[Endovascular surgery in treatment of patients with acute impairment of mesenteric circulation in the stage of intestinal ischaemia]. / Éndovaskuliarnaia khirurgiia pri lechenii bol'nykh s ostrym narusheniem mezenterial'nogo krovoobrashcheniia v stadii ishemii kishki.

Analysed herein are the results of endovascular revascularization of the superior mesenteric artery (SMA). The study included a total of 18 patients with acute impairment of mesenteric circulation in the stage of intestinal ischaemia. The patients underwent multispiral computed tomography (MSCT) and once impairments of blood flow in the SMA were revealed, we performed endovascular revascularization of the artery. Patency of the SMA was assessed by repeat contrast-enhanced MSCT. Thirteen (72.2%) patients were found to have occlusion in the system of the SMA and five (27.8%) were diagnosed as having significant stenoses of the SMA. All 13 patients with occlusion of the SMA underwent vacuum thrombextraction followed by transluminal balloon angioplasty (TBA). Of these, thrombotic masses were obtained in 11 (84.6%) patients. Stents were implanted in 3 cases wherein TBA turned out inefficient. The patients with haemodynamically significant stenoses of the SMA were subjected to TBA followed by stent implantation. Good roentgenoendovascular results of restoration of blood flow through the SMA and its branches were obtained in 83.4% of cases. Assessing blood parameters and patients' condition severity revealed positive dynamics or a tendency towards improvement. The mortality rate amounted to 16.6%. A conclusion drawn is that this technique is efficient and appropriate for SMA lesions of any localization.

[Endovascular arterial embolization for duodenal bleeding as an alternative to surgical approach].

AIM: To present possibilities of transcatheter arterial embolization (TAE) in duodenal bleeding management. MATERIAL AND METHODS: Treatment of 212 patients with acute duodenal bleeding for the period from 2012 to 2014 was analyzed. In 32 (22.5%) patients of the study group bleeding recurrence or its high risk was indication for TAE. RESULTS: Change of surgical tactics for bleeding from upper gastrointestinal tract including endoscopic hemostasis optimization, wide introduction of TAE and sharp decrease of surgical activity reduced overall mortality to 1.6% in 2012--2014. CONCLUSION: TAE is effective to control bleeding and reduces mortality rate especially in high risk and elderly patients.

[Features of pathological changes of fibro-cartilaginous tissue knee in patients with Baker cyst.]

Objective: Using magnetic resonance imaging (MRI) to evaluate the characteristics of pathological changes of fibro-cartilage of the knee in patients with Baker cyst, to assess the compliance of degrees of damage stages of osteoarthritis on a scale of Kellgren­Lawrence (K­L), and compare the results with the data of other researchers. Material and Methods: This study included patients (38­82 years) with a cyst Baker accidentally detected during ultrasound veins of the lower extremities. The subjects underwent a single knee MRI. MRI was made in three dimensions using 3D gradient-echo protocol. Independent radiologist evaluated the presence and severity of chondral defect osteophytosis, damage to the menisci and ligaments, intraosseous edema and subchondral cysts. The osteoarthritis stage of the knee were identified by X-ray performed in a standing position in the standard two projections, with K­L scale. Results: In this study, the results of a survey of 20 people, whose average age was 57.2 years. According to the radiological scale of K­L two patients were assigned to the stage 0 degree, 5 people to stage 1, 2, 4 each, and 3 ­ to stage 3. Synovitis of various severity was detected in 85% of the studies. Nineteen visualized the patellar cartilage damage, the condyles of the femur and tibia are most commonly affects the joint area. Among the most commonly injured ligament anterior cruciate ligament was determined ­ 9 (45%) patients in the same amount of detected intramedullary edema condyles femur and tibia. Eighteen subjects had at least one anomaly meniscus detectable by MRI, while in 11 (55%) persons were deviations, at least two or more regions of the knee examined. Conclusions: Our results suggest that not all visualized on MRI degenerative damage to intra fibro-cartilaginous tissue correlate positively with the stages of osteoarthritis of the knee, identified by standard radiographs and may not significantly affect the onset and progression of synovial cyst of the popliteal region.

[Tactics by the acute intestinal ischemia].

Treatment results of the acute intestinal ischemia in 72 patients were analyzed. Patients aged 69.2 ± 5.8 years. Occlusive vascular lesions of the intestinal vessels (thrombosis and embolism of the superior mesenteric artery and thrombosis of the superior mesenteric vein) were obliged to the ischemic disorders in 84.5% of patients. The rest 15.5% of patients demonstrated microvascular disorders (nonocclusive ischemia). The issue presents the novel algorithm for treatment and diagnostics of the acute intestinal ischemia.

