Novosti
Khirurgii
This journal is
indexed in Scopus









Year 2012 Vol. 20 No 2

EXPERIMENTAL SURGERY

V.E. KORYK 1, A.P. TRUKHAN 1, S.A. ZHIDKOV 2, D.A. KLYUYKO 1

DIRECT OXIMETRY AT EXPERIMENTAL ILEUS

EE “Belarusian State Medical University”1,
Military-Medical administration of the Ministry of defense 2, g. Minsk,
The Republic of Belarus

Objectives. To study possibilities of the direct oximetry application to estimate viability of the intestinal wall at acute ileus.
Methods. The research is based on the result analysis of the direct oximetry of the small intestine afferent loop in 18 guinea pigs with the experimental ileus.
Results. Correlation between the oxygen content in the small intestine wall and distance up to the level of obstruction in case of an acute ileus was revealed. Sufficient oxygen supply with its disturbed utilization was noted on the intestine sections in the direct proximity from the mechanical obstruction during the first day of ileus development. Though, if the obstruction for the intestinal content passage remains, the given parameter quickly returns to its usual values and continues to decrease progressively, testifying to the development of rough ischemic damage of the intestinal wall. The stationary level of the partial oxygen pressure remains practically unchanged during the first two days of the disease on more distant sections from the level of obstruction; though further development of the intestinal wall ischemia occurs as the result of overdistention and exhaustion of compensatory mechanisms. On the sufficiently distant sections of the intestine stationary oxygen level didn’t change remarkably during three days from the moment of the disease development; this fact once again proves a clear correlation of changes in the intestinal wall and distance to the obstruction level and time passed from the pathological process onset.
Conclusions. Direct oximetry is an objective, non-invasive method letting estimate tissue respiration in the organs and tissues which suffer from microcirculation disturbance and hypoxia on the distance from the main pathological focus. It can be used during operations to determine the level of the intestine resection and place of anastomosis application.

Keywords: acute ileus, direct oximetry
p. 3 – 8 of the original issue
References

1. Volkov AN. Ostraia kishechnaia neprokhodimost' [Acute intestinal obstruction]. Cheboksary, RF: Izd-vo Chuvash un-ta; 2007. 88 p.
2. Chernov VN, Belin BM. Ostraia neprokhodimost' kishechnika [Acute intestinal obstruction]. Moscow, RF: Meditsina; 2008. 511 p.
3. Briskin BS, Khachatrian NN, Savchenko ZI, Poliakov IA. Lechenie tiazhelykh form rasprostranennogo peritonita [Treatment of severe generalized peritonitis]. Khirurgiia. 2003;(8):56–60.
4. Eriukhin IA, Petrov VP, Khanevich MD. Kishechnaia neprokhodimost' [Intestinal obstruction ]. Saint – Petersburg, RF: Piter; 1999. 443 p.
5. Korymasov EA, Korymasov EA, Gorbunov IuV. Printsipy differentsial'noi diagnostiki i taktiki pri ostroi kishechnoi neprokhodimosti [Principles of differential diagnosis and management of acute intestinal obstruction]. Vestn Khirurgii im II Grekova. 2003;162(3):101–106.
6. Shuleiko ACh, Vorobei AV, Khulup GIa. Regionarnaia gemodinamika tonkoi kishki pri eksperimental'noi kishechnoi neprokhodimosti [Regional hemodynamics of the small intestine in experimental intestinal obstruction]. Novosti Khirurgii. 2008;16(1):8–16.
7. Zanoni FL, Benabou S, Greco KV, Moreno ACR, Costa CJWM, Filgueira FP, Martinez MB, Luiz FPF, Mauricio RSPS. Mesenteric microcirculatory dysfunctions and translocation of indigenous bacteria in a rat model of strangulated small bowel obstruction. Clinics (Sao Paulo). 2009;64(9):911–19.
8. Miliukov VE, Sapin MR. O patogeneze posleoperatsionnogo peritonita posle ustraneniia ostroi stranguliatsionnoi kishechnoi neprokhodimosti [On the pathogenesis of postoperative peritonitis after removal of acute strangulation intestinal obstruction]. Annaly Khirurgii. 2006;(1):70–71.
9.Bordakov VN. Diagnostika i lechenie intraabdominal'noi infektsii v neotlozhnoi khirurgii [Diagnosis and treatment of intra-abdominal infection in emergency surgery]. Minsk, RB; 2008. 280 p.
10. Zhidkov SA, Korik VE, Kliuiko DA, Titovets EP. Vozmozhnosti primeneniia priamoi oksimetrii dlia otsenki sostoianiia podzheludochnoi zhelezy pri ostrom pankreatite v eksperimente [The direct oximetry to assess the state of the pancreas in experimental acute pancreatitis]. Novosti Khirurgii. 2010;18(3):9–16.

Address for correspondence:
220034, Respublika Belarus', g. Minsk, ul. Azgura, 4, UO “Belorusskii gosudarstvennyi meditsinskii universitet”, voenno-meditsinskii fakul'tet, kafedra voenno-polevoi khirurgii,
e-mail: aleksdoc@yandex.ru,
Trukhan Aleksei Petrovich
Information about the authors:
Korik V.E., ñandidate of medical sciences, associate professor, colonel of medical service, a head of military field surgery chair of the military medicine faculty of EE "Belarusian State Medical University."
Trukhan A.P., candidate of medical sciences, major of medical service, an assistant of military field surgery chair of the military medicine faculty of EE "Belarusian State Medical University."
Zhidkov S.A., doctor of medical sciences, professor, colonel of medical service, the chief of military medical department of the Ministry of Defence of the Republic of Belarus.
Klyuyko D.A., major of medical service, graduate student of the chair of military field surgery chair of the military medicine faculty of EE "Belarusian State Medical University."

GENERAL AND SPECIAL SURGERY

V.A. KLOPOVA, I.V. SAMSONOVA, A.T. SHCHASTNY, M.I. KUGAEV

CHARACTER OF NEUROFILAMENT EXPRESSION IN THE PANCREAS AT CHRONIC PANCREATITIS

EE “Vitebsk State Medical University”,
The Republic of Belarus

Objectives. To study NF (neurofilament) expression in the pancreas tissue at chronic pancreatitis as well as the correlation of its expression degree and fibrous changes expression.
Methods. Using morphological, immunohistochemical, morphometric and statistical methods we investigated pancreas of 43 patients with chronic pancreatitis in whom duodenum-saving resection of its head had been done.
Results. Morphometric assessment revealed fibrous changes variation from 10 to 98% in pancreas at chronic pancreatitis. Degree of NF expression varied from 0 to 251 points and didn’t depend on the fibrous changes expression (p>0,05). Percentage of positive expressed nerve elements varied from 0 to 100, signing the decrease of mature and viable elements in pancreas specimens with more severe fibrous changes.
Conclusions. It was found out that in the pancreas at chronic pancreatitis marked fibrous changes were developing together with the diffused degenerative changes of parenchyma and the nervous tissue was involved with it total area increase. The area of mature and viable nerve tissue was decreased

Keywords: chronic pancreatitis, pancreas fibrosis, nerve tissue, neurofilament, expression degree
p. 9 – 13 of the original issue
References

1. Gustomvsova VI. Primenenie biorezonansnoi terapii v kompleksnom lechenii bol'nykh khronicheskim pankreatitom [The use of bio-resonance therapy in treatment of patients with chronic pancreatitis]. Elektron resurs. 2009. Rezhim dostupa: http://www.biorezonans.by. Data dostupa: 07.11.2010.
2. Spanier BWM, Dijkgraaf MG, Bruno MJ. Epidemiology, aetiology and outcome of acute and chronic pancreatitis. Best Pract Res Clin Gastroenterol. 2008;22(1):45–63.
3. Maev IV. Khronicheskii pankreatit: ucheb posobie [Chronic pancreatitis: a study guide]. Moscow, RF: VUMNTs; 2003. 68 p.
4. Otsuki M. Chronic pancreatitis in Japan: epidemiology, prognosis, diagnostic criteria, and future problems. J Gastroenterol. 2003;38:315–26.
5. Tret'iak SI, Rashchinskii SM, Rashchinskaia TR, Avdevich DA. Epidemiologiia i etiologiia khronicheskogo pankreatita [Epidemiology and etiology of chronic pancreatitis]. Zdravookhranenie. 2010;(1):15–19.
6. Lowenfels AB, Maisonneuve P, Cavallini G, Ammann RW, Lankisch PG, Andersen JR, DiMagno EP, Andren-Sandberg A, Domellof L, Di Francesco V, et al. Prognosis of chronic pancreatitis: an international multicenter study. International Pancreatitis Study Group. Am J Gastroenterol. 1994 Sep;89(9):1467–71.
7. Talamini G, Falconi M, Bassi C, Mastromauro M, Salvia R, Pederzoli P. Chronic Pancreatitis: Relationship to Acute Pancreatitis and Pancreatic Cancer. Journal of the Pancreas. 2000 Sep;1(3 Suppl.):69–76.
8. Gubergrits NB. Khronicheskaia abdominal'naia bol'. Pankreaticheskaia bol': kak pomoch' bol'nomu. [Chronic abdominal pain. Pancreatic pain: how to help the patient]. Moscow, RF: Medpraktika; 2005. 176 p.
9. Buscher HC, Jansen JB, van Dongen R, Bleichrodt RP, van Goor H. Long-term results of bilateral thoracoscopic splanch- nicectomy in patients with chronic pancreatitis. Br J Surg. 2002 Feb;89(2):158–62.
10. Matsumura N, Ochi K, Ichimura M, Mizushima T, Harada H, Harada M. Study on free radicals and pancreatic fibrosis–pancreatic fibrosis induced by repeated injections of superoxide dismutase inhibitor. Pancreas. 2001 Jan;22(1):53–7.
11. Bockman DE, Buchler M, Malfertheiner P, Beger HG. Analysis of nerves in chronic pancreatitis. Gastroenterology. 1988 Jun;94(6):1459–69.
12. Fink T, Di Sebastiano P, Buchler M, Beger HG, Weihe E. Growth-associated protein-43 and protein gene-product 9.5 innervation in human pancreas: changes in chronic pancreatitis. Neuroscience. 1994 Nov;63(1):249–66.
13. Buchler M, Weihe E, Friess H, Malfertheiner P, Bockman E, Muller S, Nohr D, Beger HG. Changes in peptidergic innervation in chronic pancreatitis. Pancreas. 1992;7(2):183–92.
14. Di Sebastiano P, di Mola FF, Di Febbo C, Baccante G, Porreca E, Innocenti P, Friess H, Buchler MW. Expression of interleukin 8 (IL-8) and substance P in human chronic pancreatitis. Gut. 2000 Sep;47(3):423–28.
15. Shrikhande SV, Friess H, di Mola FF, Tempia-Caliera A, Conejo Garcia JR, Zhu Z, Zimmermann A, Buchler MW. NK-1 receptor gene expression is related to pain in chronic pancreatitis. Pain. 2001 Apr;91(3):209–17.
16. Toma H, Winston J, Micci MA, Shenoy M, Pasricha PJ. Nerve growth factor expression is up-regulated in the rat model of L-arginine-induced acute pancreatitis. Gastroenterology. 2000 Nov;119(5):1373–81.
17. Friess H, Zhu ZW, di Mola FF, Kulli C, Graber HU, Andren-Sandberg A, Zimmermann A, Korc M, Reinshagen M, Buchler MW. Nerve growth factor and its high affinity receptor in chronic pancreatitis. Ann Surg. 1999 Nov;230(5):615–24.

