[Prognosis of the course of complicated ulcer disease and mortality in aged and senile patients]. / Prognoz techeniia oslozhnennoi iazvennoibolezni i letal'nosti u bol'nykh pozhilogo i starcheskogo vozrasta.

The developed system for forecasting the course of the disease in elderly and senile patients made it possible to distinguish two variants of the ulcer course: favorable and unfavorable. Its application confirmed that it is possible to use the forecast evaluation system in studies of remote results. In case of an unfavorable forecast, this provides the ground for urgent recommendations for surgical treatment in this group of patients without waiting for life-threatening complications to develop.

[Pathophysiological features of duodenal ulcers in elderly and senile patients]. / Patofiziologicheskie osobennosti izvennoi bolezni dvenadtsatiperstnoi kishki u bol'nykh pozhilogo i starcheskogo vozrasta.

The following conclusions can be drawn on the basis of the research results: 1. There is no reliable distinction between central hemodynamics and gastric blood flow indices in patients from different age groups. 2. The blood flow in the stomach wall is in a distinct direct proportion to acid production. 3. The gastric blood flow is doubled in most patients with acid peptic ulcers, as compared with the norm. 4. The role of the ischemic factor in the development of duodenal ulcers is not pronounced in elderly patients.

[Radiodiagnosis of acute appendicitis]. / Luchevaia diagnostika ostrogo appenditsita.

Sixty acute appendicitis suspects with unclear clinical picture were examined with high-frequency ultrasound and native CT. The results of the examinations were compared with clinical data, surgical findings and histological evidence. Acute appendicitis was in 39 patients, other diseases of abdominal cavity and small pelvis--in 21. Sensitivity of CT was 95%, specificity--91.3%, accuracy--96.6%. Sensitivity of US was 92.3%, specificity--100%, accuracy--95%. The above parameters for non-invasive diagnostic methods were similar to ones for laparoscopy. Native CT and US are highly precise methods for diagnosis of acute appendicitis. They are preferable in unclear clinical situations, atypical location of the appendix, in children, elderly and aged patients, and in patients with mental disorders.

[Some aspects of venous surgery based on advanced knowledge of venous anatomy of the lower extremities]. / Nekotorye voprosy flebokhirurgii v svete uglublennykh znanii anatomii venoznogo rusla nizhnikh konechnostei.

Analysis of the errors and faults in the treatment of the main diseases of veins of the vena cava inferior system showed that they can be explained to a great extent by the uncoordinated ideas of the anatomy of the lower limb venous channel. Our experience suggested the expediency of evaluating the condition of venous circulation from the standpoint of comprehensive consideration of the vascular channel structure. The suggested scheme of the structure of the venous channel with all the collaterals and the intravenous connections is systematized and logically completed. We employed it for analysis of some up-to-date problems of the diagnosis and treatment of the most frequently encountered diseases of the lower limb venous system. Knowledge of the general and individual characteristics of the structure of the venous channel opens up new opportunities for their use in surgery and at the same time protect against unreasoned and erroneous decisions.

[Anatomo-topographic basis for operations of transposition of the superficial femoral vein in post-thrombophlebitic disease of the lower extremities]. / Anatomo-topograficheskoe obosnovanie operatsii transpozitsii poverkhnostnoi bedrennoi veny pri posttromboflebiticheskoi bolezni nizhnikh konechnostei.

