Vol 6, No 4 (2013)

Short articles

Plasma Levels of Bile Acids and Level of Pressure in the Stomach and Duodenum after Cholecystectomy

., .

Abstract

Relevance At present, the frequency of operations on the gallbladder and biliary tract is constantly increasing. However, the results after removal of the gallbladder are contradictory and not always accompanied by a pronounced positive effect. The purpose of the study To study the results of cholecystectomy on the basis of data дуоденометрии, ultrasound hepatopancreatobiliary zone, estimates of the spectrum of bile acids in the blood plasma and secretory activity of the pancreas. Matherials and methods The results of cholecystectomy were traced for 10 years after the operation. The consequences of cholecystectomy were assessed by measuring plasma levels of bile acids, the levels of pressure in the stomach and duodenum, by evaluating the changes in the pancreas and stomach. Results and their discussion We detected that plasma levels of lithocholic, deoxyholic and taurodeoxyholic acids were increased by 44% during ten years after cholecystectomy. At the same time, proportions of glycocholic and tauroursodeoxyholic acids decreased by 21.5% in 5 years after the surgery. The changes in plasma levels of bile acids were accompanied by the changes of pressure in the stomach and duodenum. It was established that the most pronounced deviations were observed in the distal duodenum. The level of pressure in this area exceeded the norm by more than 2.8 times. The increase of the intestinal pressure was accompanied by the widening of pancreatic ductals in 9.5% of cases and by the increased ultrasound echogenicity of the structure in 93% of cases. In all the cases, lymphofollicular hyperplasia of gastric antral mucosa with a high degree of helicobacter pylori contamination was detected. Conclusion Сhange in the spectrum of bile acids in the plasma and blood pressure in the duodenum, apparently, is one of the factors in the pathogenesis of chronic pancreatitis after cholecystectomy. The results presented here to a certain extent can be considered as criteria for medical correction of violations occurred in the late postoperative period.
Journal of Experimental and Clinical Surgery. 2013;6(4):455-459
pages 455-459 views

Evaluating the Effectiveness of Ozonated Perftorana and Glutoksima in the Treatment of Generalized Peritonitis

., .

Abstract

The purpose of the study Was to study the performance of the immune system and cytokine profile in the patients with diffuse peritonitis and to correct these disorders to improve the results of the surgical treatment. Materials and methods The article analyzes the results of surgical treatment of 114 patients with generalized peritonitis (GP). The patients were divided into two groups. In the comparison group consisted of 38 patients who received conventional combination therapy, and a core group of 76 patients. The main group was divided into two subgroups. Patients 1st subgroups (n=40) in treatment since preoperative preparation ETA used intravenous infusion at a dose of 1 mg/kg ozone concentration of 5 mg/l. The second subgroup of patients (n=36) against systemic and local OT with OP as in the 1st subgroup further preoperatively prepared metabolic immunomodulator and detoxifier 2.0 ml of 1% glutoxim. All the patients blood before surgery, 1-3 , 5-7 and 10-14 days after the operation expression defined clusters CD3+, CD4+, CD8+, CD19+, CD4+/CD8+, phagocytic index, immunoglobulins (Jg A, M, G) and circulating immune complexes (CIC) and indicators of cytokines (TNFα, IL- 4 and IL- 8). Results and their discussion All patients in both groups at admission revealed changes in cellular and humoral immunity, phagocytosis, and cytokine balance compared with those in healthy individuals, the severity of which was dependent on the severity of peritonitis by MPI. Conclusion The results showed the effectiveness of the combined local and systemic application of the OP, OP especially with glutoxim in the complex treatment of patients with GP, which allows us to recommend them for wide clinical application.
Journal of Experimental and Clinical Surgery. 2013;6(4):460-463
pages 460-463 views

The Anatomy of the Supraclavicular Nerve During Surgical Approach to the Clavicular Shaf

., ., ., .

