Vol 7, No 1 (2014)

Year: 2014
Articles: 12
URL: https://vestnik-surgery.com/journal/issue/view/22

Original articles

Current Status and Prospects of Russian Medical Journals and Publications in Scopus Database

Abstract

Increased performance of the publication activity of Russian scientists and specialists, according to global citation indices such as Scopus and Web of Science, requires from Russian scientific journals, medical journals included, to improve their quality levels and compliance with international publishing standards. The article presents the characteristics of current status of Russian medical journals in Scopus, the reasons of incomplete representation of the required data, offers ways to remedy the unfavorable situation connected with low citation due to the lack of data. The author gives a list, and makes analysis of criteria adopted in the Scopus Title Evaluation Platform (STEP). On the basis of the STEP data the author analyzes both positive and negative experts’ opinions and refusal reasons to register the offered titles.

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Journal of Experimental and Clinical Surgery. 2014;7(1):10-24

10-24

Без имени
(Rus)

(JATS XML)

Constitutional and Anatomical Feature Structure Hypogastric Region of Abdominal Wall

., ., ., .

Abstract

The purpose of the study The identify constitutional and topographic anatomical features of the structure of the hypogastric region and the inguinal canal in patients with inguinal hernias, and without pathology of a forward abdominal wall. Materials and methods The study involved 164 corpses, 41 of them a corpse with inguinal hernias, 123 corpses without pathology anterior abdominal wall. Results and their discussion The influence of body type, abdominal shape, the structural features of the rear wall of the inguinal canal, variant anatomy of the rectus abdominal muscle on the occurrence of inguinal hernias. Conclusion In the occurrence of inguinal hernias are predisposing factors brachymorphic and mesomorphic body types, male form of the abdomen, weakness, abdominal transverse fascia, the triangular shape of the inguinal period, and the greater its lower medial angle, the higher the likelihood of disease. The high altitude inguinal gap and the minimum width of the tendons connected in people with inguinal hernias are caused by compression of the hernia sac of the tendon and the lower edge of the internal oblique abdominal muscles. When inguinal hernias are often found lipomas of the spermatic cord or round ligament of the uterus, and they can have both primary and secondary origin.

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Journal of Experimental and Clinical Surgery. 2014;7(1):25-31

25-31

(Rus)

(JATS XML)

The Stages of Complex Treatment of Patients with Pyonecrotic Forms of Diabetic Foot Syndrome

Abstract

Relevance The basis for treatment of patients with diabetic foot syndrome (DFS) is currently the staged surgical treatment in combination with conservative therapy aimed at the leading links of pathogenesis of the disease. The purpose of the study To develop and test a treatment algorithm for patients with ischemic and neuroischemic forms of capable supporting foot stump using both direct revascularization (endovascular and open) and indirect revascularization (ROT) methods. Materials and methods The long-term results (two years) in 132 patients with pyonecrotic forms of DFS developed on the background of diabetes mellitus type 2 have been studied. The surveyed patients were divided into three groups in accordance with the methods used to treat them. The first group consisted of 47 patients who received comprehensive medication. The second group consisted of 35 patients to whom in addition to surgical treatment of the affected foot and complex drug therapy to restore blood flow of the lower limb the percutaneous transluminal balloon angioplasty has been performed. In the third group consisting of 50 patients the debridement and complex drug treatment has been completed by revascularization osteotrepanation of the tibia (ROT). Results and their discussion The results of treatment were assessed according to the number of performed high lower limb amputations and mortality within two years. Found that patients with pyonecrotic forms DFS a comprehensive approach requires based on the selection of consecutive stages: the first stage - the solution of the question about emergency limb amputation or surgical treatment of purulent complications, the second stage - the choice of revascularization method based on ultrasonography and angiography. In the case of impossibility of direct reconstructive operations performance on vessels a study of acid base balance of venous blood, in particular, the determination of the partial pressure of oxygen and blood lactate level for the selection of patients to ROT, and the third stage – the performance of necrectomy in the required volume, resection operations on the foot with the formation of functional supporting ability foot stump has been conducted. Conclusion The received findings suggest that the efficacy of treatment of pyonecrotic forms of DFS is based on identifying groups of patients with the conduction of subsequent staged treatment. ROT should be included in the treatment algorithm for patients suffering DFS at impossibility of vascular reconstructive surgeries depending on the parameter of oxygen partial pressure and blood lactate.

