean body mass index was 47 +/- 9.9 kg/m2. Open operations were performed in 14 cases, laparoscopic operations--in 15 cases. 11 laparoscopies were performed in initial stages in very stout patients and in the absence of laparoscopic equipment. In 3 cases the conversion from laparoscopic to open operation was necessary: in 1st case because of hemorrhage from lesser omentum's vessels, when hemostasis cannot be performed by laparoscopy; in 2nd case as a result of bronchospasm associated with tense pneumoperitoneum in the patient with bronchial asthma; in 3rd case because of significant enlargement and rigidity of liver left lobe, which didn't permit to create the space for manipulations in cardial portion of the stomach. The mean bed day turnover after traditional HGP with LB and after laparoscopic HGP was 12.2 and 5.4 respectively. Intraoperative complication was observed in one case--hemorrhage from lesser omentum's vessels. One complication was observed in immediate postoperative period, on the 6th day after traditional HGP: the eventration as a result of hard diarrhea due to antibacterial treatment was diagnosed. One more complication was observed in a year after traditional HGP: small stomach evacuatory function disorders as a result of its significant dilatation. These disorders occurred because of gastric mucosa inflammatory edema, decrease of anastomosis diameter and frequent vomiting due to aspirin taking. In this case the repeated operation--bandage's reposition was performed. There were no other complications. The rate of repeated operations was 4% which agrees with literature data.

[Noninvasive methods of the examination in surgery of obliterating atherosclerosis of lower extremity arteries]. / Neinvazivnye metody issledovaniia v khirurgii obliteriruiushchego ateroskleroza arterii nizhnikh konechnostei.

The purpose of the study was to determine surgical policy in atherosclerotic lesions of aorta and lower extremities arteries on the basis on non-invasive diagnostic methods--duplex scanning (DS) and computer tomographic angiography (CTA). From 1998 to 1999 47 patients were examined on this program (DS + CTA). At the first stage of the study, 17 patients underwent translumbal aorto-arteriography at the same time with DS and CTA. Analysis of the angiograms revealed that sensitivity of angiography for detection of lesions in aorto-iliac segment was 94%, in femoro-popliteal segment--78%. Diagnostic mistakes were associated with partial thrombosis of aneurysm's lumen, as a result of which the aorta looked non-dilated in angiograms. Femoral arteries contrasted unsatisfactory in 4 patients because of low collateral blood velocity distal to occlusion of iliac arteries. Initial segments of deep and superficial femoral arteries closed each other in angiograms on anterior-posterior projection, and it also led to low potential of angiography in assessment of femoral arteries state. Complex of non-invasive diagnostic methods (DS + CTA) allowed to correct diagnosis in each case. The methods complemented one another: CTA permitted to make three-dimensional reconstruction of vascular tree and to study its on various projections; DS--to study the vascular wall's state and hemodynamical parameters of blood flow. At the second stage of the study, high sensitivity of DS and CTA allowed to reject traditional angiography in preoperative period. Intraoperative findings confirmed the provisional diagnosis completely.

[Treatment of hydatid echinococcosis]. / Lechenie gitatidnogo ékhinokokkoza.

In Russia the first one-stage operation for hepatic echinococcosis was performed by A.A. Bobrov by his method in 1895. At present there is much experience in surgical treating echinococcosis. With the advent of new ultrasonic diagnostic methods, computed tomography, and new germicide treatment methods have changed. The analysis of 228 patients with echinococcosis treated from 1983 to 1999 was carried out. The traditional surgical interventions were performed in 121 patients; the mortality was 2.5%, the relapse rate 22.3%. Minimum invasive interventions (punctures, hydatid cyst drainage, followed by germicidal treatment) were performed as the only treatment in 68 patients and with subsequent traditional interventions in 22 patients. Experimental studies demonstrated that the retention of gigantic acephalocysts in traditional treatment is the main cause of echinococcal dissemination. 80-100% Glycerin is the most effective germicide. Chemotherapy as the only treatment may be applied only in very minor cysts inaccessible to puncture. A combination of minimum invasive procedures and preoperative (1 course) and postoperative (2-3 courses) chemotherapy is the most effective.

[Intraoperative ultrasonography in surgery on organs of abdominal cavity and retroperitoneal space]. / Intraoperatsionnoe ul'trazvukovoe issledovanie organov briushnoi polosti i zabriushinnogo prostranstva.

