Vol 7, No 3 (2014)

Original articles

Features of Angioarchitectonics and Hemodynamics in the System of the Portal Vein in Patients with Cirrhosis of the Liver with Portal Hypertension

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Abstract

Relevance In surgery of portal hypertension (PH), special importance is attached to the variants of anatomy of the vessels of splenoportal and left renal pools which have fundamental importance in terms of the possibility of imposing different types of shunt operations. The purpose of the study To study features of angioarchitectonics and hemodynamics in the system of portal vein in patients with liver cirrhosis (LC) with portal hypertension. Materials and methods For identifying features of changes of angioarchitectonics of portal pool in the conditions of progressive PH were examined 254 patients with liver cirrhosis, which from 2007 to 2013 were performed different variants of the vascular portosystemic shunt. All patients were divided into three age groups: under 30 years; 31-49 years and older than 50 years. Results and their discussion In the older age group, the development and progression of PH does not lead to a significant increasing the size of the spleen. Conversely, in the group of 30 years spleen size had a tendency to form splenomegaly 2-3 degrees. Facticaly in equivalent level of portal pressure, diameters of v.portae and v.lienalis had significant difference. In the group of under 30 years portal vein diameter was 1,45 ± 0,03 cm in the group 31-49 years - 1,37 ± 0,02 cm, and in the group older than 50 years was the lowest diameter - 1,30 ± 0, 03 cm, and splenic 1,05 ± 0,04 cm. In comparing the diameter of the splenic vein in all of the parameter to receives significant difference with the formation of a minimum diameter - 1,05 ± 0,04 cm in patients older than 50 years. Conclusion Compensation of progressive PH due to expansion of the vascular channel of splenoportal pool is most common in patients with liver cirrhosis under 30 years, which proves maximum angiotransformation with a significant relative to the other age groups increasing of diameter of v.portae and v.lienalis, severity of splenomegaly and a lower incidence of variceal bleeding carried over. Conducted morphological studies have shown that in the conditions of liver cirrhosis with portal hypertension, the structure of the walls of veins of portolienal pool undergoes substantial changes, severity of which depends on the age of the patients and for patients older than 50 years is characterized by a more pronounced thickening of membranes, especially t. media and t. adventitia, and for patients under 30 years - increasing the lumen of the veins
Journal of Experimental and Clinical Surgery. 2014;7(3):181-189
pages 181-189 views

Differential Radiology Diagnostics of Metastasises of Renal Cell Carcinoma in the Pancreas

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Abstract

Metastatic lesion of the pancreas is an extremely rare disease, which occupies 2-5% of all pancreatic tumors, and these figures rise to 11% according to autopsies of patients with malignant tumors. Metastatic lesion of the pancreas from primary renal cancer occurs most often (65-74%).
The purpose of the study Differential diagnosis of metastatic lesions of the pancreas
Materials and methods 6 patients with histologically confirmed diagnosis - metastatic renal cell cancer in the pancreas were treated in the period from 2009 to 2013 in " A.V. Vishnevsky Institute of Surgery. Nephrectomy in history was performed in 4 (66.7%) patients in the period from 4 to 16 years. Tumor of the left kidney in conjunction with metastatic pancreatic cancer was detected in 2 (33.3%) patients.
Results and their discussion Solitary metastases were detected in 4 (66.7%) patients. Tumors were located in the head of the pancreas in 3 patients, in the body - in 1. Multiple multifocal lesion of the pancreas was in 2 (33.3%) patients. Dimensions secondary structures ranged from 10 mm to 56 mm.
The most informative diagnostic method in detecting of focal lesions of the pancreas is computed tomography with bolus contrast enhancement . Significant difficulties for interpretation are small tumors that are similar in structure to hormonally active neuroendocrine neoplasm.
Conclusion Revealed solitary or multiple focal disease of the pancreas in patients after nephrectomy for renal cell carcinoma should be regarded primarily as secondary.
Journal of Experimental and Clinical Surgery. 2014;7(3):190-195
pages 190-195 views

