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Year 2014 Vol. 22 No 3
A HEART OF SURGEON. PROFESSOR A.M. AMINEV (1904-1984 YRS.)
SBEE HPE “Samara State Medical University”
The Russian Federation
The article is devoted to the outstanding surgeon, talented scientist, outstanding teacher, doctor of medical sciences, professor of Samara (Kuibyshev) Medical University Alexander Mikhailovich Aminev. Having all features of a scientist, fine general and medical education, deep knowledge of the basic sciences, large power of observation and critical intelligence, professor A.M. Aminev engaged not only in clinical surgery. The traumatology, orthopaedics, phlebology, urology, oncology, maxillofacial surgery, neurosurgery, purulent and military-field surgery have been included in the sphere of interests of professor A.M. Aminev. He was interested in dietetics, balneology and the history of medicine. Professor A.M. Aminev is one of the pioneers in the application of the endoscopic technique in Russia. He was the first to develop the technique and perform the laparoscopic liver biopsy, liver injury tamponade with the omentum, removal of foreign body from the abdomen, dissection of adhesions. Professor A.M. Aminev is one of the founders of coloproctology in Russia. Under his supervision a comprehensive study of the rectum and colon diseases, the methods of diagnosis, conservative and surgical treatment have been carried out. Following strictly scientific direction in surgery and high moral values, professor A.M. Aminev trained a pleiad of learners and occupied an honored place in the history of Russian surgery.
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443079, Rossiyskaya Federatsiya, g. Samara, pr. Karla Marksa, d. 165 «b», Kliniki Samarskogo gosudarstvennogo meditsinskogo universiteta, kafedra i klinika gospitalnoy khirurgii,
Katorkin Sergey Evgenevich
Katorkin S.E. PhD, an associate professor of the chair and clinic of hospital surgery of SBEE HPE “Samara State Medical University”
THE ASSESSMENT OF EFFICIENCY OF TOURNIQUET APPLICATION AS A COMPONENT OF THE FIRST AID AT CRUSH SYNDROME. REPORT 1: THE CHANGES OF BIOCHEMICAL PARAMETERS
EE “Belarusian State Medical University”,
The Republic of Belarus
Objectives. To assess the effectiveness of tourniquet application as a component of the first aid in crush syndrome on the basis of blood biochemical parameters.
Methods. The work is based on the experimental modeling a crush syndrome of moderate severity by the method developed by the author (compression is 25 kg/cm2 on the area of 6 cm2 on pelvic limb for 5 hours) in rabbits. In the main group, in contrast with the comparison group, after the removal of compression on the injured limb a tourniquet was applied for 1,5 hours. To estimate the tourniquet influence on local and system changes the 2-fold venous blood sampling for biochemical study has been performed (in 1,5 and 24 hours after the compression removal).
Results. In the first hours after the injury the rapid restoration of blood flow does not occur in the focus of damage. This is confirmed statistically by insignificant differences in the content of potassium (p=0,17), calcium (ð=0,52), C-reactive protein (ð=0,72) 1,5 hours after the compression removal in the main and comparison groups. First of all it is linked to the microcirculation bed blockage due to the traumatic shock. Moreover the tourniquet applying leads to an increasing limb tissue damage, justifying statistically significant difference between the main and comparison groups in C-reactive protein (ð=0,047), urea (ð=0,01) and creatinine (ð=0,00) in a day after the compression removing.
Conclusions. Any objective signs of tourniquet application efficacy to prevent the development of reperfusion-recirculation in crush syndrome have not revealed. Besides the tourniquet application led to the increase of limb tissue damage and increase of trauma shock severity.
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220034, Respublika Belarus, g. Minsk, ul. Azgura, d. 4, Voenno-meditsinskiy fakultet, kafedra voenno-polevoy hirurgii,
Trukhan Aleksey Petrovich
Trukhan A.P. PhD, an associate professor of the military-field chair of the military-field faculty of EE “BSMU”, lieutenant colonel of medical service.
GENERAL AND SPECIAL SURGERY
L.K. KULIKOV1, O.A. BUSLAEV2, I.M. MIHALEVICH1, S. V. SHALASHOV2, Y.A. PRIVALOV1, V.F. SOBOTOVICH1, A.A. SMIRNOV1
QUALITY OF LIFE OPERATED ON PATIENTS FOR POSTOPERATIVE VENTRAL HERNIA
SBEE APE “Irkutsk State Medical Academy of Postgraduate Education”1,
NSME “Railways Clinical Hospital of JSC RR” 2
The Russian Federation
Objectives. To examine life quality operated on patients for postoperative ventral hernia.
Methods. Quality of life after the planned surgical treatment of postoperative ventral hernias in 367 patients (18-80 yrs) divided into two groups has been studied. Clinical comparison group (173 patients) was operated on according to Shumpelik method and the main group (194 patients) was operated on according to “the cut prosthesis” method. Each group was divided into two subgroups in which all patients were operated on in the variants “Sublay“ and “Inlay“, Shumpelik method and “the cut prosthesis” method. Life quality assessment was performed using the SF-36 questionnaire. The study was conducted in 15 patients from each group, randomly selected three years after the surgery. The physical and psychological components have been evaluated as a final result.
Results. The improvement of the quality of life has occurred in terms of physical health component in all comparison groups, mainly due to the domain of role functioning and pain intensity and to a lesser extent due to the general health domain. In the distant period the most pronounced improvement of the life quality was observed in patients with hernias of type W3-W4 operated on “the cut prosthesis” method. In the main group indices of physical and psychological health reliably increased in 1,5 and 1,3 – folds, respectively.
Conclusions. Quality of life after surgical treatment of postoperative ventral hernias increased after all investigated methods of prosthetic plastics. However, in the variant “Sublay“ the methods of “cut prosthesis“ has reliable advantage of life quality in the domains of role functioning due to physical and psychological component, as well as in the domain – the intensity of pain, as for the variant “Inlay“, the methods “cut prosthesis“ has reliable advantage of life quality in the scales of physical and psychological health.
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664079, Rossiyskaya Federatsiya, g. Irkutsk, m-n Yubileynyiy, d. 100, GBOU DPO «Irkutskaya gosudarstvennaya meditsinskaya akademiya poslediplomnogo obrazovaniya», kafedra khirurgii,
Kulikov Leonid Konstantinovich
Kulikov L.K. MD, professor, a head of the surgery chair of SBEE APE “Irkutsk State Medical Academy of Postgraduate Education”.
Buslaev O.A. PhD, a head of the surgical department of NSME “Railways Clinical Hospital of OJSC RR”.
Mihalevich I.M. PhD, a Corresponding member of RAMS, a head of the informatics and informational technologies chair of SBEE APE “Irkutsk State Medical Academy of Postgraduate Education”.
Shalashov S.V. PhD, a surgeon of NSME “Railways Clinical Hospital of OJSC RR”.
Privalov Y.A. PhD, an associate professor of the surgery chair of SBEE APE “Irkutsk State Medical Academy of Postgraduate Education”.
Sobotovich V.F. PhD, an associate professor of the surgery chair of SBEE APE “Irkutsk State Medical Academy of Postgraduate Education”.
Smirnov A.A. PhD, an assistant of the surgery chair of SBEE APE “Irkutsk State Medical Academy of Postgraduate Education”.
O.A. KUDELICH1, G.G. KONDRATENKO1, A.F. PUCHKOV2
THE CHARACTER AND PECULIARITIES OF COMPLICATIONS OF SEVERE ACUTE PANCREATITIS ACCORDING TO THE RESULTS OF PATHOMORPHOLOGICAL RESEARCHES
EE “Belarusian State Medical University”1,
ME “Minsk City Clinical Mortem Bureau” 2,
The Republic of Belarus
Objectives. To identify the rate, character and peculiarities of structural changes in organs and tissues in case of unfavorable outcomes resulted from a severe acute pancreatitis and work out the ways to reduce mortality on this basis.
