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The expediency of performing two-stage cytoreductive interventions in patients with complicated disseminated tumors of the abdominal cavity and pelvis is presented. Ninety-two patients with complicated disseminated tumors of the abdominal cavity and pelvis were examined into two groups. The main group consisted of 33 patients who received surgical treatment by two-stage cytoreductive surgery. The control group included 59 patients who underwent single-stage cytoreductive operations. In both groups, life-threatening complications were dominated by primary tumor necrosis (main group, n = 15; control group, n = 31) and impaired intestinal patency (main group, n = 12; control group, n = 16, respectively). The average Charlson comorbidity index was 7.85 1.37 and 7.53 1.5 points, respectively. Anesthetic risk of grades IIIIV according to the classification of the American Society of Anesthesiologists was detected in 23 (69.7%) and 45 (76.27%) patients of the main and control groups, respectively. Functional status of 23 points on the Eastern Cooperative Oncological Group was established in 23 (69.7%) and 46 (77.9%) patients of the main and control groups, respectively. The peritoneal carcinomatosis index was significantly higher in the main group (13.1 6 vs 9.9 4.8 points) than in the control group (p = 0.012). A comparative analysis of the results obtained in the treatment of the main and control groups demonstrated that the two-stage cytoreductive surgical interventions can reduce the frequency of postoperative complications, primarily ClavienDindo grades IIIIV from 40.7 to 18.2% (p = 0.049) and mortality from 16.9% to 9.1% (p = 0.468) and increase the frequency of achieving complete cytoreduction from 49.1% to 90.9% (p = 0.002) and the frequency of intraperitoneal hyperthermic chemoperfusion from 40.7 to 93.9% (p 0.001). Thus, two-stage cytoreductive surgical interventions are a safe and effective technique in the surgical treatment of complicated disseminated tumors of the abdominal cavity and pelvis.

Hepatic artery thrombosis (HAT) following liver transplantation (LT) is a severe life-threatening complication that can lead to graft loss and mortality after LT. According to different reports, HAT incidence ranges from 2% to 9%. Modern endovascular and radiosurgical techniques allow for minimally invasive liver graft revascularization. Nonetheless, a major consequence of even a successful revascularization is ischemic cholangiopathy, which can lead to ischemic biliary strictures and anastomotic leak. The paper presents a clinical case of long-term complex treatment of combined complications of LT using minimally invasive endovascular and endoscopic techniques.

Surgical treatment of locally spread tumors of pelvic organs remains an urgent and complicated oncological problem. The recurrence rate after radical treatment ranges from 15.1% to 45.2%. The key to a successful and safe surgical intervention is careful planning and intraoperative navigation, including the use of augmented reality technology. The study presents the experience in the clinical testing of augmented reality technology in the surgical treatment of 11 patients. The paper also described the main stages of the algorithm. Radical operations with intraoperative application of augmented reality technology were performed in eight patients with favorable outcomes. One patient underwent palliative intervention, and two patients did not undergo surgery. In the eight patients who underwent surgery, the median operation time was 202.5 (117.5282.5) min, the median volume of blood loss was 300 (187.5625) mL, and the median duration of hospital stay was 21 (17.7527.75) days. Three patients (37.55%) developed complications, namely, necrosis of the perineal edges of the wound, ascending pyelonephritis, and intrahospital pneumonia. No hospital fatality has been registered. In the postoperative morphological examination, a negative peripheral resection boundary (R0 resection) was achieved in all patients. Subsequently, these patients were referred for dynamic monitoring and systemic antitumor therapy. The application of an augmented reality algorithm in the surgical treatment of primary and recurrent pelvic tumors is feasible and reproducible in clinical practice. Augmented reality technology, with its innovative nature and obvious advantages, opens up certain prospects for improving the results of multivisceral resections of pelvic organs; however, further study and implementation in clinical practice are necessary.

