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Year 2011 Vol. 19 No 5

EXPERIMENTAL SURGERY

V.K. GOSTISHCHEV, V.А. KOSINETS, Е.А. MATUSEVICH, G.P. ADAMENKO

IMMUNOLOGICAL ASPECTS OF EXPERIMENTAL WIDESPREAD PERITONITIS

Objectives. To analyze the condition of the immune system at different organ levels at the experimental widespread purulent peritonitis.
Methods. The experiment has been carried out on 25 male rabbits of chinchilla breed. Influence of mitogen-induced immunocompetent cells on the dynamics of an index of neutrophil leukocytes migration of blood, Peyer's patches, spleen and inguinal lymph nodes is studied at the experimental widespread purulent peritonitis.
Results. It is established that for production of factors of neutrophil leukocytes migration's inhibition in reply to PHA, interaction of several populations of immunocompetent cells (lymphocytes and monocytes) is necessary.
Conclusions. Stimulation by mitogen-activated immunocompetent cells of neutrophil leukocytes migration at an experimental widespread purulent peritonitis is steady and widespread process which is observed within 5 days of the postoperative period with involving of organs of different levels of the immune system.

Keywords: widespread purulent peritonitis, neutrophils, mononuclear cells, monocytes, lymphocytes, PHA, LPS

p. 3 – 8 of the original issue

References

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Article in the .pdf format

V.А. KOSINETS, I.V. SAMSONOVA, E.L. RYZHKOVSKAYA

STRUCTURAL CHANGES IN THE SMALL INTESTINE AT EXPERIMENTAL WIDESPREAD PURULENT PERITONITIS

Objectives. To study structural changes in small intestine's wall and the ways of its correction at the experimental widespread purulent peritonitis.
Methods. In experiment on 55 rabbits-males of the chinchilla breed using light and electronic microscopy, structural changes of small intestine were studied at an experimental widespread purulent peritonitis.
Results. Introduction into the abdominal cavity of aerobic-anaerobic culture of E. Coli and B. fragilis causes in 6 hours the expressed destructive damages of villi of the mucous coat, dystrophic and necrotic changes of the muscular coat, and also disturbance of blood and lymph circulation in the small intestine wall. The specified changes, and also structural disorganization and damage of the small intestine muscular coat myocytes mitochondrion testify to early development of enteric insufficiency at the widespread purulent peritonitis.
Conclusions. The comparative analysis of application at experimental widespread purulent peritonitis of metabolic preparations "Citoflavin" containing amber acid and "Neoton" containing phosphocreatine has revealed high efficiency of the first one. It was proved by decrease of inflammation, preservation of an energy potential of cells due to prevention of mitochondrion destruction and as result of this decrease of dystrophic and necrotic changes development and more intensive restoration of the small intestine wall structure.

Keywords: widespread purulent peritonitis, small intestine, structural changes, mitochondria, "Neoton", "Citoflavin"

p. 9 – 16 of the original issue

References

1. Гостищев, В. К. Перитонит / В. К. Гостищев, В. П. Сажин, А. Л. Авдовенко. – М.: Гэотар-мед, 2002. – 240 с.
2. Савельев, В. С. Перитонит: практ. рук. / В. С. Савельев, Б. Р. Гельфанд, М. И. Филимонов. – М.: Литтерра, 2006. – 205 с.
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Address for correspondence:
reparative osteogenesis, polytrauma, mexidol, biophen

Article in the .pdf format

E.L. MALINOVSKY, E.A. NADYROV, V.I. NIKOLAEV

OPTIMIZATION OF RESTORATIVE OSTEOGENESIS AT POLYTRAUMA

Objectives. To study biophen and mexidol influence on the reparative osteogenesis in the experimental animals after polytrauma modeling
Methods. The study was carried out on 57 laboratory rats. Noble-Collip method was used with an additional formation of the shin fracture in rats. The animals were subdivided into three groups. The first group was a control one (no pharmacological correction was performed). The second group was treated with biophen. The third group was treated with mexidol. In 2,3,4 week periods the animals were taken out from the experiment with the excision of the shin fracture place for a histological study.
Results. Use of biophen and mexidol for osteogenesis stimulation is characterized by a higher area of a cartilaginous and cancellous tissue, bone marrow on the 2nd week of the experiment. On the 3rd and 4th week of the study the area of the cartilaginous tissue decreased and the area of the cancellous bone increased compared with the control animals.
Conclusions. Use of biophen and mexidol causes more evident processes of the regeneration of bone tissue in the area of a fracture compared with the control group animals.

Keywords: reparative osteogenesis, polytrauma, mexidol, biophen

p. 17 – 2217 of the original issue

References

1. Влияние различных механизмов травмы на клеточные источники остеорепарации и репаративный остеогенез / В. Г. Климовицкий [и др.] // Современные аспекты оказания спец. травматол.-ортопед. помощи: материалы междунар. науч.-практ. конф., Минск, 21-22 окт. 2010 г. – Минск, 2010. – С. 67-73.
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10. Корж, Н. А. Репаративная регенерация кости: современный взгляд на проблему. Системные факторы, влияющие на заживление перелома / Н. А. Корж, Н. В. Дедух, О. А. Никольченко // Ортопедия, травматология и протезирование. – 2006. – № 2. – Сообщ. 3. С. 93-99.
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Article in the .pdf format

GENERAL AND SPECIAL SURGERY

G.P. RYCHAGOV, O.A. AMELCHENYA, O.A. PERESADA, E.YU. TRUKHAN, L.V. KARTUN, E.V. KHODOSOVSKAYA

MODERN ASPECTS OF DIAGNOSTICS AND TREATMENT OF ACUTE APPENDICITIS DURING PREGNANCY

Objectives. To evaluate modern possibilities of diagnostics and operative treatment of an acute appendicitis during pregnancy and to determina perspective ways of their improvement.
Methods. The retrospective analysis of differentiated diagnostics of acute appendicitis was performed in 252 pregnant patients; in 54 patients the results of video laparoscopy were studied; in 20 patients the results of ultrasound investigation as a diagnostics method of acute appendicitis; in 17 patients the level of sex hormones was studied; in 42 operated patients the distant results of surgical treatment and life quality were studied.
Results. Laparoscopy was found out to have high diagnostic potential. Laparoscopic appendectomy is priority in comparison with a traditional one that was proved by the nearest and distant results of treatment, and also by indicators of life quality. The level of steroid hormones was established to change after the operative intervention.
Conclusions. Pregnant women with a presumed acute appendicitis must be admitted to the clinic which has experience in treatment of such patients and has possibility of rendering round-the-clock surgical and gynecologic aid at the modern level.

