[The system of hemostasis in patients with diabetic foot syndrome undergoing surgical treatment].

Characteristics of hemostasis system were studied in 185 patients with diabetic foot syndrome undergoing surgical treatment. Disturbances of procoagulative activity persisted within days 1 and 5 after surgery in patients with complicated forms of DFS due to enhanced formation of blood and tissue prothrombinase; simultaneously, the formerly increased fibrinogen level decreased by virtue of intravascular blood coagulation. The activity of natural anticoagulants (antithrombin 111, proteins C andS) continued to be low as a result of their utilization to activate coagulation processes. Resistance of Va factor to activated C protein remained as high as preoperatively. XIIa-Hageman-dependentfJibrinolysis was suppressed and showed no tendency toward recovery.

[Results of treatment of injuries to the spleen in children at the remote postoperative period].

Long-term results of treatment were studied in 56 children. Splenectomy was fulfilled in 17 of them, splenectomy with autolientransplantation--in 39 children. The results have shown that the greatest number of complications was noted in the group of patients after splenectomy (48), after autolientransplantation there were 13 cases. The complications were mostly associated with the lowered immune resistance of organism.

[Typical complications in the long-term period in patients operated for trauma of the spleen].

The course of long-term postoperative period was studied in 137 patients in the out-patient department conditions in the terms from one to 15 years: 57 patients after splenectomy, 30 patients after organ-sparing operations (OSO), and 50 patients after splenectomy with autolienal transplantation. It was found that best results were obtained in patients after OSO--13.4% of complications. The greatest number of complications was found in patients after splenectomy--45.2%.

[The hemostasis system indices after operations of spleen trauma].

The authors have studied changes of the hemostasis system in 85 patients operated on the traumatized spleen, followed up from 1 through 15 years after operation. It was established that organ-saving operations and autolientransplantation fail to result in substantial changes in indices of the hemostasis system, while after spleenectomy there were pronounced shifts.

[Early diagnosis and surgical tactics at acute destructive pancreatitis].

Based on retrospective analysis of 292 case histories of patients with acute pancreatitis the computed model permitted to differentiate destructive and hydropic pancreatitis and to predict clinical course of pancreonecrosis has been constructed. Algorithm of treatment tactics depending on this analysis has been developed. Use of laparoscopy in early period with results of computed prognosis permitted to decrease the rate of diagnostic mistakes at pancreonecrosis from 59.2 to 39.5%. Algorithm of surgical tactics permitted to reduce lethality at small- and medium-focal pancreonecrosis from 51.7 to 5.1%, and the rate of purulent complication--from 23.8 to 2.5%.

[Laser photocoagulation of bleeding gastric and duodenal ulcer].

Laser photocoagulation of bleeding ulcer is one of the effective methods of endoscopic hemostasis. Experimental studies were carried out on resected stomach preparation. The preparations were studied histologically. Clinical trial was conducted in 43 patients with gastric and duodenal ulcer for hemostasis and prophylaxis of recurrent bleeding. Initial endoscopic hemostasis was successful in all the patients. Relapse of bleeding was seen in 4 patients. Overall efficacy of laser hemostasis was 90.7%. It is concluded that laser photocoagulation is one of effective and convenient methods of endoscopic hemostasis.

[Immune status late after surgery for spleen injuries].

Immune status was studied in patients who had undergone surgery for spleen injuries (splenectomy, autolientransplantation and organ-saving surgeries). It is demonstrated that splenectomy leads to immunosuppression in long-term postoperative period. For prevention of these complications the organ-saving surgeries or autolientransplantation in addition to splenectomy are recommended.

[The course of the nearest postoperative period in patients with injuries of the spleen].

The authors have analyzed the course of the postoperative period in 410 patients operated on for isolated, combined and multiple traumas with injuries of the spleen. The character of the operation (splenectomy, splenectomy with autolientransplantation, organ preserving operations) had no significant influence on frequency of complications or lethality.

[Active policy in treatment of bleeding ulcer: update]. / Aktivnaia taktika v lechenii krovotochashchei iazvy.

Results of treatment of 2256 patients with ulcerous gastroduodenal bleeding are analyzed. From 1993 to 2000 continued bleeding and high risk of it were indications for urgent surgery. Postoperative lethality after surgeries in active bleeding was 9.3%. Experience with endoscopic hemostasis limits indications for urgent surgeries. Results of treatment during two period were compared: when active surgical policy was used (486 patients) and when endoscopic hemostasis was often performed (503 patients). Surgical activity during the latter period reduced significantly (from 52.3 to 31.5%). Postoperative lethality decreased from 9.45 to 6.25%, total lethality -- from 4.94 to 2.36%.

[The course of the nearest and long-term postoperative periods in children operated on the injured spleen]. / Techenie blizhaishego i otdalennogo posleoperatsionnykh periodov u detei, operirovannykh na travmirovannoi selezenke.

The course of the nearest postoperative period was studied in 56 children operated on for closed injury of the spleen. Spleenectomy was performed in 17 (30.3%) patients, in 39 (69.6%) patients spleenectomy was supplemented with autolientransplantation. In the nearest postoperative period after spleenectomy complications were noted in 3 (5.3%) cases, lethal outcome took place in 1 case (1.7%). Long-term results of treatment were analyzed in 56 children: in 17 of them spleenectomy had been performed, in 39--spleenectomy with autolientransplantation. The results of the investigation have shown that the greatest number of complications took place in the group of patients after spleenectomy (48), while after autolientransplantation there were only 13. The complications were mainly due to reduced immune resistance of organism.