Background. Urgent osteosynthesis requires number of organizational, material, technical and staff resources. Aim of the study to determine advantages and disadvantages of existing strategies for osteosynthesis basing on literature data and comparative analysis of organization of osteosynthesis on the first day after injury and at a later time. Methods. Data were collected through review of medical records from first half of 2021 calendar year and consist of the patients have been treated by different types of osteosynthesis on the first day after admission to the hospital and later. Average length of hospital stay (LOS) for surgical procedures and duration of the operative time were compared. Results. In total 266 osteosynthesis of the extremities immediately after admission to the hospital were performed in the first half of 2021 in 260 patients. The most frequently performed ankle fractures fixation (20.7%) and clavicle fractures surgical repairment (13.9%). Cases of early infections complications and no revision surgeries required due to unstable fixation after urgent osteosynthesis were excluded. In the same period 659 delayed osteosynthesis were performed. Mean value of inpatient day in patients, who underwent urgent surgery, was 8.4016.67 days, while patients, who underwent delayed surgery, spent significantly greater (p0.05) amount of time in the hospital 12.986.28 days in average. Discussion. Three strategies of osteosynthesis exist: urgent surgeries, delayed surgeries in daytime in operating rooms for planned surgeries and combination of these approaches. Urgent osteosynthesis surgeries do not lead to infectious complications or unstable fixation, what makes them viable option while choosing treatment tactics in case of some injuries. Precise determination of patient groups according to fracture pattern and its localization, that can be operated on in urgent manner, is necessary. Moreover, introduction of urgent osteosynthesis requires serious organizational measures. It is also necessary to perform economical assessment of described approach. Only after solving these questions, it will be possible to make final conclusions about optimal strategy for performing osteosynthesis.

The article presents the experience of treating wounded K., 29 years old, who, as a result of the suicide bombing of a homemade shell-free explosive device in a moving car of the St. Petersburg Metro 03.04.2017 received a severe mine-explosive combined wound to the head, chest and limbs with a fragmented blind skull. The trauma was accompanied by brain damage, a fracture of the cranial vault bones, lungs contusion, and fragmented fracture of the right tibia bones. The patient underwent sequential bifrontal decompressive craniotomy, external fixation of the right shin bones fractures, blocked intramedullary osteosynthesis of the latter, dura mater plasty, cranioplasty with a titanium plate after its computer modeling. The complex treatment allowed the patient to be discharged from the hospital after 4 months in a satisfactory condition.

This article presents the results of treatment of patients with ulcerative gastroduodenal bleeding who were treated in the 2nd clinic (surgery for the improvement of doctors) Military Medical Academy at the I.I. Dzhanelidze Research Institute of Emergency Medicine. A retrospective analysis was conducted of the frequency of rebleeding, surgical activity and mortality in groups with the use of transcatheter arterial embolization with and without it. The criteria for inclusion in the study were: the presence of ulcerative gastroduodenal bleeding, confirmed by laboratory and instrumental methods of examination, severe general somatic condition of patients. The comparison was carried out in the main and control groups. The main group consisted of 20 patients who underwent endovascular hemostasis. The control group included 46 patients without the use of X-ray surgical methods. The average age of patients in the main and control groups was 65.5 3.7 and 60.7 3.9 years. In both groups, most patients were admitted later than 24 hours after the onset of the disease and with severe blood loss. The severity of the somatic state of the intervention was assessed according to the APACHE II multiple organ failure assessment scale, according to which, patients in the main group were somatically more severe than in the control group. In the groups, bleeding from stomach ulcers prevailed (up to 75%). Most often, endovascular hemostasis is performed at a high risk of recurrent bleeding, and adhesive compositions and spirals were used as an embolizing agent. Angiography revealed direct or indirect signs of bleeding (extravasation, hypervascularization, aneurysmal dilatation) in 12 cases, and preventive embolization was performed in 8 cases. In 70% of cases, the source of bleeding was the left gastric artery. In the control group, recurrent bleeding and surgical activity accounted for 26%. In the main group, 20% and 15%, respectively. In the main group, recurrent bleeding occurred in 4 cases, 1 patient underwent repeated endoscopic hemostasis, 3 patients underwent open surgical interventions. All 4 patients had a fatal outcome, against the background of massive blood loss and aggravated somatic pathology. The overall mortality rate in the control group was 44%, in the main group 35%. Transcatheter arterial embolization did not significantly improve the results of treatment of ulcerative gastroduodenal bleeding due to the severity of the general somatic condition of the patients included in the study.

