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Metabolic disturbances, such as changes in blood acid-base balance and electrolytic composition; hyperglycemia and hyperlactatemia, are frequent factors that complicate the early postoperative period in patients after cardiac surgery under extracorporeal circulation. The purpose of the study was to estimate the incidence of hyperlactatemia in the early postoperative period and to reveal the predictors of its occurrence. This prospective study was conducted in our center from November 14, 2006, to September 1, 2007. The study covered 270 patients above 15 years of age, who had been operated on for coronary heart disease, acquired heart diseases, and combined lesions of valves and coronary arteries. Hyperlactatemia was observed in a substantial proportion of patients who had been operated on under extracorporeal circulation. Correlation analysis indicated a significant association between the duration of extracorporeal circulation and the magnitude of hyperlactatemia developing in the early postoperative period. Hyperglycemia with a glucose level of > 9 mmol/l is a predictor of the development of hyperglycemia.

An analysis of results of treatment of 228 patients with wounds of the lumbar region has shown that in 66.2% of cases they were not penetrating, in 33.8% they were penetrating. In 42 patients there were injuries of internal organs and of the vessels of the abdominal cavity and retroperitoneal space. The casualties must be examined under conditions of the emergency operating room and which in addition to thorough revision of the wound must include subsidiary methods of examination: USI, survey radiography of the thoracic and abdominal cavities and diagnostic survey laparoscopy, if necessary.

Based on an experience with treatment of 68 patients with injuries of the duodenum the authors have developed a diagnostic algorithm always permitting the diagnosis of injuries of the retroperitoneal part of the duodenum. A classification of severity of the duodenal injury was proposed determining the volume and type of surgery. Using the proposed therapeutic-diagnostic program decreased postoperative lethality from 52.4% to 11.8% in patients with wounds and from 60% to 13.4% in patients with closed injury of the duodenum.

A retrospective analysis of treatment of 436 patients with acute bleedings from tumors of the gastrointestinal tract was made. Elderly and senile patients made up 72% of the hospitalized patients. The emergency complex diagnostics in 75% of the patients under conditions of a multi-profile hospital allowed the source of bleeding to be detected during the first day, the strategy of treatment being also determined. Radical operations could be fulfilled both in emergency and planned order on most patients. Lethality of patients with tumors of the stomach and colon after radical operations was 10%, after palliative operations 29.5% and 27.9% respectively. Acute bleedings from tumors of the gastrointestinal tract is not the absolute sign of the patient being inoperable.

Changes in hemodynamics and blood oxygen transport function were studied during coronary bypass surgery (CBS) on the working heart under anesthesia with propofol and fentanyl. In patients operated on the working heart, the course of the basic stage of an operation was characterized by a moderate reduction in cardiac index and stroke volume due to the cardiac changes and immobilization, which resulted in cardiac compression and venous return deterioration. These impairments did not lead to worse oxygen-transportfunction and they were completely eliminated in the rehabilitative period. Analyzing the results of studies of troponin-T and creatinine kinase-MB showed that the procedure of coronary bypass surgery without using EKK had a less damaging effect on the myocardium. Analyzing the course of an early postoperative period indicated that the use of perfusionless technology substantially reduced needs for inotropic support, the time of artificial ventilation, and the length of stay at an intensive care unit.

The topographic-anatomical investigations of the extraorganic part of the arterial and nervous systems of the duodenum and the initial part of the jejunum in combination with the results of the clinical use of gastric resection by the Roux method allowed to draw a conclusion that the development of Roux syndrome can be prevented by a transection of the jejunum with the saved arcades between the first jejunal artery, the duodenal branch and the second jejunal arteries. The rules of gastric resection by the Roux method and indications to this procedures in patients with ulcer disease of the stomach and duodenum are described. Good and excellent long-term results were obtained in 75.8% of the patients operated upon.

The experience with 233 stomach resections in "difficult" ulcers is analyzed. The main cause of complications and lethality after these surgeries is duodenal stump sutures insufficiency seen in 17 (7.3%) patients, and in 10 (4.3%) patients it was the cause of death. Original duodenal stump cover was performed in 86 patients. There were no cases of suture insufficiency, two patients died of pneumonia and hepatic failure.

