Journal of Experimental and Clinical Surgery

Scientific and practical journal "Journal of Experimental and Clinical Surgery" is established by the Institute of Surgical Infection of N.N. Burdenko Voronezh State Medical Academy  in 2008.

The journal publishes original articles on clinical and experimental studies, literature reviews, brief reports on clinical observations, information on innovations, inventions and innovative projects, new methods of diagnosis and treatment, materials on the history of departments, clinics and surgical hospitals.

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Current Issue

Vol 15, No 2 (2022)

Original articles

The Quality of Life as a Criterion for the Effective Surgical Treatment of the Gastric Cardia Disease
Ruchkin D.V., Efimenko N.A., Tishakova V.E.
Abstract

The aim of the study was to assess the quality of life (QoL) in patients exposed to proximal resection of the stomach in various modifications.
Materials and methods. The study included 97 patients who underwent surgical treatment of the gastric cardia disease; of them, 87.6% having malignant neoplasms. The patients were exposed to proximal gastric resection using isoperistaltic jejunogastroplasty (Merendino-Dillard-modified) (50 patients, main group I) and conventional proximal gastric resection using “direct” esophagogastroanastomosis (47 patients, control group II). The Russian language versions of the Medical Outcomes Study 36-item Short-Form Health Survey (MOS SF-36 scale) (psychometric parameters) and Gastrointestinal Symptom-Rating Scale (GSRS) (gastrointestinal parameters) were used to assess health-related quality of life (HRQoL) in the patients before surgery and 12 and 24 months after it.
Results. The results obtained demonstrated deterioration in the quality of life of patients both in physical (on average, by 36,5±1,8 scores or 31,4%) and psychological (on average, by 34,3±1,8 scores or 34,3%) health parameters according to MOS SF-36 scale before surgical treatment. In the postoperative period, in 12 and especially in 24 months, there was an improvement in physical and psychological health parameters above 70 scores; the patients of group I recovered faster and averaged 84,8±4,1 scores (significantly closer to the population norm - 86,5±2,7 scores), and in patients of group II this parameter was 75,3±3,1. As assessed using the GSRS questionnaire, there were the least disturbances in the digestive system functioning after proximal gastric resection with the Merendino-Dillard-modified gastroplasty (in 12,0% of cases), compared to esophago-gastrostomy (in 30,0% of cases); the results are relevant (rxy=0,697±0,009; p<0,01). Proximal gastric resection with the Merendino-Dilard-modified digestive tract reconstruction creates more optimal conditions for the rapid rehabilitation of functional parameters, which positively affects the quality of life of patients.
Conclusion. The results obtained reflect the impact of the gastric cardia disease and its symptoms on the health and vital activity of patients before surgery and demonstrate how significant and effective the surgical treatment is.

Journal of Experimental and Clinical Surgery. 2022;15(2):98-106
pages 98-106 views
Clinical Laboratory Justification of Early Diagnosis and Prognosis on Surgical Sepsis Using Simple Laboratory Criteria in the Elderly
Yakovenko T.V., Movchan K.N., Tkachenko a.N., Yakovenko O.I.
Abstract

Introduction. Clinical and laboratory criteria of the Sepsis-2 Consensus disregard organ dysfunction manifestations and compensatory anti-inflammatory response in septic complications.
The aim of the study was to develop a laboratory parameter detecting sepsis at different periods of its course based on a detailed complete blood test considering the degree of pro-inflammatory response to infection, an anti-inflammatory component, presence of a particular sign of the multiple organ failure.
Materials and methods. A statistical study included 152 patients with clinical and laboratory manifestations of surgical sepsis who underwent inpatient treatment at the surgical clinical base of the North-Western State Medical University. In the group of patients who had signs of endogenous intoxication, but the diagnosis of sepsis was not confirmed, frequency of verification of septicopyemia at autopsy was identified in every 4th case. Variants of sepsis scoring were determined in accordance with the parameters of the complete blood test.
Results. The correlation between “the procalcitonin level and the scoring system” was noted at 0,5019309, the correlation between “the blood lactate level and the scoring system” did not exceed 0,542726115.
Findings. With a score higher than 7, the diagnosis of severe sepsis is very likely. With a score lower than 4, the presence of severe sepsis, including the development of septicopyemia, is unlikely. Under the condition when a score is equal 5-6 and combined with long periods of the disease, the search for distant foci of septicopyemia and assessment of the prognosis for the secondary sepsis development are priority.
Conclusion. The scoring assessment of a simple laboratory investigation (detailed complete blood test), in our opinion, indirectly reflects the presence and period of septic complications. The use of a score system in practical healthcare can improve screening of patients with surgical infection complicated by the development of sepsis at all stages of medical care.

