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Year 2009 Vol. 17 No 4

EXPERIMENTAL SURGERY

SMOTRIN I.S., MATSIUK YA.R., LIS R.E.

STRUCTURAL AND CYTOCHEMICAL CHANGES IN THE SMALL INTESTINE WALL AT COTACT IMPACT OF THE OBTURATOR OF POLYURETHANE AND TEFLON

The experimental studies have been done to determine the influence of the elastic obturators made of foamed polyurethane and teflon on the structural and cytochemical changes in the small intestine wall. It was determined that the present elastic obturators do not cause marked changes in the intestinal wall during the contact impact on the intestine for 24 hours within 14 days and the revealed deflections in enzyme activity of the epithelial cell villi are feebly marked and can not influence villi functional condition.

Keywords: small intestine, elastic obturators of foamed polyurethane and teflon
p. 3- 8 of the original issue
References
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  6. Ковальский, Г. Б. Количественная гистохимия дегидрогеназ // Введение в количественную гистохимию ферментов / Г. Б. Ковальский, Т. В. Журавлева, Р. А. Прочуханова; под ред. Т. В. Журавлевой, Р. А. Прочухановой. – М.: Медицина, 1978. – 58 с.
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GENERAL AND SPECIAL SURGERY

DZIDZAVA I.I., KOTIV B.N., BELEVICH B.L., SMORODSKY A.V.

ENDOSCOPIC LIGATION OF THE ESOPHAGEAL VARICOSE VEINS IN PATIENTS WITH THE LIVER CIRRHOSIS

The experience of endoscopic ligation of the esophageal varicose veins in 98 patients with cirrhosis complicated with portal hypertension is presented in the article. According to the Child-Pugh scale patients were distributed as follows: the class A has made – 18 (18,3%), class B – 38 (38,8%) and class C – 42 (42,9%) patients. Efficiency of band ligation to control the acute bleeding has made 92,9%. The esophageal bleeding recurrence in the early postoperative period developed in 12,2% of cases and in the long-term follow-up – in 20,4%. The hospital lethality was 5,1%. In the remote period after endoscopic ligation the recurrence of the esophageal varicose veins was diagnosed in 65,7% of patients. The survival rate of the patients with cirrhosis after endoscopic eradication during the observation up to 1 year has made 54,5±5,3%, 3 and 5 years – 34,9±5,7% and 21,5±9,6% accordingly. Endoscopic ligation is an effective method to treat and prevent esophageal varicose veins bleeding in patients with the liver cirrhosis.

Keywords: liver cirrhosis, portal hypertension, esophageal varicose veins bleeding, endoscopic ligation
p. 9 – 15 of the original issue
References
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  9. Clinical significance of variceal hemorrhage in recent years in patients with liver cirrhosis and esophageal varices / D. K. Park [et al.] // J. Gastroenterol. Hepatol. – 2004. – Vol. 19. – P. 1024-1051.
  10. Meta-analysis: endoscopic variceal ligation for primary prophylaxis of oesophageal variceal bleeding / M. S. Khuroo [et al.] // Aliment. Pharmacol. Ther. – 2005. – Vol. 21. – P. 347-361.
  11. Complication of liver cirrhosis: oesophageal varices, ascites and hepatocellular capcinoma / F. X. Troillet [et al.] // Rev. med. Suisse. – 2005. – Vol. 1. – P. 249-255.
  12. Emergency endoscopic variceal ligation versus somatostatin for acute esophageal variceal bleeding / W. C. Сhen [et al.] // J. Chin. Med. Assoc. – 2006. – Vol. 69. – P. 55-57.
  13. Холматов, П. К. Эндоскопические методы профилактики и лечения пищеводно-желудочных кровотечений портального генеза / П. К. Холматов, Т. Г. Гулмурадов, Х. Х. Курбанов // Анн. хир. гепатол. – 2005. – Т. 10. – С. 92.
  14. Embolization combined with endoscopic variceal ligation for the treatment of esophagogastric variceal bleeding in patients with cirrhosis / L. Y. Huang [et al.] // Chin. Med. J. (Engl). – 2007. – Vol. 120. – Р. 36-40.
  15. Опыт применения эндоскопического лигирования варикозно расширенных вен пищевода у больных с портальной гипертензией / А. Г. Шерцингер [и др.] // Анн. хир. гепатол. – 2005. – Т. 10. – С. 94.
  16. Comparison of endoscopic variceal ligation and nadolol plus isosorbide-5-mononitrate in the prevention of first variceal bleeding in cirrhotic patients / H. M. Wang [et al.] // J. Chin. Med. Assoc. – 2006. – Vol. 69. – Р. 453-460.
  17. Шагинян, А. К. Лигирование варикозно расширенных вен пищевода – метод выбора в профилактике рецидива кровотечения / А. К. Шагинян, Д. В. Монахов // Анн. хир. гепатол. – 2005. – Т. 10. – С. 93-94.
  18. Endoscopic hemostasis for bleeding gastric varices treated by combination of variceal ligation and sclerotherapy with N-butyl-2-cyanoacrylate / N. Sugimoto [et al.] // J. Gastroenterol. – 2007. – Vol. 42. – Р. 528-532.

