[Choice of the method of surgical treatment of spleen disruption in combined and isolated abdominal trauma in terms of endosurgery].

The results of the treatment of 378 patients with severe combined (n=270) and isolated (n=108) close abdominal trauma with an injury of the spleen are analyzed. Overall lethality was 11.9% including 7.41% during the first 24 hours. Spleen-preserving surgery was performed in 150 patients, 98% of them had severe injuries of this organ. Splenectomy was performed in 228 patients. Ligation of splenic artery is the indispensable condition of spleen-saving surgery. The level of ligation was validated by the data of own 102 x-ray and 73 anatomic examinations. Optimal level of ligation is located in proximal and middle part of the splenic artery. Spleen-preserving surgeries (especially laparoscopic procedures) significantly reduced lethality, number of postoperative complications and hospital stay.

[Surgical policy and future of endo-surgery of closed abdominal injuries in severe combined trauma].

Results of examination and treatment of 646 patients with severe combined trauma and closed abdominal trauma are analyzed. Laparocentesis and laparoscopy were used for diagnosis. Laparocentesis (342 procedures) diagnosed injuries of the abdominal organs in 47% cases and excluded them in 33% cases that made a total of 80% of accurate diagnoses. Laparoscopy (304 procedures) provided accurate diagnosis in 99.34% cases. Laparoscopy did not reveal injuries that required additional surgical procedures in 56% patients, in the rest 44% patients surgical methods of treatment were used including laparotomy (29.2%) and endo-surgical procedures (14.8%). Algorithm of diagnosis and treatment is described.

[Evaluation of status severity in patients with isolated and combined injury of abdomen associated with spleen disruption].

Results of treatment of 378 patients with severe combined and isolated abdominal trauma with spleen injury are analyzed. Severity of patients state and severity of trauma are assessed. General lethality was 11.9% including 7.41% during first day. Spleen-saving surgery was performed in 150 patients, 96% of them had severe injuries of organ. Spleen was removed in 228 patients. Spleen-saving surgeries (especially laparoscopic procedures) permitted to reduce significantly lethality, number of postoperative complications and hospital stay.

[Organ-saving method of treatment of spleen disruption].

Based on 102 X-ray and 73 anatomic examinations, the scheme of arterial circulation of the pancreas and spleen, features of their collateral circulation are analyzed. Optimal level of spleen artery ligation at proximal part as the main stage of organ-saving surgical treatment in traumatic disruption of the spleen is substantiated.

[The human umbilical cord vein in the surgical treatment of acute arterial thrombosis]. / Vena pupochnogo kanatika cheloveka v khirurgii ostrykh arterial'nykh trombozov.

The authors' experience with the application of bioprostheses of the human umbilical cord vein allows them to speak of its effectiveness and positive properties such as: 1) thromboresistance, 2) areactivity, 3) immunological compatibility, 4) firmness, 5) possibility of prolonged storage, which make it possible to be used in urgent surgery of the vessels. Positive results were obtained in 89.47% of the cases and the authors think that using bioprostheses of the human umbilical cord vein is expedient in the surgery of acute arterial thromboses.

[Isolated plastic repair of the deep femoral artery in acute arterial obstruction]. / Izolirovannaia plastika glubokoi arterii bedra pri ostroi arterial'noi neprokhodimosti.

In 67 patients with acute arterial obstruction non-direct thrombus-, embolectomy was added by plasty of the profound artery of the femur. 36 patients were discharged with reestablished blood flow in the extremity, 12 patients-after amputation and 19 patients died though in 8 of them blood circulation in the extremity was reestablished. Such an operation is a method of choice in the surgical treatment of patients with acute arterial obstruction developed against the background of chronic occlusion of the vessel of the femoro-popliteal segment when other methods of direct revascularization of the extremity are thought to be impossible.

[Transluminal arterial dilatation in the surgical treatment of acute arterial occlusion]. / Chresprosvetnaia dilatatsiia arterii pri operativnom lechenii ostroi arterial'noi neprokhodimosti.

In 22 patients with acute arterial obstruction during different reconstructive operations transluminal angiodilatation of stenozed portions with Gruntzing catheter was performed. In 16 patients excellent results were obtained, only in 2 of the patients blood circulation was not reestablished and amputations had to be performed. Indications and technique of intraoperative angioplasty were developed.

[Functional state of the extremities in patients operated on for an embolism of the bifurcation of the aorta and major arteries in follow-up]. / Funktsional'noe sostoianie konechnosti u bol'nykh, operirovannykh po povodu émbolii bifurkatsii aorty i magistral'nykh arterii, v otdalennom periode.

The clinical and electrophysiological examination of the late functional condition of the extremity in 103 patients operated upon for embolism of the bifurcation of the aorta and main arteries of the extremities has proved that the function of an operated extremity depends directly upon the condition of the circulation and the severity degree of the ischemia. A dispensary observation over such patients together with special procedures aimed at the improvement of arterial circulation in the extremity are recommended for the improvement of the function of the operated extremity.

[Dynamics of neurologic disorders following embolism of the bifurcation of the aorta and major arteries of the lower extremities]. / Dinamika nevrologicheskikh narushenii pri émbolii bifurkatsii aorty i magistral'nykh arterii nizhnikh konechnostei

The authors conducted a clinico-EMG study of 118 patients with an embolism of the aortal bifurcation and magistral arteries of the lower extremities. Among this contingent 58 were studied in the remote period -- from 2-7 years following a surgical operation. The clinical symptoms of embolism were expressed in severe pain, sensory, motor and vegetative-trophic disturbances in the affected extremities. Three degrees of the nervous system lesions were distinguished in an embolism. It was also demonstrated that there were significant changes in the bioelectrical muscle activity of the extremities. In the remote period following embolectomia, in most of the patients there still were sequalae of acute ischemia of the nervous tissue, the expressiveness of which depended upon the calibre of the occluded vessel, degree of tissue ischemia, the time of treatment and the time following the operation. A retarded restitution may be explained by the degree of the nervous tissue lesion and the persisting insufficiency of circulation in the extremities.