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Year 2008 Vol. 16 No 4

GALLERY OF THE NATIVE SURGEONS

MAZEPOVA D.V., NEBYLITSIN YU. S.

DOCTOR INNOVATOR. CARL IVANOVICH GIBENTAL

Carl Ivanovich Gibental, a native of Kashinsky uyezd Tver province, dedicated almost half a century of his life to Belarus. He worked as a surgeon and inspector in Minsk and Vitebsk medical boards. In addition to his practical activity, he paid much attention to the search of new methods of treatment. Priority in the development of some kinds of osteal-plastic surgeries as well as of new surgical instruments belongs to him. In the foreign literature the idea of the plaster bandage is connected with the name of the Belgian physician Mathisen and in Russia with the surgeon N.I. Pirogov, but it is not true, because it is determined documentary that in Europe it was first proposed and used by C.I. Gibental. In the beginning of the XIX century it was he who invented and patented the method of fracture treatment that has been used until now. Range of his interests was exceptionally wide, including surgery, urology, traumatology, infectious diseases and psychiatry. He also took an active part in public life of Vitebsk. C.I. Gibental, an experienced surgeon, competent physician and skilful organizer, managed to do much to improve medical service rendering in Minsk and Vitebsk.

Keywords: Carl Ivanovich Gibental, history of surgery
p. 2 8 of the original issue
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GENERAL AND SPECIAL SURGERY

EGOROV V.I., VISHNEVSKY V.A., KARMAZANOVSKY G.G., SCHYOGOLEV A.I., YASHINA N.I., PAVLOV K.A., DUBOVA E.A., MELEKHINA O.V., SHEVCHENKO T.V.

DIAGNOSTICS AND TREATMENT EXPERIENCE OF AUTOIMMUNE PANCREATITIS

The article presents the first in Russia experience of diagnostics and treatment of autoimmune pancreatitis and also some literature data about this pathology. The retrospective analysis of pathohistological preparations is carried out as well as of the case histories of 46 patients, who underwent during the period from 1994 till 2007 the pancreatoduodenal resection because of the pancreas cancer, which wasnt confirmed at routine histological examination. In 37 cases the signs of chronic calculous and in 9 cases of autoimmune pancreatitis were revealed on the basis of strict morphological criteria. In one observation the diagnosis of autoimmune pancreatitis was made on the basis of radiological and serologic criteria and it was also confirmed by an effective steroid therapy. Demographic, clinical and radiological features of autoimmune pancreatitis were studied as well as the immediate and distant results of the operative and conservative treatment.
The analysis of the obtained data has displayed that autoimmune pancreatitis has a certain clinical-instrumental manifestation that permits to suspect this disease after CT and MRT. However, comparative rarity of this disease and insufficient information about its manifestation limit the revelation possibilities of both diffusive and local forms of the disease and their adequate treatment consequently.

Keywords: autoimmune pancreatitis, chronic calculous pancreatitis, pancreas cancer, pancreatoduodenal resection
p. 9 18 of the original issue
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SCHASTNY A.T.

PANCREATODIGESTIVE ANASTOMOSES VARIANTS AT PANCREATODUODENAL RESECTION AND THE RESULTS OF THEIR APPLICATION

In the article the immediate results of 147 pancreatoduodenal resections performed in the clinics of Vitebsk are analyzed. The methods of pancreatodigestive anastomoses forming are presented as well as the complications associated with this stage of the operation. Pancreatodigestive anastomosis was formed in the following variants: pancreatojejunoanastomosis 17 (11,56%) patients, pancreatogastroanastomosis 111 (75,5%), pancreaticojejunoanastomosis 19 (12,9%).
The most common complication was pancreatodigestive anastomosis incompetence (14,3%). At pancreatogastroanastomosis it emerged in 34,2% of cases on the drainage, at invagination pancreatogastroanastomosis in 9,6%, at pancreatojejunoanastomosis in 5,9%. There wasnt such a kind of complication at pancreaticojejunoanastomosis forming.
We prefer pancreatojejunoanastomosis variants because we consider a cut off character of the intestine to be an important aspect; at the development of anastomosis incompetence and pancreatic fistulas no repeated surgeries were required in any case.
Taking into account the obtained results and data analyses of different clinics we may recommend to put anastomosis not with the whole resected surface of the pancreas stump but separately with its ducts or as pancreaticojejunoanastomosis or pancreatogastroanastomosis .