Abstract

Relevance Surgery for clavicular shaft fractures is becoming more common but incisional and chest wall numbness reportedly occurs in 79%-89% of patients. This may be the result of iatrogenic injury to the supraclavicular nerve branches. Purpose of the study We determined if there was a predictable branching pattern of the supraclavicular nerve at the anterior clavicular border and determined the distances to these nerves from clavicular landmarks. Matherials and methods We performed an anatomic dissection along the anterior border of the long axis of the clavicle in 10 cadavers. The branches of the supraclavicular nerve were identified at the anterosuperior clavicular border and the distances from these nerves to palpable bony landmarks were measured. Results and their discussion 50 percent of specimens had a medial and a lateral branch of the supraclavicular nerve. 50 percent had a medial, medium and a lateral branch of the supraclavicular nerve. No branch was found within 2.7 cm of the sternoclavicular joint or within 1.9 cm of the acromioclavicular joint. Between these two positions, there was wide variability in nerve branch location. Conclusions There were two or three branches of the supraclavicular nerve crossing the clavicle 100% of the time and a wide variability of the location of these branches outside the safe zones. Clinical Relevance. There are safe zones within 2.7 cm of the sternoclavicular joint and 1.9 cm of the acromioclavicular joint. Between these safe zones, the location of the nerve branches is variable and the surgeon must use meticulous dissection if he or she wishes to prevent transection
Journal of Experimental and Clinical Surgery. 2013;6(4):464-466
pages 464-466 views

Original articles

Characteristic Features of the Formation of Tissue Delimiting Barrier with Patients Having Necrotizing Pancreatitis

., ., ., ., ., ., .

Abstract

Relevance Patients with pancreatic necrosis revealed a high incidence of infection and extention of non-delimiting suppurative destructive process onto parapancreatic fat. These complicated forms of the disease are characterized by severity and high postoperative mortality. Purpose of the study Experimental basis and clinical testing of an original method aimed to form a fibrin delimiting barrier with pancreatic necrosis. Materials and methods For a series of test-tube experiments the following was used : stabilized native plasma, a blood product — plasma cryoprecipitate, standardized preparations: thrombin and thromboplastin, calcium gluconate, aminocaproic acid. As a lysis factor the following was used: native pancreatic juice and officinal drug – himopsin. Experiments to create a fibrin delimiting barrier were being performed on 6 mongrel dogs weighing 15-25 kg. Simulation of focal pancreatic necrosis was performed with intrapleural anesthesia through laparotomic access. Next, parapancreatic fiber in the area of necrosis was infiltrated with a mixture of cryoprecipitate, aminocaproic acid and calcium gluconate (original technology) through puncture. In the chronic experiment, intraoperative biopsies of the gland and the zones of fibrin block were collected with the following histological examination. The results of surgical treatment of 581 patients with necrotizing pancreatitis for the period since 2007-2011 is being researched now. Patients with infected pancreatic necrosis account for 54,8%, out of which – the ones with retroperitoneal phlegmon - 34.4% respectively. Postoperative mortality with phlegmons of retroperitoneal fat was equal to 50,2%. Throughout 2012 in the clinic the patients with necrotizing pancreatitis were being treated by an method of creating a delimiting fibrin barrier — with 19 patients. Four patients had a sterile pancreatic necrosis and were operated endoscopically. In 15 cases - patients having infected necrotizing pancreatitis complicated by the phlegmona of retroperitoneal fat we resorted to open laparotomy. Results and their discussion In the postoperative period data from laboratory studies and special investigation techniques (ultrasound, MSCT) for 13 patients demonstrated regression of phlegmona and the formation of the demarcation zone from the tissue in the form of an inflammatory infiltrate, transforming after 3-4 weeks of observation into a typical area of rumen delimitation (walled-off pancreatic necrosis). Postoperative mortality in this group was 11,8% whereas, in the basic group of patients — 50,2%. Conclusion Laboratory and experimental methods developments have proved the efffectiveness of the use of blood product (plasma cryoprecipitate donors) as implanting artificial source of fibrinogen / fibrin to form fibrin parapancreatic barrier. In the clinic this method was used in the surgical treatment of 19 patients with necrotizing pancreatitis. The use of original technology is more shows in the group of patients suffering from the most severe complications pancreatic necrosis and phlegmon of retroperitoneal fat (15 cases), Postoperative mortality rate was 11,8%.
Journal of Experimental and Clinical Surgery. 2013;6(4):397-405
pages 397-405 views

Treatment of the Purulent Wounds Using Immobilized Forms of the Chlorgexedine Bigluconate

., ., ., .

