This journal is
indexed in Scopus
XXVIII Ïëåíóì Ïðàâëåíèÿ Áåëîðóññêîé àññîöèàöèè õèðóðãîâ
«Àêòóàëüíûå âîïðîñû è ñîâðåìåííûå ïîäõîäû â îêàçàíèè
õèðóðãè÷åñêîé ïîìîùè â Ðåñïóáëèêå Áåëàðóñü»
18-19 íîÿáðÿ 2021 ãîäà â ã. Ìèíñê.
Year 2012 Vol. 20 No 5
A.N. DZIASHUK, P.V. GARELIK
PHOTODYNAMIC THERAPY OF EXPERIMENTAL ACUTE CHOLECYSTITIS
EE «Grodno State Medical University»,
the Republic of Belarus
Objectives. To evaluate the effectiveness of the photodynamic therapy in the treatment of acute cholecystitis in experi-ment.
Methods. Acute phlegmonic cholecystitis was simulated in 18 laboratory animals (rabbits). Three groups were determined. In the 1st group (control one, 6 animals) an acute phlegmonic cholecystitis was modeled, treatment was not carried out. In the 2nd group (experimental one, 6 ani-mals) in two days after acute cholecystitis modeling, Ñhlorophyllipt solution was injected into the gallbladder without consequent low-intensity laser radiation. In the 3rd group (experimental one, 6 animals) in two days after acute cholecystitis modeling, Ñhlorophyllipt solution was injected into the gallbladder and in 10 minutes low-intensity laser radiation was applied. Clinical course was estimated, general and biochemical blood tests indexes as well as bacteriological, microscopic indexes of the gallbladder content were studied. Morphological analysis was carried out in case of animals’ death in the control group and in case of excluding from the experiment in the experimental groups.
Results. A severe form of acute phlegmonic cholecystitis transforming into a destructive one with a widespread diffuse peritonitis was developing in animals, which was the cause of animals’ death in the control group of animals which hadn’t been treated. In the experimental groups a positive dynamics was registered, which was most pronounced in the rabbits treated with photodynamic therapy (PDT): acute process was stopped faster in the gallbladder wall, there was no tendency of a chronic form development with sclerotic changes; in the laboratory data general and biochemical blood tests stabilization and decrease of bacterial and leukocytes contamination of the bile was faster than in the group without PDT.
Conclusions. Application of local intravesical photodynamic therapy of acute phlegmonic cholecystitis results in the marked relief of the inflammatory process in the gallbladder of rabbits and prevents its transition into destructive and chronic forms.
1. Vetshev PS, Shkrob OS, Bel'tsevich DG. Zhelchnokamennaia bolezn' [Cholelithiasis]. Moscow, RF: Med. gaz; 1998. 192 p.
2. Bandettini L, Magrini L, Nesi S, Marranci M, Mori S, Pace M. Etiopathogenic, diagnostic and therapeutic problems apropos of 2 observations of acute acalculous cholecystitis. Ann Ital Chir. 1997 May-Jun;68(3):361–72; discussion 372–74. [Article in Italian]
3. Ermolov AS, Upyrev AV, Ivanov PA. Khirurgiia zhelchnokamennoi bolezni: ot proidennogo k nastoiashchemu [Surgery of gallstones: from the past to the present]. Khirurgiia. 2004;(5):4–9.
4. Simopoulos C, Botaitis S, Polychronidis A, Tripsianis G, Karayiannakis AJ. Risk factors for conversion of laparoscopic cholecystectomy to open cholecystectomy. Surg Endosc. 2005 Jul;19(7):905–9.
5. Garelik PV, Dubrovshchik OI, Deshuk AN, Mileshko MI. Sovremennye tekhnologii lecheniia ostrogo kholetsistita [Modern technologies of treatment of acute cholecystitis]. Khirurgiia Vostoch Evropa. 2012;(1):14–20.
6. Dziashuk A, Dovnar I, Koleshko S. Percutaneous transhepatic sanative-decompression puncture of the gallbladder under ultrasound induction in purulent cholecystitis. Polish Journal of Surgery. 2011;(1):69–70.
7. Tolstykh PI, Koraboev UN, Shekhter AB, Tolstykh MP, Stranadko EF, Radzhabov AA, Usmanov DN. Eksperimental'noe obosnovanie primeneniia fotodinamicheskoi terapii dlia lecheniia gnoinykh ran [Experimental substantiation
of photodynamic therapy use for the treatment of septic wounds]. Lazer Meditsina. 2001;5:8–13.
8. Ishchuk AV, Leonovich SI. Ispol'zovanie fotodinamicheskoi terapii lazernym apparatom «Rodnik-1» s fotosensibilizatorom «khlorofillipt» v lechenii gnoinykh ran i troficheskikh iazv nizhnikh konechnostei [The use of photodynamic therapy by laser device "Rodnik-1" with a photosensitizer "Hlorofillipt" in the treatment of infected wounds and trophic ulcers of the lower extremities]. Novosti Khirurgii. 2008;16(1):44–54.
9. Kumova IV, Zhuk IG, Bragov MIu. Vliianie NILI i FDT na zazhivlenie tolstokishechnogo anastomoza v usloviiakh posleoperatsionnogo kalovogo peritonita [Effect of LILR and PDT on the healing of colonic anastomosis in postoperative fecal peritonitis]. Zhurn GrGMU. 2007;(3):58–61.
10. Kumova IV, Zhmakin AI, Zhuk IG. Mikrobiologicheskoe obosnovanie effektivnosti primeneniia fotodinamicheskoi terapii v kolorektal'noi khirurgii [Microbiological substantiation of the effectiveness of photodynamic therapy in colorectal surgery]. Med Zhurn. 2007;(1):58–60.
11. Ushkevich AL, Zhandarov KN, Prokopchik NI. Fotodinamicheskaia terapiia v lechenii ostrogo destruktivnogo pankreatita, parapankreatita v eksperimente [Photodynamic therapy in the treatment of acute destructive pancreatitis, parapancreatitis in experiment]. Novosti Khirurgii. 2010;18(5):12–19.
230009, Respublika Belarus, g. Grodno, ul. Gorkogo, 80, UO «Grodnenskiy gosudarstvennyiy meditsinskiy universitet», kafedra obschey khirurgii,
Deshuk Anatoliy Nikolaevich
Dziashuk A.N. Post-Graduate Student of the Department of General Surgery of EE "Grodno State Medical University."
Garelik P.V. Doctor of Medical Sciences, Professor, Head of the Department of General Surgery of EE "Grodno State Medical University."
GENERAL AND SPECIAL SURGERY
A.A. ZIANKOU1,2, YU. P. OSTROVSKIJ3,4
IMMEDIATE RESULTS OF THE FULL MINIMALLY INVASIVE MYOCARDIUM REVASCULARIZATION
ME “Vitebsk Regional Clinical Hospital” 1,
EE “Vitebsk State Medical University” 2,
SE RSPC “CardiologY” 3,
SEE “Belarusian Medical Academy of Postgraduate Education” 4,
THE Republic of Belarus
Objectives. To estimate immediate results of the proposed strategy of the full minimally invasive myocardium revascularization (MIMR) at the multiple lesions of the coronary arteries.
Methods. From 2011 up to 2012 at the cardiac surgery department of ME “Vi-tebsk regional clinical hospital” 71 patients with the ischemic heart disease underwent full MIMR at the multiple lesions of coronary arteries. The proposed strategy of the MIMR was directed to avoid artificial cardiopulmonary bypass and manipulations on the ascending aorta, usage of the left minithoracotomy access and tendency to perform functionally adequate arterial revascularization of the left ventricle. Revascularization index composed 2,5. 68 patients underwent composite-sequential grafting without involving aorta; 3 patients – coronary artery bypass grafting. Full arterial revascularization was performed in 49 (69,0%) cases, in 7 (9,9%) cases – hybrid MIMR with a complete arterial revascularization of the left ventricle. In 2 (2,8%) patients the pump-assisted beating heart approach was employed during the part of the main operation stage.
Results. There were no lethal outcomes in the researched group of patients. Immediate results of the MIMR showed a low rate of the perioperative complications (bleeding, arrhythmia and infection) and they are associated with short period of ICU – stay and reduced hospital length of stay.
The development of complications during the early postoperative period hasn’t been established to depend reliably on the patient’s age, number of the affected and grafted coronary arteries, the ejection fraction of the left ventricle, the presence of the affection of the left coronary artery trunk, multifocal atherosclerosis, diabetes mellitus, heart failure and arrhythmia.
Conclusions. The worked out method of the MIMR allows achieving complete myocardial revascularization, improving early postoperative period; it is associated with a small number of complications and is effective and safe in high-risk patients.
1. Calafiore AM, Angelini GD, Bergsland J, Salerno TA. Minimally invasive coronary artery bypass grafting. Ann Thorac Surg. 1996 Nov;62(5):1545–58.
2. Jansen EW, Borst C, Lahpor JR, Grundeman PF, Eefting FD, Nierich A, Robles de Medina EO, Bredee JJ. Coronary artery bypass grafting without cardiopulmonary bypass using the octopus method: results in the first one hundred patients. J Thorac Cardiovasc Surg. 1998 Jul;116(1):60–7.
3. Angelini GD, Wilde P, Salerno TA, Bosco G, Calafiore AM. Integrated left small thoracotomy and angioplasty for multivessel coronary artery revascularisation. Lancet. 1996 Mar 16;347(9003):757–58.
4. Voutilainen S, Verkkala K, Jarvinen A, Kaarne M, Keto P, Voutilainen P, Mattila S. Minimally invasive coronary artery bypass grafting using the right gastroepiploic artery. Ann Thorac Surg. 1998 Feb;65(2):444–48.
5. Subramanian VA, Patel NU. Transabdominal mimially invasive direct coronary artery bypass grafting (MIDCAB). Eur J Cardiothorac Surg. 2000 Apr;17(4):485–87.
6. McGinn JT Jr, Usman S, Lapierre H, Pothula VR, Mesana TG, Ruel M. Minimally invasive coronary artery bypass grafting: dual-center experience in 450 consecutive patients. Circulation. 2009 Sep 15;120(11 Suppl):S78–84.
7. Lancey RA, Soller BR, Vander Salm TJ. Off-pump versus on-pump coronary artery bypass surgery: a case-matched comparison of clinical outcomes and costs. Heart Surg Forum [Electronic resourse]. 2000;3(Issue 4):277–81. Mode of access: http://www.hsforum.com. Date of access: 14.07.2012.
8. Straka Z, Widimsky P, Jirasek K, Stros P, Votava J, Vanek T, Brucek P, Kolesar M, Spacek R. Off-pump versus on-pump coronary surgery: final results from a prospective randomized study PRAGUE-4. Ann Thorac Surg. 2004 Mar;77(3):789–93.
9. Angelini GD, Taylor FC, Reeves BC, Ascione R. Early and midterm outcome after off-pump and on-pump surgery in Beating Heart Against Cardioplegic Arrest Studies (BHACAS 1 and 2): a pooled analysis of two randomised controlled trials. Lancet. 2002 Apr 6;359(9313):1194–99.
210037, Respublika Belarus, g. Vitebsk, ul. Voinov-internatsionalistov, d. 37, UZ «Vitebskaya oblastnaya klinicheskaya bolnitsa», otdelenie kardiokhirurgii,
Zenkov Aleksandr Aleksandrovich
Ziankou A.A. Candidate of Medical Sciences, Head of Cardiac Surgery Chair of ME ”Vitebsk Regional Clinical Hospital”, Associate Professor of the Surgery Chair of the Faculty of Advanced Training and Staff Retraining of EE “Vitebsk State Medical University”.
Ostrovskij YU. P. Corresponding member of National Academy of Sciences, Doctor of Medical Sciences, Professor, Head of Laboratory of Cardiac Surgery of SE RSPC “Cardiology”, Head of Cardiac Surgery Chair of SEE “Belarusian Medical Academy of Postgraduate Education."
G. A. BLUVSHTEIN, V.V. GREKOV
COMPILCATIONS IN MORPHOLOGICAL DIAGNOSTICS OF THE THYROID GLAND DISEASES
State Budgetary Educational Establishment of Higher Professional Education “Saratov State Medical University named after V.I.Rasumovsky”, Saratov,
The Russian Federation
Objectives. To study sensitivity, accuracy and specificity of pre- and intraoperative cytological examination of the nodular goiter, and also the reasons of false positive and false negative results of the cytological examination.
Methods. The results analysis of surgical treatment of 933 patients with different forms of nodular goiter for a 3-year period (2007-2009) was carried out. Data of the fine needle aspiration biopsies and intraoperative cytological examination were compared with the results of histological examination of the operative mate-rial.
Results. Preoperative cytological examination appeared to be informative in 915 cases out of 933 or in 98,1%. The application of the preoperative complex as well as intraoperative cytological examination permitted to determine correctly the character of the thyroid gland lesion, its morphological form and on the basis of these data to choose an adequate volume of the operation in 94,6% of observations. False positive results of the cytological conclusions on the thyroid gland cancer were in 22 patients (2,3%), false negative results were in 29 patients (3,1%).Intraoperative cytologi-cal examination of the touch smears permitted to improve diagnostics results and to verify the malignant tumor in 16 more patients with the thyroid gland cancer. Coincidence of the data of pre- and intraoperative diagnostics with postoperative planned histological examination composed 91,1% at the thyroid gland cancer, 86,8% – at the nodular colloid goiter, 54,2% – at autoimmune thyroiditis.
Conclusions. The performed research certified that up to present one has faced difficulties in the preoperative verification of the nodular growths of the thyroid gland. There are no special techniques permitting to exclude the malignant nodular tumor growth before the operation absolutely certainly.
Complex application of the preoperative fine needle aspiration biopsy with the consequent obligatory intraoperative cytological examination contributed to the improvement of diagnostics quality of the nodular goiter and permitted to choose an optimal type and volume of the operation.
1. Dedov II, Troshina EA, Iushkov PV, Aleksandrova GV. Diagnostika i lechenie uzlovogo zoba [Diagnosis and treatment of nodular goiter]. Petrozavodsk, RF; 2003. 64 p.
2. Vorob'ev SL, Zaitseva IV, Matveeva ZS. Informativnost' kriteriev tsitologicheskoi diagnostiki novoobrazovanii shchitovidnoi zhelezy [The informative value of the criteria of cytological diagnostics of tumors of the thyroid gland]. Vestn Khirurgii im II Grekova. 2007;(2):62–64.