Post-thrombophlebitic disease of the lower limbs may be occlusive, (2%), recanalized (54%), and mixed (44%) in character. Operations for restoration of the normal flow of blood cannot remove the retrograde flow in veins with destroyed valves. Many variants of valve restoration have been suggested. The simplest among them are transplantation of the superficial femoral vein, the lateral circumflex femoral vein, and the great saphenous vein. The anatomical structure of the lower limb venous system was studied on the corpses of humans without venous pathology. In most cases the deep femoral vein was found to have one valve (46.8%), two (30.6%), and three (12.8%) valves. Valves were found at a distance of 1.0 to 4.5 cm from the site of drainage of the deep femoral vein into the superficial vein in 48.35% of cases, 43.5% had a sufficient diameter (0.6 cm). Thus, implantation of the superficial femoral vein into the deep vein can be conducted in less than half of the patients. Study of the anatomy of the lateral circumflex femoral vein showed that the operation can be performed in 9.6% of cases. The great saphenous vein is the main route of blood drainage in post-thrombophlebitic disease. Its use as a valvular protection is very risky. It should also be taken into account that in post-thrombophlebitic disease the great saphenous vein is dilated and marked by relative venous incompetence. Though they are relatively simple, these operations, can be therefore, performed in less than half of the patients. Examination of patients should include ultrasonic angioscanning and retrograde transfemoral phlebography, which allow precise determination of the anatomical features of the lower limb venous system in each patient.

[Resection of posterior tibial veins with ligation of arteriovenous anastomosis in acute ischemia of the lower extremities]. / Rezektsiia zadnikh bolshebertsovykh ven s pereviazkoi arteriovenoznykh anastomozov pri kriticheskoi ishemii nizhnikh konechnostei.

The paper deals with the pathophysiological validation and assessment of the efficiency of a new low-traumatic operation aimed at decreasing the degree of injured extremity ischemia in patients with atherosclerosis obliterans and decompensation of peripheral circulation. The essence of the operation is to remove arteriovenous shunting into the shin. Eighteen patients were operated on, out of them only 5 underwent a subsequent amputation. It is concluded that this intervention is promising and indications for it are defined in this paper.

[The current diagnostic procedure in chronic pathology of the veins of the lower extremities]. / Sovremennaia diagnosticheskaia taktika pri khronicheskoi patologii ven nizhnikh konechnostei.

Stepwise (out- and inpatient) examination forms the basis of diagnostic examination tactics in chronic abnormalities of the veins. Noninvasive ultrasonic methods of studying the venous system are preferred. With the gradual formation of groups of patients with an affection of the veins, invasive isotope and angiographic methods are supplemented. The authors emphasize that such examination of patients in stages raises the efficacy and the quality of diagnosis in individuals with chronic venous abnormalities.

[Ultrasonic examination in the diagnosis of chronic diseases of the veins of the lower extremities]. / Ul'trazvukovoe issledovanie v diagnostike khronicheskikh zabolevanii ven nizhnikh konechnostei.

Noninvasive diagnosis of chronic diseases of the lower limb venous system is an urgent problem of modern phlebology. Ultrasonic examination (USE) makes it possible to judge adequately the condition of the deep and surface veins and, consequently, to improve significantly the management of varicose and post-thrombophlebitic diseases. The authors elaborated an original method for the diagnosis and appraisal of the condition of the lower limb venous system by means of ultrasonic scanning and various functional tests for determining the character of affection of the venous valvular apparatus. Examination of more than 200 patients with primary varicosities and post-thrombophlebitic disease, the use of highly-resolving ultrasonic equipment, and comparison of the results of USE with the findings of radiocontrast phlebography (agreement in 99.8% of cases) allow the conclusion that noninvasive ultrasonic methods must be used widely in appraising the venous status in patients with chronic diseases of the venous system of the lower limbs.

[Surgical anatomy of the posterior tibial veins]. / Khirurgicheskaia anatomiia zadnukh bol'shebertsovykh ven.

An investigation of the posterior tibial vascular plexus has established certain specific features of its structure both in normality and in patients with postthrombotic disease. The alterations found require an individual approach to choice of surgical measures which is finally determined intraoperatively. At the present time surgical interventions on the posterior tibial veins in patients with postthrombotic disease are thought to be of three types: extended resection, extravasal correction and plasty of the posterior tibial veins.

