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Year 2011 Vol. 19 No 6

EXPERIMENTAL SURGERY

V.E. KORIK, A.P. TRUKHAN, D.A. KLUYKO, A.L. POPCHENKO

DIRECT OXIMETRY OF THE ABDOMINAL CAVITY AND PARIETAL PERITONEUM ORGANS AT EXPERIMENTAL PERITONITIS

Objectives. To estimate the direct oximetry opportunities of the abdominal cavity and parietal peritoneum organs at the experimental peritonitis.
Methods. The investigation is based on the results analysis of the direct oximetry of the parietal peritoneum, the liver surface, the intestinal wall in 34 guinea pigs with the experimental peritonitis.
Results. The inflammatory process development in the abdominal cavity is accompanied by the metabolic processes activation in the peritoneum that results in the rate increase of the oxygen uptake and ultimately in the adaptation reaction failure and hypoxia progression. Depletion of the oxygen utilization mechanisms resources was registered during the terminal phase leading to the rate decrease of the oxygen uptake and to loss of possibility of its utilization by the tissues. High reserve level of the oxygen utilization mechanisms by hepatocytes was revealed that permits the liver to react adequately to the increasing intensity of the metabolic processes at inflammatory processes and endotoxicosis. Low reserve opportunities of the oxygen uptake mechanisms by the intestinal wall were shown than could explain the development of the intestinal wall ischemia and the enteral insufficiency syndrome development even at the early stage peritonitis.
Conclusions. Direct oximetry being a noninvasive method permits to perform intraoperative estimation of the respiratory activity of the organs and tissues. On the basis of the direct oximetry data one can judge on the functional state of these tissues; this can help to choose tactics of finishing the operation as well as further postoperative treatment of a patient.

Keywords: peritonitis, experimental animals, direct oximetrys
p. 3 – 7 of the original issue
References
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  5. Перитонит: клинико-патолого-анатомические сопоставления, вопросы классификации, патогенеза и танатогенеза / О. Д. Мишнев [и др.] // Рос. мед. журн. – 2006. – № 5. – С. 41-44.
  6. Глумов, В. Я. Острый перитонит: органопатология, пато- и танатогенез / В. Я. Глумов, Н. А. Кирьянов, Е. Л. Баженов. – Ижевск, 1993. – 184 с.
  7. Титовец, Э. П. Аквапорины человека и животных: фундаментальные и клинические аспекты / Э. П. Титовец. – Минск: Белорус. наука, 2007. – 239 с.
  8. Титовец, Э. П. Исследование дыхательной активности и энергетического состояния биологических тканей / Э. П. Титовец, Л. П. Пархач // Медэлектроника-2002. Средства мед. электроники и новые мед. технологии: междунар. науч.-техн. конф. – Минск, 2002. – С. 102-104.
  9. Возможности применения прямой оксиметрии для оценки состояния поджелудочной железы при остром панкреатите в эксперименте / С. А. Жидков [и др.] // Новости хирургии. – 2010. – Т. 18, № 3. – С. 9-16.
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V.А. КOSINETS, I.V. SAMSONOVA, E.L. RYZHKOVSKAYA IN THE LIVER AT THE EXPERIMENTAL WIDESPREAD

STRUCTURAL CHANGES IN THE LIVER AT THE EXPERIMENTAL WIDESPREAD PURULENT PERITONITIS

Objectives. To study structural changes in the liver using light and electronic microscopy and the ways of its correction at an experimental widespread purulent peritonitis.
Methods. The structural changes in the liver using light and electronic microscopy were studied during the experiment on 55 male rabbits of chinchilla breed at the experimental widespread purulent peritonitis.
Results. In 6 hours after initiation of peritonitis in the liver the hemodynamic disorders, interstitional edema, severe inflammatory neutrophilic parenchyma infiltration were observed. In the majority of hepatocytes dystrophic, necrobiotic and necrotic changes were defined. Intensive mitochondrial destruction testified to the deficiency of the hepatocytes power maintenance.
Conclusions. The comparative analysis of action of metabolic preparations "Citoflavin" which contains amber acid and "Neoton" containing phosphocreatine on a structural condition of the liver at the experimental widespread purulent peritonitis has revealed high efficiency of the preparation "Citoflavin". The last one provided intensive restoration of the liver structure, decrease of inflammatory changes and preservation of integrity of mitochondrions.