Abstract

The purpose of the study Is to achieve better results of topical wound treatment of the purulent inflammatory soft tissue processes using an immobilized form of the chlorgexedine bigluconate in the first stage of wound healing. Materials and methods The investigated material is an immobilized form of the chlorgexedine bigluconate consisting of: chlorgexedine bigluconate 0,05% - 100,0; sodium nitrate of carboxymethylcellulose– 4,0; purified water– 100,0. An analysis of complex examination and treatment of 58 patients suffered from purulent wounds has been accomplished. All patients were randomized into two groups. The first (control) group patients were treated using “Levomecol” whereas the second (investigated) group patients received treatment with immobilized forms of the chlorgexedine bigluconate. Dynamic changes of the wound healing were monitored by parametric, bacteriologic, and cytologic investigation methods. Results and their discussion The faster rate of wound size reduction is achieved in the second group then in control one on the 3rd day by 1,59%, on the 5th day – by 3,16%, on the 7th day – by 5,86%, on the 10th day – by 6,85%, on the 14th day –by 7,82%, on the 21st day – by 7,62%. In the second group the bacterial wound colonization (BWC in 1 gram of tissue) was lower then in control one on the 3rd day by 1,6х106 , on the 5th day – by 25,1х105 on the 7th day – by 76,9х104 , on the 10th day – by 2,4х104 %, on the 15th day – by 0,5х103 (р<0,05). The number of granulocytes in the second group was lower on the 3rd day by 11,8%, on the 5th day – by 14,2%, on the 7th day – by 8,8% , on the 10th day – by 5,2%. The number of fiberblasts in the second group was higher on the same terms by 4,55%, 5,8%, 3,6%, and 4,4% respectively. Conclusion Higher positive results are achieved in treatment of the purulent wounds using immobilized forms of the chlorgexedine bigluconate what is confirmed by results of parametric, bacteriologic, and cytologic investigation methods.
Journal of Experimental and Clinical Surgery. 2013;6(4):406-410
pages 406-410 views

Experimental Substantiation of Combined Copper Nanoparticles’ and Low-Intensity Laser Radiation Application in Surgical Treatment of Simulated Infected Burn Wounds of the Skin

., ., ., .

Abstract

Relevance Application of laser and nanotechnologies is considered to be one of the most current and promising trends in modern experimental medicine. The purpose of the study To develop the method of infected skin burn wound modelling and to substantiate experimentally the effectiveness of copper nanoparticles’ and low-intensity laser radiation (LILR) combined application in the treatment of infected burn wounds of the skin. Materials and methods On the basis of the experiment on 50 white laboratory rats of 190-200g. weight there was developed and patented the method of skin burn wound simulation; the effect of copper nanoparticles’ and low-intensity laser radiation combined application in the treatment of infected burn wounds was studied in the experiment on 50 similar animals Results and their discussion Using the developed laser radiation method, skin burns of controlled damage depth and area were modelled. Peculiarities of the simulated wound process development in skin burn wound infection, markedness of antibacterial effect of various copper nanoparticles’ concentrations and laser radiation parameters were detected. Combined local application of LILR and copper nanoparticles in experimental animals of the group under observation provided by the 7th day of treatment discontinuation of pathogenic microflora inoculation, by the 4th day – appearance of granulations, and by the 14th day of treatmentwound epithelization. Conclusion The obtained findings of experimental studies with the use of planimetric and microbiological methods of investigation suggest rather high efficiency of combined application of copper nanoparticles and laser radiation, the effect surpassing that of standard methods of treatment in duration and adequacy of wound epithelization
Journal of Experimental and Clinical Surgery. 2013;6(4):411-417
pages 411-417 views

Study of the Effects of Different Methods of the Treatment of Purulent Wounds on the Formation of a Scar

., ., .

Abstract

The purpose of the study The purpose of the study is to substantiate morphologically the effectiveness of various methods of the treatment of purulent wounds on the basis of the analysis of structural and functional state of the regenerate. Materials and methods The experiment was conducted on 70 inbred male albino rats with the weight of 200-220 g. Modeling of purulent wounds was performed using the culture of St. aureus. All the animals were divided into 2 control and 3 experimental groups depending on the method of regional treatment. Alternating electromagnetic field, light therapy and introduction of platelet-rich auto plasma were used for the treatment. These methods were utilized after the treatment of wounds by jet sanation of 0.9% NaCl solution. The animals were withdrawn under anesthesia from the experiment on the 21st day. Each group consisted of 2 subgroups: for the intake of the histological material and for the evaluation of the mechanical properties of scar tissue. Gistological as well as morphometric techniques were used, and the wound-breaking strength was estimated. Results and their discussion The combined use of jet sanation and platelet-rich auto plasma creates more positive preconditions for the formation of qualitative scars. The greatest strength of the scar is observed in those groups, where jet sanation and platelet-rich plasma are used. The increase in the diameter of collagen fibers does not reflect the presence of linear dependence on the strength characteristics of the tissues. Conclusion The combined use of jet sanation and platelet-rich auto plasma provides regeneration with the formation of tissues that have sufficient physical and biological strength.
Journal of Experimental and Clinical Surgery. 2013;6(4):418-424
pages 418-424 views

Treatment of the Surgical Infection Caused Pseudomonas Aeruginosa in Experiment

., ., .

