[Transhiatal esophagectomy]. / Transkhiatal'naia ézofagéktomiia.

Results of 56 transhiatal esophagectomies performed for cardioesophageal cancer from 1985 to 1999 are evaluated. Operation was completed by one-stage plastic repair with gastric flap or colon. Manual transhiatal esophagectomy performed in 35 cases led to many intraoperative complications in location of the tumor in the middle and top part of thoracic esophagus, including two fatal. These complications make manual transhiatal esophagectomy in this location of the tumor undesirable. Of it is indicated only in location tumor in the bottom third of the esophagus. In such cases instrumental transhiatal removal of the esophagus above the tumor is made. This method was used in 21 cases without intraoperative complications and lethal outcomes.

[Clinical and morphological characteristics and peculiarities of differentiated thyroid gland cancer course]. / Kliniko-morfologicheskaia kharakteristika i osobennosti techeniia differentsirovannykh form raka shchitovidnoi zhelezy.

221 patients were operated for cancer of the thyroid gland during the last 12 years. Adequate preoperative diagnosis including ultrasound examination, and fine needle aspiration biopsy made it possible to operate 88.7% of patients at earlier (I and II) stages of the disease. Long term results of radical surgical treatment have been studied in 197 (89.1%) patients followed up 5 to 16 years, 49.2% of patients being followed up for no less than 10 years. Majority of patients (95.9%) had differentiated forms of tumors, medullar cancer was detected in 4.1% of patients. Clinical and morphological analysis of differentiated thyroid cancer was carried out in 212 patients. Metastases to lymph nodes of the neck occur more frequently in younger patients, and extracapsular spread of the tumor was revealed in aged persons. Risk factors were male sex, old age, follicular cancer and growth of the tumor through the capsule of the gland. The minimal procedure in case of location of the differentiated tumor in a single lobe of thyroid is extrafascial hemithyreoidectomy with resection of the istmus. Prognosis in radically operated patients is relatively favourable, 5-year survival rate made up 97.5%.

[Prognosis of plasmapheresis in patients with thyrotoxicosis]. / Prognozirovanie rezul'tatov plazmafereza u bol'nykh tireotoksikozom.

The kinetic model of continuous gravitation plasmapheresis on preoperative preparation of patients with thyrotoxicosis has been developed and fried on 41 patients who had failed thyrostatic drugs or were intolerant to them. The model takes into account the process of plasma mixing. The prognostic value of the model in all cases exceeded 0.83; being in sonne cases > 0.09. The prognostic accuracy of the model was higher if the plasma volume and thyroid hormones concentration were considered.

[Some aspects of surgical treatment of postoperative ventral hernia]. / Chastnye aspekty khirurgicheskogo lecheniia posleoperatsionnykh ventralnykh gryzh.

The results of surgical treatment of of 392 patients with postoperative ventral hernia are discussed. The algorithm of treatment of patients with large hernias was developed. Special preoperative management by dosed pneumocompression in an antioverload costume makes it possible to avoid menacing complications after the operation, which are caused by increased intraabdominal pressure. Test for tolerance to increase of intraabodominal pressure allowed prognostication of the character of the operative intervention: with or without decrease of the volume of the abdominal cavity (autoplasty or alloplasty, respectively). Prevention of wound complications consisted in control of infection, improvement of operative techniques, and use of modern surgical instruments. The prevention of recurrent hernias should be directed at correct choice of the method of plastics and removal of wound complications.

[Perspectives in the advancement of abdominal wall repair using e synthetic prosthesis]. / Perspektivy razvitiia abdominoplastiki sinteticheskimi protezami.

Alloplasty with synthetic prosthesis has its advantages and shortcomings. The great number of wound complications limits the wide use of alloplastics in repair of defects in the abdominal wall in patients with large postoperative hernias. For reducing the incidence of wound complications, it is important to solve some problems: organization of herniological centers and specialized departments, industrial production of synthetic prostheses of various size in sterile packings, perfection of the alloplasty techniques, and observance of measures for the prevention of infection.

[Late results of surgical treatment of differentiated thyroid cancer]. / Otdalënnye rezul'taty khirurgicheskogo lecheniia differentsirovannogo raka shchitovidnoi zhelezy.

Retrospective analysis of 94 patients who were operated on in the clinic in 1981-1987 for differentiated carcinoma of the thyroid was conducted with the use of the classification of the disease formulated by the American United Cancer Committee and the Committee TNM of the International Anticancer Union which takes into account the patients's age. According to the new system of stages, 34 patients under 45 years of age with any indices of T, N, and MO, and 14 patients over 45 years of age with indices Tl, NO, and MO were related to stage I. The postoperative follow-up period ranges from 4 to 9.5 years. During that time, metastases to the regional lymph nodes developed in 9 (9.5%) patients, remote metastases in one (1.1%) patient, and local recurrence of the tumor was diagnosed in 14 (14.5%) patients, with the tumor recurring in most or them 5 years after the operation. Six (6.4%) patients died from carcinoma. The work appraises the prognostic significance of dividing the patients according to stages from the standpoint of the tendency to recur and metastasize, and the carcinoma mortality rate. It is shown that patients who underwent operation for thyroid carcinoma must be kept under observation for a long time.