Methods. The retrospective analysis of protocols of pathomorphological records of the patients (n=255) died from acute pancreatitis or exacerbation of chronic pancreatitis has been performed by continuous method. The local and systemic complications, changes in organs and tissues in the early and late phases of the disease, the peculiarities of contamination and extension of purulent processes have been studied. The complications were allocated into two groups according to the phases of acute pancreatitis. The first group consisted of the patients with complications occurred not more than two weeks after the disease onset (140 deaths, 62,2%), and the second group - the cases with fatal outcomes occurred more than two weeks after the onset of acute pancreatitis (85 deaths, 37,8%).
Results. The extensive pancreatic necrosis was found in the vast majority of cases (214 deaths, 95,1%), partial necrosis of the pancreas was found only in 4,9%. The expressed signs of parapancreatitis was registered in the vast majority of the patients dead from acute pancreatitis (n=203, 90,2%), peritonitis was diagnosed in 146 dead patients (64.9%), and their combination was found in 187 (83,1%) cases. Infected pancreatic necrosis was found in 65 patients (28,9%) died from acute pancreatitis, in other cases (160 patients – 71.1%) the process was aseptic. In the group of patients died in the early period (till 2 weeks from onset) the infection significantly less observed – 17 (12,1%), it was detected more often in the group with the later mortality – 48 (56,5%) cases.
Conclusions. In patients with severe acute pancreatitis lethal outcomes occurring up to two weeks from the onset of the disease were 1,7 – folds more often than in the late period. Peritoneal and retroperitoneal fluid collections was a specific and constant feature in the patients died from acute pancreatitis in the early period of the disease.
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220116, Respublika Belarus, g. Minsk, pr. Dzerzhinskogo d.83, UO «Belorusskiy gosudarstvennyiy meditsinskiy universitet», 1-ya kafedra khirurgicheskih bolezney,
Kudelich Oleg Arkadevich
Kudelich O.A. A post-graduate student of the 1st chair of surgical diseases of EE “Belarusian State Medical University”.
Kondratenko G.G. MD, professor, a head of the 1st chair of surgical diseases of EE “Belarusian State Medical University”.
Puchkov A.F. A chief of ME “Minsk City Clinical Mortem Bureau”.
A.V. FAMIN1, À.À. KIRPIHCENKO1, F.A. FAMIN2
THE TYPES OF ATTITUDE TOWARDS DISEASE AND QUALITY OF LIFE IN PATIENTS WITH ACUTE PANCREATITIS
EE “Vitebsk State Medical University” 1,
ME “Vitebsk Regional Clinical Center of Psychiatry and Narcology” 2
The Republic of Belarus
Objectives. To analyze the attitude types towards disease of patients with acute pancreatitis, quality of life and correlation between the disease and alcohol factor to justify a complex approach to rehabilitation.
Methods. 86 patients with acute pancreatitis were enrolled in the survey. Psychological test survey was carried out by means of the questionnaire “AUDIT“, test CAGE, test “Net LeGo”, technique “The types of attitude towards disease”. Life quality of patients was analyzed using the “The method of life quality evaluation of patients and invalids” NAIF.
Results. The signs testifying in favor of taking alcohol no less than 2-3 times a week were revealed in 80% of patients with acute pancreatitis. In patients related the diseases with alcohol consumption the liver changes have been revealed in 87% of cases, gastric and duodenal mucous changes – in 91%. While analyzing the attitude types towards disease in 58% patients the combined and diffused attitude types towards disease and combination of the adaptive and desadaptive types were found out. The reduction of life quality parameters in patients with desadaptive attitude type towards disease and having alcohol anamnesis was registered. Persons with intermental and diffuse attitude type towards the disease in combination of adaptive and desadaptive type, suffered from comorbidities and changes of the liver and cardiovascular system in 100% of cases.
Conclusions. In patients suffering from acute pancreatitis with the types of reactions to the disease, indicating to stress of psychological and desadaptation, in 60% of the cases symptoms of the disease indicating the relationship with alcohol consumption have been revealed. To improve life quality in patients with acute pancreatitis it is advisable to carry out the rehabilitation measures in combination with normalization of the liver function, achieving the constructive psychological adjustment and correction of alcoholic history.
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210023, Respublika Belarus, g. Vitebsk, pr. Frunze, d. 27, UO «Vitebskiy gosudarstvennyiy meditsinskiy universitet», kafedra fakultetskoy khirurgii,
Fomin Anatoliy Viktorovich
Famin A.V. MD, professor of the faculty surgery chair of EE “Vitebsk State Medical University”.
Kirpihcenko A.A. MD, a head of psychiatry and narcology chair of EE “Vitebsk State Medical University”.
Famin F.A. An intern of ME “Vitebsk regional Clinical Center of Psychiatry and Narcology”.
Y.T. TSUKANOV, V.N. NIKITIN
THE TREATMENT RESULTS OF PATIENTS WITH PERFORATED ULCERS AND CICATRICIAL DEFORMITY OF THE PYLORODUODENAL ZONE
SBEE HPE “Omsk State Medical Academy”,
The Russian Federation
Objectives. The assessment of treatment results of patients with the perforated ulcer at prestenotic scar deformity with application of perforation suturing with the original “two-layer” continuous suture and individualization of the post-operative treatment based on the ultrasound monitoring.
Methods. 101 patients were enrolled into the prospective study. In 50 (49,5%) of them the perforation suturing was performed with the original “two-layer” continuous suture, in 51 (50,5%) – with double-row suture one. Based on the results of endoscopic and ultrasound monitoring the comparison of ulcer healing process with the determination of dynamic changes of trophic disorders index has been performed.
Results. The worked out method of the perforation suturing permits to shorten time of the ulcerous defect healing in 1,7– folds due to the reduction of the perifocal inflammation volume in 10,9-folds and prevalence of the ulcerous defect scarring on the linear type in 4,9-folds as well as it reduced the risk of a scarring deformation in 1,3-folds in the distant period. An average score according to the Visick scale made up 4,7±0,5 in the main group, 6,5±0,8 (p=0,049) – in the comparison group that testifies to a greater satisfaction in the long-term period in the main group.
The designed method of the ultrasound monitoring of gastric and intestinal wall wound healing after the operation on the pyloroduodenal segment allows carrying out a noninvasive monitoring of ulcer healing status in dynamics. Index of trophic disorders provides a quantitative assessment healing and allows influencing timely their deviation from the norm, reaching the individualization of postoperative treatment.
Conclusions. Application of the methods of perforation suturing with the use of the two-level contiguous stitch and ultrasound monitoring of ulcer healing status permits to correct treatment program timely and reasonably and decrease the complication rates.
- Chernousov AF, Khorobrykh TV, Chernousov FA, Zharov AA. Iazvennaia bolezn' zheludka i rak (mify i real'nost') [Peptic ulcer and cancer (Some myths and reality)]. Vestn Khirurg Gastroenterologii. 2006;(1):4-10.
- Grishin IN, Bordakov VN, Lobko PI. Funktsional'nye i organicheskie stenozy piloroduodenal'nogo kanala [Functional and organic pyloroduodenal stenosis of the canal]. Minsk, RB: Vysheishaia Shkola; 2011. 319 p.
- Lau JY, Sung J, Hill C, Henderson C, Howden CW, Metz DC. Systematic review of the epidemiology of complicated peptic ulcer disease: incidence, recurrence, risk factors and mortality. Digestion. 2011;84(2):102–13.
- Malkov IS, Tagirov MR, Salakhov EK, Filippov VA. Vybor metoda lecheniia perforativnykh duodenal'nykh iazv [The choice of treatment of perforated duodenal ulcers]. Meditsinskii Al'manakh. 2012;(2):150–153.
- Lui FY, Davis KA.Gastroduodenal perforation: maximal or minimal intervention? Scand J Surg. 2010;99(2):73–77.
- Krylov NN. Perforativnaia iazva: patomorfoz, kollizii i trendy [Perforated ulcer: pathomorphosis, conflicts and trends]. Vrach. 2012;(1):15–20.
- Wang YR, Richter JE, Dempsey DT.Trends and outcomes of hospitalizations for peptic ulcer disease in the United States, 1993 to 2006. Ann Surg. 2010 Jan;251(1):51–58.