Address for correspondence:
210023, Respublika Belarus', g. Vitebsk, pr. Frunze, d. 27, UO “Vitebskii gosudarstvennyi meditsinskii universitet”, kafedra patologicheskoi anatomii,
e-mail: victoriya_06@tut.by,
Klopova Viktoriia Aleksandrovna
Information about the authors:
Klopova V.A., a post-graduate student of the pathologic anatomy chair of EE "Vitebsk State Medical University."
Samsonova I.V., candidate of medical sciences, associate professor, a head of the pathological anatomy chair of EE "Vitebsk State Medical University."
Shchastny A.T., candidate of medical sciences, associate professor of the surgery chair of the faculty of advanced training and retraining of specialists of EE “Vitebsk State Medical University”.
Kugaev M.I., an assistant of the chair of general surgery of EE “Vitebsk State Medical University”.

S.A. KASHEVKIN

ESTIMATION OF STATE SEVERITY DEGREE OF PATIENTS AND OF EFFICACY OF VARIOUS TREATMENT METHODS AT SUBTOTAL-TOTAL PANCREATONECROSIS

Nefteyugansk city hospital,
The Russian Federation

Objectives. To estimate the possibilities of minimally invasive technologies in treatment of patients with subtotal-total forms of pancreatonecrosis (PN) in early stages of the disease.
Methods. The analysis of 668 patients’ case histories with acute pancreatonecrosis was carried out; the group including 112 (16,7%) patients with subtotal-total forms of pancreatonecrosis was established; the results of their treatment were analyzed. The patients were divided into 3 groups” the 1st group – 39 (34,8%) patients in whom only intensive conservative therapy was applied; the 2nd group – 31 (27,7%) patients in whom minimally invasive technologies (open and half-open methods of treatment) were additionally used during the process of treatment; the 3rd group – 42 (37,5%) patients who were treated using various operative surgical techniques (open method). Severity of patients’ state as well as the course prognosis was evaluated using scales of polyorgan insufficiency MODS, APACHE III before and after used methods of treatment.
Results. In early terms in all patients severe systemic disturbances were noticed together with extensive lesions of the pancreas. The estimation system of severity and prognosis APACHE III permitted to reveal the relation between the degree of polyorgan insufficiency and the degree of expressiveness of the accompanying pathology.
Application of multicomponent intensive conservative therapy and minimally invasive operative interventions allowed getting a favorable result in 67 (95,7%) patients, in all three groups – in 95 (84,8%) patients. The general lethality at subtotal-total pancreatonecrosis in early terms of the disease correlates with the type and volume of treatment; in the group of patients with conservative treatment it made up 5,1%; with application of minimally invasive technologies – 3,2%; with the application of laparotomy – 33,3% correspondently.
Conclusions. Subtotal-total forms of pancreatonecrosis occur in 16,7% patients with the verified acute pancreatitis. APACHE III scale at subtotal-total pancreatonecrosis permits to evaluate the state severity degree and to predict the efficacy of the applied complex therapy. Application of minimally invasive technologies allows decreasing lethality rate at pancreatonecrosis at early terms of the disease.

Keywords: pancreatitis, pancreatonecrosis, state estimation, conservative treatment, minimally invasive treatment
p. 14 – 19 of the original issue
References

1. Zatevakhin II, Tsitsiashvili MSh, Budurova MD, Altunin AI. Pankreonekroz (diagnostika, prognozirovanie i lechenie) [Pancreatic necrosis (diagnosis, prognosis and treatment)]. Moscow, RF; 2007. 224 p.
2. Kukosh MV. Ostryi destruktivnyi pankreatit [Acute destructive pancreatitis]. Nizhny Novgorod , NGMA, RF; 2008. 124 p.
3. Nesterenko IuA, Laptev VV, Mikhailusov SV. Diagnostika i lechenie destruktivnogo pankreatita [Diagnosis and treatment of destructive pancreatitis]. 2e izd. Moscow, RF: BINOM-PROGRESS; 2004. 304 p.
4. Balnykov SI, Petrenko TF. Prognozirovanie iskhoda zabolevaniia u bol'nykh nekroticheskim pankreatitom [The prediction of disease outcome in patients with necrotizing pancreatitis]. Khirurgiia. 2010;(3):57–59.
5. Eachempati SR, Hydo LJ, Barie PS. Severite scoring for prognostication in patients with severe acute pancreatitis: comparative analysis of the Ranson score and they APACHE III. Arch Surg. 2002;137:730–36.
6. Lomonosov SP. Ispol'zovanie shkaly APACHE II dlia otsenki tiazhesti sostoianiia bol'nykh s infitsirovannym nekroticheskim pankreatitom [The use of APACHE II score for risk stratification of patients with infected necrotizing pancreatitis]. Ukrain Med Chasopis. 2000;(3):21–25.
7. Gostishchev VK, Glushko VA. Pankreonekroz i ego oslozhneniia, osnovnye printsipy khirurgicheskogo lecheniia [Necrotizing pancreatitis and its complications, the main principles of surgical treatment]. Khirurgiia. 2003;(3):50–54.
8. Savel'ev VS, Filimonov MI, Burnevich SZ. Pankreonekrozy [Pancreatonecrosis] . Moscow, RF; 2008. 264 p.
9. Domingues- Munos JE, Carballo F, GarciaMJ. Evaluation of the clinical usefulness of APACHE II and SARS sestems in the initial prognosticclassification of acutepancreaticus. A multicenter study. Pancreas. 1993;8:6826.
10. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II a severity of disease classification system. Cri Care Med. 1985 Oct;13(10):818–29.

Address for correspondence:
628300, Rossiiskaia Federatsiia, Tiumenskaia obl., Khanty-Mansiiskii avtonomnyi okrug, g. Nefteiugansk, Tsentral'naia gorodskaia bol'nitsa, khirurgicheskoe otdelenie,
e-mail: dm.narezkin@gmail.com,
Kashevkin Sergei Anatol'evich
Information about the authors:
Kashevkin S.A., a surgeon of the department of surgery, Nefteyugansk central city hospital.

YU.S VINNIK, Å.V. SEROVA, R.A. PAKHOMOVA, Î.V. PERYANOVA, Ò.V. RUKOSUEVA

ROLE OF BACTERIAL FACTOR IN PROGRESSION OF ACUTE CALCULOUS CHOLECYSTITIS

SBEE HPE “Krasnoyarsk State Medical University named after professor V.F.Voyno-Yasenetsky”
The Russian Federation

Objectives. To improve the treatment results of patients with acute calculous cholecystitis.
Methods. 125 patients with acute calculous cholecystitis (ACC) were examined. The first group included the patients in whom traditional conservative treatment was performed (49 patients). The second group was made up of the patients in whom pre-surgical etiotropic preventive antibiotics and rational post-surgical preventive antibiotics were used (76 people). In both groups bacteriologic examination of cystic bile, biopsy material of the gall bladder wall and biliary calculus was carried out. In the second group PCR method was applied – the identification of anaerobic microflora in the blood, cystic bile and biopsy material of the gall bladder wall.
Results. High percentage of positive results of inoculation was received at phlegmonous calculous cholecystitis – 85,7% and at gangrenous calculous cholecystitis – 84,2%. In the investigated samples the representatives of family Enterobacteriaceae prevailed. E. faecium hold the second place among all isolated cultivations. Gram-positive cocci were also represented by S. epidermidis and anaerobic cocci P. constellatus. Moraxella spp. and Pseudomonas spp. were also marked.
The highest percentage of the identified monocultures of anaerobic organisms was received during the examination of cystic bile (86,2%) and biopsy material of the gall bladder wall (92,1%) at the deconstructive forms of calculous cholecystitis.
Etiological role of anaerobic microorganisms in the progression of complicated forms of cholelithiasis was determined by PCR method in 65,5% cases.
Resistance to amikacin, gentamicin, sparfloxacine and ciprofloxacin was determined in E.coli. Pseudomonas aeruginosa is resistant to cefoperazone. Strains of P. constellatus are resistant to metronidazole.
Conclusions. One of the leading etiological factors in the progression of deconstructive forms of calculous cholecystitis is anaerobic microorganisms, which can hardly be identified by bacteriological method. PCR method is the method of choice in diagnostics of anaerobes.
Most allocated strains of microorganisms are sensitive to investigated antimicrobials. Resistance of anaerobic microorganisms to metronidazole was revealed.
Prescription of antimicrobial chemical drugs on the basis of the evaluation of microorganism sensibility results authentically allows decreasing the percentage of postoperative complications that patients with ACC can have.

