Methods Of Preoperative Preparation Research Articles

Nephrotransplantectomy Using Radiosurgical Techniques

Introduction. Aſter the loss of kidney transplant function, patient curation can be a difficult task. Nephrotransplantectomy (NTE) is the method of choice between reduction of immunosuppression with the abandonment of a non-functioning kidney transplant and embolization. This is an operation with potentially significant indicators of blood loss, complications and mortality. Along with traditional NTE, we began to use endovascular isolation of the allograſt as a method of preoperative preparation before its removal.The aim of the work is to investigate the effect of the use of radiosurgical minimally invasive techniques on the surgical tactics of nephrotransplantectomy, the degree of blood loss, the frequency of complications and blood transfusion.Materials and methods. A retrospective analysis of the data of 52 patients aſter NTE was performed. Depending on the method, patients are divided into two groups. In group 1 (main, n = 22), the operation was performed with pre-performed endovascular embolization of the graſt arteries (EEAT), in group 2 (control, n = 30) — without EEAT. The analysis of the results of the examination, intra- and postoperative indicators in patients by groups was carried out.Results. In group 1, intraoperative blood loss was 10–80 ml, on average (35.4±19.9) ml; in group 2 — from 100 to 600 ml, on average (289.7±138.4) ml (p < 0.001). In group 2, damage to the main vessels occurred more oſten (n = 4) (13.3 % vs. 0 %), hemotransfusion was performed in 53.3 % of cases (n = 16) to correct posthemorrhagic anemia. Postoperative complications in the control group were recorded in 8 patients (26.7 %).Discussion. Preventive endovascular embolization of the arteries of a kidney transplant significantly reduces the frequency ofintra- and postoperative complications, allows nephrectomy to be performed on a planned basis andin a delayed manner.

КЛИНИКО-МОРФОЛОГИЧЕСКИЕ ОСОБЕННОСТИ ОСТРЫХ И ХРОНИЧЕСКИХ РАН

Background. The chronicity of the wound is a factor leading to a greater number of postoperative complications when performing plastic closure of wound defects and requires the use of special methods of preoperative preparation. In clinical practice, it is important to use precise clinical and morphological criteria to assess the activity of the inflammatory response and the degree of impairment of the proliferative phase of the reparative process. Aim. To determine the features of clinical parameters of the local status of wound defects and their correspondence to morphological criteria in patients with acute and chronic wounds of various genesis. Material and Methods. Clinical signs of acute and chronic wounds in 26 patients with different types and duration of integumentary tissue defects were described. In a hospital setting, a morphological study of the biopsy specimens from wounds and surrounding tissues was performed to identify histological signs of chronic wound healing. The correspondence between clinical and morphological signs of acute and chronic wounds was analyzed. Results. The initial study of the local status of wound defects did not reveal significant differences in the clinical signs of acute and chronic wounds. Histological examination of the wound biopsy specimens revealed morphological signs of chronic wound healing. Conclusion. Evaluation of clinical signs of the local wound status is necessary to identify the dynamics of wound parameters during treatment. Histological examination of wound biopsy specimens makes it possible to more reliably identify signs of chronicity of the wound.

Surgical treatment of hepatic alveococcosis in highly specialized centre of non-endemic region

Objective. To estimate the results of operative treatment of hepatic alveococcosis in conditions of surgical centre of non-endemic region.
 Materials and methods. From 2004 to 2020 yr in Department of Transplantation and Hepatic Surgery of Shalimov National Institute of Surgery and Transplantation NAMS of Ukraine 13 patients, suffering hepatic alveococcosis, were radically operated. General characteristic of patients, methods of preoperative preparation, іntraoperative data, the indices of morbidity and lethality were investigated.
 Results. In 11 (84.6%) patients the disease was diagnosed on late stages: IIIa-IV in accordance to pTNM by WHO classification. Preoperatively in 5 (38.5%) patients transcutaneous transhepatic cholangiostomy and in 8 (615%) patients - roentgenendovascular occlusion of the portal hepatic vein branches - were performed. In 12 (92.3%) patients extended hepatic resections were done, including in 2 (15.3%) - complete vascular hepatic exclusion with hyperthermic perfusion in situ. Postoperative complications rate of IIIa-IV degrees in accordance to Clavien-Dindo classification have constituted 30.7%, while postoperative mortality - 7.7%. Up to the end of follow-up the disease-free period have persisted in all the patients.
 Conclusion. Aggressive surgical tactics in patients, suffering hepatic alveococcosis, permits to obtain good immediate results in highly specialized centres. Today radical operative intervention continues to be the only one method of treatment in the patients, which may guarantee satisfactory late follow-up results.