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Journal of Experimental and Clinical Surgery. 2014;7(1):32-38

32-38

Без имени
(Rus)

(JATS XML)

First Results of Radiofrequency Ablation in Patients with Benign Thyroid Nodules

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Abstract

Relevance Appreciable prevalence of nodal changes of the thyroid gland (TG), possibility of early identification, verification of educations, unjustified risk of complications at traditional operative measures, dictates need of development of concrete indications and effective methods of their treatment depending on the sizes, morphological structure and caused clinical implications. Alternative method of treatment of knots of a thyroid gland is their local destruction a way of application of a radiofrequency ablation. The application of minimally invasive technique – radiofrequency ablation (RFA) for improving the results of treatment of patients with benign thyroid nodules. Presented our own data on the treatment of patients with thyroid nodules by RFA. The purpose of the study Improvement of results of treatment of patients with good quality neoplasm of a thyroid gland by means of a radiofrequency ablation. Materials and methods Method was applied at 25 patients with the diagnosis: nodal (multinodal) euthyroid struma of 1 degree. Radiofrequency ablation carried out the radio-frequency RITA Medical 1500X generator and the electrode of StarBurst SDE 2.0 having 3 conductors. Results and their discussion In a month after carrying out a radio-frequency ablation, there was a decrease of the sizes of knots of a thyroid gland – colloid by 1,5 times, cystic twice. Conclusion The radiofrequency ablation is the method which is effectively reducing volume of good-quality nonfunctioning nodal formations of a thyroid gland. At cystic knots efficiency of a radiofrequency ablation is higher, than at the solid. The radiofrequency ablation can be an effective and safe method of treatment of good-quality nodal formations of a thyroid gland, when keeping indications to technique application.

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Journal of Experimental and Clinical Surgery. 2014;7(1):39-46

39-46

(Rus)

(JATS XML)

Criteria of Instability and Their Influence on Clinical and Radiological Parameters of the Distal Radius

., ., .

Abstract

The purpose of the study To examined the clinical and radiological (X-ray) parameters of the distal radius with different types of its damages and on this basis to develop and prove the diagnostic value of essentially new fracture instability criteria. Material and methods Clinical and radiological (X-ray) parameters (CRP) of the malunited distal radius (DR) in 129 patients were analysed. Two new criteria of instability (СI) were proposed. A basic significance test was carried out to prove the influence of the Instability Criterion (IC) on Clinical X-ray Index (CXI). Statistical null hypothesis was formulated as follows: “CXI mean value is the same regardless of the IC presence”. Thus, the alternative hypothesis meant that the influence does exist. Twelve twotailed tests were carried out (two IC for six CXIs) using Student’s t-distribution with 127 degrees of freedom for 95% confidence level. Every sampling from population of 129 patients could be certainly normalized. Results and their discussion It is established that the criterion of instability CI–A influences signifi-cantly on radial displacement (RD) of the distal fragment of the distal radius: in the presence of this criterion RD was 4,63 mm and in its absence – 1,19 mm. CI–B influences on the radio–ulnar index (RUI) – 5,23 mm and 3,76 mm accordingly; radial displacement (RD) – 2,88 mm and 1,84 mm accordingly and active room of motion (ROM) of the wrist – 47,38 % accordingly – in the presence of criterion and 53,48 % – in its absence. Conclusion The carried out research has confirmed efficiency of application of new criteria of instability in diagnostics of unstable fractures of the distal radius.