Keywords: cholelithiasis, acute calculous cholecystitis, microflora of biliary system, rational antimicrobial chemotherapy
p. 20 – 24 of the original issue
References

1. Maksimenko VB. Narusheniia kontsentratsionnoi i motorno-evakuatornoi funktsii zhelchnogo puzyria pri kholetsistolitiaze [Violations of concentration and motor-evacuation function of the gallbladder in cholecystolitiasis]. Ros Zhurn Gastroenterol Gepatol Koloproktol. 2006;(4):24–28.
2. Maliarchuk VI, Pautkin IuF, Plavunov NF. Zabolevaniia bol'shogo duodenal'nogo sosochka [Papillary disease]. Moscow, RF: Kameron; 2004. 167 p.
3. Berger MY, van der Velden JJ, Lijmer JG, de Kort H, Prins A, Bohnen AM. Abdominal symptoms: do they predict gallstones? Scand J Gastroenterol. 2000 Jan;35(1):70–6.
4. Bellows CF, Berger DH, Crass RA. Management of gallstones. Am Fam Physician. 2005;72(4):637–42.
5. Schirmer BD, Winters KL, Edlich RF. Cholelithiasis and cholecystitis. J Long Term Eff Med Implants. 2005;15(3):329–38.
6. Borodach AV, Borodach VA, Popov AL. Nekotorye patogeneticheskie aspekty khirurgicheskogo lecheniia oslozhnennoi zhelchnokamennoi bolezni [Some pathogenetic aspects of surgical treatment of complications of gallstone disease]. Novosibirsk, RF: Sibir un-t izd-vo; 2008. 188 p.
7. Petukhov VA. Zhelchnokamennaia bolezn' i sindrom narushennogo pishchevareniia [Gallstone disease and syndrome of impaired digestion]. Moscow, RF: VEDI; 2003. 128 p.

Address for correspondence:
660022, Rossiiskaia Federatsiia, g. Krasnoiarsk, ul. Partizana Zhelezniaka, d. 1, GBOU VPO “Krasnoiarskii gosudarstvennyi meditsinskii universitet”, kafedra obshchei khirurgii,
e-mail: ekaterina_s_07@mail.ru,
Serova Ekaterina Valer'evna
Information about the authors:
Vinnik Yu.S., doctor of medical sciences, professor, a Honored Scientist of Russia, a head of the general surgery chair of SBEE HPE «Krasnoyarsk State Medical University named after professor V.F. Voyno-Yasenetsky ".
Serova E.V., candidate of medical sciences, assistant the general surgery chair of SBEE HPE «Krasnoyarsk State Medical University named after professor V.F. Voyno-Yasenetsky ".
Pakhomova R.A., candidate of medical sciences, an assistant the general surgery chair of SBEE HPE «Krasnoyarsk State Medical University named after professor V.F. Voyno-Yasenetsky ".
Peryanova O.V., candidate of biological sciences, associate professor of the microbiology chair named after associate professor B.M.Zelmanovich of SBEE HPE «Krasnoyarsk State Medical University named after professor V.F. Voyno-Yasenetsky ".
RukosuevaT.V., a senior lecturer of the microbiology chair named after associate professor B.M.Zelmanovich of SBEE HPE «Krasnoyarsk State Medical University named after professor V.F. Voyno-Yasenetsky ".

S.V. ZHAROV 1, D.V. NAREZKIN 2, S.N. ROMANENKOV 1

OPERATIVE TREATMENT RESULTS OF ELDERLY AND SENILE PATIENTS WITH COMPLICATED GIANT ULCERS OF THE STOMACH AND DUODENUM

Nefteyugansk city hospital 1,
SEE HPE “Smolensk State Medical Academy”2,
The Russian Federation

Objectives. To improve the treatment results of elderly and senile patients with giant ulcers of the stomach and duodenum.
Methods. Operative treatment analysis of 61 patients (22,3%) out of 274 patients with giant stomach and duodenum ulcers was performed. The patients were divided into 2 groups. The main group included 148 patients, 133 (89,9%) of them were of old age and 15 (10,1%) – of senile age correspondently. 126 patients of young and mean age were included in the comparison group. The average age in the main group made up 66,1±5,6; in the comparison group – 46,4±9,4. 75 (50,6%) patients in the main group had ulcers of the stomach; in the comparison group 62 (49,2%) patients had it. Duodenum ulcers in the main group were revealed in 73 patients (49,4%), and in the comparison group – in 64 patients (50,8%).
Results. The main indications for the operation in both groups were hemorrhage and perforation.
25 (16,9%)out of 148 patients underwent surgical treatment: 18 patients (72%) with duodenum ulcer and 7 patients (28%) with gastric ulcer. There were 7 planned operations (28%) and 18 emergent operations (72%). The choice of operation volume in elderly patients depended on condition severity grounded by the character of the accompanying pathology, the degree of poly-organ insufficiency expression and blood loss degree.
In the comparison group 36 patients (28,6%) out of 126 were operated on. 11 patients (17,7%) out of 64 with duodenum ulcers underwent surgical interventions. 25 patients (40,3%) out of 62 with gastric ulcers were operated on. The majority of patients were operated on emergently – 23 patients (63,9%) and urgently – 7 patients (19,4%); there were 6 (16,7%) planned operations.
Postoperative lethality in the main group made up 16%, 4 out of 25 patients died. Postoperative lethality in the comparison group made up 2,8%, 1 patient died.
Conclusions. Minimal according to their volume surgeries in elderly and senile patients with severe accompanying pathology in case of life-threatening complications are less risky and should be the method of choice in the given category of patients.

Keywords: ulcer, surgical treatment, organ-saving operations, elderly age
p. 25 – 28 of the original issue
References

1. Vakhidov VV, Kalish IuI, Berezovskii AG. Gigantskie iazvy zheludka [Giant gastric ulcers]. Khirurgiia. 1990;(4):17–19.
2. Zhantalinova NA. Vybor khirurgicheskoi taktiki pri gigantskikh iazvakh zheludka i dvenadtsatiperstnoi kishki [The choice of surgical tactics in giant gastric and duodenal ulcers]. Khirurgiia. 2005;(12):30–32
3. Pantsyrev IuM, Mikhalev AK, Fedorov ED. Khirurgicheskoe lechenie probodnykh i krovotochashchikh gastroduodenal'nykh iazv [Surgical treatment of perforated and bleeding gastroduodenal ulcers]. Khirurgiia. 2003;(3):43–49.
4. Pantsyrev IuM, Mikhalev AK, Fedorov ED, Kuzeev EA. Lechenie iazvennykh gastrododenal'nykh krovotechenii [Treatment of ulcer gastroduodenal bleeding]. Khirurgiia. 2000;(3):21–25.
5. Shevchenko IuL, Korznikova AA, Stoiko IuM, Badurov BSh. Differentsirovannoe lechenie iazvennykh gastroduodenal'nykh krovotechenii [Differential treatment of gastroduodenal ulcer bleedings]. Khirurgiia. 2006;(11):18–23.
6. Asadov SA. Khirurgicheskoe lechenie «trudnykh» i oslozhnennykh gastroduodenal'nykh iazv [Surgical treatment of "difficult" and complicated gastroduodenal ulcers]. Khirurgiia. 2002;(11):64–69.
7. Bashniak VV. Narushenie krovosnabzheniia kul'ti dvenadtsatiperstnoi kishki i ego profilaktika [Circulatory disorders of the duodenal stump and its prevention]. Vestn Khirurgii. 1984;134(6):33–36.
8. Grubnik VV, Zaichuk AI, Grubnik IuV, i dr. Khirurgicheskoe lechenie bol'nykh s gigantskimi iazvami zheludka [Surgical treatment of giant gastric ulcers]. Klin Khirurgiia. 1992;(8):6–8.
9. Kuzin MI. Aktual'nye voprosy khirurgii iazvennoi bolezni zheludka i dvenadtsatiperstnoi kishki [Actual surgery problems of gastric and duodenal ulcers]. Khirurgiia. 2001;(1):27–32.
10. Nikitin NA. «Trudnaia» duodenal'naia kul'tia v urgentnoi khirurgii iazvennoi bolezni dvenadtsatiperstnoi kishki ["Difficult" duodenal stump in emergency surgery of duodenal ulcer]. Khirurgiia. 2001;(5):36–39.
11. Stoiko IuM, Bagnenko SF, Kurygin AA. Iazvennye zheludochno-kishechnye krovotecheniia [Ulcerative gastro-intestinal bleeding]. Khirurgiia. 2002;(8):32–35.
12. Kharaberiush VA, Kondratenko PG. Khirurgicheskoe lechenie bol'nykh s gigantskoi krovotochashchei iazvoi zheludka i dvenadtsatiperstnoi kishki [Surgical treatment of giant gastric and duodenal bleeding ulcers]. Klin Khirurgiia. 1991;(8):3–7.
13. Asadov SA, Salekhov IaS, Aliev EE. Formirovanie duodenal'noi kul'ti pri rezektsii zheludka po povodu «trudnykh» iazv dvenadtsatiperstnoi kishki [Formation of duodenal stump in gastric resection in the case of the "difficult" duodenal ulcers]. Khirurgiia. 2004;(2):78–81.

Address for correspondence:
214019, Rossiiskaia Federatsiia g. Smolensk, ul. Frunze, d. 40, GBOU VPO “Smolenskaia gosudarstvennaia meditsinskaia akademiia“, kafedra fakul'tetskoi khirurgii,
e-mail: dm.narezkin@gmail.com,
Narezkin Dmitrii Vasil'evich
Information about the authors:
Zharov S.V., a surgeon of the department of surgery, Nefteyugansk city hospital.
Narezkin D.V., doctor of medical sciences, associate professor, a head of the chair of faculty surgery, SBEE HPE "Smolensk State Medical Academy," the Ministry of health and social development.
Romanenkov S.N., a surgeon of the department of surgery, Nefteyugansk city hospital.

