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.     

A methods of laparoscopic suturing of perforated pyloro-bulbar ulcers

The article describes a method of laparoscopic suturing perforated ulcers of the pylorobulbar zone. The elements of all steps of the operation are analyzed including the places of introducing the trocar, the method of putting the intracorporeal stitches, means of sanitation and drainage of the abdominal cavity. The method was successfully used in operations on 43 patients with perforated ulcers without any complications.     

The application of electronic microscopic studies in the diagnosis of the degree of inflammation in necrotic pancreatitis

The electron-microscopical investigation of the pancreatic gland necrosis region had permitted to determine the organ inflammation character.     

An approach to the right hepatic duct in treating high damage and cicatricial stricture of the bile ducts

There was proposed an operative access to the duct via the lateral end of transverse hepatic fissura, basing on the results of studying of the right hepatic duct anatomy. The method performed includes the right hepatic lobe mobilization, its fibrous capsule transsection along the transverse fissura in the direction toward right posterior sectorial duct, longitudinal transsection of the duct lateral wall along 1-2 cm with subsequent formation of laterolateral hepaticojejunoanastomosis. Method was tested in 9 patients with high damage and cicatricial stricture of biliary ducts, the result was positive.     

The surgical treatment of toxic goiter in middle-aged and elderly patients

Of 128 patients, ageing more than 60 years, polynodular toxic goiter was diagnosed in 84, diffuse toxic goiter--in 34, toxic adenoma--in 10. The nodules in thyroid gland (TG) were revealed in 94 patients, cancer--in 3. There were following indications for the operation: the lack of the thyreostatic therapy efficacy, the malignant-like nodules presence, compression of cervical and mediastinal organs. After the euthyreotic state achievement all the patients were operated on using endotracheal narcosis. Subtotal resection of TG was performed in 91 patients, thyroidectomy--in 27, hemithyroidectomy--in 10. The frequency of specific complications (n. recurrence damage, bleeding, hypoparathyroidism, the wound purulent complication) was 4.7%.