- Gorskii VA, Shurkalin BK, Faller AP, Leonenko IV, Medvedev SS, Andreev SS. Problema nadezhnosti kishechnogo shva pri peritonite i kishechnoi neprokhodimosti [The problem of solidity of intestinal suture with peritonitis and intestinal obstruction]. Trudnyi Patsient. 2005;(4):18–23.
- Onopriev VI, Voskanian SE, Ponkina ON. Khirurgicheskaia gistotopografiia oslozhnennyi duodenal'nykh iazv [Surgical histotopography complicated duodenal ulcers]. Krasnodar, RF: Gruppa B; 2006. 297 p.
- Gostishchev VK, Evseev MA, Golovin RA. Radikal'nye operativnye vmeshatel'stva v lechenii bol'nykh s perforativnymi gastroduodenal'nymi iazvami [Radical surgery in the treatment of patients with perforated gastroduodenal ulcers]. Khirurgiia. 2009;(3):10–16.
- Bertleff MJ, Lange JF. Perforated peptic ulcer disease: a review of history and treatment. DigSurg. 2010 Aug;27(3):161–69.
- Lemeshko ZA, Osmanova ZM. Ul'trazvukovaia diagnostika zabolevanii zheludka: ruk dlia vrachei [Ultrasound diagnosis of gastric disorders: a handbook for physicians]. Moscow, RF: GEOTAR-Media, 2009. 80 p.
- Tsukanov IuT, Nikitin VN, Nikolaichuk AI, Klipach SG, Iovova NI. Nenatiazhnaia plastika perforativnogo otverstiia piloroduodenal'nykh iazv s primeneniem dvukhurovnevogo nepreryvnogo shva bez zakhvata slizistoi [Tension-free plasty of perforated holes of pyloroduodenal ulcers using bilevel continuous suture without capturing the mucous]. Vestn Khirurg Gastroenterologii. 2011;(4):53–61.
- Tsukanov IuT, Nikitin VN, Mikhailenko SI, Nikolaichuk AI. Primenenie UZI v diagnostike i posleoperatsionnom monitoringe piloroduodenal'noi zony pri probodnoi iazve [Application of ultrasound in the diagnosis and postoperative monitoring of pyloroduodenal zone in perforated ulcer]. Vestn Khirurg Gastroenterologii. 2012;(1):27–32.
- Afendulov SA, Zhuravlev GIu. Khirurgicheskoe lechenie bol'nykh iazvennoi bolezn'iu [Surgical treatment of patients with peptic ulcer]. Moscow, RF: GEOTAR-Media, 2008. 336 p.
644043, Rossiyskaya Federatsiya, g. Omsk, ul. Lenina, d. 12, GBOU VPO «Omskaya gosudarstvennaya meditsinskaya akademiya MZ RF», kafedra khirurgicheskih bolezney i urologii PDO,
Nikitin Vyacheslav Nikolaevich
Tsukanov Yu.T. MD, professor, a head of the surgical diseases and urology chair of SBEE HPE “Omsk State Medical Academy of MH of RF”.
Nikitin V.N. PhD, an assistant of the surgical diseases and urology chair of SBEE HPE “Omsk State Medical Academy of MH of RF”.
P.V. GARELIK, O.I. DUBROVCHIK, I.S. DOVNAR, I.T. TSILINDZ
PERFORATED GASTRODUODENAL ULCERS: A VIEW ON THE ISSUE OF CHOOSING A SPECIFIC SURGICAL APPROACH
EE “Grodno State Medical University”,
The Republic of Belarus
Objectives. To carry out a retrospective treatment analysis of patients operated on the perforated gastroduodenal ulcers.
Methods. Operative treatment results of 116 patients with perforated gastroduodenal ulcers during the period 2007-2013 yrs. have been investigated. The perforated ulcer localized in duodenum in 98 (84,5%) of patients; gastric ulcers – in 18 (15,5%). Repeated perforation of duodenal ulcer was presented in 4 patients (3,4 %). The peritonitis was presented in all cases: it was generalized in 82 (77,7 %) patients, local unlimited – in 28 (24,1 %), local limited – in 6 (5,2 %).
Results. The choice of a specific surgical approach at perforated ulcers was carried out on the basis of many factors: duration of ulcer anamnesis, results of conservative treatment, ulcer location, the form of peritonitis, accompanying diseases, etc. Suturing ulcer was performed in 73 (62,9%) cases. Sixty cases of perforations were located in the duodenum and only thirteen – in the stomach, 50 (43,1%) of them were operated laparoscopically. Excision of the perforated ulcer with pyloroplasty and truncal vagotomy was conducted in 38(30,2%) patients at the gastric/pyloric and duodenal ðerforation location. Judd pyloroplasty was added in 23 cases, Finney pyloroplasty – in 14, Heineke-Mikulicz pyloroplasty – in 1. Gastric resection was made in 5 (4,3%) patients with chronic callous gastric ulcers. Postoperative lethality rate was 2,6%.
Conclusions. The main method of surgical treatment of perforation is considered to be the suturing ulcers, which at present is mainly possible to be performed laparoscopically. It is possible to perform other surgical operations, but each of them must be carried out according to the strict indications.
- Gostishchev VK, Evseev MA, Golovin RA. Perforativnye gastroduodenal'nye iazvy: vzgliad na problemu [Perforated gastroduodenal ulcers: a look at the problem]. Rus Med Zhurn. 2005;13(25):1663–67.
- Grinev MV, Plotnikov IuV. Konferentsiia Sostoianie ekstrennoi khirurgicheskoi pomoshchi v Sankt-Peterburge [Conference. State of emergency surgery in Saint- Petersburg]. Vestn Khirurgii im II Grekova. 2012;171(3):102-105.
- Gostishchev VK, Evseev MA, Golovin RA. Radikal'nye operativnye vmeshatel'stva v lechenii bol'nykh s perforativnymi gastroduodenal'nymi iazvami [Radical surgery in the treatment of patients with perforated gastroduodenal ulcers]. Khirurgiia. Zhurn im NI Pirogova. 2009;(3):10–6.
- Evseev ME, Golovin RA, Ivakov GB. Distal'naia rezektsiia zheludka v neotlozhnoi khirurgii gastroduodenal'nykh iazv [Distal gastrectomy in emergency surgery of gastroduodenal ulcers]. Moscow, RF: 2008. 160 p.
- Bagnenko SF, Kurygin AA, Sinenchenko GI, Demko AE, Peregudov SI. Sochetannye oslozhneniia iazvy dvenadtsatiperstnoi kishki i ikh khirurgicheskoe lechenie [Combined complications of duodenal ulcers and their surgical treatment]. Vestn Khirurgii im II Grekova. 2009;(6):12–15.
- Kurygin AA, Rumiantsev VV. Vagotomiia v khirurgicheskoi gastroenterologii [Vagotomy in surgical gastroenterology]. Saint-Petersburg, RF: Gippokrat, 1992. 304 p.
- Nussbaum MS, Schusterman MA. Management of giant duodenal ulcer. Am J Surg. 1985 Mar;149(3):357–61.
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- Strizheletskii VV, Izbasarov RZh. Endovideokhirurgicheskaia tekhnologiia v diagnostike i lechenii perforativnykh gastroduodenal'nykh iazv [Endo-surgical video technology in the diagnosis and treatment of perforated gastroduodenal ulcers]. Vestn Khirurgii im II Grekova. 2009;(3):79–82.
- Siu WT1, Leong HT, Law BK, Chau CH, Li AC, Fung KH, Tai YP, Li MK. Laparoscopic repair for perforated peptic ulcer: a randomized controlled trial. Ann Surg. 2002 Mar;235(3):313–19.
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220034, Respublika Belarus, g. Grodno, ul. Gorkogo, d. 80, UO «Grodnenskiy gosudarstvennyiy meditsinskiy universitet», kafedra obschey khirurgii,
Garelik Petr Vasilevich
Garelik P.V. MD, professor, a head of the general surgery chair, EE “Grodno State Medical University”.
Dubrovschik O.I. MD, professor of the general surgery chair, EE “Grodno State Medical University”.