[Diagnosis of pre-recurrent syndrome in bleeding ulcer of the stomach and duodenum]. / Diagnostika predretsidivnogo sindroma pri krovotochashchei iazve zheludka i dvenadtsatiperstnoi kishki.

The individual surgical strategy used in the recent years has allowed to improve results of treatment of patients with ulcerous gastroduodenal bleedings. A considerable number of recurrent hemorrhages due to insufficiently reliable prognosis is responsible for high lethality in this pathology. An investigation of pathogenesis of rebleedings as well as a statistical analysis of 249 case histories of patients with ulcerous hemorrhages allowed detection of most significant clinico-laboratory and endoscopic signs of recurrent bleeding. Of the greatest importance were case histories of collapse, active bleeding by G.P. Gidikir, size of the ulcer and blood loss indices. The program Statistica 5.5 (USA, 1998) was used for the development of the algorithm of prognosis of recurrent bleeding as three trees of solutions. The prognosis exactness by each of the trees was about 80%. The combined use of several trees substantially increased the prognosis reliability. The method can be recommended for wide practical application due to its simplicity and exactness.

[Diagnosis and surgical strategy for acute pancreatitis]. / Diagnostika i khirurgicheskaia taktika pri ostrom pankreatite.

Problems with early diagnosis and assessment of the severity of acute pancreatitis (AP) are discussed on the basis of great clinical material (1340 patients). A test of the autoantibody formation was used in the examination of 83 patients with AP and 26 healthy donors as a diagnostic and prognostic criterion of AP. It was shown that the test for the formation of autoantibodies in patients with AP had a direct correlation with other markers of endogenous intoxication, and can be taken as an additional objective criterion for the assessment of the severity of the disease and effectiveness of the treatment used, and allows to make a prognosis of the outcome. In addition, a comparative analysis was made of two periods of work of the stuff of the surgical department: 1--the active surgical strategy during the acute phase of acute destructive pancreatitis (ADP); 2--intensive conservative therapy with using less invasive interventions. The change of the medical strategy allowed to get a reliable reduction of general mortality from ADP from 46.6 to 27.6% and to decrease the number of purulent complications to 27%.

[Prognosis of ulcer bleeding recurrence]. / Prognozirovanie retsidiva iazvennogo krovotecheniia.

The conception of prerecurrence syndrome is suggested. Clinical, endoscopic and laboratory characteristics of prerecurrence syndrome are described. Causes of ulcer bleeding recurrence were examined: continued ulcer alteration, digestion of a thrombus in ulcer, fibrinolysis of a thrombus in an arrosive vessel, hyperdynamic regional circulation. Individual surgical policy was developed. Urgent surgery is indicated in continued hemorrhage and verified prerecurrence syndrome.

[The possibilities for improving the surgical procedure in hemorrhaging gastroduodenal ulcer]. / Vozmozhnosti sovershenstvovaniia khirurgicheskoi taktiki pri krovotochashchei gastroduodenal'noi iazve.

The article describes an original variant of treatment of patients with bleeding ulcer of the stomach or duodenum. A classification of surgical interventions is proposed depending on the time of performing the operation. Verification of unstable hemostasis with the help of a computer expert program in patients with arrested bleeding and performing preventive emergency operation led to less postoperative lethality.

[Possibilities and results of organ-saving surgery in injuries of the spleen]. / Vozmozhnosti i rezul'taty organosokhraniaiushchikh operatsii pri travmakh selezenki.

An analysis of 218 patients with spleen traumas treated surgically has been made. The organ-saving operations were made in 70 patients with a laser scalpel. The absolute and relative indications for such operations were determined. Complications and lethal outcomes in the early postoperative period in patients with the preserved spleen and after splenectomy were 21.1% and 12.9%, 30% and 13% correspondingly.

[The outcomes of the surgical treatment of a bleeding duodenal ulcer at a specialized provincial center]. / Iskhody khirurgicheskogo lecheniia krovotochashchei iazvy dvenadtsatiperstnoi kishki v oblastnom spetsializirovannom tsentre.

Gastroduodenal bleedings were surgically treated in 244 patients with bleeding duodenal ulcers at the regional specialized center of treatment of gastroduodenal bleedings during 5 years. Postoperative lethality was 9.4%. A classification of surgical operations for bleeding ulcers is proposed depending on the time of performing. Substantiation is given to expediency of specialized medical care of such patients at the specialized center.

[Hyperbaric oxygenation in the treatment of bleeding gastroduodenal ulcers]. / Giperbaricheskaia oksigenatsiia v lechenii krovotochashchei iazvy zheludka i dvenadtsatiperstnoi kishki.

It is shown on the basis of analysis of the results of treatment of 179 patients that the use of hyperbaric oxygenation in the complex surgical management of ulcerative gastroduodenal bleeding reduced the number of postoperative complications by a factor of 3.3 and led to a decrease of mortality from 20 to 1%. The authors confirm the expedience of including hyperbaric oxygenation in the complex of therapeutic measures in patients with bleeding ulcers under conditions of accomplished hemostasis by conservative or surgical methods in one of three suggested variants: in preparation of the patients for operation in the postponed period; after operative interventions carried out at the peak of bleeding; before and after operations on patients with moderate and severe blood loss and concomitant diseases. The sessions should be conducted under pressure of 2 atm for 60 minutes.