Keywords: pancreatoduodenal resection, pancreatodigestive anastomosis, complications, lethality.
p. 19 27 of the original issue
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SYCHIKOV N.V.

TO THE PROBLEM OF THE STOMACH RESECTION RESULTS IMPROVEMENT

At present the stomach resection in its various forms is widely applied in various gastroduodenal pathologies. Many patients later develop pathological post-operative syndromes.
Our own experience of the individual-differential approach to the choice of a surgical technique is described in the article as well as indications for this or that resection variant depending on the clinical picture and results of the examination. In case of gastroduodenal ulcer, the group of patients is singled out in whom unfavorable malignant course of disease is prognosticated. The method of early detection of such patients permits to operate on them before the complications, periulcerous cicatricial-infiltrative processes, lesions of neighboring organs occur. The attention is paid to the importance of appropriate preoperative preparation at huge dissemination of Helicobacter pylori, marked gastritis. Obligatory surgical correction is carried out in case of revelation of accompanying hernias, cholelithiasis. To improve the resection results according to Bilroth-II (-II), the resection method, worked out and used since 1986, with gastroenteroanastomosis, on the spur valve is suggested. This method can be used in case of chronic gastro-duodenal ulcers, distal stomach tumors. About 300 surgeries were performed (hemiresection, 2/3 resection, subtotal resection of the stomach, antrumectomy with selective vagotomy) with gastroenteroanastomosis on the spur valve.
Examinations of the operated patients in the distant period testify that the given tactics of the patients treatment, gastroenteroanastomosis on the spur valve formation in case of vast and thrifty stomach resections with vagotomies decreases the frequency and acuteness of the post-operative pathological syndromes, increases the stability of anastomosis zone to the development of ulcerous-destructive processes and as the background of acidic-protease function of the stomach preserving.

Keywords: stomach, resection, prognosis, antrumectomy, spur valve, selective vagotomy.
p. 28 34 of the original issue
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ERMASHKEVICH S.N.

INFLUENCE OF HELICOBACTER PYLORI INFECTION ON THE POST-GASTRORESECTION ANASTOMOSITIS IN PATIENTS, OPERATED FOR GASTRODUODENAL ULCERS

The influence of Helicobacter pylori on the development of post-gastroresection anastomositis was studied on the basis of 46 patients examination during the immediate period after the stomach resection caused by peptic ulcer. Development of anastomositis in the examined patients is determined to be linked with Helicobacter pylori of cagA vacAs1a/m1a genotype presence; and its severity is correlated with the degree of its dissemination on the gastric mucous membrane (rs=0,825). In case of other types of Helicobacter pylori presence (agA- vacA-, cagA-vacAs2/m2, vacAs2/m1a and vacAs2/m1a-m2), anastomositis didnt develop, but the degree of neutrophilic infiltration of the gastric mucous membrane in the anastomositis zone was reliably higher (<0,001) in comparison with the cases in which Helicobacter pylori werent detected. The prescription of antibacterial and antisecretory drugs influencing Helicobacter pylori to the patients with post-gastroresection anastomositis contributed to rapid arresting of inflammatory changes in the anastomosis zone.

Keywords: Helicobacter pylori gastroduodenal ulcers, stomach resection, anastomositis.
p. 35 45 of the original issue
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EREMEYEV A.G., GOLUBEV A.A., VOLKOV S.V., VORONOV S.N.