Creation of Model of Acute Necrotizing Pancreatitis

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Abstract

Relevance In the pathogenesis of acute pancreatitis remains a large number of unresolved issues. Therefore, experimental studies of ETA have not lost their relevance.
The purpose of the study Is developing of model of acute necrotizing pancreatitis (ANP) characterized by increased release of cytokines into peripheral blood.
Materials and methods In our research we had 60 12 to 14-week old male outbred (Sprague Dawley) SPF rats. Cerulein, alcohol and mechanical model were created.
Results and their discussion Cerulein injection at given doses did not induce pancreatic necrosis. This model was not associated with statistically significant elevation of cytokine levels. Alcohol model also did not cause pancreatic necrosis.
Conclusion Mechanical model was characterized by pronounced inflammation and necrosis of pancreatic tissue in all animals. The model of APN reproduced by creation of partial common biliary duct obstruction may be recommended for assessment of effectiveness of medications inhibiting cytokine release.
Journal of Experimental and Clinical Surgery. 2014;7(3):196-200
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Features of Wounds Healing Sutured with Bioresorpable Antimicrobial Suture Material

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Abstract

Relevance The use of biologically active (usually antimicrobial) suture materials in surgical operations has positive impact for tissue regeneration. Among antibacterial surgical threads issued in Russia there are no bioresorpable ones that does its development an actual problems of modern surgery and medical industry.
The purpose of the study Experimental investigation of new antimicrobial bioresorpable suture material influence for reparation processes in wounds sutured with it.
Material and methods In 60 white rat males the healing of wounds sutured with a new antimicrobial bioresorpable suture material was investigated. To control the research results the cytological and histological methods were used.
Results and their discussion It turned out that use of a new bioresorpable suture material activates the wound process both in an inflammation phase and in a proliferation and regeneration phase. It is shown by fast migration of cellular blood elements into the damage zone, by high rates of granulations formation and epithelization of wound defect. The possible mechanisms of the suture material influence for wound healing are discussed.
Conclusion The results show that the new suture material is prospective and can be used in clinical practice.
Journal of Experimental and Clinical Surgery. 2014;7(3):201-207
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Rationalization of the Acute Pancreatitis Destructive Forms Intensive Therapy: Detoxification and Nutritional Support Correction on the Basis of the Haemofiltration Membrane Technology

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Abstract

Relevance The article presents the data of original research to assess the clinical effectiveness of the rationalized program of intensive therapy of acute pancreatitis destructive forms. The proposed program includes selective application of prolonged high-volume veno-venous hemofiltration as a method of extracorporal monodetoxication. Presents the results of anti-toxic potential and nutritional status improving of patients with pancreonecrosis.
The purpose of the study Improving the efficacy of intensive therapy of severe acute pancreatitis by optimizing its detoxication component based on an prolonged high-volume veno-venous hemofiltration.
Materials and methods Research materials presented are 64 patients with necrotic form of severe pancreatitis and 70 patients with edematous form of its desease. Total number of examined patients amounted to 134 people. Among the investigated contingent by each studied form of acute pancreatitis were identified the main and the control groups (32 and 35 people respectively). In the control groups used traditional program of intensive therapy. In the main groups used developed detoxication program besides the traditional intensive therapy.
Methods of research are presented selective clinical, biochemical, hematological and statistical techniques.
Results and their discussion Obtained results represent an improvement antitoxic potential and nutritional status of patients with necrotizing pancreatitis due to application of the developed program of monodetoxication. Proved the possibility of prevention the transformation of edematous in necrotic form of severe pancreatitis due to an optimized use of haemofiltration technology. All of identified intergroup differences have a high level of statistical significance.
Conclusion The obtained results allow: statistically justified to consider a elaborated detoxication program as a way to optimize the pancreonecrosis intensive therapy; recommend it to practical use.
Journal of Experimental and Clinical Surgery. 2014;7(3):208-213
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Sorbtion Methods Correction Metabolic Disorders for Mediastinitis