Monitoring And Evaluation Of Hemodynamic Parameters During Anesthesia In Endocrine Surgery

The article presents the results of preoperative preparation, anesthesia and surgical treatment of patients operated on for non-toxic nodular goiter. A new approach to preoperative preparation for thyroid surgery is described. The effectiveness in the preoperative period of using the modified method of preoperative preparation using sibazon and droperidol and anesthesia with the use of ketamine and the advantages of this method compared with other methods of general anesthesia are shown.

Can 3D-printing avoid discomfort-related implant removal in midshaft clavicle fractures? A four-year follow-up

IntroductionDue to the variation in shape and curvature of the clavicle, plates often have to be adjusted during surgery to acquire a good fit. Poorly fitted plates can cause discomfort, eventually requiring implant removal. 3D-printed replicas of the fractured clavicle can assist in planning of the surgical approach, plate selection and, if necessary, adjustment of the plate prior to surgery. We hypothesized this method of preoperative preparation would reduce implant-related discomfort resulting in a reduced reoperation rateMaterials and methodsIn a prospective cohort study, perioperative plate handling and clavicle fixation were timed and follow-up data were collected from participants undergoing operative treatment for a midshaft clavicle fracture. The control group (n = 7) received conventional surgery with standard precontoured plates. For the intervention group (n = 7), 3D-printed replicas of the fractured clavicle and a mirrored version of the healthy contralateral clavicle were available prior to surgery for planning of the surgical approach, and for plate selection and contouring. Primary outcome was reoperation rate due to implant-related discomfort. Secondary outcomes were complications and time differences in the different surgical phases (reduction, fixation and overall operation time)ResultsMore participants in the control group had the plate removed due to discomfort compared to the intervention group (5/7 vs. 0/6; P = 0.012). One participant was excluded from the intervention group due to a postoperative complication; an infection occurred at the implant site. No relevant time difference in surgical plate handling was found between both groups.ConclusionsPreoperative preparation using 3D-printed replicas of the clavicle fracture may reduce implant removal caused by plated-related discomfort. No relevant effect on surgery time was found.Trial registrationRegistered with ‘toetsingonline.nl’, trial number NL51269.075/14, 17-02-2015

117 Poster - Angiosome theory findings using new protocol of CT-angiography improves outcomes in DIEP-flap reconstruction surgery in breast cancer patients

Introduction: Autologous breast reconstruction with deep inferior epigastric artery perforator flap considered as a gold standard of final esthetic result. More and more centers are trying to perform DIEP flap reconstruction, but still there are some problems appears. What method to use? What perforants to choose? Is there a «Plan B»?. Nowadays, the best method of preoperative preparation is CT-angiography. Only this method, among others, improves of outcomes of DIEP-flap surgery: lower complication rate, lower donor side morbidity, reduce operation time, improves overall results.

