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Year 2010 Vol. 18 No 6

GENERAL AND SPECIAL SURGERY

DOVNAR R.I., SMOTRIN S.M., VASIL’KOV A.YU., ZHMAKIN A.I.

ANTIBACTERIAL AND ANTIFUNGAL EFFECT OF THE BANDAGING MATERIAL CONTAINING SILVER NANOPARTICLES

Objectives. To study antibacterial and antifungal effect of the bandaging material on the basis of medical gauze bandage containing silver nanoparticles obtained by means of the metal vapor synthesis method.
Methods. In the research the strains of microorganisms and fungi of Candida genus were used which had been isolated from the purulent wounds of the surgical patients. Determination of the antibacterial and antifungal effect of the bandaging containing silver nanoparticles was performed on Petri dishes with agar. A usual medical gauze bandage was used for control. Sensitivity to antibiotics and antibacterial preparations had been previously revealed in these strains of microorganisms. The correlation analysis of antibacterial action of the bandaging containing silver nanoparticles was carried out as well as the analysis of microorganisms’ sensitivity to antibiotics.
Results. Medical gauze bandage containing silver nanoparticles was found out to have antibacterial and antifungal action. The performed correlation analysis showed that there was no any link between microbes’ resistance to antibiotics and resistance to silver nanoparticles.
Conclusions. Nanocomposite material silver/bandage has a marked antimicrobial action in relation to gram-positive and gram-negative bacteria and Candida. Microorganisms’ resistance to silver-containing bandaging doesn’t correlate with the range and level of their sensitivity to antibiotics.

Keywords: silver nanoparticles, antibacterial and antifungal effect, medical gauze bandage
p. 3 – 11 of the original issue
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SHESTIUK A.M., KARPITSKY A.S., PANKO S.V., BOUFALIK R.I.

DETERMINATION OF THE VIDEOTHORACOSCOPY APPROACH PARAMETERS TO THE EPIPHRENIC SEGMENT OF THE ESOPHAGUS

Objectives. Determination of the videothoracoscopy approach parameters to the epiphrenic esophagus segment through the left pleural cavity in men with different kinds of the constitution.
Methods. The areas for optics and manipulators introducing to nake the epiphrenic esophagus segment are determined on the basis of the anropometric measurings and X-ray peculiarities of 106 patients.
Results. It is established that introducing of the optical trocar in the area of the 7th intercostal space on the posterior axillary line on the left is an optimal one at videothoracoscopic surgeries on the epiphrenic esophagus segment regardless of the body constitution. Instrumentation ports should be placed in the 5th intercostal space on the mid-axillary line and in the 8th intercostal space on the posterior-axillary line for dolichomorphic men, in the 5th intercostal space on the mid-axillary line and in 8th intercostal space on the shoulder line for normomorphic men, in the 6th intercostal space on the posterior-axillary line and the 9th intercostal space on the shoulder line for bradimorphic men.
Conclusions. Preparing for the videothoracoscopic intervension on the epiphrenic esophagus segment should be accompanied by previous modelling of trocars imposition areas to introduce optics and instruments which differ depending on the constitution.

Keywords: esophagus, videothoracoscopy, access
p. 12 – 20 of the original issue
References
  1. Созон-Ярошевич, А. Ю. Анатомо-клиническое обоснование хирургических доступов к внутренним органам / А. Ю. Созон-Ярошевич. – Л.: Медгиз, 1954. – 180 с.
  2. Веретенников, С. И. Топографо-анатомические аспекты выбора техники эндоскопической спленэктомии / С. И. Веретенников, М. В. Крамаров, Н. В. Островский // Эндоскопич. хирургия. – 1997. – № 1. – С. 53-54.
  3. Петришин, В. Л. Адаптация параметров оперативного действия в видеоэндохирургии / В. Л. Петришин // Эндоскопич. хирургия. – 2000. – № 6. – С. 25-27.
  4. Шнитко, С. Н. О некоторых параметрах оптимального доступа при эндоскопических операциях / С. Н. Шнитко, А. Л. Стринкевич // Эндоскоп. хирургия. – 1999. – № 2. – С. 75-76.
  5. Устинов, О. Г. Критерии оценки эндоскопических доступов / О. Г. Устинов, Ю. М. Захматов // Эндоскоп. хирургия. – 2003. – № 1. – С. 39-42.

