[Relaparotomy]. / Relaparotomiia.

For a period of 1987-1995 yrs. the operations on a peritoneal cavity organs were performed in 14,718 patients. In 87 reoperated patients 93 relaparotomies were conducted. After relaparotomy 36 (41.3%) patients died.

[Postoperative complications in patients with a perforated gastroduodenal ulcer]. / Posleoperatsionnye oslozhneniia u bol'nykh s perforativnoi gastroduodenal'noi iazvoi.

The results of treatment of 538 patients, operated on for perforative ulcer (PU), are studied up. Perforative aperture was sutured in 75 patients, in 153 the ulcer was excised, in 291 the excision was supplemented by vagotomy, resectional methods were applied in 19. In 94 (17.5%) of patients 114 complications have occurred after the operation. Postoperative complications were divided into those from the wound, in the abdominal cavity organs and retroperitoneal space, from the abdominal cavity, respiratory and cardiovascular system. After the operation 37 (6.9%) of patients have died. Complications and mortality were observed more frequently in the patients to whom the perforative aperture suturing and the ulcer excision with truncal or selective vagotomy were conducted in the presence of the increased operative risk (the elderly and senile age, concurrent diseases, widespread peritonitis). The least frequency of postoperative complications and mortality were noted after the PU and the ulcer substratum excision supplemented by selective proximal vagotomy.

[Aggressive fibromatosis of the small pelvis]. / Agressivnyi fibromatoz polosti malogo taza.

Experience in the treatment of 25 patients with aggressive fibromatosis of the true pelvis is discussed. To establish a precise diagnosis obligatory and special methods of examination were applied. Secondary changes in the adjacent organs and structures were found in 24 patients. Radical operations were conducted on 19 (76%) patients, in 13 of them the interventions were combined. The mean duration of the operations was 5.3 hours. Complications developed in 17 out of 19 patients. Hemorrhage was the most frequent (in 12 out of 19 patients) and menacing complication. The blood loss was 3036.8 ml on the average. Recurrences were registered in 8 out of 19 (42.1%) patients.

[The diagnosis of nonorganic neoplasms of the lesser pelvis]. / Diagnostika neorgannykh novoobrazovanii malogo taza.

An analysis is presented of the data on 330 patients with extraorganic neoplasms of the small pelvis (ENSP), 110 of whom are children, 105 subjects had benign neoplasms, 225 presented with malignant neoplasia. ENSP are manifested primarily by pains in the pelvis and disturbances in physiological functions due to the adjacent organs and structures being squeezed. In applying for medical advice for the first time diagnostic procedures fail to show ENSP in each third (34.2%) patient. The diagnosis of ENSP is supposed to include several studies and it is multi-stage. The most valuable information concerning ENSP is provided by rectal and/or vaginal examination of pelvic cavity. A scheme was elaborated for establishing boundaries of the focus, determining the size of a neoplasm, as was the classification according to the stages and TNM system for the objective information to be obtained on localization, size and distribution of a neoplasm. Employed in the evaluation of patients were rectoscopy (in 158 patients), cystoscopy (123), roentgenography of bones and pelvic cavity (306), pelvic pneumography (79), excretory urography (175), rectosigmoidography (178), ultrasonography (102), computerized tomography (118), angiography (112) and other procedures, all these having been done in order to be able to make as accurate and precise a diagnosis as possible.

[Soft-tissue rhabdomyosarcoma of the lesser pelvis]. / Rabdomiosarkoma miagkikh tkanei polosti malogo taza.

For the 1967-1989 period of time of 225 patients with malignant nonorganic small pelvis tumors in 15 the soft tissues rhabdomyosarcoma of small pelvis cavity was diagnosed (including 7 children and 8 adults). The main tumor symptoms are the pain and the disorders of physiologic excretions. The fourth stage of the disease was diagnosed in 13 of 15 patients. In spite of performance of extensive combined intervention, chemotherapy and irradiation therapy the treatment results are poor: the whole of the patients have died for a period of 3 years (mainly up to 1 year period of time).

[The diagnosis of neurogenic neoplasms of the lesser pelvis]. / Diagnostika neirogennykh novoobrazovanii polosti malogo taza.