Keywords: widespread purulent peritonitis, heart, structural changes, mitochondria, «Neoton», «Citoflavin»s
p. 8 – 14 of the original issue
References
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V.K. GOSTISHCHEV, V.A. KOSINETS, E.A. MATUSEVICH, G.P. ADAMENKO

IMMUNOMODULATORY EFFECT OF “OMEGAVEN” AT EXPERIMENTAL WIDESPREAD PURULENT PERITONITIS

Objectives. To study the immunotropic influence of the preparation “Omegaven” on immunocompetent cells of different immune organs at the experimental widespread purulent peritonitis.
Methods. The experiment has been carried out on 40 male rabbits of chinchilla breed. Influence of the preparation “Оmegaven” on neutrophil granulocytes’ migratory activity under the action of mitogen-induced immunocompetent blood cells, Peyer’s patches, spleen and inguinal lymph nodes was studied at the experimental widespread purulent peritonitis.
Results. It is established that regulating action of immunocompetent cells on migration of neutrophil leukocytes at the widespread purulent peritonitis is steady and widespread process which is observed within 5 days of the postoperative period.
Conclusions. Application in the postoperative period of preparation “Omegaven” containing omega-3 fatty acids corrects action of immunocompetent cells, changing their properties of regulation of neutrophil granulocytes’ migratory activity. The given effect was observed in all investigated bodies, the greatest degree was expressed in the peripheral blood and Peyer’s patches.

Keywords: widespread purulent peritonitis, omega 3 fatty acids, “Omegaven”, immunocompetent cells, immunotropic influences
p. 15 – 23 of the original issue
References
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  2. Гостищев, В. К. Перитонит / В. К. Гостищев, В. П. Сажин, А. Л. Авдовенко. – М.: ГЭОТАР-Медиа, 2002. – 238 с.
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V.A. SHOTT

EXPERIMENTAL EVALUATION OF GASTROINTESTINAL-JEJUNUM ANASTOMOSIS SUTURES

Objectives. To determine better variants of sutures in formation anastomosis between the stomach and jejunum during Billroth-2 resection of the stomach.
Methods. During the experiments on dogs (39 animals), Billroth-2 resection of the stomach with the formation of anastomosis of the stomach stump in the side of the jejunum using different types of sutures – Albert’s suture, Schieden’s suture, U-shaped serous-muscular-submucosal, mechanical, everted and inverted sutures was performed. Complications, the number and causes of lethal outcomes were analyzed. Macroscopic evaluation of changes in the anastomosis, regeneration dynamics of the mucous coat in the anastomosis sutures region as well as the character of the adhesive process in the intervention zones was carried out. Permeability and strength of sutures were studied. Quantitative morphometrics was done and the content of microbes was determined.
Results. Formation of anasthomosis between the stomach and jejunum using a mechanical suture gives better results. Essential difference between the inverted mechanical and everted mechanical sutures was revealed. It was found out that the closure of the cranial and caudal angles of anastomosis is more preferably to be performed using U-shaped serous-muscular-submucosal suture. It doesn’t require the second line of sutures as well as possesses haemostatic effect and adapts well the stomach and jejunum tissues.
Conclusions. It is reasonable to form anastomosis of the stomach stump with the jejunum at the Billroth-2 resection of the stomach using the worked out technique with a mechanical suture application.

Keywords: resection of the stomach, stomach-jejunum anastomosis, intestinal suture
p. 24 – 28 of the original issue
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GENERAL AND SPECIAL SURGERY

V.G. BOGDAN, YU.M GAIN

PATHOGENESIS OF POSTOPERATIVE HERNIAS: METABOLISM CHANGES OF THE CONNECTIVE TISSUE – CAUSE OR CONSEQUENCE?

Objectives. To establish the nature of metabolic disturbances of the connective tissue in cell cultures of the skin fibroblasts, aponeurosis, and mesenchymal stem cells of the adipose tissue of patients with postoperative ventral hernias.
Methods. The expression of collagen type III and matrix metalloproteinase 1 and 2 types in various cell cultures of patients with postoperative hernias was studied using the method of reverse transcriptase polymerase chain reaction, phenotyping of cell cultures, immuno-cytochemical techniques.
Results. General regularities inherent in primary cultures of cells of mesenchymal origin were determined indicating to the metabolic disturbance of the connective tissue in patients with the postoperative ventral hernias. A single dynamics of the expression of collagen type III decrease and metalloproteinase 1 increase at cells passaging of the fibroplastic differon in vitro was revealed.
Conclusions. The probable cause of metabolic disturbances of the connective tissue in patients with postoperative ventral hernias may be either genetic changes or long-lasting presence of the abdominal wall defect, which determines the increased threshold of the production of mediators, activating the structuring and reducing the remodeling of the connective tissue.

Keywords: postoperative hernia, pathogenesis, collagen, matrix metalloproteinases
p. 29 – 35 of the original issue
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A.A. LITVIN

SURGICAL TREATMENT OF INFECTED PANCREATIC NECROSIS

Objectives. To study the results of using optimized tactics of the surgical treatment of patients with the infected pancreatic necrosis.
Methods. The results of surgical treatment of 268 patients with various forms of the pancreatic infection during the period of 1995-2009 are studied in the research.
Results. Minimally invasive treatment of the infected pancreatic necrosis is effective in patients with pancreatic abscesses. Step-by-step combined surgical treatment is optimal for patients with the prevalent unlimited forms of the disease. Minimally invasive stage can be used as preparing for on “open” surgical treatment.
Conclusions. Differentiated step-by-step surgical tactics application permitted to improve the treatment results of patients with the infected pancreatic necrosis.