KHRYSHCHANOVICH V.YA., TRETYAK S.I., BOGOMAZOVA E.V.

HYPOTHYROIDISM AFTER HEMITHYROIDECTOMY: INCIDENCE, RISK FACTORS, TREATMENT

Objectives. To estimate the incidence and factors influencing hypothyroidism development after hemithyroidectomy.
Methods. A retrospective review of 251 patients in the nearest postoperative period who underwent hemithyroidectomy was performed. The incidence of postoperative hypothyroidism was based on thyrotropin values and clinical symptoms. The relationship between hypothyroidism, age and the character of thyroid pathology was investigated using correlation analysis.
Results. 37 of 214 patients (17%) became biochemically hypothyroid postoperatively. 163 patients (76%) became euthyroid without intervention or with low doses of thyroxine. More often postoperative hypoparathyroidism developed at patients with autoimmune thyroiditis. Thus the correlation analysis has shown the inverse relationship serum ТSH from the age of patients.
Conclusions. A minority of patients become hypothyroid after hemithyroidectomy. Some patients with biochemical hypothyroidism will become euthyroid without intervention. Development of postoperative hypothyroidism is influenced by the age of patients and in a greater degree by the inflammatory character of the thyroid gland pathology.

Keywords: hypothyroidism, hemithyroidectomy, thyroiditis, surgery
p. 21 – 28 of the original issue
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SARAP P.V., VINNIK YU.S., OSTANIN A.A.

SCALE OF OUTCOME PREDICTION IN PATIENTS WITH URGENT SURGICAL PATHOLOGY CONSIDERING IMMUNE STATUS INDICATORS

Objectives. To work out a surgical immune-associated factor evaluation scale (SIAFE) to predict the outcome in patients with urgent surgical pathology, to estimate its informativeness, sensitivity and specificity.
Methods. Training data consist of 440 patients (930 examinations). The control group consisted of 80 patients with diffuse peritonitis. To calculate the SIAFE indicators of patients’ condition and the characteristic of immune system organization clusters were used. The SIAFE scale considers severity of peritoneal inflammation, SAPS II score, CD20+ lymphocytes count, parities of CD25+, CD38+ and CD95+ lymphocytes and a distance from the immune status cluster centre.
Results. According to the results of the dispersive analysis, the SIAFE scale is more informative in comparison with traditionally used scales, permits to estimate probability of a lethal outcome statistically authentically. The ROC-analysis confirms high sensitivity and specificity, «excellent» characteristics (AUC=0,95) of SIAFE scale.
Conclusions. The basic advantage of SIAFE is its universality at the estimation of disease outcome prediction in patients with urgent surgical abdominal pathology in various terms from the moment of hospitalization.

Keywords: urgent surgery, immunity, estimation of the condition severity
p. 29 – 39 of the original issue
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KHRYSHCHANOVICH V.YA., TRETYAK S.I., MOKHORT T.V., BOGOMAZOVA E.V.

WELL–BEING AND CALCIUM-PHOSPHORUS HOMEOSTASIS IN PATIENTS WITH HYPOPARATHYROIDISM RECEIVING STANDARD TREATMENT WITH CALCIUM AND VITAMIN D

Objectives. To study calcium homeostasis and well-being of the patients with hypoparathyroidism by comparison of the obtained results with those in the patients who underwent thyroid surgery but with saved parathyroid function.
Methods. Cross-sectional controlled study in 69 patients with the postsurgical hypoparathyroidism (the period of the postoperative observation made up 38,7±10,3 months (S.D.) on stable treatment with calcium and vitamin D (or analogs) and in 26 control patients with a history of thyroid surgery but saved parathyroid function, who were matched for sex, age and time since surgery. Assessment of well–being and parathyroid homeostasis were studied using validated questionnaires (SF–36 v. 2ФМ, NAIF), serum calcium/phosphorus homeostasis, and in the hypoparathyroid patients also screening for secondary disease by means of kidney ultrasound and ophthalmological split lamp examination.
Results. Serum calcium was in the accepted therapeutic range in 10 of hypoparathyroid patients, in the majority cases calcium/phosphorus homeostasis was clearly non–physiological. Nephrolithiasis was detected in 6 and cataracts in 3 of 69 hypoparathyroid patients. As compared with controls, hypoparathyroid patients had signicantly lower parameters of quality of a life in SF–36 v. 2ФМ (р < 0,05), NAIF (р = 0,048) with predominant decreases in the scale scores for vitality, physical and social functioning, role–physical/emotional functioning.
Conclusions. Current standard treatment in hypoparathyroidism is not only associated with an altered calcium/phosphorus homeostasis but also fails to restore well–being in these patients. Future studies need to address the impact of more physiological treatment options like parathyroid hormone (1–34) or parathyroid transplantation on well–being and mood in these patients.