B.N. KOTIV, A.P. CHUPRINA, D.YA. YASYUCHENYA, D.M. MELNIK, D.S. SHELEGETOV, V.I. IONTSEV

PHYSICAL METHODS OF TISSUES DISSECTION AND COAGULATION IN THORACOSCOPIC SURGERY

FSBMEE HPE “Military Medical Academy named after S.M.Kirov” Ministry of defence of the Russian Federation,
The Russian Federation

Objectives. To investigate the possibility of practical use of different physical methods of tissue dissection and coagulation in thoracoscopic surgery, to determine the indications for their application.
Methods. The efficiency of ultrasound, argon enhanced and cold plasma coagulation to achieve a safe aerohaemostasis for resection of the lung tissue was demonstrated in the series of experiments on 25 mongrel dogs. The possibility of using these physical methods of tissue dissection and coagulation in video-assisted thoracic surgery was shown in 209 patients with the non-verified disseminated processes, lymphadenopathy and mediastinum neoplasms during the clinical part of this study.
Results. Ultrasonic lung tissue dissection and coagulation permit to achieve a safe aerohaemostasis and the lung wound hermeticity. Cold plasma coagulation is the most superficial mode of electrosurgical exposure. 140 patients had diagnostic surgery and 69 operations performed with curative intent during the study. Thoracoscopic lung resection, biopsy of mediastinal lymph nodes and neoplasms were informative in all cases. Postoperative complications occurred in 15 (7%) patients. There were no lethal outcomes. The average duration of hospitalization made up 6,3±0,4 days.
Conclusions. Thoracoscopic ultrasonic atypical lung resection can be performed in patient with peripheral lung nodules and disseminated processes. Dissection of mediastinal anatomic structures and elements of the lung root should be performed with ultrasonic dissector; cold plasma coagulation for hemostasis near the large vessels of mediastinum and lung root is the most superficial and safest mode of electrosurgical exposure.

Keywords: diffuse parenchymal lung disease, periferal pulmonary lesion, lymphadenopathy, mediastinal neoplasm, thoracoscopy, ultrasound, cold plasma coagulation, argon intensified coagulation
p. 29 – 36 of the original issue
References

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Address for correspondence:
94044, Rossiiskaia Federatsiia g. Sankt-Peterburg, ul. Akademika Lebedeva, d. 6, FGBVOU VPO “Voenno-meditsinskaia akademiia im. S.M. Kirova”, kafedra i klinika gospital'noi khirurgii,
e-mail: fsurgeonf@mail.ru,
Iasiuchenia Denis Aleksandrovich
Information about the authors:
Kotiv B.N., doctor of medical sciences, professor, colonel of medical service, a head of the chair and clinic of hospital surgery of FSBMEE HPE "Military Medical Academy named after S.M. Kirov’, Ministry of defense of the Russian Federation.
Chuprina A.P., candidate of medical sciences, associate professor, colonel of medical service, professor of the chair of hospital surgery of FSBMEE HPE "Military Medical Academy named after S.M. Kirov, Ministry of defense of the Russian Federation.
Yasyuchenya D.A., captain of medical service, graduate student of the chair of hospital surgery of FSBMEE HPE "Military Medical Academy named after S.M. Kirov, Ministry of defense of the Russian Federation.
Melnik D.M., a surgeon of the thoracic department of the clinic of hospital surgery of FSBMEE HPE "Military Medical Academy named after S.M. Kirov, Ministry of defense of the Russian Federation.
Shelegetov D.S., captain of medical service, clinical resident of the thoracic department of the clinic of hospital surgery of FSBMEE HPE Military Medical Academy named after S.M. Kirov, Ministry of defense of the Russian Federation.
Iontsev V.I., captain of medical service, senior clinical resident of the surgical department of the hospital surgery clinic of FSBMEE HPE "Military Medical Academy named after S.M. Kirov”, Ministry of defense of the Russian Federation.

A.SH. ZETOV

APPLICATION EFFICACY OF THE METHOD OF MECHANICAL SUTURE STRENGTHENING AFTER ATYPICAL LUNG RESECTION AT LUNG TUBERCULOSIS

National center of tuberculosis problems of the Ministry of health, Almaty,
The Republic of Kazakhstan

Objectives. To evaluate application efficacy of the method of the mechanical suture strengthening after atypical lung resection in patients with multiresistant forms of the lung tuberculosis.
Methods. Analysis of the designed method application in 35 patients with multiresistant forms of the lung tuberculosis after atypical resection of lung segments was carried out. The control group was composed of 31 patients with the multiresistant form of the lung tuberculosis without the given method application during the operation. The patients of the main and control groups underwent 66 operations of the resection character.
Results. Specific weight of the postoperative complications in the form of the bronchial fistula in the main group made up 8,6% cases; in the control group – 25,8%. Risk factors of postoperative complications at surgical treatment of patients with the multiresistant form of the lung tuberculosis were bacterial discharge and lung affection with tuberculosis. Application efficacy of the suggested method in the prophylaxis of the lung suture inconsistency made up 91,4% (ð<0,05); specific weight of the post-resection complications in the main group was 3 times less than in the control group.
Conclusions. The designed method of the mechanical suture strengthening after atypical lung resection in patients with the multiresistant form of the lung tuberculosis permitted to increase surgical treatment efficacy in 3 times.

Keywords: multiresistant lung tuberculosis, surgical treatment, atypical resection of the lung segments
p. 37 – 40 of the original issue
References

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5. Rakishev GB, Chaimerdenov SCh, Egemberdiev ZhE, i dr. Auto- i alloangioplastika kul'ti bronkha pri rezektsii legkikh pri tuberkuleze (eksperimental'noe i klinicheskoe issledovanie) [Auto- and alloangioplasty of bronchial stump in pulmonary resection for tuberculosis (experimental and clinical study)]. Ftiziopul'monologiia. 2005;(2):138–39.
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8. Rakishev GB, Chaimerdenov SCh, Erimbetov KD, Klenin VV, Firsov VI, Sundetov MM, Egemberdiev ZhT, Dzhetibaev BS, Kozhabekov EB, Zetov ASh. Sposob ukrepleniia mekhanicheskogo shva posle atipichnoi rezektsii legkogo [A method to strengthen the mechanical suture after atypical lung resection]: a s ¹ 51817 ot 27.10.2005 g. Resp Kazakhstan. Zaiavitel' Nats tsentr probl tub MZ RK.
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Address for correspondence:
050010, Respublika Kazakhstan, g. Almaty, ul. Bekkhozhina. d. 5, Natsional'nyi tsentr problem tuberkuleza Ministerstva Zdravookhraneniia, otdelenie khirurgicheskogo lecheniia tuberkuleza legkikh s mnozhestvennoi lekarstvennoi ustoichivost'iu,
e-mail: askarzetov@mail.ru,
Zetov Askar Shyntasovich
Information about the authors:
Zetov A.Sh., candidate of medical science, a senior research fellow of the Department of surgical treatment for pulmonary tuberculosis with multiple
drug-resistance, “National center of tuberculosis problems” of the Ministry of Health of the Republic of Kazakhstan.

B.S. SUKOVATYH, A.YU. ORLOVA, E.B. ARTYUSHKOVA

INFLUENCE OF PLASMA ENRICHED WITH PLATELETS AND OF THE PREPARATION “MYELOPID” ON THE COURSE OF ACUTE AND CHRONIC ISCHEMIA OF THE LOWER LIMBS

SBEE HPE “Kursk State Medical University”,
The Russian Federation

Objectives. To study the the influence of the plasma enriched with platelets and of the drug "Myelopid" on the course of acute and chronic ischemia of the lower limbs.
Methods. The experimental research has been performed on 120 rats-males of the “Vistar” line as well as the results of investigation and treatment of 30 patients with chronic ischemia of the lower limbs caused by the obliterating atherosclerosis were analyzed.
Experimental animals have been divided into four groups: control and three experimental. The back limb ischemia was modelled by excision of the main vessel, including femoral, popliteal and initial parts of the arteries of the shin. Treatment wasn’t carried out in the control group of animals after ischemia modeling. The plasma enriched with platelets was injected into the muscles of the hip and the shin in the first experimental group of rats; the second experimental group got the drug "Myelopid"; the third experimental group was injected wich the plasma enriched with platelets as well as "Myelopid".
500 ml of control blood analysis was taken from the patients and the plasma enriched with platelets was prepared. 100 ml of autoplasma was injected under ultrasound control into more ischemic limb along the deep artery of the thigh and popliteal artery.
Results. Intramuscular introduction of the plasma enriched with platelets, and "Myelopid" in the ischemic limbs of animals authentically has increased the level of microcirculation and reduced the area of necrosis of the muscles. In case of their combined introduction negative results have been received. The volume blood flow in the investigated limb has 1,4 times increased in patients after treatment; the main blood flow and microcirculation level has 1,2 times increased.
Conclusions. Applications of autoplasma enriched with platelets and the preparation "Myelopid" has been pathogenetically proved for use in treatment of the patients with chronic ischemia of the lower limbs.

Keywords: obliterating diseases,the lower limbs ischemia, conservative treatment, autoplasma, platelets, Myelopid
p. 41 – 48 of the original issue
References

1. Shevchenko IuL. Mediko-biologicheskie i fiziologicheskie osnovy kletochnykh tekhnologii v serdechno-sosudistoi khirurgii [Biomedical and physiological bases of cellular technologies in cardiovascular surgery]. Saint-Petersburg, RF: Nauka; 2006. 287 p.
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14. Weber C. Frontiers of vascular biology: Mechanisms of inflammation and immunoregulation during arterial remodeling. Thromb HaemOst. 2009 Aug;102(2):188–90.

Address for correspondence:
305041, Rossiiskaia Federatsiia, g. Kursk, ul. K. Marksa, d. 3, GBOU VPO “Kurskii gosudarstvennyi meditsinskii universitet”, kafedra obshchei khirurgii,
e-mail: SukovatykhBS@kursksmu.net,
Sukovatykh Boris Semenovich
Information about the authors:
Sukovatykh B.S., doctor of medical sciences, professor, a head of the general surgery chair of SBEE of HPE “Kursk State Medical University”.
Orlova A.Yu., candidate of medical sciences, an applicant for Doctor’s degree of the general surgery chair of SBEE of HPE “Kursk State Medical University”.
Artyushkova E.B., doctor of biological sciences, a director of the Scientific research institute of ecologic medicine of SBEE of HPE “Kursk State Medical University”.