Keywords: infected pancreatic necrosis, surgical treatment, step-by-step tacticss
p. 36 – 44 of the original issue
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  7. Minimally invasive ''step-up approach'' versus maximal necrosectomy in patients with acute necrotizing pancreatitis (PANTER trial): design and rationale of a randomized controlled multicenter trial [ISRCTN13975868] / M. G. Besselink [et al.] // BMC Surg. – 2006. – Vol. 6, N 6. – P. 1-10.
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  9. Литвин, А. А. Профилактика инфекционных осложнений тяжелого острого панкреатита / А. А. Литвин, А. Н. Лызиков // Проблемы здоровья и экологии. – 2011. – № 1. – С. 48-53.
  10. Аничкин, В. В. Диагностика инфицированного панкреонекроза / В. В. Аничкин, А. А. Литвин, Л. А. Мауда Шади. – М.: Интеграция, 2009. – 153 с.
  11. Радзиховский, А. П. Оценка тяжести состояния больных с перитонитом с использованием модифицированной системы APACHE II / А. П. Радзиховский, О. Е. Бобров, Н. А. Мендель // Клин. хирургия. – 1997. – № 9-10. – С. 20-22.
  12. Bradley, E. L. III. A clinically based classification system for acute pancreatitis. Summary of the International Symposium on Acute Pancreatitis, Atlanta, Ga, September 11 through 13, 1992 / E. L. III. Bradley // Arch. Surg. – 1993. – Vol. 128. – P. 586-590.
  13. Резолюция XVI Международного Конгресса хирургов-гепатологов России и стран СНГ, Екатеринбург, 16-18 сент. 2009 г. [Электронный ресурс]. – Режим доступа: http://hepatoassociation.ru/?p=775. – Дата доступа: 23.07.2011.
  14. Revision of the Atlanta classification of acute pancreatitis. Acute Pancreatitis Classification Working Group, April 9, 2008 [Электронный ресурс]. ? Режим доступа: http://pancreasclub.com/resources/AtlantaClassification.pdf. – Дата доступа: 23.07.2011.
  15. Carter, R. Percutaneous management of necrotizing pancreatitis / R. Carter // HPB (Oxford). – 2007. – Vol. 9, N 3. – P. 235-239.

V.M. MAYOROV, Z.A. DUNDAROV, S.V. SVISTUNOV

EFFICACY ESTIMATION OF LOW-INVASIVE INTERVENTIONS IN ACUTE DESTRUCTIVE PANCREATITIS TREATMENT

Objectives. To perform the comparative analysis of efficiency of the low-invasive intervention technologies at various stages of the destructive forms of acute pancreatitis.
Methods. The surgical treatment results of 132 patients with the destructive forms of acute pancreatitis were analyzed. Depending on the destructive changes prevalance in the pancreas and the parapancreatic cellulose, open and low-invasive interventions were carried out.
Results. Laparoscopic sanitation and drainage of the abdominal cavity were the final method of treatment in the patients of the 1st group with the enzymatic peritonitis (36 patients). Puncture-drainage interventions were effective in the 2nd group (44 patients) on condition of liquid parapancreatic formations presence. In case of infected pancreatic necrosis forms when a pathological process was spreading on the retroperitoneal cellulose (the 3rd group) open drainage surgeries from the open laparotomic access appeared to be the most effective.
Conclusions. Efficiency of the low-invasive interventions application is determined by the morphological form of acute pancreatitis and destruction volume, both in the pancreas, and in the retroperitoneal cellulose. These interventions are the most effective at the intraabdominal exssudation and presence of the generated parapancreatic congestions of liquid while the septic secvestration of the retroparapancreatic cellulose is absent.

Keywords: acute destructive pancreatitis, ultrasound investigation, parapancreatitis, treatment tactics, low-invasive technologies, drainage of liquid parapancreatic formations
p. 45 – 50 of the original issue
References
  1. Багненко, С. Ф. Острый панкреатит – современное состояние проблемы и нерешенные вопросы / С. Ф. Багненко, В. Р. Гольцов // Альманах ин-та хирургии им. А. В. Вишневского. – 2008. – № 3. – С. 104-112.
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  3. Ярема, И. В. Аутоиммунный панкреатит / И. В. Ярема, С. В. Колобов, В. П. Шевченко. – М.: ГОУ ВИНЦ МЗ РФ, 2003. – 208 с.
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  10. Реброва, О. Ю. Статистический анализ медицинских данных. Применение пакета прикладных программ STATISTICA / О. Ю. Реброва. – 3-е изд. – М.: Медиасфера, 2006. – 312 с.

