[Early one-stage plastic repair of tracheal lesions in the treatment of flegmon of the neck and acute contact mediastinitis].

Early plastic repair of severe tracheal defects after previous decannulation of the latter in x-ray confirmed efficacy of aspiration flow system of fat spaces of the neck and mediastinum and stability of the patient's condition. This therapeutic policy stops cross-over contamination of fat spaces of the neck, mediastinum, tracheobronchial tree; reduces cost of therapy; facilitates cleansing of foci of purulent surgical infection; shortens time to reconstruction for soft tissue defect of the neck.

[The long-term results of surgical treatment of critical lower limb ischemia by autotransplantation using different tissues]. / Otdalennye rezul'taty khirurgicheskogo lecheniia kriticheskoi ishemii nizhnikh konechnosteis pomoshch'iu autotransplantatsii razlichnymi tkaniami.

Presented herein is an analysis of the 15-year results of surgical treatment of critical lower limb ischemia (stage IV chronic ischemia according to Fontaine - Pokrovsky classification) in patients suffering from chronic occlusive diseases of lower lirtb arteries (CODLLA) with subtotal and total obliteration of the peripheral arterial system. In total lesion of the talotibial segment when the patients could not be rendered assistance using conventional vascular surgery or when roentgenoendovascular deobliterution was not feasible, use was made of indirect revascularizntion of the ischemized limb by autotransplantation of soft tissue complexes. A flap of the broadest muscle of back (FBMB) was employed as an autotransplant in 56 patients, the greater omentum in 12 patients, and a flap of the anterior dentate muscle (FADM) was used in 9 patients. Twenty-five patients with diffuse lesion of the popliteal talotibial segment were provided combined limb revascularization, when the feasibility of standard bypass graft appeared fairly questionable. The majority of patients were placed under annual observation. It is noteworthy that the monitoring of the ankle/brachial index (ABI), oxygen tension on the foot (TcpO2) and of the proximal-distal temperature gradient as well as the assessment of the number of saved limbs and of the patients' quality of life allow to regard the technique as highly effective in the strategy of the salvage of the terminally inchemized limb from amputation. The technique also makes it possible to solve the problem of patch plasty of the trophically and necrotically changed foot and to maintain its support capacity. Combined revascularization makes it possible to unite the effect of direct and indirect reconstruction of the arterial system and to perform bypass graft in non-conventional situations.

[The ozone therapy in patients with mechanical jaundice of tumorous genesis]. / Primenenie ozonoterapii u bol'nykh s mekhanicheskoi zheltukhoi opukholevogo geneza.

The complex method of treatment of patients with mechanical jaundice of tumorous genesis includes parenteral ozonotherapy in combination with traditional treatment. An analysis of treatment of 90 patients with mechanical jaundice of tumorous genesis has shown that ozonotherapy facilitates more rapid arrest of hepatic dysfunction and endogenous intoxication.

[Electro-impulse therapy in combined treatment of patients with thyrotoxic goiter complicated by cardiac fibrillation]. / Elektroimpul'snaia terapiia v kompleksnom lechenii bol'nykh s tireotoksicheskim zobom, oslozhnennym mertsiatel'noi aritmiei.

Cardiac fibrillation was revealed at admission in 260 (5.2%) of 4996 patients who were to undergo subtotal resection of thyroid gland for toxic goiter. In 114 (43.8%) patients sinus rhythm was restored with drugs in preoperative period. Electroimpulse therapy was carried out in other 146 patients which was effective in 89% cases. Efficacy of electroimpulse therapy depended mainly on the arrhythmia duration. Restoration of sinus rhythm before operation in patients with toxic goiter improves conditions of preoperative preparation and decreases the risk of surgical treatment. There were no lethal outcomes.

[Use of ozone therapy and hydro-pressure technologies in complex intensive therapy of surgical sepsis]. / Primenenie ozonoterapii i gidropressivnykh tekhnologii v komplekse intensivnoi terapii khirurgicheskogo sepsisa.

Results of treatment of 214 patients with severe sepsis and septic shock were analyzed. 125 patients treated with various methods of ozonotherapy and hydropressive sanation of infectious foci formed the study group. Control group consisted of 89 patients treated according to generally accepted principles. Comparative analysis of treatment efficacy was carried out with numerous laboratory and instrumental study methods. It is shown that ozonotherapy and hydropressive technologies reduced a lethality from 39.2% in the control group to 25.6% in the study group.

