The aim of the research is to study the efficiency of combined treatment of patients with local recurrences of rectal cancer (LRRC).

Material and methods. The results of the surgical and combined treatment of 112 patients with LRRC in the clinic of the Oncology Institute of the Academy of Medical Science of Ukraine in 1988-2003 are stated. Group A consisted of 36 patients after the surgical treatment, group B - of 26 patients after the combined treatment with the use of adjuvant radiotherapy (RT), and group C - of 52 patients after the combined treatment with the use of neoadjuvant RT.

Results. The number of the postoperative complications after the combined treatment with the use of neoadjuvant RT in the total focal doze of 20 Gy does not increase. The repeated LRRC are registered in 46.1 % patients after removing the tumor with the consequent RT, in 27.7 % after surgical treatment, in 13.4 % after the use of neoadjuvant RT. The use of adjuvant RT with the consequent reconstructive surgical intervention by means of Keniu type operation substantially increases 3- and 5-year probability of survival by 31 and 32.5 % respectively in comparison with the surgical treatment.

Conclusions. Combined treatment with the use of neoadjuvant RT is indicated to patients with resectable LRRC. The excision of the tumor with the consequent adjuvant RT is characterized by low radicalism, which is testified by the high percentage of repeated LRRC.

Keywords: local recurrences of rectal cancer, resectability, combined treatment, radiotherapy, postoperative complications, probability of survival

The purpose of the research was developing the design of cryoapplicators, experimental study of their cryogenic parameters and animal approbation of cryoapplicators which provide real temperature of cryoinfluence on the level of minus 180 °С as well as high velocity of achieving this temperature level and effective cryoablation of superficial and deep neoplasms of different localization.

Materials and methods. We conducted experimental study of thermalphysic parameters of cryoapplicators with 30mm diameter (minimal temperature and the time of its achievement) depending on the design of the heat-exchange chamber and the thickness of the cryoapplicator working part wall. Cryoapplicators whose heat-exchange chamber was constructed as cavity, radiator and porous structure with pore size of 40, 50, 60 *10^(-6)m were studied. Thermalphysic parameters of cryoapplicators were measured in the conditions of thermal contact of the working surface with the liver of the experimental animals.

Results. The experimental study revealed that application of porous structure cryoapplicators with pore size of 50 µm in heat-exchange chambers substantially increases the heat-exchange efficiency, which provides high velocity of working surface cooling to the minimal temperature as one of the conditions of achieving high refrigeratory capacity of cryoapplicators. The minimal temperature of the cryoapplicator working surface depends on the heat current which is brought to the heat-exchange surface being the function of the cryoapplicator working surface wall thickness.

Conclusions. The results of the experimental study allowed determining optimal parameters of cryoapplicators which provide high efficiency of their practical application for cryoablation of neoplasms of different localization.

Keywords: cryoapplicator, heat-exchange chamber, porous structure

The purpose of the research was to analyze the efficiency of surgical methods of treating cosmetic defects of the head, trunk, extremities which are based on creating supporting and fixing systems as well as preventing complications.

Material and methods. We tested morphohistological tissue changes in the fixation and support region of 50 rabbits. The clinical group consisted of 518 patients with cosmetic defects of the face, ears, mammary glands, anterior abdominal wall and extremities. During 1995 — 2005 they underwent 861 operations using the method based on the principle of stimulating the formation of the connective lock for fixing the soft tissue block to the stable structure as well as creating the supporting systems and redistributing the load intensity diagram of the tissues. 133 of them made up the control group and 385 — the research group. The age of the patients ranged from 9 to 75 years. The research included several stages. The first, or experimental one, was making an experiment on animals (rabbits) with the modeling on them of both the traditional methods of operations and those invented by us. The second, or clinical, stage included analyzing the causes of unsatisfactory results of surgical correction of the head, trunk, and extremities cosmetic defects in the control group of patients; the study of the efficiency of the new methods of surgical treatment of the head, trunk, extremities cosmetic defects which were devised by us and tested in experiment during the clinical research in a group of patients.

The results of surgical correction of cosmetic defects in all the operated patients were estimated in the nearest (in 6 — 12 months) and remote (in 3 — 6 years) time after the operation according to A.A. Adamian et al. [1] classification which was modified by our clinic to meet the demands of this research in the best way and to which the degree of gravitational ptosis recurrence and tissue fixation inefficiency was added.

Results. The results of the experimental research proved 100 % inefficiency of the traditional methods of fixation in respect of holding the body of tissues in the long-term postoperative period, which leads to ptosis recurrence and defect. Modeling with the use of methods elaborated by us and employing fixing and supporting system creation proves the formation of a stronger and more lasting fixation of soft tissues than modeling with the use of traditional methods. In particular, the «good» long-term result index of face-lifting improved by 53.4 %, of otoplasty — by 30 %, of mammoplasty — by 55.5 %, of abdominoplasty — by 68.7 %, of extremity plastic surgery — by 86 %.

Conclusions. The clinical application of methods of surgical correction of the head, trunk, and extremities cosmetic defects based on employing fixing and supporting systems which were elaborated by us allows increasing the number of good long-term results.

Keywords: cosmetic defect, gravitational ptosis, face-lifting, otoplasty, mammoplasty, abdominoplasty, extremity plastic surgery

The purpose of the research is to work out a diagnostic program, optimal tactics of surgical treatment and postoperative rehabilitation of patients with atherosclerotic stenoses and pathologic sinuosity of carotid arteries.