The article presents a case of treating the patient with extrapleural thoracoabdominal injury with heart and esophageal trauma. Examination of the patient in a shock trauma operating room, the use of minimally invasive technologies (thoracoscopy, laparoscopy) allowed to choose the right treatment tactics, timely identify all injuries and eliminate them. The presented clinical observation demonstrates the feasibility of using video thoracoscopy and video laparoscopy in hemodynamically stable patients with penetrating thoracoabdominal wounds to detect damage to the heart and esophagus.

The article presents a clinical case of 2-stage treatment of an elderly patient with spontaneous rupture of the esophagus. Exclusion the esophagus in the first stage of treatment with the use of minimally invasive technologies (endoscopy, laparoscopy, drainage of the pleural cavity) allowed to minimize surgical trauma and create conditions for the recovery of the patient, relief of mediastinitis, sepsis and restore the natural passage of food through the digestive tube during the second stage of treatment. The presented clinical case demonstrates the feasibility of the multistage approach using minimally invasive technology in the treatment of eldery patients with spontaneous rupture of the esophagus and severe sepsis.

Some patients experiencing health problems unreasonably bring charges against medical specialists because of inadequate medical care providing. It occurs in cases of acute appendicitis as well as in cases of its complications. This article presents data about clinical observation of the patient suffering from acute appendicitis with diagnosis pecularities, unusual tactic of treatment with the subsequent dissatisfaction in this regard with the quality of health care provision. Compliance with the deiontological principles showing mutual respect on the part of both the medical staff and patients may prevent bringing charges against organizations because of inadequate medical care provision.

The article presents two cases of intestinal perforation by a foreign body rarely being the cause for “acute abdomen”. In both cases the disease resembled acute appendicitis. The introduction of endovideosurgical technologies into surgical practice contributes to early diagnostics of a gut wall perforation by a foreign body and allows performing only low-invasive surgical treatment.

Currently, endoscopic hemostasis is the «gold» standard in the treatment of patients suffering from ulcerative gastroduodenal bleeding. General mortality in ulcerative gastroduodenal bleeding according to the Department of ambulance organization of the research Institute of emergency care. I.I. Dzhanelidze in St. Petersburg in 2016 was 5%, and postoperative8,5%. Transcatheter arterial embolization, due to the development of endovascular hemostasis techniques, is an alternative to palliative surgery in the failure of conservative treatment of ulcerative gastroduodenal bleeding using endoscopic hemostasis techniques, especially in the group of patients with high risk of surgery and adverse outcome. It was found that the reduction in mortality in patients with gastric ulcer bleeding can be achieved by reducing the number of palliative interventions, wider use of angiographic embolization for the prevention and treatment of recurrent bleeding and expanding indications for urgent radical operations outside the recurrence of hemorrhage. The use of transcatheter arterial embolization in elderly patients with severe somatic pathology and recurrent gastric ulcer bleeding can prevent the recurrence of bleeding and perform hemostasis. The success of the transcatheter arterial embolization procedure depends on many factors. Primarily from the anatomical features of the patient. In one case, the patient had a 60% stenosis of the proximal segment of the gastrointestinal splenic trunk, which did not allow the procedure to be performed. Important is the choice of agents for embolization depending on the location and diameter of the source of bleeding. Success also depends on the technical equipment of the hospital and the experience of the surgeon. The absence of significant differences in mortality between the main and control groups, in our opinion, is due to the severity of the General somatic condition of patients included in the study. The obtained results determine the need for further studies to optimize the indications and methods of transcatheter arterial embolization in emergency surgery of gastroduodenal bleeding.

