Treatment of urinary fistulas with allogenic fibroblasts growth culture

15(2.4%) of 601 patients (392 have undergone transvesical adenomectomy, 111 had gunshot wound of the external genitalia and small pelvis organs, 98 had closed pelvic traumas, injuries of the urinary bladder and posterior urethra) were treated for persistent urinary fistulas with human allogenic fibroblasts growth cultures grown in the artificial medium. Before transplantation into the fistula tracts, the fibroblasts were grown in bioreactor on the microcarriers. Application of allogenic fibroblast growth culture has reduced hospital stay to 7.5 days. This method is simple and effective in inpatients. Use of allogenic fibroblasts allows to create bank of cell transplants for application in clinical practice.     

Functional status of urinary tract after plastic surgery of the urinary bladder with a segment of the ileum (experimental study)

Replacement of the gall bladder with an isolated ileal segment was made to evaluate function of the urinary tracts depending on configuration of the created urine reservoir early and late after the operation in dogs. Intestinoplasty of the gall bladder changes parameters of ureteral function. Upper urinary tract urodynamics after ileocystoplasty is characterized by lowering of intraureteral pressure, decreased amplitude of the contractions, high tonicity and motility. The intestinal bladder has the same mean basal pressure at rest but less when full than the control animals. Reflex urination after the bladder reconstruction in subtotal resection was intact. Detubulized urinary reservoir had low intravesical pressure and no spontaneous contraction activity.     

Surgical treatment of late metastases of kidney cancer

Whereas 25-57% of patients diagnosed with renal cell carcinoma (RCC) present with metastatic disease, about 50% of (RCC) patients develop metastases after potentially curative radical nephrectomy. Five-year survival at following surgical removal of solitary metastases is approximately 35-50%. Our experience demonstrate that a small cohort of patients benefit from aggressive surgical therapy for consequtively arising solitary distant metastases with long-term palliation.     

The lipid profile in patients with obesity who have undergone vertical gastroplasty

The effect of vertical banded gastroplasty (VBG) on the lipid profile in obese patients is considered. The antiatherogenic effect of VBG and of the following weight loss consists in significantly decreased plasma triglycerides, increased content of high-density lipoproteins and decreased atherogenic coefficient. Patients with hypercholesterolemia have significantly lower total plasma cholesterol by the period of the body mass stabilization. The effect of VBG is compared with that of other methods of correction of dyslipidemia. The possibility to improve this effect is also discussed.     

The immediate results of laparoscopic treatment in perforated gastroduodenal ulcers

The article presents an analysis of immediate results of laparoscopic interventions (suturing, vagotomy) in 40 patients with perforated ulcers in the pylorobulbar zone. Postoperative complications were noted in 7.5% of the patients. There were no lethal outcomes. The authors recommend wider introduction of the laparoscopic technology as a method of optimization of surgical treatment for perforated ulcers.     

The diagnosis and surgical treatment of neck wounds

The authors share their experiences with treatment of wounds of the neck in 210 patients. Major vessels were injured in 85 of them (40.5%), arterial vessels being injured in 19 patients, venous vessels in 23 patients. 43 patients had wounds of the hollow, parenchymatous organs and nerves. All the patients with wounds of the hollow and parenchymatous organs recovered. Lethality among the patients with wounds of the major vessels was 11.9% and was due to a combination of injuries of the vessels and blood loss incompatible with life. Active surgical treatment of penetrating wounds of the neck with careful revision of the wound, use of emergency esophagogastroduodenoscopy, laryngotracheobronchoscopy, X-ray examination allow the amount of diagnostic errors and lethality to be reduced.     

The diagnosis of disorders of the colorectal innervation in children

The problem of congenital and acquired defects of innervation of the distal colon has many unsolved questions for making clinical and histological diagnosis, classification and using methods of treatment. Clinical, radiological and morphological aspects of treatment of 153 patients aged from 2 days to 14 years with disturbances of the colorectal innervation were analyzed. Radiological examination was not sufficient for making the diagnosis. Histological signs of aganglionosis, hypoganglionosis, dysganglionosis, type-A and type-B neuronal intestinal dysplasia in full-thickness biopsy specimens were used to confirm the diagnosis of congenital defects of innervation of the distal colon. The scheme of patho- and morphogenesis and clinico-morphological classification of disturbances of the colorectal innervation were proposed. Hirschsprung's disease was classified as a variant of the disturbance of the colorectal innervation.     

Monitoring of the auditory stem evoked potentials in removal of tumors of the posterior cranial fossa

The material of intraoperative monitoring of the acoustic stem evoked potentials (ASEP) in 9 patients with tumors of the stem and in 28 patients with the parastem localization was analyzed. It was shown that changes in the amplitude of ASEP rather than latency were the decisive factor in the assessment of the functional state of the brain stem. It was found that even the pronounced changes of the bioelectrical activity recorded during the excision of the tumor could be reversible after a change of the strategy of the operative intervention and/or after performing the necessary therapeutic measures. An important test of favorable prognosis of the postoperative course is considered to be the normalization of brain activity, ASEP included, at the final stages of the operation.     

Surgical treatment of recurrent goiter

The authors have analyzed and generalized their 20-years experience with surgical treatment of 247 patients with recurrent goiter. Among them 48 patients had recurrent toxic goiter and 199 patients had nontoxic goiter. Postoperative complications developed in 8.3% of the patients with recurrent toxic goiter and in 6% of the patients with nontoxic goiter. The overall postoperative lethality was 1.2%. Operative treatment is recommended by the authors for recurrent toxic and nontoxic goiter, conservative treatment with radioactive iodine is thought to be expedient for a repeated recurrence. For preventing recurrences of toxic and nontoxic goiter after the first operation the administration of small does of the thyroid hormones is considered to be expedient during 1.5-2 months.