S.A. TEREMOV, A.S. MUKHIN

SURGICAL TREATMENT RESULTS OF CHOLEDOCHOLITHIASIS AND ITS COMPLICATIONS

Objectives. To improve the results and to propose own clinical experience of surgical treatment of patients with the complicated forms of cholelithiasis.
Methods. 249 patients with the complicated forms of cholelithiasis were included in the investigation. 225 patients from the total 249 were operated on (90,4%). 154 (61,8%) patients out of 249 suffered from serious accompanying diseases. The diagnostics algorithm was worked out which is based on the principle from the simple to the complex.
Results. Kinds of surgeries on the extrahepatic bile ducts (195 cases) were the following: transduodenal papillosphincterotomy – in 73 (37,0%); latero-lateral choledochoduodenostomy – in 50 patients (26,0%); termino-lateral choledochoduodenostomy – in 5 (3%); choledocholithotomy, choledochal suture – in 35 (18%); choledochotomy, bringing the stone down to the duodenum – in 15 (8,0%); endoscopic papillosphincterotomy – in 10 (5,0%); hepaticojejunostomy – in 4 (2,0%); choledochotomy, revision and choledochal suture – in 3 (1,0%).
Conclusions. Application of the designed algorithm of the preoperative examination and rational surgical tactics based on the strict indications concerning different methods of the internal drainage permits to improve the treatment results of choledocholithiasis and its complications.

Keywords: choledocholithiasis, mechanical jaundice, diagnostic algorithm, treatments
p. 51 – 58 of the original issue
References
  1. Абдуллоев, Д. А. Хирургическое лечение больных с осложнёнными формами желчнокаменной болезни / Д. А. Абдуллоев, К. М. Курбонов, А. О. Исоев // Вестн. хирургии. – 2007. – Т. 166, № 2. – С. 68-71.
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  8. Глушков, Н. И. Миниинвазивные вмешательства в лечении желчнокаменной болезни у больных пожилого и старческого возраста / Н. И. Глушков, В. Б. Мосягин, В. С. Верховски // Хирургия. – 2010. – № 10. – С. 53-58.
  9. Нестеренко, Ю. А. Лечение калькулезного холецистита и его осложнений / Ю. А. Нестеренко, С. В. Михайлусов, В. А. Бурова // Хирургия. – 2003. – № 10. – С. 41-44.
  10. Дренаж культи пузырного протока: пат. / С. А. Теремов, А. С. Мухин. – № 99973; заяв. № 2010118213; приор. от 05.05.2010.

B.D. BOBOEV, F.I. MAKHMEDOV, B.A. IKROMOV

MINIMALLY INVASIVE METHODS IN DIAGNOSTICS AND TREATMENT OF CHOLEDOCHOLITHIASIS

Objectives. Improvement of diagnostics and treatment results of cholelithiasis, complicated by choledocholithiasis on the basis of complex application of contemporary highly informative non-invasive investigation methods and to determine advantage of minimally invasive operative methods
Methods. Examination results of 86 patients in whom choledocholithiasis was suspected during the period of 2005 to 2009 served as the basis of this research. Male patients composed 9 (10,5%) and female - 77 (89,5%); the age of the examined patients varied from 25 to 87 (the average age 67,3±12,0 years). Patients over 60 composed 48 (55,8%) of the total number of patients. As the result of the complex examination the concrements of extrahepatic bile ducts were revealed in 63 patients; in 4 of these patients – residual choledocholithiasis and combination of choledocholithiasis with Mirizzi syndrome (MS) – in 6 patients.
Results. According to our observations, magnetic resonance cholangiopancreatography (MRCP) appeared to be the most informative method of investigation of the bile ducts permitting to determine the definite cause and disturbances degree of their passability. This investigation method was applied in 34 patients (39,5%) on the tomography with magnetic field 1.5 T. MRCP permitted to verify the stones in the bile duct in 31 patients and in non-dilated general bile duct – in 8 patients. The multiple (2 to 5) concrements in the common bile duct (CBD) were revealed in 19 cases including its distal section – in 11 patients. Minimally visualizing size of the concrements was 2 mm.
Conclusions. MRCP method efficacy in choledocholithiasis diagnostics made up 98,5%. MRCP application permitted to verify diagnosis with high degree of reliability, to determine pathological process prevalence, to choose optimal operative technique and to avoid various complications development accompanying invasive diagnostics interventions.

Keywords: choledocholithiasis, magnetic resonance cholangiopancreatography, laparoscopic cholecystectomy
p. 59 – 63 of the original issue
References
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.D. BELOVA, E.P. BURLEVA, S.M. BELENTSOV

EFFICACY COMPARATIVE ESTIMATION OF THE STARTING OUT-PATIENT AND IN-PATIENT TREATMENT OF PATIENTS WITH THE LOWER LIMBS DEEP VEINS THROMBOSES

Objectives. To compare the efficiency of starting in-patient and out-patient treatment of patients with the lower limbs deep veins thromboses (DVT).
Methods. The clinical picture, ultrasonic duplex scanning (UDS) data and coagulation parameters were compared in two groups: the 1st group (in-patients) – 134 patients (135 cases); the 2nd group (out-patients) – 56 patients (58 cases) with DVT prevalence in the femoral-popliteal segment.
Results. 12 - 14 days after the therapy start slightly better parameters on the pain syndrome regress and edema were obtained in the 1st group. UDS dynamics was: occlusion conservation (the 1st group - 10 %, the 2nd group - 21,7 %), partial recanalization (the 1st group - 60,0 %, the 2nd group - 65,2 %), full recanalization (the 1st group - 30,0 %, the 2nd group - 8,7 %). The principal antithrombotic and hypocoagulatory effect was obtained in both groups without statistically significant differences in coagulation parameters. Hemorrhagic complications were the following: the 1st group – 3 (small – 2), the 2nd group – 1 (small-1).The signs of pulmonary embolism registered in the beginning (the 1st group – 4,5 %, the 2nd group – 1,8 %) have regressed after the treatment.
Conclusions. The out-patient treatment of patients with DVT in the acute period is as good as the in-patient treatment in terms of its efficiency and safety.