[The development of late dysphagia after the implantation of an antireflux prosthesis]. / Razvitie pozdnei disfagii pri implantatsii antirefliuksnogo proteza.

The paper analyzes three cases of developed uniphagia and/or dysphagia in long-term postoperative periods. No predictors of late dysphagia were observed. Maintenance of antireflux activity after prosthesis removal is of great interest. The authors recommend that the antireflux prosthesis should be used in the situations at a high risk of routine fundoplication.

[Comparative studies of immunologic characteristics in plasmapheresis and hemosorption in patients with purulent diseases of the lungs and pleura]. / Sravnitel'naia kharakteristika immunologicheskikh pokazatelei pri plazmafereze i gemosorbtsii u bol'nykh gnoinymi zaboleva- niiami legkikh i plevry.

The article deals with the comparative characteristics of the changes in immunological indices in 40 patients with non-specific purulent diseases of the lungs and pleura when plasmapheresis and hemosorption were included in the complex of therapeutic measures. The changes were found to be hetero-directional in character: a non-specific effect of immunostimulation in hemosorption, and immunodepression, particularly marked in the first 24 hours, in plasmapheresis. The post-aggressive reaction after plasmapheresis is either absent or delayed significantly, which makes it possible to conduct detoxification in extremely grave conditions of the patients without making the mechanisms of the post-aggressive reaction operative, as observed in performance of hemosorption.

[Pharmacokinetic monitoring of aminoglycoside therapy: an optimal method of administration of individualized doses of gentamicin and sisomicin]. / Farmakokineticheskii monitoring pri lechenii aminoglikozidami: optimal'nyi sposob individualizatsii dozirovaniia gentamitsina i sizomitsina.

One of the most promising approaches to design the optimal schedule for TDM provides a single determination of a drug content in the blood specimen being collected at the "ideal" sampling time equaled to the inverse value of the elimination rate constant. Three versions of the one-point method when the specimen was collected at the "ideal" time point (3 h after a single i.m. drug administration), as well as at the times of "maximum" (1 h after injection) and "minimum" (6 h after injection) concentrations were compared by the retrospective analysis of the routine TDM data obtained with HPLC-techniques in 47 patients treated with gentamicin or sisomicin. As optimal individualized doses were considered ones calculated on the base of three subsequent determinations of the aminoglycoside concentrations, i.e. 1, 3 and 6 h after injection, and the estimation of individual clearance values (Cli). The optimal doses (DCl) were calculated according to equation DCl = Dp.Cli/Clp, where Dp and Clp are population values of the dose (1 mg/kg) and Cl 72.4 ml/(h.kg), respectively. The approximate values of the individual doses (D) were calculated according to equation D = Dp.Cp/Ci, where Ci is the individual drug serum concentration 1, 3 or 6 h after administration and Cp is the corresponded population value (4.8, 1.9 and 0.8 mg/l, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

[Drug pleurodesis, an alternative to surgical treatment of spontaneous pneumothorax]. / Lekarstvennyi plevrodez--al'ternativa khirurgicheskomu lecheniiu spontannogo pnevmotoraksa.

The article describes the method of drug pleurodesis and determines the indications for its application. Study of the late-term results and the drawn conclusions provide evidence that the method of drug pleurodesis may de an alternative to operative treatment of spontaneous pneumothorax.

[Plasmapheresis in preoperative care of patients with thyrotoxicosis]. / Plazmaferez v predoperatsionnoi podgotovke bol'nykh s tireotoksikozom.

The authors studied the efficacy of plasmapheresis in preoperative management of patients with thyrotoxicosis in intolerance of and resistance to thyrostatic agents. Seventy-three patients were examined. Preoperative management was accomplished by gravitation plasmapheresis (PP) with a PP-0.5 apparatus according to the continuous flow principle. The course consisted of 1-5 sessions during which a total volume of 800-5,000 ml of plasma was removed. Heparin was administered in a dose of 150-200 U/kg before PP. It was proved that the most rational technique was replacement of the lost plasma by reopolyglucin with albumin--300% of the total volume of the plasma substitute. Dynamic study of the level of the T3, T4, and TSH hormones proved that the use of such substituting medium leads to stable euthyroidism and that PP is the optimal method of preoperative management of patients with thyrotoxicosis in intolerance of and resistance to thyrostatic agents.

[Extracorporeal elimination of CO2 as a component of the intensive therapy of status asthmaticus]. / Ekstrakorporal'naia éliminatsiia CO2 kak komponent intensivnoi terapii astmaticheskogo statusa.