3. Valdina EA. Zabolevaniia shchitovidnoi zhelezy [Thyroid diseases]. Moscow, RF; 1993. 223 p.
4. Cap J, Ryska A, Rehorkova P, Hovorkova E, Kerekes Z, Pohnetalova D. Sensitivity and specificity of the fine needle aspiration biopsy of the thyroid: clinical point of view. Clin Endocrinol (Oxf). 1999 Oct;51(4):509–15.
5. Tolstokorov AS, Ershova GI. Punktsionnye metody diagnostiki i lecheniia zabolevanii shchitovidnoi zhelezy [Puncture methods of diagnosis and treatment of thyroid diseases]. Annaly Khirurgii. 2007;(5):18–21.
6. Khmel'nitskii OK. Tsitologicheskaia i gistologicheskaia diagnostika zabolevanii shchitovidnoi zhelezy [Cytological and histological diagnosis of thyroid diseases]. Saint-Petersburg, RF: Sotis; 2002. 287 p.
7. Kononenko SN. Khirurgicheskaia taktika pri dobrokachestvennykh uzlovykh obrazovaniiakh shchitovidnoi zhelezy [Surgical approach for benign thyroid nodules]. Khirurgiia. 2001;(11):24–27.
8. Grineva EN, Malakhova TV, Goriushkina EV. Rol' tonkoigol'noi aspiratsionnoi biopsii v diagnostike uzlovykh obrazovanii shchitovidnoi zhelezy [The role of fine-needle aspiration biopsy in the diagnosis of thyroid nodules]. Problemy Endokrinologii . 2005;51(1):10–15.
9. Ershova GI. Puti uluchsheniia diagnostiki raka shchitovidnoi zhelezy [The method to improve the diagnosis of thyroid cancer]. Khirurgiia Zhurn im NI Pirogova. 2004;(12):47–49.
10. Beloborodov VA, Olifirova OS, Shevchenko SP, Saaia AT, Man'kovskii VA, Eselevich OV, Modin RV. Dooperatsionnaia tsitologicheskaia diagnostika uzlovykh obrazovanii shchitovidnoi zhelezy [Preoperative cytological diagnosis of thyroid nodules]. Annaly Khirurgii. 2007;(3):29–32.
11. Dedov II, Mel'nichenko GA, Fadeev VV, Gerasimov GA, Vetshev PS, Grineva EN, Kuznetsov NS, Vanushko VE, Bel'tsevich DG, Sviridenko NIu, Troshina EA, Petunina NA, Mazurina NV, Garbuzov PI, Rumiantsev PO, Il'in AA, Artemova AM. Klinicheskie rekomendatsii Rossiiskoi assotsiatsii endokrinologov po diagnostike i lecheniiu uzlovogo zoba [Clinical recommendations of Russian Association of Endocrinologists on the diagnosis and treatment of nodular goiter]. Problemy Endokrinologii. 2005;51(5):40–42.
12. Rosari J, Carcangue ML, de Lelis RA. Tumors of the thyroid gland. Washington, US; 1992. 343 p.
13. Kalinin AP, Maistrenko NA, Vetsheva PS, red. Khirurgicheskaia endokrinologiia: ruk [Surgical Endocrinology: A Guide]. Saint-Petersburg: Piter, RF; 2004. 960 p.
14. Korenev SV, Pleshkov VG, Tugai VV. Osobennosti dooperatsionnoi diagnostiki raka shchitovidnoi zhelezy [Features of the pre-operative diagnosis of thyroid cancer]. Ros Med Zhurn. 2005;(3):13–16.
15. Aleksandrov IuK. Punktsionnye metody v diagnostike i lechenii zabolevanii shchitovidnoi zhelezy [Puncture methods in the diagnosis and treatment of thyroid diseases]. Iaroslavl', RF: Diabet, RF; 1996. 108 p.
410012, Rossiyskaya Federatsiya, g. Saratov, ul. Bolshaya Kazachya, d. 112. GBOU VPO «Saratovskiy gosudarstvennyiy meditsinskiy universitet im. V.I. Razumovskogo», kafedra fakultetskoy khirurgii i onkologii,
Grekov Vladimir Vladimirovich
Grekov V.V. Assistant of the Faculty Surgery and Oncology Chair of SBEE HPE “Saratov State Medical University named after V.I.Rasumovsky”.
Bluvshtein G. A. Doctor of Medical Sciences, Professor, Head of the Faculty Surgery and Oncology Chair of SBEE HPE “Saratov State Medical University named after V.I.Rasumovsky”.
CHOICE OF HERNIOPLASTY METHOD AND ALGORITHM OF POSTOPERATIVE TREATMENT OF PATIENTS WITH VENTRAL HERNIAS
State Budgetary Educational Establishment of Higher Professional Education “Smolensk State Medical Academy”
The Russian Federation
Objectives. To improve the treatment results of patients with ventral hernias by individualization of treatment tactics on the basis of ultrasonic investigation of the structure and blood supply specialties of the anterior abdominal wall.
Methods. The research included 107 subjects, who have been operated on (planned hernioplasty with polypropylene mesh). The operated were divided into two groups. The main group enumerated 50 patients, the control one – 57. Treatment tactics of the control group patients was conventional. Ultrasonic tomography of the abdominal wall was carried out additionally in the main group of patients in the preoperative period; its results were used to individualize the operative intervention choice. In the postoperative period ultrasonic monitoring of the postoperative wound was used. The results of surgical treatment in the main and control groups were assessed at the early postoperative period; the character of postoperative course was analyzed as well as the number of complications.
Results. Postoperative complications in the main group developed in 5 (10%) subjects: seroma formation – in 3 (6%) cases, postoperative wound infiltration – in 2 (4%) cases. Postoperative complications in the control group were revealed in 8 (14,04%) subjects. Postoperative wound infection was revealed in 1 (1,75%) case, fistula formation – 1 (1,75%) case, seroma formation – 5 (8,8%) subjects, postoperative wound infiltration – in 3 (5,3%) cases.
In 8 (16%) observations in the main group according to ultrasound investigation we managed to reveal timely the pathological changes in the transplant zone; it permitted to foresee possibility of development of local complications and to perform effective conservative procedures.
Conclusions. The research has proved the efficacy of usage of ultrasonography in diagnostic and treatment of patients with ventral hernias. Ultrasonic methods permit to individualize the choice of hernioplasty method, to objectify the control of the wound process course, to foresee development of complications in the postoperative wound and to perform their timely correction.
1. Timoshin AD, Shestakov AL, Iurasov AV. Khirurgicheskoe lechenie pakhovykh i posleoperatsionnykh gryzh briushnoi stenki [Surgical treatment of inguinal hernias and postoperative abdominal wall]. Moscow, RF: Triada-Kh; 2003. 144 p.
2. Sazhin VP, Klimov DE, Sazhin IV, Nuzhdikhin AV, Gareski R. Nenatiazhnaia plastika perednei briushnoi stenki pri ushchemlennykh posleoperatsionnykh ventral'nykh gryzhakh [Tension -free plasty of abdominal wall with postoperative strangulated ventral hernia]. Khirurgiia Zhurn im II Pirogova. 2009;(7):4–6.
3. Shulutko AM, Zubtsov VIu, Shvachko SA, Dudov EKh. Ispol'zovanie polipropilenovykh setchatykh protezov v lechenii ushchemlennykh gryzh briushnoi stenki [The use of polypropylene mesh prosthesis in the treatment of strangulated hernias of the abdominal wall]. Ros Med Zhurn. 2008;(5):12–14.
4. Abdurakhmanov IuKh, Popovich VK, Dobrovol'skii SR. Kachestvo zhizni bol'nykh posleoperatsionnoi ventral'noi gryzhei v otdalennom periode [Quality of life in patients with postoperative ventral hernia in the late period]. Khirurgiia Zhurn im II Pirogova. 2010;(7):17–18.
5. Iurasov AV. Vybor metoda plastiki posleoperatsionnykh ventral'nykh gryzh [The choice of plasty method in postoperative ventral hernias]. Annaly Khirurgii. 2001;(6):65–68.
6. Adamian AA, Gogiia BSh, Aliautdinov RR, Kopyl'tsov AA. Lechenie bol'nykh s pupochnymi gryzhami i gryzhami beloi linii zhivota [Treatment of patients with umbilical hernias and white line abdominal hernias]. Annaly Plast Rekonstrukt i Estet Khirurgii. 2006;(4):35–36.
7. Forte A, Zullino A, Manfredelli S, Montalto G, Bezzi M. Incisional hernia surgery: report on 283 cases. Eur Rev Med Pharmacol Sci. 2011;15(6):644–48.
8. Halm JA, Lip H, Schmitz PI, Jeekel J. Incisional hernia after upper abdominal surgery: a randomised controlled trial of midline versus transverse incision. Hernia. 2009;13(3):275–80.
9. Han JG, Ma SZ, Song JK, Wang ZJ. Operative treatment of ventral hernia using prosthetic materials. Hernia. 2007;(11):419–23.
10. Hawn MT, Snyder CW, Graham LA, Gray SH, Finan KR, Vick CC Long-term follow-up of technical outcomes for incisional hernia repair. J Am Coll Surg. 2010;210(5):648–55.
11. Voilenko VN, Medelian AI, Omel'chenko VM. Atlas operatsii na briushnoi stenke i organakh briushnoi polosti [Atlas of operations on the abdominal wall and the abdominal organs] Elektronnyi resurs]. Rezhim dostupa: http://www.uroweb.ru. Data dostupa: 29.09.2011.
12. Borsukov AV, Narezkin DV, Markova IaA; Smolen gos med akad, zaiavitel'. Sposob otsenki krovotoka v arteriiakh perednei briushnoi stenki [The method to assess the arterial blood flow of the anterior abdominal wall]: pat 2408274 RF, MPK A61V 8/06; ¹2009126108/14; zaiavl. 07.07.2009; opubl. 10.01.2011. Biul;(1):7.
13. Borsukov AV, Narezkin DV, Markova IaA; Smolen gos med akad, zaiavitel'. Sposob vybora metoda plastiki posleoperatsionnykh i retsidivnykh ventral'nykh gryzh [The choice of plasty method for the postoperative and recurrent ventral hernias]: pat. 2408273 RF, MPK A61V 8/06; ¹ 2009122762/14; zaiavl. 15.06.2009; opubl. 10.01.2011. Biul;(1):11.
14. Borsukov AV, Narezkin DV, Markova IaA, Kazakova OP; Smolen gos med akad, zaiavitel'. Sposob vybora taktiki posleoperatsionnogo lecheniia u bol'nykh ventral'nymi gryzhami posle gernioplastiki setchatym transplantatom [The method of choosing the tactic of treatment in patients with postoperative ventral hernias after herniaplasty by mesh graft]: pat. 2405441 RF, MPK A61V 8/06; ¹ 2009122760/14; zaiavl. 15.06.2009; opubl. 10.12.2010. Biul;(34):13.
214001, Rossiyskaya Federatsiya, g. Smolensk, ul. Frunze, d. 40, GBOU VPO «Smolenskaya gosudarstvennaya meditsinskaya akademiya» kafedra fakultetskoy khirurgii,
Markova Yana Anatolevna
Markova A.A. intramural post-graduate student of the faculty surgery chair of SBEE HPE “Smolensk state medical academy”.
M.V. KUKOSH, A.V. VLASOV, G.I. GOMOZOV
PREVENTION OF EARLY POSTOPERATIVE COMPLICATIONS AT ENDOPROSTHESIS OF VENTRAL HERNIAS
State Budgetary Educational Establishment of Higher Professional Education “Nizhny Novgorod State Medical Academy”,
The Russian Federation
Objectives. To analyze the early postoperative complications at the endoprosthesis of ventral hernias.
Methods. The treatment results of 245 patients with ventral hernias, who were operated on using mesh synthetic endoprostheses are presented. Endoprosthesis fixation in the position “on-lay” was performed in 220 (90%) patients, in the position “sub-lay” – in 21 (9%), in the position “in-lay” in 4 (1%). To prevent the wound complications using the “on-lay” and “in-lay” methods in the main group (n=122) aponeurosis was sewed on and fixed with the vertical P- stitches to the prosthesis and the bottom of the wound. The wound drainage was performed in 4 patients (3,3%). In the control group (n=102) we carried out drainage and wound layer-wise stitch without wide taking and fixation of subcutaneous tissue. Drainage was made in 83 patients (81,4%).
Results. The application of the postoperative wound closure technique, at which wide taking and fixation of subcutaneous tissue to the prosthesis and the bottom of the wound by means of the vertical P- stitches as well as limiting of indications to the wound drainage has decreased the incidence of complications at the early postoperative period. In the main group the formation of clinically significant fluid accumulations was observed in 9 (7,4%) patients; in the control group – in 28 (27,5%) patients. Differences are statistically significant (p<0,001).
Conclusions. The main reasons of formation of fluid accumulations in the wound at endoprosthesis are the mobilization of subcutaneous tissue with vascular trauma, formation of “dead space”, absence of fixation and snug fit of tissue to the synthetic prosthesis. Wide taking and fixation of subcutaneous tissue to prosthesis and bottom of the wound with the help of vertical P- stitches according to “on-lay” and “in-lay” methods let us reduce the incidence frequency of clinically significant fluid accumulations at the early postoperative period.
1. Usov SA, Nosov VG. Problema infektsionnykh oslozhnenii alloplastiki intsizionnykh gryzh briushnoi stenki: obzor zarubezhnoi literatury poslednego desiatiletiia [The problem of infectional complications of alloplasty of incisional abdominal wall hernias: a review of world literature of the recent decade]. Biul VSNTs SO RAMN. 2006;6:221–25.
2. Egiev VN, Chizhov DV, Filatkina NV. Vzaimodeistvie polipropilenovykh endoprotezov s tkaniami perednei briushnoi stenki [Interaction of polypropylene implants with tissue of abdominal wall]. Gerniologiia. 2005;(2):41–49.
3. Slavin LE, Fedorov IV, Sigal EI. Oslozhneniia khirurgii gryzh zhivota [Complications of abdominal hernia surgery]. Moscow, RF: Profil'; 2005. 174 p.
4. Fedorov IV, Chugunov A.N. Protezy v khirurgii gryzh: stoletniaia evoliutsiia [Prostheses in hernia surgery: centenary evolution]. Gerniologiia. 2004;(2):45–53.
5. Flament J, Palot J-P, Burde A, Delattre JF, Avisse C. Treatment of major incisional hernias. In: Bendavid R, Abrahamson J, Arregui ME, Flament JB, Philllips EH, eds. Abdominal Wall Hernias Principles and Management. New York, US: Springer-Verlag; 2001. p. 508–16.
6. Samoilov AV, Ovcharnikov AN. Proteziruiushchaia ventroplastika v onlay tekhnike [Prosthetic ventroplasty in onlay technique]. Gerniologiia. 2006;(2):11–13.