Keywords: appendicitis, treatment, diagnostics, pregnancy

p. 23 – 31 of the original issue

References

1. Смотрин, С. М. Актуальные вопросы перинатологии / С. М. Смотрин, Н. И. Батвинков, Т. Ю. Егорова // Материалы науч.-практ. конф. с междунар. участием, посвящ. 60-летию Гродн. област. клин. род. дома. – 2005. – С. 329-331.
2. Al-Fozan, H. Safety and risk of laparoscopy in pregnancy / H. Al-Fozan, T. Tulandi // Curr. Opin Obstet. Gynecol. – 2002. – Vol. 14. – P. 375-379.
3. Guttman, R. Appendicitis during pregnancy / R. Guttman, R. D. Goldman, G. Koren // Canadian Family Physician. – 2004. – Vol. 50. – P. 355-357.
4. Wiad Lek / A. Konlowski [et al.]. – 1992. – Vol. 45, N 13-14. – P. 494-497.
5. Савельев, В. С. Лапароскопические вмешательства в неотложной хирургии. Состояние проблемы и перспективы / В. С. Савельев, А. Г. Кригер // Эндоскоп. хирургия. – 1999. – № 5. – С. 3-6.
6. Baer, J. L. Appendicitis in pregnancy / J. L. Baer, R. A. Reis, R. A. Arens // JAMA. – 1932. – Vol. 52. – P. 1359-1364.
7. Лапароскопия в диагностике острого аппендицита / А. Г. Кригер [и др.] // Хирургия. – 2000. – № 8. – С. 14-19.
8. Стрижаков, А. Н. Беременность и острый аппендицит / А. Н. Стрижаков, А. Г. Асланов, М. В. Рыбин // Вопр. акуш., гинекол., перинатол. – 2003. – № 1. – С. 97-100.
9. Стрижаков, А. Н. Фетоплацентарная недостаточность. Патогенез, диагностика, лечение / А. Н. Стрижаков, Т. Ф. Тимохина, О. Р. Баев // Вопр. акуш., гинекол., перинатол. – 2003. – Т. 2, № 2. – С. 53-63.
10. MRI for Appendix Location During Pregnancy / А. Oto [et al.] // AJR. 2006. – Vol. 186. – Р. 883-887.
11. Hodjati, H. Location of appendix in the gravid patient: a re-evaluation of the established concept / H. Hodjati, T. Kazerooni // Int. J. Gynaecol. Obstet. – 2003. – Vol. 81. – P. 245-247.
12. The incision of choice for pregnant women with appendicitis is through McBurneys point / C. A. Popkin [et al.] // Am. J. Surg. – 2002. – Vol. 183. – P. 20-22.
13. Пронин, В. А. Патология червеобразного отростка и аппендэктомия / В. А. Пронин, В. В. Бойко. – 2007. – С. 272.
14. Беременность и острый аппендицит / А. Н. Стрижаков [и др.] // Вестн. хирург. гастроэнтерол. – 2010. – № 3. – С. 4-16.
15. Safety of Laparoscopic Appendectomy During Pregnancy / B. Kirshtein [et al.] // World J. Surg. – 2009. – Vol. 33. – P. 475-480.

1. Смотрин, С. М. Актуальные вопросы перинатологии / С. М. Смотрин, Н. И. Батвинков, Т. Ю. Егорова // Материалы науч.-практ. конф. с междунар. участием, посвящ. 60-летию Гродн. област. клин. род. дома. – 2005. – С. 329-331.
2. Al-Fozan, H. Safety and risk of laparoscopy in pregnancy / H. Al-Fozan, T. Tulandi // Curr. Opin Obstet. Gynecol. – 2002. – Vol. 14. – P. 375-379.
3. Guttman, R. Appendicitis during pregnancy / R. Guttman, R. D. Goldman, G. Koren // Canadian Family Physician. – 2004. – Vol. 50. – P. 355-357.
4. Wiad Lek / A. Konlowski [et al.]. – 1992. – Vol. 45, N 13-14. – P. 494-497.
5. Савельев, В. С. Лапароскопические вмешательства в неотложной хирургии. Состояние проблемы и перспективы / В. С. Савельев, А. Г. Кригер // Эндоскоп. хирургия. – 1999. – № 5. – С. 3-6.
6. Baer, J. L. Appendicitis in pregnancy / J. L. Baer, R. A. Reis, R. A. Arens // JAMA. – 1932. – Vol. 52. – P. 1359-1364.
7. Лапароскопия в диагностике острого аппендицита / А. Г. Кригер [и др.] // Хирургия. – 2000. – № 8. – С. 14-19.
8. Стрижаков, А. Н. Беременность и острый аппендицит / А. Н. Стрижаков, А. Г. Асланов, М. В. Рыбин // Вопр. акуш., гинекол., перинатол. – 2003. – № 1. – С. 97-100.
9. Стрижаков, А. Н. Фетоплацентарная недостаточность. Патогенез, диагностика, лечение / А. Н. Стрижаков, Т. Ф. Тимохина, О. Р. Баев // Вопр. акуш., гинекол., перинатол. – 2003. – Т. 2, № 2. – С. 53-63.
10. MRI for Appendix Location During Pregnancy / А. Oto [et al.] // AJR. 2006. – Vol. 186. – Р. 883-887.
11. Hodjati, H. Location of appendix in the gravid patient: a re-evaluation of the established concept / H. Hodjati, T. Kazerooni // Int. J. Gynaecol. Obstet. – 2003. – Vol. 81. – P. 245-247.
12. The incision of choice for pregnant women with appendicitis is through McBurneys point / C. A. Popkin [et al.] // Am. J. Surg. – 2002. – Vol. 183. – P. 20-22.
13. Пронин, В. А. Патология червеобразного отростка и аппендэктомия / В. А. Пронин, В. В. Бойко. – 2007. – С. 272.
14. Беременность и острый аппендицит / А. Н. Стрижаков [и др.] // Вестн. хирург. гастроэнтерол. – 2010. – № 3. – С. 4-16.
15. Safety of Laparoscopic Appendectomy During Pregnancy / B. Kirshtein [et al.] // World J. Surg. – 2009. – Vol. 33. – P. 475-480.

Article in the .pdf format

A.T. SHCHASTNY

DISTANT RESULTS OF THE PANCREAS PROXIMAL RESECTION IN PATIENTS WITH CHRONIC PANCREATITIS

Objectives. To analyze distant results of the pancreas proximal resection and to study the quality of patients, life in the postoperative period.
Methods. 153 patients with chronic pancreatitis (CP) were included in the research in whom pancreas proximal resections were performed (pancreatoduodenal resection in 53 patients; Bege, rs operation in modification of the clinic – in 61 patients; Bern, s modification – in 39 patients). Criteria of treatment efficacy were the level of distant lethality, frequency of complications and repeated interventions, marked character of exocrine and endocrine insufficiency. The pain syndrome level and professional rehabilitation of patients were estimated.
Results. Late lethality related to chronic pancreatitis progressing made up 2,61%. Firstly revealed diabetes mellitus developed in 15 (9,8%) patients after all surgical interventions; reliably smaller number of such cases in patients after Beger, s operation was noted in comparison with pancreatoduodenal resection. Exocrine insufficiency was revealed in 27 (17,65%) patients and it doesnt depend on the operative technique.
High level of professional rehabilitation was marked at all techniques which was achieved in 137 (89,54%) patients. There was a reliable improvement of parameters of the pain syndrome elimination after Beger, s operation in modification of the clinic in comparison with pancreatoduodenal resection.
Conclusions. The performed analysis of the distant results of surgical treatment of CP patients demonstrates advantages of the pancreas proximal resection with the duodenum saving.