Keywords: thyroidectomy, life quality, hypoparathyroidism, management
p. 40 – 49 of the original issue
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  19. Usdin, T. B. Identication and functional expression of a receptor selectively recognizing parathyroid hormone, the PTH2 receptor / T. B. Usdin, C. Gruber, T. I. Bonner // Journal of Biological Chemistry. – 1995. – Vol. 270. – P. 15455-15458.
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KATORKIN S.E., YAROVENKO G.V., MYSHENTSEV P.N., SIZONENKO YA.V.

FEATURES OF MUSCELOSKELETAL SYSTEM BIOMECHANICAL CHANGES IN CHRONIC LOWER LIMBS LYMPHATICOVENOUS INSUFFICIENCY

Objectives. Improvement of the functional diagnostics at chronic lymph-venous insufficiency of the lower limbs using the biochemical methods of investigation.
Methods. 116 patients with lymph-venous insufficiency of C4-C6 classes (according to CEAP) and 28 practically healthy people were examined. The clinical movement analysis was performed, applying apparatus-software complex «MBN-Biomechanika» including podometrics, plantography, electromyography and goniometry.
Results. Scoliosis was found out in 56% of the patients; in 28% osteochondrosis was observed; arthrosis-arthritis was diagnosed in 45%; various disturbances of the foot configuration were seen in 89% of all investigations. The most obvious pathology of the skeletal system was noted in the classes C5-C6. Functional insufficiency of the lower limbs with the locomotor function pathology of the talocrural joint was established to develop in the classes C4-C6.
Conclusions. Functional insufficiency and static-dynamic disturbances in patients with chronic lymph-venous insufficiency of C4-C6 testified to the failure of compensatory reactions of the skeletal system that should be taken into consideration while carrying out medical rehabilitation.

Keywords: biomechanics, chronic lymph-venous insufficiency, static-dynamic disturbances
p. 50 – 57 of the original issue
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  5. Risk factor and underlying mechanisms for venous stasis syndrome: a population-based case-control study / A. A. Ashrani [et al.] // Vasc. Med. – 2009. – Vol. 14, N 4. – P. 339-349.
  6. Яровенко, Г. В. Роль биомеханических исследований при хронической лимфовенозной недостаточности нижних конечностей / Г. В. Яровенко, С. Е. Каторкин, П. Н. Мышенцев // Новости хирургии. – 2010. – № 2. – С. 56-63.
  7. Жуков, Б. Н. Инновационные технологии в диагностике, лечении и медицинской реабилитации больных хронической венозной недостаточностью нижних конечностей / Б. Н. Жуков, С. Е. Каторкин. – Самара: Сам. отд. Литфонда, 2010. – 383 с.
  8. Жуков, Б. Н. Медицинская реабилитация больных хронической венозной недостаточностью нижних конечностей: учебное пособие / Б. Н. Жуков, С. Е. Каторкин, Я. В. Сизоненко; ГОУ ВПО «Самар. Гос. Мед. Ун-т». – Самара: Самар. отд. Литфонда, 2009. – 164 с.
  9. Батышева, Т. Т. Современные технологии диагностики и реабилитации в неврологии и ортопедии / Т. Т. Батышева, Д. В. Скворцов, А. И. Труханов. – М.: Медика, 2005. – 256 с.
  10. Скворцов, Д. В. Диагностика двигательной патологии инструментальными методами: анализ походки, стабилометрия / Д. В. Скворцов, Т. М. Андреева. – М., 2007. – 640 с.

NEUROSURGERY

TSITKO E.L., SMEYANOVICH A.F.