For the 1967-1989 period of 330 patients with nonorganic small pelvis cavity tumors in 93 (28.3%) the neurogenic neoplasms were diagnosed, including 45-nonmalignant and 48-malignant. At initial admission in 30.1% observations the diagnostical mistakes were committed due to low oncological watchfulness of general profile physicians and the finger rectal examination neglect. Clinical examination of the patients was the main source of information about neurogenic neoplasms. The use of special examination methods is obligatory for the tumor spreading detection.

[Malignant tumors of the liver in children]. / Zlokachestvennye opukholi pecheni u detei.

The treatment results of 65 children with malignant tumors of liver for the 1972-1992 yrs period were analyzed. Hepatocellular cancer was diagnosed in 31, hepatoblastoma--in 23, poorly differentiated sarcoma, angiosarcoma, cancer-sarcoma--in 11. Operations were conducted in 38 (58.5%) patients, of whom radical--in 22; the right-sided hemihepatectomy--in 14 (in expanded and expanded-combined), left-sided--in 2, nonanatomical resection--in 6. Laparothoracophrenotomy was done in 8 children with massive tumor for the right-sided hemihepatectomy conduction (in 2--with diaphragm resection and vast defect plasty with the help of a capron mesh). Of 22 radically operated children 4 (18.2%) died: after the right-sided expanded hemihepatectomy conduction--3, nonanatomical liver resection--1. One more child with a massive tumor died during mobilization of the liver right lobe. Of 18 discharged children 12 died during following 18 mos, 6 survived. Five-year survival was 23.5%.

[Surgical approaches to the treatment of nonorganic pelvic neoplasms]. / Khirurgicheskie dostupy k neorgannym novoobrazovaniiam malogo taza.

Operations were performed on 242 patients (49 out of 110 children and 193 out of 220 adults) with nonorganic new growths of the true pelvis. Nine surgical approaches were used: transperitoneal (89 patients), transperitoneal-unguinal-femoral (2), extraperitoneal (48), transgluteal-transsacral (23), parasacral (14), transuterine (4), interlabial (2), perineal (16), combined (44). The transperitoneal approach was used most frequently--in 52.0% of patients (taking into account the combined approach), more often in children than in adults, and more often in males than in females. The choice of the approach was mostly guided by the location and size of the new growth in the true pelvis.

[Measuring the depth of location of non-organic neoplasms in the small pelvis]. / Opredelenie glubiny raspolozheniia neorgannogo novoobrazovaniia malogo taza.

The objective technique for determination of the depth of location of the lower and upper poles of a non-organic mass in the small pelvic cavity, irrespective of sex and age of a patient, has been developed. The correct determination of a mass location permits to choose an optimal surgical approach, increase the operability rate of the tumors and reduce the incidence of complications.

[The treatment of nonorganic neoplasms of the lesser pelvis]. / Lechenie bol'nykh neorgannymi novoobrazovaniiami malogo taza.

In 1967-1989, 330 patients with non-visceral tumors of the small pelvis (children--110 and adults--220) were registered. One hundred and five patients, 17 children included, presented with benign tumors whereas 225 (children--93 and adults--132)--with cancer. Absolute and relative, local and general contraindications to surgery were outlined. The most important criteria are the extent of tumor, patient's status, equipment and surgical skills. Tumors were approached through 9 different accesses depending on their size and site. Surgery wat performed in 242 patients, viz. 89.5% of patients with benign tumors and 65.7% of those with cancer. The percentage of operated children (37.6%) was much lower than that of adults (85.6%) since the former presented with more advanced tumors. Radical surgery was performed in 192 (79.3%) patients; benign tumors were removed in 86.7% whereas cancer--in 44.9%. Complications were encountered in 56.2% of cases, bleeding being the most frequent one (47.0%). Lethality following radical surgery was 3.1%. Radiation and chemotherapy alone proved ineffective. Complex treatment assured better clinical course. One-ten-year survival rate in adults with malignant tumors was 51.2%-31.8%. As few as 17.2% of children survived one year whereas only 6.5%-2 years which points to more aggressive clinical course of malignant non-visceral tumors of the small pelvis in children.

[Chemoembolization of blood vessels in the complex treatment of children with nephroblastoma]. / Khimioémbolizatsiia sosudov v komplekse lecheniia detei s nefroblastomoi.