EARLY HIP REPLACEMENT IN PATIENTS WITH FEMORAL NECK FRACTURES

The aim of the study was to improve the surgical treatment outcomes for hip fracture by optimizing the methods of preoperative preparation for endoprosthesis, choosing the method of endoprosthesis and postoperative management of elderly and senile patients.
 The study was based on the analysis of the treatment outcomes of 339 patients with femoral neck fractures, aged 50-85 years for 2000-2019. 206 patients underwent endoprosthetic surgery without cement fixation; in 133 cases bone cement was used. 151 (44.8%) patients had total hip replacement with Deriuh and Zimmer implants performed within 1 to 2 days. 66 (19.5%) patients underwent surgery within 5 days, and the remaining 120 (35.5%) patients underwent endoprosthetic surgery within 8-10 days. When diagnosis has been made, the patient should undergo endoprosthetic surgery as early as possible. Preoperative preparation of this group of patients, in addition to standard procedure, also included the dopplerography, densitometry, and biochemical blood tests to determine the level of calcium. Summing up these diagnostic parameters, the severity of osteoporosis was determined that in turn allowed clinicians to choose the optimal tactics for hip replacement. The average duration of the operation was about 1 hour. In the postoperative period, patients were monitored in the intensive care unit for a day. A day after the operation, the patient can move relatively freely in bed. He can be allowed to sit down if he can. It is necessary to perform deep breathing exercises. Movements in the knee joint can be started from the first day. Next day, depending on the general condition, the patient can be allowed to sit on a chair near the bed or even walk with crutches. Before getting patients on their feet on the 2-3 day after the operation, dopplerography is performed. Walking with crutches lasts 2-3 days, but patients should not avoid the load on the operated limb; after this period the patient should walk with a stick, and in a few days without a stick. Walking with additional support is recommended for up to 10 days. The average period of inpatient treatment of this group of patients was up to 12 days. 151 patients, who had endoprosthetic surgery performed on within 5 days, had no hypostatic complications, thrombosis and thromboembolism; 3 patients were found to have cardiovascular insufficiency and one patient had bedsores. In 188 patients who had hip replacement performed on in 5 days and over since the fracture, the percentage of complications was as follows: hypostatic complications thrombosis and thromboembolism was found in 3 cases, heart failure – in 4 cases, bedsores – in 7 cases. Hip replacement in femoral neck fractures in the elderly and senile age should requires as early intervention as it possible thus, providing the main prevention of hypostatic complications and early rehabilitation of patients.

Does the use of chlorhexidine gel reduce the frequency of surgical site infections?

<b>Introduction:</b> Surgical site infections (SSI) involve 2-11% of all surgical procedures. <br><b>Paper assumption:</b> The use of 6% gel with chlorhexidine as an element of preoperative skin preparation of the operated area reduces the number of surgical site infections. <br><b>Aim:</b> The aim of the study was to assess the impact of body mass index (BMI), neutrophil to lymphocyte ratio (NLR), total protein, glucose, length of hospitalization before surgery, duration of surgery, length of drainage maintenance, transfusion of red blood concentrate on the number of SSI. <br><b>Materials and methods:</b> 248 patients were subjected to prospective analysis. Patients were operated at the Department of General and Oncological Surgery of the Provincial Specialist Hospital in Zgierz. Patients were divided into three groups depending on the microbiological degree of cleanliness of the postoperative wound: Group I - clean wounds, Group II - cleancontaminated wounds, Group III - contaminated wounds, which also included emergency surgerical procedures. In each group two subgroups were distinguished depending on the method of preoperative preparation of the surgical field: A - gel without CHG, B - 6% gel with CHG. <br><b>Results:</b> Surgical site infections were found in 22 patients (8.9%). The respective frequencies for groups I, II, III are: 3.0% vs 12.9% vs 12.7%. An increase in NLR by one unit resulted in a higher incidence of surgical site infections by 11%. A transfusion of RBC to the patient resulted in a 3.5-fold increase in the frequency of surgical site infections. Extending the drain maintenance time by one day increases the SSI frequency by 41%. Lowering the total protein concentration by at least 1 g/dl below normal increases the risk of surgical site infections almost three times. <br><b>Conclusions:</b> The use of a 6% gel preparation with chlorhexidine as an element of preoperative preparation of the surgical field reduces the risk of surgical site infections, especially in clean-contaminated and contaminated wounds.