NEUROSONOGRAPHY IN THE BRAIN ABSCESS SURGERY

Objectives. To study the lethality rate in case of peritonitis after the abdominal oncologic surgeries and to determine main causes of different outcomes of the postoperative peritonitis.
Methods. 125 patients with the postoperative peritonitis developed after abdominal surgeries were included in the investigation; the lethality rate and causes of different outcomes of a complication were studied. The interventions because of peritonitis are stratified into radical and non-radical surgeries.
Results. Peritonitis outcome is determined by the tumor localization, kind of oncologic surgery, direct cause of a complication and possibilities to eliminate the infection. In 42, 4% of the patients a surgical sanitation was non- radical one. The lethality rate at non-radical elimination of the peritonitis focus was higher (р<0,001) than at radical sanitation. More frequent causes of peritonitis which can’t be corrected by means of radical surgery were infected pancreatonecrosis and esophageal-intestinal anastomosis failure.
Conclusion. Timely diagnostics of the postoperative peritonitis and adequately performed sanitation intervention permit to increase specific gravity of all radical sanitations and thus to improve direct results of treatment at the abdominal oncologic pathology.

Keywords: oncologic patients, postoperative peritonitis, radicalism of surgical sanitation, lethality rate
p. 66 – 74 of the original issue
References
  1. Лебедев, В. В. Абсцессы головного мозга / В. В. Лебедев, Н. В. Хуторной // Нейрохирургия. – 2008. – № 1. – С. 6-12.
  2. Аффи, Мехди. Хирургическое лечение абсцессов головного мозга / Мехди Аффи, А. Ф. Смеянович // Здравоохранение. – 1996. – № 10. – С. 14-16.
  3. The surgical management of infections involving the cerebrum / W. A. Hall, C. L. Truwit // Neurosurgery. – 2008. – Vol. 62, N 2. – P. 519-531.
  4. Thung-Ming, Su. Multiloculated pyogenic brain abscess: Experience in 25 patients / Su. Thung-Ming [et al.] // Neurosurgery. – 2003. – Vol. 52, N 5. – P. 1075-1080.
  5. Current concepts in the management of pyogenic brain abscecc / B. S. Sharma, S. K. Gupta, V. K. Khosla // Neurology India. – 2000. – Vol. 48, N 2. – P. 105-111.
  6. Компьютерная томография в неотложной нейрохирургии / В. В. Лебедев [и др.]. – М.: Медицина, 2005. – 360 с.
  7. Нейрохирургическая навигационная система в лечении объемных образований головного мозга / А. П. Шипай [и др.] // Неврология и нейрохирургия в Беларуси. – 2009. – № 3 (03). – С. 138-142.
  8. КТ-стереотаксические пункции, аспирации и дренирование глубинных объёмных процессов головного мозга / А. В. Меликян [и др.] // Вопросы нейрохирургии. – 1991. – № 6. – С. 1-3.
  9. Значения интраоперационного ультразвукового наведения в нейрохирургической практике при объёмных образованиях головного мозга / А. Р. Зубарев [и др.] // Ультразвуковая и функциональная диагностика. – 2004. – № 4. – С. 92-97.
  10. Гланц, С. Медико-биологическая статистика / С.
  11. Гланц. – М.: Практика, 1999. – 459 с.

ONCOLOGY

SHISHLO I.F.

TYPICAL ABDOMINAL ONCOLOGICAL SURGERIES AND THE POSTOPERATIVE PERITONITIS OUTCOME

Objectives. To study the lethality rate in case of peritonitis after the abdominal oncologic surgeries and to determine main causes of different outcomes of the postoperative peritonitis.
Methods. 125 patients with the postoperative peritonitis developed after abdominal surgeries were included in the investigation; the lethality rate and causes of different outcomes of a complication were studied. The interventions because of peritonitis are stratified into radical and non-radical surgeries.
Results. Peritonitis outcome is determined by the tumor localization, kind of oncologic surgery, direct cause of a complication and possibilities to eliminate the infection. In 42, 4% of the patients a surgical sanitation was non- radical one. The lethality rate at non-radical elimination of the peritonitis focus was higher (р<0,001) than at radical sanitation. More frequent causes of peritonitis which can’t be corrected by means of radical surgery were infected pancreatonecrosis and esophageal-intestinal anastomosis failure.
Conclusion. Timely diagnostics of the postoperative peritonitis and adequately performed sanitation intervention permit to increase specific gravity of all radical sanitations and thus to improve direct results of treatment at the abdominal oncologic pathology.