B.N. ZHUKOV, V.R. ISAEV, P.S. ANDREEV, S.E. KATORKIN, A.A. CHERNOV

COMPLEX TREATMENT OF NONSPECIFIC ULCEROUS COLITIS WITH ENDOLYMPHATIC THERAPY APPLICATION

SBEE HPE “Samara State Medical University”,
The Russian Federation

Objectives. To improve treatment results of patients with medium severe and severe degrees of nonspecific ulcerous colitis by including endolymphatic antibacterial and immunostimulating therapy in the medical complex.
Methods. 95 patients with severe and medium severe forms of nonspecific ulcerous colitis aggravation were included into the research. Patients were divided into two groups. The first group included 50 patients in whom a complex treatment of nonspecific ulcerous colitis was completed by endolymphatic and immunostimulating therapy. The second group (45 patients) was treated in a standard way.
Results. Clinical-endoscopic, laboratory and morphological studies as well as microbiological examination of the colon mucosa tissue biopsy proved the efficacy of endolymphatic and immunostimulating therapy in the conservative treatment of patients with nonspecific ulcerous colitis aggravation.
Conclusions. Application of endolymphatic and immunostimulating therapy for treatment of patients with nonspecific ulcerous colitis aggravation at medium severe and severe forms is pathogenetically justified and effective.

Keywords: nonspecific ulcerous colitis, conservative treatment, endolymphatic therapy
p. 49 – 54 of the original issue
References

1. Ivashkin VT, Lapina TL, Ivashkin VT, red. Ratsional'naia farmakoterapiia zabolevanii organov pishchevareniia: ruk dlia praktikuiushchikh vrachei [Rational pharmacotherapy of the digestive system diseases: a guide for practitioners]. Moscow, RF: Litterra; 2007. 1056 p.
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11. Vyrenkov IuE, Moskalenko VV, Shishlo VK. Limfaticheskie metody obezbolivaniia i immuno-korrektsii u khirurgicheskikh bol'nykh [Lymphatic methods of anesthesia and immune correction in surgical patients]. Khirurg. 2009;(2):16–23.
12. Rukshina OA, Pershko AM, Samedov BKh. Prognosticheskaia znachimost' strukturnykh izmenenii slizistoi obolochki tolstoi kishki u bol'nykh nespetsificheskim iazvennym kolitom [Prognostic significance of the structural changes of the colonic mucosa in patients with nonspecific ulcerative colitis]. Gastroenterol Saint-Petersburg. 2003;(2-3):142.
13. Asanin IuIu, Golofeevskii VIu, Gerasimova AV, Sitkin SI. Indeks Masevicha: novyi podkhod k otsenke kliniko-endoskopicheskoi aktivnosti iazvennogo kolita [Masevich index: a new approach to the assessment of clinical and endoscopic activity of ulcerative colitis]. Gastroenterol Saint-Petersburg. 2004;(1):14–16.
14. Truelove SC, Witts LJ. Cortisone in ulcerative colitis: final report on therapeutic trial. BMJ. 1955;2:1041–48.
15. Belousova EA. Iazvennyi kolit i bolezn' Krona [Ulcerative colitis and Crohn's disease]. Tver', RF: Triada; 2002. 128 p.

Address for correspondence:
443079, Rossiiskaia Federatsiia, g. Samara, pr. Karla Marksa, 165 «b», Kliniki Samarskogo gosudarstvennogo meditsinskogo universiteta, kafedra gospital'noi khirurgii,
e-mail: pashaandreev@yandex.ru,
Andreev Pavel Sergeevich
Information about the authors:
Zhukov B.N., doctor of medical sciences, professor, Honored Scientist of Russia, a head of the chair of hospital surgery of SBEE HPE "Samara State Medical University», Ministry of health and social development of the Russian Federation.
Isaev V.R., doctor of medical sciences, professor of the hospital surgery chair of SBEE HPE "Samara State Medical University», Ministry of health and social development of the Russian Federation.
Andreev P.S., a physician-coloproctologist, post-graduate student of the hospital surgery chair of SBEE HPE "Samara State Medical University», Ministry of health and social development of the Russian Federation.
Katorkin S.E., candidate of medical sciences, associate professor of the hospital surgery chair of SBEE HPE "Samara State Medical University», Ministry of health and social development of the Russian Federation
Chernov A.A., candidate of medical sciences, a head of the coloproctology department of clinics of SBEE HPE "Samara State Medical University», Ministry of health and social development of the Russian Federation.

V.V. BESCHASTNOV, N.YU. ORLINSKAYA, M.N. KUDYKIN

EXPERIMENTAL-CLINICAL JUSTIFICATION OF DOSED DERMOTENSION APPLICATION IN THE FIRST PHASE OF WOUND PROCESS

SBEE HPE “Nizhny Novgorod State Medical Academy”,
The Russian Federation

Objectives. To shorten the treatment terms of patients with extensive purulent wounds of soft tissues by expanding indications for the dosed hardware apparatus dermotension.
Methods. Influence of the dosed dermotension on the morphological characteristics of the structural wound components was studied in experiment on the model of the infected wound in rats. Changes occurring distantly from the area of tension were studied, directly in the area of the primary wound defect. Hypothesis was that tension of the paravulvar area tissues resulted in the production of inflammation mediators, cytokines and this in its turn led to the reparative process stimulation in the wound area. Criterion letting estimate the correctness of the hypothesis was the speed of wound healing and terms of epithelialization. Dosed hardware apparatus dermotension was applied in the clinic in 12 patients at the first stage of wound process; in 18 patients a traditional method of purulent wounds treatment “under dressing” was applied. Objective control of soft tissues state while applying hardware apparatus dermotension was carried out using the laser Doppler flowmetry method.
Results. Investigations which were done on the model of the infected wound in rats show that dosed dermotension of the paravulvar tissue influences positively the tissue qualitative composition which is formed at infected wound healing; it is proved by the ratio of granulated tissue and fibroblasts, acceleration of the wound cleaning processes and scar forming. In the clinic, using the dosed hardware apparatus dermotension, purulent wounds from 7 up to 16 cm in width were closed and after suturing wound healing according to the type of primary tension was achieved in 11 out of 12 patients.
Conclusions. Use of the dosed hardware apparatus dermotension to close extensive purulent wounds at the first stage of the wound process expands indications for application of active surgical tactics and it reduces terms of treatment of this category of patients.

Keywords: wound, wound process, primary tension, dermotension
p. 55 - 59 of the original issue
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6. Huang X, Qu X, Li Q. Risk factors for complications of tissue expansion: a 20-year systematic review and meta-analysis. Plast Reconstr Surg. 2011 Sep;128(3):787–97.
7. Nerobeev AI, Agadzhanian NA, Elfimov AI, Shekhter AB, Volozhin AI, Kibisheva AA. Gipoksicheskaia trenirovka – effektivnyi metod povysheniia zhiznesposobnosti kozhi pri mestno-plasticheskikh operatsiiakh [Hypoxic preconditioning is the effective method of skin viability icreasing in local plastic surgery]. Stomatologiia. 2006;(2):40–44.
8. Austad ED, Pasyk KA, McClatchey KD, Cherry GW. Histomorphologic evaluation of guinea pig skin and soft tissue after controlled tissue expansion. Plast Reconstr Surg. 1982 Dec;70(6):704–10.
9. Brunius U. Wound healing impairtment from sutures. À tensiometrie and histology study in the rat. Acta Ñhir Scand.. 1968;395(21):24–26.
10. Krupatkin AI, Sidorova VV, red. Lazernaia dopplerovskaia floumetriia mikrotsirkuliatsii krovi: ruk dlia vrachei [Laser Doppler flowmetry of blood microcirculation: a guide for physicians]. Moscow: Meditsina; 2005. 256 p.
11. Kanshin NN. Printsipy zakrytogo aspiratsionno-promyvnogo lecheniia zagriaznennykh i nagnoivshikhsia ran [Principles of closed aspiration/washing treatment of contaminated and festering wounds]. Khirurgiia. 1989;(6):112–15.

Address for correspondence:
603001, Rossiiskaia Federatsiia, g. Nizhnii Novgorod, ul. Nizhne-Volzhskaia nab. 1/1, GBOU VPO “Nizhegorodskaia gosudarstvennaia meditsinskaia akademiia”, kafedra khirurgicheskikh boleznei,
e-mail: lancet2003@list.ru,
Beschastnov Vladimir Viktorovich
Information about the authors:
Beschastnov V.V., candidate of medical sciences, associate professor of the chair of surgical diseases of SBEE HPE “Nizhny Novgorod State
Medical Academy”.
Kudykin M.N., doctor of medical sciences, professor of the chair of the innovative surgery of SBEE HPE “Nizhny Novgorod State
Medical Academy”.
Orlinskaya N.Yu., doctor of medical sciences, associate professor of the pathologic anatomy chair of SBEE HPE “Nizhny Novgorod State
Medical Academy”.

V.V. SLONIMSKY

TO THE PROBLEM OF INGROWN NAIL TREATMENT USING CRYODESTRUCTION

SBEE HPE “Kirov State Medical Academy”,
The Russian Federation

Objectives. To study possibilities of the modern combined cryosurgical technique of the ingrown nail treatment in conditions of the surgical room of a polyclinic.
Methods. Cryotherapy technique was used in 17 patients with complicated forms of the ingrown nail (main group). 10 of them had acute inflammation in the form of paronychia; 7 patients had inflammatory hypergranulations. A traditional method of surgical treatment was applied in the comparison group in 17 patients with the same complications. All patients of the main and comparison groups were examined 3 and 12 months afterwards.
Results. A good clinical effect and complete recovery without recurrences were achieved in all patients of the main group as well as shortening of the average terms of work disability with the given pathology up to 10,1±1,03 days (using traditional methods – 12,5±1,28 days).
Conclusions. The method of the ingrown nail treatment using cryosurgical technique is less traumatic and it contributes to quick restoring of work ability and accelerated rehabilitation; it also provides good cosmetic effect and isn’t accompanied by recurrences.

