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Year 2010 Vol. 18 No 1

GALLERY OF THE NATIVE SURGEONS

M.B. MIRSKY

THE SON OF THE BELARUSSIAN LAND. SURGEON AND EXPERIMENTALIST EVSTAPHY BOGDANOVSKY

The article is devoted to the life description of an outstanding surgeon, talented scientist and splendid teacher, Doctor of medicine and surgery, professor of St Petersburg military-medical academy, our countryman Evstaphy Ivanovich Bogdanovsky. Possessing all potentialities of a scientist such as an excellent general medical education, profound knowledge of fundamental sciences, great power of observation, critical character of intellect Evstaphy Ivanovich devoted himself not only to the clinical surgery. Urology, oncology and transplantology composed the sphere of his activities. Following strictly the scientific and rational concept in surgery as well as high moral postulates which he steadily realized in his professional work and teaching practice, Evstaphy Ivanovich Bogdanovsky has occupied the honorable place in the native surgery.

Keywords: Evstaphy Ivanovich Bogdanovsky, history of surgery
p. 3 – 12 of the original issue
References
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  13. Колосов, Г. А. Новый хирургический архив / Г. А. Колосов. – 1933. – Т. 28. – Кн. 1. – С. 11.
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  15. Опель, В. А. История русской хирургии / В. А. Опель. – 1923. – С. 278.
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GENERAL AND SPECIAL SURGERY

V.N. SHILENOK, E.YA. ZELDIN, N.YU. KONEVALOVA, L.M. PEDCHENEZ, G.B. ANTONYCHEVA

PROBLEMS OF THE SURGICAL TREATMENT OF THE NODE FORMATIONS OF THE THYROID GLAND

The article presents statistics on the thyroid pathology in Vitebsk region according to the data of the regional endocrinology clinic. A steady increase of the thyroid cancer in post-Chernobyl period is marked. The research analyzes the advantages and disadvantages of modern methods of diagnosis of thyroid diseases, indications for surgical treatment of the node formations of the thyroid gland.
Taking into consideration rather a high risk of the thyroid cancer detection on the background of the nodal formation of thyroid, extra-capsular hemithyroidectomy with the removal of isthmus and pyramidal lobe should be a minimal surgery.
In the remote period the levels of cholesterol and lipoproteins after various operations on the thyroid gland are studied. Indexes dynamics testifies to the decline in the antiatherogenic components and increase in the atherogenic lipoproteins; it increases the risk of atherosclerosis development and, indirectly, may be evidence of hypothyroidism. Various fractions of lipoproteins in the blood can serve as an additional criterion of the thyroid replacement therapy adequacy.

Keywords: thyroid disease, diagnosis, surgical treatment, lipoprotein fraction
p. 13 – 20 of the original issue
References
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  7. Климов, А. Н. Липопротеиды, дислиопротеиды и атеросклероз / А. Н. Климов, Н. Г. Никульчева. – Л.: «Медицина», 1984. – 168 c.
  8. Гринева, Е. Н. Узловые образования в щитовидной железе. Диагностика и лечебная тактика / Е. Н. Гринева // Проблемы эндокринологии. – 2003. – Т. 49, № 4 – С. 59-62.
  9. Пинский, С. Б. Опухоли щитовидной железы / С. Б. Пинский, В. В. Дворниченко, В. А. Белобородов. – Иркутск, 1999. – 320 с.
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S.M. RASCHINSKY, S.I. TRET’YAK, A.V. PROKHOROV, N.T. RASCHINSKAYA, D.A. AVDEVICH