IntroductionPlasmin and its precursor, plasminogen, are detectable in urine from patients with glomerular disease. Urinary plasmin(ogen) levels correlate with blood pressure (BP) and may contribute to renal Na+ retention by activating the epithelial Na+ channel (ENaC). In a longitudinal nested-cohort study, we asked whether urinary plasmin(ogen) levels predict subsequent increase in BP, incident hypertension, or mortality in subjects with type I diabetes, who often develop proteinuria.MethodsThe Pittsburgh Epidemiology of Diabetes Complications (EDC) study followed up type I diabetic subjects for 25 years. Urine specimens from 70 subjects with a spectrum of baseline urinary albumin levels were examined. Outcomes included increased BP after 2 years (≥1 SD over baseline systolic or diastolic BP, examined via logistic regression), 25-year incident hypertension (≥140/90 mmHg or initiating BP-lowering medications), and all-cause or cardiovascular mortality, examined using Cox regression.ResultsSubjects experiencing a 2-year increase in BP had higher baseline urinary plasmin(ogen)/creatinine levels (uPl/Cr) than other subjects (P= 0.04); the difference in baseline urinary albumin/creatinine levels (uAlb/Cr) was similar (P= 0.07). Baseline uPl/Cr was associated with increased 25-year hypertension incidence (hazard ratio= 2.05, P= 0.001), all-cause mortality (HR= 2.05, P= 0.01) and cardiovascular mortality (HR= 3.30, P= 0.005), although not independent of uAlb/Cr.ConclusionThis is the first long-term prospective study addressing clinical outcomes associated with increased urinary plasmin(ogen). Findings are consistent with a role for plasmin(ogen) in promoting increased BP, but also demonstrate the difficulty in distinguishing effects due to plasmin(ogen) from those of albuminuria.

Aim. To evaluate an effectiveness of various surgical methods for pancreatic pseudocysts complicated by bleeding. Material and Methods. The results of surgical treatment of 31 patients with pancreatic pseudocysts complicated by bleeding (false aneurysm type I) were presented. Patients were divided into two groups depending on surgical treatment: group 1 (15 patients) – laparotomy, intraoperative hemostasis and external drainage of pancreatic pseudocyst; group 2 (16 patients) – selective angiography with vascular embolization followed by US-assisted external percutaneous drainage of pancreatic pseudocyst. Results. An effectiveness of various surgical techniques was assessed by the incidence of severe sepsis and mortality rate. There were no cases of severe sepsis and lethal outcomes after minimally invasive treatment while in the 1st group severe sepsis developed in 33,3% (5 patients), mortality was 20,0% (3 patients). Conclusion. Minimally invasive measures are optimal for pancreatic pseudocysts complicated by bleeding. Laparotomy is advisable if minimally invasive interventions are impossible due to various reasons.

Introduction Renal sodium (Na+) retention and extracellular fluid volume expansion are hallmarks of nephrotic syndrome, which occurs even in the absence of activation of hormones that stimulate renal Na+ transporters. Plasmin-dependent activation of the epithelial Na+ channel has been proposed to have a role in renal Na+ retention in the setting of nephrotic syndrome. We hypothesized that the epithelial Na+ channel inhibitor amiloride would be an effective therapeutic agent in inducing a natriuresis and lowering blood pressure in individuals with macroscopic proteinuria. Methods We conducted a pilot double-blind randomized cross-over study comparing the effects of daily administration of either oral amiloride or hydrochlorothiazide to patients with type 2 diabetes and macroscopic proteinuria. Safety and efficacy were assessed by monitoring systolic blood pressure, kidney function, adherence, weight, urinary Na+ excretion, and serum electrolytes. Nine subjects were enrolled in the trial. Results No significant difference in systolic blood pressure or weight was seen between subjects receiving hydrochlorothiazide and those receiving amiloride (P ≥ 0.15). Amiloride induced differences in serum potassium (P < 0.001), with a 0.88 ± 0.30 mmol/l greater acute increase observed. Two subjects developed acute kidney injury and hyperkalemia when treated with amiloride. Four subjects had readily detectable levels of urinary plasminogen plus plasmin, and 5 did not. Changes in systolic blood pressure in response to amiloride did not differ between individuals with versus those without detectable urinary plasminogen plus plasmin. Discussion In summary, among patients with type 2 diabetes, normal renal function, and proteinuria, there were reductions in systolic blood pressure in groups treated with hydrochlorothiazide or amiloride. Acute kidney injury and severe hyperkalemia were safety concerns with amiloride.