Material and methods. 485 patients with atherosclerotic stenoses and pathologic sinuosity of carotid arteries were operated on (553 operations were performed). 346 (71.3 %) of them were men, 139 (28.7 %) — women. The patients' age ranged from 14 to 81 years (mean 55 years). Different types of atherosclerotic lesions of carotid arteries were revealed in 323 (66.5 %) patients, pathologic sinuosity — in 162 (34.5 %). All the patients underwent Dopplerographic study in triplex regime to find out the intensity of extracranial vessels lesion. Magnetic resonance tomography (MRT) or computer tomography (CT) were used to determine the condition of the arteries in the arterial circle of Willis as well as the presence of preceding cerebral infarctions zone and accompanying central nervous system pathology.

Results. Among the operative interventions the most common were the methods of carotid artery new orifice formation (22.2 %) — in case of operations on account of pathologic sinuosity and eversion technique (46.9 %) — operations on account of carotid stenoses. The number of severe postoperative complications (1.1 %) agreed with the world indices.

Conclusions.
1. The devised methods of examination, surgical procedures and rehabilitation allows achieving good short-term and long-term results of treating patients with atherosclerotic stenoses and pathologic sinuosity of carotid arteries in 64.9 % cases.
2. In case of carotid arteries pathologic sinuosity we should refuse from the resection of the internal carotid artery (ICA) and remove the configurational abnormality by means of forming the new orifice. We consider eversion carotid endarterectomy to be the operation of choice in patients with atherosclerotic stenoses of carotid arteries.
3. The patients need complex active treatment supervised by a neurologist to achieve satisfactory postoperative results. They should undergo long-term disaggregant and antisclerotic therapy.

Keywords: carotid arteries, atherosclerotic stenoses, pathologic sinuosity, surgical treatment

The purpose of the research was to investigate the microcirculation indices in the skin of patients with varicose disease (VD) of lower extremities, complicated lipodermatosclerosis in particular.

Material and methods. We analyzed the results of the examination of 34 patients (27 women and 7 men aged 27 — 64 years, mean age [45.5 ± 16.3 years]) with severe forms of chronic venous failure (CVF) of lower extremities caused by VD. Laser Doppler flowmeter (LDF) was used to investigate the microcirculation. The skin perfusion value, the vascular bed reactivity were measured by temperature trial and the classical trial of reactive hyperemia.

Results. The research of microcirculatory bed have shown that basal values of LDF in cellulitis zone are substantially (p < 0.05) higher than the norm and in patients with uncomplicated varicose veins, — (67.3 ± 16.3), (40.7 ± 8.2) and (47.7 ± 11.4) perfusion units, respectively. After heating the skin under sensor to 40oC, the elevation of microcirculation level was observed in all groups of patients, but the ratio of the peak value of the flow to the initial one in the group of patients with cellulites was considerably lower due to the substantial (p < 0.05) decrease of the maximum value of the flow. During the trial of reactive hyperemia in patients with cellulites the elevation of skin microcirculation was substantially (p < 0.05) lower (mean ratio — 1.5 ± 0.5), while during the achievement of 95 % peak postischemic LDF level it was substantially higher than the norm.

Conclusions. One of the factors of cellulites progression in case of chronic venous failure is microangiopathy. Impairment of vascular tone regulation and peak capacity of microcirculatory bed is fixed in patients with lipodermatosclerosis. Inadequate reactions of microcirculatory bed lead to the decrease of vascular response to the inflammation and progression of the process with the development of severe tissue trophism impairments.

Keywords: varicose disease, chronic venous failure, lipodermatosclerosis, microcirculation, laser Doppler flowmeter

The aim is to compare the equivaleoce of therapeutic eflectiveoess and safety of the low-molecular weight, heparin-like substance pentosan polysulphate sodium (Na-PPS) and low-molecular weight heparin (Fragmin) for prophylaxis agaiost deep leg vein thromboses.

Materials and methods. 749 patients after abdominal surgery was compared in a prospective, randomised study. Patients were allocated to three groups: groups 1 (n = 250) received Na-PPS 50 mg s. c. once daily, group 2 (n = 247) Na-PPS 50 mg s.c. twice daily and group 3 (n = 252) Fragmin in the recommended dosis of 16mg s.c. once daily. All patients wore anti-thrombosis stockings after their operations. Daily 125I-fibrinogen tests were used to assess the incidence of deep leg vein thromboses in the first 7 postoperative days.

Results. The incidence of such thromboses was 2.8 % (6 patients) in group 1, 1.2 % (3 patients) in group 2 and 1.2 % (3 patients) in group 3. No pulmonary emboli occurred. The equivalence range was defined as the standard proportion (s = 8 %). The incidence of deep leg vein thromboses in groups 1 and 2 was equivalent to that in group 3 (p < 0.0001, the one-sided 90 % confidence interval was 3.36 % for group 1 — Na-PPS once daily — and 1.84 % for group 2 — Na-PPS twice daily). There was no significant difference between the incidences in groups 1 and 2 (p = 0.2579). These results show that Na-PPS is equivalent to low-molecular weight heparin with respect to the incidence (prophylaxis) of deep leg vein thromboses. Treatment tolerance was equally good in all groups, as was the incidence of intra- and postoperative blood loss, wound haematomas and blood transfusions.

Conclusions. Na-PPS (50 mg s.c. once daily) as postoperative prophylaxis against deep leg vein thrombosis in patients wearing antithrombosis stockings after abdominal surgery is thus equally effective and safe as low-molecular weight heparin (in the recommended dosis of 16 mg s. c. once daily).