7. Galkin VN, Zheveliuk AG, Shmushkevich TB. K voprosu o lechenii serom pod UZ-kontrolem pri alloplastike perednei briushnoi stenki [Some aspects of the treatment of seromas under US-control in abdominal wall alloplasty]. Gerniologiia. 2008;(3):17–19.
603001, Rossiyskaya Federatsiya, g. Nizhniy Novgorod, ul. Nizhne-Volzhskaya nab. 1/1, GBOU VPO «Nizhegorodskaya gosudarstvennaya meditsinskaya akademiya», kafedra fakultetskoy khirurgii,
Vlasov Aleksandr Viktorovich
Kukosh M.V. Doctor of Medical Sciences, Professor, Head of the Faculty Surgery Chair of SBEE HPE “Nizhny Novgorod State Medical Academy”.
Vlasov A.V. Assistant of the Faculty Surgery Chair of SBEE HPE “Nizhny Novgorod State Medical Academy”.
Gomozov G.I. Candidate of Medical Sciences, Head Doctor of SBME ND “City Clinical Hospital ¹7”, Associate Professor of the Faculty Surgery Chair of SBEE HPE “Nizhny Novgorod State Medical Academy”.
A.T.SHASTNY 1, E. MATEVOSSIAN 2, D. DOLL 3
COMPARATIVE ASSESSMENT OF OPERATIVE TREATMENT RESULTS IN PATIENTS WITH CHRONIC PANCREATITIS AFTER BEGER’S OPERATION IN THE MODIFICA-TION OF THE CLINIC AND THE BERNE VARIANT OF BEGER’S OPERATION
EE “Vitebsk State Medical University”1,
The Republic of Belarus
Technical University of Munich 2, Munich,
Philipps-University of Marburg 3, Marburg,
Objectives. To analyze the results of two variants of duodenum-saving resection of the pancreas head with the traverse (Beger’s operation in the modification of the clinic) and without traverse (the Berne variant of Beger’s operation) of the pancreas over the portal vein in patients with chronic pancreatitis.
Methods. 82 patients are involved in the prospective research. Operative interventions were carried out in the period from 2008 up to 2011. Beger’s operation in our modification was performed in 39 (47,5%) patients, in 43 – the Berne variant of Beger’s operation. While carrying out the comparative analysis we assessed the following: duration of the operation, incidence of the postoperative com-plications, length of hospitalization, quality of patient’s life and pain syndrome severity.
Results. Comparative analysis of the operative results after Beger’s operation in the modification of the clinic and the Berne variant of Beger’s operation showed the lack of reliable differences in such parameters as duration of the operation, volume of intraoperative hemotransfusion and length of the in-patient treatment. Statistically significant improvement of the parameters of the life quality was registered after Beger’s operation in the modification of the clinic if compared with the preo-perative period in the following parameters: physical functioning, pain severity, role functioning conditioned by the physical state, life activity, general health, social functioning, psychic health and pain level value according to VAS.
Conclusions. The results of the prospective research prove that duodenum-saving resection of the pancreas head permits to achieve high professional rehabilitation in patients with chronic pancreatitis in the distant postoperative period. Duodenum-saving operations improve the quality of life in the postoperative period due to elimination of pain and obstructive complications of chronic pancreatitis and they are comparable with each other in the distant results. Beger’s operation in the modification of the clinic is more preferable in case of large size of the pancreas head and if pseudo aneurism and portal hypertension are present.
1. Singer MV, Gyr K, Sarles H. Second symposium on the classificationof pancreatitis; 28–30 March; Marseilles, 1984. Acta Gastroenterol Belg. 1985 Nov-Dec;48(6):579–82. [Article in French]
2. Otsuki M. Chronic pancreatitis. The problems of diagnostic criteria. Pancreatology. 2004;4(1):28–41.
3. Sarles H. Classification and definition of pancreatitis. Marseilles-Rome 1988. Gastroenterol Clin Biol. 1989;13(11):857–59. [Article in French]
4. Schlosser W, Schwarz A, Beger HG. Surgical treatment of chronic pancreatitis with pancreatic main duct dilatation: long term results after head resection and duct drainage. HPB (Oxford). 2005;7(2):114–19.
5. Traverso LW, Kazarek RA. Pancreatoduodenectomy for chronic pancreatitis: anatomic selection criteria and subsequent long-term outcome analysis. Ann Surg 1997Oct;226(4):429–35; discussion 435–38.
6. Beger H, Krautzberger W, Bittner R, Buchler M, Limmer J. Duodenum-preserving resection ofthehead of the pancreas in patients with severe chronic pancreatitis. Surgery, 1985 Apr;97(4):467–73.
7. Beger HG, Gansauge F, Schwarz M, Poch B. Chronic pancreatitis: inflammatory mass in the head of the pancreas pacemakerof chronic pancreatitis. In: Diseases of the pancreas. 2008. p. 311–17.
8. Beger HG, Rau BM, Gansauge F, Poch B. Duodenum-preserving subtotal and total pancreatic head resections for inflammatory and cystic neoplastic lesions of the pancreas. J Gastrointest Surg. 2008. Jun;12(6):1127–32.
9. Koniger J, Friess H, Muller M, Wirtz M, Martignioni M, Buchler M. Duodenum-preserving pancreas head resection- an operative technique for retaining the organ in the treatment of chronic pancreatitis. Chirurg. 2004 Aug;75(8):781–8. [Article in German]
10. Lankisch PG. Natural course of chronic pancreatitis. Pancreatology. 2001;1(1)3–14.
11. Lankisch PG, Seidensticker F, Lohr-Happe A, Otto J, Creutzfeldt W.The course of pain is the same in alcohol- and nonalcohol-induced chronic pancreatitis. Pancreas. 1995 May;10(4):338–41.
12. Layer P, Yamamoto H, Kalthoff L, Clain JE, Bakken LJ, DiMagno EP. The different courses of early- and late-onset idiopathic and alcoholic chronic pancreatitis. Gastroenterology. 1994 Nov;107(5):1481–87.
13. Gloor B, Friess H, Uhl W, Buchler MW. A modified technique of the Beger and Frey procedure in patients with chronic pancreatitis. Dig Surg. 2001;18(1):21–25.
14. Izbicki JR, Yekebas EF, Strate T, Eisenberger CF, Hosch SB, Steffani K, Knoefel WT. Extrahepatic portal hypertension in chronic pancreatitis: an old problem revisited. Ann Surg. 2002 Jul;236(1):82–9.
15. Beger HG, Schlosser W, Friess HM, Buchler MW. Duodenum-preserving head resection in chronic pancreatitis changes the natural course of the disease: a single-center 26-year experience. Ann Surg. 1999 Oct;230(4):512–19; discussion 519–23.
16. Buchler MW, Friess H, Muller MW, Wheatley AM, Beger HG. Randomized trial of duodenum-preserving pancreatic head resection versus pylorus-preserving Whipple in chronic pancreatitis. Am J Surg. 1995 Jan;169(1):65–9; discussion 69–70.
17. Klempa I, Spatny M, Menzel J, Baca I, Nustede R, Stockmann F, Arnold W. Pancreatic function and quality of life after resection of the head of the pancreas in chronic pancreatitis. A prospective, randomized comparative study after duodenum preserving resection of the head of the pancreas versus Whipple's operation. Chirurg. 1995 Apr;66(4):350–59. [Article in German]
18. Muller MW, Friess H, Martin DJ, Hinz U, Dahmen R, Buchler MW. Long-term follow-up of a randomized clinical trial comparing Beger with pylorus-preserving Whipple procedure for chronic pancreatitis. Br J Surg. 2008 Mar;95(3):350–56.
19. Witzigmann H, Max D, Uhlmann D, Geissler F, Ludwig S, Schwarz R, Krauss O, Lohmann T, Keim V, Hauss J. Quality of life in chronic pancreatitis: a prospective trial comparing classical whipple procedure and duodenum-preserving pancreatic head resection. J Gastrointest Surg. 2002 Mar-Apr;6(2):173–79; discussion 179–80.
210023, Respublika Belarus, g. Vitebsk, pr. Frunze, d. 27, UO «Vitebskiy gosudarstvennyiy meditsinskiy universitet», kafedra khirurgii FPK i PK,
Schastnyiy Anatoliy Tadeushevic
Shastny A.T. Candidate of Medical Sciences, Associate Professor of the Surgery Chair of the Faculty of Advaned Training and Staff Retraining of EE “Vitebsk State Medical University”.
Matevossian E. Privat docent, MD, Department of Surgery and Transplantation Clinic "Rehts der Isar" of the Technical University of Munich.
Doll D. Privat docent, MD, Department of Visceral, Vascular and Thoracic Surgery, Philipps-University of Marburg.
MORPHOLOGICAL CHANGES OF THE PRETERMINAL SECTION OF THE GREAT SAPHENOUS VEIN AT VARICOSE VEINS OF THE LOWER LIMBS
EE “Vitebsk State Medical University”
The Republic of Belarus
Objectives. To estimate the character of the morphological changes in the preterminal section of the great saphenous vein in different terms starting from the disease onset and in various forms of varicose veins.
Methods. Histological preparations of the removed great saphenous vein of 21 patients with the primary varicose veins of the C2-C6 (CEAP) clinical classes were studied. The examination was carried out by means of the light microscopy at magnification. The state of the venous wall and the character of the morphological changes, which were determined according to the severity of the prevailing pathological processes in the intima, media and adventitia, were estimated.
Results. Morphological structural disturbances in the preterminal section of the great saphenous vein were found out to be represented by the combination of elastolysis, atrophic and sclerotic changes, and hypertrophy involving all layers of the venous wall. On the basis of the pathological processes severity 3 nominal types of venous wall changes are singled out: with prevalence of sclerotic changes on the moderate hypertrophy background; with prevalence of atrophic changes and with marked hypertrophic changes. Severity of the connective tissue destruction, sclerotic changes and hypertrophy correlate with the main disease duration if a positive variant correlation is present in case of sclerosis-hypertrophy and a negative one in case of atrophy-sclerosis, atrophy-hypertrophy.
Conclusions. Pathological morphological changes in the preterminal section of the great saphenous vein are detected at early stages including minor forms of the disease. The most marked character of the connective tissue destruction is observed at early terms of the pathology development. While the disease is progressing, prevalence of the sclerotic changes and of hypertrophy is observed on the background of the severity reduction of the destructive processes of the connective tissue. The given changes show the systemic character of the vascular wall lesion at varicose veins and can predetermine the early character of failure development of the terminal valvular apparatus of the great saphenous vein in case of the given pathology.
1. Sansilvestri-Morel P, Rupin A, Badier-Commander C, Fabiani JN, Verbeuren TJ. Chronic venous insufficiency: dysregulation of Collagen Synthesis. Angiology. 2003 Jul-Aug;54(Suppl. 1):S13–8.
2. Pappas P, Duran W, Hobson R. Pathology and cellular physiology of chronic venous insufficiency. In: Handbook of venous disorders. Guidelines of American Venous Forum. Arnold, London–New York–New Deli; 2001. p. 58–67.
3. Pistorius MA. Chronic Venous Insufficiency: the Genetic Influence. Angiology. 2003 Jul-Aug;54(Suppl. 1):S5–12.
4. Jawien A. The Influence îf Environmental Factors in Chronic Venous Insufficiency. Angiology 2003 Jul-Aug;54(Suppl. 1):S19–31.
5. Stotter L, Schaaf I, Bockelbrink A. Comparative outcomes of radiofrequency endoluminal ablation, invagination stripping and cryostripping in the treatment of great saphenous vein insufficiency. Phlebology. 2006;21(2):60–64.
6. Cappelli M, Lova RM, Ermini S, Turchi A, Bono G, Bahnini A, Franceschi C. Ambulatory conservative hemodynamic management of varicose veins: critical analysis of results at 3 years. Ann Vasc Surg. 2000 Jul;14(4):376–84.
7. Maeso J, Juan J, Escribano J, Allegue NM, Di Matteo A, Gonzalez E, Matas M. Comparison of clinical outcome of stripping and CHIVA for treatment of varicose veins in the lower extremities. Ann Vasc Surg. 2001 Nov;15(6):661–65.
8. Bobrik II, Shevchenko EA, Cherkasov V.G. Razvitie krovenosnykh i limfaticheskikh sosudov [The development of blood and lymphatic vessels]. Kiev, Ukraina: Zdorov'ia; 1991. 207 p.
9. Allegra C, Bonifacio M, Carlissa A. Idiopathic venous insufficiency. Phlebolymphology. 1999;(10):5–8.
10. Vankov VN. Stroenie ven [The structure of the veins]. Moscow, RF: Meditsina; 1974. 207 p.
11. Aunapu M, Arend A. Hystopathological changes and expression of adhesion molecules and laminin in varicose veins. Vasa. 2005 Aug;34(3):170–75.
12. Wali MA, Dewan M, Eid RA. Hystopathological changes in the wall of varicose veins. Int Angiol. 2003 Jun;22(2):188–93.
13. Tsukanov IuT, Tsukanov AIu. Flebopatiia kak narushenie viazko-uprugikh svoistv stenki ven i faktory, vliiaiushchie na ee klinicheskoe techenie pri varikoznoi bolezni [Phlebopathy as a violation of a visco-elastic properties of the vein wall and the factors influencing on its clinical course in varicose veins]. Flebolimfologiia, 2003;(18):8–13.
14. Porto LC, da Silveira PR, de Carvalho JJ, Panico MD. Connective tissue accumulation in the muscle layer in normal and varicose saphenous veins. Angiology. 1995 Mar;46(3):243–9.
15. Stucker M, Krey T, Rochling A, Schultz-Ehrenburg U, Altmeyer P. The hystomorphologic changes at the saphenofemoral junction in varicosis of the greater saphenous vein. Vasa. 2000 Feb;29(1):41–6.
210023, Respublika Belarus, g. Vitebsk, pr-t Frunze, d. 27, UO «Vitebskiy gosudarstvennyiy meditsinskiy universitet», kafedra gospitalnoy khirurgii s kursami urologii i detskoy khirurgii
Krishtopov Andrey Leonidovich
Krishtopov A.L. Senior Lecturer of the Hospital Surgery with the Course of Urology and Pediatric Surgery Chair of EE “Vitebsk State Medical University”.
Myadelets O.D. Doctor of Medical Sciences, Professor, Head of the Histology, Cytology and Embryology Chair of EE “Vitebsk State Medical University”.