Dovnar I.S. PhD, an associate professor of the general surgery chair, EE “Grodno State Medical University”.
Tsilindz I.T. PhD, an associate professor of the general surgery chair, EE “Grodno State Medical University”.
THE CORRECTION FOR IMMUNOGLOBULIN AND INTERLEUKIN STATUS IN PATIENTS WITH GENERALIZED PURULENT PERITONITIS
ME “Braslav Central District Hospital”,
EE “Vitebsk State Medical University”,
The Republic of Belarus
Objectives. To study the immunoglobulin and interleukin status in patients with generalized purulent peritonitis in the postoperative period and the ways of its correction by means of citoflavin, the drug containing succinic acid.
Methods. The treatment analysis of 26 patients divided into 2 groups with generalized purulent peritonitis has been performed. The control group (n=12) received a conventional complex treatment and the main group (n=14) received additionally the drug citoflavin. Influence of citoflavin the combined drug containing succinic acid on the levels of immunoglobulins and interleukins in the blood serum of patients with generalized purulent peritonitis has been studied. The concentration of IgG, IgÌ, general IgÀ, secretory IgÀ, TNFa (tumor necrosis factor), IL-1β, IL-4, IL-6, IL in the blood serum were determined by solid-phase enzyme immunoassay.
Results. The expressed changes of immune system characterized by the increase of the secretory IgÀ and TNFa concentration as well as the reduction of IgM, IgG and general IgA levels in the blood serum are registered in patients with generalized purulent peritonitis in the postoperative period. From 1st day of post-operative period the increase of the concentration of both pro-inflammatory (IL-1β, IL-6, IL-8) and anti-inflammatory (IL-10) interleukins on the background of reduction of regulatory mediators (IL-2, IL-4) level has been established. On the 5-7th days those changes have remained testifying to continuing phenomena of the systemic inflammation in conventional therapy whereas in the group where the patients who received citoflavin the study parameters appears to be close to normal.
Conclusions. Including in the complex treatment of patients with generalized peritonitis of the drug containing succinic acid (citoflavin) promotes to normalization of immunoglobulin and interleukin profiles of the blood in the early postoperative period that indicates to the possibility of its application as a metabolic immunoregulator.
- Gostishchev VK. Rasprostranennyi gnoinyi peritonit: kompleksnyi podkhod k lecheniiu [Generalized pyoperitonitis]. Vrach. 2001;(6):32–33.
- Efimenko NA, Rozanov VE, Bolotnikov AI. Immunopatogenez i kontseptsiia sovremennoi immunoterapii peritonita u postradavshikh s tiazheloi sochetannoi travmoi zhivota [Immunopathogenesis and the concept of modern immunotherapy of peritonitis in patients with severe combined abdominal trauma]. Moscow, RF: Avtograf. 2008; 302 p.
- Gain IuM, Leonovich SI. Immunnyi status pri peritonite i puti ego patogeneticheskoi korrektsii [Immune status in peritonitis and ways of its pathogenetic correction]: Rukovodstvo dlia vrachei. Minsk, RB: OOO Iunipress, 2001. 256 p.
- Briskin BS, Khachatrian NN, Savchenko ZI. Immunnye narusheniia i immunokorrektsiia pri intraabdominal'noi infektsii [Immune disorders and immunotherapy with intra-abdominal infections]. Khirurgiia. Zhurn im NI Pirogova. 2004;(2):24–27.
- Kozlov VK. Immunopatogenez i tsitokinoterapiia khirurgicheskogo sepsisa [Immunopathogenesis and cytocinematherapy of surgical sepsis]: Posobie dlia vrachei. Saint-Petersburg, RF: Iasnyi svet, 2002. 48 p.
- Lennard TW, Shenton BK, Borzotta A. The influence of surgical operations on components of the human immune system. BrJSurg. 2005;(72): 771–76.
- Gain IuM, Leonovich SI. Immunnyi status pri peritonite i puti ego patogeneticheskoi korrektsii [Immune status in peritonitis and ways of its pathogenetic correction]: Rukovodstvo dlia vrachei. Minsk, RB: OOO Iunipress, 2001. 256 p.
- Chernykh ER, Leplina OIu, Ostanin AA, Zainutdinov IuG, Tikhonova MA, Ovechkin AV, Strel'tsova EI. Khirurgicheskii sepsis. Immunologicheskie markery sistemnoi vospalitel'noi reaktsii [Surgical sepsis. Immunologic markers of systemic inflammation]. Vesti Khirurgii. 2002;(3):101–107.
- Bul'on VV, Khnychenko LK, Sapronov NA, Kovalenko AL, Alekseeva LE, Romantsov MG, Chesnokova NP, Bizenkova MN. Otsenka metabolicheskikh sdvigov pri gipoksii na molekuliarno-kletochnom urovne i vozmozhnosti ikh medikamentoznoi korrektsii [Evaluation of metabolic changes during hypoxia at the molecular and cellular level, the possibility of their medical correction]. Uspekhi Sovr Estestvoznaniia. 2006;(12):29–32.
- Bagnenko SF, Gorbachev NB, Amagyrov VP, Batotsyrenov BV, Miroshnichenko VN, Rinchinov VB, Sergeev OV. Farmakologicheskaia korrektsiia metabolicheskikh narushenii pri razlitom peritonite [Pharmacological correction of metabolic abnormalities in diffuse peritonitis]: Posobie dlia vrachei. Saint – Petersburg, RF: NII skoroi meditsinskoi pomoshchi im Dzhanelidze, 2007. 20 p.
- Bourgoin A1, Leone M, Martin C. Therapeutic management of peritonitis. Med Mal Infect. 2004 May;34(5):183–95.
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- Matveev DV, Sergeeva NA, Gel'fand BR. Narushenie metabolizma pri peritonite: gemodinamika ili kletka [Metabolic disorder in peritonitis: hemodynamics or cell]. Sovet Meditsina. 1991;(8):3–8.
- Afanas'ev VV. Tsitoflavin v intensivnoi terapii [Citoflavin in intensive care]: Posobie dlia vrachei. Saint-Petersburg, RF: 2005. 36 p.
211970, Respublika Belarus, Vitebskaya oblast, g. Braslav, ul. Sovetskaya, d. 138, UZ «Braslavskaya tsentralnaya rayonnaya bolnitsa»,
Matusevich Evgeniy Anatolevich
Matusevich E.A. Deputy Physician on medical affairs of ME “Braslov CDH”, applicant of the hospital surgery chair with urology and pediatric surgery of EE “Vitebsk State Medical University”.
V.I. DEMCHENKO, M.V. KUKOSH, D.L. KOLESNIKOV
THE PLANNED RELAPAROTOMY IN TREATMENT OF PATIENTS WITH MESENTERIC THROMBOSES
SBEE HPE “Nizhniy Novgorod State Medical Academy”
The Russian Federation
Objectives. To evaluate the effectiveness of the planned relaparotomy in the complex treatment of patients with mesenteric thromboses.
Methods. The treatment results of 107 (49 males, 58 females) patients with mesenteric thrombosis admitted to the “City Clinical Hospital N 7” of Nizhny Novgorod during the period from 2005 to 2011yrs. have been analyzed. There were 18 patients up to 60 years, older than 60 years – 89. 35 patients were not operated on due to multiple organ failure, the mortality rate – 100%. 72 patients have been operated on. Depending on treatment the patients were divided into two groups. In the first group (20 patients, 2005-2006 yrs.) the bowel resection with anastomosis creation was performed. In the second group (52 patients, 2007-2011 yrs.) the patients were subjected to the bowel resection with suturing of its ends hermetically (in case of doubt bounds lesion), planned relaparotomies with intestinal viability assessment and anastomosis creation, circadian administration of the anticoagulants and peridural anesthesia. The groups were comparable according to the main values. Assessment of the treatment results was conducted according to the mortality rate.
Results. In the first group 20 patients were operated on, 18 died (mortality – 90%). Three “relaparotomies on demand” were carried out, 2 patients died (mortality – 66,6%). In the second group 52 patients operated on, 32 of them died (mortality – 61,5%). 15 planned relaparotomies were performed, 6 patients died (mortality – 40%). It is established that the application of the delayed anastomosis in the complex treatment of mesenteric thromboses during the early planned relaparotomy is considered to be justified. The reduction of postoperative mortality rate from 90% to 61,5% and general mortality from 93% to 74,4% have been registered.