Миомэктомия с позиций имунногистохимической характеристики опухоли матки и выбора метода предоперационной подготовки

Миомэктомия с позиций имунногистохимической характеристики опухоли матки и выбора метода предоперационной подготовки

Results evaluation of the modern surgical treatment methods for pressure ulsers in patients with the spinal cord injuries consequences

The aim — to evaluate the effectiveness of modern preoperative methods for pressure ulcers in patients with the spinal cord injuries consequences.Materials and methods. A comparative analysis of 178 patients’ records with the spinal cord injuries consequences, which were complicated by bedsores in the rehabilitation period of the traumatic disease was carried out. The patients were divided into three groups, depending on the method of preoperative preparation. Mud therapy and ozonotherapy were used in the first group (n = 76), ultrasonic­assisted wound debridement and VAC­therapy were applied in the second group (n = 44). Preoperative preparation was performed with ointment dressings, wound dressings and antiseptic solutions in the comparison group (n = 58). Closure of soft tissue defects was performed by the method of autodermoplasty, local plastics or displaced grafts.Results and discussion. The regularity of the pressure ulcers appearance was determined according to the level of damage. In patients with cervical injuries, pressure ulcers were localized in the sacral region at 48.9 %, in cases of thoracic and lumbar levels of injuries, localization in the ischial area (32.1 %) prevailed. The use of ozonotherapy and peloidotherapy in the first group, ultrasonic­assisted wound debridement and VAC­therapy in the second group reduced the preoperative period to 12.1 ± 1.1 and 10.4 ± 0.9 days, respectively. Them the routine methods were applied, the pressure ulcers were ready for plasty by 15.9 ± 1.4 day. Auto­skin­grafting was used in 11 (6.2 %) patients, local flaps in 46 (25.9 %), regional flaps in 121 (67.9 %) cases. The early postoperative period was complicated by suppuration in 19.1 %, wound breakdowns in 10.7 %, and the marginal necrosis of the flap in 10.1 %. In the second group, the smallest proportion of early complications was observed due to a decrease in the number of wound breakdowns to 4.5 % and suppurations to 11.4 %.Conclusions. VAC­therapy and ultrasonic­assisted wound debridement allows for a short period of time to achieve the readiness of tissues among pressure ulcers for the plastic surgery. The optimal method for closing pressure ulcers is the plastic with distant axial muscle flaps, combined with anatomically­functional resection of the subordinate bones.

Effects of nasal spray inhalation in preoperative preparation for patients with chronic sinusitis and nasal polyps

Objective To evaluate the method, efficacy and safety of nasal spray inhalation by applying nasal inhalation of budesonide suspension in preoperative preparation for patients with chronic sinusitis and nasal polyps. Methods Totally 25 hospitalized patients with chronic rhinosinusitis and nasal polyps were enrolled, who were given a dose of 1 mg/2 ml budesonide suspension by nasal spray inhalation twice a day for one week before surgery. Their symptoms were evaluated before and after treatment, with their Kennedy endoscopic score, morning serum glucocorticoid, surgical time and surgical bleeding measured. Results The patients showed lower scores in nasal symptoms and endoscopic polyps than they were at admission (P 0.05) ; the surgical time was (93.36 ± 14.43) min and the surgical bleeding score was level-5. Conclusions The application of budesonide suspension by nasal spray inhalation one week before surgery can improve nasal symptoms, reduce the volume of nasal polyps as well as surgical bleeding, thus it is a safe and effective method for preoperative preparation. Key words: Sinusitis; Nasal polyps; Budesonide; Endoscopic sinus surgery; Nasal spray inhalation

Assessment Of Sinoatrial Node Function In Patients With Persistent And Long-Standing Persistent Forms Of Atrial Fibrillation After Maze III Procedure Combined With Mitral Valve operation.

