[Anaerobic non-clostridial infection in acute appendicitis]. / Anaérobnaia neklostridial'naia infektsiia pri ostrom appenditsite.

Etiological factors promoting anaerobic non-clostridial infection (ANI) after appendectomy are analyzed for the last 10 years (1993-2002). Acute appendicitis was the indication for appendectomies in 2846 patients. In 55 (1.9%) patients ANI was detected 2-7 days after surgery. Later than 24 hours since beginning of the disease 40 (72.7%) patients were hospitalized. Diagnosis of ANI was based on typical clinical symptoms confirmed with bacteriological and morphological examinations. Treatment of ANI was complex: early radical surgery, massive antibiotic therapy, hyperbaric oxygenation, intensive care. 10-14 days after the last necrectomy (wound area from 139 to 1812 cm(2)) repair dermal-plastic surgeries were performed in 48 (87.3%) patients with good functional and cosmetic results. Two (3.6%) patients with ANI died. Of six patients with general forms of ANI admitted from other hospitals 3 patients died. Sepsis was the main cause of death. Late surgeries in general forms of ANI lead to worse results.

[Electrostimulation therapy--a new method of preventing postoperative wound complications in abdominal surgery]. / Elektroimpul'snaia obrabotka tkanei--novyi metod profilaktiki posleoperatsionnykh ranevykh oslozhnenii v abdominan'noi khirurgii.

Experimental investigations have shown that chemotaxic activity of microorganisms in the parietal peritoneum and abdominal organ tissues is inhibited when they are treated with impulse electric discharges preventing the process of infecting the tissues. Results of the experiments underlay the development of a new method of prophylactics of postoperative complications in abdominal surgery based on the electroimpulsive treatment of the operation wound. Clinical approbation of the method showed its effectiveness, simplicity and safety.

[Surgical prevention of postresection reflux-gastritis]. / Khirurgicheskaia profilaktika postrezektsionnogo refliuks-gastrita.

Results of treatment of 331 patients operated in surgical clinic of Karaganda Medical Academy from 1990 to 1998 for complicated form of gastric and duodenal ulcers are presented. For surgical prophylaxis of postresective reflux-gastritis and to reduce the risk of sutures insufficiency two original methods of creation of transverse terminolateral gastroduodenoanastomosis with a reflux mechanism were proposed. These methods were used in 129 (39%) patients. Biochemical, endoscopic, X-ray, ultrasonic, morphological examinations demonstrated advantages of the proposed methods of stomach resection which promote portion-tardive type of evacuation with lower rate of postresective pathological states. It is concluded that these operations may be used as methods of choice in surgical treatment of ulcer.

[Surgery of a purulent wound of the foot]. / Khirurgiia gnoinoi rany stopy.

The experience of plastic closure of purulent wounds in the foot of 55 patients is presented. The average area of wounds was 61 cm2. Treatment of defects of plantar surface was most difficult. The differential policy in plastic surgery of foot wounds was developed. Complete closure of the defect was achieved in 81% patients. The most promising method of plastic closure is dosed tissue expanding.

[Omentoplasty in limb surgery]. / Omentoplastika v khirurgii konechnostei.

The authors describe a method of omentoplasty used in 55 patients with lymphodema, chronic osteomyelitis, scalped bad burn wounds. Good results of treatment were noted in all the patients.

[The surgical treatment of injuries to the abdominal aorta and inferior vena cava]. / Khirurgicheskoe lechenie povrezhdenii briushnoi aorty i nizhnei poloi veny.

The experience of treatment of 44 patients with traumatic and abdominal aorta and inferior cava vein is represented. All traumatic injuries of these vessels were accompanied by damages organs. Various kinds of vascular suture and angioplasty with synthetic prostheses were used. 17 operated patients died (38.6%). 19 patients were followed up for period from 1 to 8 years after surgery. Neither arterial nor venous blood flow disturbances were revealed.

[Evaluation of results of surgical treatment of peptic ulcer associated with Helicobacter pylori]. / Otsenka rezul'tatov khirurgicheskogo lecheniia iazvennoi bolezni, assotsiirovannoi s Helicobacter pylori.

