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Year 2012 Vol. 20 No 3
EXPERIMENTAL SURGERY
R.M. SALMIN 1, N.I. PROKOPCHIK 1, I.G. ZHUK 2, A.V. GAYDUK 1, M.V. GORETSKAYA 1, A.YU. PAVLYUKOVETS 1, A.I. ZHMAKIN 1
EFFICACY ESTIMATION OF THE COLON ANASTOMOSIS ZONE STRENGTHENING WITH THE SPONGE “TACHOCOMB”
EE “Grodno State Medical University” 1,
Grodno regional executive committee 2,
The Republic of Belarus
Objectives. To carry out a pathomorphological evaluation of the prevention effectiveness of the colonic anastomotic failure with the sponge “TachoComb”.
Methods. White mongrel male rats, weighing 250±50 g were used in the experiment. All animals were divided into four control and four experimental groups. The intersection of the colon distally to the ileocecal angle by 2 cm with the following “end to end” anastomosis with one-line intrasite serous-musculo-submucous suture was performed in the control group. The same manipulations were carried out in the experimental groups but the anastomosis zone was additionally covered with the sponge “TachoComb”. The animals were derived from the experiment on the 3, 7, 14, 30 days after the surgery.
Results. At the macroscopic analysis it has been established that application of the sponge “TachoComb” decreases the severity of anastomosis stenosis as well as the severity of inflammatory and adhesion processes. Microscopically, at strengthening of the intestinal suture zone with the sponge “TachoComb” smaller edema and leukocyte infiltration of the submucosal and muscle membranes, early onset of the epithelial proliferation have been revealed; there was more delicate connective tissue scar, and the remainder of the sponge “TachoComb” had the appearance of a thin plate encapsulated, intimately connected with the serous coat. At immunological investigation in the experimental groups lower leucocytosis has been established; at plating of washing-up from the anastomosis zone on agar the number of the revealed colony-forming units on the 3rd day was 14 times lower than in the groups without the use of the sponge “TachoComb”.
Conclusions. The sponge “TachoComb” is an effective preventive means against colon anastomosis failure.
1. Shurkalin BK, Gorskii VA, Volenko AV, Faller AP, Leonenko IV, Andreev SS, Il'in VA. Vozmozhnosti, rezul'taty i perspektivy ukrepleniia kishechnykh shvov fibrin-kollagenovoi substantsiei «Takhokomb» [Intestinal sutures fixation by fibrin-collagen substance TahoComb: opportunities, results and perspectives]. Khirurgiia. 2004;(2):53–55.
2. Shurkalin BK, Gorskii VA, Leonenko IV. Problema nadezhnosti kishechnogo shva [The problem of reliability of the intestinal suture]. Consilium Medicum. 2004;6(6):442–46.
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8. Skipenko OG, Shatverian GA, Movchun AA. Primenenie ranevogo pokrytiia «TakhoKomb» pri khirurgicheskikh vmeshatel'stvakh na pecheni i podzheludochnoi zheleze [The application of wound dressing "Tachocomb" in the hepatic and pancreatic surgery]. Khirurgiia. 1998;(1):11–14.
230009, Respublika Belarus', g. Grodno, ul. Gor'kogo, d. 80, UO “Grodnenskii gosudarstvennyi meditsinskii universitet”, kafedra operativnoi khirurgii i topograficheskoi anatomii,
e-mail: dr.salmin@tut.by,
Salmin
Salmin R.M., a Post-graduate Student of the Chair of Operative Surgery and Topographic Anatomy of the EE "Grodno State Medical University."
Prokopchik N.I., Candidate of Medical Sciences, Associate Professor of the Pathologic Anatomy Chair of EE "Grodno State Medical University."
Zhuk I.I., Doctor of Medical Sciences, Professor, Deputy Chairman of Grodno Regional Executive Committee.
Gayduk A.V., a 6th year student of EE "Grodno State Medical University."
Goretskaya M.V., Candidate of Biological Sciences, Associate Professor of Microbiology, Virology and Immunology Chair named after S.I.Gelberg, EE "Grodno State Medical University."
Pavlyukovets A.Yu., Assistant of Microbiology, Virology and Immunology Chair named after S.I.Gelberg, EE "Grodno State Medical University."
Zhmakin A.I., Doctor of Medical Sciences, Professor, Head of Microbiology, Virology and Immunology Chair named after S.I.Gelberg, EE "Grodno State Medical University."
Article in the .pdf formatGENERAL AND SPECIAL SURGERY
S.A. VIZGALOV 1, S.M. SMOTRIN 2
COMBINED ATENSIONAL HERNIOPLASTY AT EXTERNAL INGUINAL HERNIAS
ME “City clinical emergency hospital”, Grodno 1,
EE “Grodno State Medical University” 2,
The Republic f Belarus
Objectives. To work out a new method of the combined atensional hernioplasty at inguinal hernias and to evaluate its immediate results.
Methods. A new atensional method of the inguinal canal plasty at the external abdominal hernias has been designed. The proposed method provides the inguinal canal posterior wall strengthening with the aponeurosis flap of the external oblique abdominal muscle and the anterior wall is formed from the meshy endoprosthesis. The method was applied in 25 patients. The control group included 25 patients who had been operated on using Bassini method. All patients were subjected to ultrasound scanning of both inguinal-scrotal areas the day before the operation and 5 days after it. During the whole postoperative period the intensiveness of the pain syndrome was being evaluated in the patients.
Results. It has been found out that the patients with inguinal hernias have hemodynamics disturbances in the testicle parenchyma. Decrease of the maximal systolic and diastolic speed of the blood flow has been registered. The most evident decrease of the blood flow was in the patients with the direct inguinal hernias. In the postoperative period the increase of the intratesticular blood flow speed was noted in the patients with the oblique and direct inguinal hernias. These parameters were significantly higher in the patients of the main group than the control one. At the same time in the control group of patients the resistance index increased considerably that testifies to the compression of the spermatic cord elements in deep inguinal ring forming. The designed atensional hernioplasty eliminates the present intratesticular hemodynamic disturbances. But the pain syndrome intensiveness is considerably higher at the atensional hernioplasty than at the Bassini tension plasty.
Conclusions. The combined atensional hernioplasty method permits to level the detected blood supply disturbances in the testicle, typical for the Bassini tension plasty and thus to improve the immediate treatment results.
1. Shliakhovskii IA, Chekmazov IA. Sovremennye aspekty khirurgicheskogo lecheniia gryzh briushnoi stenki [Current aspects of surgical treatment of abdominal wall hernias]. Abdomin Khirurgiia. 2002:4(7):44–47.
2. Kharnas SS, Samokhvalov LI, Ippolitov AV. Gryzhi perednei briushnoi stenki (klinika, diagnostika, lechenie): ucheb posobie. [Hernias of the anterior abdominal wall (clinical picture, diagnosis, treatment): textbook]. Moscow, RF: Russkii vrach; 2009. 84 p.
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4. Timoshin AD, Iurasov AV, Shestakov AL, Fedorov DA. Sovremennye metodiki khirurgicheskogo lecheniia pakhovykh gryzh: metod. rekomendatsii [Modern methods of surgical treatment of inguinal hernia: a guideline]. Moscow, RF; 2002. 36 p.
5. Volod'kin VV. Voprosy patogeneza i lecheniia pakhovykh gryzh [Some aspects of pathogenesis and treatment of inguinal hernia]. Novosti Khirurgii. 2007;15(2):112–20.
6. Egiev VN, Chizhov DV, Rudakova MN, Egiev VN. Plastika po Likhtenshteinu pri pakhovykh gryzhakh [Plasticity in the of Liechtenstein with inguinal hernias]. Khirurgiia. 2000;(1):19–22.
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9. Vizgalov SA, Smotrin SM. Sposob kombinirovannoi atenzionnoi gernioplastiki. [The method of combined tension-free hernioplasty: pat.N14259 Resp. Belarus' ; zaiavitel' Grodn. gos. med. un-t. ¹ a 20081392; îpubl. 30.04.11. Afitsyiny Biul. Nats Tsentr intelektual ulasnastsi. 2011;(2):50.
10. Breivik H. Assessment of pain. Br J Anaes. 2008;101(1):17–24.
230009, Respublika Belarus', g. Grodno, ul. Gor'kogo, d. 80, UO “Grodnenskii gosudarstvennyi meditsinskii universitet”, kafedra khirurgicheskikh boleznei ¹2 s kursom urologii,
e-mail: sergey_vizgalov@mail.ru,
Vizgalov Sergey Aleksandrovich
Vizgalov S.A., a Surgeon of the Surgical Department of ME “Grodno City Clinical Emergency Hospital”.
Smotrin S.M., Doctor of Medical Sciences, Professor of the Surgical Diseases Chair ¹2 with the Course of Urology of EE “Grodno StateMedical University”.
K.M. KURBONOV 1, F.I. MAKHMADOV 1, I.A. SATTOROV 2, M.G. KHOMIDOV 1, A.F. NAZAROV 1, D.SH. SHARIPOV
DIAGNOSTICS AND SURGICAL TREATMENT OF PENETRATING DUODENAL ULCERS
Tajik Abu Ali Ibn Sino State Medical University 1,
City clinical emergency hospital of Dushanbe 2,
The Republic of Tajikistan
Objectives. Improvement of the immediate results of surgical treatment of penetrating duodenal ulcers (PDU).
Methods. The analysis of diagnostics and surgical treatment of 74 patients with PDU was carried out. There were 42 (56,7%) males and 32 (43,3%) females. Ulcer history in 45 (60,8%) patients continued more than 10 years, and in 29 (39,2%) it made up over 15 years. Most patients (57/77%) were repeatedly treated ineffectively by different specialists for the liver and kidneys diseases as well as for chronic pancreatitis and cholecystitis. In 42 observations PDU combined with other complications of the ulcerous disease. Thus, in 20 (47,6%) patients the combination of penetration with stenosis was noted; in 16 (38,1%) – the combination of penetration and bleeding; in 6 (14,3%) patients the duodenal ulcer penetration combined with ulcer perforation.
In 48 (64,8%) cases in patients with PDU, the duodenal passability with varying degrees of severity demanding surgical correction took place.