Keywords: chronic pancreatitis, pancreas, proximal resection, quality of life

p. 32 – 38 of the original issue

References

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Article in the .pdf format

M.I. KUGAEV, I.V. SAMSONOVA, V.A. KLOPOVA, I.A. BEKHTEREVA, A.E. DOROSEVICH

INTERCONNECTION OF THE NERVOUS TISSUE LESION AND FIBROUS CHANGES IN THE PANCREAS HEAD WITH PAIN SYNDROME AND LIFE QUALITY OF PATIENTS AT CHRONIC PANCREATITIS

Objectives. To study the interconnection of the nervous tissue lesion in the head of the pancreas with the degree of fibrous changes as well as with the level of pain syndrome and life quality of patients with chronic pancreatitis (CP).
Methods. 37 patients with CP were examined in whom duodenum saving resection of the pancreas head was performed. The visual analogous scale (VAS) was used to evaluate the intensiveness of the pain syndrome; the questionnaire SF-36 was applied to study life quality. The area of the histological preparation, the area of each nervous structure, the number of nerves and total area of the nervous tissue were evaluated at the microscopic research.
Results. The area of the nervous tissue was reliably smaller at the 1st degree of fibrosis in comparison with the 2nd and 3rd ones. The area of the nervous tissue at the 2nd and 3rd degrees of fibrosis didnt differ significantly. While comparing the number of nerves depending on the fibrosis area it was found out that the number of nerves differs significantly at the 1st and 3rd degrees of fibrosis. While comparing the 1st and 2nd as well as the 2nd and 3rd these differences were unreliable. While comparing the area median of one nerve, one revealed no dependence on the fibrous changes. The area of the nervous tissue, numbers of nerves, area median of one nerve don, t correlate with the quality life scales as well as they don, t depend on the pain syndrome level.
Conclusions. At chronic pancreatitis the lesion of the nervous tissue in the pancreas head depends on the degree of the fibrous changes. Proportion increase of the nervous tissue area to the pancreas tissue occurs due to the number of the nervous elements increase. The marked character of the pain syndrome and life quality doesn, t depend on the nervous tissue lesion.

Keywords: chronic pancreatitis, pancreas fibrosis, life quality, intensiveness of pain syndrome, nervous tissue area

p. 39 – 45 of the original issue

References

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Article in the .pdf format

P.N. ZUBAREV, S.V. PASKAR

CHOICE CRITERIA AND EFFICIENCY OF PLAZMAPHERESIS APPLICATION IN TREATMENT OF ACUTE DESTRUCTIVE PANCREATITIS

Objectives. To work out the objective criteria of endogenous intoxication severity permitting to determine the indications and to evaluate the efficacy of plazmapheresis in the intensive therapy complex of the acute destructive pancreatitis in the enzymatic phase of the disease.
Methods. Treatment results of 304 patients with the acute destructive pancreatitis were studied. The indicators of weight level of average molecules and leukocytes intoxication index were used as criteria of endogenous intoxication severity. Complex therapy of 166 patients (the basic group) included using of medical plazmapheresis, in 138 patients (the control group) plazmapheresis wasn't used during treatment. Plazmapheresis had serial character and was applied only in the enzymatic phase of the acute pancreatitis to stop early endogenous intoxications.
Results. It is established that application of serial medical plazmapheresis in the basic group of patients in the early phase of pathological process reduces frequency of purulent complications, mortality from purulent complications and the general mortality.
Conclusions. Plazmapheresis is highly effective, pathogenetically proved method of detoxication in cases of the acute destructive pancreatitis.

Keywords: acute pancreatitis, conservative treatment, plazmapheresis, purulent complications, mortality

p. 46 - 51 of the original issue

References

1. Информационные материалы по неотложной хирургической помощи при острых хиругических заболеваниях органов брюшной полости в Санкт-Петербурге за 2007 год / С. Ф. Багненко [и др.]; С.-Петерб. НИИСП им. И. И. Джанелидзе. – СПб., 2008. – 16 с.
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10. Багненко, С. Ф. Возможности использования плазмафереза при остром деструктивном панкреатите / С. Ф. Багненко, В. Б. Краснорогов, В. Р. Гольцов // Анналы хирург. гепатологии. – 2007. – Т. 12, № 1. – С. 15-22.
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Article in the .pdf format

F.G. NAZYROV, A.V. DEVYATOV, A.H. BABADZHANOV, S.A. RAIMOV

COMPARATIVE ANALYSIS OF THE DISTAL SPLENORENAL ANASTOMOSIS RESULTS IN PATIENTS WITH PORTAL HYPERTENSION

Objectives. To carry out the comparative analysis of opplication results of distal splenorenal anastomosis results in patients with portal hypertension (PH).
Methods. The analysis of distal splenorenal anastomosis opplication results during various periods of PH surgery development in Uzbekistan has been carried out. 285 patients with PH are included in the research.
Results. The results conducted researches have shown that distal splenorenal anastomosis permits on the one hand to decrease the risk of bleedings from the esophageal varicosity dilated veins and on the other hand due to the selective decompressions to create maximal conditions for preservation residual hepatopetal blood flow and thus to reduce frequency of hepatic insufficiency. The introduced original technologies and the detailed approach have allowed to 5,2% decrease lethality during the nearest postoperative period in this category of patients.
Conclusions. On the basis of the conducted researches indications for distal splenorenal anastomosis were optimized taking into account the main risk factors of unfavorable outcome. Advanced tactical-technical aspects of this type of shunting performance permitted to decrease hepatic insufficiency in the early post shunting period up to 8, 2%, encephalopathy – up to 10, 4%, anastomosis thrombosis – up to 2, 6%, bleedings from the varicosity dilated veins of the esophagus and stomach – up to 6, 9%.

Keywords: hepatic cirrhosis, portal hypertension, varicosity dilatation of the esophageal veins, distal splenorenal anastomosis

p. 52 – 59 of the original issue

References

1. Результаты лечения больных циррозом печени после портосистемного шунтирования / Ф. Г. Назыров [и др.] // Хирургия. – 2008. – № 10. – С. 32-35.
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4. Дистальный спленоренальный анастомоз. Хирургический подход к лечению больных сахарным диабетом / Э. И. Гальперин [и др.] // Анналы хирург. гепатологии. – 1999. – № 2. – С. 17-21.
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13. Назыров, Ф. Г. Отдаленные результаты дистального спленоренального анастомоза у больных циррозом печени / Ф. Г. Назыров, А. В. Девятов, Р. А. Ибадов // Анналы хирург. гепатологии. – 2007. – № 4. – С. 36-41.
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16. Индивидуальные особенности ангиоархитектоники спленопортального ствола и ДСРА у больных циррозом печени / Ф. Г. Назыров [и др.] // Хирургия Узбекистана. – 2001. – № 4. – С. 45-51.
17. Клинико-диагностические параллели синдрома спленомегалии у больных циррозом печени с портальной гипертензией / Ф. Г. Назыров [и др.] // Хирургия Узбекистана. – 2005. – № 4. – С. 25-27.