Keywords: pentosan polysulphate sodium (Na-PPS), low-molecular weight heparin, deep vein thrombosis, pulmonary embolus, 125I-fibrinogen test, abdominal surgery, thrombosis prophylaxis

The aim of the research was to estimate the efficiency of moxifloxacin administration in patients with peritonitis.

Material and methods. 49 patients with disseminated serous fibrinogenous peritonitis (reactive phase), were examined and treated at Kyiv Central City Clinical Hospital in the period from January up to September 2005. The disease had occurred before the hospitalization. The age of the patients ranged from 23 to 74 years, mean age (39 ± 11). 31 (63.3 %) of them were men and 18 (36.7 %) of them were women. Moxifloxacin was administered in the dose of 400mg once a day. The treatment lasted from 7 to 14 days, mean duration (9.7 ± 1.8) days. The medication was injected intravenously during 3 — 7 days (mean duration [4.2 ± 0.7] days) with subsequent transition (after restoring the motor and evacuator function of the stomach and the intestines) to oral administration. No other antibacterial medications were applied. The statistical processing of the research results was conducted by the program SPSS 13.0 for Windows using Mann-Whitney methods of nonparametric statistics.

Results. 97 strains of microorganisms were differentiated altogether. Gram-negative microflora was revealed in 56.7 %, gram-positive — in 33.3 % patients. Monoculture was received from 37.3 % patients, microbe associations — from 63.7 %. Among the gram-negative microflora the prevalence was as follows: E. Coli — 24.3 %, Proteus spp — 17.1 %, Enterobacter spp. — 15.2 %, among the gram-positive — Staphyilococcus aureus — 14.7 %. The sensitivity of microflora to moxifloxacin was 100.0 %, to the IIIrd generation aminoglycosides — 62 %, to the IIIrd generation cephalosporins — 18 %. On the 5th day of the drug administration there was substantial decrease of leucocytes level, leukocytic infiltration index. At the same time bacterial flora was sowed from 5 (10.2 %) patients. By the 10th day of the research all the patients who had taken moxifloxacin reached the elimination of the microflora and positive clinical effect.

Conclusions.
1. Moxifloxacin (Avelox) is the IVth generation fluoroquinolone of wide activity spectrum against gram-positive cocci, gram-negative bacteria and anaerobes.
2. Moxifloxacin is a highly efficient antibiotic which can be used by patients with intra-abdominal infection (including that which is caused by multi-resistant microorganisms) in monotherapy regime.

Keywords: moxifloxacin (Avelox), intra-abdominal infection, antibiotic therapy

The article gives examples of successful application of the recombinant activated VIIth factor of blood coagulation (rFVIIa) for treating and preventing massive hemorrhages in cardiosurgery and pediatrics. In all the cases the application of rFVIIa contributed to blood loss decrease, reduction of the volume of blood components that are transfused, correction of hematological indices. No thromboembolic complications were observed while taking the medication. The application of rFVIIa acquires particular importance for reduction of hemorrhages in patients who refused from blood component transfusions because of religious views.

Keywords: recombinant activated VIIth factor of blood coagulation, massive hemorrhages, treatment and prevention

The aim of the research was to study the long-term results of laparoscopic Nessen's fundoplication performed on account of gastroesophagal reflux disease (GERD).

Material and methods. The clinical data of 158 patients who had undergone laparoscopic Nessen's fundoplication were analyzed. The shortest-term results were studied in the period of 3, 6 and 12 months after the operation. The long-term results were studied in 89 % patients in the period from 2 to 5 years. We performed X-ray investigation of the patients' esophaguses and stomachs with barium, fibroesophagogastroduodenoscopy, intraesophagal manometry and рН-metry.

Results. No lethal cases were registered. Complications were observed in 8 (5 %) patients. The patients tolerated the laparoscopic interventions with comparative ease; the average hospitalization period was (4.8 ± 1.5) days. Dysphagy in the early postoperative period was present in 3 patients. Substantial restrictions of diet were cancelled in 84 % patients after laparoscopic fundoplication. 90 % patients were able to resume the initial position they preferred during sleep. In the long-term period after the operation 10 % patients took antacids and medications reducing acid production of the stomach. With time the symptoms of dysphagy in patients disappeared or decreased substantially; regurgitation and vomiting inability, which was present in the short-time period after the operation, disappeared as well. The number of good and excellent results did not decrease in the course of time while the number of unsatisfactory ones decreased substantially. In the long-term period after the operation 90 % patients claimed that they were satisfied with the results of their treatment.

Conclusions. The examination of patients in the shortest as well as in the long-term period after the operation testifies to the fact that laparoscopic Nessen's fundoplication is an efficient and reliable method of treating GERD. Laparoscopic methods allow cutting out pharmacotherapy and improving patients' lives substantially.

Keywords: gastroesophagal reflux disease, laparoscopic treatment, long-term results

The purpose of the research was to estimate the results of different ways of treating patients with inguinal hernias, to find out the reasons of unsatisfactory results of treating patients with this pathology, to work out a complex of practical recommendations for preventing complications and improving the results of treating patients with inguinal hernias.

Material and methods. The results of surgical procedures in patients with inguinal hernias conducted in the period from the year 2000 to 2005 were analyzed. Out of 598 patients with this pathology 546 (91.3 %) were men and 52 (8.7 %) were women. The age of the patients ranged from 16 to 92 years, mean age 48.5 years. Nyhus (1995) classification of inguinal hernias was used in the research. Primary hernias were registered in 505 (84.4 %), recurrent — in 93 (15.6 %) cases. 40 (6.7 %) patients with inguinal hernias had urgent operations on the account of strangulation. The inguinal canal plastic operations with the use of the patients' own tissues were performed in most cases using Bassini, Girard—Spasokukotskiy and Postempskiy methods, the plastic operations with the use of cellular allografts — using Lichtenstein and Stoppa methods. Polypropylene endoprostheses of firms Ethicon and Lintex were used as cellular prosthetic devices.