X-ray, endoscopic and ultrasound investigations, CT and endoscopic ultrasound sonography were carried out to diagnose PDU; and the acid-producing function of the stomach and dumping predisposition were studied
If indicated the contrast study of the duodenum, biliary tracts was performed; pancreatic enzyme activity and the level of bilirubin were determined.
Results. The research results show that PDU together with an atypical clinical course and presence of severe complications is often accompanied by chronic disturbances of duodenal passability (64,8%) of various kinds, by chronic pancreatitis (32,4%), and a high degree of acid production and the dumping predisposition.
Conclusions. Surgical tactics in case of PDU is not standard; that is why the primary gastric resection after Roux in the combination with the stem vagotomy and corrective interventions on the extrahepatic bile ducts under strict indications significantly improve the treatment immediate results of these severe patients.
1. Pancyrev JuM, Mihalev AI, Fedorov ED. Hirurgicheskoe lechenie oslozhnennoj jazvennoj bolezni. 50 lekcij po hirurgii [Surgical treatment of complicated peptic ulcer disease. 50 lectures on surgery. Collected papers.]. Moscow, RF; 2003. p. 250–60.
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734003, Respublika Tadzhikistan, g. Dushanbe, pr. Rudaki, d. 139, Tadzhikskii gosudarstvennyi meditsinskii universitet, kafedra khirurgicheskikh boleznei ¹1,
e-mail: fmahmadov@mail.ru,
Makhmadov Farrukh Isroilovich
Kurbonov K.M., an Academician of AMS of the Republic of Tajikistan, Doctor of Medical Sciences, Professor, Head of the Chair of Surgical Diseases ¹ 1 of Tajik State Medical University named after Abuali Ibn Sina.
Makhmadov F.I., Doctor of Medical Sciences, Associate Professor of the Chair of Surgical Diseases ¹ 1 of Tajik State Medical University named after Abuali Ibn Sina.
Sattorov I.A., a Surgeon of Dushanbe City Clinical Emergency Hospital, an Applicant For Candidate’s Degree of the Chair Of Surgical Diseases ¹ 1 of Tajik State Medical University named after Abuali Ibn Sina.
Khomidov M.G., Candidate of Medical Sciences, Assistant of the Chair of Surgical Diseases ¹ 1 of Tajik State Medical University named after Abuali Ibn Sina.
Nazarov A.F., Candidate of Medical Sciences, Assistant of the Chair of Surgical Diseases ¹ 1 of Tajik State Medical University named after Abuali Ibn Sina.
Sharipov D.Sh., a Surgeon of Dushanbe City Clinical Emergency Hospital, an Applicant for Candidate’s Degree of the Chair of Surgical Diseases ¹ 1 of Tajik State Medical University Named After Abuali Ibn Sina.
D.A. KLUIKO 1, V.E. KORIK 1, S.A. ZHIDKOV 2
CITOFLAVIN APPLICATION IN COMPLEX TREATMENT OF ACUTE PANCREATITIS
EE “Belarusian State Medical University” 1,
Military medical administration of the Ministry of defense 2, Minsk,
The Republic of Belarus
Objectives. To improve treatment results of acute pancreatitis, specifically to study the effect of citoflavin on the duration of the disease, blood parameters and possibility of complications.
Methods. The research was carried out in two groups of patients with acute pancreatitis, each group numbering 15 patients. In the experimental group the preparation citoflavin was intravenously administered in the volume of 10 ml diluted on 400 ml of 0,9% sodium chloride solution b.i.d. during 5-10 days. The control group of patients were obtaining a standard treatment. The effect of the medicament therapy was studied on the 5th day after the onset of the preparation’s application. Direct percutaneous oximetry to estimate the tissue respiration parameters in the anterior abdominal wall skin was used in the diagnostic complex.
Results. Use of antioxidants and antihypoxants is able to normalize the rates of respiratory activity, in particular, the level of oxidative status violations as well as to reduce the level of hypoxia in the pancreatic tissue and, consequently, in the skin of the anterior abdominal wall, which are registered by the direct oximetry.
Conclusions. Application of citoflavin in the treatment of acute pancreatitis contributes to the restoration of oxidative status, reduction of tissue hypoxia and reduces the duration of hospital stay by 2 times.
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220034, Respublika Belarus', g. Minsk, ul. Azgura, 4, UO “Belorusskii gosudarstvennyi meditsinskii universitet”, voenno-meditsinskii fakul'tet, kafedra voenno-polevoi khirurgii,
e-mail: kluiko@list.ru,
Kluiko Dmitriy Aleksandrovich
Kluiko D.A., Major of Medical Service, a Graduate Student of the Chair Of Military Field Surgery of the Military Medicine Faculty of EE "Belarusian State Medical University."
Korik V.E., Candidate of Medical Sciences, Associate Professor, Colonel of Medical Service, Head of Military Field Surgery Chair of the Military Medicine Faculty of EE "Belarusian State Medical University."
Zhidkov S.A., Doctor of Medical Sciences, Professor, Colonel of Medical Service, the Chief of Military Medical Department of the Ministry of Defense of the Republic of Belarus.
A.L. KRISHTOPOV
ULTRASOUND ANATOMICAL AND FUNCTIONAL CHARACTERISTICS OF PRETERMINAL SECTION OF THE MAIN SUPERFICIAL VEINS AT THE LOWER LIMBS VARICOSE VEINS
EE “Vitebsk State Medical University”,
The Republic of Belarus
Objectives. To determine, using the ultrasound investigation (USI) data, the basic anatomical and functional characteristics of the main superficial veins of the lower limbs in the preterminal section at the lower limbs varicose veins (LLVV) taking into consideration clinical forms and duration of the disease.
Methods. According to the ultrasound angioscanning data, the evaluation of the large and small subcutaneous veins in the preterminal sections of 82 patients with primary varicose veins of the lower limbs (clinical classes C2-C6 CEAP) and 30 volunteers with no signs of this pathology was carried out. The diameter of the veins and the functional state of the terminal valve apparatus were determined. The obtained data were analyzed taking into account the duration of the disease and a clinical class.
Results. Distinct anatomical and functional changes in the preterminal section of the large subcutaneous vein (LSV) at LLVV were identified in most patients. Exhibiting in the form of the lumen dilatation and the terminal valve apparatus failure, these changes have already been present in the early stages of the disease, including those with relatively mild form of the disease. Increase of the LSV diameter in the pretrial section is observed together with the progression of the disease severity and it is not typical in case of lengthening of the disease duration. Reduction of the tonic-elastic properties of the LSV at LLVV can be characterized by an increase in the elasticity index: ratio of the vein diameter, determined in orthostasis and clinostasis.
Conclusions. Detected characteristic signs of the anatomical and functional changes of the main superficial veins at the lower limbs varicose veins are revealed at the early terms of the disease progression including rather mild forms of the pathology and they are accompanied by capability reduction for LSV to maintain its own tonus.
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210023, Respublika Belarus', g. Vitebsk, pr. Frunze, d. 27, UO “Vitebskii gosudarstvennyi meditsinskii universitet”, kafedra gospital'noi khirurgii,
e-mail: A.L.Krishtopov@gmail.com,
Krishtopov Andrey Leonidovich
Krishtopov A.L., a Senior Lecturer of the Hospital Surgery Chair of EE “Vitebsk State Medical University”.
V.A. KOSINETS
CHANGES IN THE IMMUNE SYSTEM AT GENERALIZED PURULENT PERITONITIS AND POSSIBILITIES OF THEIR CORRECTION
SEE HPE “I.M.Sechenov First Moscow Medical University”,
The Russian Federation
Objectives. To study the state of immune globulin and interleukin profiles of the blood serum in patients with generalized purulent peritonitis and a possibilities of correction of their changes by intracutaneous injections of the preparation «Ronkoleukin».
Methods. The treatment analysis of 26 patients with generalized purulent peritonitis has been conducted. The influence of the intracutaneous injections of the preparation of recombinant interleukin-2 – “Ronkoleukin” on the level of immune globulins and interleukins in the blood serum has been studied.
Results. In patients with generalized purulent peritonitis in the postoperative period the expressed changes in the immune system are observed, characterizing by the disimmunoglobulinemia phenomenon – the decrease in the level of IgM, IgG and the general IgA on the background of the content increase of the secretory IgA in blood serum. From the 1 day of the postoperative period the unidirectional content increase of both the pro-inflammatory (Il-1β, Il-6, Il-8), and anti-inflammatory interleukins (Il-10) has been established on the background of the decrease in the level of regulatory mediators (Il-2, Il-4).
On the background of the conventional treatment the expressed pathological changes from the immune system remained on the 5 day of the postoperative period testifying to the continuing inflammatory process. At the same time in the main group of patients in whom the preparation “Ronkoleukin” was injected intracutaneously as the immune-correcting therapy during the indicated terms the studied parameters were approaching to normal levels or didn’t differ from them.
Conclusions. The obtained data indicate the positive impact of the suggested scheme of immune-corrective therapy on immune globulin and interleukin profiles of the blood in a complex treatment of patients with generalized purulent peritonitis that is possible to regard as a productive immunotropic effect.
Thus, the intracutaneous injections of the preparation “Ronkoleukin” has been firstly proposed while treating generalized purulent peritonitis, which being rather simple in usage permits to reduce significantly the daily volume and duration of the preparation administration.
1.Gostishchev VK, Sazhin VP, Avdovenko AL. Peritonit. [Peritonitis]. Moscow, RF: GEOTAR-Media; 2002. 238 p.
2. Savel'ev BC, Gel'fand BR, Filimonov MI. Peritonit: prakt ruk [Peritonitis: a practical guideline]. Moscow, RF: Litterra; 2006. 208 p.
3. Briskin BS, Khachatrian NN, Savchenko ZI. Immunnye narusheniia i immunokorrektsiia pri intraabdominal'noi infektsii [Immune disorders and immunotherapy with intraabdominal infections]. Khirurgiia. 2004;(2):24–27.
4. Gel'fand EB, Gologorskii BR, Gel'fand BR. Abdominal'nyi sepsis: integral'naia otsenka tiazhesti sostoianiia bol'nykh i poliorgannoi disfunktsii [Abdominal sepsis: an integral assessment of the severity of patient state and multiple organ failure]. Anesteziologiia i Reanimatologiia. Saint-Petersburg, SSSR; 1998. 21 p.
