[Microflora of the small intestine in patients with perforating duodenal ulcers].

The toxic phase of peritonitis in patients with perforating duodenal ulcers is accompanied with the development of syndrome of redundant bacterial colonization of the small intestine. However, it is less pronounced than in other forms of intra-abdominal infection. The greatest quantitative growth in all the patients is observed among the species of the family of enterobacteria and aerobic Gram-positive bacilli, the bacterial species dominating in the upper part of the intestine in health being the leading etiological agents of intra-abdominal infection in patients with perforating duodenal ulcers. Unlike peritonitis of other etiology strict anaerobic bacteria are found in the small intestine much rarer.

[Associated complications of peptic ulcer and their surgical treatment].

Based on an experience with treatment of 269 patients with complicated peptic ulcer the authors came to a conclusion that the most sparing and radical operation was subdiaphragmatic truncal vagotomy with Finney pyloroplasty with lethality of 6.8%. Resection of the stomach and forced palliative interventions such as suturing of perforated and bleeding ulcers resulted in lethal outcomes in more than 50% of them.

[Experience in surgery of diastatic ruptures of the colon].

An experience with treatment of 58 patients operated upon for carcinoma of the colon complicated by acute intestinal obstruction and diastatic perforation has been analyzed, 13 patients had incomplete diastatic ruptures (tears) of the colon. In 23 patients the IV stage of the tumor process (remote metastases) were found and the other 35 patients had the III stage. In early terms after operation 37 (63.8%) patients out of 58 patients died. Lethality after incomplete diastatic ruptures of the colon made up 53.8%, and after diastatic perforation - 67.7%. The main cause of lethal outcomes was polyorganic insufficiency against the background of intoxication of mixed genesis (cancerous + endogenous). Ablation of colonic tumor is justified in cases of local peritonitis. Hemicolectomy with ablation of the diastatic rupture is indicated for the right-side localization of the tumor Obstructive resection is expedient for left-side localization of the tumor and rupture, the diastatic ruptures should be sutured or extraperitonized with application of cecostoma. Subtotal colectomy is possible for left-side localization of the tumor and diastatic ruptures of the right half of the colon. Symptomatic operations are indicated for canceromatosis of the peritoneum, terminal phase of peritonitis or infectious-toxic shock.

[Surgical treatment of perforative gastroduodenal ulcers in elderly and senile patients]. / Khirurgicheskoe lechenie probodnykh gastroduodenal'nykh iazv v pozhilom i starcheskom vozraste.

The work is based on experiences with surgical treatment of 206 elderly and senile patients with perforating gastroduodenal ulcers. In 67.5% of cases the perforations took place in duodenal ulcers, in 16%--in the pyloric canal. The gastric body and antral portion ulcers were perforative more rarely--9.8% and 4.8% respectively. Perforations of the cardial and retrobulbar ulcers were found in 1.9% and 1% respectively. At early terms after operation 67 patients (33.5%) died. After suturing the perforative opening 38 out of 98 patients died (38.8%), after dissection and suturing the ulcers died 7 out of 19 patients, after Oppel-Polikarpov operation died 7 out of 11, after resection of the stomach died 4 out of 6, after truncal vagotomy with pyloroplasty died 11 out of 72 patients (15.3%). The main cause of lethal outcomes is thought to be complications of the coexistent diseases, totally responsible for 46.2% of deaths. Truncal vagotomy with a dissection of the ulcer and pyloroplasty performed in 60-70 year old patients gave the least indices of lethality and early postoperative complications, so the indications to radical organ-saving operations in patients of this age must be wider. This method of treatment for perforative ulcers in patients of 71-80 years of age should be used with restrictions due to not bad long-term results of suturing the ulcers (good and excellent results took place in 53.8% of cases). In patients older than 80 radical operations are not indicated. In such cases the ulcer should be better dissected and sutured, the posterior wall of the organ being examined for a "mirror" ulcer.

[The Manheimer index as a criterion of the severity of the state of patients with diffuse peritonitis]. / Indeks Mankhaimera kak kriterii tiazhesti sostoianiia bol'nykh s razlitym peritonitom.

The efficiency of the calculated Manheimer index was assessed in 243 patients with diffuse peritonitis. The patients were divided into three groups according to the value of the index. The results were compared with the value of leukocytosis, leukocytic index of intoxication and level of medium molecules in the same patients. The patients of the Manheimer groups demonstrated growth of objective parameters of intoxication. The level of mortality was 2.5% in the 1st group, 63.9%--in the 2nd group and 100%--in the 3rd group. Unlike the calculated indexes accepted in the international practice, the Manheimer index does not require results of expensive laboratory methods of investigation. It can be widely used in clinical practice for a reliable assessment of the state of peritonitis patients and prognosis of results of their treatment.