Keywords: oncologic patients, postoperative peritonitis, radicalism of surgical sanitation, lethality rate
p. 66 – 74 of the original issue
References
  1. Лебедев, В. В. Абсцессы головного мозга / В. В. Лебедев, Н. В. Хуторной // Нейрохирургия. – 2008. – № 1. – С. 6-12.
  2. Аффи, Мехди. Хирургическое лечение абсцессов головного мозга / Мехди Аффи, А. Ф. Смеянович // Здравоохранение. – 1996. – № 10. – С. 14-16.
  3. The surgical management of infections involving the cerebrum / W. A. Hall, C. L. Truwit // Neurosurgery. – 2008. – Vol. 62, N 2. – P. 519-531.
  4. Thung-Ming, Su. Multiloculated pyogenic brain abscess: Experience in 25 patients / Su. Thung-Ming [et al.] // Neurosurgery. – 2003. – Vol. 52, N 5. – P. 1075-1080.
  5. Current concepts in the management of pyogenic brain abscecc / B. S. Sharma, S. K. Gupta, V. K. Khosla // Neurology India. – 2000. – Vol. 48, N 2. – P. 105-111.
  6. Компьютерная томография в неотложной нейрохирургии / В. В. Лебедев [и др.]. – М.: Медицина, 2005. – 360 с.
  7. Нейрохирургическая навигационная система в лечении объемных образований головного мозга / А. П. Шипай [и др.] // Неврология и нейрохирургия в Беларуси. – 2009. – № 3 (03). – С. 138-142.
  8. КТ-стереотаксические пункции, аспирации и дренирование глубинных объёмных процессов головного мозга / А. В. Меликян [и др.] // Вопросы нейрохирургии. – 1991. – № 6. – С. 1-3.
  9. Значения интраоперационного ультразвукового наведения в нейрохирургической практике при объёмных образованиях головного мозга / А. Р. Зубарев [и др.] // Ультразвуковая и функциональная диагностика. – 2004. – № 4. – С. 92-97.
  10. Гланц, С. Медико-биологическая статистика / С.
  11. Гланц. – М.: Практика, 1999. – 459 с.

ANESTHESIOLOGY-REANIMATOLOGY

MAMAS A.N., KOSAREVSKAYA T.E.

INVESTIGATION OF «BURNOUT SYNDROME» OF ANAESTHESIOLOGISTS-REANIMATOLOGISTS

Objectives. To study the degree of intensity of «burnout syndrome» as well as the factors, influencing given syndrome development in the anesthesiologists-reanimatologists.
Methods. 119 anesthesiologists-reanimatologists of various experience length groups were investigated. The intensity degree of «burnout syndrome» and its link with the experience length of the professional activity and the sex of anesthesiologists-reanimatologists were studied.
Results. Significant differences in the intensity degree and the structure of «burnout syndrome» in anesthesiologists-reanimatologists were determined depending on the experience length of the professional activity. The course of «burnout syndrome» has its own peculiarities in males and females.
Conclusions. The obtained data testify to the expediency of practical introducing of special programs aimed to reveal «burnout syndrome» in anesthesiologists-reanimatologists and if necessary to render a psychological assistance to them.

Keywords: professional activity of anesthesiologists-reanimatologists, «burnout syndrome»
p. 75 – 81 of the original issue
References
  1. Абдоминальная хирургическая инфекция: современное состояние и ближайшее будущее в решении актуальной клинической проблемы / И. А. Ерюхин [и др.] // Инфекции в хирургии. – 2007. – Т. 5. – № 1. – С. 45-49.
  2. Неотложная абдоминальная хирургия: справочное пособие для врачей / под ред. А. А. Гринберга. – М.: Триада-Х, 2000. – 496 с.
  3. Ciprofloxacin in primary prophylaxis of spontaneous bacterial peritonitis: a randomized, placebo-controlled study / R. Terg [et al.] // J. Hepatol. – 2008. – Vol. 48, N 5. – P. 774-779.
  4. Circulating mediators and organ function in patients undergoing planned relaparotomy vs conventional surgical therapy in severe secondary peritonitis / N. Zugel [et al.] // Arch. Surg. – 2002. – Vol. 137, N 5. – P. 590-599.
  5. Буренко, Г. В. Новые аспекты интенсивной терапии перитонита, осложненного сепсисом / Г. В. Буренко, М. В. Бондарь, В. М. Мехлин // Клин. хирургия. – 1996. – № 2. – С. 13-14.
  6. Лечение тяжелых форм распространенного перитонита / Б. С. Брискин [и др.] // Хирургия. – 2003. – № 8. – С. 56-59.
  7. Conservative surgical treatment of diffuse peritonitis / C. A. Seiler [et al.] // Surgery. – 2000. – Vol. 127, N 2. – P. 178-184.
  8. Malangoni, M. A. Evaluation and management of tertiary peritonitis / M. A. Malangoni // Am. Surg. – 2000. – Vol. 66, N 2. – Р. 157-161.
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KANUS I.I., GRACHEV S.S.