Results. Inguinal hernias of the Ist type according to Nyhus (1995) classification were registered in 25 (4.2 %) patients, of the IInd type — in 152 (25.4 %), of the IIIrd A type — in 218 (36.5 %), of the IIIrd B type — in 84 (14 %), of the IIIrd A, B type — in 26 (4.3 %), of the IVth type — in 93 (15.6 %) patients. Sliding hernias were registered in 84 (14 %) cases of our research. Bilateral inguinal hernias were diagnosed in 31 (5.2 %) patients. Single-stage surgical procedures were performed in 23 patients, two-stage procedures — in 8. The estimation of the results of treating patients with inguinal hernias was performed by comparing intraoperative, early and late postoperative complications.

Conclusions.
1. The results of treating patients with inguinal hernias proves the benefits of using cellular transplants while conducting hernioplasty, in particular, the number of autoplasty complications reached 27.1 % while the number of alloplasty complications was 8.1 %.
2. The causes of certain unsatisfactory results of treating patients with this pathology were the wrong choice of the ways of inguinal canal plastic operations (6 %) and technical mistakes during the operations (1.6 %).
3. The improvement of therapy results, in our opinion, is connected with the individual approach to the choice of the ways of inguinal canal plastic operations rather than with the more widely application of allograft ways of hernioplasty. Such individual approach is possible only if the surgeons master different methods of surgical procedures including those which use cellular polypropylene prosthetic devices.

Keywords: inguinal hernias, operative treatment, postoperative complications

The aim of the research was to devise efficient methods of conservative and operative treatment of patients with frostbites.

Material and methods. The treatment of 124 patients with frostbites was analyzed at the Centre of Thermal Trauma and Plastic Surgery of Kyiv City Clinical Hospital #2 during the period from 2001 to 2003. Superficial frostbites (of I—II degree) were observed in 50 patients, deep (of III—IV degree) — in 74. 81 victims were hospitalized within 24 hours after the trauma, 43 — after 24 hours. All the patients were divided into two groups: the control group (105 patients) and the main group (19 patients, who underwent hirudotherapy).

Results. The standards of therapy including the primary, regular and delayed measures were worked out. Acomplex of therapeutical measures which allows alleviating serious results of the freezing injury was developed. Early necrotomies and necrofasciofenestrotomies accompanied by obligatory conservative therapy were performed in 72 patients within the first 12—24 hours after hospitalization. Early amputations were performed in 4 patients before the formation of the demarcative swelling (before the 7th day) in case of grave infectious complications development. Late operations on the upper extremities were performed by amputating fingers on different levels in 16 patients. Lower extremity amputations and exarticulations of the foot were conducted using Garangio (22), Sharp (15), Lisfrank (8), Jober (1), Labori (1), Shopar (2) methods; in case of the whole foot lesion — the amputation on the shank level (8) was performed. Osteoplastic operation by Pirogov method was performed in 2 patients because of evident improbability of prosthesis. In the control group of 40 patients, who were admitted to hospital later than 24 hours after the trauma, surgical operations were performed: 24 amputations and 8 autoplasties. We operated on 32 out of 65 victims who were hospitalized within 24 hours after the trauma: 13 amputations and 19 autoplasties were performed. In 9 patients of the main group the injuries after the frostbite epithelized by themselves; in 7 patients the operations were limited by free autoplasties of the remaining wounds on the fingers; in 3 patients who were hospitalized after 24 hours hirudotherapy didn't prevent finger amputation.

Conclusions. We developed a program of conservative and operative treatment in case of frostbites: in pre-reactive period — application of heat-insulating bandages in complex with infusion and anticoagulative therapy; in the reactive period — fasciofenestrotomy in combination with infusion and medication prophylaxis of reperfusion complications in order to prevent compartment-syndrome. Operative treatment in case of deep frostbites is determined by the clinical course of the pathological process in the injured segments of the extremities and is of organ saving character.

Keywords: conservative and operative treatment, frostbite, frostbite injury

The aim of the research was analyzing our first-hand experience of preventing the esthetic dysfunctions of mammary glands in patients with purulent postnatal mastitis by means of conducting organ saving, low-invasive intrusions.

Material and methods. The results of the surgical treatment of 402 patients with purulent postnatal mastitis were analyzed. We operated on 350 women (the control group) using the traditional methods — incision and excision of abscesses; we applied modern technologies with the use of ultrasound investigation and low-invasive puncture drainage intrusions in 52 patients (the main group). The mean age of the first group patients was 25 years. On average, the manifestations of the postnatal mastitis appeared in them on the 40th day of the postnatal period. On average, they were admitted to clinic on the 9th day since the onset of the disease. The typical Shalita — Angerer radial access was performed in 339 (96.9 %) cases. The mean age of the main group patients was 27 years. On average, they got ill on the 37th day of the postnatal period. On average, they asked for medical help on the 9th day since the onset of the disease. The true puncture approach was accomplished in 49 cases (94.2 %); the drainage procedure was applied in 3 (5.8 %) patients.

Results. Different postoperative complications (66.7 % septic conditions, 54.8 % recurrences and 64.3 % mammary fistula) most often occurred in patients which were operated during the first week since the onset of the disease. In the control group the length of the surgical incision was equal to the size of the inflammatory infiltration only in 241 patients (68.9 %); in the rest of the patients the sizes of the infiltrations exceeded the length of the incisions. Cosmetic defects (the decrease of the mammary glands volume by more than 25 %) appeared in 82 (36.4 %) women after the traditional surgical procedures, after the low-invasive procedures — in one (1.9 %).