13-YEAR EXPERIENCE OF LAPAROSCOPIC OPERATION APPLICATION IN THE TREATMENT OF CALCULOUS CHOLECYSTITIS PATIENTS

The results of 13-year application of laparoscopic operations in the treatment of the calculous cholecystitis patients are presented. During a 13-year period (from 1994 till 2007) 5468 laparoscopic cholecystectomies (LCE) were performed. A general characteristic of the performed LCE is given. There were 44 (0,8%) conversions. The main reason of conversions was the perivesical infiltrate in 20 cases. The analysis of the immediate results with the application of Jannet classification (1994) was carried out. Severe complications after LCE were analyzed which required the use of invasive methods. Among them subhepatic abscesses made up 8 (0,14%), iatrogenic damages of extrahepatic bile vessels 6 (0,1 %), cystic duct stump incompetence 8 (0,14 %), bile leakage from the gallbladder space 2 (0,03 %), bleedings from the gallbladder space 6 (0,1 %). There were lethal outcomes in 4 (0,07%) cases. The straight cause of death in all these cases was heavy thromboembolism of the pulmonary artery in the 2nd and 4th day of the postoperative period. The complex of actions is used to prevent tromboembolic complications; it is aimed to both strengthen immunity of a patient and to decrease negative effects during the surgery.

Keywords: cholecystitis, laparoscopic cholecystectomy, carboxyperitoneum, complications
p. 46 49 of the original issue
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KONSTANTINOVA G.D., DONSKAYA E.D., EPSHTEIN S.L.

SURGICAL TREATMENT OF THE LOWER LIMBS VARICOSITY IN PATIENTS OVER 60 AT THE SHORT-TERM IN-PATIENT DEPARTMENT

The results analysis of the surgical treatment of 190 varicosity patients over 60 who applied for medical help testifies that in the majority of patients the indications for surgeries were complications of the disease. Modern ultrasound diagnostics, sparing anesthesia actions, mini-invasive techniques provided successful treatment of this category of patients (the only lethal outcome because of the pulmonary artery thromboembolism was in the patient with ascending thrombophlebitis. Most surgeries were of the radical character. The authors suppose that minor traumatism of the intervention and its application at the out-patient department or at the short-term in-patient department play a particular role in favorable outcome of elderly patients treatment.

Keywords: varicosity, ultrasound angioscanning, acute thrombophlebitis, trophic skin disorders
p. 50 58 of the original issue
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RAUMATOLOGY AND ORTHOPEDICS

SERDYUCHENKO N.S., BEVZELYUK A.A., RUDENKO E.V., PREDKO N.M.

ECONOMIC ASPECTS OF OSTEOPOROSIS

Economic outcomes of osteoporosis are studied on the basis of the data of Minsk clinical hospitals and the literature as well. The corresponding analysis is carried out with application of the specially worked out software which permits to determine the complex of parameters accounted on one average statistical patient with osteoporosis fracture of the femur neck (OFFN) as well as on one average statistical person from the risk group.
The morbidity damage caused by osteoporosis and prophylactic treatment effect in the common case are found out to depend on the age of a patient, cost of OFFN treatment, expenses on the prophylactic actions and on some other factors. Prophylactic actions for those who make up the risk group at the age of 50-54 are characterized by comparatively low economic efficacy due to low OFFN probability. Starting from the age of 65-70 dedication of the funds for prophylactic treatment becomes acceptable because of the social-economic efficacy criterion.

Keywords: osteoporosis, femoral neck fracture, econometry.
p. 59 64 of the original issue
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PEDIATRIC SURGERY

LEVIN M.D., TROYAN V.V.

PATHOLOGIC PHYSIOLOGY, DIAGNOSTICS AND PERSPECTIVE TREATMENT OF LOW IMPERFORATE ANUS WITH FISTULAS

In spite of the fact, that imperforate anus with perineal or vestibular fistula is considered to be a low anorectal anomaly, the majority of surgeons use posterior sagittal anorectoplasty (Pena and de Vries) for its correction, i.e. the same procedure that is used to correct high anomalies. 10% to 30% of the postoperative patients suffer from total fecal incontinence and more then 70% from chronic constipation.
It was shown that patients with these anomalies have normally formed anal canal. However, the opening of the fistula, which is usually narrower than fecal mass, is formed in the rectum with forward displacement from the proper location of the anal orifice. Megacolon and chronic constipation develop as a result of this relative stenosis in patients who are 3 + months old. The process of persistent straining of the puborectal muscle gradually results in the shortening of the anal canal. The caudal part of the anal canal does not fully open to the normal width due to muscle rigidity of the perineum. The operative procedure must be carried out before this pathologic alteration occurs.
The operating procedure of the anal orifice formation consists of brining the distal caudal wall of the anal canal to the tunnel inside the external anal sphincter using a curved catheter inserted into the fistula. This wall is separated from the surrounding tissue on the depth of 1 cm and split. Then, its edges are sewn to the skin of the perineum. After the daily widening of the anal canal, closing of the fistula isdone under the colostomy protection. Unlike the Pena operation, this procedure spares pelvic muscles from injury. And if it is done prior to megacolon development, it has good functional prognosis.