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Journal of Experimental and Clinical Surgery. 2014;7(1):47-53

47-53

(Rus)

(JATS XML)

Experience

Optimization of the Cardiosurgical Services of the Voronezh Region, Providing an Example of High-Tech Medical Care to the Patients of Older Age Group

., ., .

Abstract

Relevance Enteroparesis and perifocal edema in the zone of anastomosis lead to the rise of pressure in the intestinal lumen, the enlargement of its diameter, the stretching of its wall, the proportional increase of the distance among sutures, which may contribute to the rupture of the sutures and interfere with the reparative process in the zone of anastomosis. The purpose of the study The objective is to develop the pathogenetically justified method of a single-row continuous Z-shaped suture by using microsurgical techniques. Materials and methods Experimental research was performed on 70 adult albino rats of the line «Vistar» in two stages. At the first stage, distinctive features of the healing of intestinal wounds were compared. The anastomosis was performed using a single-row penetrating interrupted suture in the 1st series and a single-row continuous locking serous-muscular-submucous stitch in the 2d series. At the second stage, we focused on the development of the pathogenetically justified method of the single-row continuous serous-muscular-submucosal Z-shaped suture, practiced the application of this suture on 100 fresh gastrointestinal conglomerates of pigs and 10 adult albino rats of the line «Vistar». Results and their discussion In the early postoperative period, we observed the tendency towards the development of more durable sutures of the anastomosis in the second series than in the first one. The new single-row continuous Z-shaped suture has a higher strength, hermeticity and large fixing area of serous membranes. Conclusion Within the proposed use of the technique of the single-row continuous serous-muscular-submucosal Z-shaped suture, there is the distribution of the multi-vector tensile force that can prevent hyperextension of tissues and anastomotic leak.

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Journal of Experimental and Clinical Surgery. 2014;7(1):54-57

54-57

(Rus)

(JATS XML)

Analysis of Multimodal Postoperative Analgesia Optimized Progamms Efficiency as a Basis for Anti-stress Providing after Gynecological Operations of Low and Medium Traumatization Degree

., ., ., ., .

Abstract

Relevance The article presents the data of the original research to assess the clinical effectiveness of prevent and eliminate postoperative pain syndrome program after gynecological operations of low and medium traumatization degree (by the respective examples a vaginoplastics and transvaginal hysterectomy). The purpose of the study Development of optimized programs for prevention and treatment of postoperative pain syndrome in patients after gynecological operations of low and medium trauma degree based on the of multimodal and pre-emptive analgesia conceptions. Materials and methods Study materials represented 70 patients after low-traumatic gynecological operations and a similar number of patients after medium-traumatic gynecological operations. Total number of examined patients amounted to 140 people. Among the investigated contingent of operations of each trauma degree were identified the main and the control groups (by 35 patients in each). In the control groups used the traditional method of analgesia. In the main groups used the developed method analgesia. Methods of the research: assessment of the pain intensity with application of modern analogue scales (visual analogue scale, digital rating scale); assessment of the stress-tension level of the autonomic nervous system by cardiointervalography with mathematical analysis of cardiac rhythm; descriptive statistical methods to determine the level of intergroup differences significance.Results and their discussion In the study groups identified the best level of analgetic protection and neurovegetative stabilization. Proved the comprehensive effectiveness of a developed analgesia program during gynecological operations both low and medium traumaticity degree. All of identified intergroup differences have a high level of statistical significance. Conclusion The obtained results allow us to: statistically reasonably considered designed program of analgesia as a means of optimizing the anti-stress support for gynecological interventions, recommend it to practical

Results and their discussion In the study groups identified the best level of analgetic protection and neurovegetative stabilization.
Proved the comprehensive effectiveness of a developed analgesia program during gynecological operations both low and medium
traumaticity degree. All of identified intergroup differences have a high level of statistical significance.
Conclusion The obtained results allow us to: statistically reasonably considered designed program of analgesia as a means of
optimizing the anti-stress support for gynecological interventions, recommend it to practical application

application.