Abstract

The purpose of the study By morphological methods to estimate results of specific bacteriophage use for treatment of the experimental pneumonia caused Pseudomonas Aeruginosa. Materials and methods The changes of rat lungs, liver and spleen after bacteriophage application for treatment of the pneumonia caused Pseudomonas Aeruginosa were studied by method of light microscopy. Results and their discussion It was revealed that specific phagetherapy leads to disappearance of signs of respiratory insufficiency, the general intoxication, the pneumonia and sepsis phenomena, the increase in survival rate of animals. However, in the lungs after treatment there were signs of formation of abscessis, in liver - dystrophic changes of hepatocytes, and in spleen - hypertrophy and hyperplasia of lymphoid nodules. These complications, which can as well as be pneumonia consequences and phage use, demand working out and application of specific measures of preventive maintenance and treatment. Conclusion Survival of animals as a result of only a phagetherapy of the acute septic pneumonia caused by Pseudomonas aeruginosa, without application of antibacterial drugs, even in the presence of various complications, certainly, is positive result. Further researches for specifica-tion of a dosage, ways of application, indications and contraindications, complications of bacteriophage use for treatment of surgical infections are required
Journal of Experimental and Clinical Surgery. 2013;6(4):425-431
pages 425-431 views

Opportunities of the Medicamental Correction of the Postcholecystectomy Disorders of the Microbiocenosis of the Colon at the Polyclinic Stage

., ., .

Abstract

Relevance Laparoscopic cholecystectomy remains the leading treatment for gallstones. This article contains information about the state of the colonic microbiota after undergoing laparoscopic cholecystectomy. According to the literature, usually 96% of patients noted improvement in health in the first 30 days after surgery. Later, when they try to expand the diet, 37% of patients report disorders associated with the presence of intestinal dysbiosis. Materials and methods The study results are based on an analysis of the microbial status of the 179 patients receiving outpatient treatment at the outpatient hospital №4 during first 3 months after surgery. The trial showed that in the early period is characterized by a complete destabilization of the microbial balance in the colon. The correction of dysbiotic disorders with prebiotics, such as inulin and butyric acid is perspective. Results and their discussion The results of the study clearly indicated that the majority of patients in the early period after laparoscopic cholecystectomy observed clinical symptoms of colon such as flatulence (in 41.9% of cases), constipation - in 30.7% of cases, much less - diarrhea in 14.5% of patients. Alternating constipation and diarrhea was observed in 9.5% of patients. Conclusion Intestinal microbiota characterized by a total destabilization of the bacterial balance in 88.3% of patients with a prevalence of 2 degrees of dysbiosis. The use of butyric acid within 1 month after cholecystectomy helps to restore microbiota in 74.5% of patients and require further treatment. The use of drug-butyric acid for 3 months normobiotsenoza possible to achieve recovery of the colon in 91.5% of patients.
Journal of Experimental and Clinical Surgery. 2013;6(4):432-438
pages 432-438 views

The Mucous Membrane of Oral Cavity at Experimental Chronic Renal Insufficiency

., ., ., .

Abstract

The purpose of the study By morphological methods to investigate reactions of mucous membrane in rat oral cavity at the renal insufficiency. Matherials and methods The changes of a mucous membrane in rat oral cavity at the chronic renal insufficiency (CRI) of various degrees were studied by methods of light microscopy. Results and their discussion It was revealed that in 6 months after modeling of easy or mild CRI the mucous membrane in an oral cavity was diffuse infiltrated by leukocytes, the volume density of blood and lymphatic vessels was in-creased. Rats with high grade of CRI have an atrophy and hyperkeratoses of mouth epithelium, sclerosis of a mucous membrane was detect, the number of leukocytes considerably increased, first of all, neutrophils, monocytes, macrophages, small leukocytic infiltrates were formed. Besides, at mild or high grade of CRI in mucous membrane of an oral cavity the quantity of eosinophils and plasmatic cells increases that points to possible presence of a considerable allergic component in initiation and maintenance of inflammation in mouth tissues at CRI. Conclusion CRI, even easy degree, leads to considerable changes of a mucous membrane of the rat oral cavity, consisting in an atrophy of an epithelium, sclerous transformation of a mucous membrane, stomatitis and gingivitis, a being accompanied diffusion and focal leukocyte infiltration and vascular disturbances. Key words Chronic renal insufficiency, mucous membrane
Journal of Experimental and Clinical Surgery. 2013;6(4):439-445
pages 439-445 views

Assessment of the Status of Fatty Tissue after Single Ultrasonic Influence in Experiment

., ., ., .