RESULTS ANALYSIS OF SURGICAL TREAMEANT OF PAIN IN PATIENTS SUFFERING FROM CHRONIC PANCREATITIS

Comparison of the results of pancreatoduodenectomy (PD) and the resection with drainage operations (RDO) in the patients, suffering from the chronic pancreatitis (CP), according to both the efficiency of stopping a painful syndrome and quality of life which provide these kinds of surgical interventions was a research objective.
During the period from 2002 up to 2008 in 16 patients suffering from CP, the gastropancreatoduodenal resection (n=6) or pylorus-preserving resection (PPDR [n=10]), and 16 RDO – procedure Partingtone-Rochelle (ОPR [n=11]) or Frey operation (OF [n=5]) were made. The results of surgical treatment in these two groups have been analyzed according to the character of the postoperative complications and figures of the questionnaire aimed to estimate the quality of life SF-36 v.2тм.
On the basis of the received data such as PD, RDO adequately stops a painful syndrome and improve quality of life of patients suffering from CP. Under equal conditions the preference should be given to RDO as they provide more significant gain of the results of physical and psycho-emotional components of the quality of life in the operated patients.

Keywords: chronic pancreatitis, pain, surgical treatment
p. 21 – 29 of the original issue
References
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A.M. SHESTIUK

PRESENT-DAY APPROACHES TO THE TREATMENT OF THE ESOPHAGUS THORACIC REGION DAMAGES

Esophageal perforation is associated with high mortality rate and low chances of early diagnostics. The article describes the esophageal perforation treatment results for 8 patients when it was diagnosed late. Tactical approaches used to diagnose and treat the patients are detailed. The primary method for diagnosing was СT-ray. In case of 5 patients, а minimal invasive technology – video assisted thoracoscopy was used for the treatment. Thoracoscopic drainage of the esophageal rupture was performed using the patented method developed by the author as well as thoracoscopic posterior mediastinotomy and thoracoscopic drainage of the mediastinal abscess were performed for the treatment. No lethal cases were registered among the group of patients treated with thoracoscopy.

Keywords: esophagus, perforation, video assisted thoracoscopy
p. 30 – 36 of the original issue
References
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  15. Дренажная трубка для лечения разрывов наддиафрагмального отдела пищевода: пат. 3383 Респ. Беларусь, МПК А 61М27/00 / А. С. Карпицкий, С. В. Панько, Р. И. Боуфалик, А. В. Рыжко, А. М. Шестюк; заявитель Брест. обл. б-ца. – № u 20060476; заявл. 18.07.2006; опубл. 28.02.2007 // Афіцыйны бюл. / Нац. цэнтр інтэлектуал. уласнасці. – 2007. – № 1 (54). – С. 153.
  16. Способ установки дренажной трубки для лечения свища наддиафрагмального отдела пищевода и дренажная трубка для его осуществления: пат. 11816 Респ. Беларусь, МПК А 61В 17/00, А 61М27/00 / А. С. Карпицкий, С. В. Панько, Р. И. Боуфалик, А. В. Рыжко, А. М. Шестюк; заявитель Брест. обл. б-ца. – № a 20060743; заявл. 18.07.2006; опубл. 28.02.2008 // Афіцыйны бюл. / Нац. цэнтр інтэлектуал. уласнасці. – 2009. – № 2(67). – С. 45.
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O.D. AKIFYEVA, G.YU. SOKURENKO, D.V. KANDYBA, A.A. IVANOVA

SINGLE-PHOTON EMISSIVE COMPUTER TOMOGRAPHY IN ESTIMATION OF SURGERY EFFICACY IN PATIENTS WITH OCCLUSION OF THE INTERNAL CAROTID ARTERY

22 patients have been examined before and after endarterectomy and autoarterial plasty of the external carotid artery with the resection of the occluded internal carotid artery to determine the role of a single-photon emissive computer tomography in estimation of surgery efficacy in case of occlusive lesions of the internal carotid artery.
As the result of the performed investigation it has been established that a single-photon emissive computer tomography is a little-invasive and reliable method of determining cerebral tissue perfusion; it permits to use it not only for initial diagnosis in the patients with acute disturbances of the cerebral circulation but also for control of surgery efficacy in case of occlusive lesions of the internal carotid arteries.