Keywords: venous thrombosis, out-patient department treatment
p. 64 – 69 of the original issue
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  1. Амбулаторная ангиология / В. Ф. Агафонов [и др.]; под общ. ред. А. И. Кириенко, В. М. Кошкина, В. Ю. Богачева. – М.: Литтерра, 2007. – 327 с.
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V.A. GINYUK, G.P. RYCHAGOV

COMPLEX APPROACH TO TREATMENT OF PATIENTS WITH ACUTE PARAPROCTITIS WITH THE PHOTOTHERAPY APPLICATION

Objectives. To improve the treatment results of patients with acute paraproctitis (AP) at the phototherapy (PT) application.
Methods. We used the apparatus “Romashka” and the photo sensitizer “Photolon”. 103 patients with acute paraproctitis were subjected to this treatment; all patients were divided into two groups: the basic group (46 patients who underwent phototherapy) and the control one (57 patients after traditional therapy). On the admission, and also on the 1st, 3rd, 7th, 10th and 14th days after surgery the pain syndrome, edema and hyperemia of the perianal and wound areas, quantity and character of purulent separation from the wound, time of appearance of granulations and a regional epithelialization were estimated. The full blood count was performed; a body temperature was measured, microflora and wound cytology were analyzed.
Results. Photodynamic therapy (PDT) at treatment of AP causes the expressed antibacterial and healing effect. The positive result of PDT application at the treatment of patients with AP is revealed through the regenerating processes intensification as well as the inflammatory reaction reducing, the stimulation of the development of granulation tissue and regional epithelialization.
Conclusions. PDT application at treatment of patients with acute paraproctitis is pathogenetically approved and effective.

Keywords: acute paraproctitis, photodynamic therapy
p. 70 – 75 of the original issue
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ORGANIZATION OF THE SURGICAL CARE

S.V. SHAKHRAY, A.YU. SOKOLOV, M.YU. GAIN

ECONOMIC EFFICACY ESTIMATION OF ACTIVITY OF MINSK CITY CENTRE OF OUT-PATIENT AND MINIMALLY INVASIVE SURGERY

Objectives. To perform the calculation of economic benefits and economic efficiency of medical activity of Minsk city centre of the out-patient and minimally invasive surgery of the medical establishment “The 11 clinical hospital”.
Methods. Calculation of economic benefits and economic efficiency of the medical activity of Minsk city centre of the out-patient and minimally invasive surgery of the medical establishment “The 11 clinical hospital” is performed on the basis of determination of specific cost savings from the prevented losses on hospitalization, payment of temporary disablement allowances and the prevented losses of the total intrinsic product as a result of reduction of average duration of treatment of patients in the conditions of short-term hospitalization. Economic efficiency is presented by the calculated quotient of utility of expenses.
Results. Within the limits of research work on analysis of economic benefits and economic efficiency of medical activity of Minsk city centre of the out-patient and minimally invasive surgery of the medical establishment “The 11 clinical hospital”, the introduction volume made up 1212 operations in the patients with surgical (1157) and proctologic (55) pathologies. The general economic benefit has thus made up 912460,2 thousand of Belarusian rubles (for 01.01.2011). Pure economic benefit composed 537460,2 thousand of Belarusian rubles (for 01.01.2011). The quotient of economic efficiency of expenses for research work composed 2,43 or profitability of investments only within the limits of research work made up 243 %.
Conclusions. Analysis of activity results Minsk city centre of the out-patient and minimally invasive surgery allows estimating the quality of the organizational-medical model as an effective structure in the system of the public health services, permitting to minimize hospitalization terms of patients and to obtain significant economic benefit.