Journal of Experimental and Clinical Surgery. 2022;15(2):107-112
pages 107-112 views
Features of Drainage of the Implant Placement Area in Patients with Incisional Ventral Hernias
Korymasov E.A., Krivoschekov E.P., Khoroshilov M.Y., Ivanov S.A., Kolesnikov V.V., Rakhimov B.M.
Abstract

Introduction. There are different and sometimes conflicting points of view regarding the drainage of the implant placement area in patients with postoperative ventral hernias. This is due to the variability of drainage methods and the commitment of surgeons to one or another technique. In addition, the results of surgical treatment and features of the postoperative period differ in these patients. Current contradictions in the drainage techniques and management of patients with seromas after hernioplasty for PVH determine the relevance of this issue and the need to obtain additional data on benefits and drawbacks of one method or another.
The aim of the study was to analyse clinical outcomes of patients with postoperative ventral hernias depending on the drainage technique of the implant placement area.
Methods. The study included 392 patients diagnosed with postoperative ventral hernia, who were treated in GBUZ "Samara Regional Clinical Hospital named after V.D. Seredavin" in 2017-2020. Patients’ clinical outcomes were compared and analysed. Group I included 110 patients with passive drain of the surgical wound, group II included 282 patients with active drain. The groups were assessed based on major parameters of the drainage impact on the surgical treatment outcomes. Non-parametric values were compared by calculating the chi-square (χ2), parametric - by calculating the Student's t-score.
Results. In group I, the average duration of hospitalization was 22,56±4,45 bed-days. The average terms of drainage were 2,02±0,69 days. Clinically significant seroma was diagnosed in 35 (32%) patients. The average number of US-guided puncture-drainage interventions was 1,87±0,89 procedures. Suppuration of the surgical wound was diagnosed in 16 (14,5%) patients. The postoperative mortality rate in the group was 3,6%, 4 patients died. In group II, the average duration of hospitalization was 13,57±2,92 bed-days. The average terms of drainage were 6,33±2,12 days. Clinically significant seroma was diagnosed in 42 (14,9%) patients. The average number of US-guided puncture-drainage interventions was 0,65±0,39 procedures. Suppuration of the surgical wound was diagnosed in 21 (7,4%) patients. The postoperative mortality rate was 2,1%, 6 patients died.
Conclusion. Active drain of the implant placement area in patients with postoperative ventral hernias statistically significantly reduces the duration of patients stay in hospital (Student t-score = 11,51 p<0,01), frequency of clinically diagnosed seromas (χ2 = 14,36, p<0,01), frequency of suppuration of postoperative wounds (χ2 = 4,665, p<0,05). When choosing the drainage option for the implant placement area, preference of choice should be given to active penetrating open drain or active penetrating closed drain.

Journal of Experimental and Clinical Surgery. 2022;15(2):113-121
pages 113-121 views
Pharmacological Regulation of the Inflammatory Response under Mesh Implant Prosthetics in the Treatment of Patients with External Abdominal Hernias
Lukoyanychev E.E., Izmajlov S.G., Evsyukov D.A., Leontev A.E., Nikolskij V.O., Mironov A.A., Panyushkin A.V., Firsova A.O.
Abstract

Introduction. Seromas and hematomas of the implantation area are among the most common complications in prosthetic repair of a hernia defect with a mesh implant. The adequate tissue inflammation response to prosthesis implantation is achieved by the local protective role of pro-inflammatory cytokines. With suppression of the body's immune system combined with existing comorbidities, mesh implants result in even greater suppression of the immune system, which is manifested by an inadequate inflammatory response, both local and systemic, leading to the development of complications.
Previously, the authors studied the effect of pyrimidine preparation "Xymedon" (INN - hydroxyethyldimethyldihydropyrimidine) on the systemic inflammatory process after prosthetic repair of anterior abdominal wall hernias. Based on the results of the interim study, it was hypothised: “Regulation of the inflammation response to prosthesis implantation in hernioplasty manifested by changes in cytokine concentration in the blood can reduce postoperative complications”.
The aim of the study was to reduce the number of postoperative complications in prosthetic hernioplasty by regulating inflammatory reactions that occur after mesh implants.
Materials and methods. Experimental part of the study. The experiment involved 66 rats, both sexes, pure line, which were implanted with mesh prostheses. Animals in group I (n=33) – the control one - received 1 ml of 0,9% sodium chloride solution, i.e. received no specific treatment. Animals in group II (n=33) - the main one - received "Ximedon" 21 mg/day as pharmacological support. Blood sampling to determine inflammation markers was performed on the 5th day after the intervention. Animals were withdrawn from the experiment and the implantation site was taken for histological and histomorphometric investigations on the 5th day of the study. The study was carried out in the SPF vivarium at the laboratory of the Center for Genetic Collections of Laboratory Animals, Lobachevsky State University of Nizhny Novgorod. The study consisted of 4 series of experiments (2018-2021).
Clinical part of the study. Prospectively (2018 - February 2022), we analyzed clinical outcomes of 101 patients with prosthetic repair (by Liechtenstein, TAPP, eTAR, "sublay") of an aponeurosis hernia defect of the anterior abdominal wall who received treatment in the City Clinical Hospital №7 named after E.L. Berezow. Patients of the "control" group (n=33) received only conventional treatment; patients of the "Ximedon" group (n=68) received 0.5 mg of ximedon 3 times a day for 10 days orally from the first day after the operation. Blood sampling was carried out on the 5th day after surgery. The data obtained were processed and structured using Microsoft Excel 2019 (64 bit), and statistical values were calculated in StatSoft Statistica 12,5 (64 bit).
Results. Xymedon has a significant effect on the increase in the area of ​​the vessels of the implantation area in the experiment. Its use is associated with a lower level of C-reactive protein and blood IL-6 on day 5 in the experimental group compared to the control group. In the clinical study ximedon has a significant effect on the cytokine concentration in the blood: C-reactive protein, TNF-a, interleukins 6, 8 and 10. In the experimental study the dynamic of C-reactive protein, blood interleukins 6 and 10 does not significantly differ from the clinical one. In the clinical study, xymedon intake was associated with fewer postoperative complications.
Conclusion. The studies performed allow us to consider "ximedon" as a means of pharmacological support for prosthetic repair in external abdominal hernias due to a significant reduction in postoperative complications provided by the ability to regulate inflammation reactions and stimulate reparative regeneration.