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8. Kozlov VK. Sepsis: etiologiia, patogenez, kontseptsiia sovremennoi immunoterapii [Sepsis: etiology, pathogenesis, the concept of modern immunotherapy]. Saint-Petersburg, RF: Dialekt, 2008. 296 p.
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13. Anisimov AIu. Immunoterapiia Ronkoleikinom v kompleksnom lechenii bol'nykh abdominal'nym sepsisom : posobie dlia vrachei [Roncoleukin immunotherapy in complex treatment of patients with abdominal sepsis: A guideline for physicians]. Kazan', RF; 2004. 28 p.
14. Zhenilo VM, Kostriukov VK, Dudarev IV. Ekstrakorporal'naia immunofarmakoterapiia ronkoleikinom pri lechenii bol'nykh peritonitom [Extracorporeal immunopharmakotherapy by Roncoleukin in the treatment of patients with peritonitis]. Vestn Intensiv Terapii. 2010;(5):19–20.
15. Kozlov VK, Lebedev MF, Egorova VN. Korrektsiia disfunktsii immunnoi sistemy ronkoleikinom [Correction of the immune system dysfunction by Roncoleukin]. TerraMedica. 2001;(2):12–14.
119991, Rossiiskaia Federatsiia, g. Moskva, ul. Iauzskaia, d. 11, GOU VPO “Pervyi Moskovskii gosudarstvennyi meditsinskii universitet im. I.M. Sechenova”, kafedra obshchei khirurgii,
e-mail: vkosinets@yandex.ru,
Kosinets Vladimir Aleksandrovich
Kosinets V.A., Candidate of Medical Sciences, Applicant for Doctor’s Degree of the Chair of General Surgery of I.M. Sechenov First Moscow State Medical University.
M.YU. AVERYANOV 1, V.V. SLONIMSKY 2
MICROBIOLOGICAL ASPECTS OF TREATMENT OF PURULENT SKIN DISEASES AND SUBCUTANEOUS TISSUE WITH CRYOSURGICAL METHOD
SBEE HPE “Kirov State Medical Academy” 1,
Polyclinic ¹1 of the department hospital on the station Kirov of JSC “Russian railways” 2,
The Russian Federation
Objectives. To study impact of the single-stage cryosurgical treatment of the walls of purulent cavities on the microflora in a surgical wound at treatment of purulent skin diseases and subcutaneous tissue using combined cryosurgical methods in a polyclinic.
Methods. The comparative analysis of the results of microflora investigation of the postoperative wounds using plating on standard nutrient media was carried out at cryosurgical and conventional methods of treatment of purulent skin diseases and subcutaneous tissue of various localizations in 19 and 20 patients correspondently. The age varied from 18 up to 55 years; the duration of the disease – from 5 up to 15 days. The operations were carried out using the simplest sets for cryodestruction with the replaceable metal caps, cotton and gauze swabs on the instrument, intended for contact manipulations. Cryodestruction was carried out once, the exposure time was 30-45 seconds, depending on the area of pathological focus in order to ensure complete freezing of purulent cavity walls to a depth of 1-2 mm. Investigation of microflora in the wound with traditional methods and cryosurgical treatment was performed twice: immediately after opening the abscess, and one day after the operation.
Results. When using a single-stage cryosurgical treatment of the abscess cavity, significant reduction in the number of viable infectious agents in the surgical wound was obtained as well as a full recovery and reducing average terms of disability up to 7,3 days (in the traditional methods of treatment – 11 days) a good cosmetic effect.
Conclusions. Single-stage cryodestruction of the purulent cavity walls reduces significantly the content of bacterial cells in the wound; it is pathogenetically justified and effective additional component of the combined surgical treatment that can be recommended for widespread use in the surgical room.
1.Bisenkova LN, Trofimova VM.red. Gospital'naia khirurgiia: ruk dlia vrachei–internov [Hospital surgery: a guideline for physician-interns]. Saint-Petersburg, RF: Lan'; 2005. 896 p.
2. Savel'ev SV, Kirienko AI. red. 80 lektsii po khirurgii [80 lectures on surgery]. Moscow, RF: Literra; 2008. 912 p.
3. Gostishchev VK. Operativnaia gnoinaia khirurgiia: ruk. dlia vrachei [Operative purulent surgery. A guideline for physician-interns]. Moscow, RF: Meditsina; 1996. 416 p.
4. Barkhatova NA. Dinamika rezistentnosti vozbuditelei lokal'nykh i generalizovannykh form infektsii miagkikh tkanei [Activators resistance dynamics of local and generalized forms infections of soft tissues]. Kazan Med Hurn. 2009; (3):385–90.
5. Alexander JW, Solomkin JS, Edwards MJ. Updated recommendations for control of surgical site infections. Ann Surg. 2011 Jun; 253 (6):1082–93.
6. Khriakov AS, Kozlov KK, Dolgikh VT, Kobiakov DS. Lechenie bol'nykh s gnoinoi ranevoi infektsiei v usloviiakh krainego severa [Treatment of patients with a purulent wound infection in Far North conditions]. Vestn Khirurgii im. II Grekova. 2009;6:78–81.
7. Stoliarov EA, Grachev BD, Kolsanov AV, Kotel’nikova GP, red. Khirurgicheskaia infektsiia: ruk dlia vrachei [Surgical infection: a guidance for physicians]. Samara, RF; 2004. 232 p.
8. Holey RW. The scientific basis for using surveillance and risk factor data to reduce nosocomial infection ratesy. J Hosp Infect. 1995;30(Suppl):3–14.
9. Eriukhina IA, Gel'fand BR, Shliapnikov SA, red. Khirurgicheskie infektsii: prakt ruk [Surgical infections: a guide]. Moscow, RF: Littera; 2006. 736 p.
10. Kantsaliev LB, Teuvov AA, Zakhokhov RM. Rany i ranevaia infektsiia: metod rekomendatsii [Wounds and wound infection: method. recommendations]. Nal'chik, RF: Kab-Balk un-t; 2004. 27 p.
11. Washington CW, Elmer WK. Koneman’s Color Atlas and Textbook of Diagnostic Microbiology. 6th ed. Lippincott Williams & Wilkins; 2006. 1535 p.
12. Strachunskii LS, Belousov YuB, Kozlov SN. Red. Prakticheskoe rukovodstvo po antiinfektsionnoi khimioterapii Practical guidance on anti-infectious chemotherapy. Collected papers]. Smolensk, RF: MAKMAKh; 2007. 464 p.
13. Drosou A, Falabella A, Kirsner RS. Antiseptics on wounds: An area of controversy. Wounds. 2003;15(5):149–66.
14. Shafranov VV. Borkhunova EN, Geras'kin AV. Mekhanizm pervichnogo povrezhdeniia biologicheskikh tkanei pri kriodestruktsii. Meditsinskaia Kriologiia: sb nauch tr [The mechanism of primary damage of biological tissues at a cryodestruction. Medical Cryology. Collected papers.]. Nizhny Novgorod, RF: Onkolor; 2003;(Vyp. 4). p. 250–68.
15. Kabanov AN, Bozhenkov IuB, Ivanov VM. Lechenie gnoinykh zabolevanii miagkikh tkanei s pomoshch'iu kriogennogo i kriokhirurgicheskogo metodov v usloviiakh polikliniki [Treatment of purulent diseases of soft tissues by means of cryogenic and cryosurgical methods in the conditions of policlinic]. Khirurgiia. 1985;(5);141–42.
16. Kozhevnikov VA. Krioobrabotka gnoinykh ran u detei. Meditsinskaia Kriologiia. Vyp. 4: Sb nauch tr [Cryotherapy of purulent wounds in children. Medical Cryology. Collected papers]. Nizhny Novgorod, RF; 2003;(Vyp. 4). p. 133–36.
610001, Rossiiskaia Federatsiia, g. Kirov, Oktiabr'skii pr-t d. 151, GBOU VPO “Kirovskaia gosudarstvennaia meditsinskaia akademiia”, kafedra obshchei khirurgii,
e-mail: vladimirvsl.77@mail.ru,
Slonimsky Vladimir Vladimirovich
Averyanov M.Yu., Doctor of Medical Sciences, Professor, Head of the General Surgery Chair of SBEE HPE “Kirov State Medical Academy”. Slonimsky V.V., an Extramural Post-graduate Student of the Chair of General Surgery of SBEE HPE "Kirov State Medical Academy", a Surgeon of the Polyclinic ¹ 1 of the Departmental Hospital at the st. Kirov of the PC “Russian OAO "rrwy".
F.G. NAZYROV 1, A.V. DEVYATOV 1, D.SH. HODJIEV 2, A.H. BABADJANOV 1, R.YU. SADYKOV 3
OPTIMIZATION OF TREATMENT DIAGNOSING AND TACTICS OF THE ABDOMINAL CAVITY POSTOPERATIVE ABSCESSES
The Republican specialized surgical center named after academician V. Vakhidov1, Tashkent
Ministry of Health of the Republic of Karakalpakstan2
Karakalpakstan affiliate of the Republican scientific center of emergent medical aid3, Nukus
The Republic of Uzbekistan
Objectives. To improve treatment results of the postoperative abdominal abscesses by optimizing early diagnosing and treatment strategy.
Methods. The analysis of the repeated interventions in 88 patients with the abdominal cavity abscesses after the initial emergency and planned operations carried out in various hospitals of the Republic of Uzbekistan was carried out.
Results. The performed analysis has shown that in the structure of all intraabdominal complications, the limited purulent formations after emergency surgery make up 4,0-12,7% and 9,9-15,2% after planned operations. Depending on the severity of systemic inflammatory response syndrome (SIRS), mortality rate after the repeated interventions for these complications amounts to 25,6-33,3% at average SIRS and 63,2-66,7% at severe SIRS. Taking into account the results of research the tactical algorithm to select the optimum treatment strategy of the postoperative abdominal abscesses has been’ proposed.
Conclusions. The best option for the standardization of protocols of this category of patients is the use of integrated prognostic scales, summation results of which let adequately to assess the risk of a repeated surgical intervention and thus optimize the choice of the treatment tactics. The practical value of the waked out algorithm permits to determine the risk of relaparotomy and, accordingly, to optimize the surgical tactics in relation to urgency and the choice of an adequate amount of the alleged interference, which will significantly improve the results of surgical treatment for these patients.