ZHYDKOV S.A., YELIN I.A.

ACCOMPANYING PATHOLOGY INFLUENCE ON THE ACUTE CHOLECYSTITIS OUTCOMES IN PATIENTS OVER 60 YEARS OF AGE

An accompanying pathology is the basic feature of patients of both elderly and senile age. Results of treatment of 468 operated patients with an acute cholecystitis are analysed. It is established, that accompanying cardiovascular diseases are the main factors of the operational risk, and also the reasons of postoperative complications and lethal outcomes in patients over 60 years of age. It demands their adequate correction in the pre-and the postoperative period.

Keywords: acute cholecystitis, patients of the elderly and senile age, accompanying pathology, postoperative complications
p. 16 – 22 of the original issue
References
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  7. Pedersen, T. A prospective study of risk factors and cardiopulmonary complications associated with anaesthesia and surgery: risk indicators of cardiopulmonary morbidity / T. Pedersen, K. Eliasen, E. Henrikssen // Acta Anaesthesiol. Scand. – 1990. – Vol. 34. – Р. 144-155.
  8. Жидков, С. А. Тактика лечения острого холецистита у пациентов старше 60 лет / С. А. Жидков // Медицинские новости. – 2005. – № 7. – C. 68-70.
  9. Ермолов, А. С. Острый холецистит: современные методы лечения / А. С. Ермолов, А. А. Гуляев // Лечащий врач. – 2005. – № 2. – С. 16-18.
  10. Чернов, В. Н. Диагностика и лечение острого холецистита у больных пожилого и старческого возраста / В. Н. Чернов, И. В. Суздальцев. – Ростов н/Д: РГМУ, 2002. – С. 280.

TESFAYE V.A., USOVICH A.K., SACHEK M.G.

APPLICATION OF METHODS OF TISSUES OXYGENATION FOR PREVENTION OF BRONCHOPULMONARY COMPLICATIONS AFTER CHOLECYSTECTOMY IN PATIENTS OVER 60 YEARS OF AGE

In 238 patients, operated on acute cholecystitis, the impact of the integrated approach to the prevention of postoperative complications of acute cholecystitis is analyzed, which is aimed to reduce the damage of the tissue and organs hypoxia in the postoperative period, with including pre- and postoperative period in the continuous oxygenation, alkaline inhalations, bronchodilators, cardiac drugs, antihypoxant “Bemithyl”, broad spectrum antibiotics, and complexes of physical exercises therapy for the improvement of drainage function of the lymphatic system of the lung. It has been shown that oxygen therapy has a positive effect in the elderly and old patients.
Using oxygen therapy, we were able to reduce frequency of postoperative bronchopulmonary complications by 2,5 in the elderly and old patients, while in the patients between 35–60 years of age the rate is reduced only by 2%.