Keywords: out-patient surgery, «one day surgery», «short-term stay in-patient department», economic efficiency, economic benefit
p. 76 – 81 of the original issue
References
  1. Стационарзамещающие технологии в поликлинических условиях – реальность и перспективы / Н. Н. Лебедев, А. Н. Шихметов, С. И. Воротницкий // Амбулатор. хирургия. Стационарозамещающие технологии. – 2007. – № 2. – С. 3-4.
  2. Мосиенко, Н. И. Медицинская и экономическая эффективность pаботы центpа амбулатоpной хиpуpгии / Н. И. Мосиенко, А. А. Кутин, P. Х. Магомадов // Рос. мед. журн. – 2001. – № 5. – С. 9-11.
  3. Абдулжалилов, М. К. Недостатки в организации амбулаторно-поликлинической хирургической службы / М. К. Абдулжалилов, М. Н. Азизов // Амбулатор. хирургия. Стационарозамещающие технологии. – 2009. – № 3-4. – С. 8-9.
  4. Адамян, А. А., Особенности хирургического лечения в центре амбулаторной хирургии / А. А. Адамян, Р. Х. Магомадов, А. А. Кутин // Анналы. реконструкт. и эстет. хирургии. – 2007. – № 1. – С. 80-83.
  5. Воробьев, В. В. Стационарзамещающая медицинская помощь в хирургии / В. В. Воробьев // Амбулатор. хирургия. Стационарозамещающие технологии. – 2009. – № 3-4. – С. 6-8.
  6. Day surgery: operational guide. – London: Department of Health, 2002. – 40 p.
  7. Extended day surgery / D. Phillips [et al.] // J. One Day Surgery. – 1999. – Vol. 8. – P. 5-6.

TRAUMATOLOGY AND ORTHOPEDICS

A.P. MASLOV, E.A. RUTSKAYA,

X-RAY ASSESSMENT OF THE BONE TISSUE PERIPROSTHETIC REACTION AT THE STABLE FEMORAL COMPONENTS OF SLPS ENDOPROSTHESIS

Objectives. To study X-ray parameters of the bone remodeling around the stable femoral components of the hip joint cementless fixation endoprosthesis of SLPS system.
Methods. The analysis of 230 digital X-rays was performed with the average terms of observation composing 7 years after the hip endoprosthesis of SLPS system implanting with the presence of components stable fixation.
Results. It was established that bone tissue adaptation is characterized by the equable contact with the endoprosthesis surface with lack of resorption lines in 80, 9% of observations and the opposition bone growth in 97, 3%. Local areas of the prosthesis connection with the diaphysis cortical layer were revealed in 64, 3% cases and in 70, 3% of cases they were localized around the distal part of the component. Bone tissue growing into the porous titanium inserts were revealed in the form of parallel lines of the bone balks condensation in 98% of observations.
Conclusions. The research results testify to the efficacy of endoprosthesis of SLPS system in loading redistribution and periprosthetic bone tissue saving.

Keywords: endoprosthesis, bone tissue, remodeling
p. 82 – 87 of the original issue
References
  1. Осложнения при эндопротезировании тазобедренного сустава / В. А. Филиппенко [и др.] // Ортопедия, травматология и протезирование. – 2010. – № 2. – С. 11-16.
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  6. Engh, C. A. The influence of stem size and extent of porous coating on femoral bone resorption after primary cementless hip arthroplasty / C. A. Engh, J. D. Bobyn // Clin. Orthop. Relat Res. – 1988. – Vol. 231. – P. 7-28.
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  9. Маслов, А. П. К вопросу эндопротезирования тазобедренного сустава / А. П. Маслов // Ортопедия, травматология и протезирование. – 2008. – № 2. – P. 10-14.
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  12. Руцкий, А. В. Биологическая интеграция эндопротеза тазобедренного сустава Руцкого / А. В. Руцкий, А. П. Маслов // Медицина. – 2001. – № 4 (35). – С. 34-35.
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  16. Kang, J. S. The effect of diaphyseal biologic fixation on clinical results and fixation of the APR-II stem / J. S. Kang, L. D. Dorr, Z. Wan // J. Arthroplasty. – 2000. – Vol. 15, N 6. – P. 730-735.
  17. Midterm results of the Synergy cementless tapered stem: stress shielding and bone quality / T. Nishino [et al.] // J. Orthop. Sci. – 2008. – N 13, N 6. – P. 498-503.
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SH. KHALILOV, S.A. KRASNY, A.I. ROLEVICH

RISK OF CLINICAL PROGRESSION IN PATIENTS WITH PROSTATE CANCER WITH BIOCHEMICAL RECURRENCE AFTER RADICAL SURGICAL TREATMENT

Objectives. To determine predictors of clinical progression (CP) in patients with biochemical recurrence (BCR) of the prostate cancer (PC) after radical prostatectomy (RP).
Methods. Between 1997 and 2008, 483 patients with PC underwent open RP. Postoperatively in 172 patients BCR cases were diagnosed (38.5%). 34 patients of them were excluded from further analysis due to short follow-up (less than 3 months).In the remaining 138 patients 69 cases of CP were diagnosed. Overall, cancer-specific and progression-free survival in patients with BCR were calculated according to Kaplan-Meier method. Mono- and multivariate analyses with Cox proportional hazard model were performed.
Results. Only pathological Gleason score is found out to be of prognostic significance in the multivariate analysis (p <0,001). A model to predict the risk of CP was developed that permits to divide patients into 2 prognostic groups (low and high risk of CP).
Conclusions. Pathological Gleason sum is a predictor of CP in patients with BCR after RP. Early adjuvant hormonal therapy is recommended in patients of CP high risk (Gleason sum 8-10); and in low risk groups (Gleason sum 7 and less) – distant radiation therapy or observation.