1. Guseinov SA. Diagnostika i lechenie posleoperatsionnykh abstsessov briushnoi polosti, vyzvannykh neklostridial'noi anaerobnoi infektsiei [ [Diagnosis and treatment of postoperative abdominal abscesses caused by non-clostridial anaerobic infection]. Ann Khirurgii. 1999;(4):78–80.
2. Zavernyi LG. Poida AI, Mel'nik VM, Nadeev SS. Chastota i diagnostika vnutribriushnykh abstsessov v rannem posleoperatsionnom periode [The frequency and diagnosis of intra-abdominal abscesses in the early postoperative period]. Vestn Khirurgii. 1993;150(3-4):123–26.
3. Vadala G, Caragliano V., Castorina R., Caragliano L. An update in the treatment of intra-abdominal abscesses. Minerva Chir. 1999;54(4):245–50.
4. Zhebrovskii VV. Rannie i pozdnie posleoperatsionnye oslozhneniia v khirurgii organov briushnoi polosti: prakt ruk. [Early and late postoperative complications in surgery of the abdominal cavity: a guidance]. Simferopol', Ukraine: KGMU; 2000. 688 p.
5. Bufalari A, Giustozzi G, Moggi L. Postoperative intraabdominal abscesses: percutaneous versus surgical treatment. Acta Chir Belg. 1996;96(5):197–200.
6. Kumar RR. Kim JT, Haukoos J.S., Macias L.H.. Factors affecting the successful management of intraabdominal abscesses with antibiotics and the need for percutaneous drainage. Dis Colon Rectum. 2006 Feb;49(2-P):183–89.
7. Solov'ev GM, Bagdasarov VV, Kazarova EA, Karapetian MM. Povtornoe chrevosechenie posle ekstrennykh operatsii [Re-laparotomy after emergency surgery]. Ann Khirurgii. 1999;(6):109–11.
8. Ziubritskii NM, Semko NM. Ob oslozhneniiakh posleoperatsionnykh vnutribriushnykh abstsessov [On complications of postoperative intraabdominal abscesses]. Klin Khirurgiia. 1986;(1):18–20.
9. Grigorian RA. Relaparotomiia v khirurgii zheludka i dvenadtsatiperstnoi kishki [Relaparotomy in surgery of the stomach and duodenum]. Moscow, RF: MIA; 2005. 400 p.
10. Êîê ÊY, Yapp SK. Laparoscopic drainage of postoperative complicated intra-abdominal abscesses. Surg Laparosc Endosc Percutan Tech. 2000;10(5):311–13.
11. Men S, Akhan O, Koroglu M. Percutaneous drainage of abdominal abscess. Eur J Radiol. 2002;43(3):204–18.
12. Saleem M, Ahmad N, Ahsan I. Ultrasound guided percutaneous drainage of abdominal abscesses. J Ðàê Med Assoc. 2000;50(2):50–53.
100115, Respublika Uzbekistan, g. Tashkent, ul. Farkhadskaia, d. 10, Respublikanskii spetsializirovannyi tsentr khirurgii im. akad. V.Vakhidova, otdelenie khirurgii portal'noi gipertenzii i pankreatoduodenal'noi zony,
e-mail: azam746@mail.ru,
Babadzhanov Azam Khasanovich
Nazyrov F.G., Doctor of Medicine, Professor, Director of the Republican Specialized Center of Surgery named after Academician V.Vakhidov.
Devyatov A.V., Doctor of Medicine, Professor, Chief Researcher of the Department of Surgery of Portal Hypertension and the Pancreaticoduodenal Zone of the Republican Specialized Center of Surgery named after Academician V.Vakhidov.
Hohjiev D.Sh., Candidate of Medical Sciences, Minister of Health of the Republic of Karakalpakstan.
Babadjanov A.H., Candidate of Medical Sciences, Senior Researcher of the Department of Surgery of Portal Hypertension and the Pancreaticoduodenal Zone of the Republican Specialized Center of Surgery named after Academician V.Vakhidov.
Sadikov R.Yu., an Ordinator of the Department of Surgery of the Karakalpak Affiliate of the Republican Scientific Center for Emergency Medical Care.
PEDIATRIC SURGERY
G.YU. TSIRDAVA 1, G.M. LUKOYANOVA 2, A.E. KLETSKIN 2, V.P. OBRYADOV 1, E.A. ROZHDENKIN 1
OPERATIVE TREATMENT OF GASTROESOPHAGEAL REFLUX DISEASE IN CHILDREN
FSBE “Nizhny Novgorod scientific research institute of pediatric gastroenterology”1,
SBEE HPE “Nizhny Novgorod State Medical Academy”2
The Russian Federation
Objectives. To improve the surgical treatment results of the gastroesophageal reflux disease in children.
Methods. Gastroesophageal junction insufficiency is one of the causes of the gastroesophageal reflux disease (GERD). To eliminate the gastroesophageal reflux we suggest our own modification of the anti-reflux surgery – the modified purse-string suture on the gastroesophageal junction. 7 patients have been operated on according to this technique. Fibrogastroduodenoscopy, X-ray, pH-metry, ultrasound of the abdominal cavity organs have been carried out in all operated patients before and after the surgery.
Results. The proposed technique of the surgical treatment of the gastroesophageal reflux disease eliminates the gastroesophageal junction insufficiency as well as it yields good functional and clinical results in the nearest and distant postoperative periods that is backed by clinical-laboratory data.
Conclusions. Anti-reflux surgery, esophagofundoplication with the modified purse-string suture, is effective; it eliminates pathological reflux in all patients and yields good functional results.
1. Baranov AA, Klimanskaja GV, Rimarchuk GV. Detskaja gastrojenterologija (izbrannye glavy) [Pediatric gastroenterology (selected chapters)]. Moscow, RF: 2002. 589 p.
2. Privorotskii VF, Luppova NE. Gastroezofageal'neia refliuksnzia bolezn'. Detskaia gastroenterologiia (izbrannye glavy) [Gastroesophageal reflux disease (selected chapters)]. Moscow, RF: 2002. p. 180–209.
3. Shcherbakov PL. Voprosy pediatricheskoi gastroenterologii [The problems of pediatric gastroenterology]. Rus Med Zhurn. 2003;11(3):107–12.
4. Westra SJ, Wolf BH, Slaalman CR. Ultrasound diagnosis of gastroesophageal reflux and hiatal hernia in infants and young children. J Clin Ultrasound. 1990;18(6):477–85.
5. Stepanov EA. Gastroezofageal'naia refliuksnaia bolezn' u detei [Gastroesophageal reflux disease in children]. Ros Zhurn Gastroenterologii, Gepatologii, Koloproktologii. 1998;1:88–9.
6. Zaprudnov AM, Sadovnikov VI, Shcherbakov PL, Grigor'ev KI, Kvirkeliia MA. Krovotecheniia u detei s zabolevaniiami pishchevoda, zheludka i kishechnika [Bleeding in children with esophageal, gastric and intestinal diseases]. Moscow, SSSR: 1997. 125 p.
7. Lukoianova GM. Gastroezofageal'naia refliuksnaia bolezn' u detei [ Gastroesophageal reflux disease in children] V: Makarov NA, red. 40 let klin sorokovoi bol'nitse: cb nauch tr. Nizhny Novgorod, RF; 2006. p. 209–14.
8. Chernousov AF, Korchak AM, Stepankin SN, Efendiev VM. Povtornye operatsii posle funoplikatsii po Nissenu. [Reoperations after Nissen fundoplication]. Khirurgiia. Zhurn im NI Pirogova 1985;(9):5–10.
9. Marshal R. Is the degree of duodenal-gastric reflux related to the severity of gastrooesophageal reflux? Gut. 1997;41(Suppl. 3):A101.
10. Kubyshkin VA, Korniak BS, Azimov RKh. Gastroezofageal'naia ref-liuksnaia bolezn' - novye tendentsii v diagnostike lecheniia [Gastroesophageal reflux disease - new trends in diagnosis of treatment]. Klin Meditsina. 1999;(3):15–21.
11.Khavkin AI, Zhikhareva NS, Khanakeeva ZK. Vozrastnye aspekty diagnostiki i lecheniia gastroezofageal'noi refliuksnoi bolezni u detei [Age-related aspects of diagnosis and treatment of gastroesophageal reflux disease in children]. Terapevt Gastroenterologiia. 2003;(2):59–62.
12. Lukoianova GM, Sheliakhin VE, Dikushin AN. Sposob khirurgicheskogo lecheniia gastroezofageal'noi refliuksnoi bolezni [The method of surgical treatment of gastroesophageal reflux disease]: pat. RF ¹2361530; zaiavka ¹ 2007133059; reg. 20.07. 2009.
603950, Rossiiskaia Federatsiia, g. Nizhnii Novgorod, ul. Semashko, d. 22, FGBU “Nizhegorodskii nauchno-issledovatel'skii institut detskoi gastroenterologii”, otdelenie khirurgii.
e-mail: prof.mukhin@mail.ru,
Tsirdava Gocha Iur'evich
Tsirdava G.Yu., Candidate of Medical Sciences, Senior Research Fellow of FBSE "Nizhny Novgorod Scientific Research Institute of Pediatric Gastroenterology," Ministry of Health and Social Development of Russia.
Lukoyanova G.M., Doctor of Medical Sciences, Professor of the Surgery Chair of the Faculty of the Advanced Training of SBEE HPE "Nizhny Novgorod State Medical Academy," Ministry of Health and Social Development of Russia.
Kletskin A.E., Doctor of Medical Sciences, Professor of the Surgery Chair of the Faculty of the Advanced Training of SBEE HPE "Nizhny Novgorod State Medical Academy," Ministry of Health and Social Development of Russia.
Obryadov V.P., Candidate of Medical Sciences, Pediatric Surgeon of FBSE "Nizhny Novgorod Scientific Research Institute of Pediatric Gastroenterology," Ministry of Health and Social Development of Russia.
Rozhdenkin E.A., Junior Research Fellow of FBSE «Nizhny Novgorod Scientific Research Institute of Pediatric Gastroenterology», Ministry of Health and Social Development of Russia.
