Selective proximal vagotomy with excision of duodenal ulcer

257 patients with duodenal ulcer and its complications underwent selective proximal vagotomy in combination with excision of duodenal ulcer without pyloric injury. Lethality rate was 0.78%. Long-term results of the operation by Visick's classification are evaluated as excellent and good in 105 (90.5%) patients, in 9 (7.8%) as satisfactory, in 2 (1.7%) as unsatisfactory. It is emphasized that operation saving the pylorus is optimal in such patients and can be performed almost in all patients irrespective of location of the ulcer, presence and tupe of its complications.     

Embolization of splenic artery in children with portal hypertension

This study examined the results of embolization of the splenic artery (ESA) in 30 children (age ranged from 5 to 14 years) with portal hypertension. Effectiveness of ESA was evaluated by a decrease in spleen size, hypersplenism, disappearance of esophageal varices and improvement in blood count. The results show that chronic embolization of the splenic artery in children is relatively safe and effective surgical treatment for portal hypertension. It lessens portal hypertension, reduces and in some cases eliminates hypersplenism and splenomegaly. Furthermore, being pathogenically sound it may be operation of choice in treatment of chronic hepatitis with portal hypertension and is well tolerated by children.     

Opportunity of operative traumatism decrease in patients with complicated tricuspid valve defect

This study examined the results of surgical trivalve of 44 patients with trivalve heart defect. In all the patients the heart defect was combined with two and more complicating factors: advanced III-degree calcinosis of the valves, cardiomegaly, cardiac fibrillation, left atrium thrombosis, high pulmonary hypertension. In 20 patients the operative intervention on the heart was repeated. The analysis of the results allowed to recommend some surgical techniques which allowed to decrease surgical traumatism in patients with complicated trivalve heart defect. Low traumatism was possible because of incomplete removal of the calcium masses extending on the fibrotic ring and outside, use of two-row counter U-suture on linings for the prosthesis fixing, transdoubleatrial approach without isolation of the heart from the adhesions in dense pericardial obliteration, correction even insignificant trivalve heart defect or relative valve incompetence.     

Analysis of mental functions in patients after coronary bypass surgery

The neuropsychological examination was carried out in 18 men (study group), mean age 59.7 +/- 6.6 years, before and after aorto-coronary bypass. The neuropsychological tests were carried out 2-3 days before operation and 14-16 days after it. 12 non-operated men with coronary artery disease, mean age 60.0 +/- 6.7 years, were studied as a control group. In control group the neuropsychological tests were conducted with a 16-19 day interval. The tests examined short-term verbal and visual memory, semantic memory. At statistical analysis of the results the mean values and confidential intervals were calculated allowing for Student's coefficient. In control group at consecutive tests the negative dynamics of the results was not revealed. The comparison of the tests results in the study group patients before and after operation revealed the a decrease of neuropsychological parameters by 20-40% on the average irrespective of material modality. Features of cognitive changes revealed in early postoperative period, testifies to diencephalic type of the disorders.     

Substitution of an extensive defect of tissues after resection of the sternum in tumors

An original method of substitution of great defect of the soft tissues and osteochondral part of the chest wall after resection of the sternum for a malignant tumor is described. Operations were made on 4 patients. Favorable results were noted in all the patients. The terms of follow-up were from 6 to 25 months.     

The treatment in ulcerative hemorrhages in patients with liver cirrhosis and portal hypertension

Treatment of 34 patients with bleedings from chronic gastroduodenal ulcers associated with cirrhosis of the liver and portal hypertension was analysed. Overall lethality was 41.2%, postoperative lethality was 41.7%. Temporary hemostasis due to a solution of Caprofen used during fibrogastroduodenoscopy allows the operation to be delayed and complex intensive therapy can be performed in patients with hepatic insufficiency. Control medical endoscopic investigations should be performed 4 and 12 hours after admission to the hospital of patients with sub- and decompensated cirrhosis of the liver with portal hypertension and symptoms of unstable hemostasis. The emergency and delayed operative treatment of patients with subcompensated hepatic insufficiency should include organ-saving operations such as vagotomy with pyloroplasty and/or dissection of the ulcer. Operation is indicated to patients with cirrhosis of the liver at the stage of decompensation but if they have evident reappearance of bleeding and in minimal volume. The attainment of final endoscopic hemostasis will allow to avoid surgical interventions intolerable for this category of patients.     

The use of adaptive-repositioning apparatus for the closing of granulating soft-tissue wounds

The authors propose a new method of closing granulating wounds by attaching its edges with the help of an adaptation-reposition apparatus. This method was used in treatment of 53 patients with granulating wounds of different localization. Good results were noted in 88.7% and satisfactory ones in 11.3%. The method was shown to be highly efficient as compared with the control group.     

Phenotypic diversity in siblings with partial androgen insensitivity syndrome

The androgen insensitivity syndrome is a heterogeneous disorder with a wide spectrum of phenotypic abnormalities, ranging from complete female to ambiguous forms that more closely resemble males. The primary abnormality is a defective androgen receptor protein due to a mutation of the androgen receptor gene. This prevents normal androgen action and thus leads to impaired virilisation. A point mutation of the androgen receptor gene affecting two siblings with partial androgen insensitivity syndrome is described. One had cliteromegaly and labial fusion and was raised as a girl, whereas the other sibling had micropenis and penoscrotal hypospadias and was raised as a boy. Both were shown to have the arginine 840 to cysteine mutation. The phenotypic variation in this family is thus dependent on factors other than abnormalities of the androgen receptor gene alone.