Article in the .pdf format

V.A. SHOTT

A VARIANT OF ANASTOMOSIS FORMATION BETWEEN THE STOMACH AND JEJUNUM AT THE BILLROTH-2 STOMACH RESECTION

Objectives. To evaluate the results of clinical application of the worked out method of anastomosis formation between the stomach and jejunum using the apparatuses of the mechanical suture at Billroth-2 stomach resection.
Methods. A new method of the gastro-jejunal anastomosis formation at Billroth-2 stomach resection was worked out, providing the visual control of hemostasis of mechanical suture line. The analysis of a new operative method application was carried out in 50 patients; dynamics of anastomosis healing at its formation with hand stitch and with a new method was studied as well as the postoperative complications and terms of hospitalization, and distant results of the operation. As a control of the treatment results in were compared 30 patients in whom of Albert-Schmieden hand stitch was applied.
Results. The worked out method of the gastro-jejunal anastomosis formation permits to shorten the time of the intervention. The course of postoperative period is easier at its application. The method allows reducing the number of complications and terms of patients treatment after the operation. In the distant period good and satisfactory results were registered in all operated patients with the use of the given method.
Conclusions. A suggested method of anastomosis formation between the stomach and jejunum during Billroth II stomach resection has a number of advantages in comparison with a traditional one and it can be recommended for widespread clinical use.

Keywords: stomach resection, gastro-jejunal anastomosis, method of formation, intestinal suture

p. 60 – 66 of the original issue

References

1. Основы теории и практики кишечного шва / А. А. Абуховский [и др.]; под ред. А. В. Шотта, А. А. Запорожца. – Минск, 1994. – 176 с.
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3. Золлингер, Р. М. Атлас хирургических операций: пер. с англ. / Р. М. Золлингер (мл.), Р. М. Золлингер (ст.); под ред. В. А. Кубышкина. – М.: ГЕОТАР-Медиа, 2009. – 480 с.
4. Способ формирования соустья культи желудка с тощей кишкой при резекции желудка по Бильрот-2: пат. Респ. Беларусь № 7742; 28.02.06 // Афiцыйны бюл. / ГКНТ: Нац. центр интеллектуал. собственности. – № 1 (48). – С. 42.
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7. Способ наложения кишечного шва: пат. Респ. Беларусь № 8903; 28.02.07 // Афiцыйны бюл. / ГКНТ: Нац. центр интеллектуал. собственности. – №1 (54). – С. 44.
8. Кипель, В. С. Теоретические основы кишечного шва / В. С. Кипель, А. А. Запорожец, А. В. Шотт // Здравоохранение. – 2004. – № 2. – С. 2-6.

Article in the .pdf format

D. F. MYSHLIONAK

THE ROLE OF HYBRID TECHNOLOGIES IN TREATMENT OF PATIENTS WITH MULTISTAGE LOWER LIMBS ATHEROSCLEROTIC LESIONS

Objectives. To study the immediate and distant results of surgical treatment of patients with multistage atherosclerotic lesions of aorto-femoral-popliteal segment.
Methods. The treatment results of 111 patients operated on from 2006 till 2011 in Vitebsk regional clinical hospital were analyzed. Hybrid multistage reconstruction (endovascular intervention on the aorto-iliac segment and open surgery on the femoral-popliteal segment) was performed in 36 (32, 4%) cases. Aortobifemoral reconstructions with deep femoral artery revascularization were performed in 75 cases (67,6%).
Results. Hybrid surgeries showed good immediate and distant results on less traumatism and less complications severity background. Low patients, adherence to the supporting therapy was revealed as well as unsatisfactory control at the ambulatory stage.
Conclusions. Hybrid surgeries may be an effective and safe treatment method that permits to reduce traumatism; it promotes early activation of patients with obtaining good outcomes of treatment. At the ambulatory stage there is no proper angiosurgical monitoring as well as adherence of patients to treatment.

Keywords: atherosclerosis, multistage lower limb lesion, hybrid surgeries, endovascular treatment

p. 67 – 73 of the original issue

References

1. The management of severe aortoiliac occlusive disease: endovascular therapy rivals open reconstruction / Vs. Kashyap [et al.] // J. Vasc. Surg. – 2008. – Vol. 48, N 3. – P. 1451-1457.
2. Тreatment of chronic lower limb ischaemia / St. M. Thomas [et al.] // Vascular and Endovascular surgery / Ed. D. B. Jonathan. – Elsevier, 2006. – 3-rd ed. – P. 35-69.
3. Aortic reconstruction with femoral-popliteal vein: graft stenosis incidence, risk and reintervention / Aw. Beck [et al.] // J. Vasc. Surg. – 2008. – Vol. 47, N 5. – P. 36-43.
4. Combined percutaneous endovascular iliac angioplasty and infrainguinal surgical revascularization for chronic lower extremity ischemia: preliminary result / A. Mousa [et al.] // Vascular. – 2010. – Vol. 18. – P. 71-76.
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6. Hybrid therapy in patients with complex peripheral multifocal steno-obstructive vascular disease: two-year results / Ar. Cotroneo [et al.] // Cardiovasc. Intervent. Radiol. – 2007. – Vol. 30, N 7. – P. 355-361.
7. Bypass surgery or percutaneous transluminal angioplasty to treat critical lower limb ischaemia due to infrainguinal arterial occlusive disease? / Ah. Chong [et al.] // Med. J. – 2009. – Vol. 15, N 10. – P. 249-254.
8. Factors determining late patency of aortobifemoral bypass graft / L. Davidovich [et al.] // J. Celok. Lek. – 1997. – Vol. 125, N 1. – P. 24-35.
9. Clinical success using patient-oriented outcome measures after lower extremity bypass and endovascular intervention for ischemic tissue loss / S. Taylor [et al.] // J. Vasc. Surg. – 2009. – Vol. 50, N 3. – P. 534-541.
10. Harris, P. Aortofemoral bypass and the role of concomitant femorodistal reconstruction / P. Harris, D. Bigley, L. Sweeney // Br. J. Surg. –1985. – Vol. 72, N 3. – P. 17-20.
11. Perioperative outcomes and amputation-free survival after lower extremity bypass surgery in California hospitals, 1996-1999, with follow-up through 2004 / J. Feinglass [et al.] // J. Vasc. Surg. – 2009. – Vol. 50, N 4. – P. 776-783.

Article in the .pdf format

P.N. MYSHENTSEV, B.N. ZHUKOV, S.E. KATORKIN, G.V. YAROVENKO

ROLE OF COMPUTER TOMOGRAPHY IN ESTIMATION OF LYMPHEDEMA STAGE OF THE LOWER EXTREMITIES

Objectives. Elaboration of the lymphedema stage on the basis of comparative analysis of different characteristics of computer-aided tomography of the limbs.
Methods. 44 patients with lymphedema of the lower limbs with primary and secondary etiology were examined. All examinations were performed on the multi-slice CT scanner “Aquilion”, the firm “Toshiba”. Skin thickness, subcutaneous fat size, thickness of subcutaneous fat on 6 levels of extremity were determined. Fibrous changes in subcutaneous fat were estimated by localization, degree, form and abundance.
Results. With rising of the disease severity the tendency towards the increase of skin and subcutaneous fat thickness of limbs is noted in patients; all this is clearly registered on CT scanner. The appearance, spreading and growing of fibrous reorganization of tissues are in direct proportional relationship to the clinic stage of lymphedema. A quantitative determination of the compaction degree of limb tissue is of particular importance.
Conclusions. Application of CT scanner with estimation of qualitative and quantitative characteristics of tissue, especially thickness of subcutaneous fat, permits to determine the stage of the disease of each patient with high reliability.