TRAUMATOLOGY AND ORTHOPEDICS
A.P. TRUKHAN 1, S.A. ZHIDKOV 2, V.E. KORIK 1, K.A. FEDOROV 1
SURGICAL AID AT HOSPITALIZATION OF LARGE NUMBER OF PATIENTS WITH EXPLOSIVE LESIONS
EE “ Belarusian State Medical University” 1,
Military medical administration of the Ministry of defense 2., Minsk,
The Republic of Belarus
Objectives. To determine the most spread operative interventions in the patients with explosive lesions.
Methods. The research is based on the treatment analysis of 195 victims of the explosion at the metro station “Oktyabrskaya” who were hospitalized to the medical establishments of Minsk in April, 11, 2011.
Results. Operative interventions in victims as the result of the given terror act have been studied. The main types of surgeries on various anatomical areas have been analyzed; technical peculiarities and priorities of their application have been determined. The most frequent performance of the primary surgical wound treatment has been revealed and it sets conditions for the necessity to possess the technique of its carrying out. The importance of active diagnostic search in victims with explosive lesions for early revealing life-threatening outcomes of a trauma has been demonstrated. At the same time it is required to apply all possible laboratory and instrumental methods including invasive ones (celiocentesis, laparoscopy). The correlation between the type character and the operative intervention volume at the bone fractures and type of lesion, severity of patient’s state and availability of medical specialists and corresponding equipment has been viewed.
Conclusions. The victims with the explosive lesions require large amounts of operative interventions including the specialized aid and at the same time it is necessary to follow the “damage control” principles. Each surgeon must know pathogenesis and treatment peculiarities of gunshot and mine-explosive injuries as well as to posses the primary surgical wound treatment technique.
1. Nechaev EA, red. Vzryvnye porazheniia : ruk dlia vrachei i studentov [Explosive injuries: a guide for physicians and students]. Saint-Petersburg, RF: IKF Foliant, 2002. 656 p.
2. Bykova IIu, Yefimenko NA, Gumanenko EK. Voenno-polevaia khirurgiia: natsional'noe rukovodstvo [Military surgery: a national guide]. Moscow, RF: GEOTAR-Media, 2009. 816 p.
3. Bisenkov LN. Khirurgiia minno-vzryvnykh ranenii [Surgery of mine-explosive injuries]. Saint-Petersburg, RF: Akropol', 1993. 320 p.
4. Tolstykh MP, Lutsevich OE, Akhmedov BA, Geinits AB, Ataev AR. Ognestrel'nye raneniia konechnostei mirnogo vremeni [Gunshot wounds of the extremities in the peace-time]. Moscow, RF: Meditsina, 2005. 80 p.
5. Shvyrkov MB, Burenkov GI, Demenkov VR. Ognestrel'nye raneniia litsa, LOR-organov i shei : ruk dlia vrachei [Gunshot wounds to the face, ear, nose, throat and neck: a guide for physicians]. Moscow, RF: Meditsina, 2001. 400 p.
6. Revskoi AK, Liufing AA, Voinovskii EA, Klipak VM. Ognestrel'nye raneniia zhivota i taza. [Gunshot wounds to abdomen and pelvis]. Moscow, RF: Meditsina, 2000. 320 p.
7. Polishchuk NE, Starcha VI. Ognestrel'nye raneniia golovy [Gunshot wounds to the head]. Kiev, SSSR: ToN, 1996. 72 p.
8. Revskoi AK, Liufing AA, Nikolenko VK. Ognestrel'nye raneniia konechnostei [Gunshot wounds to the extremities]. Moscow, RF: Meditsina, 2007. 288 p.
220034, Respublika Belarus', g. Minsk, ul. Azgura, 4, UO “Belorusskii gosudarstvennyi meditsinskii universitet”, voenno-meditsinskii fakul'tet, kafedra voenno-polevoi khirurgii,
e-mail: aleksdoc@yandex.ru,
Trukhan Aleksey Petrovich
Trukhan A.P., Candidate of Medical Sciences, Major of Medical Service, Assistant of Military Field Surgery Chair of the Military Medicine Faculty of EE "Belarusian State Medical University."
Zhidkov S.A., Doctor of Medical Sciences, Professor, Colonel of Medical Service, the Chief of Military Medical Department of the Ministry of Defense of the Republic of Belarus.
Korik V.E., Candidate of Medical Sciences, Associate Professor, Colonel Of Medical Service, Head of Military Field Surgery Chair of the Military Medicine faculty of EE "Belarusian State Medical University."
Fedorov K.A., Lieutenant, a 6th year student of the Military Medical Faculty of EE "Belarusian State Medical University.
NEUROSURGERY
E.L. TSITKO 1, A.F. SMEYANOVICH 2
COMPARATIVE ANALYSIS OF DIAGNOSTIC VALUE OF NEUROSONOGRAPHY MODERN METHODS AT EXTENSIONAL BRAIN TUMORS
ME “Gomel Regional Clinical Hospital” 1, Gomel,
SE “Republican Scientific Clinical Center of Neurology and Neurosurgery” 2, Minsk,
The Republic of Belarus
Objectives. To evaluate predictors of quality of intraoperative ultrasound scanning at the focal brain pathology and to perform the comparative analysis with modern methods of neuroimaging.
Methods. 116 patients with the extensional lesions of the brain (tumors, intracerebral hematomas, abscesses) were included in the research. All patients were subjected to the intraoperative ultrasound scanning through the post-trepanation defect. In the preoperative period computer tomography (CT) of the brain was performed in 79 cases (68,1%), magnetic resonance imaging (MRI) – in 23 (19,8%) patients. In 10 (8,6%) cases, CT and MRI were carried out for the differential diagnosis of focal pathology. In order to determine the cause of the intracranial hypertension, in 4 (3,5%) patients diagnostic trepanation was done, followed by brain parenchyma neurosonography (NSG).
In order to determine the diagnostic value of MRI, CT and NSG, the data of the pathomorphological changes obtained during the surgery and, in cases of the brain tumors, the histopathological examination of the material obtained at the removal were used as a "gold standard".
Results. Studying of the neurosonography operative characteristics proves high informational content of the given method in the diagnostics of the brain focal pathology (validity 98%). The comparative estimation of the diagnostic value of three alternative methods of neuroimaging has shown that intraoperative ultrasound scanning has high prognostic qualities (all AUROC values exceed 0,9) and can be compared with MRI in its significance (ð>0,050 no matter what nosological form it is) and CT at intracerebral hematomas (ð=0,389). What concerns CT at tumors and brain abscesses, the importance of the intraoperative ultrasound scanning is significantly superior to native CT ð<0,001 and ð=0,001, correspondently).
Conclusions. Predictive value of intraoperative ultrasound scanning in the diagnosis of pathological extensive tumors of the brain is comparable with MRI and CT at intracerebral hematomas, but surpasses CT in cases of the brain tumors and abscesses.
1. Vasil'ev SA, Zuev AA. Ul'trazvukovaia navigatsiia v khirurgii opukholei golovnogo mozga [Ultrasonograpy-based navigation in surgical treatment of brain tumors]. Neirokhirurgiia. 2010;(4 Ch. 2.):16–23.
2. Shipai AP, Smeianovich AF, Sidorovich RR. Neirokhirurgicheskaia navigatsionnaia sistema v lechenii ob"emnykh obrazovanii golovnogo mozga [Neurosurgical navigation system in the treatment of space-occupying lesions of the brain]. Nevrologiia i neirokhirurgiia v Belarusi. 2009;(3):138–42.
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246029, Respublika Belarus', g. Gomel', ul. Brat'ev Liziukovykh, d. 5, U “Gomel'skaia oblastnaia klinicheskaia bol'nitsa“, neirokhirurgicheskoe otdelenie,
e-mail: fedor30@tut.by,
Tsitko Evgeniy Leonidovich
Tsitko E.L., Neurosurgeon, "Gomel Regional Clinical Hospital."
Smeyanovich A.F., an Academician of the National Academy of Sciences of Belarus, Doctor of Medical Sciences, Professor of SE "The Republican Scientific and Clinical Center of Neurology and Neurosurgery", Minsk.
ONCOLOGY
V.T. MALKEVICH, V.V. ZHARKOV, L.I. OSITROVA, V.P. KURCHIN, A.YU. BARANOV, I.A. ILYIN
NEW APPROACHES TO TREATMENT OF INTRAPLEURAL COMPLICATIONS IN ESOPHAGEAL CANCER SURGERY
SE “N.N.Alexandrov Republican Scientific Practical Center of Oncology and Radiology”, Minsk
The Republic of Belarus
Objectives. To work out and introduce in the clinical practice a new treatment method of the intrapleural complications caused by anastomosis sutures failure and/or esophagotransplant necrosis at surgical treatment of the esophageal cancer.
Methods. The paper presents the surgical treatment experience of 59 patients on the basis of the thoracic department of N.N.Alexandrov Republican scientific practical center of oncology and radiology, in whom, after surgical treatment for esophageal cancer, intrapleural complications developed: esophageal anastomotic sutures failure was diagnosed in 17 and esophagotransplant necrosis – in 42 patients.
Results. The conservative principle was used in 22 patients (the 1 group) with saving of the esophagogastric anastomosis; and 37 patients (the 2 group) were treated by active surgical tactics based on the disconnecting surgery with the resection of the proximal segment of gastric stem with the esophageal anastomotic segment and esophagostomy, gastro- or jejunostomy formation. In 6 patients from the 2 group, treatment of intrapleural complications was carried out using a new method by anastomotic esophageal segment and proximal gastric area apparatus resection within healthy tissue boundaries with the leaving of the resected stump in the posterior mediastinum, the formation of the cervical end esophagostomy in the left supraclavicular area and the suspended probe jejunostomy in the left mesogaster.
Conclusions. It was established that the optimal treatment method of esophagotransplant necrosis and/or esophageal anastomosis sutures failure was the active surgical tactics aimed “to disconnect” the alimentary tract continuity, allowing to reduce postoperative mortality and to provide the potential long-term survival rates for this group of patients by performing the reconstructive surgery.
