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The direct transcutaneous transhepatic portography was performed in 85 patients with hystologically confirmed liver cirrhosis, portal hypertension and varices of the esophagus and stomach. It was found out, that the left gastric vein partakes the varicous transformation in 100% of cases. The least had an isolated division in 27% of the studied patients. 68% had the significant dilatation of the posterior gastric vein, whereas 19 (22%) patients had the combined posterior, left and short gastric veins dilatation. The study allowed the modification of the M.D. Patsiora's operation (the azygo-portal disintegration), by supplementing it with the gastric devascularization. The new method increased the 2-years survival from 77 to 97%, improved the hemostatic effect from 51 to 89% and decrease the recurrences from 25 to 5%.

Results of surgical treatment of 81 patients with recurrent goiter and 79 patients with benign nodular forms of goiter are analyzed. Based on clinical data, results of ultrasonic and histological examinations, it was determined that recurrence of goiter does not depend on volume of surgery. It is seen in patients with subclinical forms of postoperative hypothyreosis and in half of cases with lymphoid infiltration of I - IV degree. Dispensary observation and timely prescription of suppressive therapy, if it is necessary, permit to reduce number of goiter recurrences from 8.2 to 2.5%.

Influence of different methods of external drainage of the biliary tract on dynamics of inflammation in the biliary tracts was evaluated based on the data examination of bioimpedance, specific electric conductivity and general microbial number of bile received during surgery and from drainage of the common bile duct during 9 days after surgery in 197 patients with cholelithiasis complicated by bile outflow disturbances. It is demonstrated that each type of external drainage has own indications depending on the degree of bacterial contamination, macroscopic structure, biophysical parameters of bile, and planned treatment policy after surgery. Right fixation of the drainage tube in the common bile duct improves immediate results of surgical treatment of patients with cholelithiasis.

The electric conductivity of the hepatic bile received during and 24 hours after surgery from the drainage introduced into the common hepatic duct was studied in 94 patients with cholelithiasis. It is demonstrated that conductivity increases in cholestasis, inflammatory process in the biliary tract and depends on the hepatic morphofunctional status. The specific electric conductivity of intraoperative bile that is more than 192 S/m is considered to be criteria for the diagnosis of cholangitis. The electric conductivity of urine before and in first 4 days after surgery decreases in inflammation of the biliary tract and depends on the degree of concomitant renal dysfunction and electrolyte disturbances. There was a decrease in the conductivity of bile and urine in all studied groups. Detection of biophysical parameters of biological fluids may objectively control the postoperative period and correct treatment policy.

Through a period from 1981 to 1996 127 roentgen-endovascular embolization of gastric veins were carried out in 95 patients for portal hypertension complicated by esophagogastric bleeding or in its threatening relapse. Group 1 consisted of 73 patients, to whom endovascular treatment was carried out urgently at the background of continuing hemorrhage, in 52 patients--it was delayed and in 21 patients in the nearest posthemorrhagic period. In 73 patients bleeding resulting from embolization was stopped. In the earliest postembolization period recurrence of hemorrhage developed in 6 patients, thus initial hemostatic effect of embolization made up 91.8%, and survival rate--74% (54 from 73 patients of the 1-st group were discharged from the clinic). Group 2 consisted of 22 patients to whom embolization of gastric veins was carried out as an elective procedure. There were bleedings in the anamnesis in the patients of the latter group, and varicose veins of the esophagus with trophic disturbances in esophageal mucosa manifested real treat of the hemorrhage. The survival rate in this group of patients made up 95.5%. The analysis of the results of elective endovascular embolization of gastric veins revealed more favourable results in the nearest postembolization period, than in urgent procedures. Far off results of embolization of gastric veins were followed up in 61 patients (43 patients of the 1st group and 18 patients of the 2nd group). Index of survival up to 6 months made up 87.8%, up to 12 months--80.5%, up to 3 years--57.5% and up to 6 years--19.6%. Hemostatic effect up to 6 months made up 100%, to 12 months--84.6%, to 3 years--54.9%, to 6 years--15.6%.

After studying the results of embolization of the hepatic artery in 14 patients with portal hypertension and resistant ascites the authors came to the conclusion that this operation often leads to the development of hepatic insufficiency and a fatal outcome and produces a clinical effect only in a small number of patients. Celiac- and mesenteric angiography and transhepatic portography were carried out for pathogenetic substantiation of the intervention. Pressure in the portal vein, hepatic veins and arteries, and in the inferior vena cava was measured during the examination. The space velocity of the portal and arterial hepatic blood flow was determined. Clinico-angiographic examination of the patients failed to reveal criteria for predicting the efficacy of embolization of the hepatic artery. A positive result may be expected in cases in which embolization leads to a reduction in portal pressure. Embolization of the hepatic artery produced no clinical effect in initial reduction of the blood flow in the liver.

The authors discuss the possibility of a laparotomy approach for endovascular embolization of the gastric veins in patients with portal hypertension and gastroesophageal bleeding. This approach was used in four patients in whom transhepatic catheterization of the portal channel was impossible. After laparotomy, catheterization of the portal vein system was conducted through one of the veins of the small intestine. The effect of embolization in two of three patients who were subjected to the operation consisted in correction of esophagitis and complete cessation of esophageal bleeding. In view of the danger of the development of operative and postoperative complications due to the specific features of the pathological condition, the authors recommend using laparotomy endovascular embolization of the gastric veins only in the presence of strict indications.

From experience in 98 studies the authors claim that transpopliteal phlebography yields information on the condition of the popliteal and the tibial veins and the ostial valve of the small saphenous vein in retrograde, and on the condition of the femoral vein in antegrade administration of the radiocontrast medium. It is indicated for patients suffering from varicosity in ectasia of the popliteal and tibial veins, as well as when the results of clinical tests for competence of the valves of the small saphenous vein are doubtful. The absence of visualization of the femoral vein in ascending distal or retrograde femoral phlebography in patients with congenital venous dysplasia or with phlebothrombosis sequelae is an indication for antegrade transpopliteal phlebography.