Keywords: newborn, imperforate anus, rectal atresia, anorectal fistula, vestibular fistula, pathologic physiology, anorectal anomalies, surgical treatment.
p. 65 76 of the original issue
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    ONCOLOGY

    SHLYAKHTUNOV E.A., LUD N.G.

    THE STATE OF THE UPPER EXTREMITY ARTERIAL BLOOD-GROOVE IN THE PROCESS OF BREAST CANCER SURGICAL TREATMENT

    By means of ultrasound color Doppler mapping the state of the arterial hemodynamics of the upper extremities in the patients with breast cancer in the process of surgical treatment is studied. It is established that in 49 % of the operated women the increase in the volume of blood-groove on the side of the operative intervention, connected with the changes of high-speed characteristics of a stream and changes of a vascular wall takes place. The maximum registered increase in the volume speed of blood-groove after operation has made 77 % from the initial one. The greatest increase in volume speed of blood-groove is fixed in the patients with the 1st stage of tumor process. Rise in the volume blood-groove increases significantly the volume of total postoperative lymph expiration. 11 % of the operated women inflow of arterial blood to a hand decreases owing to the development of skalenus-syndrome in patients in the postoperative period. The greatest registered decrease in the volume speed of blood-groove is on 53 %. In 30 % of cases arterial hemodynamics does not change. Preservation of intercostabrachialis does not influence the volume speed of blood-groove. An accompanying pathology, such as arterial hypertension, promotes the development of hemodynamic disturbances in the upper extremity on the side of the operation.

    Keywords: breast cancer, hemodynamics, lymphedema, ultrasound, color Doppler mapping.
    p. 77 85 of the original issue
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    NEUROSURGERY

    KUBRAKOV K.M., KOSINETS A.N., AKULENOK A.V.

    INTRATHECAL INTRODUCTION OF ANTIBACTERIAL PREPARATIONS IN THE NEUROSURGERY PATIENTS WITH MENINGOENCEPHALITIS

    The review of the modern literature is presented in the article concerning the methods and ways of the antimicrobial preparations administration in the neurosurgery patients with intracranial pyo-inflammatory complications. A preferable way of antibiotics administration is intravenous one. Intrathecal injection of antimicrobial preparation is also used in neurosurgery. However in literature there are no clearly motivated data for indication of antimicrobial preparation by this way. The statistical reliable criteria are chosen for the intrathecal administration the antimicrobial preparation by using the short-term prognosis model of lethal outcomes in the patients with postoperative meningoencephalitis. The model includes some findings of the blood (amount of leukocytes, lymphocytes, neutrophiles, and erythrocyte sedimentation rate), cerebrospinal fluid (the quantitative content of protein, relative content of neutrophiles and lymphocytes), presence of the traumatic brain injury of heavy degree, ischemic heart disease.

    Keywords: neurosurgery, meningoencephalitis, endolumbar administration, antibiotic therapy.
    p. 86 93 of the original issue
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    UROLOGY

    LAZARENKO T.A., BYKOV O.L., SIMCHENKO N.I.

    THE EXPERIENCE OF DISTANT LITHOTRIPSY OF BIG AND CORAL-LIKE CONCREMENTS

    The experience of big and coral-like concretions distant breaking up application in the patients with urolithiasis was studied. The patients were undergoing medical examination and treatment at the urological department of Mogilev regional hospital in 2007. Distant lithotripsy (DLT) was performed using the apparatus Siemens Lithoskop at frequency rate of 90 beats per minute with maximally permitted safe power level up to 25003000 beats (4055 J). Absence of pyelonephritis activity was obligatory. The sizes of calculi were more than 2 cm.
    Application of DLT was shown to be an effective method of big and coral-like calculi breaking up in the patients with nephrolithiasis. An average number of procedures in one patient comprised 2,20,3 (̱s). An average duration of patients stay at the in-patient department in case of DLT in the kidneys made up 9,92,1 number of days (̱s), and in case of DLT in the ureter 12,31,9 number of days (̱s).

