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Year 2010 Vol. 18 No 4

HISTORY OF SURGERY

VASILENKO N.I., NEBYLITSIN YU.S., VASILENKO S.G.

SURGEON’S SCALPEL – ARMS OF VICTORY

The article is dedicated to the staff members of Vitebsk medical institute who during the years of Great patriotic war were at the front and in the Soviet rear, where they fulfilled their professional duty, assisted the wounded and sick soldiers, contributed to their early return to active duty. Professors V.O. Morzon, I.B Oleshkevich, N.M. Yanchur, N.T. Petrov, E.S. Aleksentseva, V.S. Bazhenov, I.A. Petukhov, docents N.I. Bobrik, A.Ya. Mitroshenko, N.A. Entin, G.M. Pruss, A.F. Kotovich selflessly worked in hospitals of different kinds and undoubtedly contributed to the victory over Nazi Germany. Their further fate during the postwar period is described briefly.
Life and activity of these people are the example and lesson for present-day time and warning for the future, inculcating of patriotism in the whole generation.
The memory about the martial affairs of Belarusian doctors during the war years is in the minds of our people a shield, a barrier against all kinds of attempts to falsify the history of the country, to humiliate the national dignity.

Keywords: military doctors, surgeons, Vitebsk state order of People’s friendship medical university

p. 3-11 of the original issue

References

1. Витебский государственный медицинский университет (1934-2004) / А. Н. Косинец [и др.] ; под редакцией А. Н. Косинца. – Витебск: ВГМУ, 2004. – 547 с.
2. Вовна, А. В. Витебский государственный медицинский институт в годы Великой Отечественной войны / А. В. Вовна // Подвигу народа в Великой Отечественной войне – память и благодарность потомков: материалы научно-практической конференции студентов и сотрудников ВГМУ, посвящ. 60-летию Победы в Великой Отечественной войне. – Витебск, Изд-во ВГМУ, 2005. – С.106-110.
3. Никольский, М. А. Вклад военно-полевых хирургов в освобождении Беларуси от немецко-фашистских захватчиков / М. А. Никольский, В. П. Дейкало // Подвигу народа в Великой Отечественной войне – память и благодарность потомков: материалы научно-практической конференции студентов и сотрудников ВГМУ, посвящ. 60-летию Победы в Великой Отечественной войне. – Витебск, Изд-во ВГМУ, 2005. – С.89-93.
4. Шиленок, В. Н. Николай Михайлович Янчур – врач, учёный, защитник Отечества / В. Н. Шиленок, Э. Я. Зельдин // Новости хирургии. – 2009. – Т.17, № 3. – С. 3-7.
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6. Пересада, А. И. Заведующие кафедрами и профессора минского медицинского института (1921 –1996) / А. И. Пересада, М. В. Мальковец, Н. Ф. Змачинская. – Минск. гос. мед. ин-т, 1999. – С. 71-72.
7. Витебскому государственному ордена Дружбы народов медицинскому университету 65 лет / А. Н. Косинец [и др.]; под редакцией А. Н. Косинца. – Витебск, 1999. – С.126.
8. Шахматова, А. С. Врач, гражданин, ученый. К 110-летию со дня рождения Александра Яковлевича Митрошенко / А. С. Шахматова, Ю. С. Небылицин // Новости хирургии. – 2007. – Т.15, № 4. – С. 2-7.
9. Бурак, С. И. Путь большого успеха. К 90-летию со дня рождения Ивана Антоновича Петухова / С. И. Бурак, Ю. С. Небылицин // Новости хирургии. – 2007. – Т.15, № 3. – С. 2-7.
10. Костюкова, Е. В. Иван Антонович Петухов – хирург и человек / Е. В. Костюкова, С. И. Бурак // Актуальные вопросы современной медицины и фармации: тез. докл. 58-й науч. Сессии ВГМУ, 2003 г. / Витебск. гос. мед. ун-т. – Витебск, 2003. – С. 331-332.
11. Котович Анна Флориановна [Электронный ресурс]. – Режим доступа: http://bsmp.vitebsk.by/history/kaf.html – Дата доступа: 12.07.2010.

Article in the .pdf format

EXPERIMENTAL SURGERY

YU.M. GAIN, O.S. ALEXANDROVA, V.N. GAPANOVICH, G.V. SHERSTYUK, N.N.VEYALKINA, T.M. YURAGA

EXPERIMENTAL ESTIMATION OF THE APPLICATION EFFICACY OF A NEW LOCAL HAEMOSTATIC PREPARATION ON THE BASIS OF INORGANIC SALTS AT THE LIVER AND SPLEEN TRAUMA