Journal of Experimental and Clinical Surgery. 2022;15(2):122-130
pages 122-130 views
Treatment of Patients with Uncomplicated Sacrcoccygeal Sinus
Lavreshin P.M., Gobejishvili V.K., Korablina s.S., Gobejishvili V.V., Korkmazov I.K., Uzdenov M.B., Tatarshaov M.H.
Abstract

Introduction. Despite the progress made in the treatment of patients with sacrococcygeal sinus, the number of complications in the early postoperative period does not decrease below 23%; 12% of operated patients experience relapses of the disease, 14% of patients develop rough scars and discomfort in the area of surgical intervention.
The aim of the study was to improve clinical outcomes of patients with uncomplicated sacrococcygeal sinus.
Materials and methods. The study included 152 patients who underwent surgical interventions: 79 (52,0%) - with sacrococcygeal sinus in the stage without clinical manifestations and 73 (48,0%) - in remission. In addition to the standard laboratory and instrumental examination, the following parameters were studied: predisposition to the development of excessive scarring, the importance of acute-phase inflammation proteins in predicting the development of pathological scars. A group of patients prone to excessive scarring was identified, measures were taken to prevent its development. The authors proposed options for surgical treatment of sacrococcygeal sinus using an intradermal suture.
Results. When comparing long-term clinical outcomes of conventional treatment of patients with uncomplicated sacrococcygeal sinus and an integrated approach, there was revealed a decrease in the development of gross cicatricial deformity in the area of ​​surgical intervention by 2,7 times, discomfort in the sacrococcygeal region by 3,7 times, the number of the disease relapses by 2,4 times.
Conclusion. To predict the development of pathological scarring after surgery, it is necessary to study the dynamics of changes in the concentrations of acute-phase inflammation proteins in the peripheral blood of patients. To improve clinical outcomes in patients tending to excessive scar formation, it is necessary to include anti-scar therapy in the complex of postoperative measures. An integrated approach can significantly improve clinical outcomes of patients with sacrococcygeal sinus.

Journal of Experimental and Clinical Surgery. 2022;15(2):131-135
pages 131-135 views
Influence of the Distraction Cavity Size on the Choice of the Compression Technique in Thoracoplasty in Patients with Advanced Fibrous-Cavernous Tuberculosis
Belov S.A.
Abstract

Introduction. Extrapleural upper-posterior thoracoplasty is the most common non-resectable surgery in the treatment of patients with advanced fibrous-cavernous pulmonary tuberculosis. However, there is still no unified approach in choosing the thoracoplasty and compression options of the destruction cavity.
The aim of the study was to assess clinical outcomes of various compression methods in extrapleural upper-posterior thoracoplasty considering the destruction cavity size.
Materials and methods. The study included 233 cases of upper posterior thoracoplasty performed in 2012-2019. All cases were fibrous-cavernous pulmonary tuberculosis when the process extended beyond one lobe and was widespread. Group 1 (n=70) involved patients with hybrid thoracoplasty with polypropylene mesh; group 2 (n=60) involved patients with modified osteoplastic thoracoplasty; group 3 (n=103) involved patients with conventional selective extrapleural upper-posterior thoracoplasty. When analysed, attention was paid to elimination of the decay cavity and bacterial excretion.
Results. The publications analysed demonstrate that the main criteria for choosing a plastic surgery option are traditions of the clinic and personal preferences of a surgeon. The study evidenced the best performance of hybrid compression over conventional and modified thoracoplasty (p<0,05). Obviously, the choice of thoracoplasty option and the number of resected ribs should be based on the data including the total size of the destruction cavity and the compression technique.
Conclusion. The proposed distribution of upper-posterior thoracoplasty depending on the compression technique allows individually selecting the most effective treatment options for patients with widespread fibrous-cavernous tuberculosis with destruction cavities up to 6 cm localized in the upper lung.