Keywords: lymphedema of lower limbs, diagnostics, computer tomography

p. 74 – 77 of the original issue

References

1. Лимфедема нижних конечностей: алгоритм диагностики и лечения / О. В. Фионик [и др.] // Новости хирургии. – 2009. – № 4. – C. 49-64.
2. High resolution unenhanced computed tomography in patients with swollen legs / E. D. Monnin-Delhom [et al.] // Lymphology. – 2002. – Vol. 35, N 3. – P. 121-128.
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7. Rockson, S. G. Diagnosis and management of lymphatic vascular disease / S. G. Rockson // J. Am. Coll. Cardiol. – 2008. – Р. 799-806.
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Article in the .pdf format

V.I. PETUKHOV, M.O. RUSETSKAYA

DIAGNOSTICS OF PLEURA EMPYEMA

Objectives. To find out correlation links between the morphological structure of pleural contents and the data of the radiology diagnostics at different stages of the pleural empyema development.
Methods. Analysis of case histories of 81 patients who underwent treatment because of the pleural empyema development during the period from January 2009 to January 2011 was performed. X-ray and computer tomography of the chest organs were done in all patients.
Results. Densitometric parameters of the pleural cavity content density in the patients of the first group composed+8,5 HU (min – + 6,75HU, max – +10,3HU); in the second group – +19 HU (min – +15 HU, max – +24 HU) due to the liquid, gas and organized components; in the third group – +35 HU (min – + 33 HU, max – + 36,3 HU).
Erythrocytes, lymphocytes, macrophages, neutrophils, shadows of the destroyed cells, mesothelium cells, eosinophils, elastic fibers were determined in the cytologic examination of pleural punctate.
Connective tissue of different degrees of maturity and threads of “young” fibrin were revealed in the histological preparations in patients of the second group; areas of fibrous tissue with chronic inflammation and signs of aggravation were revealed in patients of the third group.
Conclusions. Computer tomography provides possibility to differentiate clearly the density of the pleural content and evaluate it in specific densitometric Hounsfield units. Complex radiology investigation of patients including densitometric parameters studying permits to evaluate the degree of pleural contents organization and consequently the process of chronization on the basis of computer tomography method before the operation.

Keywords: pleural empyema, diagnostics, X-ray, computer tomography, densitometric parameters, morphological changes

p. 78 – 83 of the original issue

References

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2. Delayed referral and gram-negative organisms increase the conversion thoracotomy rate in patients undergoing video-assisted thoracoscopic surgery for empyema / D. Lardinois [et al.] // Ann. Thorac. Surg. – 2005. – Vol. 79. – P. 1851-1856.
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4. Колесников, И. Н. Хирургия лёгких и плевры / И. Н. Колесников. – М.: Ленинград, 1988 – 143 с.
5. Путов, Н. В. Болезни органов дыхания / Н. В. Путов, Ю. Н. Левашов. – М.: Медицина, 1989. – 512 с.
6. Власов, В. П. Лучевая диагностика заболеваний органов грудной полости / В. П. Власов. – М.: Видар, 2008. – 376 с.
7. Тюрин, И. Е. Компьютерная томография органов грудной полости / И. Е. Тюрин. – СПб.: Питер, 2006. – 188 с.
8. Sendt, W. Early thoracoscopic debridement and drainage as definite treatment for pleural empyema / W. Sendt, E. Forster, T. Hau // Eur. J. Surg. – 1995. – Vol. 161. – Р. 6-10.
9. Chronic postpneumonic pleural empyema: comparative merits of thoracoscopic versus open decortications / G. Cardillo [et al.] // Eur. J. Cardiothorac. Surg. – 2009. – Vol. 36. – Р. 914-918.
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12. Ris, H. Video-assisted thoracoscopic surgery and open decortication for pleural empyema / H. Ris, T. Krueger // MMCTS. – 2006. – Vol. 109. – Р. 273-276.

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B.S. SUKOVATYKH, YU.YU. BLINKOV, P.A. IVANOV

INDICATIONS, CONTRAINDICATIONS AND TREATMENT TECHNOLOGY OF WIDESPREAD PURULENT PERITONITIS USING IMMOBILIZED FORM OF SODIUM HYPOCHLORITE

Objectives. To determine indications, contraindications and to optimize the abdominal cavity sanitation technology the widespread purulent peritonitis by introduction immobilized forms of sodium hypochlorite.
Methods. The analysis of complex treatment of 180 patients the with widespread purulent peritonitis was carried out; patients were randomized into 2 groups. In the first (control) group 131 patients, undergone surgical treatment according to the traditional technology, were included. The second (main) group consisted of 49 patients treated according to the same technology only that instead of aqueous solution 200 ml of immobilized form of sodium hypochlorite in 5% gel of sodium carboxymethylcellulose was introduced into the abdominal cavity.
Results. Use of the original technology of the abdominal cavity sanitation the first day after the operation permitted to 1,6 times decrease the endotoxemia parameters; 10 days after the operation – 1,8 times decrease the marked character of the postoperative adhesions formation. The number of postoperative complications 2 times decreased as well as postoperative lethality 2,2 times decreased.
Conclusions. The abdominal cavity sanitation by immobilized forms of sodium hypochlorite at peritonitis is pathogenetically grounded and effective.

Keywords: widespread purulent peritonitis, immobilized forms of sodium hypochlorite, indications, contraindications

p. 84 – 89 of the original issue

References

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2. Гостищев, В. К. Перитонит / В. К. Гостищев, В. П. Сажин, А. Л. Авдовенко. – М.: ГЭОТАР-МЕД, 2002. – 238 с.
3. Савельев, В. С. Перитонит / В. С. Савельев, Б. Р. Гельфанд, М. И. Филимонов. – М.: Литера, 2006. – 206 с.
4. Ерюхин, И. А. Хирургический сепсис (дискуссионные аспекты проблемы) / И. А. Ерюхин, С. А. Шляпников // Хирургия. – 2000. – № 3. – С. 44-46.
5. Зубарев, П. Н. Способы завершения операций при перитоните / П. Н. Зубарев, Н. М. Врублевский, В. И. Данилин // Вестн. хирургии. – 2008. – № 6. – С. 110-113.
6. Костюченко, К. В. Принципы определения хирургической тактики лечения распространенного перитонита / К. В. Костюченко, В. В. Рыбачков // Хирургия. – 2005. – № 4. – С. 9-13.
7. Сажин, В. П. Современные тенденции хирургического лечения перитонита / В. П. Сажин, А. П. Авдовенко, В. А. Юрищев // Хирургия. – 2007. – № 11. – С. 36-39.
8. Способ лечения распространенного перитонита: пат. РФ, А61К31/14, А61Р31/04, А61К31/717 / Б. С. Суковатых, Ю. Ю. Блинков, С. А. Ештокин, В. А. Липатов; заявитель Курск. гос. мед. ун-т. – № 2339368; заявл. 26.03.2007; опубл. 27.11.2008 // Открытия Изобрет. – 2008. – № 14. – С. 37.
9. Technique of ultrasonic detection and mapping of abdominal wall adhesions / B. Sigel [et al.] // Surg. Endosc. – 1991. – Vol. 5. – Р. 161-165.

