[Safety measures in gastrectomy for peptic ulcer of marked severity]. / Mery bezopasnosti pri rezektsii zheludka po povodu iazvennogo porazheniia povyshennoi tiazhesti.

During the period from 1981 till 1989 87 resections for ulcerous injuries of particular severity were made in connection with the inflammation, destruction or spread of sclerosis in the pyloroduodenal zone. Measures of safety were complex and came to refusal from buried sutures in closing the duodenal stump, predominant use of Billroth-II resection in modifications foreseeing the creation of the Brown anastomosis (after Balfour, Roux), drainage of the abdominal cavity and actions for the liquidation of postoperative complications. Relaparotomy resulting from complications was necessary for 9 patients. One patient of 87 died.

[Open treatment of postoperative peritonitis]. / Otkrytoe lechenie posleoperatsionnogo peritonita.

Results of using the open method of treatment of postoperative peritonitis in 26 patients are presented. Relaparotomy technique is described when "open abdomen" was used as a typical operation irrespective of causes of progressing peritonitis. In addition to surgical measures the authors stress the importance of intensive therapy. In relation with the character of postoperative peritonitis the abdominal cavity was closed by primary-delayed or secondary sutures on the 5-12th day. Lethality after using the open method of treatment of postoperative peritonitis was 30.7%.

[Surgical treatment of stomach and duodenal ulcer]. / O khirurgicheskom lechenii iazvennoi bolezni zheludka i dvenadtsatiperstnoi kishki.

Data on the surgical treatment of 954 patients are described, 613 of them being patients with complicated ulcers. Resection is considered to be indicated for gastric ulcers and for duodenal ulcers with pronounced hypersecretion, for atonia of the stomach and local changes hampering manipulations on the lesser omentum. Selective proximal vagotomy (SPV) was preferable in non-complicated duodenal ulcers, trunkal vagotomy was used as a forced measure in severe cases. The least postoperative lethality was noted after SPV (0,7%). Lethality after resections ranged from 1,3% to 2,2% depending on the method used.

[Microcirculatory bed in chronic arterial obliteration]. / Sostoianie mikrotsirkuliatornogo rusla pri khronicheskoi obliteratsii arterii.

The state of tissue vessels in the skin, subcutaneous fat, fasciae and muscles of the lower extremities has been studied at various levels in 10 patients suffering from endarteritis and in 23 patients suffering from atherosclerosis. Certain morphological changes manifested have been revealed in small arteries, arterioles and capillaries: thickening of the muscle tunic, twisting, obliteration of small arteries, arteriolar narrowing, a sharp thickening of the precapillary sphincters, deformity and narrowing of the capillaries, their complete occlusion and fragmentation. The increasing destruction of the tissue vessels towards the periphery, when the disease advances further, results in the microvascular bed reduction with formation of vast avascular zones in distal segments of the extremities. Therefore, it is necessary to decide whether the agents capable to produce regeneration of the destroyed vascular elements should be used. The microvessel regeneration phenomenon can be stimulated by means of repeated infiltration of soft tissues in the injured extremities with the whole autoblood. In places where extravasates are situated, produced in this way, a corresponding reaction of the interstitium takes place, a loose connective tissue rich in organic vessels, such as small arteries, arterioles and capillaries, is formed and, as a result, the ischemic syndrome intensity decreases.

[Surgical treatment results in arterial injuries of the extremities in childhood]. / Rezul'taty khirurgicheskogo lecheniia povrezhdenii arterii konechnostei v detskom vozraste.

The authors present their analysis of the surgical treatment of 20 children with injured peripheral arteries. In 14 cases a venous autograft was used for a reconstruction of the artery, in 3 cases lateral sutures were made and in 3 children the artery was ligated. In 7 cases a suture of the nerve and osteosynthesis were necessary. Remote results of the treatment observed in 15 children within the terms from 1 to 10 years and longer have shown that the venous autotransplant were functioning normally and provided a normal growth and functioning of the extremity. Functional disorders were observed following a ligation of major arteries.

[Comments on the outcome of reconstructive treatment of chronic occlusions of the peripheral arteries]. / Zamechaniia po povodu iskhodov vosstanovitel'nogo lecheniia khronicheskikh okkliuzii perifericheskikh arterii

The results of reconstructive surgery performed for obliteration of iliac arteries (8), femoro-popliteal segment (36) and brachial artery (2) in 40 patients are reported. The method of desobliteration-open thrombendarterectomy, shunting or thrombectomy -- was selected taking into account the peculiarities of each case, separately; autografts from the great saphenous vein served as a plastic material. Major blood flow was restored 27 cases, clinical improvement was noted in 11 cases, and 8 operations were a failure. The characteristic features of microcirculatory disturbances in chronic occlusions are given.