Objectives. To carry out a complex preclinical efficacy estimation of the local application of a new home haemostatic preparation on the basis of inorganic salts at the liver and spleen trauma in the induced hypocoagulation.
Methods. In the experiment with 221 laboratory animals after modeling in them of the open and closed liver and spleen trauma on the background of induced hypocoagulation, hemostasis was carried out by application of haemostatic sutures of Kuznetsov-Pensky type as well as by local application of the preparation «Kaprofer» (Armenia) and a new home haemostatic preparation on the basis of inorganic salts (State concern «Belbiopharm»). Survival rate, dynamics of functional activity restoration, hematological, hemostasiological and biochemical changes in the blood, morphological changes in the abdominal cavity and internal organs of the laboratory animals were estimated in different terms after the operation with the statistical processing of the obtained data.
Results. Application of a new haemostatic preparation permitted to decrease the lethality rate in the experimental animals from the blood loss from 100% to 0 (at the open trauma) and from 100 to 13,9% (at the closed trauma); it is reliably lower than in case of other methods application. This new haemostatic preparation was found out not to induce the adhesions formation in the abdominal cavity; it provides earlier restoration of the functional activity of the laboratory animals in the postoperative period; it permits to decrease reliably manifestation of anemia in them as well as to reduce the intensity of the systemic inflammatory response.
Conclusions. Preclinical investigations reveal high efficacy of the local application of a new home haemostatic preparation on the basis of inorganic salts at the closed and open liver and spleen trauma in hypocoagulation syndrome.

Keywords: local hemostasis, haemostatic preparations, closed abdominal trauma, open abdominal trauma, hemorrhage, trauma of the parenchyma organs

p. 12-22 of the original issue

References

1. Абакумов, М. М. Объективная оценка тяжести травмы у пострадавших с сочетанными повреждениями / М. М. Абакумов, Н. В. Лебедев, В. И. Малярчук // Вестн. хирургии. – 2001. – Т. 160, № 6. – С. 42-45.
2. Абдурахманова, С. Р. Особенности диагностики закрытой травмы кишечника: дис. … канд. мед. наук: 14.00.27 / С. Р. Абдурахманова. – М.: ГОУ ВПО Моск. мед. акад. им. И. М. Сеченова, 2006. – 125 с.
3. Багдасарова, Е. А. Тактика лечения повреждений живота при сочетанной травме: дис. … д-ра мед. наук: 14.00.27 / Е. А. Багдасарова. – М.: ГОУ ВПО Моск. мед. акад. им. И. М. Сеченова, 2008. – 292 с.
4. Лебедев, Н. В. Лечебно-диагностическая тактика при повреждениях живота у пострадавших сочетанной травмой: автореф. дис. ... д-ра мед. наук: 14.00.27 / Р. В. Лебедев; Моск. мед. акад. им. И. М. Сеченова. – М., 2003. – С. 40.
5. Сабиров, Ш. Р. Органосохраняющие принципы гемостаза при повреждениях паренхиматозных органов (печени, селезёнки и почек): дис. … д-ра мед. наук: 14.00.27 / Ш. Р. Сабиров. – М., 2006. – 348 с.
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7. Pringle, J. Notes on the arrest of hepatic hemorrhage due to trauma / J. Pringle // Ann. Surg. – 2008. – Vol. 48. – Р. 541-549.
8. Updates in the management of severe coagulopathy in trauma patients / М. Lynn [et al.] // Int. Care Med. – 2002. – Vol. 28. – S. 241-247.
9. Разработка экспериментальной модели смертельной кровопотери при открытой травме паренхиматозных органов живота / Ю. М. Гаин [и др.] // Человек и лекарство: сб. материалов XVI Рос. нац. конгр., Москва, 6–10 апр. 2009 г. – М., 2009. – С. 636.
10. Разработка экспериментальной модели смертельной закрытой травмы печени и селезенки, осложненной кровотечением / Ю. М. Гаин [и др.] // Человек и лекарство: сб. материалов XVI Рос. нац. конгр., Москва, 6–10 апр. 2009 г. – М., 2009. – С. 636.
11. Гаин, Ю. М. Способ моделирования закрытой травмы паренхиматозных органов живота у мелких лабораторных животных: рац. предложение / Ю. М. Гаин, О. С. Александрова. – № 73; выд. 09.03.09. – БелМАПО, 2009.
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13. Липатов, В. А. Обоснование применения геля метилцеллюлозы для профилактики послеоперационного спаечного процесса брюшной полости (экспериментальное исследование): дис. … канд. мед. наук: 14.00.27 / В. А. Липатов. – Курск, 2004. – 148 с.