The authors present results of surgical treatment of 98 patients with gluteal wounds. In 93.9% of cases the wounds were not penetrating and in 6.1% there were penetrating wounds. All the patients admitted to hospitals in state of shock as well as suspected to the penetrating character of the wound underwent general laparoscopy. In 2 patients with penetrating wounds of the abdominal cavity and in 7 patients with non-penetrating wounds ligation of the internal iliac artery was necessary because of huge bleeding. Two patients (2%) with penetrating wounds of the abdominal cavity died.

An analysis of results of surgical treatment of 107 elderly and senile patients with gastroduodenal ulcer bleedings was made. Emergency operations were fulfilled on 47 patients, urgent operations on 56 patients and planned operations--on 4 patients. Ulcers of large size prevailed. Most of the patients had complications of ulcer disease. Palliative interventions were performed on 27 patients: suturing the vessel--in 20, ablation of the ulcer--in 7. Lethality was 33.3%. Radical operations were performed on 80 patients: resection of the stomach--in 75, vagotomy--in 5. Lethality was 16.3%.

An analysis of results of treatment of 425 patients aged from 15 to 85 years with penetrating wounds of the neck was made. In 40 (8.1%) patients there were wounds of the cervical part of the esophagus, 29 of them had associated injuries. The proposed active surgical strategy consisted in a necessary thorough revision of the penetrating wounds of the neck using general anesthesia and then directly in the operation room using subsidiary methods of examination such as urgent x-ray analysis with a water-soluble contrast, esophagoscopy, larengotracheoscopy. This approach allowed detection of injuries of the cervical part of the esophagus, even in cases of the absence of clinical symptoms of esophagus injuries. In all the patients the wounds of the esophagus were sutured and followed by active aspiration drainage and antibacterial treatment with modern antimicrobial medicines.

The authors made an analysis of results of treatment of 339 patients with wounds and closed injuries of the neck. Laryngotracheal injuries were found in 27 (7.9%) patients, in 15 patients the injuries being of combined character. Active surgical strategy including the necessary thorough revision of the penetrating wounds of the neck during operation under general narcosis anesthesia, by instrumental methods of examination. Such strategy allowed timely detection and adequate elimination of injuries of the organs and vessels of the neck and improvement of the results of treatment of such patients.

The authors present the results of surgical treatment of 106 elderly and senile patients. In 30 patients admitted in a extremely severe condition the acute intestinal obstruction was combined with peritonitis. Postoperative mortality in this group of patients was 86.7% in spite of intensive treatment. In 28 patients generalization of the process was detected and they were given palliative interventions for liquidation of acute intestinal obstruction. Postoperative mortality in this group was 39.2%. Conventional radical operations were fulfilled on 48 patients. Postoperative mortality in this group was 20.8%. Later on the intestinal patency was reestablished in 15 patients. The data obtained show the possibility to widen the indications to radical operative interventions and to improve results of treatment of such patients.

An analysis of long-term results of pylorus-preserving resections of the stomach performed on 540 patients has shown that 44 patients (8.1%) had different postgastroresectional syndromes. Operations were made on 20 patients with severe manifestations of the postgastroresectional syndromes. An analysis of the causes of complications was made as well as the substantiation of the methods of reconstructive interventions. Indications and contraindications for pylorus-preserving resections of the stomach are proposed.

The article generalizes experiences with treatment of 257 patients with postvagotomy syndromes (PVS). The patients were distributed according to the character of the syndromes. Main causes of the development of PVS are discussed. The authors describe the specific methods of diagnosis allowing individualized approach to option of the program of treatment. Criteria of decision in favor of various methods of reconstructive-restorative procedures are proposed. The individualized approach to treatment allowed to get considerably better condition in 95% of patients with PVS.

In the clinic there were 545 patients treated for postgastroresectional syndromes, 289 (53%) of them had associated postgastroresectional syndromes. A mild degree of clinical manifestations of the associated syndromes was found in 11%; medium degree in 35% and severe--in 54% of the patients. An individualized approach to the decision for methods of reconstructive operations was substantiated which allowed to get positive results in 95% of the patients. Postoperative lethality was 1.8%.