COMPARATIVE CHARACTERISTICS OF ARDUAN, ARCURON AND ESMERON ACTION PARAMETERS AT INTRAABDOMINAL SURGICAL INTERVENTIONS

Objectives. To perform the comparative investigation of the neuromuscular blocking non-depolarizing type agents’ actions at abdominal surgeries.
Methods. 130 patients, at the age of 17 to 78 (ASA I-IV) with a surgical abdominal pathology were included in the investigation. All patients were divided into 3 groups depending on the neuromuscular blocking agent use: the 1st group – 45 patients in whom arduan was used; the 2nd group – 42 patients in whom arcuron was used; the 3rd group – 43 patients in whom esmeron was used.
Results. It is established, that in case of a single or repeated esmeron application, action duration is shorter than similar action parameters of arduan and arcuron for 42–45%. It is proved, that precuraresation reduces the time of all agents in study action start for 0,5–1,0 min. Clinical duration of action, t-90 period, total myoplegia time were increased after precurarezation for 15–22,3%. The data were obtained that succinylcholine decreased arduan, arcuron and esmeron recovery period duration in case of a single or repeated application
Conclusions. Esmeron has the optimal characteristics ensuring the neuromuscular block’s obtainment, maintenance and reversion during an abdominal surgery.

Keywords: neuromuscular blocking agents, accelerometry, neuromuscular block, anesthesia
p. 82 – 89 of the original issue
References
  1. Водопьянова, Н. Е. Синдром «психического выгорания» в коммуникативных профессиях / Н. Е. Водопьянова; Г. С. Никифоров (ред.) // Психология здоровья. – СПб.: Изд-во СпбГУ, 2000. – C. 548-573.
  2. Ронгинская Т.И. Синдром выгорания в социальных профессиях // Психол. журн. – 2002. – Т. 23, №3. – C. 85-95.
  3. Федоровский, Н. М. К вопросу о «синдроме профессионального выгорания» у анестезиологов-реаниматологов / Н. М. Федоровский, О. М. Григорьева // Вестн. интенсив. терапии. – 2004. – № 5. – С. 65-66.
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  5. Орёл, В. Е. Феномен «выгорания» в зарубежной психологии: эмпирические исследования и перспективы / В. Е. Орёл // Психол. журн. 2001. – Т. 22, № 1. – С. 90-101.
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ILYUKEVICH G.V., SMIRNOV V.M.

LOCAL MICROBIOLOGICAL MONITORING AND ANTIBACTERIAL THERAPY OF NOSOCOMIAL INFECTIONS AT THE INTENSIVE CARE UNITS

Objectives. To improve the results of treatment with secondary infections at the intensive care units by the development of the strategy of the antibacterial treatment based on antibiotics resistance monitoring data.
Methods. 17988 isolates of nosocomial pathogens taken from the biological materials of ICU patients with secondary infections have been analyzed. Structural analysis of nosocomial pathogens and their resistance dynamics has been performed. The scheme of the antimicrobial therapy for nosocomial infections obtained from the performed study has been compared to trivial antibiotic usage strategy in 126 ICU patients in the postoperative period.
Results. It was proved that prophylactic antibiotic therapy refusal and usage of early goal-directed antibiotic therapy reduces 28-day mortality, length of stay at ICU, rate of superinfections and provides quick transition to adequate antibiotic therapy. The economic effectiveness of the method was described as very high.