Under observation there were 82 patients operated on for ulcer disease of the stomach and duodenum. Dissemination of the mucosa with Helicobacter pylori (HP) was studied by means of using the urease test. Before the operation the positive result of the study was obtained in 73 patients (89%). In 1-6 months after the operation the HP infection was found in 29 patients (39.7%). The HP persistence retained in 39.7% of the patients subjected to resection of the stomach in spite of the preoperative treatment including De-nol and Metronidazole. Post-resectional reflux-gastritis and anastomositis were more pronounced in HP carriers. The antireflux variants of anastomoses (transversal, terminolateral gastroduodenal anastomosis and gastrojejunal anastomosis by Roux) were followed by much less HP persistence and less frequent cases of anastomositis and gastritis of the gastric stump.

[The diagnosis and treatment of chronic osteomyelitis in patients with spinal cord trauma]. / Diagnostika i lechenie khronicheskogo osteomielita u bol'nykh so spinnomozgovoi travmoi.

Results of examination and treatment of 75 patients with a trauma disease of the spinal cord with bedsores are presented. Osteomyelitis which developed in places of localization of longstanding bedsores took place in 39% of patients. The general complex of treatment included associated intraosseous and direct endolymphatic antibiotic therapy as the main treatment as well as the efficient preoperative preparation. Good clinical effect was obtained.

[Wounds of the abdomen and pelvis with damage to the major vessels]. / Raneniia zhivota i taza s povrezhdeniem magistral'nykh sosudov.

The results of treatment of 144 patients with major vessels injuries in abdomen and pelvis injuries are performed. They had injuries of 146 vessels and of 220 abdominal organs. Mean blood loss was 2620 ml. 39 persons died (27.1%). The main lethality causes: haemorrhagic shock, late admission to the hospital, non-adequate angiosurgical service. The most characteristic errors in polytrauma: nonremoved major vessels injuries in laparotomy, unsuccessful attempts to stop bleeding and nonprofessional placing of a vascular suture, wrong sequence of operative instruments, defects of surgical service organization.

[Stomach injury]. / Povrezhdenie zheludka.

The results of treatment of 221 patients with injury to a stomach (IS), whose age range was from 3.5 to 71 years, have been analysed. Closed IS was noted in 9 (4.1%), open--in 212 (95,9%), isolated--38.5%. The main method of operative treatment (in 92.8% of sufferers) was the organ closure. Surgical errors were made in 9.5% of the patients. The postoperative complications occurred in 75 (33.9%) sufferers. Total lethality was 11.8%. A good long-term result of treatment was noted in 48.0%, a satisfactory one--in 45.2%, an unsatisfactory one--6.8% patients.

[A combination of a duodenal diverticulum and the postcholecystectomy syndrome]. / Sochetanie divertikula dvenadtsatiperstnoi kishki i postkholetsistéktomicheskogo sindroma.

The surgical treatment results of 68 patients with duodenal diverticulum were analyzed, 21 of whom the various interventions on biliary tracts for cholelithic disease and her complications earlier were conducted. Postcholecystectomy syndrome origin was connected with non-diagnosed and non-eliminated duodenal peripapillary diverticulum. The clinical peculiarities, diagnostic algorithm and the complex of preoperative preparation, surgical treatment and complications prophylaxis are adduced. The necessity of associated terminal common bile duct portion correction plus diverticulectomy or intestine exclusion according to A. G. Zemlianoi was suggested.

[Duodenal injuries]. / Povrezhdeniia dvenadtsatiperstnoi kishki.

Experience in surgical treatment of 69 patients with open (41) and closed (28) injuries to the duodenum (D) is analysed. The wound (rupture) was closed with sutures in 52 patients, closure of the wound was supplemented by gastroenterostomy in 9 patients, other variants of treatment were applied in 8 patients. In 7 patients the damage of the D was not detected during the first operation. Complications developed in 34.8% of cases, mortality was 27.5%. A diagnostic algorithm is suggested which includes along with clinical examination, successive radioscopy (-graphy), laparocentesis or laparoscopy, and fibrogastroduodenoscopy. The therapeutic and diagnostic program included intraoperative transcatheter pneumopressure, standardized operative variants with the use of precision suture techniques, and decompressive drainage of the D with a fixed catheter. As a result the number of complications reduced by 1.5 times and lethality by half. The late-term results were studied in 26 patients, they were found to be good in 21 of them.