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NEUROSURGERY

A.F. SMEYANOVICH, R.R. SIDOROVICH, А.Е. BARANOVSKY, I.A. SEMAK, O.A. YUDINA

TRAPEZOIDAL MUSCLE TRANSPOSITION METHOD IN REHABILITATION OF PATIENTS WITH BRACHIAL PLEXUS TRAUMATIC DAMAGE OUTCOMES

Objectives. To work out the method of trapezoidal muscle transposition on the front shoulder surface to restore active forearm flexion on the basis of peculiarities studying of its innervation and blood supply.
Methods. Anatomic and topographic study was carried out on 20 anatomic preparations; peculiarities of topography, innervations and blood supply of the trapezoidal muscle were investigated. The method of monopolar transposition of the upper triangle flap of the trapezoidal muscle on the front surface of the upper third of the shoulder with fixation to the proximal part of the paralyzed shoulder bicipital muscle was worked out on the basis of the anatomical and topographic study. Operative intervention with the application of the given method was carried out in 16 patients with the brachial plexus traumatic damage outcomes.
Results. In the first 3-6 months after the operation restoration of the forearm active flexion volume from 60 up to 90° and muscular strength up to M3 (a satisfactory result) was noted in 5 operated patients (31,3%), a negative result of restoration of volume and strength of the forearm active flexion was marked in 11 patients (68,7%). In terms longer than 6 months (10,3±1,3 months) in 6 patients (37,5%) the volume of the forearm active flexion restored up to the angle of 60-90°,muscular strength of flexion up to 3 points (satisfactory result). Negative result was registered in 10 patients (62,5%).
Conclusions. This method can be applied to restore the forearm active flexion in case of other transpositioned muscles denervation; its efficacy made up 37,5%.

Keywords: trapezoidal muscle, brachial plexus trauma, trapezoidal muscle transposition

p. 90 – 95 of the original issue

References

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6. Osteotomy of the humerus to improve external rotation in nine patients with brachial plexus palsy / O. Rhmann [et al.] // Scand. J. Plast. Reconstr. Hand. Surg. – 2002. – Vol. 36. – P. 349-355.
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8. Rouholamin, E. Arthorodesis of the shoulder following plexus brachial injury / E. Rouholamin, J. R. Wootton, A. M. Jamieson // Injury. – 1991. – Vol. 22, N 4. – P. 271-274.
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11. Operative Behandlung und Rehabilitation zur Funktionsverbesserung bei Ausfall der Schultermuskulatur / O. Rhmann [et al.] // Rehabilitation. – 2001. – Vol. 40. – P. 145-155.
12. Saha, A. K. Surgery of the paralyzed and flail shoulder / A. K. Saha // Acta Orthop. Scan. – 1967. – Vol. 97. – P. 5-90.
13. Trapezius-transfer after brachial plexus palsy: indications, difficulties and complications / O. Rhmann [et al.] // J. Bone J. Surg. – 1998. – Vol. 80B. – P. 109-113.
14. Богов, А. А. Тактика хирургического лечения повреждений плечевого сплетения / А. А. Богов, И. Г. Ханнанова // Практ. медицина. – 2008. – № 25. – С. 64-66.
15. Способ восстановления сгибания предплечья и движений плеча в сагиттальной плоскости при тотальном повреждении плечевого сплетения: пат. 6210 Респ. Беларусь, BY 2205 C1, А 61В 17/56 / А. Ф. Смеянович, Р. Р. Сидорович, А. Е. Барановский, И. А. Семак; заявитель Бел. науч.-исслед. ин-т неврологии, нейрохирургии и физиотерапии. – № 950141; заявл. 16.03.95; опубл. 30.06.98 // Афiцыйны бюл. / Нац. цэнтр iнтэлектуал. уласнасцi. – 2004. – № 2 (17). – С. 101.

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UROLOGY

E.SH. KHALILOV, S.A. KRASNY, A.I. ROLEVICH

PREOPERATIVE PROGNOSTIC FACTORS OF BIOCHEMICAL RECURRENCE AFTER RADICAL SURGICAL TREATMENT OF PATIENTS WITH PROSTATE CANCER

Objectives. To identify preoperative prognostic factors of biochemical recurrence (BCR) after surgical treatment of prostate cancer (PC) patients.
Methods. Data on 447 patients with clinically localized and locally-advanced PC who underwent open radical prostatectomy (RPE) in the period between 1997 and 2008 were included in the retrospective analysis. BCR-free survival was calculated by Kaplan-Meyer method. Mono- and multi variant of Cox proportional regression analyses were performed with preoperative variables.
Results. Patients from the low risk group had significantly higher 5-year BCR-free survival comparing to high risk group (71,3±5,2% and 35,8±4,7% respectively). Patients at high risk of BCR were those with prostate specific antigen (PSA) level of 10 ng/ml and more, Gleason‘s score in biopsy 7-10 or PSA 20 ng/ml and more regardless of Gleason‘s score.
Conclusions. The developed prognostic BCR model may optimize treatment tactics of PC patients in the Republic of Belarus.

Keywords: localized, locally-advanced prostate cancer, radical prostatectomy, biochemical recurrence