Abstract

The purpose of the study To establish features of changes of rat fatty tissue after single ultrasonic influence of various duration in a diagnostic mode. Matherials and methods The morphological changes in fatty tissue after single ultrasonic influence of various duration in a diagnostic mode were studied by methods of light microscopy. Results and their discussion It was revealed that such influence leads to a hyperemia, lymphostasis and to increase of vascular permeability. Expressiveness of changes increase in process of increase in duration of influence. All found changes are reversible, and the majority of them comes back to initial level within 1-2 days. Conclusion In practical activities it is necessary to consider possibility of development of cellular and tissue damages in the time of ultrasonography. Development and application of the actions that are directed on stabilization of a vascular wall and decrease of oedema both during the ultrasonography and right after it are expedient.
Journal of Experimental and Clinical Surgery. 2013;6(4):446-450
pages 446-450 views

Application of Bulking Agent «Dam+» in Treatment Organic and Neurogenic Fecal Incontinence in Children

., ., .

Abstract

Relevance One of the reasons of organic and neurogenic fecal incontinence in children is low resting pressure in the anal canal. The purpose of the study The purpose of this article is to study the possibilities of using bulking agent «DAM+» for increasing resting pressure in the anal canal in children with fecal incontinence, and evaluate the results of this treatment. Materials and methods The study included clinical and experimental parts. Experimental part was done on Rat Model. Bulking agent «DAM+» was introduced into submucosal layer and zone of anal sphincter each rat. All boluses were measured and histological assessment was done at 1, 2, 3 weeks and 1, 3 month. Clinical study has been performed since 2007 for 2012; The 31 patient with organic or neurogenic fecal incontinence were underwent 55 procedure of introduction polyacrylamid gel «DAM+» into submucosal layer. Patients with overflow incontinence were excluded. Assessment of anorectal zone and pelvic floor included anal manometry, irrigografy, ballonoproctografy and in some cases, computed tomography was done for revealing injuries of puborectal muscle. Results and their discussion In the course of experimental study, it turned out that boluses, introduced into submucosal layer remained in stable size. Histological assessment was shown, that «DAM+» fixed into submucosal layer better than in sphincters layer. At 1 month it was detected vascular invasion of boluses, moreover «DAM+» was surrounded by thin layer of granulation tissue. Amount of resting pressure in the anal canal before and after operation also in long-term period were analyzed. The average quantity of resting pressure in the anal canal before operation is formed 20.98 ± 5.17 сm. (H2O), after operation 32.62 ± 6.63 сm. (H2 O), in long-term period 28.07 ± 6.65 сm. (H2 O) Conclusion «DAM+» should be introduced into submucosal layer. At 12 month efficiency of procedure can be decreased, however resting pressure in the anal canal remain higher than before treatment. The clinical efficiency of procedure correlates with values of resting pressure in the anal canal before and after treatment.
Journal of Experimental and Clinical Surgery. 2013;6(4):451-454
pages 451-454 views

Treatment of a Patient with a Giant Tumor Anterior Mediastinum

., ., ., .

Abstract

Relevance of this publication due to increased incidence of tumors of the mediastinum. Material and methods A case of diagnosis and treatment of a patient 48 years old with a giant tumor of the anterior mediastinum. For 10 years prior to admission to the hospital the patient routine inspection did not pass. CT scan of the chest revealed a tumor with clear smooth contours, dimensions 21х13х24 see when surgery revealed a tumor ingrowth into the tissue of the lung, vascular sprouting roots of the upper and lower lobes of the lung. There was compression of the lung tissue of the tumor. In this situation the fulfillment of the intervention aimed at tumor removal was impossible. The volume of surgical intervention expanded to pneumonectomy and removal of the tumor. Results and their discussion Complications in the postoperative period were observed. Our case study is descriptive, showing the features of the growth of tumors and diagnosis of malignancy in the mediastinum. Conclusion The development of algorithms for diagnosis and treatment of these patients required further systematization of data. Since the surgery are usually "non-standard" character, and their volume can often defined only intraoperatively, treatment of these patients should be performed in specialized medical institutions with expertise in surgery for tumors of the mediastinum. The optimum is to perform X-ray of the chest 1 times a year and in case of detection of tumor in the mediastinum, carrying a helical computed tomography of the chest in order to clarify the diagnosis
Journal of Experimental and Clinical Surgery. 2013;6(4):493-497
pages 493-497 views

Experience

Substantiation of Application of Drain Operations at the Thoracic Duct with Chronic Lympho-Venous Insufficiency of the Lower Limbs

., ., .