POSSIBILITIES OF REVASCULARIZATION OSTEOTREPANATION IN THE COMPLEX TREATMENT OF PURULENT-NECROTIC FORMS OF THE DIABETIC FOOT SYNDROME
EE “Vitebsk State Medical University”
The Republic of Belarus
Objectives. To assess the efficacy of the revascularization osteotrepanation (ROT) in the complex treatment of patients with purulent-necrotic forms of the diabetic foot syndrome (DFS).
Methods. We analyzed the treatment results of 24 patients with purulent-necrotic forms of DFS who underwent ROT according to the method of F.N.Zusmanovich (1996). The operation was carried out in case of contraindications for the method of the endovascular and direct revascularization. The critical ischemia was diagnosed according to the results of the ultrasound duplex angioscanning and angiography. To assess the impact of ROT on the lower limb blood supply the partial pressure of the oxygen and carbon dioxide was determined as well as the lactate content in the venous blood of the operated limb and the skin thermometry was also eva-luated.
Results. The ðÎ2 reading in the venous blood of the operated limb was found out to increase from 36,9 mm mercury (the interquartile mean (IQM) – 30,0-43, 0 mm mercury up to 38, 7 mm mercury (IQM – 33,0-47,3) in patients after complex treatment with ROT application. The lactate decrease was registered from 2,17 mmol/L (IQM – 2,12-2,42 mmol/L) up to 1,69 mmol/L (IQM 1,41-1,91 mmol/L). The ðÑÎ2 reading statistically reliably remained unchanged (ð=0,895). The skin temperature in the middle third of the shin of the operated limb increased from 28,13°Ñ (IQM 27,82-28,64°Ñ) up to 30,33°Ñ (IQM 29,23-31,78°Ñ). The resection operations on the foot permitting to save the sup-porting function of the limb were carried out in 81, 8% of patients in 5 months after the performed treatment.
Conclusions. Application of ROT in patients with the critical ischemia on the background of the purulent-necrotic forms of DFS leads to the blood supply improvement of the affected limb tissue as well as microcirculation enhancement and minimization of the presented metabolic disturbances; this increases the probability of the resection operations on the foot with saving the supportive function of the limb.
1. Dibirov MD, Briskin BS, Khamitov FF, Proshin AV, Iakobishvili IaI. Rol' rekonstruktivnykh sosudistykh operatsii u bol'nykh diabeticheskoi angiopatiei [The role of vascular reconstructive surgery in patients with diabetic angiopathy]. Khirurgiia Zhurn im NI Pirogova. 2009;(2):59–63.
2. Ignatovich IN, Kondratenko GG, Sergeev GA, Kornievich SN, Taganovich DA, Khrapov IM, Mikhailova NM. Vliianie revaskuliarizatsii na rezul'taty lecheniia khronicheskoi kriticheskoi ishemii pri neiropaticheskoi forme diabeticheskoi stopy [Effect of revascularization on the treatment outcomes of chronic critical ischemia in the neuropathic diabetic foot]. Angiologiia i Sosud Khirurgiia.2011;17(1):71–75.
3. Ferraresi R, Centola M, Ferlini M, Da Ros R, Caravaggi C, Assaloni R, Sganzaroli A, Pomidossi G, Bonanomi C, Danzi GB. Long-term outcomes after angioplasty of isolated, below-the-knee arteries in diabetic patients with critical limb ischaemia. Eur J Vasc Endovasc Surg. 2009 Mar;37(3):336–42.
4. Zelenov MA, Eroshkin IA, Kokov LS. Osobennosti angiograficheskoi kartiny u bol'nykh s sakharny diabetom s okkliuzionno-stenoticheskim porazheniem arterii nizhnikh konechnostei [Features of angiography in patients with diabetes mellitus and occlusive-stenotic lesion of the lower extremitie arteries]. Diagnost i Intervents Radiologiia. 2007;(2)22–29.
5. Ignatovich IN, Kondratenko GG, Kornievich SN, Taganovich DA, Shepel'kevich AP, Khrapov IM, Sergeev GA, Mikhailova NM. Angiorekonstruktsii i rezektsionnye operatsii na stope v lechenii kriticheskoi ishemii pri sindrome diabeticheskoi stopy [Foot angioreconstructions and resection operations in the treatment of critical ischemia at diabetic foot]. Novosti Khirurgii. 2010;18(4):49–56.
6. Shval'b PG, Kalinin RE, Suchkov IA, Baranov SV. Prichiny vtorichnykh amputatsii u bol'nykh s khronicheskoi kriticheskoi ishemiei nizhnikh konechnostei posle rekonstruktivnykh operatsii [The causes of secondary amputations in patients with chronic critical ischemia of the lower extremities after reconstructive surgery]. Novosti Khirurgii. 2010;18(1):41–45.
7. Troitskii AV, Lysenko ER, Khabazov RI, Orekhov PIu, Parshin PIu, Korolev VI, Ust'iantseva NV, Maliutina ED, Nishchenko AV. Rezul'taty rekonstruktivnykh operatsii u bol'nykh s porazheniem arterii goleni [The results of reconstructive surgery in patients with damage of the leg arteries]. Angiologiia i Sosud Khirurgiia. 2003;9(1):102–108.
8. Sukovatykh BS, Belikov LN, Shcherbakov AN, Magomedalieva KS, Pashkov DV, Kniazev VV. Eksperimental'noe i klinicheskoe obosnovanie revakuliariziruiushchei osteomioplastiki dlia lecheniia kriticheskoi ishemii nizhnikh konechnostei [Experimental and clinical grounds of revascularizing osteomyoplasty for treatment of critical ischemia of the lower extremities]. Vest Khirurgii im II Grekova. 2006;165(6):21–24.
9. Kliuchevskii VV, Sukhanov GA, Padalko LV. Modifikatsiia metodiki revaskuliariziruiushchei osteotrepanatsii [Modification of the method of revascularizing osteotrepanation]. Vest Khirurgii im II Grekova. 2008;(3):69–71.
10. Kosinets AN, Zen'kov AA. Sindrom diabeticheskoi stopy [Diabetic foot syndrome]. Vitebsk, RB: VGMU; 2003. 214 p.
11. Ignatovich IN, Kondratenko GG, Sergeev GA, Kornievich SN, Khrapov IM. Rezul'taty lecheniia patsientov s khronicheskoi kriticheskoi ishemiei pri neiroishemicheskoi forme sindroma diabeticheskoi stopy [The results of treatment of chronic critical ischemia by neuroischemic form of the diabetic foot]. Khirurgiia. Zhurn im NI Pirogova. 2011;(6):51–55.
10023, Respublika Belarus, g. Vitebsk, pr-t Frunze, d. 27, UO «Vitebskiy gosudarstvennyiy meditsinskiy universitet», kafedra gospitalnoy hirurgii s kursami urologii i detskoy khirurgii,
Eroshkin Sergey Nikolaevich
Eroshkin S.N. assistant of the hospital surgery chair with the courses of urology and pediatric surgery of EE “Vitebsk State Medical University”.
IDENTIFICATION AND DETERMINATION OF SENSITIVITY TO ANTIBACTERIAL PREPARATIONS OF THE MAIN CAUSATIVE AGENTS OF WIDESPREAD PURULENT PERITONITIS
ÃÎÓ ÂÏÎ «Ïåðâûé Ìîñêîâñêèé ãîñóäàðñòâåííûé ìåäèöèíñêèé óíèâåðñèòåò èì. È.Ì.Ñå÷åíîâà»,
ÓÎ «Âèòåáñêèé ãîñóäàðñòâåííûé ìåäèöèíñêèé óíèâåðñèòåò»,
Objectives. To create test-systems for identification of gram-negative and non-clostridial anaerobic microorganisms and for deter-mination of their sensitivity to antibacterial preparations, to work out effective schemes of the antibacterial therapy at treatment of patients with widespread purulent peritonitis.
Methods. By means of the developed test systems investigations of peritoneal exudate of 85 patients with widespread purulent peritonitis have been carried out. The character of gram-negative aerobic and non-clostridial anaerobic microflora has been studied, its sensitivity to antibacterial preparations has been defined, and also effective schemes of rational antibacterial therapy have been sug-gested
Results. The dominating role in peritonitis development belongs to E.coli (54,9 %) and B. fragilis (63,4 %). Rational application of antimicrobial preparations in pre – and postoperative periods in many respects predetermine success of treatment of widespread purulent peritonitis. On the basis of data on the etiologic structure and sensitivity of microorganisms to antimicrobial preparations we have established the following effective schemes of rational empirical antibacterial therapy of widespread purulent peritonitis: cephalosporins of III generation + metronidazole; cephalosporins of III generation + aminoglycosides + metronidazole; cephalosporins of IV generation + metronidazole; carbapenems (imipenem, meropenem); fluoroquinolones + metronidazole.
Conclusions. «ID-ENT» and «AB-GRAM (-)» test systems have been developed for identification of gram-negative microorganisms and determination of their sensitivity to antibacterial preparations, for obligate anaerobic microorganisms – «ID-ANA» and «AB-AN», respectively. The developed test systems are characterized by a great variety of antibiotics, relative low cost, simplicity in manufacturing and use, speed of determination of sensitivity and can find a wide application for determination of sensitivity of strains of causative agents of a surgical infection in bacteriological laboratories of a various profile.
1.Gostishchev VK, Sazhin VP, Avdovenko AL. Peritonit [Peritonitis]. Moscow, RF: GEOTAR-Media, 2002. 238 p.
2. Eriukhin IA, Gel'fanda BR, Shliapnikov SA, red. Khirurgicheskie infektsii: ruk dlia vrachei [Surgical infections: a guide for physicians]. Saint-Petersburg, RF: Piter; 2004. 325 p.
3. Savel'ev BC, Gel'fanda BR, Filimonova MI, red. Peritonit: prakt ruk [Peritonitis: a practical guide]. Moscow, RF: Litterra, 2006. 208 p.
4.Shurkalin BK. Gnoinyi peritonit [Purulent peritonitis]. Moscow, RF: Dva Mira Print; 2000. 224 p.
5. Gain IuM, Leonovich SI, Alekseev SA. Sindrom enteral'noi nedostatochnosti pri peritonite: teoreticheskie i prakticheskie aspekty, diagnostika i lechenie [Enteral insufficiency syndrome in peritonitis: theoretical and practical aspects of diagnosis and treatment]. Molodechno, RB; 2001. 265 p.
6. Briskin BS, Khachatrian HH, Ionov SA, Khmelevskii SV Antibiotikoprofilaktika v abdominal'noi khirurgii [Antibiotic prophylaxis in abdominal surgery]. Consilium Medicum Pril Khirurgiia. 2003;(1):9–13.
7. Eremin SR, Zueva LP. Aktual'nye problemy epidemiologii intraabdominal'nykh infektsii [Actual problems of epidemiology of intra-abdominal infections]. Infektsii v Khirurgii. 2003;1(2):58–62.
8. Savel'ev VS, Gel'fanda BR, red. Abdominal'naia khirurgicheskaia infektsiia: klinika, diagnostika, antimikrobnaia terapiia: prakt ruk [Abdominal surgical infection: clinical features, diagnosis, antimicrobial therapy: a practical guide]. Moscow, RF: Literra; 2006. 168 p.
9. Khachatrian NN. Antibakterial'naia terapiia peritonita [Antimicrobial therapy of peritonitis]. Consilium Medicum Pril Khirurgiia. 2002;(1):19–25.
119991, Rossiyskaya Federatsiya, g. Moskva, ul. Yauzskaya, d. 11, GOU VPO «Pervyiy Moskovskiy gosudarstvennyiy meditsinskiy universitet im. I.M. Sechenova», kafedra obschey khirurgii,
Kosinets Vladimir Aleksandrovich
Kosinets V.A. Candidate of Medical Sciences, Applicant for Doctor’s Degree of the General Surgery Chair of SEE HPE “I.M. Sechenov First Moscow State Medical University”
L.N. RUBANOV1, Y.I. YARETS2, Z.A. DUNDA-ROV2
CLINICAL AND LABORATORY CONFIRMATION OF EFFICIENCY OF CHRONIC WOUND ULTRASOUND DEBRIDEMENT IN THE PREPARATION OF PATIENTS TO SKIN GRAFTING
SME “Gomel City Clinical Hospital ¹1”
Gomel Regional Center of Thermal Trauma, Wounds, Wound Infection and Reconstructive Surgery1
ME “Gomel State Medical University” 2,
The Republic of Belarus
Objectives. The efficiency estimation of the ultrasound debridement method in the preparation of chronic wounds (CW) to skin grafting (SG).
Methods. 25 patients with CW of various etiology are included in the investigation. The first group was composed of patients (n=12), who were subjected to a single ultrasound debridement before SG. 2 procedures of ultrasound diagnostics were performed to the patients of the 2nd group (n=13): 3 days after hospitalization (the 1st procedure) and immediately before SG (the 2nd procedure).
Results. The using of two ultrasound debridement procedures while preparing chronic wounds to skin grafting is accompanied with shortening of graft healing time up to 9 (6; 10) days (p=0,015 in comparison with the results of the 1st group of patients – 12 (10; 15) days), skin graft outcome improving (complete graft healing was registered in 100% of the patients), decrease of positive results of bacteriological examination up to 70% (V2=4,22, ð=0,04 in comparison with the results of the 1st group of patients) and of bacterial wound contamination up to ≤103 CFU/ml (V2=10,6, ð=0,001 as opposed to the 1st group) and changing of microbial landscape – only monoculture of S.aureus, P.aeroginosa, P.mirabilis were isolated (V2=10,1, ð=0,0015 in comparison with the results of the 1st group of patients). And one ultrasound debridment procedure wasn’t accompanied with significant differences of the bacterial count and CW microbial landscape.
Conclusions. The use of double ultrasound debridement procedures (the first – during pre-operative conservative preparation, the second – before skin grafting) is more effective approach while preparing patients with CW to SG in comparison with the single ultrasound debridement procedure.
1. Falanga V. Classifications for wound-bed preparation and stimulation of chronic wounds. Wound Repair Regen. 2000 Sep-Oct;8(5):347–52.
2. Schultz GS, Sibbald RG, Falanga V, Ayello EA, Dowsett C, Harding K, Romanelli M, Stacey MC, Teot L, Vanscheidt W. Wound bed preparation: a systematic approach to wound management. Wound Repair and Regen. 2003 Mar;11(Suppl. 1):S1–28.
3. Sibbald RG, Orsted HL, Coutts PM, Keast DH. Best practice recommendations for preparing the wound bed: update 2006. Adv Skin Wound Care. 2007 Jul;20(7):390–405; quiz 406–7.
4. Foley L. The application of TIME (wound bed preparation principles) in the management of a chronic heel ulcer. Primary Intention. 2004;12(4):163–64, 166.