Conclusions. The conducted study confirmed the effectiveness of the planned relaparotomy assessing viability of bowel and anastomosis performance in the complex treatment of patients with mesenteric thromboses.
- Savel'ev BC, Spiridonov IV, Boldin BV. Ostrye narusheniia mezenterial'nogo krovoobrashcheniia [Acute disorders of mesenteric circulation]. Rukovodstvo po neotlozhnoi khirurgii organov briushnoi polosti. Moscow, RF: Triada-Kh, 2004. 640 p.
- Grigorian RA. Abdominal'naia khirurgiia [Abdominal surgery]. Moscow, RF: Meditsinskoe Informatsionnoe Agenstvo, 2006. 1280 p.
- Debus ES, Diener H, Larena-Avellaneda A. Acute intestinal ischemia. Chirurg 2009 Apr; 80(4):375–385.
- Pokrovskii AV. Klinicheskaia angiologiia [Clinical angiology]. Moscow, RF: Meditsina, 2004. 888 p.
- Bisenkov LN, Zubarev PN, red. Trofimov VM. Neotlozhnaia khirurgiia grudi i zhivota [Emergency surgery of chest and abdomen]: Rukovodstvo dlia vrachei . Saint-Petersburg, RF: Gippokrat, 2002. p. 512.
- Bagdasarova EA, Bagdasarov VV, Ataian AA, Guzoeva LA, Vasil'ev MV. Programmnye reoperatsii pri ostroi intestinal'noi ishemii v usloviiakh peritonita [Planned reoperation in acute intestinal ischemia of peritonitis]. Infektsii v Khirurgii. 2012;10(4):25–33.
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603011, Rossiyskaya Federatsiya, g. Nizhniy Novgorod, ul. Oktyabrskoy revolyutsii, d. 66-a, GOU VPO «Nizhegorodskaya gosudarstvennaya meditsinskaya akademiya», kafedra fakultetskoy khirurgii,
Demchenko Vitaliy Ivanovich
Demchenko V.I. An assistant of the faculty therapy chair of SBEE HPE “Nizhniy Novgorod State Medical Academy”.
Kukosh M.V. MD, professor, a head of the faculty therapy chair of SBEE HPE “Nizhniy Novgorod State Medical Academy”.
Kolesnikov D.L. An assistant of the faculty therapy chair of SBEE HPE “Nizhniy Novgorod State Medical Academy”.
B.S. SUKOVATYKH1, L.N. BELIKOV2, O.A. RODIONOV2, A.O. RODIONOV1
THE CHOICE OF RECONSTRUCTIVE OPERATION AT OCCLUSIVE-STENOTIC LESIONS OF THE ABDOMINAL AORTA, ILEAC AND INFRACLAVICULAR ARTERIES IN HIGH RISK PATIENTS
SBEE HPE “Kursk State Medical University” 1,
RBME “Kursk City Clinical Emergency Hospital”2,
The Russian Federation
Objectives. To study the efficiency of axillofemoral xenoprosthetics in the treatment of the lower limbs critical ischemia in the combined aortic, iliac, infraclavicular lesions in high-risk patients.
Methods. The results of examination and treatment of 45 patients with the lower limb critical ischemia, based on bilateral lesions of aorto-iliac segment of the atherosclerotic etiology have been analyzed. The patients were divided into 2 groups. The first group consisted of 30 patients underwent the typical axillary-femoral bypass by synthetic prosthesis. The second group included 15 patients the axillofemoral xenoprosthesis by the original method with the proximal anastomosis creation between the axillary artery and biological prosthesis of internal thoracic arteries of a bull “end to end” was performed. The formation of a tunnel and conducting the vascular prosthesis in it along the front surface of a body was carried out with the help of a special device, consisting of a metal tube, removable handle and two olives of 10 and 20 mm in diameter. The smaller olive is oriented for making the tunnel from the femoral up to the axillary artery. The bigger olive is needed for extension of the tunnel.
Results. All patients had a high operative-anesthesiological risk due to the severe accompanying diseases in the decompensation stage. The use of the original treatment technology permits in the immediate postoperative period to increase the volume of the blood flow through the shunt in 2-folds, reduce the number of postoperative complications by 10%. In the distant postoperative period the average term of shunt functioning increased in 1,8-folds, the clinical status rose by 26,6% and the number of amputation reduces by 6,7%. No patients both in the first and second groups complained of undue fatigability of the upper limbs, where blood flow was redirected to the ischemic lower limb.
Conclusions. The use of axillofemoral biological xenoprosthesis is pathogenetically grounded for high risk patients with combined occlusive-stenotic lesions of the aorta and iliac and subclavian arteries.
- Pokrovskii AV, red. Klinicheskaia angiologiia [Clinical angiology]: v 2t. Moscow, RF: Meditsina. 2004;(1):808 p.
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- Lemenev VL, Mikhailov IP, Zhulin DV, Iofik VV, Lavrenov VN, Shcherbiuk AA. Operatsiia shuntirovaniia iz otdalennykh sosudistykh basseinov v lechenii kriticheskoi ishemii nizhnikh konechnostei u bol'nykh pozhilogo i starcheskogo vozrasta [Bypass surgery from remote vascular beds in the treatment of critical limb ischemia in elderly patients]. Khirurgiia. Zhurn im NI Pirogova. 2003;(12):27–33.
- Manning BJ1, Agu O, Richards T, Ivancev K, Harris PL. Temporary axillobifemoral bypass as an adjunct to endovascular aneurysm repair using fenestrated stent grafts. J Vasc Surg. 2011 Mar;53(3):867–69
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- Sukovatykh BS, Belikov LN, Rodionov OA, Zaitsev VI, Sukovatykh MB, Kniazev VV, Akatov AL, Rodionov AO, Kursk gos med un-t. Sposob khirurgicheskogo lecheniia kriticheskoi ishemii nizhnikh konechnostei u bol'nykh s tiazhelei soputstvuiushchei somaticheskoi patologiei [The method of surgical treatment of critical limb ischemia in patients with severe concomitant somatic pathology]. Pat RF, A61V ¹ 2390310. Otkrytiia Izobretenii. 2010;(15):35.
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305041, Rossiyskaya Federatsiya, g. Kursk, ul. K. Marksa, d. 3, GBOU VPO «Kurskiy gosudarstvennyiy meditsinskiy universitet», kafedra obschey khirurgii,
Sukovatykh Boris Semenovich
Sukovatykh B.S. MD, professor, a head of the general surgery chair of SBEE HPE “Kursk State Medical University”.
Belikov LN. MD, a head of the vascular surgery department of RBME “Kursk City Clinical Emergency Hospital”.
Rodionov O.A. An intern of the vascular surgery department of RBME “Kursk City Clinical Emergency Hospital”.
Rodionov A.O. An intramural post-graduate student of the general surgery chair of SBEE HPE “Kursk State Medical University”.
V.G. BOGDAN, D.A. TOLSTOV
PROSPECTIVE RANDOMIZED CLINICAL TRIALS OF EFFICIENCY OF AUTOLOGOUS PLATELET-DERIVED CONCENTRATES TO STIMULATE REGENERATION OF TROPHIC ULCERS OF VENOUS ETIOLOGY
EE “Belarusian State Medical University”
The Republic of Belarus
Objectives. To analyze the clinical and social efficiency of the designed method of autologous platelet concentrates (APC) application in the complex treatment of patients with small-sized trophic venous ulcers.
Methods. Short- and long-term treatment results of 58 patients with chronic trophic ulcers of venous etiology have been evaluated. After pathogenetic surgical correction aimed to eliminate the causes of ulcers patients were divided into 2 groups depending on the method of treatment. In the main group to stimulate additionally the repairing of trophic ulcer a combined method of APC use (platelet-rich fibrin matrix (OTFM) and platelet-rich plasma (PRP) have been used. The main complex treatment has been performed in the comparison group. The clinical effectiveness of different treatment option was evaluated by means of the dynamics of changes of the ulcer area, epithelization rate, time of complete ulcer epithelization, duration of hospitalization. Social effect was estimated based on the analysis of life quality according to CIVIQ questionnaire.