Keywords: secondary infections, antibiotic resistance, antibiotic therapy, antibiotic prophylaxis, antibiotic usage strategy
p. 90 – 98 of the original issue
References
  1. Лекманов, А. У. Мышечные релаксанты в практике анестезиолога-реаниматолога / А. У. Лекманов. – Смоленск: Альфа-Принт, 1996. – С. 18-89.
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  6. Бутров, А. В. Опыт использования акцелографа TOF-GUARD / А. В. Бутров, М. Ф. Дробышев, В. С. Миронов // Вестн. интенсив. терапии. – 1997. – № 4. – С. 27-32.
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  8. Флеров, Е. В. Мониторинг нейромышечной проводимости акселерометрическим методом во время анестезиологического пособия / Е. В. Флеров, И. И. Шитиков, А. Е. Юматов // Анестезиология и реаниматология. – 1997. – № 2. – С. 62-65.
  9. Дарбинян, Т. М. Действие деполяризующих мышечных релаксантов у онкологических больных / Т. М. Дарбинян, Л. А. Вайсберг // Вестн. АМН СССР. – 1968. – № 10. – С. 15-20.
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  11. Марочков, А. В. Опыт применения анестезии с использованием изофлюрана при абдоминальных операциях / А. В. Марочков, В. А. Дудко, М. В. Резников // Новости хирургии. – 2008. – Т. 16, № 2. – С. 116-124.
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LECTURES, REVIEWS

ZIARKIEWICZ-WRоBLEWSKA B.

STEPS OF PATHOLOGICAL DIAGNOSIS IN THE DIAGNOSTIC PROCESS ASSOCIATED WITH ADULT LIVER TRANSPLANTATION

Consecutive steps of pathological diagnosis related to adult liver transplantation were shown herein: (1) assessment of liver biopsy taken prior to transplantation from the transplant candidates, (2) examination of donor’s liver biopsy taken prior to and during liver transplantation procedure, (3) assessment of the whole native liver removed during transplantation, and (4) examination of the graft biopsy. Additionally, basic information on pathological diagnostics of the liver transplant with its opportunities and limitations as well as, basing on own experience, the most common problems encountered in pathologist’s practice.

Keywords: liver transplantation, pathomorphological diagnosis
p. 99 – 104 of the original issue
References
  1. Vincent, J. L. EPIC II: sepsis around the world / J. L. Vincent // Minerva Anesthesiol. – 2008. – Vol. 74. – P. 293-296.
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LEVIN M.D., TROYAN V.V.

PATHOLOGICAL PHYSIOLOGY, DIAGNOSTICS AND PROSPECTS FOR TREATMENT OF THE LOW IMPERFORATE ANUS IN NEWBORNS

Despite enormous interest in the development of an ideal operation procedure to treat congenital anorectal malformations, the situation is as confusing today as it was 30 years ago. The soling or chronic constipation is observed in one third of all postoperative patients, most frequently after the correction of the high or intermediate anomalies. It was shown that anal canal in newborns with low imperforate anus is always normally formed up to the distal 3-5 mm, i.e. at the level of the skin and subcutaneous tissue of the perineum. Closed anal canal does not have any volume and it is not seen in the invertogram. The original method of X-Ray diagnosis of anorectal anomalies makes it possible to discover the anal canal if it exists. Operational findings can not be taken as a criterion for the correct diagnosis because rectal pressure decreases under the influence of anesthetics and the anal canal remains closed. A surgeon bypasses it and takes out the rectum instead. As a result, the muscles and neural connections of the anal canal and rectum are impaired. Then, patient is falsely diagnosed with high or intermediate imperforate anus which «justifies» the unsatisfactory functional results. Two methods of the operation are discussed here. They allow to utilize all elements of the anal canal that take part in the continence and defecation.

Keywords: imperforate anus, low anorectal anomalies, rectal atresia, newborn, bowel perforation, X-Ray diagnosis, invertogram, operation
p. 105 – 114 of the original issue
References
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VINNIK YU.S., PERYANOVA O.V., ONZUL E.V., TEPLYAKOVA O.V.

MICROBIAL BIOFILMS IN SURGERY: FORMATION MECHANISMS, DRUG RESISTANCE, WAYS OF SOLVING PROBLEMS

The scientific review is devoted to the meaning of microbial biofilms in forming of surgical infection foci. The mechanisms of forming biological films, peculiarities of structural organization and development of drug resistance are presented. Some examples of participation of microbial communities in the cardiac surgical and urological practice as well as in the initiation of catheter associated infections are given. The problems and the perspectives of the potential therapeutic and non-therapeutic effects to bacterial cells in the composition of biofilms are also discussed.