[Simultaneous operations in surgery of the biliary tract]. / Odnovremennye operatsii v khirurgii zhelchevyvodiashchikh putei.

The experience with simultaneous performance of the operations on the bile ducts and other organs in 802 patients, including 109 who underwent simultaneous operations on 2 or several organs for pathogenetically unrelated diseases (lethality--1.9%), 662--combined interventions on the anatomically and functionally connected organs for main disease and its complications (lethality 29%), is summarized. Simultaneous performance of the operations ensures the effective and radical surgical treatment.

[Prevention of incompetence of sutures of the colon in its injuries]. / Profilaktika nesostoiatel'nosti shvov obodochnoi kishki pri ee povrezhdeniiakh.

The authors analysed 242 clinical cases of open and closed injury to the colon and the results of experiments on 120 animals. Incompetence of the sutures of the colon was encountered in 12 (4.9%) patients: in 10 (5.2%) with punctured-incised injuries, in one (3.3%) with subcutaneous rupture, and in one (5.5%) with gunshot injury. Clinico-experimental studies allowed 2 groups of pathogenetic factors (predisposing and resolving) in the development of incompetence of colonic sutures to be distinguished. The pathogenetic approach forms the basis of the developed complex program of the prevention of incompetence of the sutures of the colon in its injuries. Introduction of the suggested program into clinical practice made it possible to reduce the incidence of incompetence of colonic sutures from 6.6 to 2.0%.

[Clinical pharmacokinetics of kanamycin in endolymphatic therapy of peritonitis]. / Klinicheskaia farmakokinetika kanamitsina pri éndolimfaticheskoi terapii peritonita.

The pharmacokinetics of kanamycin in patients with peritonitis was studied after its intramuscular, endolymphatic and lymphotropic administration. Endolymphatic administration of kanamycin provided an increase in its activity in the inflamed tissues of the peritoneum and omentum and markedly prolonged its halflife as compared to those after the routine intramuscular administration of the drug. Lymphotropic administration of kanamycin failed to provide the same effect. Endolymphatic therapy of the patients during the postoperative period provided a decrease in the lethality, development of complications and the terms of the treatment in the hospital. The therapeutic effect of the endolymphatic administration of kanamycin to the patients with peritonitis proved to be high. The more efficient antibiotic therapy of the cases was likely due to favourable shifts in the pharmacokinetics of kanamycin after its endolymphatic administration.

[The functional morphology of the regional inguinal lymph nodes during the endolymphatic antibiotic therapy of patients with vascular diseases of the lower extremities]. / Funktsional'naia morfologiia regionarnykh pakhovykh limfaticheskikh uzlov pri éndolimfaticheskoi antibiotikoterapii u bol'nykh s zabolevaniiami sosudov nizhnikh konechnostei.

The general structure and cell composition of the inguinal lymph nodes has been analysed at a direct endolymphatic antibiotic therapy, performed with the aim of prophylaxis of suppurative complications, when surgical interventions are performed in the vessels of the lower extremities. Morphokinetics of the lymph nodes depends on duration of the endolymphatic therapy. During early terms it reflects an increase in transport function of the regional inguinal lymph nodes, during late terms it reflects an increase in their immune role. In the lymph nodes, situating on the contralateral side, an analogous reaction is revealed; this appears to demonstrate presence of well developed collaterals between lymph vessels of the lower extremities.

[A surgeon's rating as objective criterion for professional competence]. / Reiting khirurga kak ob''ektivnyi kriterii professional'noi podgotovki.

The authors suggest evaluation of the qualification of a general surgeon by means of an individual coefficient-rating which is determined from 2 tables: basic and working. Its value is expressed in scores and depends, on the main, on the number of operations carried out during the year. Comparison of the rating in dynamics for several years facilitates the control over the surgeon's professional background, optimal formation of the operating team, and reduction of the degree of operative risk.