Article in the .pdf format

O.S. BOGUSHEVICH, N.V. ZAVADA, I.I. PIKIRENYA, I.A. SHVED, V.V. SEDUN

LIPID EXCHANGE PECULIARITIES IN THE POSTOPERATIVE PERIOD IN THE EXPERIMENTAL ANIMALS AFTER GASTRECTOMY

Objectives. To study the lipid exchange peculiarities and changes in all the internal organs in the postoperative period in experimental animals after gastrectomy.
Methods. The experiment was carried out on 150 white rats after gastrectomy. In the postoperative period all animals were divided into 3 groups according to the nutritional support option: 1 – feeding was provided by the preparation «Enteral»; 2 – feeding was limited to only 0,9% sodium chloride solution; 3 – no feeding at all was given – control. Survival rate, general condition, body mass dynamics, biochemical, hematologic parameters and morphological changes of the internal organs were evaluated.
Results. On the background of changes in the lipid exchange parameters, histological changes in the liver of the operated animals were revealed since the liver is the chief organ of lipid metabolism (cholesterol, phospholipids, triglycerides, lipoproteins).
Conclusions. The experiment results testify to the necessity of early correction of latent degenerative changes in the liver tissue in the postoperative period after the operations on the stomach and duodenum; these changes development hasn’t clear biochemical markers. These changes in the liver can be minimized by introducing the preparation «Enteral» in the postoperative period.

Keywords: gastrectomy, enteral tube feeding, lipid exchange disturbance, morphological picture, liver fatty dystrophy

p. 23-30 of the original issue

References

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Article in the .pdf format

GENERAL AND SPECIAL SURGERY

A.V. VOROBEY, YU.N. ORLOVSKY, N.A. LAGODICH, M.G. IVASHKO

THE EXPERIENCE OF DOUBLE BALLOON ENTEROSCOPY AT THE SMALL INTESTINE AND PANCREATOBILIARY ZONE PATHOLOGY

Objectives. To inform about the results of both diagnostic and therapeutic double balloon enteroscopy (DBE) in the patients suspected to have the small intestine pathology of various etiology as well as at the disorders of the pancreatobiliary zone after previously performed reconstructive surgeries on the biliary ducts.
Methods. Double balloon enteroscopy was carried out in 39 patients (45 investigations) in order to diagnose the small intestine and hepaticojejunostomy strictures pathology after reconstructive surgeries on the biliary ducts.
Results. The source of the intestinal hemorrhage was revealed in 9 patients, arteriovenous malformations in 8, epithelial growths of the small intestine in 3, Crohn disease of the small intestine in 2. The Roux loop and hepaticojejunostomy zone examination was successful in 17 patients. The hepaticojejunostomy zone was visualized in 8 patients (47%): in 3 cases anastomosis functioned adequately, in 5 patients the stricture was confirmed. DBE-cholangiography was performed in 4 patients.
Conclusions. The DBE application experience shows that inaccessible parts of the gastrointestinal tract have become available for diagnostics and possibility for performing not only morphological verification of a diagnosis but also for the number of therapeutic endoscopic procedures.

Keywords: double balloon enteroscopy, intestinal hemorrhage, small intestine growths, hepaticojejunostomy, stricture

p. 31-40 of the original issue

References

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3. Mulder, C. J. History and development of double balloon endoscopy / C. J. Mulder // Atlas of double balloon endoscopy / Ed. G. H. Medconnect Munich. – Germany, 2007.
4. Sugano, K. Double balloon endoscopy: Theory and Practice / K. Sugano, H. Yamamoto, H. Kita. – Springer, 2006. – Р. 9-11.
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6. A facilitated method for endoscopic interventions at the bile duct after Roux-en-Y reconstruction using double balloon enteroscopy / M. Fahndrich [et al.] // Z. Gastroenterol. – 2008. – Vol. 46, N 4. – P. 335-338.
7. ERCP with balloon-assisted enteroscopy technique: A systematic review / J. J. Koornstra [et al.] // Dig. Dis. – 2008. – № 26. – P. 324-329.
8. Use of double-balloon enteroscopy to perform PEG in the excluded stomach after Roux-en-Y gastric bypass / A. S. Ross [et al.] // Gastrointest. Endosc. – 2006. – Vol. 64, N 5. – P. 797-800.
9. A case of successful enteroscopic balloon dilation for late anastomotic stricture of choledochojejunostomy after living donor liver transplantation / H. Haruta [et al.] // Liver Transpl. – 2005. – № 11. – Р. 1608-1610.
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11. Emmett, D. S. Double-balloon ERCP in patients who have undergone Roux-en-Y surgery: a case series / D. S. Emmett, D. B.Mallat // Gastrointest. Endosc. – 2007. – N 66. – P. 1038-1041.
12. The use of the double-balloon enteroscope for endoscopic retrograde cholangiopancreatography and biliary stent placement after Roux-en-Y hepaticojejunostomy / T. G. Moreels [et al.] // Endoscopy. – 2007. – Vol. 39. –Suppl. 1. – E. 196-197.
13. Treatment of choledocholithiasis following Roux-en-Y hepaticojejunostomy using double-balloon endoscopy / T. W. Spahn [et al.] // Digestion. – 2007. – N 75. – P. 20-21.
14. Double-balloon 1. enteroscopy for endoscopic retrograde cholangiography in patients with a Roux-en-Y anastomosis / L. Aabakken [et al.] // Endoscopy. – 2007. – N 39. – Р. 1068-1071.
15. Therapeutic ERCP with the double-balloon enteroscope in patients with Roux-en-Y anastomosis / K. Mоnkemuller [et al.] // Gastrointest. Endosc. – 2008. – N 67. – P. 992-996.
16. Koornstra, J. J. Double balloon enteroscopy for endoscopic retrograde cholangiopancreaticography after Roux-en-Y reconstruction: case series and review of the literature / J. J. Koornstra // Neth. J. Med. – 2008. – N 66. – P. 275-279.
17. Double-balloon enteroscopy application in biliary tract disease – its therapeutic and diagnosis function / Y. C. Chu [et al.] // Gastrointest. Endosc. – 2008. – Vol. 68, N 3. – P. 585-591.
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Article in the .pdf format

