[The surgical treatment of a complicated low-lying duodenal ulcer].
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Biomedical subjects
Publications and source records attributed to F I Dudenko.
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Operations were carried out on 966 patients for gastric ulcer (GU) and duodenal ulcer (DU); the ages of 78% of them ranged from 31 to 50 years. 241 patients underwent operation for GU. Stenosing ulcer was found in 21.4%, penetrating ulcer in 37.3%, bleeding ulcer in 29%, perforating ulcer in 8.3%, and ulcer-tumor in 3.4% of patients. Resection of the stomach after Billroth I was conducted in 32.2%, pyloric preserving resection in 43.1%, Spasokukotskiĭ-Finsterer operation in 5.7%, and selective proximal vagotomy with excision of the ulcer in 19% of patients. DU was found in 725 patients. The ulcer was stenosing in 42.2%, penetrating in 37%, bleeding in 14.7%, and perforating in 6.1% of patients. The following operative interventions were performed: gastric resection after Spasokukotskiĭ-Finsterer, selective proximal vagotomy and pyloroplasty, selective proximal vagotomy, Billroth I operation, excision of the ulcer and selective proximal vagotomy, stitching of the vessels. The long-term results were good in 94.5% of patients.
In the experiment on 16 dogs, the morphologic structure of a colonic autotransplant utilized for restoration of a total defect of the cervical esophagus was studied. A segment of the descending colon with terminal inferior mesenteric vein and ostium of the inferior mesenteric artery with a part of the aortic wall was used. Reformation of the intestinal epithelium was noted. By day 21 after the operation, a multilayer squamous epithelium was revealed in the intestinal autotransplant, in the muscular layer--structures of the forming neuromas. No esophageal stenosis was noted.
The therapeutic possibilities of peritoneal dialysis, hemodialysis, and hemo- and lymphosorption in the treatment of the intoxication syndrome were studied in 786 patients. The causes of the intoxication syndrome were as follows: postoperative peritonitis (98), acute renal insufficiency of various etiology (493), acute hepatorenal insufficiency with exogenous poisoning (178), diffuse purulent peritonitis (11), pancreatogenic peritonitis (6). Enzymatic lavage and peritoneal dialysis were applied in 98 patients, hemodialysis methods in 493, hemosorption was conducted 360 times in 178 patients and lymphosorption in 17 patients. The efficacy of the modern methods of detoxification of the organism was demonstrated, which was evaluated from the patients' improved general condition, improvement of the values of hemodynamics, concentration of toxic metabolites and middle-mass molecules in the blood, and the results of the paramecium test.
From 1968, the authors treated under ambulatory-polyclinical conditions 10,000 patients with hemorrhoids by means of injections of novocaine++-alcoholic mixtures. In 93.3% of the patients after injections, the hemorrhage stopped, in 83.8%--hemorrhoidal nodes didn't prolapse, in 95.6%--inflammation was liquidated. At the long-term period, the positive effect was noted in 8664 (92.2%) patients.
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On 10 human cadavers, plasty of the cervical esophagus with isolated segment of the descending colon and formation of vascular anastomosis on the neck was performed. The inferior mesenteric artery was excised with the aortic wall and anastomosed end-to-side to the common carotid artery. The inferior mesenteric vein was transected in its terminal portion at the radix mesenterii, and on the neck, an anastomosis to the external or internal jugular vein, or their branches was created. Ten dogs were operated on according to the mentioned technique. No vascular thrombosis in the intestinal transplant was noted.
For chronic duodenal obstruction, duodenojejunostomy was performed in 12 patients, the Roux gastric resection--in 18, the Robinson operation--in 12. The Roux gastric resection has proved to be effective in patients with subcompensated and decompensated forms, the Robinson operations--in patients with compensated form of the disease. The different variants of duodenojejunostomy didn't contribute to recovery of the patients.
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