Keywords: cholelithiasis, acute cholecystitis, old and elderly age, bronchopulmonary complications, oxygen therapy, antihypoxant
p. 23-28 of the original issue
References
  1. Васильев, В. В. Варианты хирургического лечения острого холецистита у больных с высоким операционным риском / В. В. Васильев // Вестник хирургии. – 2007. – Т. 166, № 2. – С. 31–34.
  2. Малоинвазивные вмешательства при остром холецистите, осложненном механической желтухой, у больных пожилого и старческого возраста / А. М. Хожибаев [и др.] // Вестник хирургии. – 2007. – Т. 166, № 3. – С. 66-69.
  3. A risk score for conversion from laparoscopic to open cholecystectomy / N. A. Kama [et al.] // American J. Surgery. – 2001. – Vol. 18. – Is. 6. – P. 520-525.
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  5. Makela, J. T. Acute cholecystitis in the elderly / J. T. Makela, H. Kiviniemi, S. Laitinen // Hepatogastroenterology. – 2005. – Vol. 52, N 64. – Р. 999-1004.
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  12. Смирнов, А. В. Бемитил: механизмы действия и связанные с ним эффекты / А. В. Смирнов // Физиологически активные вещества: межвед. сб. науч. трудов. – Киев: Наукова думка, 1993. – С. 5-9.
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FOMIN S.A.

REHABILITATION PERIOD PECULIARITIES AFTER APPENDECTOMY FROM VARIOUS ACCESSES

The slanting pararectal mini-access at appendectomy was designed and introduced. The intensity of the postoperative pain by means of the visually-analogue scale is studied. The decrease of postoperative pain intensity is shown when less traumatic access is used. The analysis of the quality of life in the early and late postoperative period is carried out. In patients after appendectomy from the slanting pararectal mini-access the quality of life is higher according to all categories of the inquirer; it is caused by less traumatic character of the operation. In patients both physical and psychological health components restore faster .

Keywords: appendectomy, quality of a life, rehabilitation
p. 29 – 35 of the original issue
References
  1. Овечкин, A. M. Обезболивание и управляемая седация в послеоперационный период: реалии и возможности // Вестник интенсивной терапии / A. M. Овечкин, Д. В. Морозов, И. П. Жарков. – 2001. – Vol. 4. – C. 47-60.
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  4. Параректальный мини-доступ при аппендэктомии: пат. РФ / С. А. Фомин, А. А. Чумаков, А. В. Плюта, В. С. Виноградов. – № 2346658; опубл. 20.02.09 // Бюллетень «Изобретения. Полезные модели». – 2009. – № 5.

PLANDOVSKY V.A., SHNITKO S.N.

VIDEOTHORACOSCOPIC SUPRADIAPHRAGMATIC TRUNCAL VAGOTOMY IN THE TREATMENT OF PATIENTS WITH PEPTIC ULCER OF GASTROENTEROANASTOMOSIS

Peptic ulcer of the gastroenteroanastomosis is one of the most difficult complications developing after gastric resection and it composes 0,5–10%. Because of the non-effective medicine application, surgery is a method of choice in treatment of patients with the postoperative peptic ulcer. In the article the authors present the analysis of videothoracoscopic supradiaphragmatic truncul vagotomies performed in 11 patients with vagus-genesis peptic ulcer. While analyzing the immediate results, the character of the post-operative period course and developing postoperative complication were estimated.
The first experience of carrying out videothoracoscopic supradiaphragmatic truncul vagotomies in case of the postoperative peptic ulcer allows speaking about prospects of the given technique.

Keywords: videothoracoscopic vagotomy, peptic ulcer, gastroenteroanastomosis, surgical treatment
p. 36 – 39 of the original issue
References
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  3. Лубянский, В. Г. Видеоторакоскопическая ваготомия в хирургическом лечении больных с пептич. язвой гастроэнтероанастамоза после резекции желудка / В. Г. Лубянский, В. Н. Шевченко // Вестник хирургии. – 2007. – № 6. – С. 54-55.
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  8. Шнитко, С. Н. Видеоторакоскопическая хирургия / С. Н. Шнитко, Л.Н. Бисенков. – Минск, 2006. – 248 с.
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ZHAVADA N.V., PIKIRENYA I.I., BOGUSHEVICH O.S., SEDUN V.V., PALEEV S.A., KHVALENOV D.V.