Keywords: ischemic disturbances of cerebral circulation, pathology of extracranial vessels, occlusive lesions of the internal carotid artery, a single-photon emissive computer tomography, efficacy of surgical treatment
p. 37 – 40 of the original issue
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P.G. SHVALB, R.E. KALININ, I.A. SUCHKOV, S.V. BARANOV

THE CAUSES OF REPEATED AMPUTATIONS IN PATIENTS WITH CHRONIC CRITICAL ISCHEMIA OF THE LOWER LIMBS AFTER RECONSTRUCTIVE SURGERIES

The development of the vascular surgery at the present stage is being accompanied not only by successes but by failures as well. High amputations of the limbs go together with obliterating disorders of the arteries. The causes of high repeated amputations in 47 patients with an obliterating atherosclerosis after reconstructive surgeries have been analyzed. It has been established that the causes of such unfavorable outcomes of the reconstructive surgeries in patients with chronic critical ischemia of the lower limbs are the following: a diffusive character of arterial bed affection, technical errors while performing the reconstruction, infectious complications in the nearest postoperative period, poor hemostasis after the surgery.

Keywords: critical ischemia, amputation, causes of amputation
p. 41 – 45 of the original issue
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B.N. ZHUKOV, S.E. KATORKIN, P.F. KRAVTSOV

OPTIMIZATION OF DIAGNOSTICS PROGRAM AND INDICATIONS FOR SURGICAL CORRECTION OF THE DEEP VEINS VALVE APPARATUS INSUFFICIENCY IN PATIENTS WITH LOWER LIMBS VARICOSITY

Diagnostic aspects of the program optimization to determine the indications for the correction of the deep veins valve apparatus insufficiency at the lower limbs varicosity have been illustrated. The need for the comprehensive preoperative preparation and postoperative medical rehabilitation to restore the static-dynamic and functional viability of the lower extremities is underlined. The choice of the extravasal valve correction location is grounded by the anatomical structure of the shin muscular-venous pump, its functional state and by marked character of reflux in the deep venous system of the limbs.

Keywords: varicosity, valve insufficiency, surgical correction
p. 46 – 51 of the original issue
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YU.S. NEBYLITSIN, S.A. SUSHKOV, A.P. SOLODKOV

CORRECTION OF THE OXIDATIVE AND NITROSATIVE STRESS IN PATIENTS WITH THE LOWER LIMBS DEEP VEINS THROMBOSIS

The efficacy estimation of the preparations’ use restoring functional state of the endothelium in the complex treatment of the lower limbs deep veins acute thrombosis is carried out.
Depending on the performed treatment the patients were divided into three groups. In the 1st group a standard treatment scheme was applied: anticoagulants of direct and indirect action, antiagregants. In the 2nd group in the complex scheme of patients’ treatment the angioprotector preparations were included - pentoxifylline (trental), phleboprotector and phlebotonic – L-lysine escinate and antioxidant complex. In the 3rd group in the complex scheme of treatment the angioprotector preparations were included – pentoxifylline (trental), phleboprotector and phlebotonic – L-lysine escinate and combined antioxidant cytoprotector – lycored.
It has been found out that use in the complex treatment of such preparations as pentoxifylline (trental), phleboprotector and phlebotonic – L-lysine escinate, antioxidant complex and lycored in order to correct the functional state of endothelium as well as the processes of free-radical oxidation is pathogenetically grounded. The decrease of the increased indexes of lipid oxidation (the content of dienal conjugates, malonyl dialdehyde) is marked as well as normalization of the markers levels of the endothelial dysfunction (restoring of the nitrates/nitrites content, decrease of the circulating endotheliocytes number). Regress of the clinical manifestation of the disease has also been marked.
The conducted research has proved the efficacy of the preparations’ use restoring functional state of the endothelium in the complex treatment of patients with the lower limbs deep veins acute thrombosis

Keywords: venous thrombosis, dysfunction of endothelium, oxidative stress, nitrosative stress
p. 52 – 60 of the original issue
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  12. Гаврилов, В. Б. Измерение диеновых конъюгатов в плазме по ультрафиолетовому поглощению гептановых и изопропиловых экстрактов / В. Б. Гаврилов, А. Р. Гаврилова, Н. Ф. Хмара // Лабораторное дело. – 1998. – № 2. – С. 60-64.
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TRAUMATOLOGY AND ORTHOPEDICS