[Surgical treatment of varicosity-altered tributaries of saphenous veins].

A total of 469 patients presenting with lower-limb varicose disease were operated on at Municipal Clinical Hospital No 79 of the Chair of Hospital Surgery No 2 of the I.M. Sechenov First Moscow State Medical University over the period from 2008 to 2011. The tributaries of varicose veins were removed by means of miniphlebectomy according to the Muller technique, the Narat technique, with the use of a cryoprobe and an original-design vein extractor. The main method of removing tributaries is currently miniphlebectomy by the Muller technique. However, removal of the tributaries over 10 mm in diameter by the Muller s technique was associated with a skin tear in the site of the puncture, which healed with the formation of a hypertrophic scar. Miniphlebectomy of tributaries measuring less than 10 mm in diameter with the signs of previously endured phlebitis is accompanied, as a rule, by a rupture of the venous wall in the form of phlebosclerosis and a commissural process with the underlying cellular tissue. Phlebectomy by the Narat s technique was predominantly performed for removal of short tributaries from the altered paravasal cellular tissue. The method of cryophlebectomy was used by means of intravasal or paravasal insertion of the probe. A vein extractor was used to remove the tributaries form the altered cellular tissue at a distance of up to 20 cm. The choice of an optimal method of treatment for varicosity-altered tributaries makes it possible to decrease the complications rate and to obtain good cosmetic outcomes.

[The infusion therapy of the acute bleeding].

Intravenous colloid and crystalloid solutions are the mainstay of the acute bleeding therapy. Infusion therapy normalizes the blood circulation volume and improves its flow characteristics. The conducted study revealed that the method normovolemic hemodilution lead to an early unknown type of oxygen insufficiency called the dilutional anemic hypoxia. Authors set up and proved the hypothesis, that decompensated dilutional anemic hypoxia lead to cardiac insufficiency, leading finally to the so called dilutional circulatory hypoxia.

[Surgical treatment of patients with perforated peptic ulcers].

Results of surgical treatment of 782 patients with perforated gastric and duodenal ulcers are analyzed. Gastric ulcers of I type were diagnosed at 86 (10.9%) patients, prepyloric and pyloric ulcers - at 441 (56.4%), duodenal ulcers - at 255 (32.6%) patients. Perforation was combined with bleeding and stenosis at 24 (3.1%). Palliative operations have been performed at 172 (22.0%) patients, stem vagotomy with ulcer excision and pyloroplasty - at 58 (7.4%), various types of stomach resection - at 54 (6.9%), proximal gastric vagotomy with excision of gastric, pyloric or duodenal ulcer - at 77 (9.8%), proximal gastric vagotomy with excision or suturing of ulcer and pyloro- or duodenoplasty - at 421 (53.8%) patients. The rate of postoperative complications after proximal gastric vagotomy was 3.6%, after stomach resection - 18.2% (p<0.01). Early postoperative complications after vagotomy with ulcer excision and pyloroplasty were diagnosed at 8.3%, after stomach resection - at 18.2% patients (p<0.01). The quality of patients life was higher after organ-saving operations. Proximal gastric vagotomy with excision of ulcer and pyloro- or duodenoplasty should be regarded as operation of choice at perforated duodenal ulcers.

[Treatment of a burn stricture of the esophagus complicated with a fistula].

The experience in the treatment of esophageal fistulas is analyzed. Necessity and expediency of bougienage of esophageal burn stricture in patients with fistulas are discussed, indications and contraindications to bougienage of esophageal stricture complicated with a fistula are formulated. Surgical treatment of these patients (disfunction of esophageal fistulas and different variants of esophagoplasty) are considered.

[Esophagoplasty with the colon in flap patients with burn strictures of the esophagus]. / Plastika pishchevoda tolstoi kishkoi u bol'nykh s ozhogovymi strikturami pishchevoda.

Results of coloesophagoplasty in 366 patients with long burn strictures of the esophagus are presented. The lesion was total in 74 (21.2%) of them. Inefficacy of bougieurage was indication for plastic surgery in 133 (36.3%) patients, complete obliteration of esophagus--in 53 (14.5%). Left half of the colon was used in 296 (80.9%) cases, transverse colon--in 48 (13.1%), right half of the colon--in 22 (6.0%) cases. Retrosternal shunting esophagoplasty was performed in 247 (67.5%) patients. Complications were in 84 (34.0%), necrosis of the transplant--in 4 (1.6%) patients. Extirpation of the esophagus with posteriormediastinoplasty was performed in 16 (4.4%) patients, in 14 of them--transhiatally. Complications occurred in 7 patients coloesophagopharyngoplasty was carried out in 52 (14.2%) patients with combined stricture of the esophagus and the pharynx, in 23 of them--simultaneously. Complications were in 28 (53.8%) patients. Intrapleural of coloesophagoplasty was performed in 51 patients. General hospital lethality was 3.3%. Long-term results were studied in 259 patients. Good results of esophagoplasty were seen in 135 (52.1%) patients, satisfactory--in 65 (25.1%), unsatisfactory--in 59 (22.8%) patients. Dysfunction of the artificial esophagus was seen in 22.0% patients, 12.7% patients underwent repeated reconstructive surgeries.