AMINOACIDS LEVEL IN PATIENTS, OPERATED ON THE OCCASION OF COMPLICATIONS OF THE STOMACH AND DUODENAL ULCERS

The questions of aminoacid exchange of the blood serum in the patients with complications of the stomach and duodenal ulcers (bleeding, penetration, stenosis, perforation and their combinations) after operative interventions during traditional post-operative course without the enteral probe application and parenteral feeding use are elucidated in this article. Non-significant fluctuations of aminoacid range in the blood during pre-and postoperative period followed by hypermetabolism and catabolism with clear disintegration of visceral and muscular proteins were revealed. The high informative character of the antropometric data for protein-energy insufficiency in the patients during postoperative period was confirmed.

Keywords: stomach ulcer, bleeding, penetration, stenosis, perforation, postoperative period, antropometric data
p. 40 – 48 of the original issue
References
  1. Значение направленной антисекреторной терапии в улучшение результатов лечения больных после лапароскопического ушивания прободной пилородуоденальной язвы / С. А. Афендулов [и др.] // Эндоскопическая хирургия. – 2005. – № 1. – С. 54.
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FIONIK O.V., BUBNOVA N.A., PETROV S.V., EROFEYEV N.P., LADOZHSKAYA-GAPEYENKO E.E., SEMENOV A.YU.

LYMPHEDEMA OF THE LOWER LIMBS: ALGORITHM OF DIAGNOSTICS AND TREATMENT

The results of diagnostics and treatment of 1260 patients with lymphedema of the lower limbs are analyzed in the article. Long-term results of conservative and surgical treatment are studied, study of life quality of the patients with lymphedema of the lower limbs in dynamics is carried out, and on the basis of it conclusions are drawn on efficiency of treatment methods.
On the basis of the microcirculation state studying at various forms of lymphedema, comparison of these results with the data concerning ultrastructural changes of endotheliocytes and myocytes of lymphatic vessels walls, study of immunologic features of lymphedema, the data about lymphedema pathogenesis are expanded. The algorithm of diagnostics of the lower limbs lymphedema is formulated to determine the best medical tactics in case of this disease taking into account various links of lower limbs lymphedema pathogenesis.

Keywords: lymphangion, microcirculation, immunity, lymphedema, diagnosis, treatment
p. 49 – 64 of the original issue
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OKULICH V.K., FEDYANIN S.D., PLOTNIKOV F.V., SHILIN V.E., MATSKEVICH E.L.

RATIONAL ANTIBIOTICS USE AT TREATMENT OF HEMATOGENIC AND POSTTRAUMATIC OSTEOMYELITIS

42 patients with hematogenic osteomyelitis and 100 patients with chronic posttraumatic osteomyelitis were examined with using of bacteriological methods. Strains of microorganisms were examined with the help of commercial biochemical test systems ATB Expression. Sensitivity to antibiotics was examined with the help of ATB Expression, with a standard disks method, serial dilution method and with the original test-systems «AB-STAPH», «AB-PSEU», «AB-GRAM(-)» and «AB-ENTER». In the etiologic structure of the hematogenic and posttraumatic osteomyelitis a leading role of staphylococci was confirmed. We worked out the empiric antibiotic therapy schemes of the given diseases, based on the data concerning etiologic structure, dynamics of microflora and strains sensitivity to antibiotics.

Keywords: osteomyelitis, etiology, conservative treatment, antibiotic therapy, resistance to antibiotics
p. 65 – 77 of the original issue
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TRAUMATOLOGY AND ORTHOPEDICS

SOKOLOVSKY O.A., KOVALCHUK O.V., SOKOLOVSKY A.M., LIKHACHEVSKY YU.V., SERDUCHENKO S.N., DEMENTSOV A.B.

DEVELOPMENT OF THE HIP PROXIMAL PART DEFORMATION AFTER FEMORAL AVASCULAR NECROSIS IN CHILDREN

The article provides the development analysis for 106 patients with the avascular necrosis of the femoral hip with total of 138 joints affected, developed after the conservative treatment of 800 children (1057 joints) with a complete (624) and a partial (433) congenital hip dislocation.
The first type of Kalamchi disease was diagnosed in 56 cases (40,6%), the second one in 49 cases (35,5%), the third – in 25 cases (18,1%), the fourth – in 8 – (5,8%). Further development of the affected joints is being characterized by the development of problems in all components of joints and by further worsening of the situation; the severity of the problem is increased from the 1st type of Kalamchi disease to the 4th and that should be taken into consideration when choosing the treatment tactics.