    Keywords: urolithiasis, distant lithotripsy.
    p. 94 98 of the original issue
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    ANESTHESIOLOGY-REANIMATOLOGY

    MARACHKOV A.V., SOLOVEI E.YU., PROTASEVICH P.V.

    INTRA-OPERATIVE AND ANESTHESIOLOGICAL LETHALITY AS THE MAIN CRITERIA OF THE ANESTHESIOLOGISTS ACTIVITY EFFICACY

    The aim of this research was to determine the amount and dynamics of lethal outcomes, which occurred on the operation table as well as to detect anesthesiological lethality and to work out the measures for its prevention. The cases of death on the operative table during the period from 1975 to 2006 were retrospectively studied. 99 cases of the intra-operative lethality for 32 years were analyzed, including 89 case histories, anesthesia protocols, and autopsy data of the dead.
    283 3666 surgeries were carried out for this period of time (26 562 emergent ones and 258 804 planned ones), and anesthesiologists performed 149 363 anesthesias. The most significant criteria objectively reflecting the results of anesthesiologists work are: a) intra-operative lethality during planned operations concerning the disease; b) anesthesiological lethality. During the period from 1991 till 2006 intra-operative lethality during planned operations concerning the diseases made up 0,2 cases on 10 000 planned operations. Anesthesiological lethality decreased from the figure of 1 case on 6 700 anesthesias to the figure of 1 case on 82 200 anesthesias in the period of 19912006.

    Keywords: intra-operative lethality, anesthesiological lethality, efficacy of anesthesiologists work.
    p. 99 107 of the original issue
    References
    1. 6,.. / ..6, .., .. // . 1987. 6. . 30-37.
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    3. Holland,R. Anesthesia related mortality in Australia // International Anesthesiology Clinics. 1984 Vol. 22, N 2. P. 61-71.
    4. Death in the operating room: an analysis of a multi-center experience / D.B.Hoyt [et al.] // Journal of Trauma. 1994. Vol. 37, N 3. P. 426-432.
    5. Frequency of anesthetic cardiac arrest and death in the operating room at a single general hospital over a 30-year period / Y.Kubota [et al.] // Journal Clin. Anesth. 1994. Vol. 6, N 3. P. 227-238.
    6. Marochkov,A.V. Death in the operating room / A.V.Marochkov, E.Solovey // Abstract book of 13th World Congress of Anesthesiologist. Paris, 2004. P. 500.
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    NIKITINA E.V., SERGEYENKO N.I.

    THE VEGETATIVE NERVOUS SYSTEM FUNCTIONAL STATE AND IMMUNE STATUS INDEXES CAUSED BY PRE-OPERATIVE EMOTIONAL STRESS

    The research of a number of the immune system indexes dependence on the variant of the vegetative nervous system functional state in 69 patients of the traumatological profile during the pre-operative period has been carried out. It has been found out that a definite activity of the immune system indexes corresponds to each variant of the vegetative nervous system functional state. In the patients with sympathotony predominance on the high functional level the indexes of the immunity cellular link were inhibited more than in the patients with parasympathotony predominance on the low functional level and even less than in the control group. At the same time one could observe inhibition of the immunity humoral link in the patients with sympathotony predominance on the high functional level in comparison with the patients with parasympathotony predominance on the low functional level and even in less degree in comparison with the control group. In the patients with parasympathotony predominance on the low functional level, inhibition of the immunity cellular link was more marked than in the control group in comparison with the group of patients with sympathotony predominance on the high functional level. In the patients with parasympathotony predominance on the low functional level the indexes of the immunity humoral link were higher in comparison with the control group and much higher than in the patients with sympathotony predominance on the high functional level.

    Keywords: pre-operative emotional stress, immune status.
    p. 108 116 of the original issue
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    INFORMATION TECHNOLOGIES IN SURGERY

    ZHARIKOV O.G.