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Journal of Experimental and Clinical Surgery. 2014;7(1):58-64

58-64

(Rus)

(JATS XML)

Short articles

Comprehensive Immunotherapy as a Method of Treatment of Surgical Nosocomial Infections

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

Abstract

Relevance In recent years, the risk of nosocomial infections, especially surgical, increases. Nosocomial infections develop in patients obtaining medical care as well as medical personnel providing it. Mortality rate from these infections in different hospitals ranges from 3.5 to 60%. The purpose of the study was to develop the algorithm of prescription and evaluate the effectiveness of the differentiated immunotherapy of patients with nosocomial infections. Material and methods We observed 450 patients with different types of nosocomial infections (purulent wounds of the soft tissue, deep pyoderma, acute and flare-up of chronic salpingo-oophoritis, acute and flare-up of chronic pyelonephritis). All patients were subjected to conventional treatment for each nosological entity and additionally treated with immunomodulators and antioxidants in regulated doses (donor gamma globulin, Derinat, Limontar, Izoprenozin, Imunofan, Immunomaks, ozonated saline solution, Myelopid, Kipferon, Ridostin, Viferon and their various combinations). In addition to traditional clinical and laboratory parameters, immunological parameters were evaluated using the flow cytometer before and after the differentiated treatment in all patients. Reliability of the data was ensured by the randomization of patients in groups, representation of their number, choice of adequate statistical criteria, assessment of the formulas of disorders and targets of immunocorrection. Results and their discussion Inclusion of the immunotropic drugs in the differentiated basic treatment of pyoinflammatory diseases eliminated the immunological disorders as well as increased treatment efficiency, reduced hospitalization and risk of chronization and recurrence of infectious pathological processes in patients. Conclusion 1. Traditional therapy of the patients with 10 types of nosocomial infections in only three cases (septic wounds of the soft tissue, complications of atopic dermatitis, combination of deep pyoderma with skin allergosis) makes the satisfactory correction of immunological disorders. 2. Additional prescription of the differentiated immunotropic drugs to

eliminated the immunological disorders as well as increased treatment efficiency, reduced hospitalization and risk of chronization
and recurrence of infectious pathological processes in patients.
Conclusion 1. Traditional therapy of the patients with 10 types of nosocomial infections in only three cases (septic wounds of
the soft tissue, complications of atopic dermatitis, combination of deep pyoderma with skin allergosis) makes the satisfactory
correction of immunological disorders. 2. Additional prescription of the differentiated immunotropic drugs to the patients with
nosocomial infections successfully corrects the disorder of laboratory status. 3. Based on the analysis of the summary of the
formulas of the set targets of immunocorrection, laboratory indications for the choice of its options are determined.

the patients with nosocomial infections successfully corrects the disorder of laboratory status. 3. Based on the analysis of the summary of the formulas of the set targets of immunocorrection, laboratory indications for the choice of its options are determined.

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Journal of Experimental and Clinical Surgery. 2014;7(1):65-69

65-69

(Rus)

(JATS XML)

