[Opportunities of computed tomographic colonography in detecting of colon neoplasms].

The computed tomographic colonoscopy (CTC) was performed in 212 patients on the multislice computed tomography Siemens Open in low-dose mode during the period from 2010 to 2013. CTC was tolerated well by 80% of patients. 20% of patients complained of mild discomfort during the study. The optical colonoscopy with biopsy was done in 53 (25%) of 212 patients after CPC. This is due to the fact that it was not detected the significant endoluminal structures in other observations or small polyps were found in elderly patients. In these cases the risk of colonoscopy was not justified. Sensitivity and specificity of CTC was 55 and 91% respectively for the detection of polyps with diameter less than 5 mm; for polyps 5-9 mm - 85 and 93%; for polyps with diameter greater than 10 mm - 100 and 92%.

[The prevention of the acute urine retention and lower urinary tract infection after rectum surgery].

The possibilities of the prevention of the acute urine retention in patients with the prostatic enlargement after the rectum surgery. The method was successfully used in 106 patients.

[Treatment of villous adenoma of distal parts of the colon]. / Lechenie vorsinchatykh adenom distal'nykh otdelov tolstoi kishki.

Results of treatment of 78 patients (mean age 64 years) operated for benign neoplasms of a colon distal part are presented. In histologic examination tubular adenoma was found in 34 cases, tubular-villose adenoma--in 27, villose adenoma with different degree of epithelium dysplasia--in 16. In 10 patients villous tumors were located in low-ampular part of the rectum at the distance less than 7 cm from dermal-mucose line of the anal canal, in 27 patients--at 8 to 12 cm, in 42--at 12 to 20 cm. Area of neoplasm base in 53 patients ranged from 1.0 to 2.0 cm2, in 15--from 2.1 to 6 cm2, in 11-43 cm2, it was 14 cm2 on the average. For patients of the first group wire endoscopic polipectomy was adequate procedure. In 25% patients with neoplasm area more 2 cm2 recurrence of the disease was revealed from 3 months to 1 year after staged endoscopic polipectomy. Possibility of incomplete removal of creeping neoplasm at staged endoscopic electroexcision dictates the necessity of control colonoscopy 1 month after the procedure. If villous tumor recurs during 1 year in spite of repeated endoscopic procedures, it is reasonable to resect the colon because of danger of malignant transformation of the tumor. In 12 patients with villous adenomas location at 7-20 cm from the anal ring transanal endoscopic microsurgery (TEM) by G. Buess et al (1984) was performed. In follow-up for 25.8 months on the average recurrences of the disease were not revealed. TEM is thought as alternative to anterior resection of the rectum in benign tumors.

[One-stage combined operations on kidney and other organs]. / Odnomomentnye sochetannye operatsii na pochke i drugikh organakh.

Patients with combined diseases of the kidney, organs of abdominal cavity and retroperitoneal space require original decisions in the choice of surgical approach and sequence of interventions on different organs. The experience of one-stage combined nephrectomies and kidney resections in 36 patients with lung, stomach, intestine, liver and other organs' diseases are presented. 11 patients had primary renal carcinoma, the kidneys were affected by other malignant tumors in 15 patients. Primary benign processes in the kidneys were found in 3 patients and also in 7 patients these processes were the consequence of earlier performed operations. Interventions on 3-6 organs were necessary in 11 cases. It makes sense to begin one-stage combined transperitoneal interventions with "clean" stages--without section of gastrointestinal tract's lumen. 1 patient died because of peritonitis due to insufficiency of sutures of colon anastomosis. The follow-up ranged from 6 months to 12 years. The recurrences and metastases were found in 9 operated patients within 7 to 20 months, and there were no symptoms of diseases in 24 patients. It is concluded that extended radical one-stage operations on the organs of abdominal cavity and retroperitoneal space combined with operations on the kidney are endurable and effective if the surgical technique is thorough.

[The primary postponed radical surgical treatment of acute suppurative paraproctitis]. / Pervichno-otsrochennoe radikal'noe khirurgicheskoe lechenie ostrogo gnoinogo paraproktita.

The method of primarily postponed radical surgical treatment of acute purulent paraproctitis consists in puncture of the abscess, introduction of a double-channel drain, and continuous drop irrigation of the cavity for 1-2 days with antiseptic solutions and active aspiration for preoperative management. When the inflammatory process abates, fistulochromography is conducted and a radical operation is carried out on the same day with excision of the inner opening of rectal fistula. The method makes it possible to combine two operations in one stage which are undertaken in one third of patients in routine surgical treatment of acute paraproctitis. The described method shortens the period of treatment to 14-15 days and improves the immediate and long-term results. Eight patients were operated on with a good outcome.

[Determination of the viability of a patient's intestine by using laser doppler flowmetry during surgery]. / Opredelenie zhiznesposobnosti kishechnika u bol'nogo vo vremia operatsii s pomoshch'iu lazernoi dopplerovskoi floumetrii.

Intraoperative determination of the viability of the intestine by means of laser Doppler flow measurement was conducted in 26 patients. The method proved to be highly effective, made it possible to judge most objectively the degree of changes in blood flow in various parts of the intestine in a short time and correct them subsequently during the operation, and considerably reduced the possibility of the development of postoperative complications due to inadequate appraisal of the degree of vascularization of the mobilized segments of the small and large intestine which are prepared for the formation of the anastomosis.

[Choice of the treatment method in Hirschsprung's disease in adults]. / Vybor metoda lecheniia bolezni Girshprunga u vzroslykh.

Among 100 patients subjected to a complex examination 44 were found to have Hirschsprung's disease. Operation was fulfilled in 37 patients. Resection of dilated portions of the colon can not be considered to be a radical intervention. With the morphological features of Hirschsprung's disease in adults taken into account, Duhamel's operation is recommended as a readical operation. In patients with a pronounced decompensation of the colon accompanied by ileus the treatment should consist of many steps. In some cases the conservative treatment might be performed under conditions of dispensary observation of the patient.