Assessment of sinoatrial node function after Maze III procedure combined with a mitral valve operation. 100 patients were included in the research with persistent and long-standing persistent forms of atrial fibrillation (AF) and need of operative treatment concerning valve disease. The following preoperative preparation methods were executed to all patients: Electrocardiogram in 12 standard assignments;Two-dimensional echocardiographic with assessment of systolic and diastolic functions of the left ventricle, size of the left atrium and grade of valve disease;Transesophageal echocardiography for exclusion of blood clots in the left atrium and left atrial appendage;Coronary angiography for exclusion of coronary heart disease;Computer tomography for examination of cardiac chambers and anatomic characteristics of pulmonary veins. Electric cardioversion in X-ray operating room conditions was performed on all patients. After successful restoration of sinus rhythm, electrophysiological examination (EP) of heart was carried out. Then, on the first or second day after EP study, Maze III procedure combined with a mitral valve operation was performed. Following the results of Maze III procedure combined with correction of valve disease, disposal of AF was observed in 95% of patients. 46% of patients had stable sinus rhythm to the moment of discharge from the hospital. 24% of patients had atrial rhythm with the maximum heart rate of 80-110 bpm (according to results of 24-hour Holter monitoring). For 25% of patients, it was necessary to implant a pacemaker. According to results of EP study, 13% of these patients suffered from sick sinus syndrome before operation. For 9% of the remaining 12% of patients, the indications for pacemaker implantation were atrioventricular nodal rhythm with low heart rate and pauses more than 3 sec long. For 1% of patients the indication was second degree AV block (type 2) and second degree SA block (type 2); for 1% the indication was complete heart block, and for 1% it was atrial rhythm and pauses more than 3 sec long. 13% of patients with an atrial rhythm and normal heart rate developed typical atrial flutter (AFL) in the early postoperative period. For all of them the RF catheter ablation with linear ablation of the right atrial isthmus and creation of isthmus block was effective, and further recurrence of AFL was not observed. In the early postoperative period Maze III procedure combined with a mitral valve operation proved to be an effective surgical technique of treatment of persistent and long-standing persistent forms of AF. Only 12% of patients had dysfunction of sinus node work due to iatrogenesis.

Features preoperative preparation and postoperative treatment of chronic colostasis in children with congenital colon

The article presents an algorithm of preoperative preparation and postoperative rehabilitation of children who have been operated on for chronic colostasis. Objective . To develop the algorithm preoperative and postoperative rehabilitation of children operated on for congenital colon. Material and methods . During the period from 2006 to 2015 at the Department of Pediatric Surgery Bukovina State Medical University at the clinic of pediatric surgery (Chernivtsi) with chronic stasis of large intestine not ganglion genesis was operated on 43 children aged 2 to 18 years.To assess the effectiveness of the proposed treatment, the children were divided into two groups, group I (preoperative and postoperative treatment in the traditional way) - Comparative (21 children), II group (offered improved treatment) - research (22 children). The clinical course was allocated on compensated ,decompensated and subcompensated form of colostasis . Results and discussion . The indications for surgical treatment of congenital colon were - disease progression (increase in the duration of constipation, increased pain and symptoms of fecal toxicity), clinical recurrent bowel obstruction, lack of effect of conservative therapy for 1 year, subject to - the presence of dolichosigma in children older than 5 years ,Payra disease in children older than 13 years. Performed surgical interventions. At case of dolichosigma transanal endorectal down the colon with colo-recto-abouchement by Soave-Boley (n = 6); sigmoidectomy with colo-ascendo-abouchement “end to end” with the formation of the distal copula of colon (n = 10); the intersection of the left colo-diaphragma copula; sigmoidectomy, lowering of colon with descendo-recto-abouchement by Soave-Krivchenia (n = 2); the intersection of the left colo-diaphragma copula, sigmoidectomy with colo-recto-abouchement “end to end” with and formation of the distal copula of colon (n = 11). Disease Payra - resection of the transverse colon and overlay anastomosis “end to end”, and fixation of the left bend colon to the back-side of the abdominal wall in the physiological place (n = 13) Cyilaiditi's syndrome - withdrawal from subphrenic space right parts of colon, resection of the colon right bend with ascendo-transperso-abouchement “end to end” and right-hand colon fixing of ascendo-transperso-bend, hepatopexy (n=1). Conclusions . It is expected that the success of surgical treatment of children with chronic colostasis due to congenital colon depends on the individual chosen method of surgery, preoperative preparation and postoperative treatment. Deleting a particular segment of the colon and the child's need to adapt the organism to new physiological conditions anatomical existence of the colon is the basis for the choice of methods of preoperative preparation and postoperative rehabilitation of children with chronic colostasis. In the preoperative period in children with congenital colon appropriate to include retrograde and orthograde cleaning the colon, diet, and medication support for the proposed algorithm. The complex postoperative rehabilitation measures appropriate to add: intravenous infusions of ozonated physiological NaCl solution at a concentration of 2.5 mkg / l and intrarectally electrical stimulation when faecal incontinence.