[Bacteriological features of peritonitis in perforative gastroduodenal ulcer]. / Bakteriologicheskie osobennosti peritonita pri perforativnykh gastroduodenal'nykh iazvakh.

Bacteriological investigation of 137 probes of the exudate from the abdominal cavity has revealed positive results in 60.6%. The detection of microbial flora was the more frequent the greater was the spread and degree of peritonitis. The monoculture was revealed in 92.8%, the colibacillus being the most frequent. The isolated microbial flora was sensitive to antibiotics of the cephalosporin group.

[The ways of improvement of surgeons' training at the Department of Managerial Medical Staff of the Military Medicine Academy]. / Puti sovershenstvovaniia podgotovki khirurgov na fakul'tete rukovodiashchego meditsinskogo sostava Voenno-mediitsinskoi akademii.

The urgent need to discuss with military surgeons the problem of improvement of educational process in the faculty of managerial medical staff of the Military-and-Medical Academy under the new social-and-economic conditions against the background of the RF Armed Forces reformation has prompted the authors to write this article. The first report deals with the problems of general organization of educational process taking into account the needs for surgeons with higher military education and creation of certified specialized surgical care in the Troops. The authors suggest that all people with interests at stake should express their opinion concerning this problem.

[Surgical treatment of perforated gastroduodenal ulcers in young persons]. / Khirurgicheskoe lechenie perforativnykh gastroduodenal'nykh iazv u lits molodogo vozrasta..

The knowledge of surgical tactics in treatment of ulcerous disease and its complications in young persons is of great practical importance for military health service. The problem of choice of surgical method in perforated gastroduodenal ulcers remains contradictory. Many authors draw attention to merits and demerits of both palliative and radical interventions. The long-term results of identical operations obtained by different authors often vary and not infrequently are quite opposite. The review of our and foreign literature concerning the surgical treatment of perforated gastroduodenal ulcers in the young patients shows that the unequivocal decision of this problem today is not available. Discussions about expediency to perform different interventions in the young patients are generally concentrated around the notions of "acute" and "chronic" ulcer. However both these categories are poorly defined because the criteria of their evaluation vary in different authors. Obviously the choice of surgical method in the young patients with perforated gastroduodenal ulcers should be based both on multi-factor analysis of anamnestic data, the patient's general state, intraoperative picture and on retrospective and prospective analysis of conservative treatment, its possibilities and efficiency, on the patient's opinion. The availability of technical possibilities to perform the operation and presence of the adequately trained surgeons are necessary.

[The late results of surgical treatment in patients with perforated gastroduodenal ulcers]. / Otdalennye rezul'tatay khirurgicheskogo lecheniia bol'nykh s perforativnymi gastroduodenal'nymi iazvami.

It was shown that suturing perforative ulcers of the stomach and duodenum gives bad outcomes in more than 52% of the patients. More than half of such patients continue suffering from the ulcer and its complications, every fifth patient needs future radical reoperation. The most frequent indication for reoperation is a recurrent ulcer and stenosis of the pyloric area of the stomach. Somewhat better results of simple suturing the ulcer are observed in patients aged 15-20 years. The maximum amount of unfavourable results (60%) are noted in young patients aged 21-30 years. Perforation of "dumb" gastroduodenal ulcers was followed by a considerable amount (43.5%) of unsatisfactory results of treatment which often required reoperations. Truncal vagotomy with the dissection of the ulcer and pyloroplasty cures the disease and its complications in 85.2% of patients with perforative gastroduodenal ulcers. Somewhat worse results of this operation are noted in patients aged 21-30, considerably better outcomes in patients older than 50. In them the amount of excellent and good results is 67% and 94.2% correspondingly.

[Debatable problems in the surgical treatment of perforated gastroduodenal ulcers]. / Spornye voprosy khirurgicheskogo lecheniia perforativnykh gastroduodenal'nykh iazv.

The experience in surgical treatment of 1027 patients with perforated gastroduodenal ulcer was assessed. Particular attention was paid to the most arguable problems of surgical treatment of this disease. The records evidence that at present there are no reliable objective criteria which enable to differentiate acute perforated ulcers from chronic ones before or during the operation. It has been convincingly proved, that in spite of all known risk factors (age of patients above 60 years, accompanying diseases, preoperative shock and duration of the perforation over 24 hours, disseminated peritonitis, etc.), truncal vagotomy with excision of the ulcer and pyloroplasty provides lower lethality rate in comparison with any other surgical operation. The operation is recommended not only for saving of patients life, but for receiving in great majority of cases favourable long-term results in patients of young as well as old age irrespective of the presence of ulcer in the anamnesis.