Keywords: biofilms, drug resistance, adhesion, ultrastructure, formation of microbial communities, biocides
p. 115 – 125 of the original issue
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MAGDIEV D.A., CHULOVSKAYA I.G., EGIAZARYAN K.A.

DISTAL RADIOULNAR JOINT. FUNCTIONAL ANATOMY. DIAGNOSTICS OF INJURIES

Functional anatomy of the distal radioulnar joint on the basis of the domestic and foreign literature studying is presented in the paper. Data on the problem urgency of injuries of the distal radioulnar joint ligament system and possibilities of modern examinational methods at diagnostics of these injuries are briefly given. The data of clinical and radiological indicators in norm and in pathologies are provided as well as of computer, magnetic-resonance tomography and ultrasonography. Diagnostic possibilities of the hand and the distal radioulnar joint arthroscopy are described.

Keywords: distal radioulnar joint, triangular fibro-cartilage complex, injury, diagnostics
p. 126 – 132 of the original issue
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MASTER-CLASS

SCHASTNY A.T., SHTURICH I.P., SYATKOVSKY A.R.

DOUBLE DRAINAGE AT TREATMENT OF LARGE PSEUDO CYSTS OF THE PANCREAS

The method of double drainage was suggested to improve the results of surgical treatment in patients with the pancreas pseudo cysts of large sizes (more than 10 cm in diameter) and to widen the indications for internal drainage as the most favorable variant of treatment. The technique of surgery is described; the indications and contraindications to its performance are defined; possible complications are pointed out.
68 patients with pseudo cysts of more than 10 cm in diameter were operated on. In 14 patients the method of double drainage was applied. The usage of the suggested technique of the surgical intervention permits to decrease the number of the postoperative complications and to improve the treatment results of large postnecrotic pseudo cysts.

Keywords: chronic pancreatitis, pancreas cyst, operative treatment, double drainage
p. 133 – 138 of the original issue
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IN ASSISTANCE TO PRACTICIONER

TIKHON D.S., OGANESYAN N.A.

FONDAPARINUX AS A NEW EFFECTIVE ANTICOAGULANT FOR VENOUS THROMBOEMBOLISM PREVENTION IN SURGERY

Fondaparinux is the first of a class of selective antithrombin-dependent factor Xa inhibitors, it is a synthetic analogue of the critical pentasaccharide sequence required for binding heparin molecules to Anthitrobin. It does not interact with plasma proteins other than antithrombin, leading to a predictable pharmacokinetics, which renders monitoring and dose adjustment unnecessary. Given subcutaneously, fondaparinux demonstrates 100% bioavailability with a half-life of 17 hours permitting once-daily injection. Fondaparinux is more effective than low molecular weight heparin (LMWH) for prevention of venous thromboembolism (VTE) following major orthopedic surgery and at least as effective as for LMWH following major abdominal surgery. Several thousands of patients have been studied and the substance is safe, although a slightly higher frequency of bleedings is found than in patients on LMWH. Other side-effects are rare. Fondaparinux is cost saving and sometimes cost neutral when compared with enoxaparin. It was recommended with a Grade1A rating for VTE prophylaxis in major orthopedic and abdominal surgery. Moreover Fondaparinux was the only anticoagulant recommended with a Grade 1A rating for hip-fracture surgery.

Keywords: fondaparinux, venous thrombosis, venous thromboembolism, surgery, orthopedic surgery, major abdominal surgery, bleeding complications
p. 139 – 150 of the original issue
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JUBILEES

DEYKALO V.P., NIKOLSKY M.A., SIROTKO V.V., ASKERKO E.A.

THE 40TH ANNIVERSARY OF THE CHAIR OF TRAUMATOLOGY, ORTHOPEDICS AND MILITARY SURGERY OF VITEBSK STATE MEDICAL UNIVERSITY

The peroids of formation of the chair of traumatology, orthopedics and military surgery of the educational establishment «Vitebsk state medical university» are described in the article. The role of the chair staff in the development of the chair as well as in the scientific achievements, improvement of the educational process and progress in the orthopedic and trauma service rendering to the citizens of Vitebsk region is shown.

Keywords: Vitebsk state medical university, history, chairs, traumatology orthopedics, military surgery
p. 161 - 169 of the original issue
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