Search

The review of modern luminescent methods of research, their prospects and potentialities of practical application in biological researches is presented. Special attention is given to the study of dynamics of the processes of peroxide oxidation and to activity of the enzymes of antioxidant protection in biological systems using the chemiluminescent methods, and also to their use in experimental oncology and radiobiology.

Results of 56 transhiatal esophagectomies performed for cardioesophageal cancer from 1985 to 1999 are evaluated. Operation was completed by one-stage plastic repair with gastric flap or colon. Manual transhiatal esophagectomy performed in 35 cases led to many intraoperative complications in location of the tumor in the middle and top part of thoracic esophagus, including two fatal. These complications make manual transhiatal esophagectomy in this location of the tumor undesirable. Of it is indicated only in location tumor in the bottom third of the esophagus. In such cases instrumental transhiatal removal of the esophagus above the tumor is made. This method was used in 21 cases without intraoperative complications and lethal outcomes.

The experience of subtotal colectomy in 20 patients as a method of treatment of left-sided obturation colonic ileus has been summarised. In 18 patients the operation was performed as an urgent procedure and in 2 patients it was less urgent. In 4 patients urgent subtotal colectomy was combined with resection of the other organs due to local spread of the tumor. In 4 patients complications developed in the early postoperative period, in 2 patients they were followed by urgent operation. There were 2 lethal outcomes due to decompensation of associated chronic cardio-vascular and pulmonary diseases. The authors suggest that subtotal colectomy in treatment of acute neoplastic colorectal obstruction could be used by surgeons of nonspecialized departments of urgent surgery provided that the competence of the surgeons is high enough and preoperative treatment is adequate.

The results of surgical treatment of of 392 patients with postoperative ventral hernia are discussed. The algorithm of treatment of patients with large hernias was developed. Special preoperative management by dosed pneumocompression in an antioverload costume makes it possible to avoid menacing complications after the operation, which are caused by increased intraabdominal pressure. Test for tolerance to increase of intraabodominal pressure allowed prognostication of the character of the operative intervention: with or without decrease of the volume of the abdominal cavity (autoplasty or alloplasty, respectively). Prevention of wound complications consisted in control of infection, improvement of operative techniques, and use of modern surgical instruments. The prevention of recurrent hernias should be directed at correct choice of the method of plastics and removal of wound complications.

The article discusses the results of small intestine splinting in various modifications with the use of a standard and specially designed silicon catheter. In the period between 1985 and 1990 operations were performed on 28 patients whose ages ranged from 16 to 81 years; all of them were operated on in a state of acute obstruction of the small intestine by adhesions, no fatal outcomes occurred. Various combinations of interventions were accomplished in 5 cases. The splinting catheter had to be removed prematurely in 2 cases because of stoma suppuration; one patient was operated on again 12 months after splinting, a doubtful result was noted in another 3 cases. In the early period the splinting catheter ensures adequate decompression of the intestine and effective prevention of postoperative paresis. The method for fixation of the standard splinting catheter is chosen individually depending on the concrete intraoperative situation. A special catheter with an inflatable cuff can be used which allows splinting of the small intestine without opening its lumen.

The paper analyzes three cases of developed uniphagia and/or dysphagia in long-term postoperative periods. No predictors of late dysphagia were observed. Maintenance of antireflux activity after prosthesis removal is of great interest. The authors recommend that the antireflux prosthesis should be used in the situations at a high risk of routine fundoplication.

On the grounds of literature data and personal experience the authors evaluate manual transhiatal esophagectomy and suggest instrumental removal of the esophagus as a possible alternative. Experimental studies performed on 34 cadavers provide evidence that the topographic-anatomical properties of the esophagus allow it to be everted on a probe blindly without opening the thoracic cavity if its wall is not involved in the pathological process. This can be carried out either through the abdomen, i.e. "downwards" or through the mouth, i.e. "upwards" in which case the first method is preferable. The first successful clinical experience in transhiatal instrumental esophagectomy in 3 patients with cardio-esophageal carcinoma provides evidence of its advantages over manual esophagectomy and justifies its further use and study.

Resection of the parietal cells, a modification of the generally known Wangensteen's tubular resection, was carried out in 8 patients with duodenal ulcer. The greater curvature of the stomach was removed to the left of the line joining the prepyloric part and the His angle. The operation was not devoid of technical difficulties, especially in well-nourished patients with high position of the cardia. The immediate postoperative course was uneventful. The ulcer was not found in any of the patients by endoscopy conducted in periods of 16 to 36 months, all of them noted subjective improvement after the operation. The results allow the operation to be recommended for the treatment of duodenal ulcer complicated by penetration and hemorrhages, when distal resection is a considerable risk.

The effect of some factors on the development of wound suppuration was studied in prospective examinations including 241 operations for destructive appendicitis. It was found that the presence of exudate, monoantibacterial prophylaxis, and the method of wound closure had no essential effect on the proportion of suppurations. The determinant factor is the surgeon's qualification, not his experience in general, but his experience in appendectomy in particular and individual technical traits.

The experiments in corpses have shown that there are well developed anastomoses between the branches of the rectal arteries.