Application of clinical pathway in preparation of autoloqous stem cell transplantation

Objective To investigate the effect of clinical pathway implementation in the preoperative preparation of autologous blood stem cell transplantation. Methods 30 patients who would received autologous blood stem cell transplantation were divided into clinical pathway group and traditional group, each group had 15 cases. Patients in clinical pathway group were given clinical pathway, and traditional group were given the traditional method of preoperative preparation. Hospital stay, hospital charge, management of health knowledge, satisfaction rate, depressed and anxious were compared. Results Hospital charge in clinical pathway group was (100972 ±261 ) yuan,and (126374±306) yuan in traditional group,there was statistically different(t =4. 48,P ＜0. 05). In clinical pathway group about 93.3％ patients manage the health knowledge well, and the satisfaction rate was 86. 6％ ,both were higher than in traditional group 46.6％ ,33.3％ (x2 =9.3,8.7;P ＜0. 05) ; preparation time and the incidence of complication were lower in clinical pathway group ( P ＜ 0. 05 ). Conclusions The clinical pathway provides more effective guidance, it can improve patients' satisfaction, shorten preoperative preparation time, save hospitalization charge, reduce complications and improve the quality of care. Key words: Clinical pathway; Autologous stem cell transplantation; Preoperative preparation

Effects of shaving and no hair removal to prevent of postoperative surgical site infections: a systematic literature review

Objective To explore the effects of shaving and no hair removal to reduce surgical site infections (SSIs). Methods Retrieved domestic and international electronic literature databases by using computer. Randomized controlled triaks (RCTs) according to inclusion criteria were selected and evaluated. Special software was used to analyze data. Results There were seventeen RCTs and thirteen studies involving 4104 peoples concerned two methods of preoperative preparation of skin: shaving hair removal and only cleaning the surgical site. One trial involving 382 peoples showed that there was no difference in SSIs between shearing hair group and removing hair with a razor group. Furthermore, three trials involving 370 people compared the difference in the positive rate of culturing bacteria of surgical sit between the two methods:shaving hair removal, and cleaning the surgical site only. The result showed there was no statistically significant difference between two methods. Conclusions As for the methods of preoperative preparation of skin, in the SSIs, cleaning hair is superior to removing hair with a razor and no evidence shows sheafing hair is superior to removing hair with a razor. Key words: Preoperative hair removal; Shaving; Surgical site infections ; Systematic review

Preoperative Preparation for Pheochromocytoma Resection: Physician Survey and Clinical Practice