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Abstract

Relevance The urgency is not due to a tendency to reduce the number of patients with acute mediastinitis. An important moment of the correction of endotoxemia, which is celebrated by introducing diseases is enterosorption. unlike hemosorption plasma-pheresis eneterosorbtion is noninvasive and does not require specially trained per-sonnel, has no absolute contraindications, clinically significant side effects.
The purpose of the study Is to assess enterosorbtion patients with acute mediastinitis using enterosorbent "Li-tovit."
Materials and methods In the treatment of 29 patients with acute mediastinitis in 13 addition to the primary treatment method used enterosorbtsii drug "Litovit." All patients underwent incision and drainage of the mediastinum vneplevralnym way. Enterosorbent "Litovit" appointed for 2 - 3 days after surgery, up to the transfer of the patient from the intensive care unit in the profile department. The route of administration through a nasogastric tube or gastrostomy.
Results and their discussion Inclusion in a comprehensive program of treatment in the early postoperative period enterosorption using drugs such as "Litovit" in the treatment of patients with acute mediastinitis increased the effectiveness of intensive therapy. Application enterosorbtion accelerated the rate of decline in the inflammatory process and improve liver function. Application enterosorbtion reduced the rate of final products lopoperoxidation and increase the antioxidant system.
Conclusion Use as a sorbent "Litovit" accelerated the rate of decline in the inflammatory process, improve the treatment of patients with acute mediastinitis.
Journal of Experimental and Clinical Surgery. 2014;7(3):214-220
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Complex Approach in the Treatment of Extensive Trophic Leg Ulcers in a Multidisciplinary Hospital

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Abstract

Relevance Trophic ulcers of the lower extremities are severe manifestation of ischemic disorders like blood Genesis and manifestation of chronic venous insufficiency.
The purpose of the study Сlinical observations on the treatment of ulcers with NVG disease, diabetic foot syndrome and, as one of the rare cases.
Materials and methods The article analyzes the extensive experience in the treatment of trophic ulcers on the background of chronic venous insufficiency and post-illness and when the diabetic foot syndrome and rare observation of the ulcer Martorella illustrating clinical observations.
Results and discussion In complex treatment of patients with trophic ulcers due to decompensation of CVI and diabetes, effective stimulator of regeneration (Actovegin), and drugs that improve the microcirculation of tissues (Sulodexide) in combination with the use of relevant indications of surgical intervention with removal of pathological veno-venous reflux and adequate surgical correction of arterial ischemia, as well as in combination with a plastic closure ulcers.
Conclusion This approach accelerated healing of trophic ulcers and reduces the total hospitalization of patients. treatment of patients with trophic ulcers requires integrating the efforts of various specialists hospitals, and care. Only under this condition it is possible to successfully implement a comprehensive treatment program required for patients with severe decompensated circulatory disorders of the lower extremities.
Journal of Experimental and Clinical Surgery. 2014;7(3):221-227
pages 221-227 views

Laparoscopy in the Treatment of Acute Small Bowel Obstruction

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Abstract

Patients with acute intestinal obstruction constitute about 6% of all patients with an acute surgical pathology, coming in surgical hospitals. Patients with adhesive small bowel obstruction are 50-50%, and with obstructive ileus (benign nature) 5-6% of the total number of patients with intestinal obstruction. Surgery for acute adhesive intestinal obstruction are accompanied by a significant number of postoperative complications, especially in the case of repeated operations on the occasion of obstruction. From June 2009 to December 2013 at the surgical clinic Reutov Central city clinical hospital made 34 operations for acute small bowel obstruction. In 30 cases, the cause obstruction were postoperative adhesions, in 4 cases, the obstruction was caused by phytobezoars. In 10 cases performed laparoscopically elimination of acute adhesive small bowel obstruction, in 23 cases made laparotomy with the liquidation of the obstruction (20 cases - adhesive, in 3 cases - due phytobezoars), in 1 case performed laparoscopically assisted removal of phytobezoar with the elimination of intestinal obstruction.
The average duration of laparoscopic operations amounted to 68.1±26,min. The duration of operation of the open adhesiolysis was 144,2±50,7 min conversion rate was 23%. In the group of patients who underwent laparoscopic interventions, it was noted 1 complication - coagulative necrosis of the wall of the small intestine, which led to the development of postoperative peritonitis. In the group of patients who underwent open adhesions, in 2 patients was marked postoperative subcutaneous mantrala, 1 patient developed early postoperative adhesive obstruction. In all 3 cases it took the relaparotomy. Yet in 1 patient was noted to be a festering wound. The cost of laparoscopic interventions in acute adhesive small bowel obstruction is 5.2% more than the cost of similar interventions in the open way.
Received initial statistical data testify to the feasibility of laparoscopic the elimination of acute small bowel obstruction in the conditions of the municipal health institutions with satisfactory results compared to open surgery. From the economic point of view the cost of laparoscopic operations above the open intervention. However, reduction of term of stay of the patient in hospital and reducing the cost of treatment of complications after laparoscopic operations allow us to consider favorable prospects for performing laparoscopic interventions in the treatment of patients with acute intestinal obstruction.
Journal of Experimental and Clinical Surgery. 2014;7(3):228-236
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To Whom and When Is Thoracoscopy Indicated at Chest Trauma?