Keywords: avascular necrosis, children, Kalamchi, deformation of the proximal part of the hip
p. 78 – 91 of the original issue
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ONCOLOGY

SCHERBA A.E., SLOBODIN YU.V., RUMMO O.O., AVDEY E.L., FEDORUK A.M., KHARKOV D.P., KOROTKOV S.V.

SURGICAL TREATMENT OF KLATSKIN TUMOR

Surgical treatment of Klatskin tumor represents rather a complicated task and challenge for hepatorbiliary surgeons because of peculiarities of its localization, spreading and difficulty of its radical removal. Achievement of tumorless boundaries of resection is the only way to improve the long-term results of treatment that can require expanded volume of the operation – hemihepatectomy, the resection of extrahepatic bile ducts, the portal vein and hepatic artery, expanded lymph dissection as well as еру liver transplantation.
The description of two cases of a radical surgical treatment of the given pathology by means of right-side hemihepatectomy with the resection of extrahepatic bile ducts and orthotopic liver transplantation with lymph dissection in both cases is presented in the article. There is also the literature review devoted to the main tendencies in hepatorbiliary surgery and liver transplantation used to treat cholangiocarcinoma of the proximal extrahepatic ducts, the most widely spread of which are the following: hemihepatectomy with caudaltectomy and the portal vein resection and orthotopic liver transplantation with neoadjuvant chemical radial and brachial therapies.

Keywords: Klatskin tumor, hemihepatectomy, resection of extrahepatic bile ducts and portal vein, liver transplantation
p. 92 – 98 of the original issue
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MIKHAILOV I.V., BELYAKOVSKY V.N., LUD A.N., AL-YAHIRI A.K.

LONG-TERM RESULTS OF COMBINED TREATMENT OF LOCALLY ADVANCED RESECTABLE GASTRIC CANCER STAGE IV (T4N1-3M0) WITH POSTOPERATIVE CHEMORADIOTHERAPY

The long-term results of combined treatment of 79 patients with locally advanced resectable gastric cancer IV stage (T4N1–3M0) with the use of extended-combined operations and postoperative chemoradiotherapy (I group) were studied. As a control group we studied the results of treatment of 132 patients who received postoperative chemotherapy (II group) and 117 patients who underwent only surgery (III group). General and recurrence-free 3-year survival in group I composed 38,9% and 20,9%, group II – 22,9% and 3,4%, group III – 24,4% and 10,5%, respectively (p <0,003). The use of postoperative chemoradiotherapy was the most effective for the Borrmann III–IV macroscopic forms of the tumors, low and undifferentiated cancer, with proximal localization, subtotal and total tumor of the stomach. Carry out of the postoperative chemoradiotherapy of locally advanced gastric cancer provides a high degree of local control of the tumor. Local recurrence in patients of group I wasn’t observed, whereas in patients of II and III groups it was detected in 12,2% and 21,2% of cases respectively.

Keywords: gastric cancer, postoperative chemotherapy, radiotherapy
p. 99 – 106 of the original issue
References
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SAVITSKY S.E., GOLYSHKO P.V., KUZNETSOV O.E.

INHERITED COLORECTAL CANCEROUS SYNDROMES, CONTEMPORARY APPROACHES TO THE FORMATION OF GROUPS, CLINICAL CHARACTERISTICS

Strategy realization of the formation of the risk groups based on the genetic predisposition to malignant new growths, their subsequent monitor supervision, with use of modern methods of visualization of the pathological formations, molecular-genetic methods of diagnostics – is one of the most perspective directions of modern oncology. The article is devoted to new approaches to the organization of malignant new growths detection particularly of the colorectal cancer at its early stages.
By means of the survey the family anamnesis has been collected of more than 10706 patients, including 401 patients during the hospital screening. To study clinical and molecular peculiarities of the inherited colorectal cancer 865 patients (47,2%) have been selected from the total number 1833 of colorectal cancer patients. Selection of the patients in the main group has been performed with the help of the computer system “Diagnostic informative-analytical system “inherited tumors”, which is based on the principle of calculation of the individual risks for malignant new growths development. The conducted research shows that the designed computer system permits to increase up to 52,2% the incidence of men’s relevance who relate to the inherited non-polypous colorectal syndromes.

