[Gastric leiomyomas]. / Leiomiomy zheludka.

Leiomyomas are rare tumors found as a rule in the stomach (1-2% of all gastric tumor cases) and occasionally in the intestine. Unless they grow large or become ulcerated gastric leiomyomas run a silent course. Otherwise there is epigastric pain, hemorrhage or impaired gastric evacuation. When complicated, the disease presents diagnostic difficulties and is treated surgically. Gastrotomy with dissection of the tumor or local resection of the gastric wall proved a reliable therapeutic means. Gastric resection is indicated in ill-defined tumors or in suspected malignancy.

[Intraoperative injuries of the spleen]. / Intraoperatsionnye povrezhdeniia selezenki.

Operations for gastric and duodenal ulcers were performed in 1123 patients. Injuries of the spleen were found in 16 patients. Attention is called to special care necessary during manipulations on the upper part of the stomach.

[Surgical treatment of patients with giant stomach ulcers]. / Khirurgicheskoe lechenie bol'nykh s gigantskimi iazvami zheludka.

The authors analyse 59 cases with giant gastric ulcers (measuring 3 cm or more in diameter) treated by surgery, which accounted for 10.7% of all the operations conducted for gastric ulcers. It is shown that giant gastric ulcers are complicated and recur most frequently. Planned operations were performed on 56 patients, 3 patients underwent emergency operations at the peak of hemorrhage, the stomach was resected in all of them. Total postoperative mortality was 3.4%, no fatal outcomes occurred in emergency operations. The authors conclude that giant gastric ulcers should be treated by operation after 2-3-week course of preoperative management. Resection of the stomach is the operation of choice.

[Reconstructive surgery of peptic ulcer and ulceration of the gastroenteric anastomosis]. / Rekonstruktivnaia khirurgiia pepticheskikh iazv i iz''iazvlenii v zone gastroénteroanastomoza.

An experience with treatment of 177 patients has shown that peptic ulcers are a severe pathology with a pronounced pain syndrome and early development of complications. They are subject to operative treatment after thorough examination and a course of antiulcer therapy during 4-5 weeks before operation. Reconstructive resection of the stomach in combination with truncal vagotomy is thought to be most radical for peptic ulcer. Lethality after reconstructive operations was 5.5%. Trophic ulcers of the gastrointestinal anastomosis is subject to operative treatment but in cases of the presence of other postresection disorders requiring surgical treatment.

[Characteristics of diagnosis and surgical treatment of giant gastroduodenal ulcers]. / Osobennosti diagnostiki i khirurgicheskogo lecheniia gigantskikh gastroduodenal'nykh iazv.

Out of 1364 patients operated on in the Central Research Institute for Gastroenterology for ulcer, 130 (9.53%) appeared to have giant gastroduodenal lesions. The latter were gastric in 59 patients (more than 3 cm in diameter), duodenal in 71 (more than 2 cm in diameter). Surgical treatment of the giant ulcers is a valid therapeutic measure in view of frequent complications, uneffective conservative treatment, common recurrences. Billroth I gastrectomy was performed in 2 patients. Billroth II gastrectomy in 110 with additional bilateral subdiaphragmatic or selective vagotomy in 8 cases, Roux' operation in 2 patients. Gastroenteroanastomosis was established in 16 cases of inflammatory infiltrate, disturbed gastric evacuation, no evidence of hemorrhage from the ulcer; in 15 cases of truncal bilateral subdiaphragmatic vagotomy. Lethality reached 3.07% (4 patients), which is a relatively low rate achieved due to appropriate preoperative preparation and early surgical intervention.

[Choledochoduodenostomy in choledocholithiasis and benign strictures of the common bile duct]. / Kholedokhoduodenostomiia pri kholedokholitiaze i dobro- kachestvennykh strikturakh obshchego zhelchnogo protoka.

The methods of external and of internal drainages of the bile ducts are alternatives in choledocholithiasis and benign strictures of the choledochus. In the Central Research Institute of Gastroenterology, 349 operations were performed on the common bile duct, stones were found in the choledochus in 259 (74.2%) cases and benign strictures of the terminal part of the choledochus and the major duodenal papilla in 103 (29.5%) cases. Ninety-five operations were secondary or reconstructive in character. A precise diagnosis of affection of the biliary tract can be established only during an operation or by retrograde cholangiopancreatography. External drainage of the common bile duct was conducted in 229 (65.6%) cases. Choledochoduodenostomy was undertaken in 105 patients (55 were operated on for the first time and 50 underwent operation on the biliary tract for a second time). Endoscopic papillosphincterotomy was successful in 28 cases with short strictures of the choledochus and choledocholithiasis. The stones were removed from the ducts with instruments or were expelled spontaneously at days 2 to 5.

[Biliary ascites and biliary peritonitis]. / Zhelchnyi astsit i zhelchnyi peritonit.

Questions concerned with the penetration of bile into the abdominal cavity are discussed. The observation of 9 patients was used. The effusion of infected bile into abdominal cavity results in the development of bile peritonitis requiring urgent surgical measures. If the bile is not infected, bile ascites is developing, its clinical picture being obliterated and the patients often remaining in satisfactory condition for a long time.