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Abstract

Relevance The terms for application of endosurgical interventions appeared rather often in the surgery of chest trauma. There is need for clear selection and differentiation of indications and contraindications for performing of thoracoscopy and other operations.
Materials and methods The 3-year experience of treatment of patients with blunt chest trauma and penetrating wounds is described in the article. There was prevalence of patients with isolated blunt chest trauma (35,1%) and penetrating thoracic wounds (29,0%). We have performed thoracoscopy at 107 patients. Emergency thoracoscopy had been done 38 (35,5%), urgent thoracoscopy at 27 (25,2%) and late thoracoscopy – at 42 patients (39,3%). The rate of thoracotomy was 14,9%.
Results and their discussion The indications to thoracoscopy at chest trauma had been defined. The analysis of treatment`s results in depend of kind of traumatic lesion and operation method was carried out. The best results were at patients with isolated blunt chest trauma and those who underwent thoracoscopy. The role of thoracoscopy at urgent indications and delayed sequelae had been underlined. We have registered complications at 13,5% patients with blunt chest trauma and 6,1% patients with penetrating wounds. The general mortality is 3,8%.
Conclusion Is that results of treatment of patients with blunt chest trauma and penetrating wounds depend of severity of trauma, terms and quality of special medical management and wide application of thoracoscopy.
Journal of Experimental and Clinical Surgery. 2014;7(3):237-345
pages 237-345 views

Differentiated Approach in Treatment of the Postoperative Ventral Hernias

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Abstract

Relevance The incidence of postoperative ventral hernias (POVH) after laparotomy reaches according to different authors 4.0 - 18.1% . Results of surgical treatment POVH remain unsatisfactory because of the high recurrence rate, reaching 10 - 45.5%, and according to some authors 50-54 % . Questions of individual choice method of abdominal wall plasty in patients with POVH and the prevention of intra-abdominal hypertension syndrome are not yet fully resolved [2, 7, 9] .
The purpose of the study To improve outcomes in patients with postoperative ventral hernias by a differentiated approach to the choice of operation, based on the investigations of prognostic factors influencing to the occurrence of disease.
Material and methods The results of treatment of 288 patients with postoperative ventral hernias. Men were 92 ( 31,9 %), women - 196 ( 68,1 %). Depending on the applied treatment, all patients were divided into 2 equivalent in number, sex, type of pathology groups - control and basic. In selecting the method of surgical treatment of patients in the control group took into account the localization of hernias, size and shape of hernial ring. To close the hernia rings applied: in 76,4 % of the patients own tissue, at 9.4% - allomaterials, only 8,6% of cases, the defect sutured "edge - to - edge ." Patients of the main group selection method plastics hernial performed taking into account the risk factors POVH, controlled phases surgery tissue and intra-abdominal pressure . Local fabrics with plastic - abolished in 19,4% of patients using allomaterials - in 80,6 %. Comparison group consisted of 106 patients who had postoperative hernia was not. Methods: type definition acetylation of tissue pressure measurement, monitoring intra-abdominal pressure , Quetelet index calculation , the study of phenotypic traits external connective tissue dysplasia syndrome.
Results and their discussion Implemented a differentiated approach to the choice the method of plastic the hernias. Along with the size, shape hernia ring in choosing the method of surgical treatment into account , intra-abdominal pressure developed by the authors and prognostic factors of recurrence of the disease. Indications for auto-and alloplasty was identified. The proposed set of therapeutic and diagnostic measures have reduced the number of early postoperative complications in 2,4 times, recurrence of the disease is 8,5 times, mortality - 3 times.
Conclusions 1. Patients with postoperative ventral hernias W1,W2 when the sum of the scores of the risk factors for recurrence of the disease less than 4.5, the increase in AP test flattening the edges of the aponeurosis of not more than 10% and reaches up to 15 mm RT. column shows autoplastic hernia gate. 2. Patients with postoperative ventral hernias W1,W2 when the sum of the scores of the risk factors for recurrence of the disease more than 4.5 in converging edges of the aponeurosis, shows the stress hernia gate. 3. Patients with postoperative ventral hernias W3,W4 shows the non-pulling stress hernia gate.
Journal of Experimental and Clinical Surgery. 2014;7(3):246-251
pages 246-251 views