Conclusions. The main causes of cosmetic defects in reconvalescents after the traditional surgical procedures are inadequate surgical tactics — early interventions, when abscesses have not yet shaped, "immature"; insufficient radicalism of incision intrusions; unjustified broadening of indications to resection operations. Puncture treatment of lactational abscesses under echographic control is a low-traumatic and effective procedure which allows obtaining good and satisfactory results in 98.1 % cases. Esthetic impairments can be prevented by using new technologies — ultrasound research and low-invasive puncture drainage intrusions which are indicated in case of solitary and some multicentric abscesses when their cavities are clearly visualized.

Keywords: postnatal mastitis, cosmetic defects prevention

The aim of the research is devising and application of therapeutical and diagnostic algorithm of complex treatment for patients with diabetic foot.

Material and methods. The results of the examination and treatment of 300 patients with diabetic foot were analyzed. The patients were divided into two groups: group A (200) — patients who were treated according to the algorithm which had been devised; group B (100) — patients who were treated by conventional standard methods. Wagner classification and Fontain scale of lower extremities circulatory dysfunction degree were used to determine the degree and type of the foot lesion.

Results. In group A economical operations on the foot were performed in 176 (88 %) patients, vascular correction of lower extremities blood circulation — in 16 (8 %), amputation on the level lower than the knee — in 6 (3 %), amputation on the level of the lower third part of the thigh — in 2 (1 %). In group B amputations on the thigh level were performed in 88 (88 %) patients, on the foot level— in 12 (12 %). Lethality in group A was 0.5 %, in group B — 18 %. During 3 — 5 years the results in group A were satisfactory, no additional operative interventions were conducted. In group B during the first year after the amputation 15 (15 %) patients died. In addition, patients of this group had prosthesis problems resulting from recurrences of ulcers on the lower extremity cult.

Conclusions. The application of the devised diagnostic algorithm helps to determine the optimal approach to treatment at the early stages. The performance of small remedial surgical procedures on foot allows avoiding the development of purulent necrotic ulcerative changes in 85 % cases. Intra-arterial administration of the medication complex which was carried out allows both eliminating purulent necrotic process and avoiding high amputation in 27 % cases. The conducting of organ saving operations (atypical resections on the foot) allows preserving the lower extremity support function in 94 % patients.

Keywords: diabetes mellitus, diabetic foot, clinical features, treatment

The aim of the research was to study the application of low invasive puncture drainage methods for treating patients with purulent destructive processes in the abdominal cavity resulting from complications of acute surgical disorders or closed stomach injuries.

Material and methods. We analyzed the therapy results of 56 patients with purulent destructive processes in the abdominal cavity: caused by acute pancreatitis — 13, false pancreatic cyst — 28, subdiaphragmatic and intrahepatic abscesses of traumatic etiology — 8, abscess of чепцева bursa — 6, subdiaphragmatic abscess after liver metastasis resection — 1.The low invasive interventions were conducted together with the complex etiopathogenetic treatment of this pathological condition.

Results. The research revealed the high efficiency of puncture drainage methods under ultrasound control in treatment of patients with purulent destructive processes in the abdominal cavity. In 13 patients with acute pancreatitis the puncture methods were applied both at the stage of toxemia and the stage of purulent necrotic complications. This manipulation allowed decreasing intoxication, which was proved by the fact that the patients felt better and their clinical and laboratory indices improved. Puncture aspiration turned out to be the final method of false cyst treatment in 8 (28.6 %) out of 28 patients with false pancreatic cyst; in 20 (71.4 %) patients the puncture method as part of complex treatment turned out to be ineffective: in 6 (21.4 %) patients because of pancreatonecrosis, in 14 (50 %) — because of the link with the duct, which required surgical operation. The abscess of чепцева bursa as complication of acute destructive pancreatitis was diagnosed in 6 patients. Two patients recovered after the drainage of чепцева bursa under the control of ultrasound investigation. We managed to stabilize the state and perform the surgical operation with less operative risk in 4 patients. 8 patients with subdiaphragmatic abscesses resulting from wound dystrophy complications recovered after the puncture method application.

Conclusions. Low invasive interventions under the ultrasound control are efficient methods of treating abdominal cavity abscesses of subdiaphragmatic, subhepatic and intrahepatic localization. Their wide application will allow decreasing the number of postoperative complications and lethality in this category of patients.

Keywords: pancreatitis, polytrauma, complications, false cyst, abscess, puncture methods, ultrasound

The aim of the research was to study the prevalence and structure of the disease as well as the changes in erysipelas clinical picture during the last 20 years.

Material and methods. We examined 580 erysipelas patients hospitalized in the period of 1981—1983, 1991—1993, 2001—2003. The diagnosis of erysipelas was based on the typical clinical picture.

Results. The sickness ratio to the total number of patients with this pathology who had undergone treatment in 2001—2003 was 37.91 %, in 1991—1993 — 64.11 % and in 1981—1983 — 14.91 %. 45.2 % of hemorrhagic forms of erysipelas (erythematic-bullous and bullousnecrotic) were registered in 2001—2003, 35.0 % — in 1991—1993, 26.4 % — in 1981—1983. In 1981—1983 the ratio of the initial forms was less than that of the recurrent ones and constituted 28.7 and 65.2 % respectively, in 1991—1993 — 40.4 and 49.7 %, in 2001—2003 — 68.8 and 27.6 %.