Journal of Experimental and Clinical Surgery. 2022;15(2):136-140
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Difficulties in Diagnosis and Surgical Treatment of Bilateral Pancreaticopleural Fistula
Ivanov Y.V., Panchenkov D.N., Gritsun V.Y., Smirnov A.V.
Abstract

The study presented clinical observation of a patient with a rare complication of chronic pancreatitis - a formed bilateral pancreaticopleural fistula. The clinical picture of the disease was similar to that of recurrent bilateral hydrothorax. To specify the diagnosis, it was necessary to perform a pleural puncture with a biochemical analysis of the removed pleural fluid. A high level of pancreatic amylase in the pleural fluid, results of targeted multislice computed tomography of the pancreas with contrast and magnetic resonance cholangiopancreatography revealed a bilateral pancreaticopleural fistula. Distal resection of the pancreas proved to be an effective and sufficient radical surgical intervention, which provided reliable elimination of the pancreaticopleural fistula and bilateral enzymatic pleurisy.

Journal of Experimental and Clinical Surgery. 2022;15(2):141-146
pages 141-146 views
Comparative Assessment of Morphological Changes in the Pleura and Lung Tissue after Pleurodesis with Various Solutions in the Experiment
Izyumov M.S., Bulynin V.V., Bobrovskih A.M., Deryaeva O.G.
Abstract

Introduction. Currently, spontaneous pneumothorax occurs in 6,2-7,1% of patients with nonspecific lung diseases. There has been a steady increase in prevalence of this disease. The relevance of preventing recurrence of spontaneous pneumothorax is still beyond doubt. Most authors recommend performing chemical pleurodesis when nonspecific spontaneous pneumothorax occurs, especially if it is recurrent. At the present time, the issue of choosing the optimal chemical agent for performing pleurodesis remains important.
The aim of the study was to analyse the nature and severity of the inflammatory reaction from the lungs, pleura and adjacent subpleural tissues of the chest wall in experimental animals during chemical pleurodesis with 4% sodium bicarbonate, 6% hydrogen peroxide and 5-fluorouracil solutions.
Materials and methods. The experiment was conducted at the experimental laboratory of Voronezh Regional Clinical Hospital № 1. The study involved 200 experimental rats (WISTAR type) with simulated spontaneous pneumothorax; after a fixed time, one of the preparations was sprayed into the pleural cavity. All animals were divided into 3 groups depending on the method of pleurodesis (5-fluorouracil solution, 4% sodium bicarbonate solution and 6% hydrogen peroxide solution) and control (0,9% sodium chloride solution). Groups of animals were withdrawn from the experiment in accordance with the rules of humane treatment of animals in 3, 5, 7, 10, 30 days with sampling of organs and tissues of the chest for histological examination to compare severity of inflammatory reactions in the pleura and adjacent areas of the lungs depending on the drug used for pleurodesis. The main criterion for assessing the comparative effectiveness of chemical agents was the morphological picture of inflammation presented by counting free cell populations (lymphocytes, macrophages, neutrophils, histiocytes) in the pleura and adjacent areas of the lung tissue of the studied animals.
Quantitative results were statistically processed using parametric and nonparametric methods with STATISTICA 10. The main statistical parameters of the studied data were estimated by the methods of descriptive statistics. Comparison of the studied samples was conducted with the Kruskal-Wallis test. Differences between the compared samples were considered significant at p≤0,05.
Results. The morphology of the inflammatory reaction in the pleura and adjacent lung tissue in all the studied groups of animals was characterized by the predominance of neutrophils over other cells in the first days of the experiment; the fact supporting acute aseptic inflammation in response to drug administration. Further, the content of lymphocytes, macrophages and their inactive forms (histiocytes) increased, and the content of neutrophils decreased, which was typical for the transition of acute inflammation to chronic. Compared dynamics in the number of analyzed immunocompetent cells evidenced that the number of lymphocytes, macrophages and histiocytes increased faster. After pleurodesis with a 6% hydrogen peroxide solution, the lowest content of immunocompetent cells in the studied tissue samples was noted if compared with the samples obtained from other groups in the same period. In all cases, pleurodesis with 6% hydrogen peroxide resulted in the minimal number of neutrophils, and the dynamics of their decrease was the most pronounced. In the control group, the number of studied cells fluctuated within the average value for this group.
Conclusion. The dynamics in the number of studied cell populations in all comparison groups was assessed as common. The method of pleurodesis significantly affects the number of cellular elements involved in the inflammatory response. Clinical outcomes of pleurodesis performed with a 6% hydrogen peroxide solution are characterized by a shorter duration and severity of the inflammatory response from the pleura and adjacent parts of the chest wall, compared with 5-fluorouracil and 4% sodium bicarbonate solutions.