Differential Use of Different Colloids During Plazmaferesis in Abdominal Sepsis Patients with Acute Lung Injury

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Abstract

Relevance Sevre sepsis and septic shock continue to remain one of the most significant problems of modern medicine. The leading cfuse of a high mortality of this category of patients is formation and progressing of a multiple organ failure syndrom. The acute lung injury is leading component in structure of multiple organ failure syndrom at patients with abdominal sepsis. In development of acute lung injury in patients with abdominal sepsis the leading role is played by a syndrome of the system inflammatory responce. Therefore in intensive therapy of abdominal sepsis methods of extracorporal haemocorrection are applied. One of methods is the plasma exchange. The most serious problem when carrying out a plasma exchange is adequate replacement of remote plasma and a choice of infusional solutions taking into account the minimum negative action on gas exchange in lungs and system haemodynamics.
The purpose of the study The purpose of our research was studying of influence of a plasma exchange on gas exchange in lungs at patients with abdominal sepsis at various severity of acute lung injury.
Materials and methods We investigated 34 patients with a syndrome of acute lung injury. All patients, according to classification of J.F. Murray (1988), were divided into 2 groups. In the first group (n = 16) were included patients with moderate pulmonary damage, in the second (n = 18) – with severe acute lung injury. Plasma exchange carried out by a standard technique with removal 30-40% of volume of total plasma volume. Completion of volume of circulating plasma carried out colloidal solutions on a basis hydroxyaetylstarch (HAES 130/0,42) and cristalloids. At all patients defined: РаО2, РаСО2, SaO2, alveolar ventilation (VA), a pulmonary circulation (QT) ventilation-perfusion ratio (VA/QT), the total shunt (QVA/QT), the alveolar shunt (QS/QT).
Results and their discussion Results of research showed that at all patients before to the beginning of an extracorporal detoxication the severe hypoxemiya took place. At patients in both groups decrease in alveolar ventilation is noted. Reduction of VA and increase in QT led to decrease in an indicator of VA/QT. The main role in genesis of a hypoxia was played by alveolar shunting of blood in lungs.
At patients of the first group statistically РаО2 and SaO2 authentically exceeded values to a plasma exchange and in 24 hours after it. The average sizes VA/QT , QVA/QT and QS/QT at this group of patients in 72 hours after the first plasma exchange was normal. At patients of the second group of value of the specified indicators significantly (р<0,05) differed from normal levels.
Conclusion 1. Effectivity of a plasma exchange at patients with abdominal sepsis depends on severity of acute lung injury.
2. At moderate acute lung injury carrying out 3 sessions of a plasma exchange with an interval provides at 24 hours permanent decrease in endogenous intoxication and normalize gas exchange in lungs. 3. At severe acute lung injury more overdue and unstable improvement of respiratory function of lungs is observed. It dictates need of continuation of carrying out sessions of a plasma exchange taking into account severity of a a multiple organ failure syndrom.
Journal of Experimental and Clinical Surgery. 2014;7(3):252-257
pages 252-257 views

The Justification of Surgery Treatment of Chronic Tonsillitis

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Abstract

Relevance There is a high prevalence of chronic tonsillitis, which is one of the most important problem of otorhinolaryngology and many others clinical disciplines. There is a correlation between chronic tonsillitis as a pathological factor and different diseases of visceral organs and systems. It’s known that in development of chronic tonsillitis except some local complications (lymphadenitis, paratonsillits) there are some general diseases: an intoxication, rheumatic affection of the heart, joints, nephritis, sepsis and others.
Results of completed researches of functional activity and a functional reserve palatal tonsils shows active involvement of palatal tonsils in organization of local (in fauces) and general protection reactions. Considering that children with removed tonsillitis have high morbidity of infection diseases they have severe course of acute respiratory infections, which often complicated of tracheobronchitis and frequently pneumonia. In this connection, indications for the tonsillectomy must be more strictly.
The purpose of the study Improving diagnosis of chronic tonsillitis based on the study of the functional activity and the functional reserve of the tonsils to justify holding tonsillectomy.
Materials and methods We examined 205 people. Surveyed were divided into 3 groups. The first reference group consisted of 20 people (9.7%). Second and third groups consisted of 40 (19,4%) and 145 (70,9 %) patients with compensated and decompensated forms of chronic tonsillitis. To study the functional reserve of the tonsils used Prednisolone trial.
Results and their discussion In difference from other groups, in the third group found a sharp reduction in the migration of lymphocytes in the lacunae of tonsils. Decompensated forms of chronic tonsillitis are characterized by low functional activity of the tonsils and the lack of functional reserve. According to results of completed researches of palatal tonsil’s functional activity and reserve, there are statements for surgical treatment.
Conclusion All patients chemotherapy is necessary to assess the functional activity and the functional reserve of the tonsils, with the aim of determining the extent of compensation and decompensation of the inflammatory process and, therefore, define the indications for surgical treatment.
Journal of Experimental and Clinical Surgery. 2014;7(3):258-264
pages 258-264 views