Conclusion. We fixed the increase of erysipelas incidence by 23.6 %, the increase of hemorrhagic forms incidence by 51.8 %, the increase of initial forms — by 68.8 %; the increase of erysipelas incidence at able-bodied age (20—60 years); the prevailing (71.3 %) localization of the process in the lower extremities region. We also marked the fact that women suffer from the disease 1.6 times more often than men.

Keywords: erysipelas, B-hemolytic streptococcus of A-group

The aim of the study was to analyze the tactics of treatment in case of gastrointestinal hemorrhages in gastroduodenal zone.

Material and methods. The results of the treatment of 115 patients hospitalized on account of gastroduodenal hemorrhages of ulcer etiology were analyzed. The age of the patients ranged from 21 to 88 years. 98 (85.2 %) of them were men and 17 (14.8 %) — women. The ulcer of the stomach was revealed in 32 (27.8 %) patients, the ulcer of the duodenum — in75 (65.2 %). The combination of the ulcer of the stomach and the ulcer of the duodenum was fixed in 8 (6.9 %) cases. All the patients underwent complex examination, whose results were the criterion for choosing the tactics of treatment. Esophagogastroduodenoscopy was also performed to them.

Results. 12 (10.4 %) patients underwent emergency operations, 4 (3.5 %) — deferred ones. Postoperative lethality among the patients operated on in emergency was 12.6 % (2 cases). 97 (84.3 %) patients were not operated on; they underwent conservative treatment. The complex antiulcerative therapy included the use of quamatel (Famotidine) which was administered in the daily doze of 40 — 80 mg, clarithromycin in the doze of 500mg twice a day and metronidazole in the doze of 500mg twice a day. This therapy allowed achieving stable hemostasis.

Conclusions. The tactics of treatment with the use of endoscopic diagnosing, hemostatic and antiulcerative therapeutical remedies allows correcting the surgical tactics in time, decreasing the number of emergency operations. Active-waiting and individualized tactics of treatment must be applied to prevent the recurrence of ulcer gastroduodenal hemorrhages.

Keywords: gastrointestinal hemorrhages, tactics of treatment, complex therapy

The basic clinical and pathogenetic features of Н. рylori-positive and Н. рylori-negative ulcerative pyloroduodenal stenoses are stated. Principles of surgical treatment of such patients and ways of improving its results are considered.

Keywords: helicobacter infection, pyloroduodenal stenosis

The article contains analytical survey of the evolution of views on problems of surgical intervention classification in patients with acute cholecystitis. The reasons of terminological disagreements as well as disagreements connected with them as for the choice of operative intervention time constraints are shown. The problem of therapeutic management choice, especially for patients with serious accompanying diseases is discussed.

Keywords: acute cholecystitis, classification, terminology, therapeutic management

The aim of the research is to study the efficiency of combined treatment of patients with local recurrences of rectal cancer (LRRC).

Material and methods. The results of the surgical and combined treatment of 112 patients with LRRC in the clinic of the Oncology Institute of the Academy of Medical Science of Ukraine in 1988-2003 are stated. Group A consisted of 36 patients after the surgical treatment, group B - of 26 patients after the combined treatment with the use of adjuvant radiotherapy (RT), and group C - of 52 patients after the combined treatment with the use of neoadjuvant RT.

Results. The number of the postoperative complications after the combined treatment with the use of neoadjuvant RT in the total focal doze of 20 Gy does not increase. The repeated LRRC are registered in 46.1 % patients after removing the tumor with the consequent RT, in 27.7 % after surgical treatment, in 13.4 % after the use of neoadjuvant RT. The use of adjuvant RT with the consequent reconstructive surgical intervention by means of Keniu type operation substantially increases 3- and 5-year probability of survival by 31 and 32.5 % respectively in comparison with the surgical treatment.

Conclusions. Combined treatment with the use of neoadjuvant RT is indicated to patients with resectable LRRC. The excision of the tumor with the consequent adjuvant RT is characterized by low radicalism, which is testified by the high percentage of repeated LRRC.

Keywords: local recurrences of rectal cancer, resectability, combined treatment, radiotherapy, postoperative complications, probability of survival

The aim of the research is to study the efficiency of combined treatment of patients with local recurrences of rectal cancer (LRRC).

Material and methods. The results of the surgical and combined treatment of 112 patients with LRRC in the clinic of the Oncology Institute of the Academy of Medical Science of Ukraine in 1988-2003 are stated. Group A consisted of 36 patients after the surgical treatment, group B - of 26 patients after the combined treatment with the use of adjuvant radiotherapy (RT), and group C - of 52 patients after the combined treatment with the use of neoadjuvant RT.

Results. The number of the postoperative complications after the combined treatment with the use of neoadjuvant RT in the total focal doze of 20 Gy does not increase. The repeated LRRC are registered in 46.1 % patients after removing the tumor with the consequent RT, in 27.7 % after surgical treatment, in 13.4 % after the use of neoadjuvant RT. The use of adjuvant RT with the consequent reconstructive surgical intervention by means of Keniu type operation substantially increases 3- and 5-year probability of survival by 31 and 32.5 % respectively in comparison with the surgical treatment.

Conclusions. Combined treatment with the use of neoadjuvant RT is indicated to patients with resectable LRRC. The excision of the tumor with the consequent adjuvant RT is characterized by low radicalism, which is testified by the high percentage of repeated LRRC.

Keywords: local recurrences of rectal cancer, resectability, combined treatment, radiotherapy, postoperative complications, probability of survival

The aim of the research is to study the efficiency of combined treatment of patients with local recurrences of rectal cancer (LRRC).