Results. The additional use of APC in the complex treatment of patients with trophic venous ulcers was found out to lead to the increased rate of epithelization up to 0,09 (0,04; 0,2) cm2 per day, significant reduction of ulcerous defect in dynamics (p<0,05), decline of complete ulcer healing occurrence (p<0,05) on the 10th day, increase of life quality according to questionnaire CIVIQ on 12,5 points (p<0,05).
Conclusions. The developed method of treating patients with trophic venous ulcers based on a stimulating effect of autologous platelet concentrates is considered to improve the efficiency of complex treatment and achieve a significant social effect in the postoperative period.
- Shevchenko IuL, Stoiko IuM, Lytkina MI, red. Osnovy klinicheskoi flebologii [Fundamentals of clinical phlebology]. Moscow, RF: OAO Meditsina. 2005. p. 246.
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220034, Respublika Belarus, g. Minsk, ul. Azgura, d.4, Voenno-meditsinskiy fakultet v UO «Belorusskiy gosudarstvennyiy meditsinskiy universitet»,
Bogdan Vasiliy Genrihovich
Bogdan V.G. PhD, associate professor, medical colonel, deputy head of the military medical faculty of EE “Belarusian State Medical University” on educational work and research.
Tolstov D.A. An assistant of the military-field surgery chair of the military medical faculty of EE “Belarusian State Medical University”.
M.Y. YURIEVA, Y.S. VINNIK, E.N. ANISIMOVA, A.B. SALMINA, O.V. TEPLYAKOVA, N.G. TRETYAKOVA
THE EFFECT OF SYSTEM OZONE THERAPY ON THE LEVEL OF VON WILLEBRAND FACTOR PRODUCTION IN LOCAL COLD
SBEE “Krasnoyarsk State Medical University named after professor V.F. Voino-Yasnetsky”,
The Russian Federation
Objectives. To study the effect of the systemic ozone therapy on von Willebrand factor antigen content in the blood plasma in patients suffering from local cold injury.
Methods. Sixty patients with a local cold injury (II-IV stages) in the prereactive and early reactive period were enrolled in the study. The first group (n=20) included patients suffering from frostbite, receiving a standard basic treatment. The second group of patients (n=20) along with a basic treatment the intravenous infusions of the ozonated physiological saline solution has been added. The third group was composed of the patients (n=20) received a major ozonated autohemotherapy on the background of basic treatment. The control group consisted of healthy persons (20-60 yrs. old, males and females (n=20). To determine von Willebrand factor antigen level (vWf) in plasma an enzyme-linked immunosorbent assay (ELISA) has been applied.
Results. The von Willebrand factor antigen level in blood plasma of healthy persons (20-60 yrs. old, males and females (n=20) was within 0,69±0,31 IU / ml. The study marker value in patients suffering from frostbite at hospitalization exceeded the same in the control group. On the 10th day the level of the analyzed marker didn’t change significantly on the background of basic treatment (the 1st group). The significant reduction of the vWF was registered in patients receiving systemic ozone therapy on the background of basic treatment (ð<0,0001). Besides, on the 10th day vWF level was significantly lower in patients of the third group receiving a major ozonated autohemotherapy than in patients treated with intravenous infusions of ozonated physiological saline solution.
Conclusions. The application of systemic ozone therapy in complex treatment of patients suffering from local cold injury contributes to reduction of von Willebrand factor antigen level in blood plasma.
- Loban EK, Loban DE. Khirurgicheskaia taktika lecheniia otmorozhenii [Surgical treatment of frostbite]. Novosti Khirurgii. 2010;18(1):141–44.
- Gostishchev VK, Lipatov KV, Komarova EA, Marakutsa EV, Kho BO. Kozhno-plasticheskie operatsii u bol'nykh s otmorozheniiami konechnostei [Dermatology and plastic surgery in patients with frostbite limbs]. Rus Med Zhurn. 2009;17(25):1639–41.
- Shapovalov KG, Sizonenko VA, Tomina EA, Vitkovskii IuA. Endotelial'naia sekretsiia vazoaktivnykh molekul pri kholodovoi travme konechnostei [Endothelial secretion of vasoactive molecules in cold extremities injury]. Travmatol i Ortoped Rossii. 2008;48(2):53–56.
- Smertina EG, Petrova MM, Ionova VG, Tanashian MM, Khalo NV, Shimokhina NIu. Sostoianie funktsii endoteliia i agregatsionnaia aktivnost' trombotsitov v ostrom i rannem vosstanovitel'nom periodakh ishemicheskogo insul'ta [State of endothelial function and platelet aggregation activity in acute and early recovery period of ischemic stroke]. Sib Med Obozrenie. 2008;52(4):56–59.
- Hop C, Guilliatt A, Daly M, de Leeuw HP, Brinkman HJ, Peake IR, van Mourik JA, Pannekoek H. Assembly of multimeric von Willebrand factor directs sorting of P-selectin. Arterioscler Thromb Vasc Biol. 2000 Jul;20(7):1763–68.
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- Shapovalov KG, Vitkovskii IuA. Kollagensviazyvaiushchaia aktivnost' faktora Villebranda i agregatsiia trombotsitov u postradavshikh s otmorozheniiami [Collagen binding activity of von Willebrand factor and platelet aggregation in patients with frostbite]. Voenno-meditsinsk Zhurn. 2010;331(12):18–22.
- Bocci VA, Zanardi I, Travagli V. Ozone acting on human blood yields a hormetic dose-response relationship. J Transl Med. 2011 May 17;9:66..
- Shcherbatiuk TG, Alekhina SP. Ozonoterapiia: klinicheskie i eksperimental'nye aspekty [Ozone therapy: Clinical and experimental aspects]. N. Novgorod, RF: Litera, 2003. 240 p.
- Di Paolo N, Gaggiotti E, Galli F. Extracorporeal blood oxygenation and ozonation: clinical and biological implications of ozone therapy. Redox Rep. 2005;10(3):121–30.
660022, Rossiyskaya Federatsiya, g. Krasnoyarsk, ul. P. Zheleznyaka, d. 1, GBOU VPO «Krasnoyarskiy gosudarstvennyiy meditsinskiy universitet imeni professora V.F. Voyno-Yasenetskogo», kafedra obschey khirurgii,
Vinnik Yuriy Semyonovich
Yurieva M.Yu. A post-graduate student of the general surgery chair of SBEE HPE Krasnoyarsk State Medical University named after professor V.F. Voino-Yasenetsky”.
Vinnik Yu.S. MD, professor, a head of the general surgery chair of SBEE HPE Krasnoyarsk State Medical University named after professor V.F. Voino-Yasenetsky”.
Anisimova E.N. MD, professor, a head of the clinical-laboratory diagnostics chair of SBEE HPE Krasnoyarsk State Medical University named after professor V.F. Voino-Yasenetsky”.
Salmina A.B. MD, professor, a head of the SRI of Molecular Medicine and Pathobiochemistry of SBEE HPE Krasnoyarsk State Medical University named after professor V.F. Voino-Yasenetsky”.
Teplyakova O.V. PhD, an associate professor of the general surgery chair of SBEE HPE Krasnoyarsk State Medical University named after professor V.F. Voino-Yasenetsky”.
Tretyakova N.G. A six-year student of the medical faculty of SBEE HPE Krasnoyarsk State Medical University named after professor V.F. Voino-Yasenetsky”.
V.V. MASLYAKOV1, A.J. DADAEV2, A.Z. KERIMOV2, K.G. KURKIN1
THE IMMEDIATE TREATMENT RESULTS OF THORACIC GUNSHOT INJURY IN CHILDREN
NSEE HPE "Saratov Medical Institute «Reaviz»”1,
FSBEE HPE “Chechen State University” 2, Grozny,
The Russian Federation
Objectives. To study the immediate treatment results of thoracic gunshot injury in children received during the local conflict in the Chechen Republic.
