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Year 2010 Vol. 18 No 3

GALLERY OF THE NATIVE SURGEONS

SUSHKOV S.A., CHEPELKINA O.P., NEBYLITSIN YU.S.

STANISLAV NARBUT. LIFE FOR OTHERS AS VOCATION

The article deals with a talented surgeon, public figure and outstanding person Stanislav Narbut. This name has been forever engraved in the history of Braslav region and in memory of its people. More than 40 years Sranislav Narbut has worked as a doctor and managed to gain love and respect among people. Such features as enormous diligence, tenderness, unselfishness, active civil position helped him to win a great authority among his colleagues, gratitude among common people as well as fame of people’s doctor. The construction of the first-class hospital for those days, surgical and medical activity, love and devotion to his work are the merits which permit to say the following «Giving light for others one burns down himself…» No doubt that all his accomplishments let us say that Stanislav Narbut contributed significantly to the development of Belarusian surgery. His name is by right included in the list of the prominent representatives of the native medicine.

Keywords: Stanislav Narbut, the history of Belarusian surgery
p. 3 – 8 of the original issue
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EXPERIMENTAL SURGERY

ZHIDKOV S.A., KORIK V.E., KLUIKO D.A., TITOVETS E.P.

POSSIBILITIES OF DIRECT OXIMETRY APPLICATION FOR THE PANCREAS STATE EVALUATION AT ACUTE PANCREATITIS IN EXPERIMENT

Objectives. to estimate experimentally the diagnostic significance of the direct oximetry at acute pancreatitis for evaluation of the pancreas state, to reveal the regularities of changes of oxygenation indexes of the affected tissue in various periods of the disease.
Methods. 81 nonlinear cavies were investigated. Experimental animals were accidentally divided into 6 experimental and 2 control groups. The oxygen sensor type Clark was applied to carry out oximetry. Measuring was done throughout different time intervals by all contact methods.
Results. The advantages of the investigated method are in possibility of the quantitative description of the dynamic and statistic parameters of absorption and utilization of oxygen in different phases of the pancreas diseases inflammatory processes passing and they permit to objectify the degree of the pancreas affection.
Conclusion. Acute pancreatitis is accompanied by the marked disturbance of the oxygen absorption rate and change of the degree of the pancreas tissue oxygenation. Measuring of the oxygen absorption rate and the level of the oxygen partial pressure in the investigated organ using the method of the direct oximetry at further studying of the morphological picture may possibly give an idea about the degree of the pancreas parenchyma affection at acute pancreatitis.

Keywords: acute pancreatitis, direct oximetry, oxygenation
p. 9 – 16 of the original issue
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GAIN YU.M., ALEXANDROVA O.S., GAPANOVICH V.N., VLADIMIRSKAYA T.E., SHERSTYUK G.V., VEYALKINA N.N.

OPEN AND CLOSE ABDOMINAL TRAUMA MODELLING, COMPLICATED BY FATAL INTRA-ABDOMINAL HEMORRHAGE WITH THE SIGNS OF HEMORRHAGIC SHOCK AND DIC-SYNDROME

Objectives. To design the experimental models of the fatal intra-abdominal hemorrhage, caused by the abdominal parenchymatous organs trauma, maximally approximating the open and close injuries of these organs in man according to pathogenesis and thanatogenesis. Methods. The experimental models of the open and close abdominal parenchymatous organs (the liver and spleen) trauma have been worked out, at which the mechanical injury of the organs occurs on the background of the prior intravenous injection of heparin in the dose of 750 U per 1 kg of the animal’s weight.
Results. The designed models result in the development of the continuous internal hemorrhage from the injured organs with subsequent development of the hemorrhagic shock and DIC-syndrome the animals, leading to their 100% death in case of medical aid lacking.
Conclusion. The designed models of the open and close traumas of the abdominal parenchymatous organs can be used for the efficacy comparative estimation of various ways of the local and systemic hemostasis; the obtained results will maximally approximate the results while rendering medical aid to the injured in the clinical settings.

Keywords: hemorrhage, local hemostasis, DIC-syndrome, modeling of DIC-syndrome, experimental model, hypocoagulation, trauma of the liver, trauma of the spleen
References
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  11. Назаренко, Г. И. Клиническая оценка результатов лабораторных исследований / Г. И. Назаренко, А. А. Кишкун. – М., 2000. – 544 с.
Address for correspondence:
17 – 25

VOLKOVICH T.K., SAMSONOVA I.V.