Abstract

Peripheral (lower limb) and central (thoracic duct) lymphodynamics were studied in 40 patients who suffered from chronic lymphovenous insufficiency of the lower limbs using ultrasound (US) scanner in. The other 40 patients (without any pathology of vessels) were under the same control. The findings obtained of lymphatic hypertension in patients who suffered from chronic lympho-venous insufficiency of the lower limbs both in the peripheral and at thoracic duct levels and development of dynamic insufficiency of the thoracic duct orifice. It allowed us to apply variants of draining operations at the cervical part of the thoracic duct to decrease lymphatic hypertension. The series of experiments on the anatomic material, particular on 19 corpses of different constitution were have been performed to improve the method of performing lympho-venous anasthomosis (LVA). Thus the method of surgical treatment of chronic lymphovenous insufficiency of the lower limbs (patent № 2466685) was introduced. Variants of draining operations of the thoracic duct were performed in 30 patients who suffered from chronic lympho-venous insufficiency of the lower limbs. The effect was studied and comparative assessment of the results of treatment with traditional methods was also conducted. The experience of application of draining operations in the thoracic duct and immediate favorable results allowed us to continue our research in a given direction
Journal of Experimental and Clinical Surgery. 2013;6(4):475-477
pages 475-477 views

Method of Programmed Intrapleural Sanation in the Combined Treatment of Pleural Empyema

., ., .

Abstract

Relevance Drainage of the pleural cavity with constant aspiration and antiseptic lavage is the method of choice in the treatment of acute pleural empyema. For the active aspiration and creation of the negative pressure in the pleural cavity, we used an aspiratorirrigator AMP-01. The purpose of the study The effectiveness of using the new method of programmed intrapleural sanation in patients with acute pleural empyema was studied. Matherials and methods The results of the treatment of 34 patients with pleural empyema in the age from 23 to 48 years old are presented. Results and their discussion On the basis of clinical, laboratory and bacteriological methods of investigation, we found that recovery was achieved in 10 (90.9%) patients of the study group; one patient (9.1%) had a large bronchial fistula. In 3 cases out of 11, small residual cavities (till 50 ml) were formed, which subsequently closed on their own. In the control group, recovery was observed in 17 (73.9%) patients. Fractional drainage of the pleural cavity in 6 (26.1%) patients of the same group was ineffective in the combined treatment. As the result, these patients were transferred to a Specialized Thoracic Department of the Regional Hospital for operative therapy. Besides, in 7 cases out of 23 small residual cavities were formed, which subsequently closed on their own. Conclusion Thus, the developed method allows performing sanation of the pleural cavity more effectively, which improved the results of the treatment and reduced the rehabilitation time for this group of patients
Journal of Experimental and Clinical Surgery. 2013;6(4):478-482
pages 478-482 views

To the Question of Surgical Tactics in Children with Facial Bites

., ., .

Abstract

Relevance Treatment of children with facial bites is known as an unresolved medical and social problem. Questions of surgical tactics are discussed to date. The purpose of the study To study of possibilities of new tactic approach in treatment of children with facial bites. Matherials and methods 84 children with facial bites were observed in Nizhnii Novgorod Regional Children Hospital (2002 – 2012). In the basic group were included children, who was operated in Nizhnii Novgorod Regional Children Hospital (n=70). In the control group were included patients, who were operated in hospitals of us region in the first step, and later were treated in Nizhnii Novgorod Regional Children Hospital (n=14). In the groups were no significant distinction on gender, age, basic trauma and intercurrent diseases. Results and their discussion Complications rate in the basic group was two times lower than in the control. Treatment of children with bite wound of the face in special children hospital with multidisciplinary approach led to decrease of complications and better esthetic results. Conclusion The traditional concept of treatment in children with facial bites, including delivery of the patients to the nearest hospital and perform all the necessary actions in the health primary care, needs to be revised. Transportation of children to involve a multidisciplinary hospital at a cost of time, but does not reflect negatively on the quality of care. Children with facial bites should be delivered immediately after the trauma in the specialized surgical center. In first-aid care should be hemostasis and applying aseptic dressing. Diagnostic and surgical procedures carried out without intermediate steps, directly in the department of oral and maxillofacial surgery, lead to significantly better immediate and long-term results, both clinical and esthetic. This approach is associated with significant reduction of complications rate and reconstructive operations
Journal of Experimental and Clinical Surgery. 2013;6(4):483-488
pages 483-488 views

The Method of Remodelling of the Inconsistent Scar on the Uterus During Cesarean Section Operation

., ., .

