[The weakened form of familial adenomatosis: clinical and genetic characteristics and methods of treatment].

Clinical and genetic analysis of 24 Russian patients with attenuated form of family colon adenomatosis was undertaken. On the basis of obtained clinical and genetic data it was defined the algorithm of therapeutic measures in this group of patients--from dynamic monitoring or endoscopic polypectomy to performing extensive resections of the colon in situations associated with cancer development, an increase of the intensity of growth of polyps or an appearance of villous lesions. Some of the patients had molecular-genetics causes of a weakened form of family adenomatosis.

[The comparative analysis of the surgical treatment of the familial adenomatosis of the colon with the use of cell transplantation].

Authors represent the surgical technique of colectomy with preserving the natural intestinal passage in the treatment of the familial colic adenomatosis. The technique is based on the preserving the distal part of the rectum with its demucosation and connecting with the ileal conduit. The rectal mucosa reconstruction is performed with the use of allogenic transplantation of fetal intestinal cells. 27 patients were operated on. The rectal mucosa reconstruction was registered in all cases range 4-12 weeks postoperatively. The long-term follow-up showed no disease recurrence within 5 years. The method demonstrated better intermediate and long-term functional results.

[Rehabilitation of operated patients with diffuse polyposis of the large intestine]. / Reabilitatsiia operirovannykh bol'nykh diffuznym polipozom tolstoi kishki.r

In 1965 to 2000, the State Coloproctology Research Center operated on 584 patients for diffuse polyposis of the large intestine. A 18-year follow-up showed that metabolic disorders developed in 85% of cases due to the loss of large intestine that is important for maintaining homeostasis. The authors consider it necessary to continuously follow up the patients operated on for diffuse polyposis for timely diagnosis of occurring metabolic disorders and their correction. This approach to complex treatment of diffuse polyposis promotes social and working rehabilitation of patients operated on.

[Pregnancy and diffuse intestinal polyposis]. / Beremennost i diffuznyi polipoz tolstoi kishki.

A follow-up of 52 pregnant women with diffuse polyps of the colon showed that gestation deteriorated the course of diffuse polyposis and provoked the appearance of the first symptoms of this disease. Diffuse polyposis had virtually no effect on the course of pregnancy and labor. Gestation eventuated in normal full-term delivery in 22 patients, in preterm delivery in 4, in 3 patients cesarean section was performed, in 1 the fetus was extracted with obstetrical forceps, 1 delivery finished with manual detachment and extraction of the placenta. Late spontaneous abortions occurred in 4 women, induced abortions were carried out in various periods in 68 women. Previous extensive resections of the colon undertaken for diffuse polyposis were not a contraindication to surgical delivery.

[Effectiveness of preserving large intestinal segments in surgical treatment of proliferative diffuse polyposis]. / Effectivnost sokhraneniia segmentov tolstoi kishki pri khirurgicheskom lechenii proliferiruiushchei formy diffuznogo polipoza.

Among 390 patients who were operated on in the Research Institute of Proctology for the proliferative form of diffuse polyposis, 242 underwent various types of operations in which polyp-free segments of the large intestine were not resected. In the first 5 postoperative years all 242 patients were examined, in follow-up periods of 6 to 10 years 144 patients (59.5%), in periods of 11 to 15 years 88 patients (36.4%), in periods of 16 to 20 years 28 patients (11.6%), and after 21 years 8 patients (3.3%) were examined. Development of carcinoma in the preserved segments was encountered in 26 patients (10.7%), and intensive growth of polyps for which the preserved segment had to be removed was found in 5 patients (2.1%). There was no significant increase of the risk of carcinoma development in the preserved intestinal segments in patients who previously had a malignant tumor in the resected part of the large intestine. The development of carcinoma and intensive growth of polyps were encountered most frequently in patients in whom the distal parts of the large intestine were not removed during the operation. The obtained data are evidence of the validity of the choice of the volume of the operation based on the endeavor to preserve the polyp-free parts of the large intestine for rehabilitation of the patients.

[Comparative characteristics of various types of operations performed in treatment of diffuse colonic polyposis]. / Sravnitel'naia kharakteristika razlichnykh vidov operatsii, primeniaemykh pri lechenii diffuznogo polipoza tolstoi kishki.

Diffuse polyposis of the large intestine characterized by the development of multiple polyps in it and their subsequent malignant degeneration is one of the most severe disease of the gastrointestinal tract. That it must be treated by surgery needs no proof. However, the volume and the character of the surgical intervention on the large intestine is still a debatable problem. The article discusses the experience in the follow-up of 445 patients for periods of 12 months to 30 years after operation for diffuse polyposis. In 228 patients various segments of the large intestine which were free from polyps were not resected. During these follow-up periods malignant tumors developed in the preserved parts of the large intestine in 10.1% patients and intensive growth of polyps was encountered in 3.5% of patients. The frequency of carcinoma development depended significantly less on the length of the follow-up period and much more on the character of affection of the preserved parts of the large intestine with the polyps.