Keywords: ingrown nail, cryosurgery, cryodestruction, inflammatory granulomaû
p. 60 – 63 of the original issue
References

1. Apanasenko BG, Vinnik LF, Galichin AS, Dergachev SV, i dr, Apanasenko BG, red. Spetsializirovannaia ambulatornaia khirurgiia: prakt ruk dlia vrachei [Specialized outpatient surgery: a practical guide for physicians]. Saint-Petersburg, RF; 1999. 407 p.
2. Maslov VI. Malaia khirurgiia [Minor surgery]. Moscow, RF: Meditsina; 1988. 208 p.
3. Tkachenko SS. Voennaia travmatologiia i ortopediia [Military traumatology and orthopedics]. Leningrad, RF; 1989. 326 p.
4. Iumashev GS, red, Gorshkov SZ, Silin LL, i dr. Travmatologiia i ortopediia [Traumatology and orthopedics]. 4-e izd, pererab. i dop. Moscow, RF: Meditsina; 1995. 560 p.
5. Gritsenko VV, Ignatov IuD. Ambulatornaia khirurgiia: spravochnik prakt vracha [Ambulatory surgery: a guide practitioner]. Saint-Petersburg, RF: Izdat dom Neva; Moscow, RF: Olma-Press Zvezdnyi mir; 2002. 448 p.
6. Kochenov VI, Bulanov GA, Tsybusov SN, i dr. Sposob kriokhirurgicheskogo lecheniia pri vrosshem nogte. Meditsinskaia kriologiia [Method of cryosurgical treatment of ingrown nails.]. In: Kochenova VI, red. Medical cryology: Mezhdunar sb nauch tr. Nizhny Novgorod, RF: onKolor; 2009;(Vyp 7). p. 229–39.
7. Aver'ianov MIu, Kochenov VI, Slonimskii VV. Patent 109402 RF, MPK: A61B18/02. Nakonechnik dlia kriodestruktora [Tip for cryodestructor]. Kirov gos med akad. ¹2010147172/14; zaiavl 18.11.2010; opubl.20.10.2011. Biul;(29).
8. Aver'ianov MIu, Kochenov VI, Slonimskii VV. Patent 111421 RF, MPK: A61B18/02. Kriozakhvat dlia kompressionnoi kriodestruktsii i krioapplikatsii [The grip for compressive cryodestruction and cryoapplicatrion]. Kirov gos med akad. ¹ 2011118774/14; zaiavl 10.05.2011; opubl 20.12.2011. Biul;(35).

Address for correspondence:
610001, Rossiiskaia Federatsiia, g. Kirov, Oktiabr'skii pr-t d. 151, GBOU VPO “Kirovskaia gosudarstvennaia meditsinskaia akademiia”, kafedra obshchei khirurgii,
e-mail: vladimirvsl.77@mail.ru,
Slonimsky Vladimir Vladimirovich
Information about the authors:
Slonimsky V.V., an extramural post-graduate student of the chair of general surgery of SBEE HPE "Kirov State Medical Academy", a surgeon of the polyclinic ¹ 1 of the departmental hospital at the st. Kirov of OAO "RRW".

TRAUMATOLOGY AND ORTHOPEDICS

S.V. BLINOV 1, S.N. KOLESOV 2, M.N. KUDYKIN 1, E.E. MALYSHEV 2, N.L. MURAVINA 2, E.S. MALYSHEV 1

EARLY DIAGNOSTICS OF POSTTRAUMATIC KNEE JOINT OSTEOARTHRITIS AFTER OPERATIVE TREATMENT OF FRACTURES OF THE TIBIA CONDYLES

SBEE HPE “Nizhny Novgorod State Medical Academy” 1,
FBSE “Nizhny Novgorod research institute of traumatology and orthopedics” 2,
The Russian Federation

Objectives. To design the method of early diagnostics of the knee joint posttraumatic osteoarthritis based on radiothermometry application.
Methods. Knee joint radiothermometry was applied in 34 patients in the postoperative period at the fractures of the tibia condyles. The research was conducted starting with the 8th week after the operative treatment and every 4 weeks in terms up to 6 months. Control temperature measuring was carried out 1 year afterwards. Control group included 36 healthy volunteers in whom there were no injures, diseases and operations in the knee joint regions in the anamnesis.
Results. While studying temperature readings in dynamics, one revealed statistically significant differences in the temperature reaction of the tissues in patients with a normal course of processes of the bone tissue consolidation and pathological reactions linked with the posttraumatic osteoarthritis development. Tendency to the gradual temperature reduction on the side of the injury in all sections is observed in case of a normal course. In case of the posttraumatic osteoarthritis development the temperature in all sections of the injured joint tends to reduce only in the early period of observation. Temperature increase is further observed which remains up to the end of the period of observation, despite the temperature of the uninjured joint increases in comparison with the control group. One year after the operative intervention the development of the postoperative osteoarthritis was observed in 5 patients making up 14,7%. On studying temperature reaction of the tissues, thermoasymmetry was registered in them due to high temperature readings on the side of the injury in all sections of the knee joint including the projection points of the joint split. Several variants of relationship of the tissue temperature reactions in dynamics characterizing the postoperative osteoarthritis development were revealed.
Conclusions. The suggested method provides an additional diagnostic criterion which permits to assume the development of the postoperative osteoarthritis at the before X-ray stage of the disease.

Keywords: knee joint, condyle fracture, osteoarthritis, radiothermometry, thermoasymmetry, abyssal temperature
p. 64 – 73 of the original issue
References

1. Kallaev NO, Zubov VV, Kallaev TN. Operativnoe lechenie vnutrisustavnykh perelomov kolennogo sustava [Operative treatment of the intraarticular fractures of knee joint]. Vestn Travmatol i Ortopedii im NÈ Priorova. 2006;(3):47–51.
2. Putiatov SM, Shestakov DIu, Golubev VG. Lechenie perelomov plato bol'shebertsovoi kosti metodom chreskostnogo osteosinteza po Ilizarovu [Treatment of tibial plateau fractures by transosseous osteosynthesis (Ilizarov technique)]. Vestn Travmatol i Ortopedii im NI Priorova. 2002;(4):17–23.
3. Gilev IaKh, Pronskikh AA, Miliukov AIu. Sovremennye tekhnologii lecheniia perelomov kolennogo sustava [Current therapeutic technologies of knee fractures]. Politravma. 2007;(2):28–34
4. Manek NJ, Lane NE. Osteoarthritis: current concepts in diagnosis and management. Am Fam Physician. 2000 Mar 15;61(6):1795–804.
5. Kosinskaia NS. Degenerativno-distroficheskie porazheniia kostno-sustavnogo apparata [Degenerative and dystrophic lesions of the locomotor apparatus]. Leningrad, RF: Medgiz; 1961. 196 p.
6. Kellgren JH, Lawrence JS, Radiological assessment of osteoarthrosis. Ann Rheum Dis. 1957 Dec;16(4):494–502.
7. Hinton R, Moody RL, Davis AW, Thomas SF. Osteoarthritis: Diagnosis and Therapeutic Considerations. Am Fam Physician. 2002 Mar 1;65(5):841–48.
8. Zabavskaia O, Agabalaeva A, Akhmedzhanov F, Sakharova O, Malygina M, Kliukvin I. Vozmozhnosti MRT v diagnostike povrezhdenii khriashcha i miagkikh tkanei kolennogo sustava [MRI capabilities in the diagnosis of cartilage and soft-tissue knee injuries]. Vrach. 2009;(2):75–78.
9. von Engelhardt LV, Kraft CN, Pennekamp PH, Schild HH, Schmitz A, von Falkenhausen M. The evaluation of articular cartilage lesions of the knee with a 3-tesla magnet. Arthroscopy. 2007 May;23(5):496–502.
10. Rakhmilevich AB, Chantsev AV, Raspopova EA. Vozmozhnosti artrofonografii v diagnostike i kontrole lecheniia rannikh stadii osteoartroza [Arthrophonography in the diagnosis and monitoring of early stages of osteoarthritis treatment]. Vrach-aspirant. 2010;43(6):45–49.
11. Kanakov VA, Kisliakov AG, Peliushenko S.A. Kontaktnaia radiotermometriia millimetrovogo diapazona dlin voln [Contact radiothermometry of millimeter wave]. Teplovidenie v Meditsine, Promyshlennosti i Ekologii: tez dokl konf. «TeMP 96» v ramkakh Mezhdunar konf. «Prikladnaia optika – 96». Saint-Petersburg, RF; 1996. p. 26–28
12. Kolesov SN, Volovik MG, Priluchnyi MA. Meditsinskoe teploradiovidenie: sovremennyi metodologicheskii podkhod: monografiia [Medical thermoradiovision: contemporary methodological approach. Nizhny Novgorod, RF: FGU NNIITO Rosmedtekhnologii; 2008. 184 p.

Address for correspondence:
603001, Rossiiskaia Federatsiia, g. Nizhnii Novgorod, ul. Nizhne-Volzhskaia nab. 1/1, GBOU VPO Nizhegorodskaia gosudarstvennaia meditsinskaia akademiia”, kafedra khirurgii FPKV (kurs travmatologii i ortopedii),
e-mail: serg512@bk.ru,
Blinov Sergei Valer'evich
Information about the authors:
Blinov S., an assistant of the surgery chair of the specialists retraining faculty (the course of traumatology and orthopedics) of SBEE HPE "Nizhny Novgorod State Medical Academy."
Kolesov S.N., doctor of medical sciences, professor, a leading researcher, a head of the heat-radiovision group of FSBE "Nizhny Novgorod institute of traumatology and orthopedics."
Kudykin M.N., doctor of medical sciences, an assistant of the surgery chair of the specialists retraining faculty of SBEE HPE "Nizhny Novgorod State Medical Academy."
Malyshev E.E., candidate of medical sciences, associate professor of the traumatology, orthopedics and field surgery named after M.V.Kolokoltsev of SBEE HPE "Nizhny Novgorod State Medical Academy."
Muravina N.L., doctor of functional diagnostics of department the heatradiovision of FSBE "Nizhny Novgorod Institute of traumatology and orthopedics."
Malyshev E.S., doctor of medical sciences, professor of the surgery chair of the specialists retraining faculty (the course of traumatology and orthopedics) of SBEE HPE "Nizhny Novgorod State Medical Academy."