Clinical Case of Treatment of the Patient with Martorell's Ulcer

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Abstract

Relevance "Hypertensive ischemic ulcer" was first described by the Spanish cardiologist Martorell in patients older age group with severe hypertension. Martorell syndrome is not well known to most practitioners, as "pure" form, as described by the author, is rare. Provoking moments can serve as scratching, trauma or other reasons, that the patient is not always able to recover his memory. Onset of the disease is characterized by the appearance of papules or area of red-bluish color, with a slight soreness, passing in expressions. Martorell shallow ulcers with granulation sluggish and scanty discharge, developing very slowly. The main distinguishing feature of these ulcers - constant excruciating pain. Patients put traditionally diagnosed "trophic ulcer". The basis of the diagnosis "Martorell ulcer" based on the following criteria: the presence of severe hypertension and stable constant pain in the ulcer, as well as the data of histological examination, during which the phenomena are endoarterialnoy proliferation and subendothelialhyalinosis
The purpose of the study Description of a case of treatment of the patient with an ulcer Martorell.
Materials and methods The patient presented with severe hypertension and the presence of ulcers on the left lower leg. In a survey of the diagnosis - a trophic ulcer of the left shin syndrome (Martorell). Coronary artery disease, angina, FC 2-3.Cardiosclerosis diffuse. Hypertension, Art. III, the risk of MTR 4. H2A. In the treatment of the correction of blood pressure, rheological, angiotropnaya, antibiotic therapy, topical treatment of wounds, physiotherapy. As a result, 3 weeks achieved complete epithelialization of trophic ulcers.
Conclusion The basis of a positive result of treating a patient with an ulcer Martorell is the correct diagnosis of the underlying disease and the subsequent complex therapy, including normalization of blood pressure, angioprotektory modern dressings.
Journal of Experimental and Clinical Surgery. 2014;7(3):265-268
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Possibility of Infectious Complications Prognosing after Surgical Interventions for a Hip Arthroplasty

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Abstract

In the context of any hospital is a risk of infectious complications of surgical intervention after hip arthroplasty. Despite the availability of modern operating, under strict aseptic and antiseptic rules, practically impossible to avoid bacterial contamination of the surgical field during surgery. Therefore, this kind of prediction of complications is important for medical science and practice. In recent years, have become part of everyday life in the system of mathematical modeling course and outcome of disease as therapeutic profile, and surgical pathology. The need for establishment of such systems for the prediction and prevention of postoperative complications during hip arthroplasty great. Among the complications of hip replacement, identified in the area of operations, surgical site infection is most commonly stated - in 2-8% of patients. Several studies have noted the dependence of the frequency of suppuration early on various factors: 71.4% during the intervention marked technical difficulties, 77.7% used additional biological or synthetic materials, 90.0% of the duration of surgery more than 3 hours, 69 2% intra-and postoperative blood loss was more than 1000 ml, with 76.9% of patients pronounced comorbidities. In this case, the observation of deep suppuration in the area of the hip joint is marked in 0.2 - 5% of cases. Presented an overview of the literature allows to navigate in the state of this issue to date.
Journal of Experimental and Clinical Surgery. 2014;7(3):296-278
pages 296-278 views

On the Issue of “Gold Standards”: is All that Glitters Gold? (Comparative Evaluation of Uncomplicated Cholelithiasis Surgical Treatment Methods Effectiveness)