P.V. SARAP, Y.S. VINNIK, A.A. OSTANIN

FEATURES OF CONDITION SEVERITY IN PATIENTS WITH URGENT SURGICAL PATHOLOGY FROM THE CONCEPT OF CLUSTER ORGANISATION OF IMMUNE RESPONSE

Objectives. To allocate separate variants (clusters) of the immune response organization in the patients with urgent abdominal surgical pathology and to estimate interrelation between condition severity and distance of their indicators from the cluster center (DC).
Methods. 442 patients were examined. Using the factorial analysis the most informative indicators for clusterisation were determined: quantity CD3+, CD4+, CD8+, CD16+ lymphocytes. 6 clusters of the immune status were allocated. To estimate the interrelation of indicators the correlation and dispersive analyses were applied.
Results. In all clusters the DC directly correlates with condition severity and higher functional loading on immune system. It confirms assumptions of more rational immune response organization in the patients which indicators are most approached to the centers of clusters. Scales of severity are true for each cluster.
Conclusions. It is appropriate to consider the organization and functions of the immune system from the concept of fundamental knowledge about difficult self-regulated systems organization. Researches open prospects in working out of new criteria of patients’ severity estimation, the forecast of a current and an outcome of diseases, a choice of the most effective tactics of treatment.

Keywords: urgent surgery, immunity, severity, clusters

p. 41-48 of the original issue

References

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Article in the .pdf format

I.N. IGNATOVICH, G.G. KONDRATENKO, S.N. KORNIYEVICH, D.A. TAGANOVICH, A.P. SHEPELKEVICH, I.M. KHRAPOV, G.A. SERGEYEV, N.M. MIKHAYLOVA

FOOT ANGIORECONSTRUCTIONS AND RESECTION OPERATIONS IN THE TREATMENT OF CRITICAL ISCHEMIA AT DIABETIC FOOT SYNDROME

Objectives. To study the application results of the conservative open endovascular and hybrid revascularization interventions at the critical ischemia of the lower limbs on the background of neuroischemic form of diabetic foot syndrome.
Methods. 47 patients were operated on from the total 108 observed ones suffering diabetes mellitus with the occlusive-stenotic lesions of the arteries and chronic critical ischemia of the lower limbs. 12 open reconstructive operations were carried out, 33 endovascular interventions, 2 hybrid revascularization operations combining both the transluminal endovascular dilatation and conservative open vascular operation.
Results. One managed to avoid high amputation and save a support function of 30 lower limbs (63, 8%) from 47 patients who underwent revascularization operations. In these patients the average duration of the foot lesion made up 1, 1 year, and the level of the glycated hemoglobin was 7,1±1,3 mmol/l. In the group consisting of 17 patients in whom high limb amputation was done after the revascularization the average duration of the foot lesion made up 2, 0 years, and the level of the glycated hemoglobin made up 9,6±0,8 mmol/l.
Conclusions. Angioreconstructions both open and endovascular at the neuroischemic form of diabetic foot syndrome are effective and justifiable. They permit to cut short the phenomenon of chronic critical ischemia of the lower limbs which inevitably results in high amputation.

Keywords: diabetic foot, treatment, endovascular surgery, angioreconstruction

p. 49-56 of the original issue

References

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14. Земляной, А. А. Гнойно-некротические поражения нейроишемической формы синдрома диабетической стопы. Новые возможности комплексного хирургического лечения / А. А. Земляной // Эндокрин. хирургия. – 2008. – № 1. – С. 11-13.