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13. Mal'kevich VT, Bogushevich EV, Ositrova LI, Serova TN, Il'in IA. Rentgenodiagnostika vnutriplevral'nykh oslozhnenii posle khirurgicheskogo lecheniia po povodu raka pishchevoda i kardii. [X-ray diagnosis of intrapleural complications after esophageal and cardia cancer surgery]. Novosti Khirurgii. 2011;19(6):95–100.
14. Davydov MI, Stilidi S. Rak pishchevoda. [Cancer of the esophagus]. Moscow, RF: Izdat. gruppa RONTs, Prakt meditsina; 2007. 392 p.
223040, Respublika Belarus', Minskaia obl., Minskii raion, pos. Lesnoi 2, ÃÓ “RNPTs onkologii i meditsinskoi radiologii im. N.N. Aleksandrova“, otdel torakal'noi onkopatologii,
e-mail: malkvt@mail.ru,
Mal'kevich Viktor Tikhonovich
Malkevich V.T., Candidate of Medical Sciences, Senior Research Fellow, Department of Thoracic Cancer Pathology of the RSPC of Oncology and Medical Radiology named after N. N. Alexandrov.
Zharkov V.V., Doctor of Medical Sciences, Professor, Chief Research Fellow, Department of Thoracic Cancer Pathology of the RSPC of Oncology and Medical Radiology named after N. N. Alexandrov.
Ositrova L.I., Candidate of Medical Sciences, Oncologist-Surgeon of the Oncological Thoracic Department ¹ 1 of the RSPC of Oncology and Medical Radiology named after N. N. Alexandrov.
Kurchin V.P., Doctor of Medical Sciences, Head of the Department of Thoracic Cancer Pathology of the RSPC of Oncology and Medical Radiology named after N. N. Alexandrov.
Baranov A.Yu., Head of the Oncological Thoracic Department ¹ 1 of the RSPC of Oncology and Medical Radiology named after N. N. Alexandrov.
Ilyin I.A., a Clinical Resident of the RSPC of Oncology and Medical Radiology named after N. N. Alexandrov.
V.V. ZHARKOV, S.A. YESKOV, V.P. KURCHIN
THE LEFT ATRIUM RESECTION IN PATIENTS WITH LOCALLY ADVANCED NON-SMALL CELL LUNG CANCER
SE “N.N.Alexandrov Republican scientific practical center of oncology and radiology”, Minsk
The Republic of Belarus
Objectives. To evaluate the surgical method efficacy while treating patients with non-small cell lung cancer (NSCLC) extending to the intrapericardial sections of the pulmonary veins and/or the left atrium (LA).
Methods. The result analysis of the surgical treatment of 55 patients with locally advanced NSCLC requiring LA resection was carried out in this research. The average age made up 58,4 years (from 38 up to 77 years), median was 59 years. The process was staged as T3N1M0 in 2 cases, as T3N2M0 – in 4 cases, T4N0M0 – in 5 cases, T4N1M0 – in 18 cases, T4N2M0 – in 26 cases. According to the histological structure of the tumor, the patients were divided as follows: the squamous cell carcinoma – 48 (87,3%), adenocarcinoma – (7,3%), the adenosquamous carcinoma – 2, the undifferentiated large cell carcinoma – 1. LA myocardium lesion was noted in 21 cases (38,2%), in the intrapericardial sections of the pulmonary veins – in 34 cases (61,8%). The LA resection was carried out with the help of the linear suturing apparatus in 43 cases, in 2 cases – with vascular clamp. In 10 patients LA resection and its plasty with xenopericardium was done under the conditions of the artificial blood circulation (ABC).
Results. Incidence of the postoperative complications made up 32,7%, postoperative lethality – 10,9%. One-year, three-year and five-year survival rates (n=55) made up 60,9%, 43,3% and 25,1% correspondently, survival rate median – 18,3 months. Among the patients (n=49) with the tumor, classified as pT4N0-2M0, – 62,4%, 33,4% and 27,8% correspondently, survival rate median – 18,3 months. In patients with metastatic lesions of the mediastinal lymph nodes (pT4N2M0, n = 26) five-year survival rate was 29,2%, survival rate median – 18,9 months without mediastinal lymph nodes lesions T4N0-N1 (n = 22) – 21,2% and 16,0 months correspondently (p=0,55).
Conclusions. Surgical method of treatment in patients with NSCLC extending to the heart structures can ensure high long-term survival rate at acceptable frequency parameters of the postoperative complications and postoperative lethality.
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223040, Respublika Belarus', Minskii r-n, p. Lesnoi, 2, GU “RNPTs onkologii i meditsinskoi radiologii im. N.N. Aleksandrova“, otdel torakal'noi onkopatologii s gruppoi anesteziologii,
e-mail: 445e@mail.ru,
Eskov Sergey Aleksandrovich
Zharkov V.V. Doctor of Medical Sciences, Professor, Chief Research Fellow of the Department of Thoracic Cancer Pathology of the RSPC of Oncology and Medical Radiology named after N. N. Alexandrov.
Yeskov S.A., a Research Fellow of the Department of Thoracic Cancer Pathology of the RSPC of Oncology and Medical Radiology named after N. N. Alexandrov.
Kurchin V.P., Doctor of Medical Sciences, Head of the Department of Thoracic Cancer Pathology of the RSPC of Oncology and Medical Radiology named after N. N. Alexandrov.
ANESTHESIOLOGY-REANIMATOLOGY
A.V. MAROCHKOV, V.A. DUDKO, A.L. LIPNITSKY
QUALITY CONTROL OF SYNCHRONIZATION OF THE ARTIFICIAL LUNG VENTILATION AND PATIENT’S SPONTANEOUS BREATHING USING ELECTROENCEPHALOGRAPHIC MONITORING
ME “Mogilev regional hospital”
The Republic of Belarus
Objectives. To determinate the effectiveness of electroencephalogram-based control (EEG) according to Bispectral (BIS-index®) as the criterion of the adequate drug synchronization during the prolonged artificial lung ventilation (ALV).
Methods. 78 episodes of artificial lung ventilation were under analysis (ALV) in 12 patients with the syndrome of acute lung injury (ALI) who underwent ALV longer than 48 hours.
The registration of ALV regimen and parameters as well as the parameters of the respiration monitoring, the analysis data of the arterial and venous blood gases and acid-base state (ABS), the method of introduction and doses of the sedative preparations and analgesics was performed.
To assess the state of the central nervous system, bispectral index parameters (BIS-index) were registered. The evaluation of the patients’ state with Ramsey sedation scale was also carried out. All the analyzed episodes of ALV were divided into 4 groups: in the 1 group the psychotropic drugs were not administered, the 2 group – episodes of ALV with the use of narcotic analgesics, the 3 group – only sedatives preparations were used and the 4 group – both narcotic analgesics and sedatives were simultaneously used.
Results. It was established that higher values of BIS-index, an average of 89,1±10,6 were recorded in the 1 group of episodes of ALV. In the second group BIS-index decreased more significantly and amounted to an average of 75,0±16,1. In the third and fourth groups BIS-index was significantly different from the values in the first two groups; average values were 37,2±11,6 and 43,2±18,1, respectively. The reliable inverse correlation between the readings of BIS – monitoring and evaluation on Ramsey score scale was revealed. A clear direct correlation between the numerical values of the BIS-index and the volume of spontaneous breathing in the total volume of the minute lung ventilation was established. It was found out in the episodes of ALV demanding deep sedation, the significantly more severe disturbance of oxygenation and changes in the mechanical properties of the lung were registered in patients.
Conclusions. BIS – index is an objective criterion for effective drug synchronization during the prolonged ALV.
1. Kassil' VL, Vyzhigina MA, Khapii KhKh. Mekhanicheskaia ventiliatsiia legkikh v anesteziologii i intensivnoi terapii [Mechanical lung ventilation in anesthesiology and intensive care]. Moscow, RF: MEDpress - inform, 2009. 608 p.
2. Satishur OE. Mekhanicheskaia ventiliatsiia legkikh. [Mechanical ventilation of lungs]. Moscow, RF: Med-lit, 2006. 352 p.
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7. Molchanov IV, Alekseeva GV, Alekseev M. V. Kontseptsiia anal'gezii i sedatsii patsientov otdelenii intensivnoi terapii [The concept of analgesia and sedation in intensive care patients]. Klin Anesteziol i Reanimatol. 2004;(1):14–9.
8. Gritsan AI, Kolesnichenko AP. Graficheskii monitoring respiratornoi podderzhki [Graphical monitoring of respiratory support]. Saint-Petersburg, RF: SpetsLit, 2007. 103 p.
9. Nilsestuen JO, Hargett KD. Using ventilator graphics to identify patient-ventilator asynchrony. Respir Care. 2005;50(2):202–34.
10. Kelli SD. Monitoring sostoianiia soznaniia pri provedenii anestezii i sedatsii: rukovodstvo dlia vrachei po ispol'zovaniiu tekhnologii BIS® [Monitoring of the consciousness state during anesthesia and sedation: a guide for physicians on the use of technology BIS ®]. Aspect Medical Sistems; SRK Group. 157 p.
11. Kichin VV, Kulikov AS, Likhvantsev VV. Primenenie metodov kontroliruemoi sedatsii i sedoanal'gezii pri provedenii dlitel'noi IVL patsientam s ostrym parenkhimatoznym povrezhdeniem legkikh [Application of controlled sedation and sedoanalgesia during prolonged mechanical ventilation in patients with acute parenchymal lung injury]. Vestn Intensiv Terapii. 2002;(1):20–22.
12. Kulen R, Guttmann I, Rossent R. Novye metody vspomogatel'noi ventiliatsii legkikh [New methods of assisted lung ventilation]. Moscow, RF: Meditsina, 2004. 160 p.
212026, Respublika Belarus', g. Mogilev, ul. B.-Biruli, d.12, UZ “Mogilevskaia oblastnaia bol'nitsa“, reanimatsionno-anesteziologicheskoe otdelenie Tsentra serdechno-sosudistoi khirurgii,
e-mail: vladimirdudko@mail.ru,
Dudko Vladimir Aleksandrovich
Marochkov A.V., Doctor of medical sciences, Head of the Resuscitation and Anesthesia Department of ME "Mogilev Regional Hospital."