[Diagnosis and treatment of liver abscesses]. / Diagnostika i lechenie abstsessov pecheni.

The authors experience in diagnosing and treating 67 patients with abscesses are summarized. The value of different methods of topic diagnosis is analyzed. New approaches to surgical treatment are presented, which involves the use of both open methods (dissection, sanitation and drainage of abscesses) and minimum invasive methods (abscess puncture under ultrasound and video laparoscopy guidance). The new method of assisted minimum invasive surgical treatment of large hepatic abscesses is described. To realize the principle of different approach to choosing treatment method and using new technologies permits improvement of treatment outcomes in these patients.

[New trends in the treatment of liver abscesses]. / Novye napravleniia v lechenii pri abstsessakh pecheni.

The authors share their experiences with treatment of 85 patients with abscesses of the liver aged from 17 to 83 years. The size of abscesses was from 2.5 to 23 cm in diameter. For the topical diagnostics the following methods were used: ultrasound scanning, computed tomography, scintigraphy, diagnostic puncture biopsy of the liver, laparoscopy etc. Decision between the methods of operative treatment depended on the concrete clinical situation. Both open and minimally invasive methods were used. Hydropressive technologies and ozone therapy were used for better sanitation of the abscess cavity. A new method of the assisted minimally invasive intervention was developed especially for treatment of patients with large abscesses of the liver. The new technologies allowed to reduce the amount of postoperative complications and to make the time of staying at the hospital substantially shorter.

[Surgical treatment of patients with terminal stages of occlusive diseases of the lower limb peripheral arteries]. / Khirurgicheskoe lechenie bol'nykh v terminal'nykh stadiiakh okkliuziruiushchikh zabolevanii perifericheskikh arterii nizhnikh konechnostei.

During the period of 1987-1998 operations for obliterating diseases of the peripheral arteries were performed on 104 patients having critical ischemia of the diseased extremity. The microsurgical technique was used. Indirect revascularization of the ischemic extremity with the soft tissue flap was fulfilled in 56 patients, femoro-distal-crural bypass was used in 38 patients, in 11 of them the bypass was "unloaded" into the flap of the broadest dorsal muscle, in 10 patients arterialization of the origins of the major subcutaneous veins was made. In cases of shunting with the "unloading" into the flap the extremity was saved in all the patients, after revascularization the extremity was saved in 89% of the patients, two years after the operation these patients had chronic ischemia of the operated extremity of the IIA degree. After arterialization of the foot vein 60% of the patients avoided amputation of the extremity.

[The technic of liver resection]. / K tekhnike rezektsii pecheni.

The use of the method of jet dissection of tissue with the "jet scalpel" in resection of the liver for separation of the parenchyma allows to substantially decrease the intraoperative blood loss, to visualize the vessels and ducts and thus facilitates their ligation which prevents different complications. The device developed by the authors for reinfusion of blood is very helpful for preventing complications associated with the hemotransfusion therapy.

[Jet dissection of tissues in liver surgery]. / Struinaia dissektsiia tkanei v khirurgii pecheni.

The results of applying jet dissection in resections of the liver in experiments and in the clinic are discussed. The method is based on washing off the hepatic tissues with a high-pressure jet of liquid to expose the intact vessels and ducts. To realize the method, "A device for separating tissues of parenchymatous organs" was developed, which worked according to the principle of an injector without a needle. The efficacy and the degree of trauma inflicted by the method were tested in experiments, after which it was applied in the clinic in 14 patients. The method made it possible to reduce essentially the volume of intraoperative blood loss, prevent the escape of bile in the postoperative period, reduce to the minimum hemotransfusion therapy, and shorten the stay of patients in the clinic. The results of jet dissection show the expedience of its use in surgical hepatology.

["Jet scalpel" in the liver resection]. / Opyt primeneniia "struinogo skalpelia" pri rezektsiiakh pecheni.

The use of the "jet scalpel" in liver resection allows the vascular-ductal structures to be adequately separated. This, in turn, prevents the risk of leaving hepatic areas devoid of blood supply or bile drainage, contributes to essential decrease of intraoperative blood loss, and decrease of the number of postoperative complications: bile seeping, biliary peritonitis, hepatic insufficiency, etc. The obtained results provide evidence that the use of the "jet scalpel" in surgical hepatology is advisable.