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Abstract

Relevance The necessity to improve tactic approaches to and methods of cholelithiasis surgical treatment is dictated by the steadily increasing prevalence of this pathology among persons of various ages and social groups.
The purpose of the study Retrospctive analysis of the surgical treatment of patients with uncomplicated cholelithiasis in the comparative plan with the literature data and generally accepted criteria of effectiveness of modern kinds of operative aids.
Materials and methods The treatment experience of 4557 patients operated from 2003 to 2012 and the modern literature data were assumed as the study basis. The methods of statistical data processing of case histories by application of microsoft office excel and statistica 6.0 Programmes. The literature data are given in the interpretation of the authors of the publications.
Results and their discussion The conducted detailed comparison of videolaparoscopic and minilapatomic cholecystectomy according to modern generally accepted criteria of effectiveness showed that these two technologies do not differ significantly in traumaticity, duration, conversions frequency, number of intra- and postoperative complications, durations of the rehabilitation period.
Conclusion The submitted literature and our own material reveal that today these two methods co-exist on a quite compatative basis and there are not any sufficient reasons to consider videolaparoscopic cholecystectomy as “a golden standard” in the surgical treatment of cholelithiasis.
Journal of Experimental and Clinical Surgery. 2014;7(3):279-285
pages 279-285 views

On the Question of the Pathogenesis and Classification of Liver Failure

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Abstract

The liver failure is the actual problem of modern surgery. It is great scientific interest to study the features of liver failure in patients with obstruction of the biliary tract. Abnormal liver function in surgical practice are common, but are treated differently, as in parallel with the progression of cholestasis are always evolving phenomenon of liver failure. Aim of this study was to evaluate the biochemical and morphological criteria of liver failure in patients with obstructive jaundice. The analysis of the clinical data of 23 patients with obstructive jaundice benign and tumor genesis is presented. All patients underwent percutaneus transhepatic cholangiostomy. Patients were devided into 5 groups of comparison. The resulting differences in clinical biochemical indicators and liver biopsy allowed to develop its own classification of liver failure. The presented data demonstrate the primacy of bile ductal changes in patients with obstructive jaundice and can use it as a qualitive change criterion for assessing liver failure.
Journal of Experimental and Clinical Surgery. 2014;7(3):286-292
pages 286-292 views

The Systems Approach in the Analysis of the Oncology Service

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Abstract

Possibilities of use in the Oncology service methods of system analysis. The tools of this process is represented by subsystems provides preventive, diagnostic, management, cancer screening, examination of cancer patients with the relevant units and elements. Effectiveness of a systematic approach in the analysis of the effectiveness of health care for patients with malignant neoplasms. Special attention is paid to the interaction of the individual subsystems, units and elements. A systematic approach may be required to control not only the Oncology service, but also in other areas of medical practice.
Journal of Experimental and Clinical Surgery. 2014;7(3):293-296
pages 293-296 views

Kursk School of Gerniology

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Abstract

Endoprosthesis surgery of the abdominal wall remains one of the important problems in the prevention and treatment of ventral hernias, the decease that about 5 million Russians have. This paper contains an analytical overview of current abdominal wall implant methods. Comparative analysis of implants’ scientific biocompatibility shows that among different materials based on polyvinylidene fluoride, polypropylene and polytetrafluoroethylene, polyvinylidene fluoride implants are the most intact. Experimentally proved that the injection of embryo fibroblast cell culture near the implant helps to reduce the inflammation and accelerate the granulation tissue development. It is now possible to predict the progress of implant tissue response based on the cytokine profile dynamics, temperature, leukocyte and exudative reactions. It is shown that the implantation of the prosthesis in the infected wound increases the leukocyte-macrophage response to inflammation, which leads to the prosthesis implantation lengthening during serous inflammation and complete adaptation failure in case of phlegmonous inflammation. For the first time tissue reaction and the propylpropylene implant application for abdominal wall surgery in contact with sterile and contaminated urine were studied. Clinical and ultrasound parameters of the anatomical and functional failure of the abdominal wall were present. The first grade characteristics are abdominal deformation, moderate thinning and muscle expansion of white and semilunar abdominal lines. At the second degree deformation is stronger, and dramatic thinning of the muscles and abdominal lines leads to a complete abdominal press function loss. Absolute indication for preventive abdominal wall implant during surgery on the abdominal and retroperitoneal space is anatomical and functional failure of the second degree, and relative - the first degree in combination with other factors producing postoperative hernias.
Journal of Experimental and Clinical Surgery. 2014;7(3):297-307
pages 297-307 views

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