[Radio-frequency ablation appliance in resection of the liver]. / Ispol'zovanie apparata radiochastotnoi ablatsii pri rezektsii pecheni.

Pilot experience with "Radionics Cool-Tip RF System" appliance for radio-frequency ablation (RFA) in hepatic resection in the patients with focal lesions of the liver is presented. Advantages of RFA as an alternative method for hemostasis are demonstrated. With this technique bisegmentectomy (II - III) was performed in 4 patients, right-sided hemihepatectomy - in 2 patients. RFA permitted to minimize intraoperative blood loss without increase of surgery time. There were no severe complications during surgery and in early postoperative period. The method permits to perform combined surgeries without a significant increase of surgical risk.

[Quality of life of patients after antireflux surgery]. / Kachestvo zhizni bol'nykh posle antirefliuksnykh operatsii.

The purpose of our research was to study the patients' quality of life after different traditional and laparoscopic, partial--180, 270 and complete 360 surgical operations in cases of diaphragm esophagus hole hernia and the gastroesophageal reflux disease (GERD).

[Surgical treatment of chronic pancreatitis in combination with duodenal ulcer disease]. / Khirurgicheskoe lechenie khronicheskogo pankreatita v sochetanii s iazvennoi bolezn'iu dvenadtsatiperstnoi kishki.

Results of two surgeries--total and subtotal resection of pancreatic head in combination with selective proximal vagotomy (SPV)--performed for chronic pancreatitis and duodenal ulcer disease (DUD) are presented. In one case surgery was supplemented with circular resection of the duodenum and fundoplication. Reconstructive stage of both surgeries included creation of pacreato- and biliodigestive anastomosis on Roux intestinal loop. Choledochojejunoanastomosis was created on the same loop of the small intestine either "end-to-side" with supraduodenal part of common bile duct or "side-to-side" with its pancreatic part. The former surgery was finished with duodenoduodenoanastomosis "end-to-end" for recovery of duodenal passage. This surgery was characterized by complete removal of pancreatic head. The latter surgery corresponded to Beger's operation. There were no complications in the nearest postoperative period. Long-term results were favorable and followed up during 17.5 and 7 months, respectively. This experience testifies that resection of pancreatic head with SPV may be considered as alternative to pancreatoduodenal resection in surgical treatment of patients with chronic pancreatitis.

[Bronchopulmonary and laryngeal symptoms of gastroesophageal reflux disease: diagnosis and treatment]. / Bronkhopul'monal'nye i laringeal'nye simptomy gastroézofagealnoi refliuksnoi bolezni: diagnostika i lechenie.

The article discloses the results of the examination and treatment of patients with gastroesophageal reflux disease, the course of which was complicated with extraesophageal (bronchopulmonary and laryngeal) symptoms. The authors managed to establish the connection between gastric reflux and pulmonary and laryngeal symptoms with a high degree of reliability, based on the results of functional methods of research (24-hour pH-measurement in the esophagus). The obtained results of the treatment testify to the efficiency of active surgical tactics in this group of patients.

[Place of laparoscopic surgery in the treatment of gastroesophageal reflux]. / Mesto laparoskopicheskoi khirurgii v lecheni gastroézofageal'noi refliuksnoi bolezni.

62 patients (57 females and 5 males, mean age 42.3 years) with gastroesophageal reflux disease were treated and followed up in the A.V. Vishnevsky Institute of Surgery. The diagnosis was established at endoscopic examination, which revealed esophagitis of the 1st degree in 39 patients, of the 2nd--in 20, of the 3d--in 2 and of the 4th--in 1. Roentgenologic examination of the esophagus and the stomach revealed manifestations of the reflux in 43 patients, hernia of the esophageal orifice (of the diaphragm)--in 27. According to esophageal manometry data, basal pressure in the area of the lower esophageal sphincter made up 9.8 +/- 5.7 mm Hg; in 24-hour pH-metry the index of the De Meester exceeded normal 4-5 times and made up 61.1 +/- 33.8. All the patients have undergone a course of conservative antireflux therapy which in the majority of patients resulted in temporary improvement. Laparoscopic operations were carried out in 41 patients (fundoplication by Nissen--in 32, Toupet procedure--in 4 and--by Dor--in 5). In 23 patients cruroraphy and in 32 cholecystectomy have been performed. The patients were followed up from 1 to 36 months. In the majority of them the results were good and favourable.