[The surgical treatment of patients with perforated stomach and duodenal ulcers]. / Khirurgicheskoe lechenie bol'nykh s perforativnymi iazvami zheludka i dvenadtsatiperstnoi kishki.

An experience with surgical treatment of 1027 patients with perforated gastroduodenal ulcers was analyzed. Radical operations were performed on 541 patients (52.7%), palliative operations on 486 patients (47.3%). Total lethality was 7.5%, among them 13.2% after the palliative procedures, 2.4% after radical ones (p < 0.01). With all well-known risk factors (age older than 60 years, coexistent diseases, preoperative shock, time since the moment of perforation more than 24 hs, diffuse peritonitis etc.) the reliably lower lethality and less amount of early complications were noted after the bilateral truncal subdiaphragmatic vagotomy with dissection of the ulcer and pyloroplasty. The minimum volume of surgical interventions must be chosen in patients with critical general condition and terminal phase of intraperitoneal infection. Palliative operations (dissection and suture of the ulcer) are justified for perforating ulcers of the antral portion and body of the stomach against the background of risk factors.

[The single-row suture in the pyloroplasty of patients with perforated pyloroduodenal ulcers]. / Odnoriadnyi shov pri piloroplastike u bol'nykh s perforativnymi piloroduodenal'nymi iazvami.

The authors made an analysis of the immediate and long-term results of truncal vagotomy for perforating gastroduodenal ulcers in accordance with the kind of the suture in operation of stomach drainage. In 282 patients pyloroplasty was performed with placing a two-row suture, in 239 patients a one-row suture was used. Lethality among the patients with the two-row sutures was 2.1% in those with the one-row suture--0.4%. The placing of one-row sutures was followed by a relatively smaller amount of complications at the early postoperative period. An analysis of long-term results has shown that the one-row suture gives much greater amount of excellent results as compared with the two-row suture. The authors recommend to use the one-row suture in all the cases of perforating pyloroduodenal ulcers irrespective of the phase of intraperitoneal inflammation.

[The surgical treatment of gastroduodenal ulcers complicated by perforation and hemorrhage]. / Khirurgicheskoe lechenie gastroduodenal'nykh iazv, oslozhnennykh perforatsiei i krovotecheniem.

Medical histories of 67 patients with perforation of gastroduodenal ulcers combined with gastroduodenal hemorrhage were analyzed. The frequency of this complication makes 7.5% of all patients with perforated peptic ulcers. High mortality rate is thought to result from wrong diagnosis and inadequate operation. Best results were obtained when truncal bilateral subdiaphragmatic vagotomy was used in combination with some pyloroplasty techniques. Resection of the stomach is known to be dangerous because of frequent complications often leading to death. Operations aimed at the arrest of hemorrhage and liquidation of peritonitis are indicated to patients in critical state. X-ray examination of the abdomen and fibrogastroduodenoscopy allowed the combination of perforation and hemorrhage to be diagnosed in due time in all the patients.

The small intestine as the origin of bacteremia in acute diffuse peritonitis.

Studies have demonstrated the failure of gut barrier function in all cases of experimental acute diffuse peritonitis. Histobacterioscopy and electron microscopy showed the occurrence of bacteria under the basal membrane, in lymphatic and blood capillaries of the small intestinal villi. Experimental and clinical trials with blood sampling from different regions of the circulation have demonstrated the gut origin polymicrobial bacteremia in 66% of patients and in 75% of experimental animals with acute diffuse peritonitis.

[The late results of the surgical treatment of perforated gastroduodenal ulcers in young people]. / Otdalennye rezul'taty khirurgicheskogo lecheniia perforativnykh gastroduodenal'nykh iazv u liudei molodogo vozrasta.

The article is devoted to surgical treatment of perforating gastroduodenal ulcers. An investigation of remote results of palliative and radical interventions for the perforation of the stomach and duodenum in patients of young age has shown that recurrent ulcers after suturing the perforation take place in 67.2% of the people operated upon against 21% of those subjected to bilateral truncal subdiaphragmatic vagotomy with pyloroplasty. A conclusion is made that for perforating ulcers it is expedient to perform radical operative interventions as a bilateral truncal subdiaphragmatic vagotomy with pyloroplasty.