5. Falabella AF. Debridement and wound bed preparation. Dermatol Ther. 2006 Nov-Dec;19(6):317–25.
6. Sibbald RG, Woo KY, Ayello E. Wound bed preparation: DIM before DIME. Wound Healing Southern Africa. 2008;1(1):29–34.
7. Gillian B. Low frequency ultrasonic debridement: a new tool in our armoury? J Foot Ankle Res. 2011;4(Suppl. 1):7.
8. Breuing KH, Bayer L, Neuwalder J, Orgill DP. Early experience using low-frequency ultrasound in chronic wounds. Ann Plast Surg. 2005 Aug;55(2):183–87.
9. Paramonov BA, Porembskii IaO, Iablonskii V.G. Ozhogi: ruk dlia vrachei [Burns: a guide for physicians.].Saint-Petersburg, RF: SpetsLit; 2000. 480 p.
10. Widgerow, A.D. Persistence of the chronic wound – implicating biofilm. Wound Healing Southern Africa. 2008;1(2):5–9.
11. Lessing C, Slack P, Hong KZ, Kilpadi D, McNulty A. Negative pressure wound therapy with controlled saline instillation (NPWTi): dressing properties and granulation response in vivo. Wounds. 2011;23(10):309–319.
246000, Respublika Belarus, g. Gomel, ul. Lange, d. 5. UO «Gomelskiy gosudarstvennyiy meditsinskiy universitet», kafedra klinicheskoy laboratornoy diagnostiki,
Yarets Yuliya Igorevna
Rubanov L.N Head of the Burn Department of SME "Gomel City Clinical Hospital ¹ 1", the Head of Gomel Regional Center of the Thermal Injury, Wounds, Wound Infections and Reconstructive Surgery.
Yarets Y.I. Candidate of Medical Sciences, Assistant of Clinical Laboratory Diagnostics Chair of EE "Gomel State Medical University."
Dundarov Z.A. Doctor of Medical Sciences, Professor, Head of the Surgical Diseases Chair ¹2 with the Course of Pediatric Surgery of EE "Gomel State Medical University."
TRAUMATOLOGY AND ORTHOPEDICS
A.N. MASTYKAU, V.P. DEYKALO, K.B. BALABOSHKA
PLATELET-ENRICHED PLASMA IN TREATMENT OF POSTTRAUMATIC CHONDROPATHY OF THE KNEE JOINT
EE “Vitebsk State Medical University”
The Republic of Belarus
Objectives. To improve the results of complex treatment of patients with posttraumatic chondropathy of the knee joint using in-traarticular injections of platelet-enriched plasma.
Methods. Treatment results of 55 patients who had undergone different traumas of the knee joint with the arthroscopically verified diagnosis “posttraumatic chondropathy” were studied. Intraarticular injection of platelet-enriched plasma was used in the treatment of 31 patients with posttraumatic cartilage defects in the knee joint. The control group included 24 patients with posttraumatic chondropathy who were not injected platelet-enriched plasma. To evaluate treatment efficacy, besides clinical investigation methods, we used the evaluation scale of outcomes of injuries and diseases of the knee joint – KOOS 2 and 6 months after the course of treatment.
Results. The performed research has shown that 6 months after the course of the intraarticular injection of platelet-enriched plasma, the patients were characterized by reliably higher indexes of subscales “symptoms” (p<0,01), function in daily living” (p<0,01), “function in sport and recreation” (p<0,01) and “knee-related quality of life” (p<0,01) and summarized index on the KOOS scale (ð<0,01)if compared with the patients of the control group. We haven’t revealed any side-effects and complications while applying this method of treatment.
Conclusions. Using platelet-enriched plasma for intraarticular injections permits to improve significantly the indexes of the functional state of the knee joint as well as the life quality of patients with posttraumatic chondropathy. This method is up-to-date, effective and simple in use and is promissory for treatment of the given pathology.
1. Joern WPM, Schluter-Brust KU, Peer E. The epidemiology, etiology, diagnosis, and treatment of osteoarthritis of the knee. Dtsch Arztebl Int. 2010 March; 107(9):152–62.
2. Widuchowski W, Widuchowski J, Trzaska T. Articular cartilage defects: study of 25,124 knee arthroscopies. Knee. 2007 Jun;14(3):177–82.
3. Wong M, Carter DR. Articular cartilage functional histomorphology and mechanobiology: a research perspective. Bone. 2003 Jul;33(1):1–13. Review.
4. Newman AP. Articular cartilage repair. Am J Sport Med. 1998 Mar-Apr;26(2):309–24. Review.
5. Loken S, Heir S, Holme I, Engebretsen L, Aroen A. 6-year follow-up of 84 patients with cartilage defects in the knee. Knee scores improved but recovery was incomplete. Acta Orthop. 2010 Oct;81(5):611–18.
6. Marijnissen AC, Lafeber FP. Re: Hunziker EB. Articular cartilage repair: basic science and clinical progress. A review of the current status and prospects. Osteoarthritis and cartilage 2002; 10:432-63. Osteoarthritis Cartilage. 2003 Apr; 11(4):300–1; author reply 302–4.
7. Eismont OL, Skakun PG, Borisov AV, Bukach VA, Maliuk B.V, Bukach DV, Pipkin AM, Peresada AS. Sovremennye vozmozhnosti i perspektivy khirurgicheskogo lecheniia povrezhdenii i zabolevanii sustavnogo khriashcha [Modern possibilities and prospects of surgical treatment of injuries and diseases of the articular cartilage]. Med Novosti. 2008;(7):12–19.
8. Roberts S, Menage J, Sandell LJ, Evans EH, Richardson JB. Immunohistochemical study of collagen types I and II and procollagen IIA in human cartilage repair tissue following autologous chondrocyte implantation. Knee. 2009 Oct;16(5):398–404.
9. Erggelet C, Mandelbaum BR. Principles of Cartilage Repair. Germany: Steinkopff Verlag; 2008. 119 p.
10.Geremicca W, Fonte C, Vecchio S. Blood components for topical use in tissue regeneration: evaluation of corneal lesions treated with platelet lysate and considerations on repair mechanisms. Blood Transfus. 2010 Apr;8(2):107–12.
11. Everts PA, Knape JT, Weibrich G, Schonberger JP, Hoffmann J, Overdevest EP, Box HA, van Zundert A. Platelet-rich plasma and platelet gel: a review. J Extra Corpor Technol. 2006 Jun;38(2):174–87.
12. Marx R, Garg A. Dental and craniofacial applications of platelet-rich plasma. Carol Stream: Quintessence Publishing Co, Inc.; 2005. 221 p.
13. Deikalo VP, Mastykov AN, Boloboshko KB. Obogashchennaia trombotsitami plazma v lechenii zabolevanii i povrezhdenii oporno-dvigatel'nogo apparata [Platelet-rich plasma in the treatment of diseases and injuries of the musculoskeletal system]. Vestn VGMU. 2011;10(4):6–12.
14. Kon E, Buda R, Filardo G, Di Martino A, Timoncini A, Cenacchi A, Fornasari PM, Giannini S, Marcacci M. Platelet-rich plasma: intra-articular knee injections produced favorable results on degenerative cartilage lesions. Knee Surg Sports Traumatol Arthrosc. 2010 Apr;18(4):472–79.
15. Sanchez M, Anitua E, Azofra J, Aguirre JJ, Andia I. Intra-articular injection of an autologous preparation rich in growth factors for the treatment of knee OA: a retrospective cohort study. Clin Exp Rheumatol. 2008 Sep-Oct;26(5):910–13.
16. Cameron ML, Briggs KK, Steadman JR. Reproducibility and reliability of the outerbridge classification for grading chondral lesions of the knee arthroscopically. Am J Sports Med. 2003 Jan-Feb;31(1):83–6.
210023, Respublika Belarus, g. Vitebsk, pr. Frunze, d. 27, UO «Vitebskiy gosudarstvennyiy meditsinskiy universitet», kafedra travmatologii, ortopedii i VPH,
Mastyikov Anton Nikolaevich
Mastykau A.N. Post-Graduate Student of the Traumatology, Orthopedics and Military-Field Surgery Chair of EE “Vitebsk State Medical University.
Deykalo V.P. Doctor of Medical Sciences, Professor, Rector of EE “Vitebsk State Medical University.
Balaboshka K.B. Candidate of Medical Sciences, Associate Professor of the Traumatology, Orthopedics and Military-field Surgery Chair of EE “Vitebsk State Medical University.
M.H. MALIKOV1, U.A. KURBANOV1, A.A. DAVLATOV2
TRANSPLANTATION OF THE VASCULARIZED BONE TANSPLANTS AT TRAUMATIC DEFECTS AND FALSE JOINTS OF THE UPPER LIMBS BONES
Tajik Abu Ali Ibn Sino State Medical University 1,
THE Republican Scientific Center of the Cardiovascular and Thoracic Surgery 2,
The Republic of Tajikistan
Objectives. Preliminary analysis and development of the optimal methods for transplanting simple and compound vascularized flaps at the post-traumatic bone defects and false joints of the upper limb.
Methods. 14 free and transferred microsurgical transplants, simple and compound skin and bone grafts were done at the traumatic bone defects and false joints of the upper limb. There were 10 males and 4 females. The age of patients ranged from 11 to 37. The cause of traumatic bone defects and false joints were: gunshot wounds, (3), industrial accident injuries and falls from heights (9), electric trauma (2). Arteriography, electroneuromyography, Doppler sonography were performed in all patients as additional methods of investigation in the perioperative period.
Results. While choosing a way of treatment and studying a long-term outcome it was found out that the reconstruction results of the upper extremity defects depend on the nature of an injury, concomitant injuries of other anatomic structures and the proper selection of the graft. At the same time the benefits of vascularized combinations of tissues over traditional methods of autoplasty was proved. It was established that patients with posttraumatic defects and false joints had a simultaneous damage of the neurovascular bundles, tendons as well as the defects of covering tissues worsening the severity of the injury.
Conclusions. Absence of complications in the donor sites, an adequate recovery of limb function in relatively short time testifies to appropriateness of more widespread use of vascularized grafts in post-traumatic defects and false joints of the upper limb.
1. Nikitin G.D., Rak A.V., Linnik S.A., Nikolaev V.F., Nikitin D.G. Kostnaia i myshechno-kostnaia plastika pri lechenii khronicheskogo osteomielita i gnoinykh lozhnykh sustavov [Osteo- and osteomuscular flap in the treatment of chronic osteomyelitis and septic pseudarthrosis]. Saint-Petersburg, RF: LIG; 2002. 192 p.
2. Amiraslanov Iu.A., Svetukhin A.M., Mitish V.A., Borisov I.V., Blatun L.A., Ternovykh M.V. Osnovnye printsipy lecheniia bol'nykh s khronicheskim osteomielitom dlinnykh kostei [Basic principles of treatment of patients with chronic osteomyelitis of long bones]. Vestn Khirurgii. 2000;(2):91–96.
3. Urazgil'deev ZI, Furtseva LN, Kumar R, Roskidailo AS, Bushuev OM, Gorokhova GP, Lialin VA. Kompleksnoe odnoetapnoe lechenie nesrosshikhsia perelomov, lozhnykh sustavov i defektov dlinnykh kostei konechnostei, oslozhnennykh osteomielitom [Comprehensive one-step treatment of ununited fractures, false joints and defects of long bones, complicated by osteomyelitis]. Vestn Travmatologii i Ortopedii im NN Priorova. 2002;(4):33–38.
4. Makushkin VD. Rezul'taty mnogofaktornogo analiza iskhodov lecheniia po Ilizarovu bol'nykh s defektami kostei treatment outcomes for patient with bone defects of the lower limb by Ilizarov]. Genii Ortopedii. 1995;(1):67–70.
5. Belousov AE. Mikrokhirurgiia v travmatologii [Microsurgery in traumatology]. Leningrad, SSSR; 1988. 224 p.
6. Belousov AE. Plasticheskaia rekonstruktivnaia i esteticheskaia khirurgiia [Plastic reconstructive and aesthetic surgery]. Saint-Petersburg, RF: Gippokrat; 1998. 744 p.
7. Amiraslanov IuA, Borisov IV, Zhukov AO, Ushakov AA, Ismailov AS. Rekonstruktivno-vosstanovitel'nye operatsii u bol'nykh osteomielitom dlinnykh kostei [Reconstructive surgery in patients with osteomyelitis of long bones]. Annaly Plast Rekonstrukt i Estet Khirurgii. 2008;(4):61–70.
8. Reshetov IV, Kravtsov SA, Matorin OV, Poliakov AP, Filiushin MM, Ratushnyi MV. Ispol'zovanie reberno-myshechnykh autotransplantatov dlia ustraneniia obshirnykh sochetannykh defektov u onkologicheskikh bol'nykh. [The use of costal-muscular autografts to eliminate co-extensive defects in cancer patients]. Annaly Plast Rekonstrukt i Estet Khirurgii. 2003;(2):38–54.
9. Taylor GI, Miller GDH, Ham FJ. The free vascularized bone graft. A clinical extension of microvascular techniques. Plast Reconstr Surg. 1975 May;55(5):533–44.
10. Watson N, Taylor GI. Microvascular free flap and free bone transfer. J Bone Joint Surg. 1978;60-B(1):141–41.
11. Shibaev EIu, Simakov VI, Zelianin AS, Komarov AS. Mikrokhirurgicheskaia rekonstruktsiia goleni pri obshirnykh defektakh miagkikh tkanei i bol'she6bertsovoi kosti. [Microsurgical reconstruction of the lower extrimity in extensive defects of soft tissue and tibial bone]. Annaly Plast Rekonstrukt i Estet Khirurgii. 2002;(1):62–69.
12. Dzhekson IT, red, Bostvik Dzh III, Zommerled B, Douden RV, Dzemeshkevich SL. Poslednie dostizheniia v plasticheskoi khirurgii [Recent advances in plastic surgery]: per s angl. Moscow, SSSR: Meditsina; 1985. 316 p.
13. Reshetov IV, Poliakov AP. Khirurgicheskaia anatomiia grudnoi stenki kak donorskoi zony kostno-myshechnykh autotransplantatov. [Surgical anatomy of the thoracic wall as a donor area of osteo-muscular autografts]. Annaly Plast Rekonstrukt i Estet Khirurgii. 2002;(3):47–74.
14. Abovian GR, Kuzanov AI, Timoshenko EN. Mikrokhirurgicheskaia peresadka luchevogo nadkostnichno-kortikal'nogo autotransplantata v lechenii lozhnykh sustavov dlinnykh trubchatykh kostei.[ Microsurgical transplantation of radial periosteal-cortical autograft in the treatment of pseudarthrosis of long bones]. Annaly Plast Rekonstrukt i Estet Khirurgii. 2005;(2):61–62.