    PURULENT-SEPTIC COMPLICATIONS PREDICTING OF SEVERE ACUTE PANCREATITIS

    The article is devoted to a differentiated prospective estimation of severity and the complications predicting of severe acute pancreatitis proceeding from the available clinical-laboratory data, with the use of a new mathematical method based on modeling of the cogitative activity of the brain. The basic contents of the article makes the description of the mathematical device artificial neural networks and the substantiation of its advantages in comparison with the standard international scales of gradation of the condition severity, focused on the nonspecific prognosis of the pathological process development. The ANN method of predicting allows the doctor not only to check up his own assumptions, but also to address to the machine for consultation in difficult diagnostic cases.

    Keywords: an acute pancreatitis, artificial neural networks, artificial intellect, surgery
    p. 117 125 of the original issue
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    PRACTICAL CASES

    YURLEVICH D.I., KIRKOVSKY L.V., KOROTKOV S.V., FEDORUK A.M., SHULEYKO A.CH., BOLONKIN L.S., DZYADZKO A.M., SLOBODIN YU. V., SCHERBA A.E., RUMMO O.O.

    APPLICATION OF THE SELECTIVE VASCULAR ISOLATION IN THE LIVER SURGERY

    One of the priority problems in the liver surgery is decrease of hemorrhage amount. Occlusion use of only the hepatoduodenal ligament at the liver tumors resections localized in the hepatocaval onfluence region or infiltrating vena cava inferior is connected with high risk of massive loss of blood and air embolism. Technique of the liver vascular isolation provides a possibility of safe and aggressive approach to the majority of the focal liver formations. Total vascular liver isolation provides fast and reliable control over hemorrhage, but it is accompanied by the marked hemodynamic disturbances. A clinical case of hemangioma resection, occupying 78 liver segments with the right liver vein inflow from the 6th segment saving in terms of selective vascular resection, is described in the article. The selective vascular resection is shown to be an effective and safe method in case of the right liver lobe tumor resection in the hepatocaval onfluence region. It is more complicated technically due to necessity of the liver veins detection, but it doesnt result in the marked hemadynamic disturbances and the patients bear it better.

    Keywords: liver resection, vascular liver isolation.
    p. 126 130 of the original issue
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    1. Couinaud,C. Conrtolled hepatectomies and exposure of intrahepatic bile ducts: anatomical and technical study / C.Couinaud. Paris: C. Couinaud, 1981.
    2. Bismuth,H. Major hepatic resection under total vascular exclusion / H.Bismuth, D.Castaing, J.Garden // Annals of Surgery. 1989. Vol. 210. P. 13-19.
    3. Safety of selective vascular clamping for major hepatectomies / B.Malassagne [et al.] // Journal of American College of Surgeons. 1998. Vol. 187. P. 482-486.
    4. Belghiti,J. Techniques, hemodynamic monitoring and indications for vascular clamping during liver resections / J.Belghiti, J.Marty, O.Farges // Journal of Hepatobiliarypancreatic surgery. 1998. Vol. 5. P. 69-76.
    5. Surgical and anesthetic management of patients undergoing major hepatectomy using total vascular exclusion / J.C.Emond [et al.] // Liver Transplantation Surgery. 1996. Vol. 2. P. 91-98.
    6. Selective hepatic vascular exclusion and Pringle maneuver: A comparative study in liver resection / W.Zhou [et al.] // European Journal of Surgical Oncology. 2008. Vol. 34. P. 49-54.
    7. Portal triad clamping of hepatic vascular exclusion for major liver resection: a controlled study / J.Belghiti [et al.] // Annals of Surgery. 1996 Vol. 224. P. 155-161.

    LECTURES, REVIEWS

    MINKOVICH P.V.

    PRESENT-DAY TENDENCIES AND CONCEPTS IN PERFORATED PYLORODUODENAL ULCERS TREATMENT

    Surgical treatment of perforated duodenal ulcers (PDU) is an important problem of modern medicine. PDU is a frequent and dangerous complication, which is revealed in 530 % patients with ulcer diseases. PDU lethality stays rather high, varying between 3,3% and 17,2% without any tendency to decrease. In this article we represent the review of the main ways of surgical treatment of perforated pyloroduodenal ulcer.

    Keywords: perforated pyloroduodenal ulcer, pharmacological vagotomy, pyloroplasty.
    p. 131 140 of the original issue
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    NEBYLITSIN YU.S., SUSHKOV S.A., SOLODKOV A.P., DOROSHENKO A.P.

