Vol 6, No 1 (2013)

Relevance Burn injury is one of the most severe types of traumatism. In this regard, infectious complications of burn disease are significantly more likely to develop, even in patients with relatively small area burns, and mortality rate increases substantially.

The purpose of the study To detect changes in the amount of functional activity and to determine the prognostic significance of immune cells.

Materials and methods The study was conducted on 38 patients at different periods of burn disease, depending on the area of   the burn injury and its depth, in the Burn Center of the Institute of Surgery named after A.V. Vishnevsky and the City Burn Center at the 36th City Clinical Hospital. Phenotypic analysis of lymphocytes, granulocytes and monocytes (constitutive and activation markers, the functional activity of cells) was performed.

Results and their discussion In the period of acute burn toxemia in patients, significant changes in many immune parameters remain and are quite serious in 10-14 days after burn injury. In this regard, two cocurrent alternative processes are generally develop - hyperactivation of the immune system (leukocytosis with a shift of the blood count to the left, a sharp increase of granulocytes expressing the receptor of LPS and a high affinity Fcγ-receptor, increase of their oxygen metabolism, the functional activation of HLA-DR + monocytes) and its deep deficit (natural killer cells, lymphocytes, cytotoxic CD8 + T-cells, T-helpers and overall T-lymphocytes, B-lymphocytes).

Conclusion Based on the analysis of the complex immune parameters, it is possible not only to predict the course and outcome of burn disease, but also to determine the necessary treatment in patients with severe burns, immunotherapy and evaluate its effectiveness.

Relevance Surgical treatment for diseases of the distal part of the small intestine and the right part of the large intestine requires not only repair of continuity of the intestinal tube but also restoration of the lost function of iliocecal valvular apparatus.

The purpose of this study To develop a new method for forming invaginated cross kontsebokovogo tonkotolstokishechnogo anastomosis and study experimentally in comparison with that of the anastomosis in the way it Ya.D.Vitebskogo areflyuksnye, microbiological and morphological characteristics.

Materials and methods A new technique for formation of aruflux small-to-large intestinal anastomosis was suggested. Experiments on animals were performed.  The character of healing of anastomosis and its valvular properties were studied. Pneumopression and microbiology were compared with Ya.D. Vitebsky’s anastomosis.

Results and their discussion Both anastomoses have equal areflux properties. Morphology showed that the suggested anastomosis is characterized by full adaptation of mucous and submucous layers of both intestines. The healing processes are characterized by obvious reparable reactions. There were no evident processes of alteration and development of connective tissue.

Conclusion According to the results of pneumopression and microbiological studies have equal valvular properties. The main advantage of the suggested technique is primary character of healing.

Relevance At present manuals on anaesthesia see epidural anaesthesia as a major method in surgery on the arteries of the lower limbs. However, this method can involve some risks. One of the worst complications of epidural anaesthesia is artery hypotension which can be a serious threat to patients especially with vascular problems. The authors have sought to work out some measures aimed at preventing critical incidents of haemodynamics which can lead to postoperative complications and even lethal outcome.

The purpose of the study The present study was aimed at finding the optimal methods of prevention AG heavy degree in EA at patients of the Department of vascular surgery, оперируемых on the arteries of the lower extremities, evaluation of their efficiency, safety and impact on the operational анестезиологический stress, preparation of recommendations for practical medicine.

Materials and methods The experiment involved 102 patients from vascular surgery department divided into control and main groups to bring out the effect of Gutron® (Nycomed Austria GmbH) in the main group patients whose preparation for surgery included the use of the medicament.

Results and their discussion As the findings show, Gutron® proved itself quite safe and effective in preventing severe hypotension. The paper also shows how the use of Gutron® can be effective in reducing risks of operational stress. There is also evidence that intraoperational medicament and infusion pressure tends to be reduced as a result of stabilized haemodynamics.

Сonclusion The authors provide some practical recommendations for anaesthesiologists on the use of artery hypotension prevention programs. The authors are not interested in commercial or any other benefits from pharmaceutical firms.

Relevance The problem of the treatment of chronic osteomyelitis is the focus of surgeons and traumatologists and does not lose its relevance over the years.  Interest is the biodegradable  polymers of microbial origil– polyhydroxyalkanoates (PHA), which have compatibility with the animal tissues, high mechanical strength, which makes them promising materials for use in medicine.

The purpose of the study An experimental basis for the use of biopolymers - PGA - in the treatment of chronic osteomyelitis.

Materials and methods The study included 60 males- rabbits of Chinchilla breed.  A bone defect in the first study group completed filling powder from the PGA, the second - the implant, based on PGA and antibacterial drug of carbapenem antibiotic group (thienam) combined 10:1, in the comparison group – autogenous bone (bone autotrasplantant). Removal of animals from the experimental and collection of  the material was carried out on 30 th, 90 th day of  the observation. We evaluated clinical parameters, Х-ray pictures, microbiological and morphological results.

Results and their discussion When plastic osteomyelitic cavity filling material PGA restore the functional properties of the operated lower limbs was happening 1.2 times faster than in the comparison group. Radiographically proven that the use of the material structure of the PGA restoration of bone tissue and the defect occurred in the second study group. Morphogenesis of reparative processes after plastic PGA characterized restoration of anatomic and functional integrity of the bone to the 90 th day.