Since 1984 to 1999 intraoperative US examination (IOUSE) was made in 863 patients. 236 of them had diseases of the liver, 137 diseases of the gall bladder and biliary tract, 158 pancreatic disorders, 151 diseases of gastro-intestinal tract, 72 diseases of the adrenal glands, 101 constitutional obesity, 3 splenic disorders and 5 gunshot wounds of the organs of the abdominal cavity and the retroperitoneal soft tissues. In masses of the liver IOUSE showed limits for resection of the liver, location of the diseased area with the vessels and biliary ducts, unpalpablefoci. OUSE allowed to perform US-guided puncture and sclerosizing small metastatic nodes as well as a puncture and antiparasitic treatment of inaccessible echinococcal cysts. In cholelithiasis IOUSE allows to reveal or to rule out the presence of the concrements in bile ducts. In cases of diseases of the pancreas IOUSE helps to localize pathologic area, defines its interrelations with adjacent major vessels and ducts, reveals unpalpable masses and enables US-guided puncture of the major pancreatic duct followed by its further opening. In gastric tumors it is possible under US control to determine precisely the limits of the infiltration of gastric wall which defines the volume for resection. In operation on the adrenals from thoracophrenolumbar approach IOUSE through the diaphragmatic cupula determines the place and the length of phrenotomy and elucidates interrelations of the tumor with adjacent organs. Sensibility of IOUSE made up from 87 to 100%, and specificity--92-100% depending on the disease.

[Ultrasonic diagnosis of complications after bypass operations in lower extremities arteries]. / Ul'trazvukovaia diagnostika oslozhnenií posle shuntiruiushchikh operatsií na arteriiakh nizhnikh konechnosteí.

After reconstructive vascular operations the patients need dynamic control and non-invasive monitoring. The purpose of the study was to reveal the potential of duplex scanning (DS) in assessment of bypasses function and diagnosis of postoperative complications. 148 patients after aorto-femoral and femoro-popliteal bypass, including patients with late postoperative complications (shunt thrombosis, stenosis or spurious aneurysm of anastomosis) were examined. Energy colored DS was performed in scans "Toshiba" SSH-140 and "Acuson" Sequoia-512. In ultrasonic diagnosis the vascular graft was imaged as a tube structure with hyperechogenic walls and distinct pulse; it was easy to detect the material of vascular graft. In examination of distal anastomosis the initial portions of efferent arteries were usually imaged distinctly. In satisfactory distal vascular bed, the shunt's blood flow did not differ from normal blood flow. In patients with multifocal lesions the spectrum of shunt's blood flow was similar to main-changed blood flow. Substantial change of blood velocity was revealed in complications (aneurysm or stenosis of anastomosis). Spurious aneurysm was imaged as a hypoechogenic pulsating formation. Thrombotic masses in aneurysm's cavity were distinctly detected at DS, unlike at angiography. In case of anastomosis insufficiency, the suture's disrupted filaments and free branch's ends could be imaged. Stenosis of anastomosis was characterized by visible lumen's stenosis, local thickening and unevenness of wall, spectrum's change and blood velocity increase. In shunt's thrombosis the DS permitted to follow the thrombed graft's path, to reveal the cause of thrombosis and to detect the condition of outflow tract. The authors regard DS as a method of choice in dynamic control for state of bypasses and arteries in patients after reconstructive operations in lower extremities arteries.

[Combined operations for cholelithiasis]. / Sochetannye operatsii pri kholelitiaze.

The experience of 1560 combined operations performed in N.N.Burdenko clinic from 1974 to March 1999 for cholelithiasis is analysed. The results of 7461 cholecystectomies are analysed depending on patients' age (17.8% of patients aged 65 years and older), urgency of the operations (there were 35.6% of patients of this age group who underwent surgery under strictly urgent conditions), and complicacy of the operation (combined operations were carried out in 837 patients with cholecystitis). Last years in the clinic each 10th cholecystectomy is carried out as an additional procedure in more complicated surgery, or it is combined with less complicated one. Thus, in 389 patients with more complicated diseases than cholelithiasis (approximately in a half of them tumors of various locations were observed), cholecystectomy was performed as a combined procedure (1st group), and in 448 patients (2nd group) it was the main procedure. In the 1st group 27% of patients were aged 65 years and older, the overwhelming majority of the operations were carried out by the same approach, mortality rate being 3.3%. In the 2nd group elderly patients made up 20.7%; 68.3% of patients were operated by two approaches, lethality rate being 0.2%. Thus, lethality after 837 combined operations made up 1.7%, total mortality rate after 7461 cholecystectomies made up 0.29%.

