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The authors present a report of 14 patients with the syndrome of portal hypertension without liver cirrhosis and with recurring esophagogastric bleedings. The cause of the alterations in portal hemodynamics remains unknown. Operative treatments (splenorenal shunts in 9 cases, 3 splenectomies and 1 ligation of the splenic artery) were successful. Two patients in whom splenectomy had been performed in combination with omentohepatopexy died 6 and 10 years after operation due to recurrent hemorrhages. The other patients did not have recurrent bleedings, but in 6 patients 6-10 years after splenorenal shunts there appeared other diseases (encephalopathy, nephrolithiasis, arterial hypertension, duodenal ulcer). The authors consider that indications for shunting operations for idiopathic portal hypertension, especially when using renal veins, should be determined more carefully, phlebosclerotic therapy and transsection of the esophagus being recommended as alternative interventions.

Transplantation of autologous bone marrow was performed in 62 patients with carcinoma of the thoracic portion of the esophagus for prophylactics of disturbance of hemopoiesis and severe infectious complications in the postoperative period. With the help of myelokariocytopheresis procurement of the bone marrow was made 2-3 days before starting preoperative radiotherapy. After exfusion of the bone marrow mixture erythrocytes were separated and returned completely and immediately to the patient, myelokaryocytes being frozen. The volume of the bone marrow suspension from 1 patient made up on the average from 300 to 800 ml, the amount of the bone marrow cells in it from 4.5 to 11.2.10(9). Studies of the dynamics of concentrated and volumetric parameters of blood were performed. The functional specific features of the bone marrow erythropoiesis were estimated in the sternal punctate. The use of automyelotransfusion substantially reduced the frequency of infectious complications and, in the author's opinion, it is a fairly effective method of prophylactics and treatment of postoperative anemia.

The literature data and original experience (11 relevant cases) have provided evidence in support of marked diagnostic benefit of ultrasonography and transcutaneous transhepatic portography employed in suspected esophagogastric hemorrhage due to isolated thrombosis. Splenectomy and disconnection of pathological portocaval shunt through short gastric veins present surgery of choice.

From study of the results of exclusion of the spleen in 87 patients with portal hypertension by ligation of the splenic artery (47) or its truncal embolization (40) with a Gianturko-type spiral, the authors conclude that in some cases these operations reduce portal pressure, manifestations of hypersplenism, and risk of bleeding, but do not guarantee that they will not develop. Ligation of the splenic artery or its truncal embolization is justified as an independent operative intervention when decompression anastomoses cannot be formed or the risk of their performance is extremely high.

The article presents modern ideas of the most rational methods of antibiotic therapy in treatment of patients in the surgical clinic.

The analysis of lethal outcomes and complications following the reconstruction of the abdominal aorta and iliac arteries has shown that in the small and large intestines of 6 patients (12,6%) among 225 operated upon there were deep morphological alterations of the ulcero-necrotic type. The main cause of intestinal ischemia and severe enteropareses following the reconstructive operations on the aorto-iliac segment was found to be a continuous hypotonia and reduced capacitance blood flow in the system of celio-mesenterial arteries. Prophylactic measures against hypotensive reactions during the operations and in the postoperative period in combination with peridural blockade, decompression of the intestine, administration of sorbitol and other drugs are of great significance in the prevention of intestinal ischemia, severe postoperative gastro-enteropareses following reconstructive operations on the abdominal aorta and iliac arteries.

The authors present the results of the studies of the intensity of plasma super-weak chemical luminescence for the diagnosis of acute appendicitis (35 cases) and various forms of cholecystitis (131 cases). The increase of the intensity level of the blood plasma chemical luminescence has been found in all the forms of cholecystitis and in appendicitis. With the improvement of the patients condition the indices of the luminescence intensity start to normalize. On the grounds of their observations the authors consider that the use of this method in surgical practice will provide information on an early development of complications before their evident clinical manifestations occur.

The complex investigation of central hemodynamics by methods of sphygmography and tachooscillography was carried out in 98 patients with the syndrome of portal hypertension (59 with cirrhosis of the liver and 39 without cirrhosis) who were subjected to various operations. Central hemodynamics was shown to be normalized by shunting operations especially by proximal splenorenal venous anastomosis in combination with splenectomy. Organ anastomoses in combination with splenectomy are inferior in this respect to vascular anastomoses and ligation of the splenic artery.

The authors consider that it is the correct choice of patients for lumbar sympathectomy which is responsible for good remote results in 84.3% of patients subjected to the operation.

A study was made of liver cells of cirrhosis-affected patients and those with portal hypertensia due to subhepatic block. It was shown that the extent of cellular injury was directly related to the pattern of pathological process in the liver. In the case of active cirrhosis, the necrobiotic processes observed might be due to changes in the structures providing cellular metabolism. With stable cirrhosis, the changes observed suggest abnormalities in cell synthesis, in addition to the rise in aerobic respiration. The analysis of the data obtained in the cases of subhepatic block without cirrhosis showed a sufficient functional activity of liver cells.

Surgical diseases are not infrequently responsible for severe operations when the choice between its endurability and poor effects of the conservative treatment speaks in the favour of surgery. The method of integral body rheography when allows the main hemodynamic indices to be reliably assessed as frequently as it is necessary and under any conditions, gives differentiated and quantitative characteristics of the degree and dynamics of heart failure and circulatory insufficiency. It makes the method valuable as an instrument of surgical control good for a wide clinical application.