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YU.M. STOYKO, V.G. GUDYMOVICH, S.I. TRIFONOV, A.M. NIKITINA, M.V. NIKITIN

ENDOTHELIUM DYSFUNCTION IN THE PATIENTS WITH LOWER LIMBS CHRONIC VENOUS INSUFFICIENCY AND POSSIBILITY OF ITS CORRECTION

Objectives. To improve diagnostics, treatment and prognosis of the lower limbs chronic venous insufficiency (LLCVI) based on the study of the endothelium functional state.
Methods. 128 patients with LLCVI were included in the investigation. Changes of the endothelium dysfunction marker were studied – circulating endothelium cells (CEC). In 22 patients the study of the preparation «Antistax» effect on the endothelial dysfunction was performed.
Results. Study of the CEC number in the patients with intradermal and segmental subcutaneous varicosity without pathological veno-venous reset showed the features of the endothelium dysfunction in 30% of patients. The level of endothelemy in the patients with widespread varicosity with the reflux of superficial and perforant veins exceeded the normal limit in 26,4% patients. Trophic disorders of the shin skin and soft tissues weren’t associated with the increased endothelemy. Endothelium dysfunction wasn’t revealed in any patient with trophic ulcers. Endothelium dysfunction was detected in all patients (100%) in case of segmental subcutaneous varicosity with the reflux of superficial and perforant veins. After therapy with the preparation «Antistax» the normalization of the CRC number was observed accompanied with the marked improvement of the subjective sensations.
Conclusions. The obtained data testify to the significance of the endothelium dysfunction at LLCVI as well as to the necessity of including endothelium protectors in the treatment program.

Keywords: chronic venous insufficiency of the lower limbs, venous transformation, endothelium dysfunction, phlebotonics

p. 57-64 of the original issue

References

1. Покровский, А. В. Хроническая венозная недостаточность нижних конечностей, современные проблемы диагностики, классификации, лечения / А. В. Покровский, С. В. Сапелкин // Ангиология и сосудистая хирургия. – 2003. – № 9. – С. 53-58.
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L.V. KOVALCHUK, V.V. POTEMKIN, T.N. BALDINA, P.B. BARBIN

IMMUNOTHERAPY AT TYPE 2 DIABETIS COMPLICATED BY DIABETIC FOOT SYNDROME, BY THE COMPLEX OF NATURAL CYTOKINES AND ANTIMICROBIAL PEPTIDES

Objectives. Evaluation of the clinical efficacy of the preparation «Syperlymph» in the complex treatment of the patients with diabetic foot syndrome (DFS).
Methods. The results of examination and treatment of 75 patients with DFS are analyzed in the research. The patients were divided into two groups according to the character of the disease and therapy schemes. The first group included 25 (33,3%) patients to whom conventional treatment was applied (antibacterial therapy, disaggregants, angioprotectors, antioxidants, correction of the hyperglycemia level, surgical treatment, dressing with the ointment «Levomekol»). 50 (66,7%) patients with pyo-necrotic lesions of the foot made up the second group; in these patients, together with conventional treatment, immunotherapy with the preparation «Syperlymph» was used. Control group consisting of 25 persons was presented by healthy people.
Results. It is established that immunotherapy application of the complex of natural cytokines and antimicrobial peptides at type 2 diabetes mellitus complicated by diabetic foot syndrome is pathogenetically justified. There is reduction of the activity of the lipid peroxidation as well as stabilization of antioxidant protection of the blood, decrease in endogenous intoxication, normalization of the phagocyte immunity, level of circulating immunoglobulins of the blood.
Conclusions. Immunotherapy with the preparation «Syperlymph» is the method of choice of the immunomodulatory therapy in the patients with diabetic foot syndrome.

Keywords: diabetic foot syndrome, cytokines, immunotherapy, Syperlymph

p. 65-71 of the original issue

References

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NEUROSURGERY

S.A. LIKHACHEV, R.R. SIDOROVICH, V.V. ALESEYEVETS, D.N. SHKOUT, L.N. YUDINA, A.N. KACHINSKY

APPROACHES TO THE SURGICAL TREATMENT OF THE MOVEMENT DISORDERS AT PARKINSON DISEASE

Objectives. Working out of indications and contraindications for the surgical treatment of Parkinson disease, the estimation of the obtained results.
Methods. 189 Parkinson disease patients were examined. While selecting the candidates for the operative treatment the test with levodopa was used. Preoperative scanning of the brain was carried out with magneto-resonant tomography with the intravenous contrasting of the vessels. To estimate the efficacy and objectification of the treatment results the method of analysis of the statokinetic function of the Parkinson patients was used.
Results. From all the examined patients 48 (25,4%) corresponded to the selection criteria for the operative treatment. Stereotaxic thalamo- and pallidotomies were carried out in 32 patients. The operative intervention was done with the stereotaxic apparatus Leksell G (Sweden) and the computer planning station. There were no complications. Significant improvement of the movement function was observed in all patients in the postoperative period, it permitted to decrease the dose of the medicinal preparations and taking into account possible side-effects of preparations against Parkinson disease one managed to reverse the complications of this medication.
Conclusions. Use of the described selection criteria and methods of computer planning of the operation permitted to increase significantly the efficacy of the operative treatment as well as to minimize the number of postoperative treatment.