V.P. DEYKALO, A.N. TOLSTIK, L.G. KRAVCHENKO, A.E. TSERKOVSKY

REHABILITATION OF PATIENTS WITH INVETERATE DEGENERATIVE LACERATIONS OF THE EXTENSOR APPARATUS AT THE PROXIMAL INTERPHALANGEAL JOINT LEVEL OF THE HAND FINGERS

The article is dedicated to the description of the approach to rehabilitation of patients with inveterate degenerative lacerations of the extensor mechanism of fingers at proximal interphalangeal joint level. It was determined that degenerative lacerations of the extensor mechanism develop at the age of over forty. The conservative treatment of such kind of lacerations is not effective and does not give the intended effect. The rehabilitation of that category of patients is the deal of specialists having special training in the field of hand surgery. The technique of restoration of the structure was presented and grounded in the article on the basis of rehabilitation experience of such patients in the clinic of traumatology, orthopedy and military surgery of EE “VSMU”, dependant on the state and level of degenerative lacerations of extensor mechanism. The methods of post-operative care are described.

Keywords: fingers of the hand, extensor apparatus, degenerative changes, rehabilitation
p. 61 - 66 of the original issue
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ONCOLOGY

V. JOTAUTAS, E. POSKUS, P. ZEROMSKAS, D. SEININ, K. STRUPAS

TREATMENT OF RECTAL TUMOURS WITH TRANSANAL ENDOSCOPIC MICROSURGERY: SIX YEAR’S EXPERIENCE IN LITHUANIA

Vilnius University Hospital «Santariskiu Klinikos» ,
National Center of Pathology ,
Lithuania

Objective. The aim of this study is to assess six year’s experience gained in Lithuania while treating rectal tumours with transanal endoscopic microsurgery in the Centre of Abdominal Surgery of the Vilnius University Hospital «Santariskiu Klinikos».
Materials and methods. Patients having rectal adenomas and low-risk malignant tumours of stage T1, good or medium differentiation, with no lymphatic and vascular invasion were chosen for operations. The stage of the tumour has been determined before the operation after transanal endosonoscopy, MRI and rectoscopy with multiple macrobiopsies.
Results. 155 patients were operated, 161 TEM were performed and 172 tumours were removed. The median size of tumours was 3, 17±1,93 cm (ranged from 0,3 to 12 cm). Overall 60 (33,7%) malignant tumours and 106 (59,9%) adenomas were removed. Pre-operative and final clinical diagnoses did not coincide for 24 patients (13,9%). 154 (89,5%) radical operations (R0), 1 (0,6%) not radical (R1) and 17 (9,9%) operations of unknown radicality (RX) were performed. Three (1,9%) complication were observed. After the removal of nine Ca T2 five patients underwent adjuvant radiotherapy. 132 patients were followed-up for 2–44 months after the operation. Two (1,2%) recurrence of a tubulovillous adenoma and one of a CaTis (0,6%) was diagnosed. No other complications were reported.
Conclusions. The results of transanal endoscopic microsurgery obtained while treating rectal adenomas and low-risk T1 cancers are good. The low rate of complications and recurrences in this group offers much hope. The experience of the treatment of T2 cancers with transanal endoscopic microsurgery and adjuvant radiotherapy is limited but the results are encouraging. The results of randomised and controlled trials need to be awaited before definite conclusions can be drawn.

Keywords: rectal tumours, minimally invasive surgery, transanal endoscopic microsurgery
p. 67 – 74 of the original issue
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A.A. KASYUK

RETROSPECTIVE ANALYSIS OF ANTICOAGULATING PROPHYLAXIS IN ONCOLOGICAL PATIENTS, DIED OF THE PULMONARY EMBOLISM IN THE POSTOPERATIVE PERIOD

100 cancer patients who died in the postoperative period of the pulmonary embolism (PE) verified by autopsy were included in this original research. From the total 100 patients anticoagulants were prescribed for 64, low molecular weight heparins were administered to 63 of them. Prescription of the anticoagulants decreases postoperative venous thrombotic complications rate, but doesn’t allows protecting the patients from their development in all cases.