ANESTHESIOLOGY-REANIMATOLOGY

A.V. MAROCHKOV, A.L. LIPNITSKY, S.A. TOCHILO

EFFECT OF VARIOUS OXYGEN CONCENTRATIONS APPLIED AT MULTICOMPONENT ENDOTRACHEAL ANESTHESIA ON THE PARAMETERS OF VENOUS BLOOD GAS COMPOSITION

ME “Mogilev regional hospital”
The Republic of Belarus

Objectives. To investigate the effect of oxygen various concentrations applied at multicomponent endotracheal anesthesia on the basis of sevoflurane on the parameters of venous blood gas composition and the acid-basic state.
Methods. 67 persons (12 men and 55 women) at the age from 18 till 80 years who were being operated routinely were included in a prospective, randomized controlled trial. Patients were divided into two groups depending on the applied intraoperative concentration of oxygen in the inhaled mixture with FiO2 50%and 35%. The acid-basic state and venous blood gas composition at three stages (prior to the beginning of operation, during it and after anesthesia) were investigated.
Results. Application of high oxygen concentration during anesthesia results in substantial growth of oxygen pressure and an oxygen saturation in the venous blood. At using during anesthesia of FiO2=35%, oxygen pressure was 78,6±27,1mmHg, and the saturation was 92,8±7,9%. It testifies to the fact that at multicomponent balanced anesthesia with sevoflurane, patients without lung diseases have raised oxygen content in the venous blood. Reduction of the previously increased lactate level in the venous blood (1,3±0,3 mmol/l in comparison with 2,9±0,9mmol/l at 1 stage (ð <0,001)) during anesthesia also testifies to the sufficient body oxygenation.
Conclusions. Application in patients during endotracheal anesthesia of the oxygen concentration which when inhaled is equal to 35% results in oxygen pressure increase in the venous blood as well as in lactate level decrease testifying to the adequate oxygen supply to the organism tissues.

Keywords: general anesthesia, acid-basic state, gas composition of the blood
p. 74 – 78 of the original issue
References

1. Lodato RF. Oxygen toxicity. Crit Care Clin. 1990; Jul;6(3):749–65.
2. Greif R, Lacyni S, RapfB, Hickle RS, Sessler DI. Supplemental oxygen reduces the incidence of postoperative nausea and vomiting. Anesthesiology. 1999 Nov;91(5):1246–52.
3. Al-Niaimi A, Safdar N. Supplemental perioperative oxygen for reducing surgical site infection: a meta-analysis. J Eval Clin Pract. 2009 Apr;15(2):360–65.
4. Qadan M, Akca O, Mahid SS. Hornung CA, Polk HC Jr. Perioperative supplemental oxygen therapy and surgical site infection: a meta-analysis of randomized controlled trials. Arch Surg. 2009 Apr;144(4):359-66; discussion 366–67.
5. Rothen HU. Oxygen: avoid too much of a good thing! Eur J Anaesthesiol. 2010 Jun;27(6):493–94.
6. Orhan-Sungur M, Kranke P, Sessler D, Apfel CD. Does supplemental oxygen reduce postoperative nausea and vomiting? A meta-analysis of randomized controlled trials. Anesth Analg. 2008 Jun;106(6):1733–38.
7. Brar MS, Brar SS, Dixon E. Perioperative supplemental oxygen in colorectal patients: a meta-analysis. J Surg Res. 2011 Apr;166(2):227–35.
8. Meyhoff CS, Wetterslev J, Jorgensen LN, Henneberg SW, Hogdall C, Lundvall L, Svendsen PE, Mollerup H, Lunn TH, Simonsen I, Martinsen KR, Pulawska T, Bundgaard L, Bugge L, Hansen EG, Riber C, Gocht-Jensen P, Walker LR, Bendtsen A, Johansson G, Skovgaard N, Helto K, Poukinski A, Korshin A, Walli A, Bulut M, Carlsson PS, Rodt SA, Lundbech LB, Rask H, Buch N, Perdawid SK, Reza J, Jensen KV, Carlsen CG, Jensen FS, Rasmussen LS. Effect of high perioperative oxygen fraction on surgical site infection and pulmonary complications after abdominal surgery: the PROXI randomized clinical trial. JAMA. 2009 Oct 14;302(14):1543–50.

Address for correspondence:
212026, Respublika Belarus', g. Mogilev, ul. B.-Biruli, d.12, UZ “Mogilevskaia oblastnaia bol'nitsa“, reanimatsionno-anesteziologicheskoe otdelenie,
e-mail: Lipnitski.al@gmail.com,
Lipnitsky Artur Leonidovich
Information about the authors:
Marochkov A.V., doctor of medical sciences, a head of the resuscitation and anesthesia department of ME "Mogilev regional hospital."
Lipnitsky A.L., an anesthesiologist-resuscitator of the resuscitation and anesthesia department of ME "Mogilev regional hospital."
Tochilo S.A., an anesthesiologist-resuscitator of the resuscitation and anesthesia department of ME "Mogilev regional hospital."

OTORHINOLORYNGOLOGY

EL-REFAI HUSAM 1, V.P. SITNIKOV 1, T.I. KOLESNIK 2

RESTAPEDOPLASTY AFTER OPERATIONS BECAUSE OF OTOSCLEROSIS

EE “Gomel State Medical University” 1,
ME “Gomel regional specialized clinical hospital” 2,
The Republic of Belarus

Objectives. To improve the restapedoplasty efficiency in patients with otosclerosis.
Methods. During the period of 2008-2011 the analysis of the intraoperative findings in 24 patients who had undergone stapedoplasty because of otosclerosis recently but with unsatisfactory functional outcome was carried out. Before the operation all patients underwent complete complex of clinical-audiological investigation.
Results. The causes of unsatisfactory results of stapedoplasty according to intraoperative findings data are the cicatricial changes in the posterior and superior sections of the tympanic cavity, in the region of the remote bone overhang of the back of the external auditory canal, tympanic membrane retraction and its fusion with the long leg of the incus in 12 patients (50%) patients. Dislocation of prosthesis, short prosthesis, not tight fixation of the prosthesis ring on a long stalk anvil, anvil dislocation occurred in 8 (33,4%) patients. Reossification foci in the oval window are detected in 4 (16,6%) patients.
Excellent and good functional results were achieved in 22 (91,6%) patients. In 2 (8,4%) operated patients hearing has not changed. After reoperation the closure of air-bone interval (ABI) was noted in all patients.
Conclusions. At reoperations because of poor functional results of stapedoplasty besides removing the leading pathogenetic factors responsible for the immobilization of the auditory ossicles, it is necessary to apply individual variants of surgical correction. They include the excision of the scar with the secondary partial reconstruction of the posterior wall of external auditory canal, malleostapedoplasty, reprostheses of the vestibular window, ossiculoplasty with autotissues or the implant.

Keywords: otosclerosis, stapedoplasty, unsatisfactory results, restapedoplasty, audiometry
p. 79 – 84 of the original issue
References

1.Preobrazhenskii NA, Patiakina OK. Stapedektomiia i stapedoplastika pri otoskleroze [Stapedectomy and stapedoplasty in otosclerosis]. Moscow, RF: Meditsina; 1973. 272 p.
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6. Lesinski SG. Causes of conductive hearing loss after stapedectomy or stapedotomy: a prospective study of 279 consecutive surgical revisions. Otol Neurotol. 2002 May;23(3):281–88.
7. Martin Ch, Messary A, Bertholon P, Prades JM. Failure of regain full function after surgery for otosclerosis: causes, diagnosis and treatment. Rev Laryngol Otol Rhinol (Bord). 2003;124(1):23–29. [Article in French]
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9. Wiet RG, Harvey SA, Bauer GP. Complications in stapes surgery. Options for prevention and management. Otol Clin North Am. 1993 Jun;26(3):471–90.
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15. Shea JJ, Sanabria FS. Teflon piston operation for otosclerosis. Arch Otolaryng. 1962;76(5):516–21.
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Address for correspondence:
246050, Respublika Belarus', g. Gomel', ul. Lange, d. 5, UO “Gomel'skii gosudarstvennyi meditsinskii universitet”, kafedra otorinolaringologii s kursom oftal'mologii,
e-mail: drhossam64@mail.ru,
El'-Refai Khusam
Information about the authors:
Al-Refai Hossam, candidate of medical sciences, assistant professor of the chair of otorhinolaryngology with the course of ophthalmology of EE “Gomel State
Medical University”.
Sitnikov V.P., doctor of medical sciences, professor of the chair of otorhinolaryngology with the course of ophthalmology of EE “Gomel State
Medical University”.
Kolesnik T.I., a head of the otorhinolaryngology department of ME “Gomel regional specialized clinical hospital”.

LECTURES, REVIEWS

V.M. POPKOV, D.YU. POTAPOV, A.N. PONUKALIN

HEMOSTASIS METHODS AT KIDNEY RESECTION

SBEE HPE “Saratov State Medical University named after V.I. Razumovsky”,
The Russian Federation

The indications for performing the kidney resection at various pathologies have recently been expanding. The key point of the operation is assurance of reliable final bleeding stoppage from the dissected organ parenchyma. There are many methods of hemostasis. The general advantages and disadvantages of each group are viewed in the article. It has been concluded that it is necessary to apply ligature methods of hemostasis at the middle kidney segment resection as well as at all operations with opening of the cavitary kidney system.