EXPERIMENTAL MODEL OF THE BACTERIAL KERATITIS

Objective. To work out the experimental model of the bacterial keratitis approximating to the disease development in man according to clinical, cytological and morphological signs.
Methods. The experimental model of the bacterial keratitis was designed on 25 rabbits by means of the sectional trepanation of the cornea with its subsequent being infected with the bacterial suspension Staphylococcus aureus. The impression cytology of the cornea and histological investigation of the cuts of the eye’s anterior segment were performed to evaluate the pathomorphological changes.
Results. The experimental model of the bacterial keratitis was designed with initiation of the inflammatory process of the conjunctiva, the cornea, the iris and the ciliary body; it is proved by the marked necrotic and necrobiotic changes of the eyeball anterior segment structures.
Conclusion. The designed experimental model of the bacterial keratitis according to its clinical, cytological and histological signs approximates the same in man and can be used for further investigation of the inflammatory process pathogenesis of the cornea and for working out new approaches to its conservative and surgical treatment.

Keywords: bacterial keratitis, cornea, inflammatory process, epithelium, regeneration
p. 26 – 31 of the original issue
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GENERAL AND SPECIAL SURGERY

SACHEK M.G., ERMASHKEVICH S.N.

ERADICATION THERAPY IN PREVENTION AND TREATMENT OF ANASTOMOSITIS IN THE PEPTIC ULCER SURGERY

Objective. To study the connection of H. pylori with the development of the postgastroresectional anastomositis and efficiency of the eradication therapy in its prevention and treatment.
Methods. 63 patients were inspected in the nearest period after gastrectomy because of peptic ulcer disease. The patients were divided into two groups. Revealing H. pylori in both groups was carried out by the histological method; in the first group the determination of H. pylori was done by PCR-method. 46 patients were included in the first group. Eradication of H. pylori wasn’t carried out in them. 17 patients were included in the second group. The preoperative eradication therapy was performed in 16 H. pylori-positive patients. The upper gastrointestinal endoscopy with the biopsy of the anastomosis zone was carried out in all the patients 10–12 days after the operation.
Results. In the first group anastomositis was diagnosed in 15 (32,6%) patients. Highly pathogenic types of H. pylori (сagA vacAs1a/m1a) contributed to the development of anastomositis which severity correlated (rs=0,85; р=0,000028) with the degree of their dissemination of the gastric mucosa. The number of neutrophils in the gastric mucosa in the anastomosis zone was more in H. pylori-positive patients and it also increased with the growth of pathogenic characteristics of H. рylori (presence of genes сagA and vacA, type vacA, the degree of dissemination of the mucosa with H. рylori). In the second group anastomositis was diagnosed in 3 (17,6%) cases. The number of neutrophils in the gastric mucosa in the anastomosis zone in case of H. pylori elimination in the patients without anastomositis approximated their number in H. pylori-negative patients.
Conclusions. Preoperative eradication therapy is an effective method of preventive maintenance of anastomositis in the peptic ulcer surgery.

Keywords: peptic ulcer, partial gastrectomy, anastomositis, Helicobacter pylori, eradication therapy
p. 32 - 46 of the original issue
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  24. Бураков, И. И. Язвенная болезнь, ассоциированная с Helicobacter pylori (патогенез, диагностика, лечение) / И. И. Бураков, В. Т. Ивашкин, В. М. Семенов. – Витебск: ВГМУ, 2002. – 144 c.

TARASENKO A.V., ALEKSEEV S.A.

