[Tissue pressure in patients with phlebogenic edema]. / Tkanevoe davlenie pri flebogennykh otekakh.

This paper describes the results of tissue pressure measurement according to the Emmet technique in the subcutaneous fat at phlebogenic edema in 31 patients with lower extremity varicosity. The changes in the pressure were recorded over a length of 5-10 after needle impaction. The rate of tissue fluid resorption was measured. The indicators appeared normal in 16% of patients, absorption was accelerated in 39%, and deceleration of absorption was marked in 45% of patients. In the event of decelerated resorption, chronic edema was observed more frequently. The rate of saline resorption in health exceeded 4.8-fold the rate of tissue fluid absorption. In valvular insufficiency of the deep veins, this indicator is up to 4.8-fold as increased. Cessation of tissue fluid and/or saline resorption points to tissue swelling at the microcirculatory level. The given technique allows to diagnose latent edema, to objectively evaluate the patient tissue response to a specific drug and elastic appliance, to work out the well-founded indications for phlebectomy, especially in young people. Also, it enables the assessment of the results of surgical intervention and making the early diagnosis of disease recurrences.

[Thoracoscopic splanchnic sympathectomy in pancreatic diseases]. / Torakoskopicheskaia splankhniksimpat¿ektomiia pri zabolevaniiakh podzheludochnoi zhelezy.

Thoracoscopic splanchnicsympathectomy (TSSE) was performed in 8 patients with inoperable tumors of the corpus and tail of the pancreas and in 3 patients with painful syndrome of chronic pancreatitis. Severe painful syndrome in the upper abdominal region was the main indication for ISSE. Thoracoscopic resection of the lower thoracic sympathetic ganglia and splanchnic nerves was performed. Postoperative complications were detected in 3 patients: in one case it was pneumothorax, in two--pains in the thorax due to the injury of intercostal nerve by thoracoport. There were no lethal outcomes accounted for surgical procedure. The effectiveness of the operation was evaluated by the use of descriptive and visual analogue scales of pain sensitiveness and changes of the amplitude of somatosensor provoked potentials of the brain. Favourable and satisfactory results were obtained in 9 cases.

[Morphologic and functional aspects in the treatment of patients with intestinal fistulas]. / Morfofunktsionalnye aspekty pri lechenii bolnykh s kishechnymi svishchami.

Combination of severe purulent processes (peritonitis, phlegmons, and extensive wounds of the abdominal wall), eventration, and complete high unformed intestinal fistulas leads to rapid hemostasis disorders and emaciation. In nonoperative treatment lethality reaches 70%. Complete bilateral disconnection of the fistula bearing intestinal loop is the operation of choice in such situations. In this case the length of the disconnected intestinal segments may be two thirds of the length of the jejunum and the greater part of the colon. The results of morphofunctional study of an intestinal segment disconnected for a long period are analysed. The tactics of active surgical treatment is illustrated by clinical cases.

[Cystic tumors of the pancreas]. / Kistoznye opukholi podzheludochnoi zhelezy.

Thirty-three patients were operated on for cystic tumors of the pancreas at the Vishnevsky Institute of Surgery in 1980-90. Cystadenoma of the pancreas was found in 16 (48.5%) of them and cystadenocarcinoma in 15 (45.5%). Fifteen (45.5%) patients had been previously operated on in different institutions presumably for a "cyst" of the pancreas, 6 of them repeatedly; the tumor recurred rapidly in all of them. In the Institute 30 patients underwent radical operations: 30 distal resection of the pancreas and 5 pancreatoduodenal resection. Diagnostic and palliative manipulations were performed on 3 patients. Postoperative lethality was 9.1% (3 patients). Postoperative follow-up periods lasted from 12 months to 9 years. Dissemination of the tumor occurred in 2 patients two years after the operation. The remaining 25 patients are alive and capable of working.

[Problems in the surgical treatment of pancreatic chronic diseases]. / Problemy khirurgii khronicheskikh zabolevanii podzheludochnoi zhelezy.