Keywords: kidney resection, bleeding stoppage, hemostasis techniques
p. 85 – 95 of the original issue
References

1. Aliaev IuG, Krapivin AA. Rezektsiia pochki pri rake [Partial nephrectomy for cancer]. Moscow, RF: Meditsina; 2001. 224 p.
2. Popov VA. Gemostaz i germetizatsiia shvov (operatsii na vnutrennikh organakh) [Hemostasis and suture sealing (operations on the internal organs). Moscow, RF: GEOTAR-Media; 2008. 320 p.
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15. Nishiwaki Y, Daikuzono N, Joffe SN. Nd:YAG laser bipolar dissector--preliminary results. Lasers Surg Med. 1992;12(2):184–89.
16. Johnson DE, Wishnow KI, von Eschenbach AC, Grignon D, Ayala AG. Partial nephrectomy using the Nd:YAG laser: a comparison of the 1.06 mu and 1.32 mu lasers employing different delivery systems. Lasers Surg Med. 1988;8(3):241–47.
17. Eret V, Hora M, Sykora R, Hes O, Urge T, Klecka J, Matejovic M. GreenLight (532 nm) laser partial nephrectomy followed by suturing of collecting system without renal hilar clamping in porcine model. Urology. 2009 May;73(5):1115–18.
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33. Sabino L, Andreoni C, Faria EF, Ferreira PS, Paz AR, Kalil W, De Figueiredo LP, Ortiz V. Evaluation of renal defect healing, hemostasis, and urinary fistula after laparoscopic partial nephrectomy with oxidized cellulose. J Endourol. 2007 May;21(5):551–56.
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Address for correspondence:
410012, Rossiiskaia Federatsiia, g. Saratov, ul. Bol'shaia kazach'ia, d. 112, GBOU VPO “Saratovskii gosudarstvennyi meditsinskii universitet”, kafedra urologii,
e-mail: potapovmed@rambler.ru,
Potapov Dmitrii Iur'evich
Information about the authors:
Popkov V.M., candidate of medical sciences, assistant professor, a head of the urology chair of SBEE HPE “Saratov State
Medical University named after V.I.Razumovsky”, Ministry of health and social development of Russia
Potapov D.Yu., a post-graduate student of the urology chair of SBEE HPE “Saratov State
Medical University named after V.I.Razumovsky”, Ministry of health and social development of Russia
Ponukalin A.N., candidate of medical sciences, assistant professor of the urology chair of SBEE HPE “Saratov State Medical University named after V.I.Razumovsky”, Ministry of health and social development of Russia.

PRACTICAL CASES

M.M. YELOVOY, V.G. BOROZNA, A.A. KUKHTAREV, T.E. RAZUMOVA

STOMACH AND SMALL INTESTINE TRICHOBEZOARS IN CHILDREN

ME “Mogilev regional hospital”,
The Republic of Belarus

The article analyzes rare observations of giant stomach trichobezoars in girls of 12, 14 years of age and the small intestine trichobezoars in a 7-year old child. The possibilities of ultrasound examination, fibrogastroduodenoscopy (FGDS) and radiological studies in the diagnostics of the given pathology are presented. Attention is paid that trichotillomania (2 cases) may be the cause of the given pathology development. The peculiarities of surgical treatment are described and the necessity of the hospital observation of the given category of patients with the obligatory annual FGDS during a 3-year period is indicated.

Keywords: trichobezoar, trichotillomania, diagnostics, treatment
p. 96 – 100 of the original issue
References

1. Pitkevich AE, Shmakov AP, Zuev NN, Zuev NI. Gigantskii trikhobezoar zheludka i tonkoi kishki u rebenka 8 let [Giant hairball of the stomach and small intestine in a child of 8 years old]. Novosti Khirurgii. 2009;17(2):174–76.
2. Tsuman VG, Shcherbina VI, Semilov EA, i dr. Trikhobezoary zheludochno-kishechnogo trakta u detei [Hairballs of the gastrointestinal tract in children]. Det Khirurgiia. 2000;(4):52–54.
3. Sokolov IuIu, Davidov MI. Bezoary zheludochno-kishechnogo trakta u detei [Bezoar of the gastrointestinal tract in children]. Pediatriia. 2010;89(2):60–65.
4. Cataliotti F, Livoti C, Di Pace. M. Esophageal achalasia and hypertrophic pyloric stenosis associated with a phytobezoar in an adolescent. J Pediatr Surg. 2002 Sep;37(9):1363–64.
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7. Pitkevich AE, Shmakov AP, Zuev NN., Zuev NI. Trikhobezoar zheludka i tonkoi kishki u rebenka [Hairball of the stomach and small intestine in a child]. Det Khirurgiia. 2010;(1):48–49.
8. Carr JR, Sholevar EN, Baron DA. Trichotillomania and trichobezoar: a clinical practice insight with report of illustrative case. J Am Osteopath Assoc. 2006 Nov;106(11):647–52.
9. Sapozhnikov VG, Kulikov VA, Shabalin VA, i dr. Vozmozhnosti diagnostiki bezoarov u detei [Diagnosis of bezoar in children]. Ros Pediatr Zhurn. 2001;(4):51–53.

Address for correspondence:
212026, Respublika Belarus', g. Mogilev, ul. B.-Biruli, d.12, UZ “Mogilevskaia oblastnaia bol'nitsa“, detskoe khirurgicheskoe otdelenie,
e-mail: m.elovi@mail.ru,
Yelovoy Mikhail Makarovich
Information about the authors:
Yelovoy M.M., a pediatric surgeon of children's surgical department of ME "Mogilev Regional Hospital”.
Borozna V.G., an endoscopist, endoscopy department of ME "Mogilev Regional Hospital”.
Kukhtarev A.A., a head of children's surgical department of ME "Mogilev Regional Hospital”.
Razumova T.E., a pediatric surgeon of children's surgical department of ME "Mogilev Regional Hospital”.

EXCHANGE BY EXPERIENCE

V.A. KOSINETS 1, I.P. SHTURICH 2, E.A. UKRAINETS 3

EXPERIENCE OF COMBINED ABDOMINOPLASTY AND TENSION-FREE HERNIOPLASTY OF THE ANTERIOR ABDOMINAL WALL

SEE HPE “First Moscow Medical University” named after I.M.SECHENOV 1,
The Russian Federation
EE “Vitebsk State Medical University”2,
ME “Vitebsk regional clinical hospital” 3,
The Republic of Belarus

Objectives. To improve the results of surgical treatment of patients with anatomo-functional insufficiency of anterior abdominal wall.
Methods. 21 patients at the age from 33 till 52 with the presence of belly ptosis and hernial defect of the anterior abdominal wall of various localizations were operated on. In all cases a classical abdominoplasty was performed. The choice of the technique and direction of displacement of a flap were defined according to the expressiveness of skin and fat «apron». In 75% cases abdominoplasty was supplemented with liposuction of lateral departments of the anterior abdominal wall. Tension-free hernioplasty was carried out on «inlay» method with the application of partially resolving facilitated multifilament grids VYPRO (Johnson & Johnson, Ethicon).
Results. Classical abdominoplasty is evident to patients with the expressed changes of the anterior abdominal wall. Additional performance of liposuction allows generating a natural contour of the waist, and also gets rid of necessity of wide lateral separation of skin and fat flap, thus saving vessels feeding it. At allocation of skin and fat flap for the purpose of preventive maintenance of lymphorrhea preservation out of a seams zone of a fatty cellulose lower than Thompson’s fascia is necessary.
The analysis of the postoperative course has shown that serious complications from respiratory organs and cardiovascular system weren’t observed. As a result of liposuction and removal of skin and the «apron» the weight of a body of patients decreased on 9,54±2,82 kg.
Conclusions. Thus, abdominoplasty permits to obtain technically convenient access at tension-free hernioplasty of the anterior abdominal wall of any localization. Combined performance of abdominoplasty and tension-free hernioplasty of the anterior abdominal wall allows achieving simultaneously good esthetic and functional result. Abdominoplasty combined with liposuction of the lateral sections of the anterior abdominal wall permits to achieve more natural and esthetically attractive contour of a belly.

Keywords: abdominoplasty, tension-free hernioplasty, liposuction
p. 101 – 104 of the original issue
References

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19. Lukomskii GI, Shulutko AM, Antropova NV. Chastnye aspekty khirurgicheskogo lecheniia posleoperatsionnykh ventral'nykh gryzh [Some aspects of surgical treatment of postoperative ventral hernias]. Khirurgiia. 1995;(1):51–53.

Address for correspondence:
119991, Rossiiskaia Federatsiia, g. Moskva, ul. Iauzskaia, d. 11, GOU VPO “Pervyi Moskovskii gosudarstvennyi meditsinskii universitet im. I.M. Sechenova”, kafedra obshchei khirurgii,
e-mail: vkosinets@yandex.ru,
Kosinets Vladimir Aleksandrovich
Information about the authors:
Kosinets V.A., candidate of medical sciences, an applicant for Doctor’s degree of the chair of general surgery of I.M. Sechenov First Moscow State Medical University.
Shturich I.P., candidate of medical sciences, associate professor of the hospital surgery chair of EE “Vitebsk State Medical University”.
Ukrainets E.A., a head of the 1st surgical department of ME “Vitebsk regional clinical hospital”.

TO HELP THE PRACTITIONER

S.A. SUSHKOV

COMPRESSIVE THERAPY AT CHRONIC VENOUS INSUFFICIENCY

EE “Vitebsk State Medical University”,
The Republic of Belarus

The questions concerning the application of the compressive therapy at the lower limbs chronic venous insufficiency are comprehensively viewed in the article. Its role in complex treatment of patients with the given pathology is demonstrated. The mechanism of the compressive therapy action is described in details. The characteristics of the present facilities is also given that can be used for a permanent compressive therapy as well as concrete recommendations are formulated dealing with their application in various clinical cases. The application technique of elastic compressive dressings, special compressive bondages, compressive knitwear is described. The questions of application of a variable (intermittent) compression are also studied. Indications and contraindications for its application are formulated; the recommendations on the application regimens of pneumocompression in different clinical classes are given.
The compressive therapy is shown to be an effective, scientifically grounded and promissory method of chronic venous insufficiency treatment. A properly performed compressive therapy results in venous outflow improvement, regress of signs of the disease as well as in improvement of subjective sensations of patients. At present it is an integral part of chronic venous insufficiency complex therapy.

Keywords: chronic venous insufficiency, compressive therapy, compressive knitwear, intermittent compression
p. 105 – 117 of the original issue
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Address for correspondence:
210023, Respublika Belarus', g. Vitebsk, pr. Frunze, d. 27, UÎ “Vitebskii gosudarstvennyi meditsinskii universitet”, kafedra obshchei khirurgii,
e-mail: sergery@nm.ru,
Sushkov Sergei Al'bertovich
Information about the authors:
Sushkov S.A., candidate of medical sciences, àssociate professor, vice-rector on scientific research work of EE “Vitebsk State Medical University.
Contacts | ©Vitebsk State Medical University, 2007