EXPRESS DIAGNOSTICS OF THE IMMUNITY Т-CELL COMPONENT STATE AND DYNAMIC IMMUNOCORRECTING THERAPY AT ACUTE DESTRUCTIVE PANCREATITIS

Objectives. To work out the express estimation methods of the immune disturbances with the use of the combined intradermal tests at acute destructive pancreatitis and to propose the ways of immunocorrection.
Methods. 21 patients (the 1st group) with acute destructive pancreatitis (conventional therapy) and 19 patients (the 2nd group) with acute destructive pancreatitis (modern immunomodulators were used in the complex treatment) were examined. 7–8 days after treatment «triple» intradermal tests and immunological monitoring were performed. The incidence of purulent-septic complications as well as of the general lethality rate was estimated.
Results. A significant alteration of the cellular component of the immunogenesis at acute destructive pancreatitis was found out. Carrying out «triple» intradermal tests in combination with PHA, tuberculin, imunofan, polyoxidonium helps to predict effectively the course and the outcome of the pathological process. Decrease of the complications incidence as well as of the lethality rate was marked in case of the systemic application of polyoxidonium and imunofan.
Conclusion. The worked out express estimation methods with the usage of the combined intradermal tests permit to detect in proper time immune disturbances which develop at acute destructive pancreatitis. The proposed methods of immunocorrection should be included in the complex treatment of the given pathology.

Keywords: acute destructive pancreatitis, treatment, prognostication, intradermal tests, immunomodulators, imunofan, polyoxidonium, anergy
p. 47 – 57 of the original issue
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SHEVELA A.I., EGOROV V.A., SEVOSTYANOVA K.S., NOVIKOVA YA.V., FILIPENKO M.L.

GENETIC RISK FACTORS OF VENOUS THROMBOSIS

Objectives. To determine the distribution of prothrombotic polymorphisms in patients with venous thrombosis in comparison with the control group and in different groups of patients with thromboses of inferior vena cava.
Methods. 43 patients without venous thrombosis in the anamnesis were investigated as well as 169 patients with phlebothrombosis of the lower limbs, divided into groups according to the age and the cause of the disease. The genes of plasma, platelet hemostasis factors, folate cycle enzymes were studied.
Results. The effects of polymorphism genes V factor of coagulation, methylenetetrahydrofolate reductase, tissue plasminogen activator, VII coagulation factor and fibrinogen on the development of thrombosis, particularly early and idiopathic were reliably revealed.
Conclusion. The risk of venous thrombosis development is increased not so much by general number of involved genes, but by single polymorphisms having reliable influence on the development of the given disease. Correction of the conservative therapy in patients with the developed phlebothrombosis is possible on the ground of gene-typing as well as preventive methods in the patients of risk group.

Keywords: thrombophilia, coagulation factors, polymorphism, venous thrombosis, gene
p. 58 – 65 of the original issue
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SHAKHRAY S.V.

EVALUATION OF QUALITY OF LIFE IN PATIENTS WITH ANAL ITCHING

Objectives. To study qualitative indexes of physical and psychic-emotional health in patients with idiopathic anal itching.
Methods. Survey of patients with idiopathic anal itching was done by questionnaire SF-36 and Spielberger-Khanin test. 123 patients were questioned; the group of female patients aged 25-34 with duration of the disorder 1-2 years was chosen aimed to make the investigation results reliable.
Results. The analysis of quality of life testifies to the decrease of mental and physical well-being level in the patients of the investigated group. When estimating the level of the situational anxiety in the questioned patients, the increase of this figure up to 48,2±4,72 was revealed; it testified to high reactive anxiety in patients (> 46) and to the presence of the neurotic conflict with emotional distresses.
Conclusion. The initial anal itching is a pathology which changes significantly the quality of a patient’s life worsening his psycho-emotional state and influencing his physical activity. The presence of long lasting itching in a patient increases his level of the situational anxiety being a factor of the emotional state destabilization.

Keywords: anal itching, quality of life, situational anxiety
p. 66 – 74 of the original issue
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TRAUMATOLOGY AND ORTHOPEDICS

BELETSKY A.V., MURZICH A.E., VORONOVICH A.I.

SURGICAL TREATMENT OF FRACTURES OF THE POSTERIOR WALL AND POSTERIOR COLUMN OF THE ACETABULUM

Objectives. To evaluate the effectiveness of the surgical treatment application in case of the displaced fractures of the acetabulum posterior column and posterior wall.
Methods. The experience of surgical treatment of 31 patients with fractures of the acetabulum posterior wall and column has been analyzed. The fractures with more than 2–3 mm displacement, the interposition of the fragments in the joint, not set fracture-dislocations in terms up to 3–4 weeks from the moment of trauma were the indications for the operation. Kocher-Langenbeck posterior access was applied in all cases. The fixation of fractures was done by means of the reconstructive plates.
Results. Clinical results of treatment have been evaluated in terms up to 7 years after the operation. Excellent results have been obtained in 48 %, good and satisfactory in 29%, unsatisfactory in 23% of patients. X-ray outcome has corresponded to the clinical result characteristics.
Conclusion. Precise anatomical reposition and stable fixation by means of plates permit to achieve optimal treatment results of the given injuries and to start rehabilitation actions in early terms.