p. 96 – 101 of the original issue

References

1. Klein, E. A. Surgeon experience is strongly associated with biochemical recurrence after radical prostatectomy for all preoperative risk categories / Е. А. Klein, F. J. Bianco, A. M. Serio // J. Urol. – 2008. – Vol. 179. – P. 2212-2216.
2. Boccon-Gibod, L. Management of prostate specific antigen relapse in prostate cancer: a European Consensus / L. Boccon-Gibod, W. B. Djavan, P. Hammerer // Int. J. Clin. Pract. – 2004. – Vol. 58. – P. 382-390.
3. Moul, J. W. Prostate specific antigen only progression of prostate cancer / J. W. Moul // J. Urol. – 2000. – Vol. 163. – P. 1632-1642.
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5. Natural history of progression after PSA elevation following radical prostatectomy / C. R. Pound [et. al.] // JAMA. – 1999. – Vol. 281. – P. 1591-1597.
6. Kupelian, P. Correlation of clinical and pathologic factors with rising prostate-specific antigen profiles after radical prostatectomy alone for clinically localized prostate cancer urology / P. Kupelian, J. Katcher, H. Levin // J. Urol. – 1996. – Vol. 48. – P. 249-260.
7. Han, M. Long-term biochemical disease-free and cancer-specific survival following anatomic radical retropubic prostatectomy. The 15-year Johns Hopkins experience / M. Han, A. W. Partin, C. R. Pound // Urol. Clin. North Am. – 2001. – Vol. 28. – P. 555-565.
8. San Francisco, I. F. Percent of cores positive for cancer is a better preoperative predictor of cancer recurrence after radical prostatectomy than prostate specific antigen / I. F. San Francisco, M. M. Regan, A. F. Olumi // J. Urol. – 2004. – Vol. 171. – P. 1492-1499.
9. Noguchi, M. Preoperative serum prostate specific antigen does not reflect biochemical failure rates after radical prostatectomy in men with large volume cancers / M. Noguchi, T. A. Stamey, J. E. McNeal // J Urol. – 2000. – Vol. 164. – P. 596-600.
10. Тombal, B. Free/total PSA ratio does not improve prediction of pathologic stage and biochemical recurrence after radical prostatectomy / B. Тombal, M. Querton, P. De Nayer // Urology. – 2002. – Vol. 59. – P. 256-260.
11. Grossfeld, G. D. Predicting Recurrence After Radical Prostatectomy for Patients With High Risk Prostate Cancer / G. D. Grossfeld, D. M. Latini, D. P. Lubeck // J. Urol. – 2003. – Vol. 169. – P. 157-163.
12. Freedland, S. J. Preoperative model for predicting prostate specific antigen recurrence after radical prostatectomy using percent of biopsy tissue with cancer, biopsy gleason grade and serum prostate specific antigen / S. J. Freedland, M. K. Terris, G. S. Csathy // J. Urol. – 2004. – Vol. 171. – P. 2215-2220.

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ANESTHESIOLOGY-REANIMATOLOGY

V.G. PECHERSKY, A.V. MAROCHKOV

FEMORAL NERVE BLOCKADE WITH SMALL DOSES OF THE LOCAL ANESTHETIC

Objectives. To determine minimally effective volume and quantity of lidocaine for the femoral nerve blockade.
Methods. 35 femoral nerve blockades in 35 patients under ultra-sound visualization control with the peripheral nerves electrostimulator were performed. The blockades were done by various volumes of 0,75%, 1%, 1,5%, 2%, 3%, 4% lidocaine solution. The character of the local anesthetic spreading (complete or incomplete wrapping of the femoral nerve) was evaluated during the anesthesia on the ultra-sound apparatus monitor. During 40 minutes after the blockade the quality of the motor and sensor blockode was estimated.
Results. The following minimal lidocaine volumes, at which the compete blockade of the sciatic nerve was achieved, have been estimated: 0,75% of the solution– 10 ml; 1% – 7,5 ml; 1,5% – 5ml; 2% – 5ml.
Conclusions. Minimal volume of the local anesthetic solution when an effective femoral nerve blockade can be obtained is 5 ml, and minimal lidocaine volume is 75 mg.

Keywords: femoral nerve blockade, lidocaine, local anesthetic minimal volume, ultra-sound visualization

p. 102 – 105 of the original issue

References

1. Дюк, Дж. Секреты анестезии: пер. с англ. / Дж. Дюк. – М.: МЕДпресс-информ, 2005. – 511 с.
2. Кузин, М. И. Местное обезболивание / М. И. Кузин, С. Ш. Харнас. – М.: Медицина, 1993. – 224 с.
3. Марочков, А. В. Эффективность и безопасность регионарной анестезии периферических нервов и сплетений / А. В. Марочков, А. Н. Бордиловский, А. И. Евсеенко // Новости хирургии. – 2007. – № 4. – С. 96-102.
4. Малрой, М. Местная анестезия: ил. практ. рук.: пер. с англ. / М. Малрой. – М.: БИНОМ. Лаборатория знаний, 2003. – 301 с.
5. Рафмелл, Дж. Р. Регионарная анестезия: самое не обходимое в анестезиологии: пер. с англ. / Дж. Р. Рафмелл, Д. М. Нил, К. М. Вискоуми. – М.: МЕДпресс-информ, 2007. – 272 с.
6. Chelly, J. E. Peripherial nerve blocks: a color atlas. / J. E. Chelly. – 3-rd ed. – Wolters Kluwer/Lippincott Williams & Wilkins, Philadelphia, 2009. – 394 р.
7. Van Geffen, G. J. The value of ultrasonography for performing peripheral nerve blocks. Theory, practice and clinical experience in adults and children / G. J. van Geffen. – Optima Grafische Communicatie, Rotterdam, 2008.

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P.A. LYUBOSHEVSKY, A.M. OVECHKIN, A.V. ZABUSOV

THE ROLE OF EPIDURAL ANAESTHESIA IN LIMITATION OF PERIOPERATIVE HAEMOSTASIS DISTURBANCES AT ABDOMINAL SURGERIES

Objectives. To estimate haemostasis system changes at the abdominal surgeries depending on an anesthesia method.
Methods. 140 patients undergone the scheduled upper- abdominal surgeries were included into the research. Patients were allocated into two groups: only total intravenous anesthesia (n=70) or general anesthesia combined with epidural analgesia (n=70). The quality of postoperative pain relief, concentrations of glucose and cortisol, coagulation and platelets aggregation indexes were investigated. The frequency of hemotransfusions and complications connected with haemostasis disturbances were also analyzed.
Results. It was established that epidural anesthesia and analgesia provided more adequate postoperative pain relief and limited increase of glucose and cortisol concentration during and after surgery. In both groups activation of coagulation and platelet aggregation with acceleration of fibrinolysis was marked. These changes were significantly less marked at epidural group. Frequency of blood transfusions at epidural anesthesia was lower and this probably is connected with restriction of fibrinolysis activation.
Conclusions. Epidural anesthesia at the upper-abdominal surgeries limits changes of haemostasis and reduces requirement for blood transfusions

Keywords: abdominal surgery, epidural anesthesia, haemostasis, blood transfusion

p. 106 – 111 of the original issue

References

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2. Овечкин, А. М. Спинальная и эпидуральная анестезия в хирургии: клиническое значение и влияние на исход лечения / А. М. Овечкин // Регионарная анестезия и лечение острой боли. – 2006. – Т. 1, № 1. – С. 16-24.
3. Небылицин, Ю. С. Диагностика тромбоза глубоких вен нижних конечностей / Ю. С. Небылицин, С. А. Сушков // Новости хирургии. – 2007. – № 3. – С. 45-56.
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5. Intraoperative thoracic epidural anaesthesia attenuates stress-induced immunosuppression in patients undergoing major abdominal surgery / O. Ahlers [et al.] // British Journal of Anaesthesia. – 2008. – Vol. 101, N 6. – P. 781-787.
6. Влияние анестезии и антикоагулянтной профилактики на возникновение послеоперационных тромбоэмболических осложнений у ортопедических больных / М. И. Неймарк [и др.] // Анестезиология и реаниматология. – 2006. – № 2. – С. 35-38.
7. Effects of epidural-and-general anesthesia combined versus general anesthesia alone on the venous hemodynamics of the lower limb. A randomized study / K. T. Delis [et al.] // Thrombosis & Haemostasis. – 2004. – Vol. 92, N 5. – P. 1003-1011.
8. Epidural anesthesia prevents hypercoagulation in patients undergoing major orthopedic surgery / M. W. Hollmann [et al.] // Regional Anesthesia and Pain Medicine. – 2001. – Vol. 26, N 3. – P. 215-222.
9. The effects of local anesthetics on perioperative coagulation, inflammation, and microcirculation / K. Hahnenkamp [et al.] // Anesthesia & Analgesia. – 2002. – Vol. 94. – P. 1441-1147.
10. Роль спинально-эпидуральной анестезии в профилактике интраоперационной кровопотери при операциях на брюшном отделе аорты / С. И. Ситкин [и др.] // Регионарная анестезия и лечение боли: сб. науч. ст. / под ред. А. М. Овечкина, С. И. Ситкина. – Тверь: Триада, 2004. – С. 210-213.
11. Загреков, В. И. Влияние уровня артериального давления на кровопотерю при операции эндопротезирования тазобедренного сустава / В. И. Загреков, И. Ю. Ежов // Новости хирургии. – 2010. – Т. 18, № 4. – С. 82-90.

