[Differential diagnosis of non-epithelial rectal neoplasms]. / Differentsialnaia diagnostika neépitelialnykh opukholei priamoi kishki.

Experience in the treatment of 118 patients with nonepithelial new growths of the rectum has been accumulated at the Scientific Research Institute of Proctology in the period from 1970 to 1991. They accounted for 1.5% of all benign and malignant tumors of this organ. Leiomyoma was diagnosed in 44, leiomyosarcoma in 18, lipoma in 30, fibroma in 17, neurinoma in 7 and rhabdomyoma in 2 of these patients. A differential diagnosis was made between benign and malignant tumors, as well as with other nonepithelial new growth of the rectum. On the basis of the clinical picture and the results of digital and instrumental (radiological, endoscopic, and ultrasonic) examination of the rectum the correct preoperative diagnosis may be established with certain probability. This influences directly the choice of the volume of the operative intervention in various types of nonepithelial rectal tumors. Morphological verification of the tumor is the principal method of examination in establishing the differential diagnosis in the preoperative and postoperative periods.

[Orthograde intestinal lavage in the preparation for colonoscopy]. / Ortogradnoe promyvanie kishechnika kak metod podgotovki k kolonoskopii.

Thirty-eight proctological patients were prepared for colonoscopy by drinking 2l of aqueous solution of polyethylene glycol-4000 and electrolytes, so that additional purgatives, cleansing enemas, and waste-free diet are not needed. Control of hemodynamics, clinical and biochemical blood tests, and plasma electrolyte content revealed no significant changes in these parameters after preparation for the examination. Colonoscopy was conducted to a full measure in 94% of cases. This method was preferred rather than the use of purgatives and enemas by 82% of patients. Intestinal lavage with polyethylene glycol and electrolyte solution is a simple and effective method, it is convenient for the patient and does not cause marked side effects.

[Surgical treatment of anal insufficiency]. / Khirurgiia analnoi nedostatochnosti.

Organic defects in the lateral walls of the rectal obturative apparatus involving no more than one fourth of its circumference are repaired by end-to-end or side-to-side sphincteroplasty. Sphincterolevatoroplasty is indicated in anterior or posterior defects and sphincterogluteoplasty with short or long grafts of the greatest gluteus muscles in larger defects. For cases in which the gluteal muscles cannot be used, an operation has been developed for repair of the defects with the medial part of the great adductor muscle. A damaged internal sphincter muscle of the anus is reconstructed by means of a muscular cuff formed from the wall of a pulled down rectum.

[Surgical methods in the treatment of colonic obstruction]. / Khirurgicheskaia taktika pri obturatsionnom narushenii prokhodimosti obodochnoi kishki.

The treatment of 365 patients with carcinoma of the colon complicated by intestinal obstruction is analysed. In 30.9% of patients the signs of acute obstruction were relieved by decompression therapy including a method suggested by the authors. The other patients were subjected to an urgent and even emergency operation. Two group of patients are compared. I the first group the traditional surgical tactics were used, in the second group new methods for decompression of the large intestine were applied both before and during the operation: endolymphatic and intravenous infusion of antibiotics, formation of double-channel colostomy of the type of "partial anastomosis". With such changed tactics the number of postoperative complications and fatal outcomes reduced from 38.7 and 20.4% to 12.1 and 6.4%, respectively. The percentage of patients subjected to a radical operation increased from 69.3 to 85.7%.

[Congenital angiodysplasias of the large intestine]. / Vrozhdennye angiodisplazii tolstoi kishki.

Angiodysplasia is a rare disease of the intestinal vessels. One of its types is the congenital form (so-called hemangioma or vascular hamartoma) which is mostly encountered at young age. Forty-eight patients with congenital forms of angiodysplasia of the large intestine were treated at the Scientific Research Institute of Proctology, RF Ministry of Health, beginning from 1962. According to morphological structure, there were 26 cases of the cavernous type, 11 of the capillary type, 11 of the mixed forms. In 46 of 48 patients the rectum and sigmoid were involved in the pathological process. Intestinal bleeding of various degree and intensity, occurring in 40 patients from early childhood, was the principal symptom in the clinical picture of the disease. The endoscopic picture of congenital angiodysplasia of the large intestine has characteristic macroscopic signs. Irrigoscopy and angiography are also very valuable and informative methods in the diagnosis of this form. Surgical interventions were performed on 28 patients, which accounted for 58.3% of the total number of patients with congenital angiodysplasia. Profuse bleeding leading to stable anemization of the patient is an indication for surgery. The volume of the operation was determined by the localization and spread of the pathological process. In concurrent localization of dysplasias, particularly in the pelvic cavity, and bearing in mind the seriousness of the operation itself, the degree of intraoperative blood loss, and the technical peculiarities of the intervention we prefer many-stage treatment. We encountered 18 complications, which mainly developed on the part of the perineum.