Keywords: acetabulum fracture, operative treatment, reconstructive plate, X-ray evaluation
p. 75 – 83 of the original issue
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KHVISYUK N.I., VASILINETS M.M., GOLOBOROD’KO S.A., RAMALDANOV S.K.

ULTRASONOGRAPHY AFTER SURGICAL TREATMENT OF CARPAL TUNNEL SYNDROME

Objective. To find out whether a dense cicatrix between the edges of the dissected retinaculum of the flexors is formed after retinaculotomy performed because of the carpal tunnel syndrome.
Methods. Ultrasonography investigation with the ultrasound diagnostic apparatus ULTIMA-PRO-30 (Ukraine) was carried out in 9 patients with the carpal tunnel syndrome on 10 operated hands. To compare, ultrasonography was performed in these patients on non-operated hands.
Results. On non-operated hands the flexors retinaculum constituted the unbroken fibrillar cross-linear hyperechogenic bundle located the volar median nerve. On all 10 operated hands the continuity of the hyperechogenic bundle- retinaculum of the flexors was disturbed. And on 4 hands sonographically clear one could distinguish the edges and size of this «break». Echogenic density of the soft tissues was identical to the echogenic density of volar the subcutaneous fat median nerve.
Conclusion. Ultrasonography proved the assumption that after conducting the described retinaculotomy a new modified flexor retinaculum isn’t formed.

Keywords: ultrasonography, surgical treatment, carpal tunnel syndrome
p. 84 – 88 of the original issue
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NEUROSURGERY

TSITKO E.L., SMEYANOVICH A.F., SVISTUNOV S.V.

STANDARDIZATION OF THE ULTRASOUND BRAIN SCANNING STAGES

Objective. To systematize indications, to standardize the stages of neurosonography, to develop the protocol and algorithm of the brain ultrasound examination.
Methods. 48 patients with various volumetric formations of the brain were included in the research. In all the patients CT was performed before the operation; and the ultrasound scanning of the brain parenchyma was performed itraoperatively or in the postoperative periods through the trepanation defect. Neurosonography was carried out in B-mode as well as in color Doppler mapping and power Doppler modes.
Results. A clear sequence and criteria of ultrasound examination of the brain were developed. The algorithm of the neurosonographic research, indications, modes and methods of ultrasonic scanning of the brain were worked out.
Conclusion. Use of the protocol and of the algorithm of ultrasound examination provides recurrence and accessibility of neurosonography in the establishments of health care at various levels and contributes to the wide introduction of the technique into the clinical practice.

Keywords: neurosonography, protocol of ultrasound scanning, neurovisualization
p. 89 – 96 of the original issue
References
  1. Савелло, А.В. Мультимодальная нейронавигация и интраоперационная ультразвуковая визуализация в хирургии внутричерепных новообразований / А. В. Савелло // Вопр. общей и частной хирургии. – 2007. – Т. 166, № 5. – С. 11-18.
  2. Значения интраоперационного ультразвукового наведения в нейрохирургической практике при объёмных образованиях головного мозга / А. Р. Зубарев [и др.] // Ультразвук. и функцион. диагностика. – 2004. – № 4. – С. 92-97.
  3. Компьютерная томография в неотложной нейрохирургии: учебное пособие / В. В. Лебедев [и др.]. – М.: Медицина, 2005. – 360 с.
  4. Лебедев, В. В. Особенности КТ и МРТ-диагностики при внутричерепных кровоизлияниях и инфарктах / В. В. Лебедев, Т. Н. Галян // Нейрохирургия. – 2006. – № 4. – С. 40-48.
  5. Ошибки диагностики при травматических внутричерепных гематомах / А. Э. Талыпов [и др.] // Нейрохирургия. – 2009. – № 1. – С. 68-73.
  6. Ультразвуковая томография головного мозга у больных с посттравматическими костными дефектами / М.Д. Благодатский [и др.] // Актуальные вопросы соврем. клин. медицины. – Иркутск, 1995. – С. 74-75.
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PAEDIATRIC SURGERY

KOVALCHUK V.I., NOVOSAD V.V.