Keywords: pulmonary embolism, anticoagulant prevention, postoperative period
p. 75 – 79 of the original issue
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  6. Reduction in fatal pulmonary embolism and venous thrombosis by perioperative administration of subcutaneous heparin / R. Collins [et al.] // N. Engl. J. Med. – 1988. – Vol. 318. – P. 1162-1173.
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ANESTHESIOLOGY-REANIMATOLOGY

S.A. YURCHENKO, N.I. SERGEENKO,L.V. TIKHONOVA

INDEXES OF RESULTS CORRELATION, OBTAINED AT STUDYING OF THE FUNCTIONAL ACTIVITY OF THE VEGETATIVE NERVOUS SYSTEM BY MEANS OF TRADITIONAL METHODS AND MATHEMATICAL ANALYSIS OF VARIABILITY OF THE CARDIAC RHYTHM IN THE POSTOPERATIVE PERIOD

While studying the results correlation obtained by the traditional method of the VNS investigation and by the STV mathematical analysis in the planned patients in the preoperative period before premedication, the reliable correlation between Kerdo index and the number of the cardiointervals, the moda amplitude, PAPR, tension-time index, RRNN, moda and between QVm and the number of cardiointervals, moda amplitude, PAPR, tension-time index, RRNN, SDNN, pNN50, VLF, LF, TP, moda, variation amplitude was determined.
On the premedication background with atropine and sibazon the reliable correlation remained only between Kerdo index and RRNN, moda and between QVm and moda, RRNN, tension-time index, LF/HF. The chief cause of the decrease of correlation reliable indexes number is the opposite and variational mechanism of the medications action for premedication on the VNS sections in the patients with the initial para- and sympathotony.

Keywords: the heart rate variability, vegetative balance, stress, premedication, Kerdo index
p. 80 – 89 of the original issue
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A.V. MAROCHKOV, D.V. OSIPENKO, V.M. DOROGOKUPETS, D.P. SHMAT’KO

THE EXPERIENCE OF ANESTHESIA MAINTENANCE AND THE PECULIARITY OF THE EARLY POSTOPERATIVE PERIOD COURSE AT RECONSTRUCTIVE OPERATIONS ON THE ABDOMINAL AORTA SECTION

The results of the operation anesthesia maintenance on the abdominal aorta section in 59 patients are analyzed. The aorta-femoral and bifurcation prosthesis because of the atherosclerotic aneurisms of the abdominal aorta section was carried out in 29 patients; the aorta-femoral and bifurcation shunting because of the atherosclerotic lesions of the abdominal aorta section was done in 30 patients (51%). Balanced multicomponent anesthesia with the endotracheal intubation and the artificial lung ventilation was applied in all patients to provide anesthesia protection during the operation. The used scheme of the anesthesia maintenance, specialization of anesthesiologists at the cardiology in-patient department, prevention of the cardiological complications development during the intra- and postoperative periods permitted both to exclude the lethality and to reduce significantly the incidence of cardiological complications (up to 1, 7%). The increase of the lactate level was marked in the patients during the postoperative period with the maximal indexes 6 hours after the operation with subsequent normalization of indexes by the end of the first 24 hours.

Keywords: multicomponent anesthesia, endotracheal intubation, operations on the abdominal aorta section, lactate level
p. 90 – 100 of the original issue
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ОTORHINOLARINGOLOGY

