Radical operations for benign esophageal leyomyoma were performed in 50 patients in 1976-2006 in the clinic. Highly informative roentgenologic, endoscopic and ultrasonographic (including intraesophageal) methods were applied in the disease diagnosis, permitting to establish the diagnosis, as a rule, accurately before the operation. The diagnosis was verified definitely, basing on intraoperative revision data and the results of express-histologic investigation of the tumor excised. Extramucosal enucleation of benign leyomyoma with plastic closure of esophageal muscle defect or its suturing was done in 33 (66%) patients. Subtotal esophageal resection was performed in 11 (22%) patients, reconstructive operations--in 10 (20%), including in 5 (10%)--retrosternal esophagocolonoplasty, in 2 (4%)--intrathoracic esophagogastroplasty and in 1 (2%)--retrosternal esophagojejunoplasty. In 2 (4%) patients with small benign leyomyoma the esophageal wall portion resection was performed using suturing apparatus and in 1 (2%)--gastrostomy. Postoperative mortality had constituted 2%. Results of treatment were studied in 46 (92%) patients in 1-18 yrs, 4.8 at average. There were no recurrences. The result was estimated as good in 39 (78%) patients and fair--in 7 (14%).
Frequency, severity of clinical course, pathophysiological mechanisms of occurrence and consequences of gastroduodenal erosion and ulcer, complicated by hemorrhage, were analyzed in patients with noninflammatory diseases of pancreas, complicated by jaundice, by cancer, in particular. Basing on investigations done there was elaborated complex programme of prophylaxis of gastrointestinal hemorrhage occurrence in such patients.
The prospective analysis of the results of treatment of postburn cicatricial esophageal stricture (PCES) in 338 (32%) patients, using shunting retrosternal esophagocolonoplasty (SRECP), constituting 76.1% of esophagoplasties performed, was conducted. Postoperative mortality was 4.7% (16 patients died). Early postoperative complications had occurred in 116 (34.5%) patients and the late--in 68 (24.9%). SRECP constitutes the method of first choice in patients, suffering tubular PCES and in formation of fistula, diverticulum and false ways. The standard variant of the procedure includes the performance of wide one-raw esophago-colonoanastomosis in end-to-end fashion with isoperistaltic passage of transplant. Such a tactic owes significant advantages, such as the lower risk of specific severe early and late postoperative complications occurrence, and also secures the esophagoplasty functional adequacy.
Radical operative interventions using abdominocervical access were performed in 145 patients for esophageal and gastroesophageal cancer. Of them in 99 (68.3%) patients isoperistaltic esophagoplasty was performed: in 54 (54.5%)--using isoperistaltic tube, formatted from gastric big curvature, in 23 (23.2%)--portion of jejunum, in 18 (18.2%)--portion of colon and in 4 (4.1%)--ileocecal angle. Retrosternal way of transplant transposition toward the neck was choused in 86 (86.9%) patients, via the resected esophagus bed--in 10 (10.1%) and subcutaneous one, presternal--in 3 (3%). Postoperative mortality had constituted 10.3%. For locally advanced cancer, affecting thoracic esophagus or gastroesophageal one the performance of subtotal-total esophageal resection is indicated. Application of abdominocervical access owes essential advantages for the patient and surgeon, comparing with lateral thoracotomy, because it secures less traumatic, adequately wide and visually controlled approach to mediastinal structures in esophageal cancer, and is characterized by oncological loyalty and surgical utility.
In a prospective investigation, efficacy and safety of use of valproate (depakine-syrup) was studied in infants presenting with the epileptic convulsive syndrome that was resistant to phenobarbital. The study comprised 26 patients who ranged from 3 months to 1 year old presenting with primary and secondary generalized convulsive epileptic fit. The use of valproate (depakine-syrup) in a medium therapeutic dose (15 +/- 5) mg/kg per day permitted controlling fits in sixteen babies (61.53%) over six weeks; in other three infants (11.53%) the frequency of paroxysms has come to be strikingly decreased, in one infant (3.84%) there has been achieved only partial control of fits, and it is only in 6 babies that the state remained unchanged. In this way, the use of valproate (depakine-syrup) in babies presenting with primary and secondary generalized cerebral seizure resistant to phenobarbital is an effective means of control of seizures with lesser incidence of ill effects recordable than in case of employment of phenobarbital.
Disturbances were studied in the system of hemostasis, lipid peroxidation, functional condition of the cardiac muscle in patients with acute mild, moderately severe, and severe viral myocarditis. The studies were made before and after the treatment of patients with basal drug preparations, heparin, antioxidants (thiotriasaline, captopril). Therapeutic benefit from treatment with heparin, thiotriasaline was but insignificant in patients with mild, moderately severe, and severe course of the disease. It was only with the adoption of a complex therapy (basal drug preparations, heparin, thiotriasaline, captopril, diuretics) that patients derived clinical-and-laboratory-instrumental-and-social-and-economic benefit from treatment.