Methods. The analysis of the immediate treatment results of thoracic gunshot injury in 34 children has been carried out. The non-penetrating wounds were detected in 6 children. The victims with penetrating wounds (28 patients) were allocated into two groups. In the first group 21 (75%) patients were enrolled hospitalized during the first hour after an injury. In the second group 7 (25%) victims delivered more over than in one hour after an injury (1,5-8 hours) were enrolled.
Results. Complications in the first group of patients in the nearest postoperative period developed in 9 (42,8%) cases. The main complications: pneumonia and festering of the postoperative wound have been registered in 7 (33,3%) cases. In the nearest postoperative period 6 (28,5%) children died. Causes of death were: hemorrhagic shock – in 2 (9,5%) cases, traumatic shock – in 2 (9,5%), heart tamponade – in 1 (4,7%), sepsis – in 1 (4,7%). In the second group the complications developed in all cases. The main complication was pneumonia which developed in 6 (85,7%) patients. Rethoracotomy was performed in 2 (28,5%) patients with the lungs collapse and empyema. In this group 4 (57,1%) victims died. The cause of death was acute blood loss, hemorrhagic shock – 3 (42,8%) cases and septic shock – 1 (14,2%) case. The treatment and diagnostic algorithm in children with the thoracic gunshot injury have been worked out and it includes the following: pain relief, restoration of the airways passability, puncture or (as it required) adequate drainage of the pleural cavity, cessation of bleeding and reinfusion, infusional, antibacterial and symptomatic therapy.
Conclusions. Treatment results of the thoracic gunshot injury in children depend on the terms of delivery. In case of delivery during the first hours the complications develop in 42,8%, lethality – 28,5%. In case of delivery after more than 1,5 hours complications develop in 100% of cases, lethality makes up 57,1%.
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410012, Rossiyskaya Federatsiya, g. Saratov, ul. Verhniy ryinok, korpus 10, NOU VPO «Saratovskiy meditsinskiy institut «REAVIZ», kafedra klinicheskoy meditsinyi,
Maslyakov Vladimir Vladimirovich
Maslyakov V.V. MD, professor Vice Rector for research and public relations, a head of the clinical medicine chair of NSEE HPE “Saratov Medical Institute «REAVIZ»”.
Dadaev A.J. MD, a head of the hospital surgery chair of FSBEE HPE “Chechen State University”, Grozny.
Kerimov A.Z. PhD, an associate professor of FSBEE HPE “Chechen State University”, Grozny.
Kurkin K.G. A post-graduate student of the clinical medicine chair of NSEE HPE “Saratov Medical Institute «REAVIZ»”.
V.V. ANICHKIN, E.A. POVELITZA, V.V. MARTINUCK
A METHOD OF ATYPICAL LIVER RESECTION WITH ANTIPARASITIC TREATMENT OF HEPATIC TISSUE WITH THE MIXTURE OF GLYCEROL AND 1-2% SOLUTION OF ALBENDAZOLE IN DIMEXIDUM IN PATIENTS SUFFERING FROM HEPATIC ECHINOCOCCOSIS
EE “Gomel State Medical University”,
The Republic of Belarus
Objectives. To work out a new method of the atypical liver resection with the antiparasitic treatment of liver tissue.
Methods. 6 patients suffering from the hepatic echinococcosis underwent the surgery from 2002 to 2013 yrs. are under the survey. All patients underwent a comprehensive examination including clinical, functional, laboratory and instrumental methods of diagnosis. In all cases the diagnosis was verified by morphological examination of surgical material. In surgical treatment of echinococcosis with a parasitic cyst the atypical liver resection was performed. In all cases the surgery was completed with the intraoperative antiparasitic treatment of the liver tissue by the mixture of glycerol and 1-2% solution of albendazole in dimexidum (ratio 2,3:1). Clearance efficacy of germinal cells was assessed by means of the washouts microscopically prior and after antiparasitic treatment. During the postoperative period all patients underwent the generic course of albendazole chemotherapy (the dosage 10-15 mg/kg, the maximum dosage – 800 mg/ per day). Each course lasted for 1 month, the number of courses were no less than 3 per each person.
Results. The stay of patients in hospital varied from 14 to 21 days. The patients receiving the combined treatment (surgical and chemotherapeutic) had good and satisfactory short- and long-term results; there were no relapses of the disease during the period from 3 to 6 years. Cases of surgical complications and deaths were not observed either.
Conclusions. The supplement of atypical liver resection by an intraoperative application of antiparasitic mixture of glycerol and 1-2% solution of albendazole in dimexidum combined with the course of albendazole chemotherapy according to the conventional scheme is a highly effective combination of surgical and chemotherapeutic methods of hepatic echinococcosis treatment, which provides the complete recovery of patients and allows preventing the development of surgical complications and relapse of the disease.
- Vetshev PS, Musaev GKh. Ekhinokokkoz: sovremennyi vzgliad na sostoianie problemy [Echinococcosis: a current view on the issue]. Annaly Khirurg Gepatologii. 2006;11(1):111–17.
- Eckert J, Deplazes P. Biological, epidemiological, and clinical aspects of echinococcosis, a zoonosis of increasing concern. Clin Microbiol Rev. 2004 Jan;17(1):107–35.
- Duseja A1, Dhiman RK2, Chawla Y2, Kalra N3, Behera A4. Giant hydatid cyst of the liver. Trop Gastroenterol. 2013 Apr-Jun;34(2):112–13.
- Concha F, Maguina C, Seas C. Disseminated intra-abdominal hydatidosis. Am J Trop Med Hyg. 2013 Sep;89(3):401–2..
- Symeonidis N, Pavlidis T, Baltatzis M, Ballas K, Psarras K, Marakis G, Sakantamis A. Complicated liver echinococcosis: 30 years of experience from an endemic area. Scand J Surg. 2013 Sep 1;102(3):171–77.
- Bektas H, Lehner F, Werner U, Bartels M, Piso P, Tusch G, Schrem H, Klempnauer J. Surgical therapy of cystic echinococcosis of the liver. Zentralbl Chir. 2001 May;126(5):369–73.
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246050, Respublika Belarus, g. Gomel, ul. Lange, d. 5, UO «Gomelskiy gosudarstvennyiy meditsinskiy universitet», kafedra khirurgicheskih bolezney ¹3 s kursom serdechno-sosudistoy khirurgii,
Martinuck Vasiliy Vladimirovich
Anichkin V.V. MD, professor, professor of the surgical diseases chair ¹3 with the course of the cardiovascular surgery of EE “Gomel State Medical University”.
Povelitza E.A. PhD, an assistant of the surgical diseases chair ¹3 with the course of the cardiovascular surgery of EE “Gomel State Medical University”.
Martinuck V.V. An assistant of the surgical diseases chair ¹3 with the course of the cardiovascular surgery of EE “Gomel State Medical University”.
D.M. KURBANOV, N.I. RASULOV, A.S. ASHUROV
COMPLICATIONS OF LAPAROSCOPIC CHOLECYSTECTOMY
Tajik State Medical University named after Abu Ali ibn Sina, Tajikistan, Dushanbe
The Republic of Tajikistan
The contemporary literature review dealing with the laparoscopic cholecystectomy (LCE) complications is presented in the article. According to the literature data various complications during LCE occur in 0,1-0,6 % of cases. The most frequent complications are: the intersection of the biliary ducts, injuries of large abdominal vessels and the hepatic porta. Risk factors of intraoperative complications are chronic inflammatory infiltrate in the gall bladder and hepato-duodenal ligament, obesity, fat deposits in the lig. hepatoduodenale zone, a poor exposure and visualization in the Calot triangle. The frequency of bile duct (BD) injury during cholecystectomy ranges from 0,22 to 0,86 %. Damaging of arteries during the operation is one of the most difficult types of injuries. The right hepatic artery is damaged more often, the incidence of damage reaches 7%.