S.A. SEMENOV

CHOICE OF ANESTHESIA METHOD AT THE NASAL BONES REPOSITION

The description and comparative estimation of anesthesia methods used at nasal bones reposition are presented in the article. According to the survey of 42 patients who underwent the nasal bones reposition as well as of 11 otorhinolaryngologists who regularly performed this operation, the anesthesia adequacy was determined, differential approach to anesthesia choice depending on the type and remoteness of the fracture, age and wish of a patient was worked out. Intravenous anesthesia permits to perform the operation with less degree of pain and is a choice method in the treatment of emotionally labile patients and children. Intravenous general anesthetization is advisable to combine with local applicational anesthesia. Local anesthesia is recommended to be used in case of latest fractures in adults when allergies to local anesthetics are absent. It is more efficiently to use combination of applicational, infiltrational and conducting anesthesia. In case of the posterior nasal clivus fractures without nasal pyramid and nasal septum shifting it is possible to use only applicational anesthesia. Endotracheal anesthesia is recommended when the nasal form is restored in patients with inveterate fractures and in case of repeated fractures of nasal bones with deforming presented earlier when surgery had been performed according to the closed type of rhinoplasty.

Keywords: anesthesia, nose, fracture, reposition
p. 101 – 107 of the original issue
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O.G. KHOROV, D.M. PLAVSKY

TYMPANOPLASTY WITH USE OF THE CARTILAGE PLATES AT EXTENSIVE DEFECTS OF THE TYMPANIC MEMBRANE

The authors present the comparative results of tympanoplasty using the cartilage and perichondrium of the auricle and autofascia of the temporal muscle. 62 patients with the chronic suppurative otitis media were operated on, tympanoplasty being performed by means of the allocartilage plate and autoperichondreal tragus of the auricle flap by means of a new technique. The obtained data prove high morphological (94,9%) and functional (88,2%) outcomes.

Keywords: tympanoplasty, tragus perichondrium, fascia of the temporal muscle, cartilage plate
p. 108 – 113 of the original issue
References
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LECTURES, REVIEWS

Z.A. DUNDAROV, V.M. MAYOROV

STRATEGY AND TACTICS OF ANTIBACTERIAL THERAPY AT ACUTE DESTRUCTIVE PANCREATITIS

The significance of the discussed problem is determined by progressively increasing number of patients with an acute destructive pancreatitis, high frequency of development of various intraperitoneal and extra-abdominal purulent-septic complications naturally determining high percentage of unfavorable outcomes. The fact that infecting of destruction foci in the pancreas and parapancreatic tissue occurs in 40-70% of patients with ADP in different terms of this disorder is well-known now. In the review the discussion of the range of questions is given linked with the problem of an adequate and rational intake of antibiotics at ADP depending on their penetrating capability in the pancreas tissue. The discussed problem gains more significance because of surgical tactics activation, of impossibility of single-stage sanitation of all purulent-necrotic foci, of using many-stage necrsequestrectomies and programmed interventions which are an additional risk factor of nosocomial infecting at ADP. On prescribing antibiotics one should take into consideration the circumstance that successes of а modern intensive therapy have permitted to decrease lethality in the acute phase of the pancreatogenic shock; however the possibility of purulent-septic post-necrotic complications development of the late period of ADP evolution increases in this case. The indications for two tactics approaches to antibacterial preparations use – preventive and medical – are studied in the review.

Keywords: acute destructive pancreatitis, conservative treatment, antibacterial therapy
p. 114 – 123 of the original issue
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T.N. GRINEVICH

VENOUS THROMBOSES IN TRAUMATOLOGY AND ORTHOPEDICS: DIFFICULTIES OF DIAGNOSTICS

In the review the data are given about significance of the problem of hemostasis disturbance after operations in case of fractures of long tubular bones and big orthopedic operations relating to surgical operations with high risk of thromboembolic episodes development, and also well-timed and high-grade diagnostics of these severe complications. Data value of clinical inspection in these patients is insignificant. Tool methods allow diagnosing already generated thromboembolic masses. It is not enough to carry out corresponding preventive and medical actions. One manages to reveal prethrombosis condition only using laboratory methods. Among the laboratory tests available today only determination of D-dimer level can help to make clear the thrombotic risk in a patient. However this test possesses high diagnostic sensitivity only in the late posttraumatic phase and at the same time possesses low specificity, especially in the patients of a traumatology-orthopedic profile. Therefore, determination of D-dimer can be insufficient to exclude the diagnosis of a venous thrombosis in this group of patients.