Abstract

Relevance Following up of a pregnant women with a scar on a uterus is one of actual problems of modern obstetrics. Scarring of uterus wall increase probability of complications, such as fetoplacental insufficiency, fetal hypoxia, threat of interruption of pregnancy. Special danger to life of mother and fetus is represented by an inconsistent scar on a uterus in connection with probability of a rupture of a uterus at pregnancy or childbirth. Restoration of a uterus wound quite often becomes complicated by cutting of threads through fragile scar tissue, bleeding and repeated formation of an inconsistent scar. The purpose of the study was development of a technique of remodeling of an inconsistent scar on a uterus, allowing to restore anatomic and functional full value of the lower segment of a uterus. Materials and methods Research of 122 pregnant women with a inconsistent scar on a uterus who were divided into two groups is conducted. The control group included 57 patients at whom the uterus during Cesarean section was taken in by a traditional technique. The main group was made by 65 women at whom the offered technique of remodeling of a scar on a uterus was used. Results and their discussion During use of the offered technique in comparison with traditional, additional haemostatic sutures on a uterus were imposed 3 times less often, need for application of uterotonic medications was decreased, the total amount of blood loss decreased at operation. By the 4 days after the delivery the average thickness of a scar on a uterus in the main group varied from 7,2 to 8,3 mm, in control group – from 2,9 to 3,4 mm. Important difference was absence of early postnatal bleedings and endometritis at patients in the main group that promoted more favorable current of the postnatal period and formation of a consistent scar on a uterus.
Journal of Experimental and Clinical Surgery. 2013;6(4):489-492
pages 489-492 views

New in surgery

Experimental Substantiation New Ways of Spleno- and Mesorenal Anastomosis

., ., ., .

Abstract

Relevance Portocaval shunting is one of the main methods for prevention of gastroesophageal bleedings at patients with a portal hypertension syndrome. From proposed methods portocaval shunting most frequently used anastomosis with the roots of the portal vein - the splenic and superior mesenteric veins. However, the vascular anastomosis with the roots of the portal vein are often accompanied by complications, including thrombosis of fistulas and recurrence of gastroesophageal bleeding. This is caused by a small caliber of shunted vessels. In addition recurrent gastroesophageal bleeding is caused by excessive high portal pressure, arising as a result of hydrodynamic resistance at the mouth of the anastomosis, flutter blood flow, collapsing walls of the blood vessels, deformation of the inosculate vessels. For improving portocaval shunting results may be the introduction of microsurgical techniques and the operating methods of external fixation the vascular wall, creating a frame mechanism for the prevention of anastomotic valve structures. The purpose of the study The aim of the study was an experimental anatomical study and development of new microsurgical frame end-to-end splenorenal and mesorenal anastomosis in portal hypertension. Materials and methods The section on anatomy justification of microsurgical spleno- and mesorenal anastomosis performed on a section material (54 human cadavers). The study of topography and anatomy features of splenic, renal and superior mesenteric veins were conducted, their morphological characteristics, the histology characteristics of vascular anastomosis, the parameters of their tightness and mechanical strength. Experimental studies carried out on 48 mongrel dogs. There have been five sets of experiments. The analyses of morphological and functional status of improved vascular anastomosis in the short and long periods after surgery were accomplished. Results and their discussion There are developed new ways of microsurgical organ-save splenorenal and mesorenal anastomosis. New data on the dynamics of the vascular healing at various periods after reconstructive surgery, their morphological and functional characteristics were received. Conclusion Results of the study show that the use of microsurgical techniques in combination with an external frame of demineralized bone can create portocaval anastomosis with preservation of the kidney and spleen, to ensure good functioning of the anastomosis without the use of anticoagulants
Journal of Experimental and Clinical Surgery. 2013;6(4):467-474
pages 467-474 views

Review of literature

Modern Approaches to Сomplex Treatment of Necrotic Tissue Diseases

., .