Keywords: Parkinson disease, stereotaxic thalamotomy, stereotaxic pallidotomy, stabilometry

p. 72-81 of the original issue

References

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ANESTHESIOLOGY-REANIMATOLOGY

V.I. ZAGREKOV, I.YU. EZHOV

EFFECT OF THE BLOOD PRESSURE LEVEL ON THE BLOOD LOSS AT THE TOTAL HIP REPLACEMENT SURGERY

Objectives. To evaluate the effect of the blood pressure level on the blood loss at the primary total hip replacement carried out under the spinal anesthesia.
Methods. 607 patients were included in the investigation in which hip replacement was performed under the normotensive spinal anesthesia (197 patients) with the maintenance of the systolic blood pressure at 95-120 mm Hg and under the spinal anesthesia with the controlled hypotensive effect on the background infusion of the micro-doses of adrenaline (410 patients) at the systolic blood pressure level 70-95 mm Hg during the key stages of the operation.
Results. The level of the blood pressure at the hip replacement is found out to influence significantly the volume of the intraoperative and total blood loss as well as the rate of the intraoperative blood loss. The volume of the intraoperative and total blood loss decreases significantly at the maintenance of the systolic blood pressure at 80-100 mm Hg at the key stages of the operation.
Conclusions. Reducing systolic blood pressure less than 80 mm Hg at the hip replacement is inappropriate since it isn’t accompanied by further reduction of the intraoperative or total blood loss volume.

Keywords: hip replacement, spinal anesthesia, blood loss

p. 82-90 of the original issue

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22. Реброва, О. Ю. Статистический анализ медицинских данных. Применение прикладных программ STATISTICA / О. Ю. Реброва. – М.: МедиаСфера, 2002. – 312 с.
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E.V. NIKITINA

FUNCTIONAL ACTIVITY OF THE PITUITARY-ADRENAL SYSTEM AND IL-1α,, TNF-α, CONTENT IN PATIENTS WITH THE ORIGINAL HIGH VEGETATIVE REACTANCE IN THE PREOPERATIVE PERIOD AND THEIR CORRECTION

Objectives. To study changes of the functional activity of the pituitary-adrenal system and IL-1α, TNF-α content in the preoperative period in the patients with high vegetative reactance and to estimate the efficacy of their correction with diazepam.
Methods. 57 patients hospitalized for the planned operation were investigated. The vegetative status was characterized by the vegetative indexes, level of ACTH and cortisol was determined by RIA method, the cytokines content was determined by ELISA.
Results. In the preoperative period in the patients with high vegetative reactance on the background of parasympathetic impact activation, decrease of the vegetative reactance and increase of ACTH content the parameters of IL-1α, TNF-α reduced. On the background of diazepam injection in such patients during two days of the preoperative period the sympathetic activity increased, ACTH and cortisol content decreased; this contributed to IL-1α increase and TNF-α decrease.
Conclusions. Injecting diazepam to the patients with high vegetative reactance during two days of the preoperative period prevents the development of maladjustment contributing to IL-1α synthesis.

Keywords: interleukin-1α, tumor necrosis factor-α, vegetative reactance, АCTH, cortisol, diazepam

p. 91-96 of the original issue

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VOLKOVICH T.K., SAMSONOVA I.V.

THE ROLE OF CORNEAL EPITHELIUM MORPHOFUNCTIONAL STATE IN THE COURSE OF BACTERIAL KERATITIS OF VARIOUS ETIOLOGY

Objectives. To determine the interrelation of the corneal epithelium morphofunctional state with its epithelization duration at bacterial keratitis of various etiology.
Methods. 54 patients with bacterial keratitis were being observed. The patients have been divided into two groups: the 1 group – a primary bacterial keratitis (n=21), the 2 group – a secondary bacterial keratitis (n=33).
For determination of the cellular structure and the corneal epithelium morphofunctional state impression cytology was used. Light microscopy and photoregistration of cellular samples were carried out on the microscope Leica DM2500. Morphometry was carried out by means of Leica Application Suite software.
To define the interrelation of the corneal epithelium morphofunctional state with its epithelization duration the correlation analysis was performed with the application of Spearman criterion using electronic packages «STATISTICA 6.0».
Results. It has been established that duration of corneal epithlisation is directly connected with morphofunctional state of the epithelium and depends on a quantitative parity of basal epithelial cells (BEC) and epithelial cells with nuclear pyknosis kernels (ECPN).
Conclusions. The morphofunctional state of the corneal epithelium in perifocal and paralimbal zones at bacterial keratitis testifies objectively to the current of an inflammatory process in the cornea and reflects epithelium’s reparative ability.

Keywords: bacterial keratitis, morphofunctional state, epithelization, corneal epithlization factor

p. 97-104 of the original issue

References

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HYPOTHESIS

LEVIN M.D., MENDELSON G., TROYAN V.V., KORSHUN Z.