Keywords: hemostasis, thrombosis, endoprosthesis, D-dimers
p. 124 -132 of the original issue
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Т.L. SHEVELA

BASIS FOR ACUPUNCTURE APPLICATION IN THE COMPLEX REHABILITATION TREATMENT FOR PATIENTS WITH PARTIAL SECONDARY ADENTIA AT DENTAL IMPLANTATION

The aim of the work is to make theoretical basis for the examination of possibility and expediency for the acupuncture application as a part of the complex rehabilitation treatment for patients after dental implantation after having analyzed and summarized the literature. In this correlated article we presented our analysis of experimental examinations results and dental implantation application in the clinical practice after having studied 37 publications (32 of articles are in Russian and 5 foreign articles). We determined the main directions for study of acupuncture influence on the process of osteointegration in the system of the jaw-dental implant based on the principles of case-based medicine using: 1) clinical examinations; 2) indices of laboratory researches which characterize the state of crania-maxillofacial area as well as homeostasis of a patient in general – physical and chemical, immunological indices of fluid mediums (blood serum, oral fluid).

Keywords: secondary adentia, dental implantation, rehabilitation, acupuncture
p. 133 – 139 of the original issue
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EXPERIENCE EXCHANGE

E.K. LOBAN, D.E. LOBAN

SURGICAL TACTICS OF FROSTBITE TREATMENT

While preparing this paper the application of the early surgical tactics in the patients with frostbite of large segments of the upper and lower limbs has been studied. The results of treatment are compared with the group of patients who underwent traditional therapy. The analysis has shown that use of the early necrotomy during pathogenetic treatment of the patients with frostbites of large limb segments produces favorable conditions for frostbites treatment and permits to carry out radical operations at early stages. The performed comparison testifies that application of the early necrotomy in the complex treatment permits to decrease significantly the development of purulent-septic complications, to shorten the total staying at the in-patient department and the terms of temporal incapacity for work; it also makes possible the improvement of medical aid quality to the patients with this pathology.

Keywords: frostbites of large limb segments, early necrotomy
p. 141 – 144 of the original issue
References
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N.A. PUSHKAREVA, A.M. MILICHKINA, A.V. KURNOSOV, V.V. SABELNIKOV, E.K. SHULEPOVA, A.I. PROKOPETS, O.V. ZLOBIN

RATIONAL ANESTHESIA CHOICE AT SURGICAL TREATMENT OF PATIENTS WITH THE LOWER LIMBS VARICOSITY

In the article the result analysis of various kinds of anesthesia at surgical treatment of the lower limbs varicosity is given. 3466 surgeries were performed. In 2364 patients regional conductive anesthesia (with femoral, obturator, external cutaneous, sciatic nerves of the lower limbs) was applied; in 1213 – spinal and epidural anesthesia; in 88 – intravenous narcosis; in 16 patients endotracheal anesthesia was used. Advantages, disadvantages and the most common complications occurring at different methods of anesthesia are presented. The optimal methods of anesthesia at phlebectomy are regional – conductive and spinal ones, at which the anesthesia risk is commensurable with the risk of а performed surgical intervention.

Keywords: varicosity, surgical treatment, aesthesia manual
p. 145 – 148 of the original issue
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IN ASSISTANCE TO PRACTICIONER

A.V. VOROBEY, A.A. LITVIN, V.M. KHOKHA

INTERNATIONAL CLASSIFICATION OF THE ACUTE PANCREATITIS (ATLANTA, 1992) – MODERN TENDENCIES IN REVISION

The literature review presents modern tendencies in revision of the acute pancreatitis classification (Atlanta, 1992). All sections of the third revision of the acute pancreatitis classification by International Working Group are subjected to analysis. The revisited classification of the acute pancreatitis is compared with the definitions of 1992 (Atlanta) as well as with the domestic classification. The advantages and disadvantages of the revisited classification of the acute pancreatitis are discussed.

Keywords: acute pancreatitis, classification, Atlanta
p. 149 – 160 of the original issue
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