An experience with treatment of iatrogenic and criminal traumas of the esophagus included 57 patients. There were 36 patients with iatrogenic traumas (perforation of the esophagus during diagnostic and curative manipulations and operations on the lungs and esophagus). Different kinds of operations were made depending on the localization of the injury. Three patients of this group died. Criminal traumas of the esophagus (wounds with cold steel) were treated in 21 patients, sutures on the esophagus were put in 19 of them, drainage--in 2 patients. All the patients recovered. Better results of treatment of the penetrating iatrogenic and criminal injuries of the esophagus can be achieved by timely diagnosis and operation using the proper volume and method.

The authors share their experiences with treatment of wounds of the neck in 210 patients. Major vessels were injured in 85 of them (40.5%), arterial vessels being injured in 19 patients, venous vessels in 23 patients. 43 patients had wounds of the hollow, parenchymatous organs and nerves. All the patients with wounds of the hollow and parenchymatous organs recovered. Lethality among the patients with wounds of the major vessels was 11.9% and was due to a combination of injuries of the vessels and blood loss incompatible with life. Active surgical treatment of penetrating wounds of the neck with careful revision of the wound, use of emergency esophagogastroduodenoscopy, laryngotracheobronchoscopy, X-ray examination allow the amount of diagnostic errors and lethality to be reduced.

An experience with treatment of 545 patients with organic, functional and combined postgastroresectional syndromes (PGRS) is analyzed. The patients are divided into groups depending on the character of the syndromes and their combinations. The most frequent causes of the development of PGRS are formulated. Special methods of preoperative examination and preparing are described which allow individual approach to choice of the method of reconstructive-restorative operations. Some technical details of the reconstructive interventions are described. In 95% of the patients operated upon long-term results of treatment were good and satisfactory.

A working classification of gastroduodenal ulcers was developed by the authors on the basis of surgical treatment of 1838 patients with ulcer disease of the stomach and duodenum. When used in combination with the complex examination of the patients it allows to individually choose the operative method. The indications and contraindications for different kinds of surgery are given. Specific features of the postoperative management are described.

The article analyzes results of treatment of 900 thousands patients with acute surgical diseases of organs of the abdominal cavity. Factors responsible for unfavorable results are shown. The authors consider that reduced lethality depends on strict observation of the main principle of the medical doctrine in emergency surgery and on wider introduction of endovideosurgical technologies into practice.

Based on findings of general diagnosis in 62 patients the authors have determined indications for using Roux resection of the stomach which was used as primary operation in 22 patients and repeated operation--in 40 patients. Main indications for Roux resection were chronic disturbance of duodenal patency, chronic pancreatitis, afferent loop syndrome, reflux-gastritis. The work describes technical peculiarities of the Roux resection of the stomach with necessary observation of 6 pathogenetically substantiated rules. Results of Roux resection of the stomach are good, no evacuatory disorders of the gastric stump were noted.

Experience with the treatment of 224 patients with acute ileus is described. Direct correlation has been established between outcomes of the treatment and terms of staying at the hospital and surgery. Due to late consultation with a physician and diagnostic errors 29% of patients were admitted to the hospital later than in a day. The causes of errors, risk and complications are analyzed. Ways for their prevention are proposed. Lethality after the surgical treatment of acute ileus was 9.3%.

The authors describe a case of successful treatment of medicamentous agranulocytosis (induced by mercasolyl) using hemoperfusion, an extracorporeal method for the treatment of intoxications. In the severe total intoxication syndrome, application of hemoperfusion in multimodality therapy of myelotoxic agranulocytosis improves the disease prognosis.

An analysis of treatment of ulcer disease of the stomach and duodenum with the help of helium-neon lasers has been made. The pathological focus (ulcer) was influenced in two ways: through the endoscope and by means of biologically active points. Positive effects were obtained in 96.9% of the patients. Operations were performed on 3.1% of the patients where laser therapy failed to give good effects. Contraindications to laser therapy were considered to be bleeding, callous and malignant ulcers.