TO THE PATHOGENESIS OF THE PRIMARY DUODENAL DIVERTICULA

Objectives. To study the pathological physiology of the duodenum in patients with the duodenal diverticula.
Methods. 116 X-ray examinations of the upper part of the alimentary tract were analyzed in the patients with the dyspeptic syndrome. The patients’ age varied from 55 to 92 years (the average age composed 82).
Results. The duodenal diverticula were detected in 21,5% of investigations while performing a standard X-ray examination. The parapapillary diverticula (PPD) made up 60%. The length of Kapandzhi and Ochsner sphincters was determined. The acidification of barium suspension was shown to lead to a sharp contraction of the functional duodenal sphincters. A reliable narrowing of the duodenum, located between Kapandzhi and Ochsner sphincters was revealed in the patients with PPD in comparison with the patients without PPD.
Conclusion. A comprehensive hypothesis of the pathogenesis of PPD and pathology in the pancreato-biliary area is suggested. Dyskinesia of the functional sphincters and rise in the duodenal tonus occur reacting to the irritating impact of the hydrochloric acid in the gastric juice. As the result the increase of the intraluminal pressure periodically occurs between sphincters.. It results in the prolapse of the mucous layer through the weakened muscular layer of the bowel wall. Thus diverticula are formed. As the result of the increased intraluminal pressure the reflux of the duodenal contents with the local flora into the bile ducts happens causing the congestion and inflammatory reaction as well as leading to the development of cholelithiasis and chronic pancreatitis.

Keywords: duodenum, duodenal diverticula pathogenesis, functional sphincters, hypothesis, cholelithiasis pathoqenesis, pancreatitis pathoqenesis

p. 105-112 of the original issue

References

1. Dahnert, W. Radiology Review Manual / W. Dahnert. – 2-nd ed. – Williams & Wilkins, 1993. – 505. p.
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15. Function of the sphincter Oddi in patients with juxtapapillary duodenal diverticula: evaluation by intraoperative biliary manometry under a duodenal pressure load / S. Miyazaki [et al.] // World J. Surg. – 1995. – Vol. 19, N 2. – P. 307-312.

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INFORMATIC TECHNOLOGIES IN SURGERY

N.V. ZAVADA, O.S. BOGUSHEVICH, S.E. GUTNIKOV, I.I. PIKIRENYA, S.G. SHOROKH, L.V. TARASIK

EVALUATION OF PATIENTS’ NUTRITIOUS STATUS AND CALCULATION OF THE INDICATORS FOR NUTRIENT DISTURBANCES CORRECTION USING COMPUTER PROGRAM «ENTERAL»

The employees of the urgent surgery department of the Belarusian Medical Academy of Post-graduate Education together with the laboratory of computer graphics and information systems of the Belarusian State University developed the computer program (CP) «Enteral» aimed at the evaluation of the nutritious status, calculation of indicators for the correction of nutritious disturbances of surgical patients with application of a domestic medicine for enteral tube feeding «Enteral».
On the basis of the anthropometrical data of a patient, taking into account laboratory researches, the aggression factor (severity of a trauma, disease, complexity of operative intervention), the course of the postoperative period, the degree of nutritious insufficiency, actual requirements for basic nutrients and energy, dosage and the mode of introduction of the medicine for enteral tube feeding «Enteral» are calculated for each patient.
CP «Enteral» has been tested in medical establishments in order to evaluate the nutritious status of patients and to calculate the indicators for correction of nutrition disturbances in 54 patients of the surgery department.

Keywords: nutritious status, nutrition disturbances, enteral tube feeding, «Enteral», postoperative period, computer program

p. 113-118 of the original issue

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LECTURES, REVIEWS

SUSHKOV S.A.

DEEP VENOUS VALVE INSUFFICIENCY IN VARICOSE DISEASE

The review of the research works dedicated to studying etiology and pathogenesis of valve insufficiency of deep veins at the lower limbs varicosity is presented in the article. The problems of diagnostics of hemodynamic disturbances and their role in pathogenesis of the disease are viewed.
The literature data analysis has shown that despite of rather a long period of studying etiology, pathogenesis, clinical significance of functional disturbance of the deep veins valvar apparatus, the whole set of problems still remains unsolved. Up to the present the frequency of valve insufficiency in patients of different sexes, in different age groups and at different stages (classes) of the disease hasn’t been determined. Etiopathogenic mechanisms resulting in the deep veins valve insufficiency at varicosity haven’t been found out. Further investigations demand the determination of the role of the deep veins insufficiency in the disease progression. The questions of different diagnostic techniques application to evaluate the state of the deep veins demand the detailed study.