Keywords: inherited non-polypous colonic cancer, clinical signs, prevalence
p. 107 – 117 of the original issue
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UROLOGY

POVELITSA E.A., VOSCHULA V.I., NADYROV E.A., NURULLOEV B.S.

DIAGNOSTICS OF BENIGN HYPERPLASIA, PROSTATIC INTRAEPITHELIAL NEOPLASIA OF THE PROSTATE GLAND FROM THE POSITION OF PRESENT-DAY MOLECULAR-BIOLOGICAL MARKERS

We have determined the concentration of insulin-like growth factor I (IGFI) and of public prostatic specific antigen (PSA) in the blood serum of the patients with benign hyperplasia of the prostate gland (BHP), as well as in the patients with morphologically confirmed diagnosis of prostatic intraepithelial neoplasia (PIN) and prostate carcinoma (PC) before special treatment, as well as in the control group. We’ve used the immune-enzyme analysis. We have carried out a standard clinical examination of the patients with prostate gland pathology and calculated the PSA density marker. We offer a method of differential diagnostics of BHP using the combination of three parameters: public PSA, IGFI and PSA density. We show benefit of using combination of these three parameters for BHP diagnostics before definition only the PSA and PSA density. Specificity of the offered test has made up 92,7%; sensitivity has made up 75%.

Keywords: benign hyperplasia of the prostate gland, prostatic intraepithelial neoplasia, prostatic specific antigen, insulin-like growth factor I, diagnostics
p. 118 – 127 of the original issue
References
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  14. Дифференциально-диагностическое значение простатического специфического антигена при гиперплазии предстательной железы / В. А. Максимов [и др.] // Урология. – 2001. – № 2. – С. 37-40.
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  16. Воробьев А.В. Скрининг мужского населения, стандартное обследование, классификация рака предстательной железы / А. В. Воробьев // Практическая онкология. – 2001. – № 2. – С. 8-16.
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ANESTHESIOLOGY-REANIMATOLOGY

NIKITINA E.V.

DYNAMICS OF LEUKOGRAM INDEXES AND IMMUNE STATUS DEPENDING ON THE VEGETATIVE REACTIVITY MARKED CHARACTER IN THE PREOPERATIVE PERIOD

The study of the immune status and leukogram indexes changes depending on the state of the vegetative nervous system (VNS) functional activity in the preoperative period has been performed in 61 patients without accompanying purulent-septic complications.
It has been determined that in case of different functional indexes of the VNS the activity difference of the cellular and humoral immunity can be observed. Changes of the vegetative reactivity in the preoperative period cause changes in the immunity system. In the patients with prevalent high VNS functional activity during the preoperative period T-cellular immunity levels indexes tend to increase. The B-lymphocytes and immunoglobulin indexes in the patients with prevalent high VNS functional activity decrease. The number of circulating immune complexes in the patients with high VNS functional activity is considerably lower than in the patients with low VNS functional activity.
The significant difference in the eosinophil content in the groups with differing vegetative reactivity has been registered. The eosinophil number in the patients with high vegetative reactivity was significantly lower than the number of eosinophils in the patients with low vegetative reactivity.

Keywords: preoperative period, immune status, leukogram, vegetative nervous system
p. 128 – 137 of the original issue
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LECTURES, REVIEWS

TRET’YAK S.I., RASCHINSKY S.M.

CHRONIC AUTOIMMUNE PANCREATITIS

Autoimmune pancreatitis (AIP) is a rare form of chronic pancreatitis (CP). It has no clinical picture of disease peculiar only to it; however, the combination of particular to it serological, histomorphological and imaging features allows establishing its presence. To establish the diagnosis of AIP, the systemic approach which is more fully reflected in the diagnostic criteria offered by the researchers from clinic of Mayo is required. From the practical point of view the presence of similar symptoms which are observed in the pancreas cancer patents is significant. It can cause the performance of extensive surgical interventions which worsen the prognosis of AIP course. In our article we have tried to summarize the available data of the literature, concerning pathogenesis, clinical picture, and diagnostics and therapy principles of AIP.