Microsurgery Method Single-Row Continuous Z-Shape Suture

Abstract

Relevance of the bowel Paresis and perifocal edema zone anastomosis leads to increased pressure in the intestinal lumen,
increasing its diameter, stretching walls, the proportional increase of the distance between the joints, which can promote the
development of the cutting of seams and violate the reparative process in place of the anastomosis.
The purpose of the study is development of pathogenetically grounded way single row of continuous Z-shape seam made using
microsurgical techniques.
Materials and methods of Experimental investigations were carried out on 70 Mature white rats of line Vistar» in two stages. At
the first stage compared the features of the healing intestinal wounds. In the first series anastomosis were performed using singlerow-through
a hub seam, 2nd - row type continuous blanket serous-muscular-submucosal seam. The second stage was devoted
to development of pathogenetically grounded way single row of continuous serous-muscular-submucosal Z-shaped seam, the
development of technology developed seam 100 fresh gastrointestinal conglomerates pigs and 10 adult white rats of line Vistar»
Results and their discussion the early postoperative period in the series, where the anastomosis is performed continuous blanket
serous-muscular-submucosal seam has the tendency to the formation of a more durable joint anastomosis than in series, where the
anastomosis is performed through a hub seam. Developed new single row of continuous Z-seams having greater strength, integrity,
large clamping area of contact serous membranes.
Conclusion To the extent that the equipment proposed single row of continuous serous-muscular-submucosal Z-shaped seam is
distributed multi-vector tensile strength that can prevent restretching tissues and prevent insolvency anastomosis

eries, where the anastomosis is performed continuous blanket serous-muscular-submucosal seam has the tendency to the formation of a more durable joint anastomosis than in series, where the anastomosis is performed through a hub seam. Developed new single row of continuous Z-seams having greater strength, integrity, large clamping area of contact serous membranes. Conclusion To the extent that the equipment proposed single row of continuous serous-muscular-submucosal Z-shaped seam is distributed multi-vector tensile strength that can prevent restretching tissues and prevent insolvency anastomosis

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Journal of Experimental and Clinical Surgery. 2014;7(1):70-73

70-73

(Rus)

(JATS XML)

Rationalization of Multimodal Analgesia During Coronary Stenting

., ., ., .

Abstract

Relevance The article presents the data of the original research to assess the clinical effectiveness of prevent and eliminate intraoperative pain syndrome program during coronary stenting in patients with stable angina pectoris. The purpose of the study Increase of efficiency an integrated anti-stress protection during coronary artery stenting by improving analgesic and sedative components of intraoperative anesthetic management. Materials and methods 200 cardiology patients (without concomitant acute coronary syndrome) with indications for coronary artery stenting. Among the investigated contingent differentiated two contrasting groups. 100 patients were included in the control group (using the traditional analgesia program). Other 100 patients were included in the basic group (using the developed analgesia program). Assessment of the pain intensity with using of modern analogue scales (visual analogue scale, digital rating scale); assessment of the stress-tension-level of the autonomic nervous system by cardiointervalography with mathematical analysis of cardiac rhythm; descriptive and variational statistical methods for determination of intergroup differences significance level. Results and their discussion

Relevance The article presents the data of the original research to assess the clinical effectiveness of prevent and eliminate
intraoperative pain syndrome program during coronary stenting in patients with stable angina pectoris.
The purpose of the study Increase of efficiency an integrated anti-stress protection during coronary artery stenting by improving
analgesic and sedative components of intraoperative anesthetic management.
Materials and methods 200 cardiology patients (without concomitant acute coronary syndrome) with indications for coronary
artery stenting. Among the investigated contingent differentiated two contrasting groups. 100 patients were included in the control
group (using the traditional analgesia program). Other 100 patients were included in the basic group (using the developed
analgesia program).
Assessment of the pain intensity with using of modern analogue scales (visual analogue scale, digital rating scale); assessment of
the stress-tension-level of the autonomic nervous system by cardiointervalography with mathematical analysis of cardiac rhythm;
descriptive and variational statistical methods for determination of intergroup differences significance level.
Results and their discussion In the basic group identified the best level of analgetic protection and neurovegetative stabilization.
Proved possible to complete prevention of intraoperative pain in the studied conditions. All identified intergroup differences have a
high level of statistical significance.
Conclusion The obtained results allow us to: statistically reasonably considered the developed program of analgesia as a means
of optimizing the anti-stress-support for coronary stenting, recommend it to practical application.