Material and methods. The results of the surgical and combined treatment of 112 patients with LRRC in the clinic of the Oncology Institute of the Academy of Medical Science of Ukraine in 1988-2003 are stated. Group A consisted of 36 patients after the surgical treatment, group B - of 26 patients after the combined treatment with the use of adjuvant radiotherapy (RT), and group C - of 52 patients after the combined treatment with the use of neoadjuvant RT.

Results. The number of the postoperative complications after the combined treatment with the use of neoadjuvant RT in the total focal doze of 20 Gy does not increase. The repeated LRRC are registered in 46.1 % patients after removing the tumor with the consequent RT, in 27.7 % after surgical treatment, in 13.4 % after the use of neoadjuvant RT. The use of adjuvant RT with the consequent reconstructive surgical intervention by means of Keniu type operation substantially increases 3- and 5-year probability of survival by 31 and 32.5 % respectively in comparison with the surgical treatment.

Conclusions. Combined treatment with the use of neoadjuvant RT is indicated to patients with resectable LRRC. The excision of the tumor with the consequent adjuvant RT is characterized by low radicalism, which is testified by the high percentage of repeated LRRC.

Keywords: local recurrences of rectal cancer, resectability, combined treatment, radiotherapy, postoperative complications, probability of survival

The aim of the research is to study the efficiency of combined treatment of patients with local recurrences of rectal cancer (LRRC).

Material and methods. The results of the surgical and combined treatment of 112 patients with LRRC in the clinic of the Oncology Institute of the Academy of Medical Science of Ukraine in 1988-2003 are stated. Group A consisted of 36 patients after the surgical treatment, group B - of 26 patients after the combined treatment with the use of adjuvant radiotherapy (RT), and group C - of 52 patients after the combined treatment with the use of neoadjuvant RT.

Results. The number of the postoperative complications after the combined treatment with the use of neoadjuvant RT in the total focal doze of 20 Gy does not increase. The repeated LRRC are registered in 46.1 % patients after removing the tumor with the consequent RT, in 27.7 % after surgical treatment, in 13.4 % after the use of neoadjuvant RT. The use of adjuvant RT with the consequent reconstructive surgical intervention by means of Keniu type operation substantially increases 3- and 5-year probability of survival by 31 and 32.5 % respectively in comparison with the surgical treatment.

Conclusions. Combined treatment with the use of neoadjuvant RT is indicated to patients with resectable LRRC. The excision of the tumor with the consequent adjuvant RT is characterized by low radicalism, which is testified by the high percentage of repeated LRRC.

Keywords: local recurrences of rectal cancer, resectability, combined treatment, radiotherapy, postoperative complications, probability of survival

The aim of the research is to study the efficiency of combined treatment of patients with local recurrences of rectal cancer (LRRC).

Material and methods. The results of the surgical and combined treatment of 112 patients with LRRC in the clinic of the Oncology Institute of the Academy of Medical Science of Ukraine in 1988-2003 are stated. Group A consisted of 36 patients after the surgical treatment, group B - of 26 patients after the combined treatment with the use of adjuvant radiotherapy (RT), and group C - of 52 patients after the combined treatment with the use of neoadjuvant RT.

Results. The number of the postoperative complications after the combined treatment with the use of neoadjuvant RT in the total focal doze of 20 Gy does not increase. The repeated LRRC are registered in 46.1 % patients after removing the tumor with the consequent RT, in 27.7 % after surgical treatment, in 13.4 % after the use of neoadjuvant RT. The use of adjuvant RT with the consequent reconstructive surgical intervention by means of Keniu type operation substantially increases 3- and 5-year probability of survival by 31 and 32.5 % respectively in comparison with the surgical treatment.

Conclusions. Combined treatment with the use of neoadjuvant RT is indicated to patients with resectable LRRC. The excision of the tumor with the consequent adjuvant RT is characterized by low radicalism, which is testified by the high percentage of repeated LRRC.

Keywords: local recurrences of rectal cancer, resectability, combined treatment, radiotherapy, postoperative complications, probability of survival

The aim of the research is to study the efficiency of combined treatment of patients with local recurrences of rectal cancer (LRRC).

Material and methods. The results of the surgical and combined treatment of 112 patients with LRRC in the clinic of the Oncology Institute of the Academy of Medical Science of Ukraine in 1988-2003 are stated. Group A consisted of 36 patients after the surgical treatment, group B - of 26 patients after the combined treatment with the use of adjuvant radiotherapy (RT), and group C - of 52 patients after the combined treatment with the use of neoadjuvant RT.

Results. The number of the postoperative complications after the combined treatment with the use of neoadjuvant RT in the total focal doze of 20 Gy does not increase. The repeated LRRC are registered in 46.1 % patients after removing the tumor with the consequent RT, in 27.7 % after surgical treatment, in 13.4 % after the use of neoadjuvant RT. The use of adjuvant RT with the consequent reconstructive surgical intervention by means of Keniu type operation substantially increases 3- and 5-year probability of survival by 31 and 32.5 % respectively in comparison with the surgical treatment.

Conclusions. Combined treatment with the use of neoadjuvant RT is indicated to patients with resectable LRRC. The excision of the tumor with the consequent adjuvant RT is characterized by low radicalism, which is testified by the high percentage of repeated LRRC.

Keywords: local recurrences of rectal cancer, resectability, combined treatment, radiotherapy, postoperative complications, probability of survival

The aim of the research is to study the efficiency of combined treatment of patients with local recurrences of rectal cancer (LRRC).