Keywords: chronic pancreatitis, autoimmune pancreatitis, diagnostic criteria
p. 138 – 149 of the original issue
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ZHEBENTYAEV A.A., GOLDYTSKY S.O.

PRESENT-DAY DIAGNOSTICS AND TREATMENT METHODS OF ERECTILE DYSFUNCTION

The researches in the erectile dysfunction (ED) made during the last 15 years have led to the development of several new treatment options and strategies for ED. Worldwide availability of the three oral PDE 5 inhibitors (sildenafil, tadalafil, vardenafil) are associated with high efficacy and safety rates, even in difficult-to-treat populations (e.g. diabetes mellitus, radical prostatectomy). Many physicians without background knowledge and clinical experience of the diagnosis and treatment of ED are involved in decision-making concerning the evaluation and treatment of these men. Treatment options for patients not responding to oral drugs (or with contraindications) include intracavernous injections, intraurethral alprostadil, vacuum constriction devices and implantation of penile prosthesis. It must be emphasized that the physician should warn the patient that sexual intercourse is considered to be a high physical activity, which increases the heart rate as well as cardiac work. Physicians should assess the cardiac risks of patients prior to treating ED. Reconstructive vascular surgery is associated with poor outcomes in long-term follow-up. Further studies are underway. Data of numerous investigations have led to creation of standards of diagnostics and treatment of ED of the European Association of Urology (EAU-2009).

Keywords: erectile dysfunction, methods of diagnostics, standards of treatment, 5 PDE blockers
p. 150 – 159 of the original issue
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GAIN YU.M., ALEXANDROVA O.S., GAPANOVICH V.N.

PRESENT-DAY METHODS OF THE LOCAL HEMOSTASIS AT THE ABDOMINAL PARENCHYMATOUS ORGANS

The present-day state concerning the ways of the local hemostasis at traumas of the abdominal parenchymatous organs is presented in the review. Physical, mechanical, chemical and biological ways to stop the bleeding of the abdominal parenchymatous organs in case of closed and open traumas are described. Positive and negative sides of using various ways of the hemostasis in case of versatile damages of the abdominal parenchymatous organs are presented. The role and place of modern preparations of the local haemostatic action in the complex of medical actions in case of open and closed abdominal traumas are determined.

Keywords: trauma, bleeding, parenchymatous organs, local hemostasis
p. 160 – 171 of the original issue
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RESERCH

EGOROV V.I., SCHASTNY A.T., VISHNEVSKY V.A., SHEVCHENKO T.V., LYARSKY S.P., YASHINA N.I., VINOKUROVA L.V., PETROV R.V., SYATKOVSKY A.R., ZHAVORONKOVA O.I., MELEKHINA O.V.

TWO-CENTRAL RANDOMIZING CONTROLLED RESEARCH «COMPARATIVE ESTIMATION OF THE RESULTS OF DUODENUM-SAVING SUBTOTAL PANCREAS HEAD RESECTION WITH AND WITHOUT THE LONGITUDINAL PANCREATICOENTEROANASTOMOSIS AT CHRONIC PANCREATITIS WITH THE WIDENING OF THE MAIN PANCREATIC DUCT AT STRICTURES AND CALCULI ABSENCE IN ITS LUMEN»