Keywords: localized, locally-advanced prostate cancer, radical prostatectomy, biochemical recurrence, clinical progression
p. 88 – 94 of the original issue
References
  1. Van den Ouden, D. Progression in and survival of patients with locally advanced prostate cancer (T3) treated with radical prostatectomy as monotherapy / D. Van den Ouden, W. Hop, F. H. Schroder // J. Urol. – 1998. – Vol. 160. – P. 1392-1397.
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  16. Pinover, W. H. Validation of a treatment policy for patients with prostate-specific antigen failure after three-dimensional conformal prostate radiation therapy / W. H. Pinover, E. M. Horwitz, A. L. Hanlon // Cancer. – 2003. – Vol. 97. – P. 1127-1133.
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  19. Limited value of bone scintigraphy and computed tomography in assessing biochemical failure after radical prostatectomy / C. J. Kane [et al.] // Urology. – 2003. – Vol. 61. – P. 607-611.

V.T. MALKEVICH, E.V. BOGUSHEVICH, L.I. OSITROVA, T.N. SEROVA, I.A. ILYIN

RADIOLOGY DIAGNOSTICS OF INTRAPLEURAL COMPLICATIONS AFTER SURGERY FOR CANCER OF THE ESOPHAGUS AND CARDIA

Objectives. Determination of radiology diagnostics possibilities of intrapleural surgical complications in patients operated on for esophageal cancer and cardia.
Methods. The investigation included 1026 patients who were treated in the RNPC of oncology and medical radiology named after N.N. Alexandrov and were performed subtotal resection of the esophagus with the formation of intrapleural esophageal anastomoses, including cancer of the esophagus – 429, cancer of esophagogastric junction – 597 during the period from 1990 up to 2010.
Results. 84 patients composing 8,2% from the total number dhad surgical complications. X-ray examination proved to be the most effective in early diagnosis of intrapleural esophageal anastomosis leaks and esophagotransplantat necrosis. The diagnostic value of this method was 88%.
Conclusions. Timely diagnosis of the intrapleural complications permitted to determine the surgical tactics and to select the optimal time to perform emergency surgery.

Keywords: esophageal cancer, gastroesophageal cancer, X-ray diagnostics, esophageal anastomotic leak, esophagotransplantat necrosis
p. 95 – 100 of the original issue
References
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ANESTHESIOLOGY-REANIMATOLOGY

R.E. RZHEUTSKAYA

CENTRAL HEMODYNAMIC PARAMETER CHANGES AT THE SEVERE TRAUMATIC BRAIN INJURY

Objectives. To define specific features of central hemodynamic parameter changes at the isolated severe traumatic brain injury (STBI).
Methods. The study of central hemodynamic parameters was carried out in 13 patients with the isolated STBI – the 1st group as well as in 15 patients with the isolated STBI and the determined brain death – the 2nd group. The parameters of central hemodynamics were investigated using the method of transpulmonary thermodilution. The 1st group patients were monitored in the acute period of traumatic disease for 7 days following the injury. The 2nd group patients’ central hemodynamic parameters were monitored during 1-3 days.
Results. The performed study revealed various types of hemodynamic reaction in the patients with the isolated STBI in the acute period of traumatic disease and in the patients with the clinically determined brain death.
Conclusions. Monitoring of the central hemodynamics parameters allows determining the cause of disorders as well as timely correcting of the developed disturbances, purposefully changing the infusion inotropic and vasopressor therapy strategy.

Keywords: severe traumatic brain injury, transpulmonary thermodilution, central hemodynamic parameters
p. 101 – 105 of the original issue
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LECTURES, REVIEWS

V.YA. KHRYSHCHANOVICH, S.I. TRETYAK, V.A. KONDRATOVICH, A.M. PISARENKO, K.S. KOMISSAROV

PARATHYROID AUTOTRANSPLANTATION AS A PREVENTIVE METHOD OF POSTOPERATIVE HYPOPARATHYROSIS

The researches review dedicated to the parathyroid autotransplantation application to prevent postoperative hypoparathyrosis is presented in the article. Historic and clinical aspects of the problem are studied as well as the prospects of its solution. The literature analysis has demonstrated that together with parathyroid glands saving in situ, having satisfactory blood supply, parathyroid autotransplantation (PA) is an effective alternative to support parathyroid function; this is especially actual concerning the glands with a questionable viability. The necessity to perform autotransplantation of the parathyroid glands which have been removed or injured accidentally is of no doubt. At the same time up to present moment the most optimal variant of PA which would guarantee the parathyroid function saving hasn’t been worked out. To improve PA results it is necessary to carry out further researches, aimed to work out new surgical approaches and estimation techniques of the parathyroid glands viability. To understand deeper the molecular bases of PA it is required to study peculiarities of revascularization, reinnervation, and reimplantad parathyroid tissue functioning.