The article presents an experience with the operative treatment of 476 patients with recurrent dilatation of superficial veins of lower extremities. True and false variants of the recurrences are discussed as well as problems of their diagnosis and treatment. Stress is made on high specific weight (87%) of patients with the development of recurrences due to incomplete examinations and technical defects during the first operation. In 13% of the patients recurrences were caused by progress of the varicose disease and non-eliminated hypertension in profound veins due to their ectasia and incompetence of the valves.

Two hundred patients with carcinoma of lungs, 56 patients with chronic pneumonia and 142 donors were investigated to reveal the presence of 3-hydroxyanthranilic acid antigen in their blood serum. The antigen was found to equal 91,5%, 25% and 1,4% respectively. The pronounced tendency to decrease the response to 3-hydroxyanthranilic acid antigen and to increase the titres of isohemagglutinins was observed in radically operated patients. The opposite tendency was found to develop in incurable patients.

Six cases of pseudotumorous lesions simulating gastric cancer are described. Pathological changes in the gastric wall were characterized by diffuse mainly lymphoid infiltration, associated with sclerosis and ulcers. These lesions are regarded as pseudo-sarcomatous lymphomatosis of the stomach. It is the authors' opinion that these are a benign nonsystemic reactive process in response to the previously suffered inflammation.

The authors presented the method of laboratory elaboration of biologically active surgical sutures with hemostatic and antiiinflammatory properties as developed by the Leningrad S. M. Kirov Memorial Institute of Textile and Light Industry. With the carboxyl groups of the KFM type fibres (addition product of polyvinylfurfural with maleic acid) adrenalin sorbed from aqueous suspensions was linked by ionic bond. The sutures were tested in the A. I. Bakuliev Memorial Institute of Cardiovascular Surgery. Due to the slow release of adrenalin the sutures exert hemostatic effect. In the in vitro tests there were determined the serum calcium level, hemolysis of red blood cells, pH, prothrombin time and plasma protein content changes. The authors showed also preliminary data on the sterilization of the fibres.

The problem dealing with the effect of various nitrogen sources upon the protein metabolism indices and also with the effect of the main pathological process and volume of surgical intervention upon these indices in the closest postoperative period following gastrointestinal surgery, are discussed in this paper. According to the authors' findings there is no statistically significant difference in using such nitrogen sources in parenteral feeding as moriamine, aminozol and hydrolyzine solution. Some findings prove a higher albumin and beta-albumin contents and a high albumin-globulin coefficient in recovered patients within the first days after the operation. The authors came to the conclusion on the necessity of elaborating individual parenteral feeding programs.

The results of 254 experimental studies and 117 case reports of patients with multiple soft tissue injuries of different localization are analysed. Mutiple cutimuscular wounds were found to decrease the tolerance of injured tissues to purulent infection. Experimentally, on 130 rabbits the methods of rational prophylaxis of local purulent infection in case of multiple soft tissue wounds were studied. Their prophylactic effect in this pathology was 20% lower compared with single wounds of identical character.

107 patients were examined in different terms after vagotomy (up to 6 years) performed for ulcerous disease of the duodenum, 43 of them--prior to and after the operation. It is found that the suppression of the acid- and enzyme secretory function of the stomach is not related to the development of the mucosa atrophy, but it is conditioned by eliminating the resolving role of vagus nerves and by a reduced sensitivity of fundic glands to humoral stimuli.

An investigation of ADP-induced aggregation of thrombocytes in 62 patients with the portal hypertension syndrome has revealed pronounced functional alterations of blood platelets characterized by a lower aggregation rate, lower rate and degree of thrombocyte deaggregation. More profound alterations were found in patients with cirrhosis of the liver. It was established that the decreased rate and degree of the thrombocyte deaggregation with the growing aggregation rate, change of the aggregation into the irreversible form is a very dangerous portent of gastrointestinal bleeding.

The dependence of the activity of lysosomal enzymes upon the degree of the pyo-destructive process and the character of the course of the postoperative period has been established on the basis of studying the activity of lysosomal enzymes of leukocytes of blood and pleural exudate, titre of natural and heterophyllic antibodies, components of the kallikrein-kinin system in pyo-destructive diseases of the lungs and pleura. Pathogenetically substantiated ways of prevention of postoperative infectious complications are proposed.

Based on an examination of 105 patients with cirrhosis of the liver with the syndrome of portal hypertension complicated by gastroduodenal bleedings who were subjected to splenectomy (in 86 patients there were proximal splenorenal anastomoses) the authors make a conclusion that infectious complications in the postoperative period in the group under analysis were developing against the background of the concomitant and predisposing conditions and can be compared in their incidence with infectious complications after other similar in severity operative interventions on organs of the abdominal cavity. In remote terms after operation the normalization of the indices of both cellular and humoral immunity was noted.

The indications, contraindications, variants and methods of autohemotransfusions as well as problems of their use in surgery, urology and other fields are discussed in detail on the basis of great clinical experience (about 3000 autohemotransfusions).

Under study were the results of treatment in 10 056 patients with acute appendicitis, including 418 patients having its complicated forms. It is concluded that the extent of surgical intervention in complicated forms should be determined by the character of the complication, manifested in pathological changes of the peritoneal coat and patient's status. Appendectomy may be performed in most patients with appendicular infiltration. It is the authors' opinion that indications to peritoneal dialysis in peritonitis of appendicular origin should be largely restricted. The tactics employed by the authors enabled them to reduce the mortality in complicated forms of appendicitis up to 4.4%.

The "phenomenon of streaming" has been found by the author in splenoportography in 9,4% of patients. The variants of the phenomenon are described. The phemenon seen as a conoid shade superimposed on the shade of the portal vein trunk can suggest possible stenosis of the mouth of the splenic vein. Under these conditions it is inexpedient to fulfill distal splenorenal anastomosis.