COMPARATIVE ESTIMATION OF THE OPERATIVE TREATMENT RESULTS OF THE ESOPHAGUS ATRESIA

Objective. To study the treatment results of the esophagus atresia in the clinic of pediatric surgery and to estimate the efficacy of the proposed techniques.
Methods. The present investigation was carried out at the clinic of pediatric surgery of GSMU, Grodno. The results analysis of the early postoperative period in the children with the esophagus atresia operated on in the period of 1995 to 2004 years (group A) was carried out by us. And the treatment results of children with the esophagus atresia were analyzed during the period of 2005 to 2009 years (group B), when the modified techniques of this defect treatment were used.
Results. The comparative estimation of the methods of treatment and their results in children with the esophagus atresia up to 2004 year and later was performed. The modified techniques of the esophagus prolongation, the tracheoesophageal fistula treatment and esophagoesophagoanastomosis application are proposed.
Conclusion. The reduction of the general and postoperative lethality rate is marked as well as the reduction of the failures of the esophagus and lack of hemorrhage and lack of recurrences of the tracheoesophageal fistula. The use of the bougieurage technique of the proximal end of the esophagus and the method of the anastomosis application at diastasis of 1,5–2,0 cm permitted to avoid completely esophagocoloplasty. The applied technique of the tracheoesophageal fistula treatment permits to avoid trachea deformations and fistula recurrences.

Keywords: esophageal atresia, dehiscence of anastomosis, esophageal stricture, recurrence of the tracheoesophageal fistula, hemorrhage
p. 97 – 102 of the original issue
References
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  8. Способ оперативного лечения атрезии пищевода: пат. 12192 Респ. Беларусь, МПК А 61В 17/00 / В.И. Ковальчук, В.В. Новосад; заявитель Гродн. гос. мед. ун-т. – № а 20070339; заявл. 02.04.07; опубл. 30.08.09 // Афіцыйны бюл. / Нац. цэнтр інтэлектуал. уласнасці. – 2009. – № 4. – С. 63-64.
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ONCOLOGY

YABLONSKY P.K., PAVLUSHKOV E.V., PETROV A.S., PISCHIK V.G., KOZAK A.R., NOKHRIN A.V.

EVALUATION OF THE REGIONAL METASTATIC SPREADING OF THE NON-SMALL CELL LUNG CANCER COMPLICATED BY THE SECONDARY INFLAMMATORY PROCESS

Objectives. Estimation of the diagnostic value of the computer tomography and mediastinoscopy at complications of the non-small cell lung cancer course (NSCLC) with the secondary inflammatory process.
Methods. The retrospective analysis of the treatment results of 365 patients operated on with NSCLC was carried out. In 280 of them the course of cancer was without the signs of the infection; in 85 of them the secondary inflammatory changes of the lung tissue were revealed. On the ground of the patients’ inspection results before the operation and the data of the pathological-anatomical investigation of the operative material the diagnostic value of the CT and mediastinoscopy was estimated in the evaluation of the regional metastasis spreading of NSCLC.
Results. The presence of the secondary inflammatory process practically doesn’t influence the CT sensitivity in the evaluation of N criterion; at the same time the specificity is significantly lower and it results in the reduction of the general diagnostic accuracy of CT informational content of mediastinoscopy doesn’t depend on the presence of the secondary inflammation (accuracy – 89,7% and 91,7% in the groups compared).
Conclusion. The secondary inflammation at NSCLC reduces the diagnostic value of CT in the evaluation of the metastasis lesion of the intrathoracic lymphatic nodes; though the accuracy of mediastinoscopy remains high.

Keywords: non-small cell lung cancer, complications, staging
p. 103 – 111 of the original issue
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ANESTHESIOLOGY-REANIMATOLOGY

KANUS I.I., KIZIMENKO A.N., PITKEVICH E.S.