The results of roentgeno-endovascular intervention in nephroblastoma in 31 child are presented. For chemoembolization, suspension of lipiodol and adriamycin was used, for control of the effectiveness of the intervention--the radiopharmaceutical preparation pyrophosphate. After embolization, the decrease in tumor size was noted. This made easier the performance of nephrectomy, the volume of blood loss reduced. Pathomorphism of neuroblastoma induced by chemoembolization was studied. No complications were noted.

[The possibilities of using the free polyamines of the peripheral blood as biochemical tumor markers in nephroblastoma in children]. / Vozmozhnosti ispol'zovaniia svobodnykh poliaminov perifericheskoi krovi kak biokhimicheskikh opukholevykh markerov pri nefroblastome u detei.

Thin-layer chromatography was used to measure free polyamine level in blood plasma and peripheral blood cells in 38 pediatric nephroblastoma patients and 30 apparently healthy children. Thirty-six nephroblastoma patients were examined in the course of treatment of whom 25-during 1-36 months following basic treatment course as well. A significant increase in the initial free polyamine level in blood cells (92.4% of cases) and plasma (63%) of nephroblastoma patients was observed. A correlation was established between changes in free polyamine level, on the one hand, and response to treatment and subsequent course of disease, on the other. At 8-10 days following radical surgery, a decrease in polyamine level was observed in 58% of operated cases and an increase-in 41.8%. The latter proved prognostically unfavorable. Recurrence and metastases development was associated with a rise in polyamine concentration in plasma and, particularly, in blood cells which in some cases preceded the appearance of other signs of tumor progression. The polyamine test can be recommended for monitoring pediatric nephroblastoma patients.

[Cytologic diagnosis of non-organ neoplasms in the small pelvis]. / Tsitologicheskaia diagnostika neorgannykh novoobrazovanii malogo taza.

Puncture biopsy specimens from 165 patients, 93 of these children, were examined to elucidate the potentialities and specific features of the diagnosis of inorganic neoplasms in the small pelvis. Cytologic diagnosis has proved to be a rational and sufficiently informative method, permitting a correct recognition of the process type in 83.6 percent of cases. Malignant tumors were correctly diagnosed in 94.1 percent of cases, benign and inflammatory processes in 45.6 percent. In the children teratoblastomas, neuroblastomas, and unclassified sarcomas predominated.

[Combined interventions in non-organic neoplasms of the small pelvis]. / Kombinirovannye vmeshatel'stva pri neorgannykh novoobrazovaniiakh malogo taza.

Experience with 62 combined operations on patients with nonorganic new growths of the true pelvis is discussed. They accounted for 33.3% of 227 radical interventions undertaken for this disease. The ages of the patients ranged from 4 months to 64 years. Ten patients were admitted after exploratory laparotomies. Benign new growths were diagnosed in 14 and malignant new growths in 48 patients. Different variants of operative approaches were used. Most frequently the tumor was resected together with bones, iliac vessels, genitalia, and urinary bladder. Various complications were noted in 39 patients who were operated on. Hemorrhage was the most frequent and menacing complication--in 26 patients. Two patients died. Recurrences were found in 8 of a group of 60 patients discharge from the clinic. After combined operations for malignant nonorganic tumors of the true pelvis 3-year survival was 36.0%, 5-year survival was 29.4%.

[Non-Hodgkin's lymphoma of the abdominal cavity and small pelvis in children]. / Nekhodzhkinskaia limfoma briushnoi polosti i malogo taza u detei.

At the department, 138 children with non-Hodgkin's lymphoma of the abdominal cavity and small pelvis were examined. Resulting from the combined and complex treatment, in stage II of the disease, the complete remission was noted in 9 patients; in stage III, the partial remission--in 14, complete remission--39; in stage IV--in 17 and 9, respectively. Sixteen (11.6%) patients died. In non-organic lymphosarcoma spread, the intensive polychemotherapy, with subsequent irradiation of the abdominal cavity at the total dosage of 20 Gr and all the revealed foci of lesion--up to 35--40 Gr is effective. In involvement of the alimentary canal, the extended resection of the affected area with administration after the operation of polychemotherapy and irradiation of the zones of metastatic spreading is indicated.