[Correction of the glicemia level in elderly and senile patients with diabetes mellitus, operated for purulent-necrotic foot lesion].

Basing on the analysis of surgical treatment experience of 685 elderly and senile patients with diabetes mellitus, suffering purulent-necrotic affection of foot, the authors admit possibility of the insulinotherapy abolition before the operation in patients with for the first time diagnosed diabetes type II or in those, who before hospitalization received preparations in tablets, while the signs of intoxication are absent (extended purulent process, humid gangrene) and initial level of glycemia no more than 10 mmol/l.

[Treatment of mediastinitis]. / Lechenie mediastinita.

The authors work is based on experience in the study of 56 patients with acute mediastinitis of various origin who were treated in the period from 1981 to 1990. There were 33 males and 23 females whose ages ranged from 16 to 65 years, Odontogenous mediastinitis was diagnosed in 23, tonsillogenous in 2, and mediastinitis resulting from injury to the esophagus in 31 patients. Instrumental injuries prevailed. All patients underwent operation. The character of the operation was determined by the duration, localization, and severity of the pyonecrotic process in the mediastinum. Diffuse anterior mediastinitis was managed by tunneling and drainage of the mediastinum through the seat of the removed xiphoid process. Prophylactic treatment of the mediastinal space and intensive therapy including active detoxification were applied in the 56 patients who underwent operation died, 26 of them were admitted to the clinic 24-72 hours after the onset of the disease in a state of severe intoxication caused by violently developing mediastinitis. The remaining 27 patients recovered.

[Methods for the prevention and treatment of acholia]. / Sposoby profilaktiki i lecheniia akholicheskoi bolezni.

In the clinic, the special appliances and apparatus for collection of the bile, its filtration, sterilization and introduction into the stomach of a patient were developed and used in patients with external biliary fistula. Since 1987, the original method for treatment of the alcoholic disease has been introduced. It was used in 40 patients.

[Recurrent pulmonary hemorrhage]. / Retsidiviruiushchee legochnoe krovotechenie.

The results of treatment of 235 patients with pulmonary hemorrhage of various etiology which stayed in clinic in 1980-1992 yrs. were analyzed. Of 216 patients, whom diagnostic bronchoscopy was performed, the hemorrhage origin was found in 137, of whom in 13 its localization was imprecise. Seventeen patients have died, of whom 11--before operative intervention was done. The method of temporary occlusion of presumably bleeding lobar or segmental bronchus with the help of obturator containing the leaded out transnasally catheter was proposed to localize precisely the pulmonary hemorrhage origin. The hemorrhage origin localization is confirmed by subsequent appearance of blood from the external end of catheter.

[Methods of designing a prognostic system, regression models and risk scale in the surgical treatment of cholelithiasis]. / Metodika postroeniia prognosticheskoi sistemy, regressionnykh modelei i shkaly riska v khirurgichedskom lechenii zhelchnokamennoi bolezni.

An automated assessment of the results of treatment and prediction of a course of the postoperative period was performed in 218 patients with cholelithiasis by means of ES computer according to 100 parameters. Five statistic packs of the application programs (VMDR-75 version) were used. Cluster-analysis, factor analysis and a method of the main components were employed. Four most essential risk factors were distinguished, the regressive models of a postoperative period obtained. This permitted to choose the most rational method for treatment.

[Injuries of the heart]. / Raneniia serdtsa.

The authors had 53 patients with heart injuries under observation; 52 patients were operated on for vital indications. The heart wound was sutured, the concomitant injuries to other organs were removed, and the pericardial and pleural cavities were drained. Air-tightness of the injured heart muscle was attained in all cases. Seven of the patients who were operated on died. One patient who did not undergo operation died suddenly in complete well-being from acute cardiac tamponade 2 days after injury to the chest inflicted with a pin-like object. The authors emphasize the importance of organizational measures promoting earliest performance of the operation.

[Traumatic injuries and diseases of the diaphragm]. / Travmaticheskie povrezhdeniia i zabolevaniia diafragmy.