The classification of Bismuth-Corlette and E.E. Galperin finds the largest application in case of bile ducts damage. When bile ducts are damaged in many cases Roux biliary-enteric anastomosis, hepaticojejunostomy with transhepatic drainage by Pradery-Smith or Goetze-Saypol-Kurian, and hepatico-jejunostomy by Hepp-Couinaud are considered to be the operation of choice. Frequency of good and satisfactory results in patients with damaged BD at the biliary-enteric anastomoses 46% to 94%. In 50-60% cases the restoration of the coledoch “end -to-end” on the T-type drainage leads to unsatisfactory results.
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734003, Respublika Tadzhikistan, g.Dushanbe, Tadzhikskii gosudarstvennyi meditsinskii universitet imeni Abuali ibni Sino, kafedra operativnoi khirurgii i topograficheskoi anatomii,
Kurbanov Dzhurabek Muminovich
Kurbanov D.M., PhD, associate professor, a head of operative surgery and topographic anatomy of the Tajik State Medical University named by Abu Ali ibn Sina.
Rasulov M.I. A graduate student of operative surgery and topographic anatomy of the Tajik State Medical University named by Abu Ali ibn Sina.
Ashurov A.S., A graduate student of operative surgery and topographic anatomy of the Tajik State Medical University. Abu Ali ibn Sina.
EXCHANGE OF EXPERIENCE
V.V. SELESNEV1, N.S. MIKUTSKI2, P.F. CHERNOGLAZ2,L.G. SHESTAKOVA2, A.S. ZHIGALCOVICH2 , YU.P. OSTROVSKY1
THE URGENT ANGIOSURGICAL PROBLEMS IN CARDIAC SURGERY CLINIC
SEE “Belarusian Medical Academy of Postgraduate Education” 1,
SE RNPC “Cardiology”2 , Minsk,
The Republic of Belarus
Objectives. To evaluate the character and frequency of angiological complications in cardiac surgery clinic after invasive interventional surgeries as well as to determine the measures of their preventions and methods of elimination.
Methods. The work result of the cardiosurgical clinic of Republic Scientific Practical Centre “Cardiology” has been analyzed. During the recent years (2011-2012) 5537 operations on the open heart and major vessels, 2234 coronary angiographies, 804 of coronary artery stenting, 221 stenting of periferal, renal, visceral arteries, 34 stenting of thoracic and abdominal aorta, 103 intraaortic balloon counter pulsation procedures, 18 extracorporeal membrane oxygenation, 10 paracorporeal and implantable heart bypasses, 72 sessions of ultrafiltration of the blood, 9 acute hemodialysis sessions have been performed.
The analyses of reports from the profile departments is carried out as well as of cases history, reports of interventions, procedures, investigations in case of angiological complications development demanding on the operative correction. Such complications as bleeding, strained hematoma, pseudoaneurisms, perforations and thromboses of the vessels have been registered.
Results. During the period 2011-2012 yrs. the frequency of vascular complications after coronary angiography made up the following: 27 of cases (1,2%) – strained thigh hematoma, 2 cases – the shoulder strained hematoma, 19 cases – false aneurysm of the femoral arteries, 5 cases – humeral artery thrombosis (as an access), 1 case of the distal bed embolism. At the stenting of the thoracic and abdominal aorta (34 interventions) 1 complication was registered (2,9%) – perforation of the iliac segment during the delivery system application, eliminated by means of the open intervention such as the defect suturing. The complications requiring surgical correction and associated with intra-aortic balloon counter pulsation have not been registered in 2011-2012 yrs.
Conclusions. In cardiosurgical clinics taken into consideration the character of profile pathology and wide use of intervention methods of diagnostics and treatment the different vascular complications can occur including those dangerous for life demanding on adequate and well-timed surgical correction. To reduction the incidence of complications mentioned above, it is advisable the concentration of the collective efforts of cardiovascular surgeons, endovascular internists, the introduction of current technologies and procuring by highly qualified professionals.
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220036, Respublika Belarus, g. Minsk, ul. R.Lyuksemburg, d. 110, RNPTs «Kardiologiya»,
Mikutskiy Nikolay Stanislavovich
Selesnev V.V. PhD, an associate professor of the cardiac surgery chair of SEE “Belarusian Medical Academy of Postgraduate Education”.
Mikutski N.S. PhD, cardiac surgeon of the 1st cardiac surgery department of SE RSPC “Cardiology”.
Chernoglaz P.F. An endovascular surgeon of the endovascular surgery department of SE RSPC “Cardiology”.
Shestakova L.G. MD, a head of the extracorporeal blood circulation department of SE RSPC “Cardiology”.
Zhigalcovich A.S. PhD, a head of the 1st cardiac surgery department of SE RSPC “Cardiology”.
Ostrovsky Yu.P. Corresponding Member of NAS, MD, professor, a head of the cardiac surgery chair of SEE “Belarusian Medical Academy of Postgraduate Education”, Chief Freelance cardiologist of MOH of RB.
T.K. GVENETADZE1, G.T. GIORGOBIANI1 2, V.SH. ARCHVADZE1, L.O. GULBANI3
PREVENTION OF MALE INFERTILITY DEVELOPMENT AFTER DIFFERENT METHODS OF INGUINAL HERNIA REPAIR WITH THE MESH EXPLANT
Tbilisi State Medical University 1,
“Aversi Clinic” 2, Tbilisi
SEE “Belarusian Medical Academy of Post-Graduate Education” 3, Minsk,
The Republic of Belarus
Objectives. The study and comparison of quantitative composition of spermatozoids prior and after Lichtenstein and Gvenetadze operations.
Methods. For the recent 6 years 1000 patients have been operated on by the isolation method. 215 patients of the reproductive age (19-40 yrs.) with the bilateral inguinal hernias became the object of study. The patients were allocated into two groups. The first group contained those 66 patients (30,7%) who underwent bilateral Lichtenshtein hernia repair. The second group – 149 patients (69,3%) on whom bilateral hernia repairs by Gvenetadze method have been utilized. Complete spermomorphocitological investigations have been performed in all groups 2 days prior to surgery, 30 days and six months after surgery.
Results. Oligospermia, reduction of the quantitative sperm composition by 30-35% was revealed only in the first group (p<0,01). In the second group no significant differences was registered. 68 patients had children after surgery by Gvenetadze method.
Conclusions. Hernioplasty by Gvenetadze prevents male infertility in all cases especially for bilateral inguinal hernia repair as well as in reproductive age. The given technique is more solid as the posterior wall of the inguinal canal presented by the transverse fascia, mesh and aponeurosis of the external oblique muscle therefore the recurrence rates of hernia is minimized and practically excluded. Based on the foregoing results this method is considered as an effective method of hernioplasty as for young as well for elderly patients.
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- Skawran S., Schmits B, Weghe D. Obstructive azoospermia after bilateral endoscopy total extra peritonial inguinal hernia repair- the role of surgeon. Hernia 2009 1(13):25.
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- Peiper C1, Junge K, Klinge U, Strehlau E, Ottinger A, Schumpelick V. Is there a risk of infertility after inguinal mesh repair? Experimental studies in the pig and the rabbit. Hernia. 2006 Mar;10(1):7–12.
- Peiper Ch1, Klinge U, Junge K, Schumpelick V. Meshes in inguinal hernia repair. Zentralbl Chir. 2002 Jul;127(7):573–77. [Article in German]
- Egiev VN. Nenatiazhnaia gernioplastika [Tension -freel hernioplastics]. Moscow, RF; Medpraktika, 2002. 147 p.
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- Trabucco E. Atlas of herniology. Turin, 2006, p.44.
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0160, Gruziya, g. Tbilisi, pr. Vazha-Pshavela, d. 27 b, Klinika «Aversi»,
Gvenetadze Tamaz Kalenikovich
Gvenetadze T.K. MD, professor of the emergency surgery chair ¹2 of Tbilisi State Medical University.
Giorgobiani G.T. MD, professor, a head of the emergency surgery chair ¹2 of Tbilisi State Medical University, clinical director of “Aversi Clinic”.
Archvadze V.Sh. MD, professor of the general surgery chair of Tbilisi State Medical University.
Gulbani L.O. A clinical intern of the surgery chair of SEE “Belarusian Medical Academy of Post-graduate education”.