[Recurrent profuse hemorrhage in gastric angiodysplasia]. / Retsidiviruiushchie profuznye krovotecheniia pri angiodisplazii zheludka.

Dieulafoy's disease--i.e. arteriovenous malformation--is a rare cause of gastric bleedings, which makes up 1.5-3% of all sources of hemorrhage. All the armory of diagnostic modalities may require to reveal arteriovenous malformations. Angiography of the stomach appeared to be the most informative method for diagnosis of this disease in 2 patients. Radical treatment of patients with Dieulafoy's disease implies resection of the proximal part of the stomach or gastrectomy. Endoscopic hemostasis (with the use of coagulation and injections of sclerogenous preparations around the diseased area) results in temporary effect.

[Leiomyomas of small bowel]. / O leiomiomakh tonkoi kishki.

The analysis of our own country and foreign literature, devoted to the problems of clinical aspects, diagnosis and treatment of leiomyomas of the small bowel for the last 48 years has been carried out. The authors present their personal experience in follow-up of 6 cases of the small bowel leiomyomas, the main clinical manifestations of which being recurrent intestinal bleedings and in lesser degree--small bowel obstruction. The results of preoperative examination evidence that besides thorough physical, endoscopical and ultrasound examination the necessity may arise to use for diagnosis angiographic and computed-tomographic methods. The subject of special attention of each clinical physician should be the danger of malignant transformation of benign leiomyomatous neoplasms of the small bowel, which the authors encountered in 2 patients.

[Deep cystic colitis]. / Glubokii kistoznyi kolit.

From 1970 to 1990 the authors treated 4 patients with deep colitis (DCC). There were 2 males and 2 females aged from 19 to 48 years (average age 28.7 years). A local form of DCC with involvement of the rectum (infero- and preampullar part) was recognized in all cases. The only method for DCC treatment is an operative intervention whose volume is determined by the form of the disease and the results of emergency intraoperative morphological study of the affected parts of the large intestine. All 4 patients underwent organ- and sphincter-preserving operation-transanal resection of the rectum. The postoperative period was uneventful. None of the patients had a recurrence of the disease in follow-up periods of 3 to 7 years.

[Differential diagnosis of non-epithelial rectal neoplasms]. / Differentsialnaia diagnostika neépitelialnykh opukholei priamoi kishki.

Experience in the treatment of 118 patients with nonepithelial new growths of the rectum has been accumulated at the Scientific Research Institute of Proctology in the period from 1970 to 1991. They accounted for 1.5% of all benign and malignant tumors of this organ. Leiomyoma was diagnosed in 44, leiomyosarcoma in 18, lipoma in 30, fibroma in 17, neurinoma in 7 and rhabdomyoma in 2 of these patients. A differential diagnosis was made between benign and malignant tumors, as well as with other nonepithelial new growth of the rectum. On the basis of the clinical picture and the results of digital and instrumental (radiological, endoscopic, and ultrasonic) examination of the rectum the correct preoperative diagnosis may be established with certain probability. This influences directly the choice of the volume of the operative intervention in various types of nonepithelial rectal tumors. Morphological verification of the tumor is the principal method of examination in establishing the differential diagnosis in the preoperative and postoperative periods.

[The surgical treatment of benign smooth-muscle tumors of the rectum]. / Khirurgicheskoe lechenie dobrokachestvennykh gladkomyshechnykh opukholei priamoi kishki.

From analysis of the surgical treatment of 36 patients with rectal leiomyoma the authors suggest and substantiate the indications for various types of operative interventions according to the size and location of the tumor. The late-term results of the treatment were studied in all patients who underwent surgery and a brief review of literature on the methods of diagnosis and surgical management of benign smooth-muscle tumors of the rectum is given.

[Locally disseminated cancer of the sigmoid colon]. / Mestno-rasprostranennyi rak obodochnoi kishki.

The study discusses the experience of treatment of 207 patients with locally-advanced cancer of the sigmoid colon who made up 13.5% of the total number of cases of cancer of this site seen in the clinic in 1972-1990. Radical surgery was performed in 170 (82.1%) patients. Postoperative lethality rate was 5.8%, five-year survival rate--70.5 +/- 5.6%. The use of adjuvant preoperative radiotherapy assured a higher resection rate and had no adverse effect on immediate results.