The article analyses experience in diagnosing the pathological condition and treating 125 patients with acute injury to the diaphragm (61 patients) and chronic traumatic diaphragmatic hernias (64 patients). The authors indicate the therapeutic and diagnostic means in this pathological emergency due to the acute trauma of the chest and abdomen or incarceration of the abdomen. The diagnostic errors and their consequences are analysed. Operation was conducted on 104 patients. In ruptures of the diaphragm in the zone of the esophageal hiatus the cardia was drawn downwards and fastened under the diaphragm; in cases of fractures of the bony framework of the chest with the formation of fragments, panel fixation of the costal fragments and the sternum was carried out by the authors' methods. The results of the surgical interventions are shown (18 patients--17.4% died) with emphasis on the character of the disorders and the lapse of time from the development of the emergency to the application of therapeutic aid.

[Complications in hiatal hernia]. / Oslozhneniia pri gryzhakh pishchevodnogo otverstiia diafragmy.

Of 1498 patients suffering of hiatal hernias of the diaphragm 375 were operated on for complicated course of the disease. It was established that in some of the complicated course of the disease the background is the vagal-solar syndrome developing due to traumatization of the branches of vagal nerves and solar structures by the stomach prolapsing into the mediastinum. To control this phenomenon the authors used in 167 patients their original method of surgical correction of hiatal hernias of the diaphragm. The result was favourable in 87.7% of the total number of 375 patients with complicated forms of hiatal hernias of the diaphragm. Lethality--0.8%.

[Temporary occlusion of the bronchi in the treatment of complex suppurative destruction of the lungs]. / Vremennaia okkliuziia bronkhov v lechenii oslozhennykh gnoinykh destruktsii legkikh.

In the period from 1984 to 1987 the authors had under observation 179 patients with acute pulmonary destruction following various courses. Variants of temporary occlusion of the fistula-carrying bronchus were performed in 54 patients in whom the disease was complicated by bronchopleural fistula and pyopneumothorax. Occlusion of a lobar or segmental bronchus (51 patients) was preceded by preliminary flow cleansing of the affected bronchopulmonary areas and intrapleural hydrolavage of the lung with alternating pressure. In 3 patients temporary occlusion of the bronchus was conducted with a hollow obturator according to the method suggested by the authors; the method allows cleansing of the affected lung with the occluded bronchus to be combined with its gradual re-expansion. Four among the 54 treated patients died, 50 recovered.

[New approach to the treatment of status asthmaticus caused by hiatal hernia]. / Novyi podkhod k lecheniiu astmaticheskogo sostoianiia, obuslo- vlennogo gryzhei pishchevogo otverstiia diafragmy.

From 1986 to 1988, 170 patients with asthmatic state were observed. Of them in 13, the X-ray study revealed hiatal hernia (HH) and reflux-esophagitis. The analysis of observations of 1173 patients with HH was carried out. In a number of patients together with the symptoms of pathology of the respiratory system, the vegetative, cardial and other disorders were found. All these disorders the authors consider a consequence of irritation of the vagus and celiac plexus occurring in HH. A complex of medicamentous therapy of the asthmatic state caused by HH is suggested.

[Respiratory and dysuric disorders in hiatal hernia]. / Respiratornye i dizuricheskie narusheniia pri gryzhakh pishchevodnogo otverstiia diafragmy.

In the period of 1973-1987 the authors followed-up 1053 patients with hiatal hernia with different types of a clinical course. Various respiratory symptoms (cough, attacks of asphyxia, etc.) were observed in 181 patients, dysuric symptoms (dysuria, urethral colics, etc.) were observed in 66 patients. Of this number 347 were operated upon. A positive effect was achieved in 36 of 41 operated patients with bronchopulmonary disorders and in 16 of 23 patients with dysuric disorders. Organic respiratory and urinary changes were undetectable before operation. The authors considered a possibility of the development of the vagosolar syndrome lying in the basis of the pathogenesis of the above disorders.