Keywords: autotransplantation, estimation of transplant function, hypocalcemia, parathyroid gland, thyroidectomy
p. 106 – 114 of the original issue
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V.A. YANUSHKO, D.V. TURLYUK, P.A. LADYGIN, D.V. ISACHKIN

CURRENT APPROACHES TO DIAGNOSTICS AND TREATMENT OF MULTI-LAYERED LOWER LIMBS ARTERIES LESIONS BELOW THE INGUINAL FOLD AT THE CRITICAL ISCHEMIA STAGE

The article includes the analysis of the international literature on the problem of critical atherosclerotic lower limbs lesion and peculiarities of the clinical course of the disease in patients of the 4-6 category according to Rutherford. Also some current approaches to the conservative therapy are reflected and various sorts of interventional operations at multi-layered lower limbs artery lesions in critical ischemia are studied. Some perspective innovation challenges in this area of medicine are studued.

Keywords: critical ischemia, lower limb arteries, clinic, therapyv
p. 115 – 128 of the original issue
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E.V. SHAYDAKOV, E.A. ILYUKHIN, A.V. PETUKHOV

RADIO-FREQUENCY OBLITERATION WITH CLOSURE FAST CATHETERS APPLICATION IN THE CHRONIC VENOUS DISORDERS TREATMENT

One of the methods of the vertical reflux elimination at treatment of chronic venous diseases is the radio-frequency obliteration. In 2007, significant constructive changes influencing the mechanism of obliteration of the target vein in the most spreading technology of radio-frequency obliteration (VNUS Closure) occurred. The review of history of radio-frequency obliteration method development and literature publications on experimental and clinical trials with new generation radio-frequency obliteration catheters is present in the article.

Keywords: radio-frequency obliteration, chronic venous disorders
p. 129 – 133 of the original issue
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I.O. POKHODENKO-CHUDAKOVA, E.V. MAKSIMOVICH

CHOICE OF ANESTHESIA METHOD IN PATIENTS WITH ARTERIAL HYPERTENSION DURING TREATMENT AT DENTAL SURGEON

Basing on the analysis and generalization of the specialized literature data, their systematization is presented in the article aimed to more definite determination of the research direction concerning the choice of anesthesia method in patients suffering from arterial hypertension as well as complications prevention during the out-patient treatment by dental surgeon.

Keywords: anesthesia, arterial hypertension, reflexology
p. 134 – 138 of the original issue
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HYPOTHESISES

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

SPHINCTER OF ODDI AND ITS ROLE IN THE PATHOGENESIS OF THE BILE-PANCREATIC AREA DISEASES

Based on the analysis of literature and our own research the hypothesis of the dysfunction of sphincter of Oddi (DSO) is suggested. DSO is the reaction of the sphincter in response to dyskinesia of the duodenum. It is expressed in a periodic increase pressure in the duodenal segment, in which the sphincter of Oddi opens. Dyskinesia of the duodenum develops in excessive amounts of hydrochloric acid, chronic constipation, colitis, etc. DSO is the cause of biliary dyskinesia, formation of the stones and development of chronic pancreatitis. DSO deteriorated over time. Initial increase in SO pressure gradually transitions into insufficiency. At both high and low pressure of SO conditions are provided for the reflux of duodenal contents into the ducts. The sphincter of Oddi dysfunction may be part of a more generalized motility disorder of the gastrointestinal tract and, therefore, targeting to the SO only is not the solution to problem. A practical conclusion that follows is: if you have to remove the gallbladder, you need to find the cause of DSO and solve the problem without waiting for the appearance of post cholecystectomy symptoms.

Keywords: sphincter of Oddi, pathophysiology, dyskinesia of the bile ducts, digestive tract functional diseases, duodenum, diverticula
p. 139 - 145 of the original issue
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EXCHANGE OF EXPERIENCE

SH.SH. AMONOV, M.I. PRUDKOV, O.G. ORLOV

RESULTS OF SURGICAL TREATMENT OF THE LIVER HYDATID CYSTS

Objectives. To evaluate application efficacy of 33% hydrogen peroxide solution to destruct the fibrous capsule of the liver hydatid cysts.
Methods. For the period of 2002-2010 68 patients with the liver echinococcosis at the age of 26-65 years were examined. Depending on the cyst’s size and volume one distinguished small cysts up to 5 cm in 4 patients, medium ones up to 10 cm – in 16 patients and large and giant ones, more than 10 cm – in 48 patients. The patients were included into two groups – the main group numbering 32 patients and the control one numbering 36 patients. The control group was represented by the patients in whom the residual cavity of the fibrous capsule of the liver hydatid cysts was treated with 96 % alcohol solution. In the main group the residual cavity of the patients was treated with glycerin and 33% hydrogen peroxide solution. The operative intervention was carried out from the extensive laparotomy in the patients of both groups.
Results. Postoperative complications in the control group were observed in 17 (47%) cases. The average period of hospitalization after the surgery made up 19,2 days. Postoperative complications in the main group were registered in 7 (21%) cases. The average period of hospitalization made up 16 days.
Conclusions. The designed method of the fibrous capsule perhydrol treatment of the liver hydatid cysts combines availability and application efficacy and it is safe from the point of intra- and postoperative complications development.

Keywords: liver echinococcosis, hydatidectomy, fibrous capsule destruction with perhydrol
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