15. Neverov VA, Khromov AA, Cherniaev SN, Egorov KS. Vozmozhnosti blokiruiushchego osteosinteza pri metafizarnykh perelomakh plechevoi kosti. [Possibility of blocking osteosynthesis in metaphyseal fractures of the humerus]. Vestn Khirurgii im II Grekova. 2008;167(6):52-54.
16. Neverov VA, Khromov AA, Cherniaev SN, Shebarshov AL. Primenenie blokirovannykh sterzhnei pri psevdoartrozakh i defektakh kostei predplech'ia. [The use of blocked bars in pseudarthrosis and defects of the forearm bones]. Vestn Khirurgii im II Grekova. 2007;166(3)35–38.
734003, Respublika Tadzhikistan, g. Dushanbe, ul. Sanoi, d. 33 Respublikanskiy nauchnyiy tsentr serdechno-sosudistoy i grudnoy khirurgii, otdelenie rekonstruktivno-plasticheskoy mikrokhirurgii,
Malikov Mirzobadal Halifaevich
Malikov M.H. Candidate of Medical Sciences, Associate Professor of the Surgical Diseases Chair ¹ 2 of Tajik Abu Ali Ibn Sino State Medical University.
Kurbanov U.A. Doctor of Medical Sciences, Professor, Rector of Tajik Abu Ali Ibn Sino State Medical University.
Davlatov A.A. Candidate of Medical Sciences, Head of the Reconstructive and Microsurgery Department of Republican Scientific Center of Cardiovascular and Thoracic Surgery.
V.P. MOROZOV, E.G.PETROVA
SURGICAL TREATMENT OF CHILDREN WITH BENIGN TUMORS AND TUMOR-LIKE DISEASES OF LONG TUBULAR BONES
State Budgetary Educational Establishment OF HIGHER Professional Education “Saratov State Medical University named after V.I.Rasumovsky”, Saratov,
The Russian Federation
Objectives. To develop an algorithm of surgical treatment tactics of benign tumors and tumor-like processes of long bones permitting to restore the integrity of a bone and limb function.
Methods. 184 children with benign tumors and tumor-like diseases were under observation; they were subjected to different types of resection within healthy tissues. Various types of osteoplastic material in combination with fixation of the damaged segment in different ways were used. In addition, computer simulation of the axial load on the long tubular bone defects with different localization and size was carried out.
Results. The performed computer simulation shows that presence of the bone defect in its size 1/3 larger than the length of the diaphysis circle and 25% bigger than the bone length weakens the bone toughness so that at usual physiological load on a limb, a pathological break in the defect zone may occur.
On the basis of analysis results, we developed an algorithm for treatment tactics selection, taking into account the nature of the pathological process, the size and location of the resulting bone defect. It was determined that patients operated on using the developed algorithm, in spite of the greater volume of the present defect, rehabilitation period was 15-18% shorter if compared with patients in whom continuous external plaster immobilization was applied and early motor load was not realized.
Conclusions. Differential use in children with post-resection bone defects of osteoplastic materials and preventive osteosynthesis gives the most favorable clinical results with maximally early activation of patients and preservation of a usual life style of a patient during treatment.
1. Grigorovskii VV, Luchko RV, Zotikov LA. Patomorfologicheskie izmeneniia, otrazhaiushchie biologicheskieprotsessy v kal'tsii-fosfatnykh implantatakh, pri plastike ostatochnykh polostei v kostiakh cheloveka. [Pathological changes reflecting biological processes in calcium phosphate implants for plastic residual cavities in human bones]. Vestn Travmatol Ortoped im NN Priorova. 2008;(1):82–88.
2. Seinian S. G., Aivazian V. P., Khanamirian T. V. Khirurgicheskoe lechenie dobrokachestvennykh opukholei i opukholepodobnykh porazhenii kostei s primeneniem alloplastiki demineralizovannymi kostnymi transplantatami. [Surgical treatment of benign tumors and tumor-like lesions of bone with the use of alloplastic demineralized bone grafts]. Vestn Travmatol Ortoped im NN Priorova. 1996;(2):18–20.
3. Lekishvili MV, Balberkin AV, Vasil'ev MG, Kolondaev AF, Baranetskii AL, Buklemishev IuV. Pervyi opyt primeneniia v klinike kostnoi patologii biokompozitsionnogo materiala "Osteomatriks" [The first experience of application of biocomposite material "Osteomatrix" in the clinic of bone disease]. Vestn Travmatologii i Ortopedii. 2002;(4):80–83.
4. Malakhov OL, Belykh SI, Berchenko GN, Kozhevnikov OV, Saltykova VG., Ivanov AV, Malakhov OO, Krasnoiarov GA. Primenenie «materiala dlia osteoplastiki» v detskoi ortopedii: otsenka effektivnosti i izuchenie protsessov biotransformatsii [The use of "material for osteoplasty" in pediatric orthopedics: efficacy and learning processes of biotransformation]. Vestn Travmatol Ortoped im NN Priorova. 2004;(2):49–53.
5. Yanagawa T, Watanabe H, Shinozaki T, Takagishi K. Curettage of benign bone tumors without grafts gives sufficient bone strength. Acta Orthop. 2009 Feb;80(1):9–13.
6. Knetes IV, Pfafrod GO, Saulgozis IuZh. Deformirovanie i razrushenie tverdykh biologicheskikh tkanei. [Deformation and fracture of solid biological tissue]. Riga, SSSR: Zinatne; 1980. 319 p.
7. Petrova EG, Rubashkin SA, Kurkin SA. Meditsinskii instrument dlia izmereniia vnutrennego ob"ema organov [Medical instrument for the measurement of the internal volume of organs]: pat. RF ¹78056; patentoobladatel': FGU SarNIITO Rosmedtekhnologii. ¹2008128088/22; zaiavl. 09.07.2008; opubl. 20.11.2008. Ofitsial'nyi Biul Rospatenta Izobreteniia i Poleznye Modeli. 2008;(32).
8. Ianson KhA. Biomekhanika nizhnei konechnosti cheloveka [Biomechanics of human lower extrimity]. Riga, SSSR: Zinatne; 1975. 324 p.
410002, Rossiyskaya Federatsiya, g. Saratov, ul. Chernyishevskogo, d. 148, FGU «Saratovskiy NII travmatologii i ortopedii Rosmedtehnologiy», kafedra travmatologii i ortopedii,
Petrova Ekaterina Gennadievna
Morozov V.P. Doctor of Medical Sciences, Professor of Traumatology and Orthopedics Chair of SBEE HPE “Saratov State Medical University named after V.I.Rasumovsky”
Petrova E.G. Post-Graduate Student of Traumatology and Orthopedics Chair of SBEE HPE “Saratov State Medical University named after V.I.Rasumovsky”
EFFICIENCY INTENSIFICATION OF THE SCIATIC NERVE BLOCKADE BY USING THE COMBINATION OF LIDOCAINE AND ROPIVACAINE
ME “Mogilev Regional Hospital”
The Republic of Belarus
Objectives. To assess the efficiency of combination of a local anesthetic with short time of blockade and short period of action (li-docaine) and the preparation with longer duration of anesthesia development but more continuous analgesic effect (ropivacaine) to support operation interventions on the limbs.
Methods. 54 blockades of the sciatic nerve under ultrasound control with electro stimulator of the peripheral nerves were done. The sciatic nerve blockade in the 1st group was done using 5 ml of 0,75% ropivacaine; in the 2nd group – 10 ml of 0,75% ropivacaine; in the 3rd group – by combination of local anesthetics composed of 5 ml of 0,75% naropin and 5 ml of 1% lidocaine. The primary final point was the time of a complete sensory block. Assessment of time of sensory and motor blocks development was performed from the moment when the local anesthetic was injected in the fascial cover of the sciatic nerve.
Results. Onset time of the complete motor and sensor block was shortened due to combining 1% lidocaine solution with 0,75% ropivacaine solution. Time for the complete block development in groups with using 5 and 10ml ropivacaine composed 46 (39;47) and 28 (28;30) minutes correspondently in contrast of 12(10;12) minutes when the combination of anesthetics was used (ð<0,01). There was no any difference in analgesia duration in the postoperative period between the groups (ð>0,05).
Conclusions. Combination of 5ml of 1% lidocaine with 5 ml of 0,75% ropivacaine resulted in time shortening of the sciatic nerve complete sensor and motor blocks development without reduction of the postoperative analgesia time.
1. De Tran QH, Bertini P, Zaouter C, Munoz L, Finlayson RJ. A prospective, randomized comparison between single- and double-injection ultrasound-guided infraclavicular brachial plexus block. Reg Anesth Pain Med. 2010 Jan-Feb;35(1):16–21.
2. Pecherskii VG, Marochkov A.V, Bordilovskii AN, Evseenko AI. Sravnitel'naia otsenka effektivnosti i bezopasnosti metodov regionarnoi anestezii perifericheskikh nervnykh stvolov i spletenii [Comparative evaluation of efficacy and safety of regional anesthesia techniques of peripheral nerve trunks and plexuses]. Novosti Khirurgii. 2011;19(2):88–93.
3. Piachersky V, Marochkov A. An increase in the efficacy and safety of peripheral nerve blocks for regional anesthesia performed using ultrasonic visual guidance. In: Patient Safety through Audit and simulation: Proceedings 31st Congress Scandinavian Society of Anaesthesiology and Intensive Care Medicine; 2011 June 15–17; Bergen, Norway. p. 29–30. Abstracts 0078.
4. Pecherskii VG, Marochkov AV. Opredelenie minimal'no neobkhodimogo kolichestva mestnogo anestetika (lidokaina) dlia obespecheniia effektivnoi i bezopasnoi blokady sedalishchnogo nerva.[Determination of the minimum quantity of local anesthetic (lidocaine) to ensure safe and effective blockade of the sciatic nerve]. Novosti Khirurgii. 2011;19(1):77–81.
5. Pecherskii VG, Marochkov AV. Blokada bedrennogo nerva malymi dozami mestnogo anestetika.[The blockade of the femoral nerve by small doses of local anesthetic]. Novosti Khirurgii. 2011;19(5):102–105.
6. Cuvillon P, Nouvellon E, Ripart J, Boyer JC, Dehour L, Mahamat A, L'hermite J, Boisson C, Vialles N, Lefrant JY, de La Coussaye JE. A comparison of the pharmacodynamics and pharmacokinetics of bupivacaine, ropivacaine (with epinephrine) and their equal volume mixtures with lidocaine used for femoral and sciatic nerve blocks: a double-blind randomized study. Anesth Analg. 2009 Feb;108(2):641–19.
7. Gioia L, Prandi E, Codenotti M, Casati A, Fanelli G, Torri TM, Azzolini C, Torri G. Peribulbar anesthesia with either 0.75% ropivacaine or a 2% lidocaine and 0.5% bupivacaine mixture for vitreoretinal surgery: a double-blinded study. Anesth Analg. 1999 Sep;89(3):739–42.
8. Chelly, J. E. Peripherial nerve blocks: a color atlas. 3-rd ed. Wolters Kluwer/Lippincott Williams & Wilkins, Philadelphia, US; 2009. 394 ð.
9. Malroi M. Mestnaia anesteziia [Local anesthesia: il prakt ruk]: per s angl. Moscow, RF: BINOM. Laboratoriia znanii; 2003. 301 p.
10. Olman K., Uilson A. Oksfordskii spravochnik po anestezii [Oxford handbook of anesthesia]: per s angl. Moscow, RF: BINOM. Laboratoriia znanii; 2009. 764 p.
11. Geert-Jan van Geffen. The value of ultrasonography for performing peripheral nerve blocks. In: Theory, practice and clinical experience in adults and children. Optima Grafische Communicatie, Rotterdam, NL; 2008. p. 234–79.
12. Gautier P, Vandepitte C, Ramquet C, DeCoopman M, Xu D, Hadzic A. The minimum effective anesthetic volume of 0.75% ropivacaine in ultrasound-guided interscalene brachial plexus block. Anesth Analg. 2011 Oct;113(4):951–55.
13. Rafmell DP, Nil DM, Viskoumi KM. Regionarnaia anesteziia: samoe neobkhodimoe v anesteziologii [Regional anesthesia: the essentials of anesthesiology]: per. s angl. Moscow, RF: MEDpress-inform; 2007. 272 p.
212026, Respublika Belarus, g. Mogilev, ul. B.-Biruli, d. 12, UZ «Mogilevskaya oblastnaya bolnitsa», otdelenie anesteziologii-reanimatologii,
Pecherskiy Valeriy Gennadevich
Pechersky V.G. Anesthetist-resuscitator of ME "Mogilev Regional Hospital”.
E. K. AZAMATOVA1, L. ZH. ATTAEVA2, K. A. EGIAZARYAN 3
PROBLEMS OF SPECIALIZED MEDICAL CARE RENDERING AT CHRONIC TONSILLITIS TREATMENT IN CHILDREN IN THE SUBJECT OF THE RUSSIAN FEDERATION
Medical Establishment of Public Health Care Service “City Children’s Polyclinic ¹ 2» 1, Nalchik,
FSBE “Central Scientific and Practical Institute of Organization and Informatization of Public Health Care2, Moscow
State Budgetary Educational Establishment of Higher Professional Education “Russian National Research Medical University named after N.I.Pirogov” 3, Moscow
The Russian Federation
Objectives. Consideration of problems of specialized medical care rendering at treatment of chronic tonsillitis in children in the subject of the Russian Federation on the example of the Kabardino-Balkarian republic (KBR).
Methods. The retrospective analysis of 2894 medical records of a municipal organization of public health care of City children’s policlinic ¹ 1 and a municipal organization of health care of City children’s polyclinic of ¹ 2 g of Nalchik from 2001 to 2010 was carried out. The analysis of incidence of children with diseases of respiratory organs was performed. The structural features of public health care of KBR and its personnel resources were analyzed.
Results. Chronic tonsillitis occurs on the average in 4,2% of the general children’s population of KBR; its share in the general structure the ENT diseases incidence makes up 49,3%. The timely treatment begun at the pre-hospital stage allows curing a patient in the out-patient conditions that should limit development of complications and, as a result, reduce the number of addressing to a hospital. At present the volume of rendered specialized medical care isn’t sufficient and incapable to satisfy fully needs of the children’s population for the treatment-and-prophylactic and medical-social help.
Conclusions. The most significant because of the social and clinical importance is tonsillar pathology. Now it is possible to say confidently that this subject fell outside the limits ENT diseases and has paramount importance in clinic of children’s diseases. It’s explained by considerable prevalence of the disease at children and persons of young age.