Conclusion The results allow us to recommend the PGA as osteoplastic material for reconstruction of bone defects and  require further study.

Relevance Finding reliable methods is forming colorectal anastomosis actual problem of modern Coloproctology because the failure them reaches 69%. Development and application of compression-ligature methods is forming colorectal anastomosis, the most priority. Results of experimental and clinical studies have shown that compression-ligature suture is not traumatic, provides a high degree of reliability and hermetic through the compression effect, prevents infection in crosslinkable tissue, minimal inflammation and smooth wound healing anastomosis.

The purpose of the study The development, experimental and clinical approbation and the evaluation of the original method forming colorectal anastomosis on the transanal drainage.

Materials and methods The approbation of the developed method in the experiment performed on 20 white laboratory rats. The basis of the clinical section of the included 20 patients aged 41 to 74 years, with both tumor and non-tumor diseases of the colon and rectum, the operation which complete the formation of compression-ligature colorectal anastomosis on the transanal drainage.

Results and their discussion Full restoration of motility of the gastrointestinal tract occurred to 9 days after surgery. The intubation drainage and drainage of the abdominal cavity removed from 12 to14 days. Anastomosis failure and death was not. All patients discharged from the hospital from 15 to 22 days. At 30 days after surgery performed colonoscopy with polyfocal biopsy. The healing of anastomosis first intention in all cases. Histomorphological dissection of anastomosis in the experiment showed that in the anastomosis formed by our method, in all cases alterative and exudative phase of inflammation is minimal. By the fifth day after surgery identified process of regeneration, and by the tenth day identified process of scarring in all layers of the intestinal wall. With increasing periods of postoperative period marked the gradual formation of young connective tissue, other tissue replacement.

Conclusion The developed method allows you to create reliable compression colorectal anastomosis on the transanal drainage in limited pelvis space without regard to its anatomical features, diameters and wall thicknesses of bound segments intestine. The atraumatic of method and high impermeability of compression suture, as well as lack of foreign material in the lumen of the intestine after the removal of the intubation drainage ensures minimal inflammation in the tissue and smooth anastomosis healing.

Relevance Acute destructive pancreatitis is one of the most serious diseases in emergency abdominal surgery. In Russia, in recent years there is a high incidence of acute pancreatitis (20-80 cases per 100,000 population). In a large proportion of patients (1530%) destructive forms of acute pancreatitis are registered. They are accompanied by development of septic and complications. In necrotizing pancreatitis a high mortality rate is registered – up to 25-40%, in cases accompanied by septic and systemic complications – up to 82%. The key aspects in management planning of patients with acute pancreatitis are to determine the severity of the pathological process, and the prediction of its further course, the probability of destructive forms and septic complications.

The purpose of the study The goals of the study – analysis of the results of the treatment of patients with acute destructive pancreatitis hospitalized in the surgical departments of Clinical Emergency Hospital in Smolensk

Materials and methods The diagnostic tactics in acute destructive pancreatitis at 129 patients hospitalized in Smolensk Clinical hospital of emergency medical service during the period 2008-2012 has been analysed. Used the data of clinical, laboratory and instrumental methods of investigation. Additionally, data of liver biopsy histological morphometric and immunohistochemical studies with the help of software system «Videotest 4.0» was used in 30 patients.

Results and their discussion Standard diagnostic methods for treatment control and identification of  demanding operation complications efficiency has been defined. On the material of liver biopsy specimens of 30 patients with necrotizing pancreatitis the relative square of macrophages and periportal B-lymphocytes was investigated. The relative square of macrophages in a sterile phase of acute destructive pancreatitis accepted values from 0,89 to 2,95 %, in a septic phase – from 4,34  to 9,52 %. The relative square taken by periportal B-lymphocytes in a micropreparation in sterile pancreonecrosis varied from 0,4 to 1,14 %, in a septic phase – from 1,41  to 4,98 %.

Conclusion The use of scales Ranson and APACHE II is not possible in all cases of destructive pancreatitis in hospitals of general surgery. Possibility of liver bioptates morphometry use with research of mentioned parameters as objective criteria for septic phase verification and treatment tactics correction, including operations, has been proved.

Relevance Obturator hernias in a surgical practice meet extremely seldom. In a world practice it is described only 600 cases of hernias obturator apertures. Hernias obturator the channel make 0,05 % of hernias of a belly wall. To diagnose obturatoria a hernia very inconveniently. Being complex diagnostic cases, hernias obturator the channel come to light at a stage of complications and are accompanied high death rate. Death rate at the given pathology makes from 12 % up to 70 %, with postoperative complications in 11,6 % cases. The greatest supervision of the given pathology the Japanese colleagues have.

Materials and methods The review of the literature and one author’s supervision of a hernia obturator the channel Is presented. The analyzed clinical material confirms, that owing to rare occurrence and scarcity of clinical displays obturatoria the hernia is a complex diagnostic case. The final diagnosis has been established during operative intervention, executed resexshin eunae.  Lean gut with imposing anastomosis, but in the early postoperative period on a background of depression hemodynamic there has come a lethal outcome.

Conclusion Obturator hernias in view of rare occurrence and scarcity of clinical displays are complex diagnostic cases. The knowledge of symptoms characteristic for the given pathology, including HRS a symptom and use of a computer tomography of a stomach and a basin has extremely great value, in many respects defining an outcome of disease.