Dudko V.A., Head of the Resuscitation and Anesthesia Department of the Center of the Cardiovascular Surgery of ME "Mogilev Regional Hospital."
Lipnitski A.L., an Anesthesiologist-resuscitator of the Resuscitation and Anesthesia Department of ME "Mogilev Regional Hospital."
M.Z. DUGIYEVA, S.V. SVIRIDOV, N.I. SLEPTSOVAS, K.V. MOROZOVA
CONTROLLED SUPERVISED BY THE PATIENT IN THE EARLY POSTOPERATIVE PERIOD AT GYNECOLOGIC PATIENTS
SBEE HPE “Russian National Research Medical University named after N.I.Pirogov”
The Russian Federation
Objectives. To carry out the efficiency estimation of patient-controlled analgesia (PCA) in the early postoperative period in patients after gynecological surgery.
Methods. Depending on the performed treatment the patients were divided into three groups. To relieve postoperative pain the method of patient-controlled analgesia with the infusion of morphine bolus doses was applied in all groups. While using the PCA method in 32 patients TsOG-1 inhibitor ketorol (group A) was additionally applied; in 36 patients – TsOG-2 inhibitor parecoxib (group B) was used. The other 29 patients (control group) did not receive the preparations of nonsteroid anti-inflammatory agents. The visual analogue scale (VAS) of pain has been widely used and studied as a method of postoperative pain measurement in each of the allocated groups.
Results. The conducted research permits to state that the additional use of ketorol and parecoxib combined with PCA procedure with morphine provided an authentic decrease of the used morphine within the first 6 hours of PCA and in general for all circadian period of this technique application. At the same time difference of the used morphine quantity within singled out time intervals wasn’t statistically significant (ð>0,05) between groups A and B. It means that ability of ketorol and parecoxib to reduce morphine requirements in patients during PCA procedure turns out to be almost identical.
Conclusions. Identical efficacy of ketorol and parecoxib in providing of total daily morphine dosage reduction during patient-controlled application has been confirmed.
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117997, Rossiiskaia Federatsiia, g. Moskva, ul. Ostrovitianova, d. 1, GBOU VPO “Rossiiskii natsional'nyi issledovatel'skii meditsinskii universitet imeni N. I. Pirogova“, kafedra akusherstva i ginekologii ¹1,
e-mail: Morozovadk@mail.ru,
Morozova Kseniia Vladimirovna
Dugiyeva M.Z., Candidate of Medical Sciences, Associate Professor of the Chair of Obstetrics and Gynecology of the Medical Faculty of SBEE HPE "Russian National Research Medical University named after N.I. Pirogov” Ministry of Health and Social Development of Russia.
Sviridov S.V., Doctor of Medical Sciences, Professor, Head of the Chair of Anesthesiology and Reanimation of the Medical Faculty of SBEE HPE "Russian National Research Medical University named after NI Pirogov, Health Ministry of Russia.
Sleptsova N.I., Candidate of Medical Sciences, Assistant of the Chair of Obstetrics and Gynecology of the Medical Faculty of SBEE HPE "Russian National Research Medical University named after N.I. Pirogov” Ministry of Health and Social Development of Russia.
Morozova K.V., a Post-graduate Student of the Chair of Obstetrics and Gynecology of the Medical Faculty of SBEE HPE "Russian National Research Medical University named after N.I. Pirogov” Ministry of Health and Social Development of Russia.
LECTURES, REVIEWS
V.YA. KHRYSHCHANOVICH, S.I. TRETYAK
ÑOMPARATIVE ANALYSIS OF MATERIALS USED FOR CELLS IMMUNOISOLATION AT TRANSPLANTATION
EE “Belarusian State Medical University”, Minsk,
The Republic of Belarus
The primary aim of the cell encapsulation technology is the “addressed” delivery of the synthesized molecules to the target organ. The principle of the cell immunoisolation is the backgrounds of this method – prior to transplantation donor cells are set in the semi-permeable membrane to protect them against their interaction with the host’s immune system. This membrane is selectively permeable to transport the nutrients and the products of the cellular secretion but relatively impermeable to larger molecules and cells of the hosts’ immune system. Besides the most immunoisolating devices have the internal matrix which contributes to the compact immobilization of cells inside the capsule. The proper choice of the synthetic materials and methods of their processing influences significantly the functioning efficacy of the semi-permeable membrane and matrix components. Up-to-date immunoisolating devices permit to reconstruct natural three-dimensional tissue environment thus maintaining functional activity and viability of the encapsulated cells. This review summarizes recent developments in the field of materials production used to make devices for cell encapsulation.
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220116, Respublika Belarus', g. Minsk, pr-t. Dzerzhinskogo, d. 83, UO “Belorusskii gosudarstvennyi meditsinskii universitet”, 2-ia kafedra khirurgicheskikh boleznei,
e-mail: vladimirkh77@mail.ru,
Khryshchanovich Vladimir Ianovich
Khryshchanovich V.Ya., Doctor of Medical Sciences, Associate Professor of the 2nd Department of Surgical Diseases of EE «Belarusian State Medical University." Tretyak S.I., Doctor of Medical Sciences, Professor, Head of the 2nd Department of Surgical Diseases of EE “Belarusian State Medical University."
MASTER CLASS
G.V. YAROVENKO, B.N. ZHUKOV, S.E. KATORKIN
OPERATIVE CORRECTION VARIANTS OF LYMPH OUTFLOW AT THE LOWER LIMBS LYMPHEDEMA
SBEE HPE “Samara State Medical University”
The Russian Federation
To improve the results of surgical treatment of patients with the lower limbs lymphatic edemas at their early stages one suggested applying various types of lymph-venous anastomosis. The step-by-step technique of lymphadenovenous and lymphangiovenous anastomosis application is described in the article; indications and contraindications to their performance are established; possible complications and mistakes as well as methods of their prevention are showed.
The results of lymphadenovenous and lymphangiovenous anastomoses application while treating the patients with the lower limbs lymphatic edemas of different degrees of severity are suggested. 69 patients were operated on. The 1-2 degrees of lymphedema were diagnosed in 17 of them; the 3-4 degrees – in 52 operated patients. In 18 cases the lymphadenovenous anastomosis according to “side by side” type was applied; in 45 cases anastomosis according to “end to side” type was applied; in 5 episodes lymphangiovenous anastomoses were formed.
Application of lymphadenovenous and lymphangiovenous anastomoses permits to improve the nearest and distant treatment results of patients with the lower limbs lymphedema and can be recommended at lymphatic edemas of various etiology.
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443079, Rossiiskaia Federatsiia, g. Samara, pr. Karla Marksa, 165 «b», Kliniki Samarskogo gosudarstvennogo meditsinskogo universiteta, kafedra gospital'noi khirurgii.
e-mail: yarovenko_galina@mail.ru,
Iarovenko Galina Viktorovna
Yarovenko G.V., Doctor of Medical Sciences, Physician of the Vascular Department of the Hospital Surgery Clinic of SBEE HPE "Samara State Medical University».
Zhukov B.N., Doctor of Medical Sciences, Professor, Honored Scientist of Russia, Head of the Chair of Hospital Surgery of SBEE HPE "Samara State Medical University», Ministry of Health and Social Development of the Russian Federation.
Katorkin S.E., Candidate of Medical Sciences, Associate Professor of the Hospital Surgery Chair and Clinic of SBEE HPE "Samara State Medical University», Ministry of Health and Social Development of the Russian Federation.
PRACTICAL CASES
B.N. KOTIV, A.P. CHUPRINA, D.A. YASYUCHENYA, D.M. MELNIK, O.A. LITVINOV, I.V. BOYKOV, A.S. GRISHCHENKOV
ONE-STAGE BILATERAL LUNG RESECTION IN THE TREATMENT OF COLORECTAL ADENOCARCINOMA METASTASES IN A PATIENT WITH PRIMARY MULTIPLE METACHRONOUS COLORECTAL AND PROSTATE CANCER
FSBMEE HPE “Military Medical Academy named after S.M.Kirov” Ministry of Defense of the Russian Federation
The Russian Federation
We presented a clinical case of a 67-year-old man suffering from the primary multiple metachronous cancer: the colorectal cancer T2N0M0 (2001 year), prostate cancer T4N0M0 (2010 year). In 2008, 7 years after the extirpation of the rectum, the patient was performed the one-stage bilateral lung resection: the lower left lobectomy, video- assisted thoracoscopic resection of the right lower lobe for metastases of colorectal cancer. Clinical case demonstrates the effectiveness of one - stage surgeries in the complex treatment of such patients and has value as the observation of rarely occurred primary multiple metachronous cancer of the rectum and prostate.
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194044, Rossiiskaia Federatsiia g. Sankt-Peterburg, ul. Akademika Lebedeva, d. 6, FGVOU VPO “Voenno-meditsinskaia akademiia im. S.M. Kirova”, kafedra i klinika gospital'noi khirurgii,
e-mail: fsurgeonf@mail.ru,
Iasiuchenia Denis Aleksandrovich
Kotiv B.N., Doctor of Medical Sciences, Professor, Colonel of Medical Service, Head of the Chair and Clinic of Hospital Surgery of FSMEE HPE "Military Medical Academy named after S.M. Kirov," Ministry of Defense of the Russian Federation.
Chuprina A.P., Candidate of Medical Sciences, Associate Professor, Colonel of Medical Service, Professor of the Chair of Hospital Surgery of FSMEE HPE "Military Medical Academy named after S.M. Kirov," Ministry of Defense of the Russian Federation.
Yasyuchenya D.A., Captain of Medical Service, a Graduate Student of the Chair of Hospital Surgery of FSMEE HPE "Military Medical Academy named after S.M. Kirov," Ministry of Defense of the Russian Federation.
Melnik D.M., a Surgeon of the Thoracic Department of the Clinic of Hospital Surgery of FSMEE HPE "Military Medical Academy named after S.M. Kirov," Ministry of Defense of the Russian Federation.
Litvinov O.A., Colonel of Medical Service, Doctor of Medical Sciences, Aassociate Professor of the General Surgery Chair of FSMEE HPE "Military Medical Academy named after S.M. Kirov, " Ministry of Defense of the Russian Federation.