In this regard strategy of development of regional public health care in modern conditions should be directed on efficacy increase of material and personnel resources use, improvement of the structure of establishments of public health care, providing a fairness and quality of the medical care rendered at treatment of chronic tonsillitis in children.
1. Belov V.A. Primenenie Sumameda v lechenii khronicheskogo tonzillita u detei [Sumamed application in the treatment of chronic tonsillitis in children]. Trudnyi Patsient. 2008;(90):25–28.
2. Garashenko TI, Bogomil'skii MR, Shishmareva EV. Novye podkhody k lecheniiu obostrenii khronicheskogo tonzillita u detei [New approaches to the treatment of acute exacerbations of chronic tonsillitis in children]. Det Infektsii. 2004;(1):24–27.
3. Tsvetkov EA. Adenotonzillity i ikh oslozhneniia u detei. Limfoepitelial'noe glotochnoe kol'tso v norme i patologii [Adenotonsillitis and its complications in children. Lymphepithelial pharyngeal ring in health and disease]. Saint-Petersburg, RF: Izd-vo ELBI SPb; 2003. 124 p.
4. Averbukh TV. Organizatsiia LOR-pomoshchi v Surgutskom regione Tiumenskoi oblasti [Organization of oto-rhino-laryngeal care in the Surgut region of Tyumen area]. Novosti Otorinolaringol i Logopatol. 2001;2:3–4.
5. Lazarev VN, Bogomil'skii MR. Chistiakova VR, red. Khronicheskii tonzillit: ruk dlia vrachei [Chronic tonsillitis: a guide for physicians]. Detskaia otorinolaringologiia. Moscow, RF; 2005. 308 p.
6. Pluzhnikov MS, Lavrenova GV, Ia.Levin M, Nazarov PG, Nikitin KA. Khronicheskii tonzillit. Klinika i immunologicheskie aspekty [Chronic tonsillitis. Clinical and immunological aspects]. Saint-Petersburg, RF: Dialog; 2005. 222 p.
7. Preobrazhenskii BS, Popova AM. Angina, KhT i sopriazhennye s nim obshchie zabolevaniia: ucheb posobie [Angina, CT and associated systemic diseases: a manual]. Moscow, RF: Meditsina; 1970. 383 p.
8. Agarval DK, Ray PK. In vitro anti-oxidant property of protein-A of Staphylococcus aureus. Ind J Exper Biol. 1991 Dec; 29(12):1130–33.
9. Brook I. The role of anaerobic bacteria in tonsillitis. Int J Pediatr Otorhinolaryngol. 2005 Jan;69(1):9–19.
10. Khmel'nitskaia NM, Vlasova VV., Kosenko VA. Otsenka funktsional'nogo sostoianiia nebnykh mindalin u bol'nykh khronicheskim tonzillitom.[Evaluation of the functional state of the tonsils of patients with chronic tonsillitis]. Vestn Otorinolaringol. 2000;(4):33–39.
11. Brook I. The role of bacterial interference in otitis, sinusitis and tonsillitis. Otolaryngol Head Neck Surg. 2005 Jul;133(1):139–46.
12. Singh S, Dolan JG, Centor RM. Optimal management of adults with pharyngitis--a multi-criteria decision analysis. BMC Med Inform Decis Mak. 2006 Mar;13(3):6–14.
127254, Rossiyskaya Federatsiya, g. Moskva, ul. Dobrolyubova, d. 11, FGBU «Tsentralnyiy nauchno-issledovatelskiy institut organizatsii i informatizatsii zdravoohraneniya», otdelenie monitoringa i strategicheskogo planirovaniya regionalnogo zdravoohraneniya,
Attaeva Leyla Zhamalovna
Azamatova E.K. Candidate of Medical Sciences, Otorhinolaryngologist, ME “City Children’s Polyclinic ¹ 2» Kabardino-Balkarian Republic, Nalchik.
Attaeva L..Zh. Candidate of Medical Sciences, Senior Researcher of the Department of Monitoring and Strategic Planning of Regional Health of FSBE “Central Scientific And Practical Institute of Organization and Informatization of Public Health Care, Ministry of Health and Social Development of Russia, Moscow
Egiazaryan K. A. Candidate of medical sciences, Associate Professor of the Traumatology, Orthopedics and Military-field Surgery Chair of SBEE HPE “Russian National Research Medical University named after N.I.Pirogov”, Ministry of Health and Social Development of Russia, Moscow.
MATTERS OF PERSONNEL TRAINING
ASSESSMENT OF KNOWLEDGE LEVEL OF BATTLE SURGICAL TRAUMA PECULIARITIES
PART 1: GUNSHOT WOUNDS
EE “Belarusian State Medical University”
The Republic of Belarus
Objectives. To evaluate the level of knowledge of surgeons who work in the establishments of Ministry of Health of the Republic of Belarus and deal with the problems of pathogenesis and treatment of battle surgical trauma.
Methods. Analysis data of testing results of 270 surgeons of the establishments of Ministry of Health are presented in the article.
Results. Insufficient level of knowledge on this problem among surgeons has been established in 3 cases (2-4) (Me (25%-75%)) out of 10 possible. Individual parameters of surgeons (work expe-rience, qualification category, restricted specialization, clinical residency) as well as place of employment (the level of establishment of Public health care and its location) haven’t any statistically significant impact on the knowledge level of this problem.
Conclusions. It is necessary to bring changes in the system of surgeons’ training in our country to improve the quality of medical aid rendering to victims of extreme situations.
1. Musatov KhA. Khirurgiia katastrof: uchebnik [Surgery of disasters: a textbook]. Moscow, RF: Meditsina; 1998. 592 p.
2. Nechaev EA, red. Vzryvnye porazheniia: ruk dlia vrachei i studentov [Explosive destruction: a handbook for physicians and students]. Saint-Petersburb, RF: Foliant; 2002. 656 p.
3. Bykov IIu, Efimenko NA, Gumanenko E.K. Voenno-polevaia khirurgiia: natsional'noe rukovodstvo [Military surgery: a national guide]. Moscow, RF: GEOTAR-Media; 2009. 816 p.
4. Bisenkov LN. Bisenkov LN, Akimov GV, Glaznikov LA. Khirurgiia minno-vzryvnykh ranenii [Surgery of mine blast wounds]. Saint-Petersburg, RF: Akropol'; 1993. 320 p.
5. Tolstykh MP, Lutsevich OE, Akhmedov BA, Geinits AV, Araei AR. Ognestrel'nye raneniia konechnostei mirnogo vremeni [Gunshot wounds of the extremities in peacetime]. Moscow, RF: Meditsina; 2005. 80 p.
6. Trukhan AP, Zhidkov SA, Korik VE, Fedorov KA. Khirurgicheskaia pomoshch' pri postuplenii bol'shogo kolichestva postradavshikh s vzryvnymi porazheniiami. [Surgical care in entering a large number of injured persons with explosive lesions]. Novosti Khirurgii. 2012;20(3):60–64.
7. Trukhan AP, Zhidkov SA, Korik VE. Osobennosti obrashcheniia za meditsinskoi pomoshch'iu postradavshikh pri terroristicheskom akte 11 aprelia 2011 goda [The specificity of treatment of victims of a terrorist attack April 11, 2011]. Ekstr Meditsina. 2012;(2):56–62.
220034, Respublika Belarus, g. Minsk, ul. Azgura, d. 4, UO «Belorusskiy gosudarstvennyiy meditsinskiy universitet», voenno-meditsinskiy fakultet, kafedra voenno-polevoy hirurgii
Truhan Aleksey Petrovich
Trukhan A.P. Candidate of Medical Sciences, Major of Medical Service, Assistant of Military –Field Surgery Chair of The Military Medicine Faculty of EE "Belarusian State Medical University."
PRINCIPLES OF MULTICOMPONENT FAST-TRACK PROGRAM IN COLORECTAL SURGERY: APPROACHES AND POSITIVE EFFECTS
SEE “Belarusian Academy of Post-Graduate Education”
The Republic of Belarus
Analytical review of the scientific literature concerning the perioperative care of patients undergoing colonic resection with primary anastomosis application is presented in the article. Traditional perioperative care is associated with high postoperative complication rate and prolonged hospital stay. The approach introduction of an alternative, based on the principles of fast-track surgery when conducting the perioperative period has been expanded recently. The history of elaboration, basic elements and positive effects of fast-track surgery are described.
Advantages of the given approach permitting earlier terms of recovery, reduction of postoperative complications, length of hospital stay and treatment costs are highlighted. Basic tendencies of the program are absence of the mechanical bowel preparation and restriction of the prolonged preoperative starving before surgery, epidural anesthesia, intraoperative fluid management, avoidance of intra-abdominal drains, early enteral nutrition and active mobilization in the postoperative period.
1. Kokhniuk VT. Kolorektal'nyi rak [Colorectal cancer]. Minsk, RB; 2005. 384 p.
2. Rivkin VL, red, Fain SN, Bronshtein AS, An VK. Rukovodstvo po koloproktologii [Handbook of Coloproctology]. Moscow, RF: ID Medpraktika-M; 2004. 488 p.
3. Fedorov VD, Dul'tsev IuV. Proktologiia [Proctology]. Moscow, RF: Meditsina; 1984. 384 p.
4. Gouvas N, Tan E, Windsor A, Xynos E, Tekkis PP. Fast-track vs standard care in colorectal surgery: a meta-analysis update. Int J Colorectal Dis. 2009 Oct;24(10):1119–31.
5. Schwenk W, Muller JM. What is "Fast-track"-surgery? Dtsch Med Wochenschr. 2005 Mar 11;130(10):536–40. [Article in German]
6. Fearon K. Overview: key elements and the impact of enhanced recovery care. In: Francis N, Kennedi RH, Ljungqvist O, Mythen MG, ed. Manual of fast track recovery for colorectal surgery. London, UK: Springer-Verlag; 2012;(Ch. 1):1–14.
7. Bardram L, Funch-Jensen P, Jensen P, Crawford ME, Kehlet H. Recovery after laparoscopic colonic surgery with epidural analgesia, and early oral nutrition and mobilization. Lancet. 1995 Mar 25;345(8952):763–64.
8. Wilmore DW, Kehlet H. Management of patients in fast track surgery. BMJ. 2001 Feb 24;322(7284):473–76.
9. Salmon P, Evans R, Humphrey DE. Anxiety and endocrine changes in surgical patients. Br J Clin Psychol. 1986 May;25(Pt 2):135–41.
10. Jung B, Lannerstad O, Pahlman L, Arodell M, Unosson M, Nilsson E. Preoperative mechanical preparation of the colon: the patient's experience. BMC Surg. 2007 May 4;7:5.
11. Slim K, Vicaut E, Launay-Savary MV, Contant C, Chipponi J. Updated systematic review and meta-analysis of randomized clinical trials on the role of mechanical bowel preparation before colorectal surgery. Ann Surg. 2009 Feb;249(2):203–9.
12. Bucher P, Gervaz P, Egger JF, Soravia C, Morel P. Morphologic alterations associated with mechanical bowel preparation before elective colorectal surgery: a randomized trial. Dis Colon Rectum. 2006 Jan;49(1):109–12.
13. Businger A, Grunder G, Guenin MO, Ackermann C, Peterli R, von Flue M. Mechanical bowel preparation and antimicrobial prophylaxis in elective colorectal surgery in Switzerland--a survey. Langenbecks Arch Surg. 2011 Jan;396(1):107–13.
14. Lassen K, Soop M, Nygren J, Cox PB, Hendry PO, Spies C, von Meyenfeldt MF, Fearon KC, Revhaug A, Norderval S, Ljungqvist O, Lobo DN, Dejong CH; Consensus review of optimal perioperative care in colorectal surgery: Enhanced Recovery After Surgery (ERAS) Group recommendations. Arch Surg. 2009 Oct;144(10):961–69.
15. Abraham N, Albayati S. Enhanced recovery after surgery programs hasten recovery after colorectal resections. World J Gastrointest Surg. 2011 Jan 27;3(1):1–6.
16. McLeod R, Fitzgerald W, Sarr M. Preoperative fasting for adults to prevent perioperative complications. Can J Surg. 2005 Oct;48(5):409–11.
17. Basse L, Hjort Jakobsen D, Billesbolle P, Werner M, Kehlet H. A clinical pathway to accelerate recovery after colonic resection. Ann Surg. 2000 Jul;232(1):51–7.
18. Rodgers A, Walker N, Schug S, McKee A, Kehlet H, van Zundert A, Sage D, Futter M, Saville G, Clark T, MacMahon S. Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomized trials. BMJ. 2000 Dec 16;321(7275):1493.
19. Moraca RJ, Sheldon DG, Thirlby RC. The role of epidural anesthesia and analgesia in surgical practice. Ann Surg. 2003 Nov;238(5):663–73.
20. McQuay H, Moore A, Justins D. Treating acute pain in hospital. BMJ. 1997 May 24;314(7093):1531–35.
21. Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth. 1997 May;78(5):606–17.
22. Brandstrup B, Tonnesen H, Beier-Holgersen R, Hjortso E, Ording H, Lindorff-Larsen K, Rasmussen MS, Lanng C, Wallin L, Iversen LH, Gramkow CS, Okholm M, Blemmer T, Svendsen PE, Rottensten HH, Thage B, Riis J, Jeppesen IS, Teilum D, Christensen AM, Graungaard B, Pott F. Effects of intravenous fluid restriction on postoperative complications: comparison of two perioperative fluid regimens: a randomized assessor-blinded multicenter trial. Ann Surg. 2003 Nov;238(5):641–48.
23. Mintz Y, Weiss YG, Rivkind AI. Effects of intravenous fluid restriction on postoperative complications: comparison of two perioperative fluid regimens: a randomized assessor-blinded multicenter trial. Ann Surg. 2004 Aug;240(2):386; author reply 386–88.
24. Hilton AK, Pellegrino VA, Scheinkestel CD. Avoiding common problems associated with intravenous fluid therapy. Med J Aust. 2008 Nov 3;189(9):509–13.
25. Watcha MF, White PF. Postoperative nausea and vomiting. Its etiology, treatment, and prevention. Anesthesiology. 1992 Jul;77(1):162–84.
26. Kurz A, Sessler DI, Lenhardt R. Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. Study of Wound Infection and Temperature Group. N Engl J Med. 1996 May 9;334(19):1209–15.
27. Esnaola NF, Cole DJ. Perioperative normothermia during major surgery: is it important? Adv Surg. 2011;45:249–63.
28. Nelson R, Tse B, Edwards S. Systematic review of prophylactic nasogastric decompression after abdominal operations. Br J Surg. 2005 Jun;92(6):673–80.