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OPHTHALMOLOGY

T.A. IMSHENETSKAYA, I.I. MALINOVSKAYA

EFFICACY OF BEVACIZUMAB INTRAVITREAL INJECTION AT REFRACTORY DIABETIC MACULAR EDEMA TREATMENT

Objectives. To estimate both efficacy and safety of bevacizumab intravitreal injection in patients with refractory diabetic macular edema.
Methods. Randomized trial of 160 eyes of 82 patients with refractory diabetic macular edema has been carried out. Patients in whom intravitreal injections of 1, 25 mg in 0, 05 ml of bevacizumab were done composed the main group (61 eyes). In the given group ophthalmological examinations were performed on the 2nd, 4th, 8th, 12th, 16th, 20th and 24th weeks of observation and further they were carried out every 3 months up to the end of the observation period. Control group of patients (99 eyes) were subjected to repeated sessions of focal laser coagulation with ophthalmological examinations before the procedure.
Results. Clinical trials have determined that a new method of treatment reliably permits to decrease central thickness of the retina and to increase visual acuity in comparison with control group of patients
Conclusions. Intravitreal injection of bevacizumab is an effective and safe method of patients with refractory diabetic macular edema treatment; it permits in short time to reduce the retina edema, to stabilize or to increase patients, visual acuity and it also contributes to regression of the retina neovascularization.

Keywords: diabetic macular edema, inhibitors of vascular endothelial growth factor, antiangiogenic therapy

p. 112 – 117 of the original issue

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LECTURES, REVIEWS

V.T. MALKEVICH, I.A. ILYIN

PLACE OF COLONIC ESOPHAGOPLASTY IN SURGICAL TREATMENT OF ESOPHAGEAL CANCER

The article is dedicated to the urgent problem of oncology, namely, reconstructive surgical treatment of esophageal cancer. Historical review of the colonic esophagoplasty is presented. The anatomical conditions of esophagoplasty are shown. A diverse range of operational approaches is determined. Past experience shows that the number of patients in a deficit of plastic material needs to be reconstructed, where the intestine transplant will act as the plastic material.
The modern trend of reconstructive surgery of esophageal cancer is on the way of intraoperative prophylaxis and prevention of ischemic complications. Recently, in connection with the development of microsurgical techniques various options for revascularization of the graft by applying a microvascular anastomosis between the crossed vessels of the graft and donor vessels have been developed, which permits to create an additional source of blood supply and to ensure the adequate circulation.

Keywords: esophageal cancer, esophagoplasty, colonic graft, revascularization

p. 118 – 127 of the original issue

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Article in the .pdf format

E.V. SHAYDAKOV, O.I. TSAREV

THROMBOLYSIS IN TREATMENT OF THE LOWER LIMBS DEEP VEINS ACUTE TROMBOSIS

Today study of development dynamics and course of acute thrombosis of deep veins (TDV) in experiment, randomized comparisons of thrombolysis and thrombectomy with anticoagulant therapy proves the thesis that treatment strategy aimed to remove thrombus decreases the marked character of post thrombotic changes. The literature review with justification of the role and place of catheter thrombolysis in TDV treatment is presented in the article. It is proved that early thrombus removal from the main veins permits not only to decrease significantly the risk of post thrombotic disease (PTD) development but also to improve the life quality of patients.

Keywords: venous thrombosis, thrombolysis, thrombectomy

p. 128 - 137 of the original issue

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Article in the .pdf format

A.A. LITVIN, V.M. KHOKHA, V.N. LURYE

CURRENT TRENDS IN SURGICAL TREATMENT OF ACUTE NECROTIZING PANCREATITIS AND INFECTED PANCREATIC NECROSIS

Current trends in the surgical treatment of acute necrotizing pancreatitis and infected pancreatic necrosis are revealed in the review article. The authors analyze the options of “open” and minimally invasive treatment of severe acute pancreatitis and its septic complications. Current trends in the surgical treatment of acute necrotizing pancreatitis and infected pancreatic necrosis are: minimally invasiveness; performing of operations at a later date; types of an operation and drainage are determined by the predominance of liquid or solid component, pancreatic or peripancreatic necrosis, the appearance of acute fluid collection or acute post-necrotic collection; enhancing the role of ultrasound, CT, MRI; step-up surgical approach.

Keywords: acute necrotizing pancreatitis, infected pancreatic necrosis, surgical treatment

p. 138 – 146 of the original issue

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EXCHANGE OF EXPERIENCE

F.I. MAKHMADOV, K.M. KURBONOV, K.R. KHOLOV, S.T. NAZIPOV

POSSIBILITIES OF ENDOSCOPIC TECHNOLOGIES APPLICATION IN DIAGNOSTICS AND TREATMENT OF THE LIVER ECHINOCOCCOSIS

Objectives. To improve the quality of diagnostics and treatment of the liver echinococcosis by using endoscopic technologies.
Methods. Video laparoscopic interventions were carried out in 69 (27, 9%) patients at the age of 16 up to 66 with the liver echinococcosis. They are presented in three types of technologies: laparoscopic hydatidectomy (17 patients), endovideoscopy of the residual cavity at traditional liver hydatidectomy (49 patients), transfistula endovideoscopy of the residual cavity (3 patients). In 3 cases of the complicated echinococcosis, percutaneous puncture under ultrasound control was done. Comparison of the results of different types of the operative treatment was done on the basis of analysis of the number of postoperative complications cases, duration of patients hospitalization and the recurrences number.
Results. It was found out that endoscdopic interventions application permits to evaluate the qualitative parameters of the hydatid cyst as well as to optimize the treatment tactics. Evaluation of the nearest and distant results showed that endovideosurgical interventions permit to decrease the number of complications, to reduce the terms of hospitalization and to accelerate their rehabilitation.
Conclusions. Endoscopic technology application in the form of video laparoscopy, diagnostics and treatment endovideoscopy of the residual cavity in the intra- and postoperative periods allows improving the diagnostics quality and treatment results of patients with the liver echinococcosis.

Keywords: liver echinococcosis, surgical treatment, laparoscopic hydatidectomy, videoendoscopy of the residual cavity, transfistula videoendoscopy

p. 147 - 150 of the original issue

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