Journal of Experimental and Clinical Surgery. 2022;15(2):147-153
pages 147-153 views

Experience

Endovideosurgery Potential in the Treatment of Liver Cysts
Sigua B.V., Zemlyanoy V.P., Gurzhii D.V., Syomin D.S., Ivanyukova M.A., Zakharov E.A.
Abstract

Non-parasitic cystic lesions of the liver are asymptomatic for a long time and appear to be an accidental diagnostic finding. It should also be noted that when choosing a treatment strategy, it is necessary to carry out differential diagnostics with parasitic cysts in echinococcosis and opisthorchiasis, as well as decay areas in alveococcosis and liver cancer. The paper describes a clinical case of successful management of a patient with a liver cyst. Prior to admission, the patient was examined outpatiently: ultrasound examination, spiral computed tomography of the abdominal organs detected a liquid formation in the projection of liver segments II–III measuring 89x79x88 mm. In addition, immunological studies were carried out to differentiate the origin of cystic formation. The presence of IgG antibodies to Toxocara was confirmed, the fact allowing for the parasitic origin of the cyst. The patient was admitted to the Surgical Clinic named after I.I. Grekov, North-Western State Medical University named after I.I. Mechnikov, for planned surgical treatment - en bloc resection of liver segments II-III and cholecystectomy, due to concomitant cholelithiasis. The resected edge of the liver and the gallbladder bed were processed using argon plasma coagulation. The postoperative period appeared unremarkable. The histopathological examination finding was a solitary cyst of the bile duct, with chronic active inflammation in the surrounding liver tissue. The patient was discharged in a satisfactory condition on the eleventh day after the operation under the supervision of a surgeon, therapist and infectious disease specialist. Thus, an interdisciplinary approach is a key in the treatment of patients with liver cysts and allows choosing the optimal treatment tactics.
Endovideosurgical technologies allow conducting radical surgical interventions for liver cysts, even in cases when their parasitic origin cannot be excluded.

Journal of Experimental and Clinical Surgery. 2022;15(2):154-157
pages 154-157 views
Surgical Treatment of Jejunal Diverticula
Kamanin A.A., Bogdanov P.I., Krasnopeeva M.K., Makarenko A.R., Banko V.V., Slabkova A.A.
Abstract

Тhe article presents a clinical case of a patient with jejunal diverticulum. The patient complained of spastic pains after eating for a long time, these were regarded as manifestations of gastroduodenitis, hernia of the anterior abdominal wall, psychosomatic pathology. The diagnosis of jejunal diverticulum was confirmed by abdominal MRI and diagnostic laparoscopy. Laparoscopic resection of the diverticulum was performed. In the postoperative period, the syndrome of abdominal pain completely arrested.

Journal of Experimental and Clinical Surgery. 2022;15(2):158-161
pages 158-161 views
Clinical Case of Absence of the Appendix
Glukhov A.A., Andreev A.A., Gorlunov A.V., Lobas S.V., Boev S.N., Ostroushko A.P., Laptiyova A.Y.
Abstract

Surgical interventions related to inflammatory changes in the appendix are among the most common surgeries in inpatient departments. Yet, there is a high variability in the position of the appendix, and various abnomalities in its structure, which can cause errors in the management of patients. The article describes a case of aplasia of the appendix and presents literature data on the prevalence of this pathology (1:100,000 laparotomies).

Journal of Experimental and Clinical Surgery. 2022;15(2):162-164
pages 162-164 views

Review of literature

Potential of Minimally Invasive Drainage Interventions for Acute Pancreatitis
Fedorov A.V., Ektov V.N., Khodorkovsky M.A., Skorynin O.S.
Abstract

The article reviews literature data on the potential use of minimally invasive drainage interventions in the treatment of acute necrotizing pancreatitis. Detailed information is provided on the terminology, indications and technical features of the main types of drainage interventions - percutaneous and endoscopic transluminal drainage. The results of numerous studies evaluating drainage effectiveness and possible combined applications are presented. The article also focuses on the current international clinical guidelines evidencing advisability of minimally invasive drainage interventions as part of a phased intervention strategy for the treatment of infected necrotizing pancreatitis.

Journal of Experimental and Clinical Surgery. 2022;15(2):165-173
pages 165-173 views
The Era of Minimally Invasive Techniques in the Surgical Treatment of Hernias of the Anterior Abdominal Wall - a Review of the Global Experience
Orlov B.B., Mitsinskaya A.I., Sokolov A.Y., Mitsinskiy M.A., Akhmetov A.D., Yuri A.V., Ignatenko O.V., Babayants A.V.
Abstract

Currently, the range of hernia types of the anterior abdominal wall is extremely diverse, and their frequency does not tend to decrease, despite the active and widespread introduction of laparoscopic techniques. Concurrently, the surgery of hernias of the anterior abdominal wall is undergoing active and continuous development, due to changing views on the technology of operating this pathology and the principles of anesthetic management. This results in a growing interest in aspects of the development of this industry - from open techniques to minimally invasive endoscopic robotic techniques. However, each surgical method used in the surgical treatment of ventral defects has its own benefits and drawbacks, as well as complications during anesthesia. This article presents an overview of the global experience in the use of laparo- and endoscopic techniques for the treatment of hernias of the anterior abdominal wall, in the context of both - surgical and anesthetic aspects of these operations.