[One-stage esophagoplasty with pathologically changed or operated stomach in patients with benign esophageal strictures]. / Odnomomentnaia ézofagoplastika patologicheski izmenennym ili operirovannym zheludkom u bol'nykh s dobrokachestvennymi strikturami pishchevoda.

Results of surgical treatment of 71 patients who have undergone extirpation of the esophagus with one-stage plastic surgery with pathologically changed or operated stomach are presented. All the patients suffered from benign diseases of the esophagus: burn and peptic strictures, peptic esophageal ulcers, cardiospasm of degree IV, benign tumors. Fifty-one patients had been previously operated on the stomach, 10 patients had burn deformation of the stomach, 3--benign tumors of the esophagus involving the stomach, the others--gastric and/or duodenal ulcers. In all the cases an isoperistaltic gastric tube was used for plastic repair of the esophagus. Postoperative lethality was 1.4%.

[Local esophagoplasty in patients with burn strictures of the esophagus]. / Mestnaia ézopfagoplastika u bol'nykh s ozhogovymi strikturami pishchevoda.

Local plastic reconstruction of short burn strictures of the esophagus (SBSE) was performed in 14 patients aged from 22 to 37 years, 9 were men, 5--women. Decreased body mass was revealed in all the patients, mass deficit over 20% was in 4 (28.6%) of them. SBSE located in the upper third of the esophagus in 9 (64.3%) patients, in middle third--in 5 (35.7%). Local esophagoplasty was performed from cervical approach in 9 (64.3%) patients, from right-sided thoracotomy--in 5 (35.7%). Dissection of SBSE with 3/4 anastomosis was performed in 5 (35.7%) patients; circulatory resection of esophageal stricture with end-to-end anastomosis--in 7 (50.0%); detour side-to-side anastomosis without stricture resection--in 2 (14.3%). There was no hospital lethality. Postoperative complications were seen in 14.2% cases. Long-term results were good in 10 (71.4%) patients, satisfactory (strictures of anastomosis)--in 3 (21.4%), unsatisfactory--in 1 (7.2%). Local esophagoplasty is indicated for patients with SBSE when bouginage and dilatation of stenosis are not effective.

[Surgical policy for patients with prolonged esophageal burn strictures]. / Lechebnaia taktika i vybor khirurgicheskogo lecheniia bol'nykh s protiazhennymi ozhogovymi strikturami pishchevoda.

Concept of early radical surgical treatment of prolonged esophageal burn strictures (PEBS) is presented. From 1980 to 2000 one-stage esophagoplasty was performed in 503 (62.0%) of 811 patients with PEBS. Bouginage was effective in 17.2% patients. Extirpation of the esophagus with posteriormediastinal plastic repair was performed in 119 patients. Mean age of patients was 48 years, mean anamnesis time--11 years. 13 (10.9%) patients had total PEBS. Combined burn of the stomach was revealed in 25 (21.0%), of the pharynx--in 4 (3.4%) patients. Isoperistaltic gastric tube was used in 102 (85.7%) patients, whole stomach--in 1 (0.8%), left half of the large intestine (antiperistaltic)--in 16 (13.4%) patients. Esophagectomy was performed transiatally in 114 (95.8%), from three approaches (+ right-sided thoracotomy)--in 5 (4.2%) patients. Transplant on the neck was connected with esophagus in 106 (89.1%) patients, with the pharynx--in 13 (10.9%). Combined operations were performed in 14 (11.8%) patients. Intraoperative complications were in 6 (5.0%), postoperative--in 39 (33.0%) patients. Insufficiency of cervical anastomosis was seen in 16 (13.4%), paresis of recurrent nerve--in 4 (3.4%) patients. Hospital lethality was 3.4% (4 patients). Good and satisfactory long-term results of esophagoplasty were achieved in 97 (97.0%) patients. PEBS is the indication for transhiatal extirpation of the esophagus with its one-stage plastic repair with gastric tube (or large intestine) during first 6 months after burn.

[50 years after ante-thoracic esophagoplasty]. / 50 let posle antetorakal'noi ézofagoplastiki.

Fifty years after antethoracic esophagoplasty the patient's quality of life was rather satisfactory.