Chronic pancreatitis (CP) is an inflammatory disease characterized by irreversible replacement of the pancreatic parenchyma with the fibrous tissue. In the majority of CP patients the pancreas head is a trigger of the chronic inflammation; that’s why the pancreas head tissue resection is becoming the central part of the surgical intervention. The role of the duct drainage of the remained part of the pancreas for providing prolonged anesthetic effect and maximal high quality of life is still unclear.
Design. Two-central randomizing controlled research “Comparative estimation of the results of duodenum-saving subtotal pancreas head resection with and without the longitudinal pancreaticoenteroanastomosis at chronic pancreatitis with the widening of the main pancreatic duct at strictures and calculi absence in its lumen. 44 patients will be included and intraoperatively randomized. The choice criteria: all patients with CP with indications for pancreas head resection, who signed the informed consent.
Comparable interventions:
1. subtotal duodenum-saving resection of the pancreas head without its intersection (Bern’s variant of the Beger’s operation)
2. subtotal duodenum-saving resection of the pancreas head without its intersection (Bern’s variant of the Beger’s operation) with the longitudinal pancreaticoenteroanastomosis
Combined main ultimate point (hierarchic model): the duration of the operation, the life quality in one year after the operation, duration of stay at the reanimation unit, duration of hospitalization.
Duration: September, 2009 – October, 2012
Organization and responsibility: the research is organized in accordance to the moral, ethical, regulating and scientific principles of clinical researches realization according to the Declaration of Helsinki, 1989 and the Rules of conscientious clinical practice. The subjects responsible for the planning, conducting and final analysis of the research are “A.V. Vishnevsky institute of surgery” , Moscow, Russia (Egorov V.I.) and Vitebsk regional scientific-practical center of the liver and pancreas diseases, Vitebsk, the Republic of Belarus (Schastny A.T.)

Keywords: chronic pancreatitis, operative treatment, pancreas head resection, two-central randomizing controlled research
p. 172 – 182 of the original issue
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PRACTICAL CASES

ZAKREVSKY G.I., VYSOTSKAYA V.V.

OSTEOPOIKILOSIS OF THE FOOT BONES IN CHILDREN

The clinical cases of rather a rare systemic congenital pathology of the skeleton – osteopoikilosis (scattered sclerosing or spotted numerous osteopathy) is described in the article. The disease was initially diagnosed in one of twin sisters during X-ray examination of the right foot. During X-ray examination of the other sister the presence of the focal changes was also revealed and they were more marked with sclerosis foci spreading to the tibial and fibular metaphyses. The aim of this report is to inform practitioners about the possibility of revelation in children of the systemic osteal disease – osteopoikilosis.

Keywords: osteopathy, osteopoikilosis, sinfant’s age
p. 183 – 184 of the original issue
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IN ASSISTANCE TO PRACTICIONER

SIROTKO V.V., NIKOLSKY M.A., ZHELEZNYAK A.V., FEDоROV G.V., TSERKOVSKY A.E.

TREATMENT OF THE FEMUR NECK FRACTURES: OSTEOSYNTHESIS OR PROSTHESIS

The article includes the results of the analysis of a clinical material (more than 120 observations) and the modern literature about the methods of treatment of medial fractures of the femur neck. The obtained findings indicate that features of the fractures adhesion depend on the degree of the osteal fragments shift, on the action of compressing forces on the line of a fracture, on the age of patients. The criteria for osteosynthesis performance of the femur neck and primary endoprosthesis of the femur joint had been selected, which resulted in the restoration of the basic function of the lower extremity, in reduction of terms of invalidity and rehabilitation that allows to improve the quality of patient’s life and to return them to an active way of life.

Keywords: medial fractures of the femur neck, osteosynthesis, endoprosthesis of the hip joint
p. 185 – 193 of the original issue
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YURKOVSKY A.M., VORONETSKY A.N.

EARLY DIAGNOSTICS OF OSTEOMYELITIS IN CHILDREN: LIMITS OF DIAGNOSTICS POSSIBILITIES

The comparative analysis of the diagnostic possibilities of X-ray, X-ray computer tomography, ultrasound diagnostics, magneto-resonant tomography, radionuclear diagnostics and searching osteoperforation is conducted in case of acute hematogenic osteomyelitis depending on the age, localization, phase and stage of the disease. The diagnostic algorithm is suggested which takes into account diagnostic possibilities of the radial diagnostics methods in the intramedullary and extramedullary phase of the acute hematogenic osteomyelitis. The possibilities of diagnostics and/or therapeutic osteoperforation under the X-ray computer tomography control and ultrasound diagnostics (especially in 1-year old children) are discussed.

Keywords: osteomyelitis, X-ray, ultrasound diagnostics, radionuclear diagnostics
p. 194 - 199 of the original issue
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