Journal of Experimental and Clinical Surgery. 2022;15(2):174-181
pages 174-181 views
The Role of the Commensal Skin Microbiota in the Processes of Reparative Regeneration of Soft Tissue Wounds
Tulupov A.A., Beschastnov V.V., Pogodin I.E., Shirokova I.Y., Dudareva E.V., Andryukhin K.V., Badikov E.F.
Abstract

The issues of soft tissue wound management and combating complications of the wound process caused by colonization of the wound bed by pathogenic microflora are constantly in the field of view of surgical specialists. The steady growth of injuries accompanied by soft tissue damage and spread of antibiotic-resistant microflora prompt clinicians to preserve the body's natural defenses in order to improve tissue repair processes, thereby reducing hospital stay and achieving rational use of the economic resources of a health care facility. The article presents generalized data of scientific research arguing the significant contribution of representatives of the commensal skin microbiota to the processes of reparative regeneration of soft tissue wounds.

Journal of Experimental and Clinical Surgery. 2022;15(2):182-187
pages 182-187 views

Memorials

Fyodor Ivanovich INOZEMTSEV - Professor, founder of the Moscow Society of Russian Doctors. To the 220th of birthday
Andreev A.A., Ostroushko A.P.
Abstract

Fyodor Inozemtsev was born on February 24, 1802 in the family of a manor manager in the village of Belkino, Kaluga province. In 1814, after the death of his father, F.I. Inozemtsev moved to his older brother, a student of the medical faculty of Kharkiv University, Egor. At the age of 12, Fyodor studied first at a college, then at a gymnasium, and after completing preparatory courses, he entered the verbal faculty of Kharkiv University to study at the state expense, although he initially aspired to the medical faculty. Protesting against studying at the Faculty of Words, he skips classes, becomes the "first hooligan" and for re-education is sent as a history teacher to the Kursk province, where he also teaches arithmetic, geometry and German. In 1826, F.I. Inozemtsev was already studying medicine at the 2nd year of Kharkov, and after that - Dorpat University. A good knowledge of the German language in which the teaching is conducted distinguishes him from other students. The famous surgeon Nikolai Yellinsky, considering that F.I. Inozemtsev has an unconditional "operator talent" already in the 3rd year allows him to perform his first operation - amputation of the lower leg. In 1833, Fyodor Ivanovich defended his doctoral dissertation and went on an internship abroad. Since 1835, F.I. Inozemtsev has been an extraordinary, and in 1937 – an ordinary professor of surgery at Moscow University. In 1839-1840 F.I. Inozemtsev studied medicine in Germany, France, Italy, after which he created his own free clinic. He was one of the reformers of the educational system (1840-1860): he prepared a new modern training program for practical surgery (1850), was one of the first in the country to lecture on topographic anatomy; developed a course of eye diseases; created the first faculty surgical clinic in Russia at Moscow University (1846). Fedor Inozemtsev was a very popular doctor, who treated over 6 thousand patients a year. F.I. Inozemtsev performed the operation under general ether anesthesia for the first time in the country; Russian Russian doctor proposed to use a setting for treatment, the recipe of which has been used for more than 100 years; was the organizer of the Congress of Russian doctors, the founder of the Society of Russian Doctors in Moscow (1861); created the Moscow Medical Newspaper (1858-1878). Fyodor Ivanovich advocated that the surgeon should be a therapist at the same time. F.I. Inozemtsev – author of 3-x monographs and 33 scientific articles, the founder of the medical school, whose prominent representatives were I.M. Sechenov, S.P. Botkin, G. A. Zakharin, N.V. Sklifosovsky and others. Inozemtsev was awarded the rank of state councilor with seniority, the Orders of St. Anna of the 2nd and 3rd degrees, St. Stanislav of the 2nd degree. In 1859, F.I. Inozemtsev retired due to deteriorating health, but in 1864 he was elected an honorary member of Moscow University. F.I. Inozemtsev died on August 6, 1869 and was buried in the famous cemetery of the Donskoy Monastery. The historian Pyotr Ivanovich Bartenev wrote about Fyodor Ivanovich: "A useful professor, a skilled doctor, a well-meaning citizen, a kind man, an ever-memorable friend of mankind."