Effectiveness of enhanced recovery program is being earnestly confirmed in various surgical areas. Certain aspects of fast track rehabilitation are analyzed in the article.Эффективность программы ускоренного восстановления после операции подтверждается в различных хирургических областях. В статье анализируются некоторые аспекты быстрой реабилитации больных.

Rationale and feasibility of isolated pelvic perfusion (IPP) as a high-tech treatment modality for patients with pelvic malignancies was studied and analyzed based on the systematic review of the literature. Indications, techniques and regimens of IPP are reviewed. There is a focus on anticancer agents for IPP and methods of complete vascular isolation of the perfusated region. Data on the short- and long-term outcome of patients after IPP are presented. To the best of authors’ knowledge this is the first Russian article regarding application of IPP in oncology practice.

OBJECTIVE Cardiovascular disease (CVD) is the leading cause of death among American postmenopausal women and all adult Americans. The medical community and the lay community have recently become intrigued with vitamin D and its potential role in reducing the risk of CVD. Research findings from multiple retrospective studies, few prospective studies, and recent nonhuman primate studies have been inconsistent and conflicting. The objective of this study is to review what is known about the topic, what questions remain unanswered, and where the research community should be focusing. METHODS A literature search was conducted through PubMed and Google Scholar up to August 1, 2014. One hundred six articles, including 18 double-blind, placebo-controlled, randomized clinical trials, relevant to the study topic were identified. All studies were stratified based on study design and primary outcome. The effects of vitamin D on CVD were reviewed and summarized. RESULTS Although there is an abundance of observational studies suggesting an association with CVD protection, the most well-controlled randomized human trial data available show no benefit of vitamin D on CVD. However, highly controlled nonhuman primate studies indicate a beneficial relationship. CONCLUSIONS Well-designed research, with CVD as primary outcome, is needed to help bridge the gap in our knowledge on this topic. In the meantime, caution should be applied to avoid overdiagnosis and overtreatment of vitamin D deficiency.

OBJECTIVES To assess the risk of endometrial cancer (EC) associated with atypical glandular cells of endometrial origin (AGC-EM) in 2 age groups (age younger than 51 vs 51 years or older). METHODS A retrospective case series was assembled identifying AGC from a pathology database between January 1, 2005 and January 1, 2009. Demographics, cervical cytology results, and final diagnoses (including clinically significant diseases and cancers) were recorded from the initial AGC diagnosis until August 30, 2011. Data were analyzed using the χ test to compare rates of disease between age groups. RESULTS Among the 444 patients with AGC, 41% (183/444) had AGC-EM. Women younger than 51 years, compared to those 51 years or older, had significantly lower rates of AGC-EM (35% [105/296] vs 53% [78/148]; p < .001; odds ratio, 0.49; 95% confidence interval, 0.33-0.74). The rate of EC was significantly lower in those younger than 51 years, compared to those aged 51 or older (5% [8/158] vs 19% [18/95]; p < .001; odds ratio, 0.23; 95% confidence interval, 0.09-0.55) in women who underwent endometrial biopsy. In women younger than 51 years who underwent an endometrial biopsy, the rate of EC had a stepwise increase across 3 subclasses of AGC (from AGC of endocervical origin [AGC-EC] to AGC not otherwise specified to AGC-EM) (p = .04). CONCLUSIONS Women aged 51 years or older who have AGC are more likely to have AGC-EM and EC than women younger than 51 years. In women younger than age 51, AGC-EM is the subclass most associated with EC while compared to 2 other subclasses (AGC not otherwise specified and AGC-EC).

Various contradictory definitions of "iatrogenicity" are considered. Bearing in mind the absence of the universally recognized interpretation of this concept, the authors believe it nappropriate to use the term "iatrogenic" in expert and juridical practice.