The first industrial Soviet membrane oxygenator "MOCT-122" was used for extracorporeal CO2 elimination lasting for several (up to 24) hours, in 4 patients with severe asthmatic status. This led to hypercapnia liquidation and optimization of an intensive regimen of controlled lung ventilation, which made it possible to perform effective tracheobronchial lavage in the most favourable conditions. No complications of assisted veno-venous perfusion have been observed as a result of therapeutic procedures performed. Third degree asthmatic status was arrested in all the patients and they were discharged from hospital in a satisfactory condition.

[Plasma scalpel in pulmonary surgery]. / Plazmennyi skal'pel' v khirurgii legkikh.

The "Plasma scalpel CP-M" device was used in experiments on dogs to study the possibility of applying plasma irradiation in the surgery of the lungs. The morphology of their "plasma wound" and reparative processes was studied. The plasma device was employed in the clinic in 40 various operations on the lungs and thoracic wall for cleansing the pleural cavity and operative wound, hemostasis from the walls of the pleural cavity, and hermetic closure of the lung wound surface. It was established that the plasma scalpel can be used effectively in hermetic closure of defects in the pulmonary tissue and cleansing of the pleural cavity and operative wound; for arresting diffuse bleeding from the walls of the pleural cavity, the plasma scalpel may be used only in combination with other methods of hemostasis.

[Pharmacokinetic monitoring during aminoglycoside treatment: the optimal method for individualizing the dosage of tobramycin]. / Farmakokineticheskii monitoring pri lechenii aminoglikozidami: optimal'nyi sposob individualizatsii dozirovaniia tobramitsina.

The results of tobramycin concentration monitoring in 33 patients with nonspecific pulmonary infections showed a marked individual variability of the antibiotic blood levels and model-independent pharmacokinetic parameters: total clearance, steady-state volume of distribution and mean residence time whose values were distributed log-normally. Adjusting of the tobramycin dosage by the individual values of the clearance (three-point method, by concentrations 1 h (C1), 3 h (C3) and 6 h (C6), after intramuscular single administration of the antibiotic and one-point method, by C3, after repeated administrations of the antibiotic) provided by the end of a 7-day course a 1.7-fold decrease in the individual ranges of the antibiotic concentration as compared to those without the dosage adjusting. Retrospective analysis revealed that reliable individual dosing of tobramycin was provided with the simplest one-point method when the only blood specimen was collected 3 hours after the injection, i.e. the time interval inversed to the elimination rate constant. According to this method individual doses Dind were calculated by the equation Dind = DpopCpop/Cind, where pop was the population value of D and C. The values of Dind estimated in such a way did not practically differ from those estimated with the more complicated two-point (by C1 and C6) and three-point methods. Application of the equation to the tobramycin "maximum" concentration C1 or the "minimum" one (toward the end of the dosing interval, C6) resulted in less accurate and unbiased estimation of Dind.

[Individual schedule of administration of aminoglycosides with reference to anatomo-physiological and pathological factors]. / Individualizatsiia skhem vvedenia aminoglikozidov s uchetom anatomo-fiziologicheskikh i patologicheskikh faktorov.

Potentiality of designing individual dosage of sisomicin and gentamicin in regard to "patient factors" was estimated. 62 adult patients with various pulmonary diseases at the background of volemic disorders of diverse degrees were treated with the aminoglycosides under monitoring of their blood levels. Concentrations of sisomicin and gentamicin in serum 1, 3 and 6 hours after their single administration in a dose of 1 mg/kg were determined by HELC. The antibiotic pharmacokinetics was characterized by pronounced individual variability. The ratio of the difference between the upper and lower confidence limits to the average values of the steady-state volume of distribution, the total clearance and the mean residence time amounted to 70, 60 and 57 per cent respectively. To elucidate the cause of the variability multiple correlation analysis of the pharmacokinetic parameters by the "patient factors" was performed. The highest coefficient of the multiple correlation (r = 0.690) defined relation between the aminoglycoside concentration 1 hour after the injection and the hematocrit, globular volume and phase of the volemic disorders which was expressed in coded variables. The coefficient of the multiple correlation between the total clearance and the body surface area, concentrations of creatinine and urea in serum, hematocrit, circulating blood volume and the phase of the volemic disorders was equal to 0.439. Therefore, the consideration of the above factors allowed to explain only 20 per cent of the observed individual variability of the pharmacokinetic parameters. In this connection mediated prediction of total clearance and subsequently individual dosage of the aminoglycosides by the "patient factors" was expedient only until the primary data on the pharmacokinetic monitoring were obtained.

[Predicting surgical risk in acute cholecystitis]. / Prognozirovanie riska operatsii pri ostrom kholetsistite.

From mathematical treatment of the results of operative treatment of 163 patients with acute cholecystitis on a computer with the use of program complexes on the basis of the mathematical theory of image recognition the authors obtained a decisive rule which allowed calculation of the prognostic index reflecting the severity of the patient's condition and the prognosis of the surgical treatment according to the initial values of total protein, leucocytosis, AlAT, and the patient's age. Besides, the efficacy of the preoperative management can be judged from the dynamics of changes of the index. Development of the tactics of treatment of patients with acute cholecystitis on the basis of the prognostic index improved the results of operative treatment considerably.