    ENDOTHELIUM DYSFUNCTION IN CASE OF ACUTE AND CHRONIC VENOUS INSUFFICIENCY

    Up-to-date presentations concerning physiology of the venous vessels endothelium which plays one of the central roles in the intravascular homeostasis maintenance are given in the article. The functional and structural endothelium changes in case of the venous stasis are studied. Endothelium cells are more perceptible to the blood composition changes, first of all to the oxygen deficiency in case of the stress-like influence under the condition of the venous wall hypoxia. It is accompanied by oxidative and nitrosyling stress resulted in the endothelium dysfunction and dysregulation characterized by the disturbance of the vessels capacity for autoregulation.
    In the work the estimation of the diagnostic tests is given which characterize the functional endothelium disturbances and correction by means of medicaments of endothelium dysfunction in case of venous insufficiency.
    Application of modern medicaments at the early stages of the disease helps to prevent complications development, it improves the results of treatment in the patients with the venous insufficiency, promotes their return to the active way of life.

    Keywords: endothelium dysfunction, acute venous insufficiency, chronic venous insufficiency.
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    EXPERIENCE EXCHANGE

    ZASIMOVICH V.N., NAZARUK A.M., MALASCHITSKY E.A., MOGUCHY V.V., BORISENKO M.N.

    EXPERIENCE OF THE DEEP VEINS THROMBOSIS OF THE VENA CAVA INFERIOR SYSTEM TREATMENT PROVIDED IN THE SPECIALIZED HOSPITAL

    The results of various methods of treatment usage are summarized and analyzed in 165 patients with deep veins thrombosis of the vena cava inferior system. The patients were divided into 3 groups according to the thrombotic process character: occlusive phlebothrombosis, parietal and floating ones. Anti-coagulant therapy was carried out in both three groups. The patients of the 3rd group were operated on. Thrombolytic therapy was performed in 40 patients of the second group and in 14 patients of the 1st one. There was the systemic thrombolysis in 32 cases, in 22 a regional one according to its own technique. The results were estimated according to marked character of hemorrhagic and pyrogenic reactions, the pulmonary artery thromboemboly frequency, and the degree of the marked character of the chronic venous insufficiency in the distant period. The best results were observed in the patients with parietal phlebothrombosis in case of the regional thrombolysis.

    Keywords: deep veins thrombosis, conservative treatment, thrombolytic therapy.
    p. 154 159 of the original issue
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    DUDAREVICH F.L., SHAPEL I.A.

    SPINAL ANESTHESIA APPLICATION IN CASE OF THE LOWER LIMBS AMPUTATION IN DIFFICULT CONDITIONS ACCORDING TO URGENT INDICATIONS

    The authors experience concerning the spinal anesthesia application in 104 patients who have become victims of urgent surgeries caused by traumatic amputation of the lower limbs as the result of the mine trauma in African country is presented in the article. The spinal anesthesia is demonstrated to be the choice method for an adequate neurovegetative protection in the period of the surgical intervention taking into account local organizational and technical difficulties, climatic conditions and living peculiarities of native inhabitants.

    Keywords: spinal anesthesia, the mine trauma, the lower limbs amputation.
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    TO ASSITANCE OF PRACTITIONER

    SUSHKOV S.A.

    POSTOPERATIVE RECURRENCE OF THE LOWER LIMBS VARICOSITY

    Up-to-date approaches to diagnostics and treatment of varicosity recurrence are given in the article. The main causes resulting in varicosity recurrence are investigated in details. It is demonstrated that the results of treatment may be improved by using organizational measures as well as by introducing up-to-date diagnostic and surgical techniques. Surgical interventions in case of recurrence must be performed only in the specialized departments by highly-qualified surgeons. In the pre-operative period it is required to carry out thorough investigation of the superficial and deep veins with the application of Duplex angio-scanning, phlebography to clear up the cause of disease recurence and to evaluate hemodynamic disturbances. During surgeries it is necessary to make correction of the venous blood-flow in all sections of the muscular-venous pump without restricting oneself only to varicose veins removal.

    Keywords: varicosity, varicosity recurrence, chronic venous insufficiency, recurrence treatment
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