[A present-day approach to surgery for the formation of crossed femoro-femoral shunts in unilateral occlusions of the ilio-femoral venous segment (indications, principles of the surgical technique)]. / Sovremennyi podkhod k operatsiiam perekrestnogo bedrenno-bedrennogo shuntirovaniia pri odnostoronnykh okkliuziiakh podvzdoshno-bedrennogo venoznogo segmenta (pokazaniia, printsipy khirurgicheskoi tekhniki).

As distinct from the classical Palme-D'Esperon operation in which the anastomosis is established with the common femoral vein, the authors prefer to form the anastomosis in the region of the saphenofemoral communication in inadequate drainage in the iliofemoral segment in patients with the postthrombotic disease. Seven variants of crossed femorofemoral shunting (CFFS) were carried out. The anastomoses were formed by means of precision techniques; an operating microscope was used when the anastomosis measured less than 5 mm in diameter. The CFFS was found to be patent in follow-up periods of up to 2.5 years in all cases. From analysis of the late-term results of CFFS, the authors claim that functional block of venous drainage from the femoro-iliac segment, rather than anatomical occlusion, is the indication for this operation.

[The role of rheological factors in circulatory disorders in patients with arteriosclerotic lesions of major arteries]. / Rol' reologicheskikh faktorov v rasstroistvakh krovoobrashcheniia u bol'nykh ateroskleroticheskim porazheniem magistral'nykh sosudov.

The blood rheologic properties were studied in 49 patients with chronic arterial insufficiency. The values of systemic and regional circulation were studied in 25 patients. Changes in blood viscosity and aggregate condition were found to play an essential role in the occurrence of general and regional hemodynamic disorders. Reversal of the syndrome of hemorrheologic disorders led to normalization of central hemodynamic and regional circulatory values in patients with atherosclerotic lesions of the great vessels in the areas with maintained blood flow in the main channels and improved essentially the blood flow distal to the occlusion of the arterial trunk.

[Rheologic effects of normovolemic hemodilution]. / Reologicheskie éffekty normovolemicheskoi gemodiliutsii.

The effect of normovolemic hemodilution on blood viscosity has been studied in 79 patients with arterial obstruction in the lower extremities. It has been established that 21 to 25% hemodilution (which corresponds to hematocrit level of 0.34-0.36 l/l) was optimal for the correction of blood viscosity abnormalities. With this hemodilution level, the oxygen transport index reflecting blood oxygen transport function reached its maximum approaching the values of healthy persons. The most marked hemodilution effect was observed with slow shift rate.

[Doppler echographic diagnosis in postthrombotic syndrome]. / Doplerograficheskaia diagnostika posttromboticheskogo sindroma.

On the basis of rich experience and the elaborated techniques of study, the authors claim that ultrasonic doppler echography is a highly informative and safe method for the diagnosis of the postthrombotic syndrome of the lower limbs yielding all the necessary data on the condition of the superficial and deep veins. The introduction of this method into the wide practice of out-patient clinics will make it possible to recognize the disease in time and determine its stage and form as well as the indications for operative or nonoperative treatment. The use of highly sensitive apparatuses will allow phlebography, which is still a necessary diagnostic procedure, to be rejected as a more hazardous and costly method.

[Dynamics of regional blood circulation in normovolemic hemodilution in patients with arterial occlusive diseases]. / Dinamika regionarnogo krovoobrashcheniia pri normovolemicheskoi gemodiliutsii u bol'nykh s obliteriruiushchimi zabolevaniiami arterii.

Normovolemic hemodilution was used in 81 patients as preparation to reconstructive operation for the occlusion of main arteries of extremities. Regional hemodynamics was studied in 18 of them. It was established that acute hemodilution substantially increased the volume and tissue blood flow, regional systolic arterial pressure distal to the occlusion of the main vessel and reestablished the vessel tone. The oxygen transport became normal in the zones with preserved main blood flow and considerably increased in the places distal to the occlusion of the main artery.