[Transillumination-assisted phlebectomy with the help of the TriVex system in comprehensive management of varicose disease of lower-limb veins].

The present work was undertaken to evaluate a new minimally invasive method of surgical management of varicose disease by means of the TriVex unit. The method is based on transillumination of saphenous veins in an aqueous medium, which makes it possible to perform radical removal thereof form separate punctures under visual control with the help of a specially designed vein stripper. Transillumination-assisted phlebectomy (TIP) was compared with microphlebectomy (MPE) according to the Varady's technique. We operated on a total of one hundred and eight patients suffering from varicose disease of the lower extremities. All of them underwent duplex scanning of the veins. Group One (study group) was composed of fifty-six patients subjected to TIP within the scope of a comprehensive treatment for varicose disease. Group Two consisted of fifty-two patients who were subjected to removal of varicosely altered affluents on the crus by means of microphlebectomy. The results of surgical management for varicose disease were analysed according to the following parameters, the duration of a surgical intervention, intensity of the pain syndrome in the postoperative extremity, a cosmetic outcome by visual analogue scales, and the incidence rate of complications. The obtained findings demonstratively showed that the duration of the operation in the study group was substantially shorter, averagely amounting to 35.5+/-6.2 minutes, as compared with as long as 65.0+/-6.2 minutes (P<0.0001) in the control group. The number of incisions in the study group turned out to be also significantly less than that in the control group, amounting to 4.0+/-1.3 vs. 12.0+/-2.5 (p<0.0001), which largely contributed to both a decrease in the level of the pain syndrome and obtaining aesthetically pleasing cosmetic outcomes. Hence, TIP being a minimally invasive procedure in surgical management of varicose disease, by its clinical efficiency appeared to be not inferior and at least equivalent to microphlebectomy, displaying at the same time certain advantages over the latter, consisting in the very positive cosmetic outcome obtained, a lesser operative injury inflicted, and shorter terms of rehabilitation of the patients involved.

[Prognosis of the severity of acute pancreatitis by the neural network method].

For prognozing the character of the development of acute pancreatitis a neural network of the direct spread of the signal was developed with 15 inlets, 5 neurons of the latent layer and two outlets. The network was trained with the help of an algorithm of an inverse spread of the error. The sensitivity of the produced prognostic model was 100%, specificity at admission--70%, on the first day--80%, on the second and third day--90%. Before the moment of hospitalization 57 patients were observed during 72 hours. The diagnosis was confirmed in all cases by the methods of computed tomography with contrast amplification.

[The combined treatment of severe craniocerebral trauma taking into account the nature of the brain damages and the extent of the hypertensive-dislocation syndrome]. / Kompleksnoe lechenie tiazheloi cherepno-mozgovoi travmy s uchetom kharaktera povrezhdenii golovnogo mozga i vyrazhennosti gipertenzionno-dislokatsionnogo sindroma.

The intracranial pressure was measured in 95 patients with a severe cranio-cerebral trauma at the postoperative period. Four degrees of the hypertension-dislocation syndrome were established. The characteristic of operative accesses is given. Drainage of the ventricular system of the brain and anterior falxotomy were shown to be expedient. The estimation is given to the efficiency of dehydration therapy at the early postoperative period against the background of intracarotid and intravenous infusions of remedies.

[Endoscopic nerve block of the acid-producing area of the stomach in the treatment of duodenal ulcer]. / Endoskopicheskaia medikamentoznaia blokada kislotoprodutsiruiushchei zony zheludka v lechenii iazvennoi bolezni dvenadtsatiperstnoi kishki.

The work describes the method of endoscopic medicamentous++ block of the acid-producing zone of the stomach (EMB AZS) and the results of its use in the treatment of 135 patients with duodenal ulcer. It is shown that EMB AZS leads to a significant reduction of acid production and does not disturb the motor-evacuation activity of the stomach and duodenum, which allows it to be considered a pathogenetically substantiated method of nonoperative management of chronic duodenal ulcer. The authors evaluate the clinical efficacy of EMB AZS in recurrent ulcer after operation on the stomach caused by a high level of acid production and ulcerative gastroduodenal bleeding. A conclusion is made on the expediency of including EMB AZS in the complex of therapeutic measures for these diseases.

[Results of truncal and selective proximal vagotomies combined with stomach-draining surgery in ulcer-related pyloro-duodenal stenosis]. / Rezu'ltaty stvolovoi i selektivnoi proksima'lnoi vagotomii v sochetanii s dreniruiushchimi zheludok operatsiiami pri iazvennom piloroduodena'lnom stenoze.

The authors have shown that remote results of draining operations in combination with truncal vagotomy in ulcerous pyloroduodenal stenosis proved to be similar to results of their combination with selective proximal vagotomy in practically all the parameters. Advantages of the selective proximal vagotomy due to somewhat less amount and less degree of postoperative functional disorders observed after this intervention become practically levelled down by a considerably greater amount of recurrences of ulcers after it as compared with truncal vagotomy and drainage of the stomach.

[Anesthesiological provisions during operations in acute appendicitis]. / Anesteziologicheskoe obespechenie operatsii po povodu ostrogo appenditsita.

An experience with anesthesiological maintenance of 622 operations for acute appendicitis has shown that in 50% of the cases general anesthesia is expedient. In most patients of this group it can be maintained by non-inhalation means, mainly by Ketamine against the background of spontaneous respiration.

[Enteral feeding of patients with surgical diseases of the digestive tract using the Soviet balanced food mixture Inpitan]. / Enteral'noe pitanie bol'nykh s khirurgicheskimi zabolevaniiami pishchevaritel'nogo trakta otechestvennoi polnotsennoi pishchevoi smes'iu "Inpitan".

"Inpitan" is the first Soviet full-value balanced food mixture for tube feeding, produced under industrial conditions. It was used for enteral nutrition of 50 patients with different diseases of the upper gastro-intestinal tract. The mixture contains protein (12%), fat (30%), carbohydrates (58%), all the necessary mineral substances, and water- and fat-soluble vitamins. Depending on the clinical situation the patients received 2000-3200 ml of the mixture/day. The use of "Inpitan" with the energy density of 1 kcal/ml as the only source of nutrition during 7-75 days has demonstrated its high nutritious effectiveness. When the mixture was introduced directly into the small intestine according to the authors' schedule, no dyspeptic symptoms (eructation, nausea, vomiting, abdominal pain, meteorism, diarrhea) were recorded, dipsosis and the sense of starvation disappeared, the body weight increased, biochemical parameters returned to normal, the time of the preoperational preparation was significantly reduced, the post-operational complications were better managed.

[Unsolved problems and prospects in the surgical treatment of duodenal ulcer]. / O pereshennykh voprosakh i perspektivakh khirurgicheskogo lecheniia duodenal'noi iazvy.

Different variants of vagotomy in combination with pyloroantrumectomy or operations draining the stomach are regarded to be expedient for the treatment of duodenal ulcer instead of the classical resection of the stomach. The selective proximal vagotomy vagotomy is thought to be perspective when used without a drainage of the stomach as an intervention preventing the threat of the development of complications with a chronic course of the disease. In the surgery of complicated duodenal ulcers, specially with high operative risk, it is quite justifiable to use sparing operative interventions such as vagotomy combined with operations draining the stomach. An individual approach to choosing the operative method in the ulcer disease resulting in lower postoperative lethality and better remote results of the treatment may be ensured in specialized gastroenterological hospitals only.