The percutaneous endoscopic gastrostomy takes an important place in operative endoscopy of the digestive system. At the same time it is the method of choice in patients who need a long-term administration of enteral feeding. Given article reflects the main indications, contraindications and complications of the percutaneous endoscopic gastrostomy and presents the basic stages of the method. The authors hope, that the data would be useful for both entry-lever surgeon-endoscopists and specialists who used the method.

The authors analyzed the data of 281 cases of iatrogenes of manipulator character in abdominal surgery in order to investigate the circumstances and character of origin. There were 187 cases of operative confirmation and 84 cases of unintentional intraoperative retained foreign bodies. It was detected, that primary planned intervention of higher category of complexity should be related to the high risk group of the development of the operative confirmation. Retained foreign bodies with soft fabric base were diagnosed in early postoperative period as the result of the beginning of postoperative complications. The retained foreign bodies with tough backer material as a rule didn't cause the complications in early postoperative period. They were diagnosed in long-term postoperative period in majority of cases.

OBJECTIVE To compare several fracture risk-prediction models and their predictive values. METHODS Women older than age 49 years were sent for dual-energy X-ray absorptiometry screening between January 2007 and March 2009. Data collection included multiple osteoporosis risk factors. The ability to identify fractures was analyzed and compared using the North American Menopause Society 2006 and 2010 Position Statements, The Fracture Risk Assessment Tool, along with age alone. The area under the curve (AUC) comparison with chance (AUC 0.50) and paired AUC comparisons between models were used to investigate the efficacy of each model in predicting osteoporotic fractures. RESULTS Among the 615 women studied, with mean (standard deviation) age of 61.4 (8.3) years and 94.5% being white, 15 have experienced a fracture. All screening approaches were significantly better than chance at predicting fractures. Paired comparisons of the detection ability of fracture prediction models showed no significant differences. Age alone was a significant predictor for fracture (AUC 0.79, 95% confidence interval [CI] 0.67-0.91, P

Based on an experience with treatment of 269 patients with complicated peptic ulcer the authors came to a conclusion that the most sparing and radical operation was subdiaphragmatic truncal vagotomy with Finney pyloroplasty with lethality of 6.8%. Resection of the stomach and forced palliative interventions such as suturing of perforated and bleeding ulcers resulted in lethal outcomes in more than 50% of them.

Test-analyze-and-fix is the most commonly recognized method of improving equipment reliability. The author considers the evaluation method used to measure the effectiveness of design fixes implemented during test. A nonmathematical, practical approach is offered to evaluate nonlinear growth as might be observed during an actual reliability growth test. Graphical illustrations show how the AMSAA (Army Systems Analysis Activity) and Duane least squares growth analysis techniques deal with nonlinear growth data. It is pointed out that both analyses are insensitive to discontinuities and/or sudden changes in growth slopes and rely heavily on early test data. A piecewise regression method is offered to overcome the shortcomings of the Duane regression and AMSAA methods. A case-history approach is used to analyze both hypothetical and actual data representing a wide variety of growth curve shapes. >

Commercial-off-the shelf (COTS) military equipment offers the promise of technology advancement, low cost and reduced acquisition time. Unfortunately, it also offers the opportunity for a reliability and logistics disaster because commercial parts, standards, and practices may not meet military requirements. Additionally, commercial vendors have little or no experience in providing the kind of technical data required to support military deployment logistics. COTS hardware is expected to have the following characteristics: low cost; currently available from multiple suppliers; and built to documented standards in high volume production with a mature design. The reliability challenge in the next decade will be to manage COTS to take advantage of the promise and avoid the disaster. This can be done by carefully selecting the COTS vendors, thoroughly testing the hardware/software and applying only those analyses and data requirements (ESS, EQT, verification testing, prediction, FMEA, derating, parts control and FRACAS/FRB) to ensure reliability performance and logistics support. This paper offers some guidance in managing COTS program elements and provides insight into their impact on reliability.