[Diagnosis and treatment of isolated subdiaphragmatic liquid accumulations under ultrasound control]. / Diagnostika i lechenie ogranichennykh poddiafragmal'nykh zhidkostnykh skoplenii pod kontrolem UZI.

The analysis of diagnostic abilities of ultrasound and miniinvasive treatment under ultrasound examination control in 39 patients with subdiaphragmatic local fluid accumulations in abdominal cavity has been carried out. The revealed by US examination manifestations of the abscess formation in 15 patients, local noninfected accumulation of fluid in 20 patients, haematomas (hemolized)--in 4 are described. Indications for the treatment by punctures and drainage of local subdiaphragmatic fluid accumulations under US control depending on the size, form and character of liquid accumulation are given. 11 patients were cured by a single puncture, 1--by multiple punctures, 27--by drainage under US-control. The use of miniinvasive technologies resulted in no complications and mortality in this group of patients. Laboratory examination of the material taken by punctures and drainage under US-control demonstrated in 20 patients infected material and in 14--uninfected one, in 5 patients hematoma was detected. Standard operations performed from 1946 in the surgical clinic resulted in lethality of 19%.

[Minimally invasive interventions in treatment of mechanical jaundice]. / Maloinvazivnye vmeshatel'stva v lechenii mekhanicheskoi zheltukhi.

For the period from 1972 to 1997 676 transcutaneous transhepatic and 370 endoscopical interventions in 953 patients with mechanical jaundice were carried out. In 58.5% of cases jaundice was caused by malignancies, in 41.4%--by benign strictures of bile ducts. 40 external biliary bypasses, 427 external-internal biliary bypasses, 55 cholecystostomies and 154 operations of biliary endoprosthetic reconstructions were conducted under US control and TV imaging. In 33.5% of cases biliary bypass and endoscopical procedures were made as a preliminary stage of preparation of patients for operation or as a final method of treatment after conventional operation procedures, in 66.5% of cases it was final method of treatment. There were no deaths caused by biliary bypass procedures nor complications related to laparotomy. Thus low invasive interventions, undoubtedly, are the method of choice in mechanical jaundice for preparation of patients before radical operations as well as for relief of the course of disease in patients with inoperable cancer which causes obstruction of biliary ducts.

[The role of duplex scanning in determination of indications for shunting procedures in patients with Leriche syndrome]. / Rol' dupleksnogo skanirovaniia v opredelenii pokazanii k shuntiruiushchim operatsiiam u bol'nykh s sindromom Lerisha.

Duplex scanning (DS) is the only available method for visualization of the internal aperture and arteries walls, to evaluate hemodynamic significance of stenosis. DS was used in 41 patients with aorto-femoral occlusions. The vessels diameter parallel with the specific features of the walls lesions and parameters of doppler frequency spectrum have been examined. In all patients the results of DS were compared with the results of paracentetic translumbal or i.v. digital angiography, equally with intraoperative evaluation. The classification of iliac arteries stenosis based on ultrasound examination has been proposed. In cases of stenosis less than 80% the results of DS appeared to be more accurate than results of angiography. In critical stenosis the results of DS coincided with the results of angiography. The use of DS in 11 patients without clinical and angiographical signs of stenosis made it possible to reveal the lesion and take the decision for bifurcation by-pass surgery. In 98% the results of DS coincided with the results of intraoperative evaluation. DS must be used in patients with Leriche syndrome.

[Treatment of peritonitis complicated by multiple organ insufficiency]. / Lechenie peritonita s poliorgannoi nedostatochnostíu.

Comparison evaluation of the methods of treatment was based on the analysis of the results of management of 347 patients with general purulent decompensated peritonitis with polyorganic insufficiency. The efficacy of closed drainage in 98 patients, continuous flow irrigation (dialysis) in 126, stage programmed irrigation and inspection of the abdominal cavity in 99, and open drainage in 24 patients was compared. The causes of peritonitis were: complications after acute surgical diseases (in 156 cases), in planned operations (59), and in obstetrical and gynecological diseases (132). Most of the patients were brought to the clinic from other hospitals because of unsuccessful treatment of peritonitis and absence of means for performing hemodialysis and management of polyorganic insufficiency. The incidence of the last-named reached 71.0 to 91.0% in the different groups of patients. In monotypic complex treatment, stage programmed irrigation was marked by a much lesser number of abscesses and other complications and a lower mortality (20.2%) as compared to flow irrigation (30.0%, closed drainage (27.5%), and open (laparostomy) treatment (37.5%). Despite the very serious contingent of patients, total mortality (27.0%) in the application of the indicated methods was quite low.