Material and methods. The results of the surgical and combined treatment of 112 patients with LRRC in the clinic of the Oncology Institute of the Academy of Medical Science of Ukraine in 1988-2003 are stated. Group A consisted of 36 patients after the surgical treatment, group B - of 26 patients after the combined treatment with the use of adjuvant radiotherapy (RT), and group C - of 52 patients after the combined treatment with the use of neoadjuvant RT.

Results. The number of the postoperative complications after the combined treatment with the use of neoadjuvant RT in the total focal doze of 20 Gy does not increase. The repeated LRRC are registered in 46.1 % patients after removing the tumor with the consequent RT, in 27.7 % after surgical treatment, in 13.4 % after the use of neoadjuvant RT. The use of adjuvant RT with the consequent reconstructive surgical intervention by means of Keniu type operation substantially increases 3- and 5-year probability of survival by 31 and 32.5 % respectively in comparison with the surgical treatment.

Conclusions. Combined treatment with the use of neoadjuvant RT is indicated to patients with resectable LRRC. The excision of the tumor with the consequent adjuvant RT is characterized by low radicalism, which is testified by the high percentage of repeated LRRC.

Keywords: local recurrences of rectal cancer, resectability, combined treatment, radiotherapy, postoperative complications, probability of survival

The aim of the research is to study the efficiency of combined treatment of patients with local recurrences of rectal cancer (LRRC).

Material and methods. The results of the surgical and combined treatment of 112 patients with LRRC in the clinic of the Oncology Institute of the Academy of Medical Science of Ukraine in 1988-2003 are stated. Group A consisted of 36 patients after the surgical treatment, group B - of 26 patients after the combined treatment with the use of adjuvant radiotherapy (RT), and group C - of 52 patients after the combined treatment with the use of neoadjuvant RT.

Results. The number of the postoperative complications after the combined treatment with the use of neoadjuvant RT in the total focal doze of 20 Gy does not increase. The repeated LRRC are registered in 46.1 % patients after removing the tumor with the consequent RT, in 27.7 % after surgical treatment, in 13.4 % after the use of neoadjuvant RT. The use of adjuvant RT with the consequent reconstructive surgical intervention by means of Keniu type operation substantially increases 3- and 5-year probability of survival by 31 and 32.5 % respectively in comparison with the surgical treatment.

Conclusions. Combined treatment with the use of neoadjuvant RT is indicated to patients with resectable LRRC. The excision of the tumor with the consequent adjuvant RT is characterized by low radicalism, which is testified by the high percentage of repeated LRRC.

Keywords: local recurrences of rectal cancer, resectability, combined treatment, radiotherapy, postoperative complications, probability of survival

The aim of the research is to study the efficiency of combined treatment of patients with local recurrences of rectal cancer (LRRC).

Material and methods. The results of the surgical and combined treatment of 112 patients with LRRC in the clinic of the Oncology Institute of the Academy of Medical Science of Ukraine in 1988-2003 are stated. Group A consisted of 36 patients after the surgical treatment, group B - of 26 patients after the combined treatment with the use of adjuvant radiotherapy (RT), and group C - of 52 patients after the combined treatment with the use of neoadjuvant RT.

Results. The number of the postoperative complications after the combined treatment with the use of neoadjuvant RT in the total focal doze of 20 Gy does not increase. The repeated LRRC are registered in 46.1 % patients after removing the tumor with the consequent RT, in 27.7 % after surgical treatment, in 13.4 % after the use of neoadjuvant RT. The use of adjuvant RT with the consequent reconstructive surgical intervention by means of Keniu type operation substantially increases 3- and 5-year probability of survival by 31 and 32.5 % respectively in comparison with the surgical treatment.

Conclusions. Combined treatment with the use of neoadjuvant RT is indicated to patients with resectable LRRC. The excision of the tumor with the consequent adjuvant RT is characterized by low radicalism, which is testified by the high percentage of repeated LRRC.

Keywords: local recurrences of rectal cancer, resectability, combined treatment, radiotherapy, postoperative complications, probability of survival

Цель работы — оценить эффективность комбинированных методов лечения больных с местными рецидивами рака прямой кишки (МР РПК).

Материалы и методы. Приведены результаты хирургического и комбинированного лечения 112 больных с МР РПК в клинике Института онкологии АМН Украины в 1988—2003 гг. Группа А состояла из 36 больных после хирургического лечения, группа В — из 26 пациентов после комбинированного лечения с использованием адъювантной лучевой терапии (ЛТ), группа С — из 52 больных после комбинированного лечения с использованием неоадъювантной ЛТ.

Результаты. Количество послеоперационных осложнений после комбинированного лечения с использованием неоадъювантной ЛТ суммарной очаговой дозой 20 Гр не увеличивается. Повторное возникновение МР РПК регистрируется у 46,1 % больных после удаления опухоли с последующей ЛТ, у 27,7 % после хирургического лечения, после применения неоадъювантной ЛТ — у 13,4 %. Использование адъювантной ЛТ с последующим реконструктивным хирургическим вмешательством по типу операции Кеню достоверно увеличивает 3- и 5-летнюю выживаемость соответственно на 31 и 32,5 % по сравнению с хирургическим лечением.

Выводы. Больным с резектабельными МР РПК показано комбинированное лечение с использованием неоадъювантной ЛТ. Иссечение опухоли с последующей адъювантной ЛТ имеет низкий радикализм, о чем свидетельствует высокий процент повторных МР РПК.

Keywords: местные рецидивы рака прямой кишки, резектабельность, комбинированное лечение, лучевая терапия, послеоперационные осложнения, выживаемость