In the absence of military reliability performance verification standards, the author proposes one way of implementing reliability performance accountability. The proposal consists of incorporating a real-time reliability meter (RTRM) into critical military equipment, particularly commercial off-the shelf (COTS). The methodology used in this paper results in an equation that depicts the observed failure rate as a two dimensional plane, whose values are a function of the three failure rates. The RTRM permits two types of reliability assessments: comparison of measured reliability performance to expected performance; and computation of the operating, dormant, and cyclic failure rates for a group of like equipment by capturing and storing the necessary data in the data log function.

Reliability development growth testing (RDGT) is the most common method used to improve equipment reliability. The author had an opportunity to perform an analysis of hardware that experienced environmental stress screening (ESS), environmental qualification testing (EQT), RDGT and field usage. The failure mode and corrective action data were used to qualitatively assess the effectiveness of RDGT testing. The results of this analysis yield the following conclusions: (1) RDGT is not a very good precipitator of field related failure modes, therefore RDGT alone does not appear to be a strong driver of reliability growth; (2) RDGT, EQT, ESS, and EQT tests precipitate a high percentage of failure modes that occur only in "chamber-type" environments, and are not related to field use; (3) of the three "chamber-type" tests (ESS, RDGT, and EQT) evaluated as precipitators of field related failure modes, ESS appears to be the most effective; and (4) "chamber-type" tests are more efficient in developing corrective actions than field operation.

The authors made an analysis of the immediate and long-term results of truncal vagotomy for perforating gastroduodenal ulcers in accordance with the kind of the suture in operation of stomach drainage. In 282 patients pyloroplasty was performed with placing a two-row suture, in 239 patients a one-row suture was used. Lethality among the patients with the two-row sutures was 2.1% in those with the one-row suture--0.4%. The placing of one-row sutures was followed by a relatively smaller amount of complications at the early postoperative period. An analysis of long-term results has shown that the one-row suture gives much greater amount of excellent results as compared with the two-row suture. The authors recommend to use the one-row suture in all the cases of perforating pyloroduodenal ulcers irrespective of the phase of intraperitoneal inflammation.

Medical histories of 67 patients with perforation of gastroduodenal ulcers combined with gastroduodenal hemorrhage were analyzed. The frequency of this complication makes 7.5% of all patients with perforated peptic ulcers. High mortality rate is thought to result from wrong diagnosis and inadequate operation. Best results were obtained when truncal bilateral subdiaphragmatic vagotomy was used in combination with some pyloroplasty techniques. Resection of the stomach is known to be dangerous because of frequent complications often leading to death. Operations aimed at the arrest of hemorrhage and liquidation of peritonitis are indicated to patients in critical state. X-ray examination of the abdomen and fibrogastroduodenoscopy allowed the combination of perforation and hemorrhage to be diagnosed in due time in all the patients.

The article is devoted to surgical treatment of perforating gastroduodenal ulcers. An investigation of remote results of palliative and radical interventions for the perforation of the stomach and duodenum in patients of young age has shown that recurrent ulcers after suturing the perforation take place in 67.2% of the people operated upon against 21% of those subjected to bilateral truncal subdiaphragmatic vagotomy with pyloroplasty. A conclusion is made that for perforating ulcers it is expedient to perform radical operative interventions as a bilateral truncal subdiaphragmatic vagotomy with pyloroplasty.

This paper develops a model that relates availability to the usage profile. Where the usage profile consists of operating (on) time, dormant (off) time and cycles (turn-on/ turn-off). The availability is described as a function of the off rate (cum. off time/cum. on time) and the cycle rate (cum. cycles/cum on time). The operating, dormant and cyclic failure rates are constants. A parametric sensitivity* study of the model was performed and it indicates that: Max. MTBF is achieved during contin- uous operation. Availability is most sensitive to changes in dormant failure rate, cycle rate, and off rate. When all other parameters are kept constant, the availability can be maximized by selecting an appropriate off rate. Tht model was applied to a Life Cycle Cost (LCC) analysis under three usage conditions (dormant, moderate and continuous operation). The results** indicate that