Journal of Experimental and Clinical Surgery. 2022;15(2):188-188
pages 188-188 views
Caesar Alphonse RU - Professor, founder of reconstructive surgery of the gastrointestinal tract. To the 165th of birthday
Andreev A.A., Kanivets A.S., Ostroushko A.P., Laptiyova A.Y.
Abstract

Cesar Alfonce Roux was born on March 23, 1857 in the Swiss Republic, in the town of Mont-La-Ville, canton of Vaud. He did not belong to the medical elite of that time, as he grew up in a poor family, having been accustomed to work since childhood and endowed with a sense of responsibility. His father worked as a school inspector, and Caesar himself was the oldest among his eleven brothers and sisters. After graduating from a local school and college, on the instructions of a family friend – a rural doctor - he decides to enter the medical faculty. Due to the fact that Caesar Roux's family was from among the French Huguenots, which excluded the possibility of studying at the universities of Lausanne or Geneva, he chose the faculty in Bern. In it, Caesar, in addition to studying, also combined work as a laboratory assistant at the departments of anatomy, physiology and, finally, pathological anatomy. Being an extraordinary person and a great workaholic, by the end of his studies he was noticed by one of the "masters" of surgery at that time – Theodor Kocher, who offered him an internship at the clinic "Hôpital de l'Isle". At this time, Caesar also managed to visit Vienna and get acquainted with the works of advanced surgeons of his time. In 1884, he began working as a doctor in the city of Lausanne. Due to his professional qualities, great humanism and mercy, Caesar is gaining popularity relatively quickly and already in 1887 he headed the surgical department. After 3 years, the Faculty of Medicine opens in Lausanne, where Caesar Roux receives a professorship. Over time, he brought his department to an unattainable level and Lausanne became one of the centers of European surgery.
It is necessary to note the huge range of surgical areas in which there are author's innovations of Caesar Ru, but he considered abdominal surgery and surgical gastroenterology to be his most favorite sections of medicine. It was the achievements in the latter field that immortalized his name. The technique of turning off the loop of the small intestine has firmly taken its place in surgery and is widely used in our time. The famous Y-shaped anastomosis performed during gastric resection according to Billrot-II in the Ru modification is still showing good long-term results. Among the achievements of the great surgeon are operations for pre–thoracic plastic surgery of the esophagus with a small intestine. In 1883, Caesar Roux first applied the method of surgical treatment of acute appendicitis – appendectomy, and already in 1888 the operation became officially recognized. He proposed a huge number of author's surgical interventions not only in abdominal, but also in thoracic surgery, urology, and even in operative endocrinology, because Caesar Ru continued the work of Emil Theodor Kocher, developing surgical treatment of goiter. Under the leadership of Caesar Ru, 126 scientific studies were defended (almost all of them doctoral dissertations) and a large number of students were trained, who later became famous surgeons. Among them is Peter Alexandrovich Herzen, the founder of oncology in Russia, one of the world's first female surgeons in the world, Vera Ignatievna Giedroyts, who defended her doctoral dissertation, proving the high efficiency of the method of inguinal hernia repair using the Ru method.
Caesar Roux worked as a professor in Lausanne until 1926, when he had to retire due to deteriorating health, but even after that he still continued to operate, work in the clinic. On December 21, 1934, during a patient's consultation, the surgeon's heart, weakened by long-standing angina, could not stand it.
Caesar Ru has left us a magnificent legacy among the author's operations, talented students, and in the memory of his contemporaries he is imprinted as a great professional in his field, a man with a big soul, mercy and simplicity.

Journal of Experimental and Clinical Surgery. 2022;15(2):189-189
pages 189-189 views
Valentin Feliksovich VOINO-YASENETSKY - Archbishop, professor-surgeon. To the 145th of birthday
Andreev A.A., Ostroushko A.P.
Abstract

