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Considerable disturbances of the visceral blood circulation have been found to occur in stenosis of the celiac trunk. Circulatory disorders in the liver, pancreas, stomach and duodenum are dependent on the degree of the celiac trunk narrowing. The collateral vascular bed fails to provide the complete compensation of the reduced organic blood flow. As a result, chronic ischemia of the organs persists.

The experience of treatment of 88 cases of gallbladder cancer was used in developing a TNM staging classification of the lesion. The extent and procedure of radical surgery versus tumor stage as well as long-term results of treatment are discussed.

In the paper the diagnostic and therapeutic policy employed in 11 patients with internal biliary fistulas, most frequently caused by cholelithiasis, is analysed. Some aspects of the preoperative diagnosis are eluciadated, and it is concluded that patients with internal biliary fistulas are to be treated surgically: cholecystectomy, suturing of defects in the gastric and intestinal wall, the drainage of bile tracts.

The autoradiographic method was used for a comparative study of regeneration of the gastric mucosa after wounding the rat with a preliminary loss of blood and without it. The H3-thymidin label index was determined in the portions of the mucosa of the wound edge and far from it. A histological analysis of healing the wounds failed to reveal any difference in terms of this process in rats with a loss of blood and without it. A momentary massive loss of blood did not influence the strain and intracellular regeneration processes in the healing wound of the stomach: the amount of cells synthesizing DNA at the edges of the gastrotonic wound proved to be the same in experiments both with a loss of blood and without it. The authors believe that it may serve as an indirect evidence of a somewhat exaggerated danger of surgery at the height of gastroduodenal bleeding.

The content of biogenic amines in gastric tissues was studied in rats with celiac trunk stenosis 3 hours, one day, 2 and 7 days after operation. Chronic ischemia of the gastric wall was found to lead to the development of dystrophic changes in the gastric mucosa, accompanied by the decreased catecholamine content and elevated levels of histamine and serotonin.

Experience with the surgical treatment of 265 patients with a compressive stenosis of the celiac trunk has been analyzed. Stenosis of the celiac trunk is known to be a cause of ischemic abnormalities of the stomach, duodenum, pancreas. Decompression of the celiac trunk is an effective method of treatment of the ischemic disease of digestion organs resulting in better organic blood circulation and involution of the appearing pathologic processes. In a number of patients there appeared symptoms for associated interventions due to complications of ischemic gastroduodenal ulcers or concomitant diseases. Excellent and good remote results were noted in 79,6%, satisfactory--in 16,7%, unsatisfactory--in 3,7%.

Experience in the treatment of 218 patients with compression stenosis of the celiac trunk is generalized. The clinical symptoms and the angiographic semiotics of the disease are described in detail. Active surgical tactics is substantiated and the results of operations are studied.

Experience in repeated operations on the biliary tract in 51 patients is analysed. Endoscopic retrograde cholangiopancreatography is one of the informative methods. The choice of the method of operative treatment must be individualized according to the nature of the pathological process in the biliary system. An endoscopic intervention may be an alternative to surgical operations in many cases.

Experimentally and clinically, the authors have studied the effect of massive blood loss and various operative procedures (Billroth I and Hofmeister-Finsterer gastrectomies, pyloroplasty with vagotomy) on the hemopietic system. It has been found that the bone marrow response was mainly dependent on blood loss. A surgical intervention renders but insignificant effect on hemopoiesis, similar to that of a moderate hemorrhage, the character of an operative procedure being of no improtance.

Compressive stenosis of the celiac trunk is a common cause of chronic ischemia of the digestive organs with consequent morphological and functional changes in these organs. Decompression of the celiac trunk is an effective operation which normalizes the central and visceral circulation and results in resolution of ischemic lesions of the digestive organs and cicatrization of ischemic gastroduodenal ulcers, in particular. In some cases it is necessary to combine decompression of the celiac trunk with other surgical procedures to eliminate complications of ischemic lesions of the stomach and duodenum or other associated lesions.

Clinical observations in 25 patients with cancer of the gallbladder are described. Tumor of this localization, as a rule, is characterized by a latent course with symptoms of cholelithiasis, chronic cholecystitis, manifested by jaundice and signs of neoplasia only ar later stages. Special attention is given to a frequent association of gallbladder cancer with an acute inflammatory process. The prophylaxis against gallbladder cancer is early surgery for cholelithiasis.

An analysis of results of simultaneous operations in 103 patients with different surgical diseases has shown advantages of such operations saving the patient from several diseases.

25 cases were operated upon at the climax of a massive gastrointestinal bleeding from acute ulcers and erosions. Among them 20 patients underwent stomach resection. One patient died from pancreonecrosis within the early postoperative period. There were no cases of the recurrence of bleeding. Excellent late results were found in 12 of 17 cases, in other 5 cases the results were good.

Follow-up clinical results have been analyzed for 564 patients with occlusions of visceral arteries, which presented clinically as symptoms of chronic pancreatitis in 115 patients. As a rule, chronic pancreatic ischemia leads to exocrine hyposecretion evident from the derangement of cyclonucleotide metabolism. There were also metabolic shifts in pancreatic cells related to hypoxia. Intravital biopsies revealed dystrophy of the acinar tissue as well as inter- and intralobular infiltrates of the connective and fatty tissue.