[Prophylaxis of venous thromboembolic complications in patients operated on abdominal organs]. / Profilaktika venoznykh troboémbolicheskikh oslozhnenii u bol'nykh, operirovannykh na organakh briushnoi polosti.

Comparative analysis of results of venous thromboembolic complications prophylaxis (deep vein thrombosis--DVT1, pulmonary artery thromboembolism--PAT) in patients operated on abdominal organs during two periods--from 1980 to 1983 (when traditional methods were used--leg bandage, rarely--0.25-0.5 g aspirin 1-2 times a day 5-8 days after surgery) and from 1984 to 1998 (when in the operated patients with moderate, high and very high risk of DVT and PAT combination of physical methods of blood flow acceleration in leg deep veins with drugs was used--minidoses or individually selected doses of non-fractionated heparin, low-molecular heparin, dextrans) was carried out. Compared with first period the rate of manifested DVT decreased from 1 to 0.3%, fatal PAT (percentage of those who died from all operated)--from 0.3% in 1982-1983 to 0.026% in 1998, i.e. more than 10 times. In some years (1992-1993) there were no lethal outcomes of PAT.

[Gastrectomy in treating gastric hemorrhage]. / Gastréktomiia v lechenii zheludochnykh krovotechneii.

Use of gastrectomy for gastric bleeding in emergency cases is analyzed. Gastrectomy was performed in 15 patients over 7 years. When tumor of the stomach penetrated into other organs combined operations were performed: gastrectomy with splenectomy and left-sided hemipancreatectomy, gastrectomy with cholecystectomy, choledocholythotomy and choledochoduodenostomy. Results of treatment were good. There were no lethal outcomes. New variant of gastrectomy was developed and performed in 5 patients. Technical simplicity and reliability of esophagoduodenal anastomosis, optimal functional result and good life quality were demonstrated in gastrectomized patients.

[Management of stomach cardial ulcers complicated by bleeding]. / Lechenie kardial'nykh iazv zheludka, oslozhnennykh krovotecheniem.

The results of treatment of the patients with bleeding ulcers of cardial part of the stomach have been analysed. In contrast to gastric ulcers of another location, cardial ones are poorly respond conservative treatment, are usually accompanied by severe complications, and are more frequently prone to malignant transformation. New method for proximal resection of the stomach has been developed, which was successfully used in 14 patients. There were no complications and lethal outcomes. Yearly and long-term results were favourable.

[Postoperative deep venous thrombosis of legs and pulmonary embolism]. / Posleoperatsionnyi tromboz glubokikh ven nizhnikh konechnostei i émbolia legochnoi arterii.

324 patients operated on the organs of abdominal cavity small pelvis and retroperitoneal space were examined by the method of I-125-fibrinogen accumulation and contrast phlebography. In 109 (33.6%) patients thrombosis of deep veins of lower extremities was diagnosed, among which in 24 cases (7.5%) it was proximal. In most cases thrombosis was predisposed by postthrombotic disease and chronic venous insufficiency of lower extremities, circulatory disturbances of the 2-3 degree, tumors, obesity, preoperative thrombophilia. Combination of 2 and more risk factors increased possibility of intravascular thrombosis. The rate of clinically registered pulmonary artery embolism (14,833 general surgical patients were avau label) made up 1.2%; in 54 (0.3%) of operated patients it was the cause of death. Postoperative lethality of embolism made up 13%. Four risk levels of development of thrombo-embolic complications were established: low (common rate of thrombosis--10.3%, proximal--1.4%, clinically evidenced pulmonary artery embolism--0.7%, with lethal outcome--0.02%), medium (28.5; 6.5; 2; 0.76%, respectively), high (80.4; 17.8; 6; 2.8%, respectively) and very high (93.3; 26.6; approximately 8; approximately 4, respectively). The prevalence of thrombo-embolic complications in patients urge surgeons and reanimatologists to carrying out prophylactic to reduce the risk of intravascular thrombosis in pre- and postoperative period.

[The risk and prevention of deep venous thrombosis of the lower extremities in abdominal surgery]. / Risk i profilaktika tromboza glubokikh ven nizhnikh konechnostei v abdominal'noi khirurgii.

According to the age, duration of the surgical procedure and risk factors the patients were divided into 3 groups: with a low, medial and high risk of the appearance of thrombosis of the profound veins (TPV). A test with 125I-fibrinogen was used in order to determine the frequency of this postoperative complication for each group, the frequency of lethal thromboembolism being counted on the basis of many years observations. Prophylactics of TPV was differential depending on the degree of risk of its appearance: nonspecific methods (elastic stockings, physical exercises for legs in bed) in the first group and specific (heparin in small doses, poly- and rheopolyglukin) in the 2nd and 3rd groups. An assessment of the efficiency of heparin prophylactics is given by a comparison of frequency of TPV in the control and investigation groups. The total number of patients operated upon in whom medicamentous methods of TPV prophylactics were used during 11 years (from 1984 till December 1994) was about 4 thousand. The frequency of clinical forms of thrombosis of the profound veins was decreased from 1 to 0.3%, lethal thromboembolism--from 0.26% (1980-1983) to 0.01% (1991-1994).

[Low doses of heparin in the prevention of postoperative thrombosis of deep veins of the lower limbs]. / Malye dozy geparina v profilaktike posleoperatsionnogo tromboza glubokikh ven nizhnikh konechnostei.

As shown by 125I-fibrinogen, in the course of 10-year investigation on low-dose heparin given in low doses (15000 U/day) to prevent postoperative thrombosis in the deep veins of the lower limbs, the investigators succeeded in the reduction of the thrombosis occurrence from 32 to 8%. Out of 3700 surgical patients (age over 40, duration of surgery 1 hour and more) pretreated with anticoagulant only 6 (0.16%) died of pulmonary artery thrombosis. This means that relevant lethality decreased 9-fold compared to controls untreated with prophylactic heparin. Serious hemorrhagic complication due to low-dose heparin were not observed.

[The use of low heparin doses for the prevention of postoperative thrombosis of the deep veins and of pulmonary artery thromboembolism]. / Primenenie malykh doz geparina dlia profilaktiki posleoperatsionnogo tromboza glubokikh ven i tromboémbolii legochnoi arterii.

The results of small doses heparin application (15,000 units) for the prophylaxis of postoperative deep vein thrombosis and the pulmonary artery thromboembolism were analyzed. The lowering of incidence of deep vein thrombosis from 32 to 8% was determined using 125I-fibrinogen. Of 3540 patients aged 40 years old and more, while the operation duration no less than 1 hour and anticoagulant administered, 6 (0.16%) died due to the pulmonary artery thromboembolism. The mortality was 9 times more in the group of patients, whom the prophylaxis was not conducted. Severe hemorrhagic complications after heparin application in above mentioned dose were not noted.