Vol 4, No 3 (2011)

It was subjected to analysis the result of examination and treatment of 243 patients with liver cirrhosis, whom was performed different variants of portosystemic shunting for 2004-2010 years period. “HEPAtonorm TM - Analyzer” device was used in liver encephalopathy diagnostics complex, allowing to induce glimmer critical frequency, which threshold is in direct dependency from progressing liver encephalopathy. According to results of examinations it is proved, that defi nition of glimmer critical frequency threshold both in preoperative period and after portosystemic shunting allows objective to value not only severity level and risk of progressing liver encephalopathy of patients with liver cirrhosis but also effi ciency of taken treatment.

In this paper shows the results of treatment of 47 patients with a cloelithiasis, complicated by an acute cholecystitis and paravesical infi ltrate by using atypical ways of a cholecystectomy from minilaparotomy access. Criteria and indications for performance universally recognized cholecystectomy from minilaparotomy access, from a bottom and by Pribram are showed. Rational receptions of operating and tool maintenance of a hemostasis are detailed at minicholecystectomy in the conditions of dense paravesical infi ltrate. It is shown that frequency of conversion at the acute cholecystitis complicated by dense infi ltrate, at performance of atypical ways minicholecystectomy, makes 4,2 % that is statistically authentic more low, than at performance standard minicholecystectomy at which frequency of conversion reaches 15 %. Introduction of atypical ways of minicholecystectomy at destructive forms of the acute cholecystitis complicated by dense paravesical infi ltrate, reduces risk of damage of anatomic formations of a hepatoduodenal ligament, and number of intra and postoperative complications from 12,7 to 2,1 %.

The research includes the 86 occurrences of treatment the patients with fractures of cancellous bones of lower extremity. Long-term results were studied in all cases. The new method supposes the using of circular hollow cutter. The study includes mathematical proof of the new method’s advantage as against classical bone grafting technique.

80 newborns with necrotizing enterocolitis were observed from2006 – 2009 in Nizhniy Novgorod Children's Municipal Clinical Hospital No 1. The research of parameters cellular and humoral immunity is executed 40 (50%) patients. The negative infl uence on formation immune system was rendered by harmful habits of the parents, sharp and chronic diseases of the mothers, intrauterine infection, chronic hypoxia, complication during childbirth. The parameters immunograms of the patients with necrotizing enterocolitis refl ect a clinical picture of disease, but are not specifi c, therefore can be additional diagnostic criterion of forecasting infl ammatory process.

Ярославская государственная медицинская академия

Treatment results of 29 patients with dislocations of the acromial end of the clavicle were analyzed. Depending on the
severity and remoteness of ligamentous system injury the most rational methods for clavicle fi xation using devices with shape
memory effect were determined. In 4 (13,8%) patients with II degree of clavicle dislocation by Tossy transarticular fi xation
using devices with shape memory effect was performed. In 3 (10,3%) – cases transarticular fi xation knitting Kirshers. In
7 (24,1%) – cases clavicular-coracoid fi xator was used to stabilize the clavicle in sagittal plane. In 15 (51,8%) patients with
clavicular dislocations of III degree combined fi xation by S-shaped clip with protective leg and clavicular-coracoid device
was performed. Treatment results were assessed at terms 1-3 years. In patients with clavicu lar acromial end dislocations
of II degree the effective treatment method was fi xation with clavicular-coracoid (85,7% of good results). In clavicular
acromial end dislocations of III degree the fi xation with clavicular-coracoid device and transarticular fi xation of the clavicle
by S-shaped tightening clip gave good results in 86.6% of cases.

To identify the markers of possible activators of posttraumatic gonartritises in children a research study of knee joint
puncture samples and cubital vien blood samples was performed with the help of gas chromatography–mass spectromerty
and mass fragmentography assay (GC-MS-MF). An increase of bacterial markers concentration of mainly gut organisms in
knee joint punctates was identifi ed. Thus, a traumatic injury of a knee joint is a stress factor for an organism and contributes
to an endogenic infection of a knee joint and development of a posttraumatic arthritis immediately after the injury.

Morfo-functional characteristics of dorsal root ganglion neurons allow to estimate in dynamics occurring in initial department
of refl ex arch of nervous system processes. Neurons react to wounds of soft tissue with complex of the adaptive reactions
shows us populations of cells with a various functional condition: cells with reversible changes and cells with destructive
changes. At application platelet-rich blood plasma for treatment of wounds, in comparison with a natural current of process,
are observed quantitative changes of neurons with a various functional condition. The quantity of cells with destructive
changes decreases in all terms of research, and the quantity of cells with reversible changes increases in the beginning of
experiment and decreases in late terms. Such dynamics is refl ection of activation of processes of healing at application of
platelet-rich blood plasma for wound treatment.

In four years 338 patients were diagnosed with ischemic and neuroischemic forms diabetic foot syndrome affection of necrotic
suppurative process. Early direct revascularization on aorta and great vessels were carried out to 71 patients of main group.
The post-pone direct revascularization were carried out to 30 patients in control group. And indirect revascularization –
isolated lumbal sympathoectomy, were carried out to 46 (37%) patients. In conclusion, early revascularization and bilateral
lumbal sympathoectomy, don’t late then 24-48 hours after surgical treatments, are recommend of patients with ischemic and
neuroischemic forms diabetic foot syndrome with necrotic suppurative process. It’s help to save damaged limbs from higher
amputations and to limit them at the foot and decrease lethal rates.

The need to replace the patella in total knee arthroplasty is still a subject of debate among orthopedic surgeons. Existing
studies show heterogeneous and even contradictory results. А study of 249 patients with unilateral knee osteoarthrosis , who
underwent total knee arthroplasty with (group I) and without (group II) patellar resurfacing in the orthopaedic department
of National Medical Surgical Center named N.I.Pirogow was carried out. Group I included 128 patients (51.4%), and group
II included 121 patients (48,6%), Posterior Stabilized Sigma (DePuy Johnson&Johnson) implants were used. We studied
the rate and structure of general and specifi c (patellofemoral), complications and the revision rate related to patellofemoral
complications after total knee replacement with and without patellar resurfacing. On the basis of the study results, we
concluded that, with the design of prosthesis used in our study, in patients with primary knee osteoarthrosis, similar results
may be achieved with and without patellar resurfacing.

The paper presents the results of patient investigation with chronic colonic ischemia after abdominoperineal pull through
operations. The publication is based on material of coloproctologic department of RCCH. The patients underwent next
diagnostic procedures: contrast enema, colonoscopy, angiography, morphology. The results are interest for pediatric surgeons.

The study the effects on blood protein of extent hepatectomy under anatomic and atypical methods operation. In experiments
on a 27 dogs was demonstrated that operative trauma oppressed proteometabolism, but anatomic liver resections impacting
on modifi cation of quantitative and qualitative changes of serum blood protein in a less degree.