[A comparative study of nonsurgical methods in the treatment of hemorrhoids]. / Sravnitel'naia otsenka neoperativnykh metodov lecheniia gemorroia.

The authors conducted comparative appraisal of the results of treatment of hemorrhoids in 3 groups of patients at a higher surgical risk in 1989-1990. Group 1 consisted of 79 patients given the traditional nonoperative treatment. Group 2 was made up of 17 patients in whom the hemorrhoidal nodes were ligated by means of latex rings. Forty-three patients of group 3 were treated by the traditional nonoperative methods and, in addition, by infrared photocoagulation, 33 at in-patients and 10 at out-patient clinics. The follow-up periods range from 3 to 12 months. The study showed that nonoperative therapy produced a temporary effect, clinical manifestations of hemorrhoids recurred in 100% of patients. In group 2 59% of patients were cured, which is evidence of the pathogenetic substantiation of the method. The treatment, however, in this group was marked by a great number of complications of an inflammatory character. The best effect was produced among patients of group 3; 37 (86%) patients were cured. Thus, the results of comparative analysis of the efficacy of these methods of treatment in patients at a higher surgical risk showed the advantages of infrared photocoagulation over nonoperative treatment and ligation of hemorrhoids with latex rings. The method of infrared photocoagulation is technically simple, convenient, and can be applied both in in- and out-patient clinics.

[Colectomy with resection of the rectal mucosa and formation of the ileo-rectal anastomosis as an alternative of permanent ileostomy]. / Koléktomiia s mukozéktomiei priamoi kishki i formirovaniem ileorektal'nogo anastomoza kak al'ternativa postoiannoi ileostome.

A new method for surgical management of patients with diffuse polyposis of the large intestine is described. It was applied in 22 patients with total involvement of all parts of the large intestine in polyps. The essence of the suggested operation consists in preservation of the rectum after its demucosation and the formation of a cecal++-ileorectal anastomosis at the level of the pelvic peritoneum. The operative techniques are described. Experience in various types of intestinal anastomoses with a demucosated rectum as well as the techniques of the most optimal anastomosis are analysed. Retrospective analysis of the results of treatment allowed the authors to conclude that in inclusion of demucosated rectum into the intestinal passage its reservoir and accumulative function is maintained. Follow-up of the patients showed that small intestinal type mucosa regenerates in the rectum after mucosectomy in one third of patients and colonic-type mucosa in the remaining patients. It is pointed out that recurrent growth of polyps in the rectum after adequate demucosation was not encountered.

[The therapeutic procedure for desmoids in patients with diffuse polyposis of the large intestine]. / Lechebnaia taktika pri desmoidakh u bol'nykh diffuznym polipozom tolstoi kishki.

Desmoid was diagnosed in 54 out of 632 patients who had been operated on for diffuse polyposis. The age of patients with desmoid ranged from 18-61 years. Twenty of them had desmoid in the anterior abdominal wall whereas 30--in the small intestine mesentery or retroperitoneal space. Dissection was carried out in 14 out of 18 patients with anterior abdominal wall desmoid. Recurrence was registered in 6 patients. Dissection was attempted in 12 out of 26 patients with intraabdominal desmoid but radical procedure could be performed in 5 only. In a group of 4 patients with synchronous desmoid of both sites, both tumors were removed in one patient only whereas in the other 3--only anterior abdominal wall tumor could be dissected.

[Secretion of thyrocalcitonin and parathyroid hormone in diffuse polyposis of the colon]. / Cekretsiia tireokal'tsitonina i paratgormona pri diffuznom polipoze tolstoi kishki.

The article presents data obtained in studying the content of calcium regulating hormone thyrocalcitonin and parathyroid hormone in blood plasma of patients with diffuse polyposis of the colon prior to and after a radical surgical treatment. The content of these hormones was also studied in extracts from colonic polyps. The concentration The concentration of thyrocalcitonin was found to decrease after operation. The elevated concentration of thyrocalcitonin was established in polyp extracts which might suggest its "ectopic secretion" in the polyp tissue in diffuse polyposis. Removal of the colon with polyps is followed by normalization of metabolism in the organism which proves the expediency of early surgical treatment.

[Therapeutic tactics in patients operated on for diffuse polyposis of the colon]. / Lechebnaia taktika u bol'nykh, operirovannykh po povodu diffuznogo polipoza tolstoi kishki.

The endoscopic sanitation is possible in patients operated upon for diffuse polyposis in cases of the absence of malignization of the polyps in the other parts of the colon. The endoscopic polypectomy performed on patients with diffuse polyposis allows preserving the rectum in 88.8% and the upper parts of the gastrointestinal tract in 99.1% of the cases.

[Therapeutic tactics in colonic diverticulosis]. / Lechebnaia taktika pri divertikuleze obodochnoi kishki.

Based on an analysis of results of treatment of 556 patients the authors think operative measures to be indicated in cases with the perforation of diverticula, chronic peridiverticular infiltration and failure of the conservative therapy. In noncomplicated diverticulosis resection of the altered segment of the intestine should be added by serosomyotomy by an original authors' method.