ACTOPROTECTOR «BEMITYLUM» EFFECTS ON THE HEMODYNAMICS STATE AT HYSTERECTOMY FOR LEIOMYOMA COMPLICATIONS

Objectives. To determine the character of the preparation «Bemitylum» effects on the hemodynamics state at hysterectomy for leiomyoma complications.
Methods. Effects of the preoperative administration of the actoprotector «Bemitylum» on the intraoperative hemodynamics state were analyzed. 130 women who underwent hysterectomy for leiomyoma were examined; 30 of them (the 1st group) were given 0,25 g of «Bemitylum» twice. 100 patients (the second group) were not given this preparation.
Results. It was found out that stabilization of the hemodynamics indexes on lower figures was present in the patients received «Bemitylum»; decrease of indexes variability at different stages of the operation was revealed as well as limitation of the stressor changes of hemodynamics at more traumatic stages of the surgery.
Conclusion. Preoperative administration of «Bemitylum» contributes to the intraoperative hemodynamics stabilization and increases the quality of anesthesia for hysterectomy.

Keywords: leiomyoma, hysterectomy, intraoperative hemodynamics, anaesthesia, bemitylum
p. 112 – 119 of the original issue
References
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LYUBOSHEVSKY P.A., ZABUSOV A.V.

REGIONAL ANAESTHESIA IN THE PREVENTIVE MAINTENANCE OF THE POSTOPERATIVE RESPIRATORY DYSFUNCTION IN THE ABDOMINAL SURGERY

Objectives: To estimate the postoperative respiratory dysfunction after the abdominal surgery depending on the kind of anesthesia, analgesia and operation area.
Methods. 195 patients scheduled to undergo the abdominal surgeries of high traumatism have been investigated. In the upper-abdominal group 45 patients were allocated to receive either general anesthesia alone; in 45 other patients the general anesthesia combined with epidural analgesia. In lower-abdominal group 35 patients received general anesthesia alone, 35 patients received general anesthesia combined with epidural analgesia and 35 – general anesthesia combined with spinal anesthesia. We investigated the course of anesthesia and the period of postanaesthesia adaptation, postoperative pain relief, spirometric parameters, and arterial blood gases.
Results. Use of both kinds of regional anesthesia led to the decrease in the charge of anesthesia medications that was accompanied by faster postanaesthesia adaptation and restoration of spontaneous breath. The pain relief was considerably better among patients receiving epidural analgesia. In all groups decrease in spirometric parameters was noted, it was more expressed after upper-abdominal surgery. Epidural analgesia improved spirometric parameters both after upper-abdominal, and after lower-abdominal surgeries. In upper-abdominal group it also improved oxygenation. Spinal anaesthesia accelerated postanaesthesia adaptation, but did not influence postoperative pain, spirometric parameters and gas exchange. Frequency of a postoperative pneumonia was lower among the patients receiving regional anaesthesia.
Conclusion. Continuous epidural analgesia significantly reduces respiratory dysfunction in major abdominal surgery.

Keywords: abdominal surgery, regional anesthesia and analgesia, respiratory dysfunction
p. 120 – 128 of the original issue
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LECTURES, REVIEWS

SHESTUYK A.M., KARPITSKY A.S., PANKO S.V., BOUFALIK R.I.

PENETRATING LESIONS OF THE THORACIC PART OF THE ESOPHAGUS: MODERN STATE OF THE PROBLEM

Lesions of the intrathoracic part of the esophagus remain one of the most dramatic sections of the thoracic surgery. Incorrect interpretation of the inspection data and often of intraoperative detection results in late diagnosing and performance of the necessary surgical aid. The lethality rate at the esophagus trauma reaches 85%. In the review the modern approaches concerning diagnostics and treatment of the esophagus lesions are proposed. As the performed literature analysis shows, tactical aspects of the surgical aid haven’t been completely specified; though at present modern less traumatic methods of treatment are widely approved and introduced in practice; this permits to increase the survival rate of patients.

Keywords: esophagus, lesion, diagnostics, treatment
p. 129 – 137 of the original issue
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PRACTICAL CASES

KOKHNYUK V.T., TATARINOVICH V.T., BYLINSKY G.I.

COLON CANCER AND BREST SARCOMA IN THE PREGNANT

A clinical case of a very rare combination of the primary-multiple synchronous malignancy belonging to different organs and of various histological forms in a young pregnant woman is presented in the report. The authors also focus their attention on the development of the clinical signs of the tumors even before the gestation onset as well as on the errors and difficulties in the disease diagnosis. The treatment policy with obstetric aid resulting in a favorable outcome is presented.