The objectives of this study are to assess the perceptions of endocrinologists regarding sufficient preoperative preparation for resection of pheochromocytoma (PHEO) and to evaluate how patients with PHEO are actually managed preoperatively. A survey on methods of preoperative preparation was sent to all 39 endocrinologists who had privilege at a large academic hospital. The charts of 43 patients who underwent adrenalectomy for PHEO resection at this hospital between 1997 and 2007 were reviewed. Age, tumor size, blood pressure medications, volume assessment and repletion, duration of preparation, preoperative and intraoperative blood pressures, and length of stay were recorded. Sixteen endocrinologists (41%) returned surveys, with 15 questionnaires completely answered. Seven endocrinologists who saw more PHEOs (5.9 cases per 5 years) indicated they would manage preoperative preparation themselves while 8 endocrinologists who saw 0.4 case per 5 years would refer the care to a subspecialist. Six of the 7 self-managing endocrinologists recognized all important components of preoperative preparation. All 43 patients received appropriate anti-hypertensive medications for PHEO and had blood pressure well controlled preoperatively; however volume status was not addressed in medical records of 65% of patients and only about 50% of patients received preoperative preparation that lasted longer than 1 week. Suboptimal preoperative preparation was associated with longer length of stay but not with intraoperative or postoperative labile blood pressure. We conclude that most endocrinologists possess correct judgment and knowledge on preoperative preparation for PHEO resection. In clinical practice, however, a significant number of patients are not optimally managed preoperatively. Endocrinologists should pay more attention to volume repletion and adequate duration of preparation in clinical practice.

Preparation of Adolescents for Outpatient Surgery: Using an Internet Program

This study compared the effectiveness of an Internet-based method with a standard method for preparing adolescent patients scheduled for out-patient tonsillectomy procedures. A two-group experimental design compared adolescents' state anxiety, knowledge acquisition, postoperative pain intensity, and satisfaction with the method of preoperative preparation. Parents' state anxiety and satisfaction with their child's preparation method also were compared. Data analysis revealed significantly increased knowledge acquisition and satisfaction among adolescents who were assigned to the Internet method of preparation and increased satisfaction among their parents.

Suction drainage. A study in wound healing.

Abstract This paper relates the results of a clinical investigation into the value of suction drainage in general surgery which has covered 5 years and was conducted under some measure of control. The number of drained wounds observed is 1193; the results obtained show that the method produces great improvement in the healing of operations on the genito-urinary tract. In operations on the breast and thyroid, in herniotomies in which drainage has been indicated, and in a miscellaneous group, some improvement has been noted clinically. In the biliary tract fringe benefits have also occurred, but in these five groups statistical analysis of the figures obtained has not disclosed truly significant differences. It has not been found satisfactory in operations involving the lumen of the alimentary tract or in cases where frank infection with purulent exudate was present at operation. The results of two other investigations are also shown. One related to comparative studies of Lugol's solution, iodophor solution, and antibiotic sprays as methods of preoperative preparation, and the other to the time of the preliminary preoperative skin preparation and the effect this may have on wound healing.

Hergastroplasty in combined gastrectomy

The question of the scope of surgical intervention in common forms of stomach cancer remains complex, controversial and unresolved. There is a lively discussion in the literature between specialists who adhere to extreme points of view. As the methods of preoperative preparation, anesthesia, surgical techniques and postoperative management of patients with gastric cancer are improved, combined gastrectomies are increasingly used. According to V. N. Sagaidak (1969), in inoperable stomach cancers, true tumor ingrowth into distant neighboring organs was found only in 50% of patients. According to Nicolosi (1971), extended radical intervention is justified in gastric cancer complicated by ascites, peritoneal dissemination, jaundice, liver metastases, Krukenberg tumor, cancer ingrowth into the colon and into the anterior abdominal wall. The life of such patients can be prolonged, according to the author, risky, "crippling" operations.

The use of lithium carbonate in preoperative preparation of patients with toxic goiter

Preoperative preparation of patients with toxic goiter remains a difficult and urgent problem for surgeons and endocrinologists. One of the effective methods of preoperative preparation of patients with thyrotoxicosis is the combined use of mercazolil with inorganic iodine preparations, reserpine, beta-adreno blockers, ganglioblockers. However, a number of authors [2, 5], using iodine and bromine preparations with mercazolil, did not note a significant thyrostatic effect and therefore such a combination was considered unjustified. Antithyroid therapy with mercazolil, along with positive, has a number of negative aspects: it has a goitre effect, inhibits hematopoiesis in large doses, is contraindicated in pregnant women, and most importantly, is often ineffective. There are patients who are completely resistant to mercazolil [1].