Valentin Feliksovich was born on April 27, 1877 in the eastern part of the Crimea, in one of the oldest cities in the world, at a unique resort located on two seas at once – Kerch. His father, Felix Stanislavovich, was a pharmacist and worked as a manager of a private pharmacy of D.I. Kundin, whose daughter, Maria Dmitrievna, was his mother. Valentin Feliksovich was born into a family belonging to an ancient family of impoverished Polish nobles. Of his 14 sisters and brothers, only five survived to adulthood.
In 1880, the family of Valentin Feliksovich left Kerch for Kherson, then to Chisinau, in 1889 – to Kiev. In 1896, Valentin Feliksovich graduated from the gymnasium and art school of Nikolai Ivanovich Murashko.
Then Valentin Feliksovich studied for a year at the Faculty of Law, at the private art school of Knirr in Munich, but in 1898, deciding to become a doctor, he entered the medical faculty of Kiev University.
Valentin Feliksovich, having received a doctor's degree, worked at the Red Cross hospital in Kiev, during the Russian-Japanese war he headed the surgical department of the Chita hospital as part of the Red Cross medical detachment, later worked as a surgeon in Ardatov, Simbirsk province, in the village of Verkhny Lyubazh and Fatezh, Kursk region. During this period, he married the daughter of the estate manager, sister of mercy Anna Vasilyevna Lanskaya. In 1909, Valentin Feliksovich entered the Moscow University as an external student to Professor P.I. Dyakonov.
In 1915 he published the monograph "Regional Anesthesia" and in 1916 defended it as a dissertation with the award of the degree of Doctor of Medicine. By this time, Valentin Feliksovich had mastered operations on the heart, brain, organs of vision, gastrointestinal tract, including stomach, intestines, bile ducts, kidneys, spine and joints. Until 1917, Valentin Feliksovich worked as a doctor in hospitals in central Russia, later as the chief physician of a hospital in Tashkent, professor at the Central Asian State University. Moving to Tashkent is associated with the progression of his wife's tuberculosis, which required her to stay in a warmer climate, but in 1919, the wife of V.F. Voino-Yasenetsky died, leaving him to take care of four children. In February 1921, he was ordained a deacon, a week later – a priest, on May 31, 1923, he was tonsured a monk and consecrated a bishop with the name Luke, and a week later he was arrested.
At the beginning of 1926, Valentin Feliksovich returned to Tashkent. But on May 6, 1930, he was detained and transferred to Arkhangelsk. In the autumn of 1933, from exile, Valentin Feliksovich wrote a letter to the People's Commissar of Health about the need to organize an institute of surgical infection in the country and, having received no response, went to Moscow at the first opportunity for a personal meeting, at which he rejected the offer to renounce holy orders and instead accept the post of director of the institute.
In the autumn of 1934, Valentin Feliksovich published a widely known monograph, including abroad: "Essays on purulent surgery". For several years, Professor Voino-Yasenetsky headed the main operating room of the Tashkent Institute of Emergency Care, but on July 24, 1937, he was arrested again, for the third time. Since March 1940, he has been working as a surgeon a hundred kilometers from Krasnoyarsk – in the Bolshaya Murta of the Yelovskaya volost.
After the outbreak of the Great Patriotic War, Valentin Feliksovich sends a telegram to M.I. Kalinin, in which he asks to be sent as a surgeon to the hospital, expressing his readiness to continue exile after the Victory.
In September 1941, the chief surgeon of the region took V.F. Voino-Yasenetsky by plane to Krasnoyarsk to work as the chief surgeon of the evacuation hospital No. 1515, which was later recognized as the best of the 17 hospitals of the region.
Since October 1941, Valentin Feliksovich has been a consultant to hospitals in the Krasnoyarsk Territory and chief surgeon of the evacuation hospital. In the autumn of 1942, he was elevated to the rank of archbishop and appointed to the Krasnoyarsk department. In 1944, Valentin Feliksovich published his monographs: "On the course of chronic empyema and chondrates", "Late resections of infected gunshot wounds of joints". Since February 1944, Archbishop Luke has been the head of the Tambov Department, and is a consultant surgeon at Tambov hospitals. In February 1945, Valentin Feliksovich was awarded by Patriarch Alexy I the right to wear a diamond cross. He is writing the book "Spirit, Soul and Body". Since May 1946, he has headed the Crimean Department in Simferopol and in the same year was awarded the Stalin Prize for the monograph "Essays on purulent Surgery", 130 out of 150 thousand of which he gives to the needs of wartime orphans.
In 1955, Valentin Feliksovich completely went blind, but continuing to work and in 1957 dictated his memoirs. V.F. Voino-Yasenetsky died on June 11, 1961 in the rank of Archbishop of Crimea and Simferopol on the Day of All Saints who shone in the Russian land.
Valentin Feliksovich is the author of 55 scientific works on medicine, ten volumes of sermons. He was elected an honorary member of the Moscow Theological Academy in Zagorsk. He was awarded the Chojnatski Prize from the University of Warsaw (1916), the Diamond Cross (1944), the medal "For Valiant Labor in the Great Patriotic War" (1945).
In 1995, Valentin Feliksovich was canonized as a locally venerated saint in the Crimean diocese, in 2000 he was glorified as a confessor (saint) in the host of New martyrs and confessors of Russia. His relics are installed for worship in the Cathedral of Simferopol.
On July 14, 2008, V.F. Voino-Yasenetsky posthumously became an Honorary Citizen of Pereslavl-Zalessky. On June 19, 2020, by Decree of the President of the Russian Federation, the Medal of Luke Krymsky was established, awarded for merits in healthcare.
In memory of V.F. Voino-Yasenetsky, over 69 churches of St. Luke were opened, including in Russia (Moscow, Balashikha, Voronezh, Yevpatoria, Yeysk, Yekaterinburg, Donetsk, Zheleznogorsk, Kerch, Kovrov, Krasnoyarsk, Murmansk, Nizhny Novgorod, Novosibirsk, Novy Svet, Obninsk, Olginka, Orenburg, Perm, Petrozavodsk, Saki, Saratov, Simferopol, Stavropol, Ulyanovsk, Chelyabinsk, Chita, Yuzhno-Sakhalinsk), in Ukraine (Kiev, Sumy, Odessa, Vinnytsia, Dnipro), Greece and other countries. Monuments and busts were installed only in Russia in the years Moscow, Yeysk, Krasnoyarsk, Lipetsk, Nizhny Novgorod, Simferopol, Tambov and other cities. The name of Professor V.F. Voino-Yasenetsky was given to the Krasnoyarsk State Medical University, St. Petersburg Clinical Hospital, and the Society of Orthodox Doctors of St. Petersburg.

Journal of Experimental and Clinical Surgery. 2022;15(2):190-191
pages 190-191 views

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