Keywords: primary-multiple synchronous neoplasm, colon cancer, breast sarcoma, pregnancy
p. 139 – 143 of the original issue
References
  1. Медицинский женский журнал [Электронный ресурс] – Режим доступа: http//www. medmoon.ru/beremennnnost/akuherstvo 378.html. – Дата доступа: 23.03.2010.
  2. Morphological characteristics of the phyllodes tumours of the breast / M. Granic [et al.] // Med. Arh. – 2004. – Vol. 58, N 4. – P. 220-222.
  3. Barwijuk-Machala, M. Proliferating activiti in the epithelian and stromal component of the fibroadenomas and phylodes tumors of the breast / M. Barwijuk-Machala // Rocz. Akad. Med. Bialymst. – 2004. – Vol. 49. – Suppl. 1. – P. 55-57.
  4. Вишневская, Е. Е. Рак и беременность / Е. Е. Вишневская. – Мн.: Выш. шк., 2000.– 320 с.
  5. Кохнюк, В. Т. Колоректальный рак / В. Т. Кохнюк. – Минск: ООО ХАРВЕСТ, 2005 – 384 с.

EXPERIENCE EXCHANGE

S.S. STEBUNOV

PECULIARITIES OF LAPAROSCOPIC CHOLECYSTECTOMY IN OBESITY PATIENTS

Objectives. To improve the results of surgical treatment of cholelithiasis in overweight patients; to determine indications and to work out the technique of laparoscopic intervention; to ground the method choice of the operative treatment in the given category of patients.
Methods. The work is based on the experience of surgical treatment of 37 patients with cholelithiasis and III degree obesity. The immediate and distant results of the operative treatment of this category of patients are studied.
Results. All patients were operated on compliance with the designed principles and technical methods. There was the cystic artery bleeding in 2 patients among the intraoperative complications. In both cases the bleeding was laparoscopically stopped. There were no cases of conversion and septic complications. In terms of up to 5 years good results were marked in 80,3% of patients. Satisfactory results are registered in 19,7% of patients.
Conclusion. Laparoscopic cholecystectomy at cholelithiasis is the operation of choice in persons with obesity. It permits to make patients more active in early terms as well as to avoid possible specific complications and to improve the treatment results.

Keywords: cholelithiasis, obesity, laparoscopic operations, immediate and distant results
p. 144 – 149 of the original issue
References
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  13. Технические аспекты гастроскопических и лапароскопических вмешательств при алиментарном ожирении / С. И. Емельянов [и др.] // Эндоскоп. хирургия. – 2001. – № 2. – С. 23.

IN ASSISTANCE TO PRACTICIONER

VAVILOVA T.V.

LABARATORY TESTS FOR ANTITHROMBOTIC THERAPY MONITORING

Antithrombotic therapy is widely applied in the practice of surgeons to treat thromboembolic complications (TEC) and in their prophylaxis. The main groups of the medicinal preparations traditionally used in the treatment and prevention of thromboses are antiplatelet agents and anticoagulants (direct and indirect ones). Their own laboratory control methods correspond to each group of preparations.
Laboratory investigations are divided into two groups – methods which permit to determine the effect of the anticoagulant on functioning of the blood coagulation system and methods which estimate the efficacy of the antithrombotic effect – thrombinemia cupping.
The programs of the laboratory monitoring of the action of direct and indirect anticoagulants and antiplatelet agents are presented; the main laboratory tests and terms for their use are determined as well as the algorithms of the selection of the preparations’ dosage. Additional investigations while using heparins are found out as well as the investigation frequency of INR and APTT during therapy with warfarin. In such cases laboratory diagnostics is aimed at ensuring efficacy and safety of the antithrombotic therapy.
Patients taking warfarin are shown and they differ from each other in the period of induction and in the period of maintenance dose. The factors influencing the hyporcoagulation degree, INR result and its stability during therapy with indirect anticoagulants, indications for extraordinary investigation of INR are identified.

Keywords: thromboembolic complications, anticoagulant therapy, laboratory control
p. 150 – 161 of the original issue
References
  1. Вавилова, Т. В. Гемостазиология в клинической практике / Т. В. Вавилова. – СПб.: СПбГМУ им. акад. И.П. Павлова, 2005. – 92 с.
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