In the basic group identified the best level of analgetic protection and neurovegetative stabilization. Proved possible to complete prevention of intraoperative pain in the studied conditions. All identified intergroup differences have a high level of statistical significance. Conclusion The obtained results allow us to: statistically reasonably considered the developed program of analgesia as a means of optimizing the anti-stress-support for coronary stenting, recommend it to practical application.

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Journal of Experimental and Clinical Surgery. 2014;7(1):74-79

74-79

(Rus)

(JATS XML)

Analysis of Preеmptive Post-Operative Analgesia Optimized Programm Effectiveness as a Basis for Anti-Stress Providing after Hysterectomy

., ., ., ., .

Abstract

Relevance The article presents the data of the original research to assess the clinical effectiveness of prevent and eliminate postoperative pain syndrome program after hysterectomy. The purpose of the study Improving the efficiency of complex anti-stress protection during hysterectomy based prevention and treatment optimization of postoperative pain syndrome. Materials and methods 80 gynecological patients with indications for hysterectomy. Among the investigated contingent differentiated two contrasting groups. 40 patients were included in the control group (using traditional program of analgesia). Another 40 patients were included in the study group (using the developed program of analgesia). Assessment of the pain intensity with application of modern analogue scales (visual analogue scale, digital rating scale); assessment of the stress-tension level of the autonomic nervous system by cardiointervalography with mathematical analysis of cardiac rhythm; descriptive statistical methods to determine the level of intergroup differences significance. Results and their discussion In the study group identified the best level of analgetic protection and neurovegetative stabilization. Proved the possibility o

Relevance The article presents the data of the original research to assess the clinical effectiveness of prevent and eliminate
postoperative pain syndrome program after hysterectomy.
The purpose of the study Improving the efficiency of complex anti-stress protection during hysterectomy based prevention and
treatment optimization of postoperative pain syndrome.
Materials and methods 80 gynecological patients with indications for hysterectomy. Among the investigated contingent
differentiated two contrasting groups. 40 patients were included in the control group (using traditional program of analgesia).
Another 40 patients were included in the study group (using the developed program of analgesia).
Assessment of the pain intensity with application of modern analogue scales (visual analogue scale, digital rating scale);
assessment of the stress-tension level of the autonomic nervous system by cardiointervalography with mathematical analysis of
cardiac rhythm; descriptive statistical methods to determine the level of intergroup differences significance.
Results and their discussion In the study group identified the best level of analgetic protection and neurovegetative stabilization.
Proved the possibility of prevention of postoperative pain syndrome severe forms in the studied conditions. All of identified
intergroup differences have a high level of statistical significance.
Conclusion The obtained results allow us to: statistically reasonably considered designed program of analgesia as a means of
optimizing the anti-stress support for gynecological interventions, recommend it to practical application.

f prevention of postoperative pain syndrome severe forms in the studied conditions. All of identified intergroup differences have a high level of statistical significance. Conclusion The obtained results allow us to: statistically reasonably considered designed program of analgesia as a means of optimizing the anti-stress support for gynecological interventions, recommend it to practical application.

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Journal of Experimental and Clinical Surgery. 2014;7(1):80-85

80-85

(Rus)

(JATS XML)

Review of literature

Surgical Anatomy of the Pancreas

., .

Abstract

According to the Ministry of health, the Russian Federation has experienced growth in the number of people with newly diagnosed diseases of the pancreas and, accordingly, increase of operational activity in the treatment of these diseases. The development of pancreatic surgery requires a deeper study of the peculiarities of her anatomy, normal and pathological conditions. In addition, a number of surgical diseases of abdominal cavity organs accompanied by clinical symptoms caused by the changes of the pancreas, involved in the pathological process. Knowledge of anatomy and relationships of the pancreas with other bodies necessary for a choice of surgical tactics and feasibility stages of surgical interventions, identify opportunities volume of surgical treatment and development of new technologies, which is a pressing issue of practical surgery.

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Journal of Experimental and Clinical Surgery. 2014;7(1):86-93

86-93