The work analyses the results of 999 operations on the pancreas conducted in 861 patients with chronic oncological and nonneoplastic diseases of the gland. Pancreatoduodenal resection (PDR) was performed in 171 patients (for tumors of the pancreaticoduodenal zone in 151 and for chronic pancreatitis of the head of the gland in 20) in 13 of them a modified operation with preservation of the stomach and pylorus was carried out. The late-term results were satisfactory in both groups of patients, the survival of oncological patients was much higher after radical operations then after palliative surgery. Total duodenopancreatectomy has no advantages over PDR and should be undertaken only when there are strict indications. In chronic pancreatitis, complicated also, preference was given to organ-preserving interventions, primarily to draining operations, which preserve more fully pancreatic exocrine and endocrine functions: longitudinal pancreatojejunostomy was conducted in 106 patients, internal drainage of pancreatic cysts in 184, and occlusion of external pancreatic cysts in 70 patients. It is advisable that the most complicated, particularly repeated and reconstructive, operations on the pancreas are carried out at specialized centers in which the problem of surgical diseases of the pancreas is studied more closely.

[Morphologic rationale for selecting composition and structure of biologically active material based on sodium alginate for wound treatment]. / Morfologicheskoe obosnovanie vybora sostava i struktury biologicheski aktivnoi kompozitsii na osnove al'ginata natriia dlia lecheniia ran.

Morphological evaluation of composition and structure of a biologically active compound (BAC) based on sodium alginate, comprising 1% sizomycin and 0.25% protease C, on wound healing in infected rats wounds was made in experiment. The results have clearly shown that for the infected wound treatment during the first period of wound healing BAC of polyfunctional action must be applied. Biologically active substances (sizomycin and protease C) promote removal of inflammatory etiopathogenic factors, i. e. necrotic tissues and microbic bodies, while polysaccharide basis of the composition promotes stimulation of reparative processes in the wounds. Powder with granules size 315 m including 24% potassium gluconate is believed most suitable BAC structure.

Potent debriding ability of collagenolytic protease isolated from the hepatopancreas of the king crab Paralithodes camtschatica.

The debriding activity of the protease complex produced from the hepatopancreas of the king crab Paralithodes camtschatica was evaluated in vivo. The results clearly showed that the crab preparation had a high debriding ability. Individual proteases were isolated chromatographically from the crab complex to compare their debriding activities. All the purified proteases were active in vivo. The most active component of the complex was the isozyme C of crab collagenolytic protease, a member of the chymotrypsin-like protease class.

[A morphological evaluation of the action of collagenase from the king crab Paralithodes camtschatica on the experimental wound process]. / Morfologicheskaia otsenka vozdeistviia kollagenazy kamchatskogo kraba Paralithodes camtschatica na ranevoi protsess v éksperimente.

The paper presents the results of experimental morphological evaluation of the effect of a new proteolytic enzyme collagenase of crab Paralithodes camtschatica on wound healing in infected and aseptic rabbit wounds. The enzyme was applied on wounds using gauze and gelevin. The findings show that this protease is highly effective for debridement of infected wounds, the effect increasing at gelevin addition. To reach maximal therapeutical effect and diminish the inhibition effect of collagenase on granulation tissue, it is recommended to reduce the dose of protease during debridement process. Clinical application of crab collagenase must be individual as well as duration of wound enzymotherapy.

[The transfascial excision of indurated subcutaneous fat in the postthrombophlebitic syndrome]. / Chresfastsial'noe issechenie indurativno-izmenennoi podkozhnoi kletchatki pri posttromboflebiticheskom sindrome.

The authors came to the conclusion that in surgical treatment of the postthrombophlebitic syndrome it is necessary in some cases to excise the indurated fatty tissue on the leg during the operation on the veins. It should be carried out transfascially through a Felder incision in combination with ligatin of the perforating veins on the leg. The suggested method produces better results than those of excision of the changed fatty tissue through a cut made in the skin overlying it. Excision of the indurated fatty tissue removes the focus of chronic infection and autoallergy.