Keywords: chronic venous diseases, chronic venous insufficiency, varicosity, deep veins, valve insufficiency

p. 119-134 of the original issue

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Article in the .pdf format

A.A. LYZIKOV

APPLICATION OF THE ARTIFICIAL PROSTHESES IN THE VASCULAR RECONSTRUCTIONS

The article is devoted to the review of modern vascular prostheses. The history of development, advantages and disadvantages of the conduits in use are described. Biological reactions of vascular conduits at different stages of searching are depicted. Complications of vascular prostheses use at different terms are described in details. Spread of vascular prostheses infection is analyzed with the description of possible infectious agent and contamination pathways. Requirements to «ideal» prosthesis are determined. Merits and demerits of various types of allogenous, xenogenous and autogenous conduits are analyzed. Criteria of choice of the prostheses and preparation to implantation and possible problems and complications are determined. Ways and methods of improvement of functional characteristics of existing artificial vascular prostheses are described

Keywords: artificial vascular prosthesis, PTFE, vascular graft infection, choice of vascular graft, complications of vascular graft use

p. 135-145 of the original issue

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Article in the .pdf format

O.P. KEZLYA, L.V. GIVOYNO

ACUTE COMPARTMENT SYNDROME AS A COMPLICATION OF FRACTURES OF SHIN BONES

An acute compartment syndrome is rather a widespread complication of the fractures of the shin bones though its symptoms are frequently unnoticed resulting in unsatisfactory functional results of treatment. In the article the problems concerning etiology, pathogenesis of acute compartment syndrome at the fractures of the shin bones are studied. Principles of this condition diagnostics are viewed as well as the management tactics of acute compartment syndrome: indications for fasciotomy, conservative methods of treatment. The most reliable diagnostic method of acute compartment syndrome is the change of the interstitial pressure. But the level of the interstitial pressure at which one has to carry out fasciotomy up to present moment remains discussible. It’s more preferable to perform full fasciotomy with the disclosure of all fascia casings.

Keywords: fractures of shin bones, compartment syndrome, fasciotomy

p. 146-156 of the original issue

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EXPERIENCE EXCHANGE

GORDEEV N.A., SEDOV V.M., BALLYUZEK F.V., MYASNIKOVA M.O., KHON A.E., YURLOV V.V., SHABANOVA N.A.

PULMONARY ARTERY THROMBOEMBOLISM PROPHYLAXIS BY CLIPPING THE VENA CAVA INFERIOR AND ILIAC VEIN: INDICATIONS, TECHNIQUE, IMMEDIATE AND REMOTE RESULTS

Objectives. To summarize 25 years experience of the mechanical devices implantation averting the migration of thromboembolism in the vena cava inferior system.
Methods. Kava-clipping was applied in 900 and kava-filters were used in 130 cases at embologenity forms of phlebothromboses. The complex of modern control and diagnostics equipment was applied while inspecting before, during and after the implantation of the extra- and endovenous devices. The immediate and remote results were evaluated.
Results. The study of the immediate and remote results of the kava-clipping showed that extremely few complications were observed at the early stages of the method approbation and they were not threatening. The results of kava-clipping are significantly better than the data of kava-filters application.
The obtained data testify to the favor of external extravenous clipping as a good and less dangerous alternative of kava-filtration.
Conclusion. Unlike the intravenous inserting of the migration delaying devices – filters, the external «plicators» lack the danger of complications which are specific for them and in the remote period are not the source of dangerous outcomes.

Keywords: deep vein thrombosis, kava-clipping, kava-filter

p. 157-165 of the original issue

References

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IN ASSISTANCE TO PRACTICIONER

V.V. KUREK, A.E. KULAGIN

COMPLICATIONS AND SAFETY OF A CHILD AT ANESTHESIA

Quality and safety of anesthesia can be regarded as an actual problem of modern medicine. Anesthesia uses potentially dangerous for life preparations and manipulations demanding from a specialist high professionalism and no right for a mistake. At the same time it is necessary to distinguish clearly such notions as a mistake, anesthetic complication and anesthetic mortality rate. One should remember that most complications are the result of mistakes of medical staff. Studying the given problem one should pay attention to the fact that different clinics take into consideration different complications and many don’t register them at all. It demands the development of the list of the anesthetic complications demanding registration. Accounting and analysis of anesthetic complications will help to improve the quality of anesthesia and will increase its safety.

Keywords: anesthesia safety, anesthetic complications

p. 166-168 of the original issue

References

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SURGICAL SCHOOLS

A.B. KOGAN, O.V. TEPLYAKOVA, L.V. KOCHETOVA, M.YU. YURIEVA

KRASNOYARSK SCIENTIFIC AND PEDAGOGICAL SCHOOL OF THE ABDOMINAL SURGERY

The article is devoted to the thirtieth anniversary of Krasnoyarsk surgical scientific school and narrates about its organizers, scientific directions and the basic achievements. The foundation of the surgical school is connected with the names of two outstanding surgeons, professors of Krasnoyarsk State medical university named after V.F. Voyno-Yasenetsky M.I.Gulman and Ju.S.Vinnik who managed to create the team and to focus their efforts on the study of various aspects of pathogenesis of urgent surgical diseases as well as on the development of new risk prognosis systems of occurrence, nature of the course and outcome of diseases as well as of complex treatment methods.

Keywords: Krasnoyarsk, general surgery department, scientific school

p. 172-179 of the original issue

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