29. Chopra SS, Schmidt SC, Fotopoulou C, Sehouli J, Schumacher G. Evidence-based perioperative management: strategic shifts in times of fast track surgery. Anticancer Res. 2009 Jul;29(7):2799–802.
30. Ramirez JM, Blasco JA, Roig JV, Maeso-Martinez S, Casal JE, Esteban F, Lic DC. Enhanced recovery in colorectal surgery: a multicentre study. BMC Surg. 2011 Apr 14;11:9.
31. Zargar-Shoshtari K, Connolly AB, Israel LH, Hill AG. Fast-track surgery may reduce complications following major colonic surgery. Dis Colon Rectum. 2008 Nov;51(11):1633–40.
32. Barlow R, Price P, Reid TD, Hunt S, Clark GW, Havard TJ, Puntis MC, Lewis WG. Prospective multicentre randomised controlled trial of early enteral nutrition for patients undergoing major upper gastrointestinal surgical resection. Clin Nutr. 2011 Oct;30(5):560–66.
33. Andersen HK, Lewis SJ, Thomas S. Early enteral nutrition within 24h of colorectal surgery versus later commencement of feeding for postoperative complications. Cochrane Database Syst Rev. 2006 Oct 18;(4):CD004080.
34. Kehlet H, Wilmore DW. Evidence-based surgical care and the evolution of fast-track surgery. Ann Surg. 2008 Aug;248(2):189–98.
35. Zingg U, Miskovic D, Pasternak I, Meyer P, Hamel CT, Metzger U. Effect of bisacodyl on postoperative bowel motility in elective colorectal surgery: a prospective, randomized trial. Int J Colorectal Dis. 2008 Dec;23(12):1175–83.
36. Wiriyakosol S, Kongdan Y, Euanorasetr C, Wacharachaisurapol N, Lertsithichai P. Randomized controlled trial of bisacodyl suppository versus placebo for postoperative ileus after elective colectomy for colon cancer. Asian J Surg. 2007 Jul;30(3):167–72.
37. Hjort Jakobsen D, Sonne E, Basse L, Bisgaard T, Kehlet H. Convalescence after colonic resection with fast-track versus conventional care. Scand J Surg. 2004;93(1):24–8.
38. Ionescu D, Iancu C, Ion D, Al-Hajjar N, Margarit S, Mocan L, Mocan T, Deac D, Bodea R, Vasian H. Implementing fast-track protocol for colorectal surgery: a prospective randomized clinical trial. World J Surg. 2009 Nov;33(11):2433–38.
39. Wang G, Jiang ZW, Xu J, Gong JF, Bao Y, Xie LF, Li JS. Fast-track rehabilitation program vs conventional care after colorectal resection: a randomized clinical trial. World J Gastroenterol. 2011 Feb 7;17(5):671–76.
40. Baldini G, Carli F. Anesthetic and adjunctive drugs for fast-track surgery. Curr Drug Targets. 2009 Aug;10(8):667–86.
220013, Respublika Belarus, G. Minsk, ul. P.Brovki, d. 3, korp. 3, GUO «Belorusskaya meditsinskaya akademiya poslediplomnogo obrazovaniya», kafedra hirurgii,
Semyonova Yuliya Aleksandrovna
Siamionova J.A. Post-Graduate Student of the Surgery Chair of SEE “Belarusian Academy of Post-Graduate Education”.
M.D.LEVIN, Z.KORSHUN, G.MENDELSON
RARE CASE OF SURGICAL TREATMENT OF THE IRRITABLE BOWEL SYNDROME
State Geriatric Center, Netanya, Israel
We present the case of the severe irritable bowel syndrome in a 76 year old woman. Chronic constipation and abdominal pain grew with time, and there was no relief in response to medication, diet, and psychotherapy. Severe spasm of the left part of the colon was found on barium enema. Laxatives didn’t help, and most of them even increased the severity of pain. Some relieve appeared only after a bowel movement after an enema. The procedure of purgation has taken up to 5 hours recently; and if there was no any effect the patient had to call for emergent hospital aid. The patient has lost 18 kg due to constrained dietary restriction. Quality of life has dramatically improved after the colostomy of the right transverse colon. The intensity and frequency of the pain syndrome decreased significantly. During the first 6 months after the surgery the patient regained 3 kg.
The described observation shows appropriateness of the surgical treatment in cases of severe irritable bowel syndrome which can’t be treated by means of conservative therapy. To solve the problem of the place of fecal fistula application, X-ray examination with the contrast substance is advisable to plan the operation proximal to the spastic site.
1. Everitt HA, Moss-Morris RE, Sibelli A, Tapp L, Coleman NS, Yardley L, Smith PW, Little PS. Management of irritable bowel syndrome in primary care: feasibility randomised controlled trial of mebeverine, methylcellulose, placebo and a patient self-management cognitive behavioural therapy website. (MIBS trial). BMC Gastroenterol. 2010 Nov 18;10:136.
2. Ron Y. Irritable bowel syndrome: epidemiology and diagnosis. Isr Med Assoc J. 2003 Mar;5(3):201–2.
3. Engsbro AL, Simren M, Bytzer P. The Rome II and Rome III criteria identify the same subtype-populations in irritable bowel syndrome: agreement depends on the method used for symptom report. Neurogastroenterol Motil. 2012 Jul;24(7):604–e266. doi: 10.1111/j.1365-2982.2012.01908.x.
4. Ishihara S, Yashima K, Kushiyama Y, Izumi A, Kawashima K, Fujishiro H, Kojo H, Komazawa Y, Hamamoto T, Yamamoto T, Sasaki Y, Shimizu T, Okamoto E, Yoshimura T, Furuta K, Noguchi N, Tanaka H, Murawaki Y, Kinoshita Y. Prevalence of organic colonic lesions in patients meeting Rome III criteria for diagnosis of IBS: a prospective multi-center study utilizing colonoscopy. J Gastroenterol. 2012 Mar 30. [Epub ahead of print]
5. Ritchie J. Pain from distension of the pelvic colon by inflating a balloon in the irritable colon syndrome. Gut. 1973 Feb;14(2):125–32.
6. O'Connor OJ, McSweeney SE, McWilliams S, O'Neill S, Shanahan F, Quigley EM, Maher MM. Role of radiologic imaging in irritable bowel syndrome: evidence-based review. Radiology. 2012 Feb;262(2):485–94.
7. Jailwala J, Imperiale TF, Kroenke K. Pharmacologic treatment of the irritable bowel syndrome: a systematic review of randomized, controlled trials. Ann Intern Med. 2000 Jul 18;133(2):136–47.
8. Olden KW. Irritable bowel syndrome: an overview of diagnosis and pharmacologic treatment. Cleve Clin J Med. 2003 Jun;70(Suppl. 2):S3–7.
9. Ducrotte P. Irritable bowel syndrome: from the gut to the brain-gut. Gastroenterol Clin Biol. 2009 Aug-Sep;33(8-9):703–12. [Article in French]
10. Shafik A, Shafik AA, Ahmed I, el-Sibai O. Treatment of irritable bowel syndrome with colonic pacing: evaluation of pacing parameters required for correction of the "tachyarrhythmia" of the IBS. Hepatogastroenterology. 2004 Nov-Dec;51(60):1708–12.
11. Gasiorowska A, Poh CH, Fass R. Gastroesophageal reflux disease (GERD) and irritable bowel syndrome (IBS)–is it one disease or an overlap of two disorders? Dig Dis Sci. 2009 Sep;54(9):1829–34.
12. Nastaskin I, Mehdikhani E, Conklin J, Park S, Pimentel M. Studying the overlap between IBS and GERD: a systematic review of the literature. Dig Dis Sci. 2006 Dec;51(12):2113–20.
13. Sjodahl R, Schulz C, Myrelid P, Andersson P. Long-term quality of life in patients with permanent sigmoid colostomy. Colorectal Dis. 2012 Jun;14(6):e335-8. doi: 10.1111j.1463-1318.2012.02941.x.
14. Kald A, Juul KN, Hjortsvang H, Sjodahl RI. Quality of life is impaired in patients with peristomal bulging of a sigmoid colostomy. Scand J Gastroenterol. 2008;43(5):627–33.
42202, Israel, Natanya Amnin ve-Tamar, 1/2, State Geriatric Center,
Levin Michael Davidovich
Levin M.D. MD, Radiologist of State Geriatric Center of Netanya
Korshun Z. Head of the Geriatric Department of State Geriatric Center of Netanya
Mendelson G. Head of the Geriatric Department, Head Doctor of the Hospital of State Geriatric Center of Netanya
EXCHANGE OF EXPERIENCE
EFFICIENCY OF ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY AND PAPILLOSPHINCTEROTOMY AT TREATMENT OF BILIARY SYSTEM DISEASES
Military Hospital, the State Border Service of AR, Baku
The Republic of Azerbaijan
Objectives. To evaluate the efficiency of the endoscopic retrograde cholangiopancreatography and endoscopic papillosphincterotomy at treatment of the biliary system diseases.
Methods. During the period from 2006 to 2011, 175 endoscopic retrograde cholan-giopancreatographies (ERCP) and 159 endoscopic papillosphincterotomies (EPST) were performed. All kinds of papillotomy were used: cannulation (complete, incomplete), needle (pre-cut, fistulotomy).
Results. The effectiveness of ERCP composed 92,7%. When it was impossible to carry out cannulation of Vater papilla and to reach the biliary system without trauma, we used needle or incomplete pre-cut papillotomy. Complication rate made up 8,9%. The highest percentage of complications was observed during the operation of EP-pre-cut (16,7%) with the needle electrode providing access to the common bile duct in the process the hindered cannulation. In 12 cases of the failed bile duct cannulation we managed to achieve positive results using a needle electrode.
Conclusions. The result analysis of the endoscopic procedures effectiveness indicates a high resolution capability of ERCP method (96,5%), and it is the «gold standard» at treatment of extrahepatic pathologies. Endoscopic papillotomy has high effectiveness amounting to 98,7%.
1. Nichitailo ME, Grubnik VV. Minimal'noinvazivnaia khirurgiia patologii zhelchnykh protokov [Miniinvasive surgery of biliary pathology]. Kiev, Ukraina: Zdorov'e; 2005. 424 p.
2. Adler DG, Baron TH, Davila RE, Egan J, Hirota WK, Leighton JA, Qureshi W, Rajan E, Zuckerman MJ, Fanelli R, Wheeler-Harbaugh J, Faigel DO. Standards of Practice Committee of American Society for Gastrointestinal Endoscopy. ASGE guideline: the role of ERCP in diseases of the biliary tract and the pancreas. Gastrointest Endosc. 2005 Jul;62(1):1–8.
3. Egiev VN, Valetov AI, Rudakova MN, Meshkov VM. K vyboru taktiki lecheniia kholedokholitiaza [Some aspects of treatment choice of choledocholithiasis]. Endoskop Khirurgiia. 2000;(6):13–15.
4. Ermakov EA, Lishchenko AN. Miniinvazivnye metody lecheniia zhelchnokamennoi bolezni, oslozhnennoi na-rusheniem prokhodimosti zhelchnykh protokov [Miniinvasive treatment of cholelithiasis complicated by bile duct obstruction]. [Khirurgiia Zhurn im NI Pirogova. 2003;(6):68–74.
5. Masci E, Toti G, Mariani A, Curioni S, Lomazzi A, Dinelli M, Minoli G, Crosta C, Comin U, Fertitta A, Prada A, Passoni GR, Testoni PA. Complications of diagnostic and therapeutic ERCP: a prospective multicenter study. Am J Gastroenterol. 2001 Feb;96(2):417–23.
6. Katsinelos P, Mimidis K, Paroutoglou G, Christodoulou K, Pilpilidis I, Katsiba D, Kalomenopoulou M, Papagiannis A, Tsolkas P, Kapitsinis I, Xiarchos P, Beltsis A, Eugenidis N. Needle-knife papillotomy: a safe and effective technique in experienced hands. Hepatogastroenterology. 2004 Mar-Apr;51(56):349–52.
7. Linder S, Soderlund C. Factors influencing the use of precut technique at endoscopic sphincterotomy. Hepatogastroenterology. 2007 Dec;54(80):2192–97.
8. Gal'perina EI, Vetsheva PS, red. Rukovodstvo po khi-rurgii zhelchnykh putei. Moscow, RF: Vidar; 2009. 560 p.
9. Mallery JS, Baron TH, Dominitz JA, Goldstein JL, Hirota WK, Jacobson BC, Leighton JA, Raddawi HM, Varg JJ 2nd, Waring JP, Fanelli RD, Wheeler-Harbough J, Eisen GM, Faigel DO. Complications of ERCP. Gastrointest Endosc. 2003 May;57(6):633–38.
AZ 1072, Respublika Azerbaydzhan, g. Baku, Narimanovskiy r-n, ul. Fatali Han Hoyski 99, Voennyiy gospital, gosudarstvennaya pogranichnaya sluzhba AR,
Yusif-zade Kenan Rafael oglyi
Yusif-Zade K.R. Candidate of Medical Sciences, Chief of the Military Hospital of the State Border Service of Azerbaijan.
SCIENTIFIC CONGRESSES AND CONFERENCES
A.A. LITVIN 1, 2, V.A. KOVALEV 3, V.A. LITVIN 4
INTERNATIONAL CONGRESS «COMPUTER- ASSISTED RADIOLOGY AND SURGERY»
(JUNE 27-30, 2012, PISA, ITALY)
Gomel Regional Clinical Hospital 1,
Gomel State Medical University 2,
United Institute of Informatics Problems of NAS 3,
Belarusian State University 4, Minsk, Belarus
The article presents the main issues discussed at the international congress «Computer Assisted Radiology and Surgery» (27-30 June 2012, Pisa, Italy). The most pressing areas of the research are image- and model-guided interventions, advanced medical imaging, image processing and visualization, computer aided diagnosis, medical simulation and e-learning, surgical navigation and robotics, personalized medicine.
246029, Respublika Belarus, g. Gomel, ul. Bratev Lizyukovyih, d. 5, U «Gomelskaya oblastnaya klinicheskaya bolnitsa»,
Litvin Andrey Antonovich
Litvin A.A. Candidate of Medical Sciences, Associate professor, Deputy of Head Doctor on Surgery, ME "Gomel Regional Hospital," Associate Professor of Surgery Chair ¹ 1, EE "Gomel State Medical University."
Kovalev V.A. Candidate of Technical Sciences, Head of the Laboratory Analysis of Biomedical Images of the United Institute of Informatics Problems of NAS of RB
Litvin V.A. Student, Faculty of Radiophysics and Computer Technologies of EE "Belarusian State University."