[A method for forming and the morphological characteristics of artificial liver cysts]. / Metodika formirovaniia i morfologicheskaia kharakteristika iskusstvennykh kist pecheni.

Application of ultrasound surgical aspirator promotes rapid formation of major cavities with dry inner surface in the depth of hepatic parenchyma. Filling of the latter with sutured copolymer of monovinyl ether of ethyleneglycol in the ratio of one filler volume to three cavity volumes results in the formation of cysts with the given stable dimensions. Good aspiration of necrotic tissues promotes rapid formation of thin-walled cysts. The given hepatic cyst model may be used in the development of new surgical and puncture methods of treatment, as well as testing of new drugs.

[Morphological reaction of various tissues and organs on the administration of the occluding material "Rabrom"]. / Morfologicheskaia reaktsiia razlichnykh tkanei i organov na vvedenie okklioziruiushchego materiala "Rabrom".

A new occlusive X-Ray opaque antibacterial substance of biological origin was experimented on rats and dogs. The substance was administered intraperitoneally, intrahepatically and on the soft tissues of the limbs. Morphological studies conducted showed accumulation of macrophages.

[The dynamics of the morphological changes in the liver after resections using the Soviet ultrasonic surgical aspirator]. / Dinamika morfologicheskikh izmenenii pecheni pri ee rezektsiiakh s pomoshch'iu otechestvennogo ul'trazvukovogo khirurgicheskogo aspiratora.

The possibility of hepar resection by means of Soviet-made ultrasound device URSK-7N-18 was investigated in experiment on 13 mongrel dogs. The device was adapted to this surgery and was supplied with a special working part with a vacuum pump and channel for inspiration of liquid. The working part frequency is 26.5-30.0 kHz, resonance frequency is 26.5 kHz. The device does not damage blood vessels, nerves, and ducts but on the basis of morphology it provides both hemostasis at the early period after surgery owing to changes in microcirculation, and rapid wound healing by means of aspiration of necrotized tissues.

[A method of pancreato-duodenal resection and total duodeno- pancreatectomy]. / Metodika pankreatoduodenal'noi rezektsii i total'noi duodeno- pankreatéktomii.

During 1975-88 the staff of the Vishnevskii+ Institute of Surgery performed 95 pancreatoduodenal resections (PDR) and 23 total duodenopancreatectomies (TDPE) in malignant tumors of the head of the pancreas (49), major duodenal papilla (30), terminal choledochus (12), duodenum (12), and in 15 patients with chronic pancreatitis. In 13 cases PDR and TDPE were undertaken as a second operation after creation of biliodigestive anastomoses: after laparoscopic cholecystostomy in 24 and after various abdominal operations in 20 cases. In 30 cases PDR was carried out with the formation of a pancreaticojejunal+ anastomosis, by the longitudinal techniques in 7 of them, in 47 cases with occlusion of the pancreatic duct, and in 6 with the formation of a "occlusive" pancreaticojejunal anastomosis++ suggested by the authors. PDR was performed in 3 cases with maintenance of the stomach and in 4 in combination with vagotomy. The mortality rate was 20% after PDR and 39.1% after TDPE.

[Morphological assessment of Co2-laser fusion using a flexible light guide in lymphovenous and venovenous anastomoses in experimental animals]. / Morfologicheskaia otsenka svarki Co2-lazerom s gibkim svetovodom limfo- i veno-venoznykh anastomozov v éksperimente.

In experiments on 13 mongrel dogs with CO2 laser supplied with flexible fiber guide there were formed 17 lympho-venous and 4 veno-venous anastomosis. There were no inadequate sealing, narrowing or aneurysm of the anastomosis. Histopathologic investigations after 3, 6-8, 13-16 days and 1 year showed that vascular walls were positioned correctly. Endothelial surface has continuous character both along the vessel as anastomosis line.