Boykov I.V., Candidate of Medical Sciences, Colonel of Medical Service, a Senior Lecturer of the Chair of Roentgenology and Radiology (with the Course of Ultrasound Diagnostics) of FSMEE HPE "Military Medical Academy named after S.M. Kirov," Ministry of Defense of the Russian Federation.
Grishchenkov A.S., a Clinical Resident of the Chair of Roentgenology and Radiology (with the Course of Ultrasound Diagnostics) of FSMEE HPE "Military Medical Academy named after S.M. Kirov," Ministry of Defense of the Russian Federation.
I.V. MISHIN 1,2, A.V. DANCH 3
MUCOCELE OF THE APPENDIX
National scientific practical center of the urgent medicine 1,
N.A.Testemitsanu State University of Medicine and Pharmacy 2,
Republican hospital of medical sanatorium and restorative association 3,
The Republic of Moldova
Mucocele of the appendix is the obstructive dilatation of the appendix with the gelatinous masses accumulation in the lumen. Mucocele of the appendix is rather rare and composes 0,3-0,7% of all appendectomies and 8% of all tumors of the appendix. Taking into account the given pathology rareness the authors have described their own clinical observation of mucocele of the appendix in a 40-year-old patient who had been operated on for acute appendicitis. Taking into consideration that the appendix base and the cecum cupola were not involved in the pathological process, a standard appendectomy was performed. There was mucinous cystadenoma of the appendix at the histological investigation of the preparation. The postoperative period was rather even. The wound healed by first intention.
There were no complaints at the control examination 12 months afterwards; the ultrasound data and colonoscopy revealed no pathology. The level of tumormarkers of carcinoembryonic antigen, ÑÀ-19-9 and ÑÀ-125 was normal. The authors described in details the questions concerning pathogenesis and possible complications of mucocele of the appendix, the peculiarities of the radiological diagnostics as well as the choice of the operative intervention volume in various cases.
1. Ruiz-Tovar J. Mucocele of the appendix. World J Surg. 2007:31(3):542–48.
2. Dhage-Ivatury S, Dhage-Ivatury S, Sugarbaker PH. Update on the surgical approach to mucocele of the appendix. J Am Coll Surg. 2006;202(4):680–84.
3. Kleemann M. Mucocele of the appendix – a heterogenous surgical pathology. Zentralbl Chir. 2010;135(4):330–35.
4. Stocchi L, Wolff BG, Larson DR, Harrington JR. Surgical treatment of appendiceal mucocele. Arch Surg. 2003 Jun;138(6):585–89. discussion 589–90.
5. Higa E, Rosai J, Pizzimbono CA, Wise L. Mucosal hyperplasia, mucinous cystadenoma, and mucinous cystadenocarcinoma of the appendix. A re-evaluation of appendiceal "mucocele". Cancer. 1973 Dec;32(6):1525–41.
6. Kim MK, Lee HY, Song IS, Lee JB, Kim GH, Yoo SM, Rho JY, White CS. A case of a giant mucocoele of the appendiceal stump presented with a palpable mass in the right thigh: pre-operative diagnosis based on characteristic multidetector CT findings. Br J Radiol. 2010 Oct;83(994):e220–23.
7. Sidorova EE. Pugacheva OG, Stepanova IuA, Karmazanovskii GG, Shchegolev AI. Mukotsele appendiksa. Obzor literatury i opisanie sobstvennogo klinicheskogo nabliudeniia [Mukocele of the appendix. A literature review and a description of own clinical observations]. Med Vizualizatsiia. 2008;(1):72–6.
8. Ghidirim G, Gagauz I, Misin I, Canariov M, Ionesii P, Zastavnitchi G. Mucinous cystadenocarcinoma of the appendix complicated with spontaneous cutaneous fistula. Chirurgia (Bucur). 2007 Mar-Apr;102(2):231–35. [Article in Romanian]
9. Mishin I, Ghidirim G, Zastavnitsky G, Popa C. Torsion of an appendiceal mucinous cystadenoma Report of a case and review of literature. Ann Ital Chir. 2012 Jan-Feb;83(1):75–8.
10. Savchenko IuP, Polovinkin VV, Fedosov SR, Pryn' PS. Sochetanie gigantskogo mukotsele cherveobraznogo otrostka i adenokartsinomy priamoi kishki [The combination of a giant mukocele appendix and rectal adenocarcinoma]. Khirurgiia Zhurn im NI Pirogova. 2006;(10):57–59.
11.Liberale G, Lemaitre P, Noterman D, Moerman C, de Neubourg E, Sirtaine N, El Nakadi I. How should we treat mucinous appendiceal neoplasm? By laparoscopy or laparotomy? A case report. Acta Chir Belg. 2010 Mar-Apr;110(2):203–7.
2004, Respublika Moldova, g. Kishinev, ul. Toma Chorbe, d 1, Natsional'nyi nauchno-prakticheskii tsentr urgentnoi meditsiny, kafedra khirurgii ¹1 im. N.Kh. Anestiadi i laboratoriia gepato-pankreato-biliarnoi khirurgii Gosudarstvennogo Universiteta meditsiny i farmatsii im. N.A. Testemitsanu,
e-mail: mishin_igor@mail.ru,
Mishin Igor Valentinovich
Mishin I.V., Doctor of Medical Sciences, Deputy Director on Science of the National Scientific Research Center for Urgent Medicine, a Leading Scientific Researcher of the Laboratory of Hepato-Pancreato-Biliary Surgery of State University of Medicine and Pharmacy named after N. Testemitsanu, Danch A.V., Candidate of Medical Sciences, Head of the Department of Endoscopy and Minimally Invasive Surgery of the Republican Hospital of Medical Sanatorium and Restorative Association.
EXCHANGE BY EXPERIENCE
A.A. LERNER, M.V. FOMENKO
FOLLOWING “DAMAGE CONTROL” PRINCIPLES AT SEVERE LIMB INJURIES TREATMENT
Medical center “Ziv”, Safed,
Israel
High-energy injuries cause deep and extensive damages to soft tissue, to a certain extent restricting possibilities of the restorative treatment and range of medical procedures. Less traumatic methods of external fixation of fractures based on the “Damage control” principles permitting to stabilize the damaged segment of the limb with minimal additional trauma avoiding introducing foreign bodies in the damage zone are more preferable in such cases. Besides, one-side apparatuses of the external fixation practically don’t restrict surgical access to a damaged limb and don’t prevent further skin defects closure. Simplicity of this method and relatively short duration of the operation are significant for patients with multiple traumas and in cases of mass hospitalization.
The main indications for the primary stabilization with the tubular apparatuses are
– open diaphyseal and open intra-and periarticular fractures with significant damages and soft tissue defects, especially due to high-energy traumatic factors (such as Gustilo-Andersen 2-3 fractures);
– severe general condition of the victim after multiple or combined traumas requiring minimally traumatic, bloodless and rapid stabilization of the limb fractures;
– unstable fractures of the pelvis in hemodynamically unstable patients.
Further final reposition and stable fixation in the Ilizarov apparatus promotes early mobilization, including the full axial load, stimulating bone fusion and healing of the damaged soft tissues.
Minimally invasive staged treatment in the apparatuses of external fixation based on the “Damage control” principles permits to save severe-damaged limbs and to contribute to their functional recovery, in cases of extensive damage and defects of osseous and soft tissues, as well as in patients in critical condition.
1. Nechaev EA, Gritsanov AI, Fomin NF. Minno-vzryvnaia travma [Mine blast injury ]. Saint-Petersburg, SSSR: Al'd; 1994. 488 p.
2. Foglar C, Ibarra M, Miclau T. Gunshot wounds of the forearm. Injury. 1997;28(Suppl. 3):18–22.
3. Has B, Jovanovic S, Wertheimer B, Mikolasevic I, Grdic P. External fixation as a primary and definitive treatment of open limb fractures. Injury. 1995 May;26(4):245-8.
4. Kenwright J. The principles of use of external fixation. Curr Orthop. 1992;6:214–19.
5. Labeeu F, Pasuch M, Toussaint P, Van Erps S. External fixation in war traumatology: report from the Rwandese war (October 1, 1990 to August 1, 1993). J Trauma. 1996 Mar;40(3 Suppl):S223–27.
6. Saleh M, Yang L, Sims M. Limb reconstruction after high-energy trauma. Br Med Bull. 1999;55(4):870–84.
7. Lerner A, Reis D, Soudry M. Severe Injuries to the Limbs. Staged. Treatmen. Berlin, Germany: Springer-Verlag-Heidelberg; 2007. 235 p.
8. Lerner A, Soudry M. Armed Conflict Injuries to the Extremities. A treatment manual. Berlin, Germany: Springer-Verlag-Heidelberg; 2007. 407 p.
9. Lerner A, Soudry M. Hybrid external fixation in high-energy elbow fractures: a modular system with a promising future. J Trauma. 2000;49:1017–22.
10. Norris RI, Kellam JF. Soft-tissue injuries associated with high-energy extremity trauma: principles of management. J Am Acad Orthop Surg. 1997;5(1):37–46.
11. Johnson KD, Cadambi A, Seibert GB. Incidence of adult respiratory distress syndrome in patients with multiple musculoskeletal injuries: effect of early operative stabilization of fractures. J Trauma. 1985;25:375–84.
12. Omer GEJr. Injuries to nerves of the upper extremity. J Bone J Surg Am. 1974;56-A:1615–24.
13. Buckwalter JA, Grodzinsky AJ. Loading of healing bone, fibrous tissue, and muscle: implications for orthopaedic practice. J Am Acad Orthop Surg. 1999;7:291–99.
14. Ilizarov GA. The transosseous ostheosynthesis: theoretical and clinical aspects of the regeneration and growth of tissue. New-York, US: Springer; 1992. 589 p.
13100, Izrail', g. Tsfat, Meditsinskii tsentr «Ziv», otdeleniia ortopedii,
e-mail: alex_lerner@yahoo.com,
Lerner Aleksandr Aronovich
Lerner A.A., a Senior Lecturer of the Medical Faculty of Bar-Ilan University, Director of the Department of Orthopedics, “Ziv” Medical Center, Safed, Israel.
Fomenko M.V., Candidate of Medical Sciences, Physician of the Department of Orthopedics, “Ziv” Medical Center, Safed, Israel.