Abstract

This article presents the relevant information on the prevalence, etiology and pathogenesis modification factors, as well as evaluation of modern methods of treatment necrotic soft tissue diseases. Special attention is paid to the actively developing method of physical therapy of necrotic process - the low-frequency ultrasonic (LFUS) cavitation. Presented a detailed assessment of the basic properties of ultrasound treatment on the wound process: mechanical wound cleansing cavitation squirt, acceleration of metabolism at the subcellular and tissue levels, bactericidal and bacteriostatic effect on microorganisms , the potentiation of antibacterial and antiseptic , strengthening of regional blood flow , enhancing the repair processes in the wound. Application LFUS cavitation relevant to the outpatient treatment phase necrotic diseases of soft tissues due to its high-performance, ease of use , and also show the best correlation with program implementation of hospital- substituted technologies in outpatient link of health care. The study of literature shows that few studies use LFUS in outpatient practice do not contain explicit organizational and structural features and algorithms for the treatment of patients with purulent-necrotic diseases of soft tissues LFUS cavitation. Matters relating to the definition of optimum conditions , the multiplicity and duration of exposure to wound, the optimum compositions of acoustic mediums, the optimal method of local anesthesia, when used LFUS in patients with different clinical forms of necrotic soft tissue diseases , there remains little known
Journal of Experimental and Clinical Surgery. 2013;6(4):498-518
pages 498-518 views

Characteristics of Esophageal-Intestinal Anastomoses in Gastrectomy

., ., .

Abstract

In a review article, which includes 67 sources, including 48 domestic and 19 foreign, was analyzed challenges and options overlay esophageal anastomoses after gastrectomy – the most common surgery for stomach cancer. Was described the current requirements for their implementation. Set out the existing methods of the esophageal anastomoses in chronological order. Was shown are the positive and negative sides of the esophageal-duodenal anastomoses, including the use of different versions of "insertions" of the small and large intestine. Was noted the prevalence of esophageal-enteric anastomoses "end-to-end" and allocated their group. Was outlined the advantages and disadvantages of anastomoses: of dangling into the lumen of organ, of made with plastic techniques, of invaginated, of formed by double-row or three-row sutures, of performed using suturing apparatus. Was noted that using of modern and atraumatic needles led to a reduction percentage of insufficiency esophageal-intestinal anastomoses and allowed the introduction technique of single-row suture in the practice which simplifies implementation that minimizes the trauma of the esophageal wall and reduces the time of operative intervention. Was shown author's interest in the prevention of reflux esophagitis, of dumping syndrome, of rumen stricture esophago-enteric anastomosis by performing an antireflux anastomoses. Was noted the importance of overlay of the precision suture, without the seizure of the mucosa which allowing accurate, “joint-to-joint”, to join of the walls of the organs.
Journal of Experimental and Clinical Surgery. 2013;6(4):
views

Acute Paraproctitis. Review of the Literature

., .

Abstract

Acute anal abscess remains the issue of the day of modern surgery, which is due to, in particular, its occurrence in 0.5% of the population, 0.5-4% of surgical and 10-50% of coloproctological patients. In the article, the analysis of the literature on the etiology, classification, clinical picture, diagnosis and treatment of acute anal abscess is performed. The review revealed that 98% of acute anal abscess is caused by mixed microflora - staphylococci, streptococci in combination with E. coli. The clinical picture of acute anal abscess depends on the localization of inflammation, the virulence of microflora and the immunoreactivity of the organism. Diagnostic methods of acute anal abscess are finger and bidigital rectal examination, anoscopy, rectal examination with a mirror and rectoromanoscopy. Endorectal electrical thermometry, ultrasonography, abscessography, chromoabscessography, computed tomography, magnetic resonance imaging and others can be used as well. Once the diagnosis of acute anal abscess is established, urgent surgical intervention must be performed, which consists of the incision and drainage of abscess with the possible elimination of the opening in the zone of the anal crypt. The postoperative management of patients with acute anal abscess may involve the use of ultrasound, laser, phototherapy, oxygen and ozone therapy, wound dialysis, hydrophonophoresis, multicomponent drugs and others. Thus, as the data in the literature reveals, many questions concerning the management of patients with acute anal abscess are not resolved to the full extent. This is evidenced by the development of inflammatory complications in 13-20%, relapses in 1.5-40%, anal sphincter deficiency in 1.5-27.9% of cases, which makes it worthwhile to continue research on developing new methods of treatments for acute anal abscess
Journal of Experimental and Clinical Surgery. 2013;6(4):526-535
pages 526-535 views

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies