Vol 11, No 3 (2018)
- Year: 2018
- Articles: 16
- URL: https://vestnik-surgery.com/journal/issue/view/44
Full Issue
Original articles
Biomechanical Characteristics of Light Synthetic Materials for Hernioplasty (Experimental Study)
Abstract
Relevance of research. The inclusion of light synthetic materials in the structure of strengthening zones is one of the ways to improve the efficiency of hernioplasty.
Purpose. To compare functional effectiveness of the light endoprosthesis and the light strengthened polypropylene one for hernioplasty on the base of studying biomechanical characteristics of anterior abdominal wall tissues after endoprostheses' implantation in experiment.
Materials and methods. Experimental studies were conducted on 36 rabbits of “chinchilla” breed. All animals were divided into 2 series of experimentsThe light polypropylene endoprosthesis was implanted to rabbits from the first (control) group. A new cancellated endoprosthesis from monofilamentous polypropylene consists of the basic and strengthened zones in the form of horizontally located, alternating with each other monothreads of the high thickness. It was implanted to animals from second (experimental) group. Pathomorphological changes and biomechanical properties of the abdominal wall tissues were studied macroscopically in the experiment by implantation of endoprostheses in onlay position on the 7th, 30th and 90th days.
Results and their discussion. There was proved that in direction of the loop column as well as in the loop row after implantation of the studied materials breaking load increased from the 7th to the 90th day of experiment, that was related to the formation of the connective tissue capsule around materials. The light strengthened endoprosthesis was more durable and stronger in 1,6 times compare to the light analog at all stages of observation. Along the loop column there was no significant difference detected. In both series of experiment in the direction of the loop column as well as in loop row the reduction of sample lengthening took place. Along the loop column indicators of lengthening, characterizing elasticity of the prosthesis aponeurosis, in the series of the light strengthened endoprosthesis were 1,4-1,6 times lower than in its light analog. Along the loop row there was no significant difference of indicators.
Conclusion. Introduction of the strengthened zones in a light endoprosthesis increases its durability with preservation of the material’s elasticity.
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The Role of System connective tissue dysplasia in the Formation of hernia Inguinal Area
Abstract
Relevance. Despite advances in the treatment of inguinal hernias the issues of post-operative wound complications and disease recurrence are still being discussed. The inclusion in the list of risk factors for complicated postoperative course of systemic connective tissue dysplasia will allow a new look at the mechanisms of herniation in the groin area and develop morphologically adapted methods of surgical treatment.
Objective is studying the characteristics of connective tissue dysmorphogenesis at hernia protrusions in the inguinal region.
Results. In the main group absolutely reliable connection with all possible variants of hernia disease in the inguinal region possessed 6 (12 %) morphological predictors, namely: dystonia dysfunction, curvature of the spine, hallus valgus, hypermobility joints, varicose disease of the lower limb and hemorrhoids. The curvature of a backbone and hypermobility of joints occurred among manifestations of a dysmorphism at patients of control group.
The area of electromyograms with the traction of muscles forming the destroyed inguinal hernia was 20% inferior to the area of electromyograms of similar muscles contraction on the contralateral side of the inguinal hernia and 61.4 % of the area of electromyograms of the inguinal muscles contraction of the control group patients. In a smaller proportion, but with similar characteristics groups of lateral muscles flexed, which is considered as local functional predictors of the implementation of systemic connective dysplasia in the hernia disease of the inguinal region by us.
The density of the collagen fibers in the dermis of patients with inguinal hernias was 75.6 + 1.9%, which is 12,3 % lower than the result of such collagen metrics index of patients of the control group. Intensity of coloring of micropreparations of dermis of patients of control group was at the level of 36,33 + 2,1, that on 1,8 times less than this index in patients of the basic group.
Conclusions. Thus, results of histology confirm reliability of the revealed morphological and local functional prerequisites of formation of inguinal hernias at connective dysplasia.
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Evaluation of the dynamics of the main indicators of treatment care and the long-term results of conservative treatment of ulcerative gastroduodenal bleeding
Abstract
Relevance. Improvement of medical and diagnostic care for ulcerative gastroduodenal bleeding is a complex problem of modern medicine, the solution of which is connected both with the search for modern medical technologies and introduction of ones into clinical practice, and with the necessity to conduct in-depth analysis of the effectiveness of medical care at various stages of its delivery in this pathology.
Purpose. To study the dynamics of the main indicators of the provision of medical and diagnostic care to patients with ulcerative gastroduodenal bleeding in a large hospital for in-patients and to evaluate the long-term results of conservative treatment of this group of patients.
Materials and methods. The data of the Voronezh regional clinical hospital for the period from 1989 to 2010 (during which 1831 patients were hospitalized) were taken to assess the dynamics of the main indicators of treatment and diagnostic care for ulcerative gastrointestinal bleeding. The long-term results of 106 patients were analyzed. Among the patients, males predominated (70.7%), the average age was 50.2 ± 4.7 years (median - 18 - 79 years). In 62 patients (58.5%) bleeding ulcer was located in the duodenum.
Results. There was a general tendency to reduce the number of hospitalizations by 57.8% during the analyzed period. Frequency of surgery in this pathology was 56.0% in 1989-1993. This indicator decreased to 33.8% against the background of an increase in the postoperative mortality to 8.7% in the period from 2009 to 2013. Favorable outcomes of treatment were noted in 74.5% of patients. The development of various complications and recurrences of bleeding was noted in 17.9% of patients with peptic ulcer with predominant localization of ulcers in the duodenum. This gives grounds for recommending in the current situation the implementation of planned surgical interventions.
Conclusions. Conservative treatment of ulcerative gastroduodenal bleedings with the use of endoscopic technologies creates conditions for optimization of immediate and long-term outcomes of treatment. The polyetiologic nature of the disease and the significant specific gravity of severe combined pathology makes it urgent to introduce a multidisciplinary brigade principle for the treatment of ulcerative gastroduodenal bleeding.
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Kinetics of wound process with various methods of stimulation of regeneration in wounds
Abstract
Relevance of research. Objective indicators of the dynamics of the wound process are planimetric methods, including the determination of the area of ulcerative defects and the rate of their epithelialization.
The aim of the work is to assess the kinetics of the wound process in venous, ischemic and neurotrophic ulcers of the lower extremities using various methods of stimulating regeneration in wounds.
Materials and methods. 4 blocks of studies were carried out: in the first block, the healing of venous trophic ulcers up to 20 cm2 was evaluated; in the second one - the healing of venous trophic ulcers more than 20 cm2; in the third block, the course of the wound process was studied in patients with ischemic trophic ulcers of the lower extremities; in the fourth one - in patients with neurotrophic ulcers of the lower extremities. In each block, patients were divided into 4 groups according to the methods of stimulation of regeneration: combination of platelet-rich donor plasma and collagen preparations; interactive bandages; collagen preparations; platelet-rich donor plasma. Exponential function and the parameter τ (the characteristic time of wound healing) were used to assess changes in the area of wounds in time and its allowing a single number to characterize the kinetics of healing and to measure the period of wound healing.
Results and their discussion. Complex use of collagen preparations and platelet-rich donor plasma provides the shortest reduction of the wound area in comparison with other considered methods for venous trophic ulcers up to 20 cm2.
Stimulation of regeneration before autodermoplasty with a split skin flap only using collagen-containing preparations (14.4 days) or platelet-rich donor plasma (11.6 days) provided a greater percentage of survival of the autodermograft for venous trophic ulcers of large and giant size (more than 20 cm2).
The complex use of collagen preparations and platelet-rich donor plasma is most effective among other methods in reducing the area of neurotrophic ulcers, the characteristic time of reducing the wound area is 48.9 days, which is faster than other methods by 1.25 - 2, 93 times.
The healing process of ischemic trophic ulcers is more difficult to express by mathematical formulas. However, among the compared methods, the use of the complex of drugs leads to a statistically faster decrease in the area of wounds - 24.3 days against 31.6, 29.3 and 88 days.
Conclusion. The complex of preparations provides in general the best kinetics of healing of venous, ischemic and neurotrophic ulcers in comparison with the use of modern dressings and separate use of collagen-containing preparations and platelet-rich donor plasma.
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Metastatic adrenal lesions in cancer patients.
Abstract
Relevance. The collective concept of "incidentaloma" of the adrenal glands includes a group of neoplasms of more than 1 cm in diameter, accidentally revealed by radiation methods of research. With the development of methods of instrumental diagnostics, the number of detected incidentaloma of adrenal glands is steadily increasing including in patients with a history of malignant neoplasm (ZNO).
Objective. Study of the frequency of occurrence metastatic adrenal tumors in cancer patients after definitive therapy.
Materials and methods. 137 fine-needle aspiration biopsies (FNAB) of adrenal tumors were made in the patients in whom during follow-up were detected adrenal incidentaloma.
Results. According to the results of morphological verification adrenal tumors were metastatic in 44(32%) cases.
Conclusion. Adrenal tumors, detected in patients with malignant neoplasms of different localization, can be provided as metastatic and benign tumors. However, each revealed a tumor in the adrenal glands of patients underwent treatment shall be considered as potentially metastatic.
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Relapse of varicose veins of lower extremities
Abstract
According to modern data, there are no signs of chronic venous disease in only 15.9% of people. Observing the clinical data of recent years, there is a tendency to increase the number of people with venous diseases and, unfortunately, the number of young patients is increasing (there are data that schoolchildren of the senior classes have signs of varicose transformation in 10-15%). Polymorphism of matrix metalloproteinase-12 is a key link in the pathogenesis of varicose veins.
We conducted surveys of 50 patients. The average age is 43.7 ± 15.9 years, of them women 32, men 18 people. All patients with the class C2-C6 varicose veins (CEAP-classifier) were divided into two groups by the method of serial sampling: group I (n = 20) - with relapse of varicose veins; Group II (n = 30) - patients treated with varicose disease for the first time. The only exception was patients with previous vein thrombosis. Ultrasound diagnosis of the main veins of the lower extremities and genomic analysis of blood samples of patients was used.
The obtained results confirm that in patients of the I group the MMP-12 gene occurs in 80% of cases (homo- and heterozygous variation), whereas in group II only in 33.3% of cases. The Pearson consensus criterion is 10.4 (the critical value of the criterion is 6.63). The significance level of this relationship corresponds to p <0.01. The statistical significance of the frequency of recurrence of varicose disease and the MMP-12 gene was established using the Spearman rank correlation coefficient, which is equal to 1,000 (criterion value is 0.398). Dependence of signs is statistically significant, with p <0.05
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Microbiological diagnostic criteria of infectious inflammatory complications after total knee replacement in the aspect of periprosthetic joint infection (PJI) pathogenesis
Abstract
Background. The system of accurate microbiological diagnostics of implant-associated inflammation for timely identification of infectious inflammatory complications after total joint replacement and distinguishing between peritransplant and aseptic infection has not been yet defined which is associated with the peculiarity of pathogenesis of infection process.
The aim of the study is to define valuable microbiological diagnostic criteria for implant-associated infection and to estimate diagnostic value of various clinical specimens with the account to pathogenetic features of infectious complications after primary total knee replacement.
Material and methods. We analyzed 412 specimens of various clinical origin obtained from 182 patients with deep PJI after primary total knee replacement treated at the Research Institute of Traumatology, Orthopedics and Neurosurgery of Razumovsky Saratov State Medical University in 2014-2018. Analysis was both retro- and prospectively.
Results and discussion. Studies of the discharge fistula, superficial wounds and aspirate from the joint cavity are not sufficiently informative methods of diagnosis of implant-associated infection. Optimized microbiological algorithm included prolonged culture time, the complex of 3-5 tissue bioptates cultures and implant ultrasonic treatment which allowed obtaining more valuable results for PJI diagnostics. Tissue bioptates and lavage fluid specimens’ tests were the most sensitive methods for PJI diagnostics with sensitivity of 81% and 95% and specificity of 96% and 97% respectively, especially in case of coagulase-negative Staphylococcus and Gram-negative bacteria frequently appearing in the biofilm form at PJI.
Conclusions. Complex assessment of obtained results and optimization of microbiological methods allow obtaining sufficient diagnostic accuracy of PJI.
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A New Method of Boerhaave Syndrome Surgical Treatment and Its Experimental Justification
Abstract
Relevance. Spontaneous esophageal rupture (Boerhaave syndrome) is observed relatively rare ranging from 2.9% to 12% of all cases of damage of the esophagus. Today, there is not any categorical opinion about the effectiveness of different treatments among surgeons, there are not any single algorithms for the diagnosis and evaluation of treatment. Spontaneous esophageal rupture is a real threat for the life of patient because mortality is up to 75% in the prehospital period and more than 90% in the postoperative period, and it depends on the time interval between the rupture of the esophageal wall and the operation time, and also complications (suppurative esophagitis, suppurative mediastinitis, bilateral suppurative lobular pneumonia, sepsis)
Purpose is to improve results of surgical treatment of patients with spontaneous esophageal rupture using the results obtained in the experiment.
Materials and methods. Twelve patients with spontaneous esophageal rupture were treated in our hospital since 2004 till 2017. Ways of treatment of lower third of esophageal rupture was this: drainage of pleural cavity (2 patients); closure of the defect, fundoplication with covered stitches by the bottom of the stomach (2 patients); perforated hole was not sutured, and a cuff, covering the perforation, was formed from the bottom of the stomach (fundoplication by Chernousov) (8 patients). These methods of surgical treatment were applied in the experiments on 120 rats. Each group consisted of 40 rats.
Results and discussion. Lethality made up 50% (1 patient) at the pleural cavity drainage. There was the suturing of the defect of the esophageal walls, the fundoplication with the stitches, covered by the bottom of the stomach and failure of stitches in 2 patients (lethality – 50% (1patients)). The perforated hole was not sutured, and the cuff was shaped from the bottom of the stomach, covering the perforation. Lethality made up 25% (2 patients) in this case, caused by bilateral pneumonia in background of progressive sepsis. Other patients operated on this method didn’t have any failure of stitches.
In the experiment: in the 1st group the failure of stitches was 87.5% and lethality – 100%; in the 2nd group the failure of stitches was 85% and lethality – 100%; in the 3rd group there was not any failure of stitches, lethality – 17.5%.
Conclusions. The most effective method of treatment is the restoration of rupture esophagus without suturing, but forming a cuff from the bottom of the stomach, covering the perforation. Drainage of pleural cavity and nutrition through a nasogastric tube must be in postoperative period.
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Circulatory Condition in Kidney Patients with Pururlent Pyelonephritis
Abstract
The article provides up-to-date statistics on the prevalence of purulent pyelonephritis in Russia and shows the pathogenesis of purulent pyelonephritis in terms of circulatory disorders in the kidney for example 23 patients operated personally by the author in Urology unit of the Altai Krai hospital on his own technique in the period 2016 - 2017. Morphological studies were carried out in the unit of pathologic anatomy. The morphological disorders in the kidney with significant changes in the microcirculation were assessed during the operation of the apostem zone, perifocal zone of inflammation around 1 cm from the pockets of destruction and healthy sections of kidney parenchyma by electromicroscopic method. Areas of tissues of the kidneys removed due to have resulted them irreversible destructive changes were additionally investigated.
Irreversible development of acute purulent pyelonephritis associated with renal tissue ischemia. Appropriate action must be taken to restore the lost blood flow to achieve good results in the treatment of patients.
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Application of Stereotactic Radiation Therapy for Removing Pain Syndrome to Patients with Non-researchable Cancer of Pancreas
Abstract
Purpose is control of pain syndrome in patients with locally advanced and recurrent pancreatic cancer using stereotactic radiation therapy (SRT).
Materials and methods. Our clinical observations relate to 103 patients with locally advanced (LAPC)and recurrent pancreatic cancer who received radiation therapy in the radiological unit of the National Medical Research Institute named after N.N. Blokhin in the periods: 2000-2010 and 2010-2015. The first group consisted of 77 patients with locally advanced non-resectable pancreatic cancer, of which (1a subgroup), 30 patients received radiotherapy in a classical fractionation regimen of 54-60 Gy/5 fraction, 40 patients (1b subgroup) received radiotherapy in a mode of hypofractionation per week 37.5 Gy/5 fraction. Group 2 consisted of 26 patients with recurrent pancreatic cancer, including radiation therapy was performed in the classical fractionation regimen of 54-60 Gy/5 fraction for 15 patients (2a subgroup), and 11 patients (2b subgroup) underwent a course of radiation therapy in the mode of hypofractionation. Gr 5 times a week 37.5 Gy/5 fraction.
Results. There was a reduction of all types of pain syndrome in 70% of cases in SRT compared to 37.8% in the control group.
The conclusion. Stereotactic radiation therapy in the mode of hypofractionation is a highly effective, safe method of radiotherapy that effectively reduces pain syndrome in unresectable pancreatic cancer in a short time of treatment in comparison with the traditional method of radiotherapy, which significantly improves the quality of life of this severe category of patients.
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Factors of the Risk of Developing a Secondary Cataract and Recommendations for Conducting a Primary Posterior Capsulorhexis
Abstract
Relevance. At the present stage, cataract surgery techniques perfectly cope with the task of restoring the transparency of the optic system of the eye, which makes it possible to quickly restore visual functions and patient performance. Throughout the world, there is a trend of cataract surgery in the initial stages, recommending that patients do not wait for cataract ripening. However, as practice has shown, this leads to an increase in the number of patients with secondary cataract.
The aim is to develop recommendations and ways of preventing secondary cataract.
Materials and methods. A comparative analysis of two groups of patients who applied for laser discission (192) and operated on cataracts (2590) for one calendar year was carried out. The interrelation of a type of a cataract and development of opacifications of a back capsule is analyzed.
Results. The risk of developing secondary cataract is 3.5 times higher with a high degree of statistical significance (p <0.005) in patients with myopia, which is a sign of complicated cataracts. The next risk is diabetes mellitus of both types, as a sign of complicated cataract with concomitant pathology, which increases the risk of developing a secondary cataract up to 3 times (p <0.01). According to our observations, immature cataract stages increase the risk of secondary cataract development by 1.4 times also with statistical reliability (p <0.01).
Conclusions. We proposed recommendations for the primary posterior capsulorhexis with a transparent posterior capsule, taking into account the revealed clinical risk factors for the development of secondary cataracts (myopia, diabetes mellitus of both types, initial and immature cataracts).
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Features of the topographic anatomy of the rat trachea and the possibility of performing surgical interventions.
Abstract
Relevance. The number of postoperative complications in surgical interventions on the trachea remains high despite the improvement of surgical techniques. One of the ways to improve the results of treatment is the development and study of new surgical interventions.
Aim. The work is devoted to the study of the topographic and anatomical features of the structure of the rat trachea.
Materials and methods. The study was performed using rats of the Wistar line and was approved by a local ethical committee. Methods of descriptive anatomy and morphology were used.
Results. The obtained results made it possible to reveal features of the topographic-anatomical structure of the rat trachea such as: the presence of hyaline cartilages in the form of a ring; accrete cartilaginous rings forming the fusion of the X, Y, W forms; there are multiple clusters of mucoses-associated lymphatic tissue in the submucosal layer of the trachea; pronounced venous traheoidesis plexus; developed and dense adventitia of the trachea. The transition from a stratified epithelium to a ciliated epithelium occurs below the vocal cords in rats. According to the histological structure, the rat trachea wall is close to the human trachea and has adventitia, a cartilaginous framework, a submucosal osseous and a mucous membrane.
Conclusion. These features of the structure of the trachea of Wistar rats allow them to be used to model pathology of the trachea and to develop surgical interventions.
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Morphological changes in the tissues of the experimental model of hemangioma with concurrent medication of β-blockers and interstitial introduction of the Kenalog preparation.
Abstract
Relevance. Hemangiomas are the most common variety among tumors of the skin and soft tissues in children. The number of patients with this pathology is currently increasing. There are many methods to therapy hemangiomas in children. Currently, such drugs as Propranolol and Kenalog are widely used in the treatment of this pathology.
The aim is to study the effect of β-blockers and the preparation of Kenalog on the tissues of the experimental model of hemangioma at joint administrated.
Materials and methods. 20 live chickens were used for the experimental study. The histological structure of the vascular or capillary zone of the crest of the chicken resembles the human hemangioma. All chickens were divided into 4 groups of 5 individuals. Observing the general condition of chickens, macroscopic and histological examination of the crest of the hens were carried out.
Results and conclusions. All the chickens from the experimental group had died presumably by the 15th day because of massive vascular thrombosis. The joint administrated of β-blockers and the Kenalog product is not recommended because of the possibility of thrombus formation and a high probability of death.
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Memorials
Mayat Valentin Sergeevich - a well-known scientist, surgeon, teacher, creator of the surgical scientific school (on the 115th anniversary of his birth)
Abstract
Mayat Valentin Sergeevich - surgeon, doctor of medical sciences (1946), professor (1950), Honored Worker of Science of the Russian Federation, Hero of Socialist Labor (1969), laureate of the USSR State Prize (1976, 1987).
Mayat Valentin Sergeevich was born in 1903. He worked in a hospital surgical clinic (since 1925) after graduating of the 2nd Moscow University, served in the Red Army (since 1939). V. Mayat was the leading surgeon of the Penza evacuation hospital No. 1649 (since October 1941), the chief surgeon of the evacuation hospitals in the Penza region (from August 1942 to August 1945) during the Great Patriotic War. V.S. Mayat worked in the surgical department of the government hospital in the People's Republic of China (PRC) In 1949, while lecturing at Peking University. He was elected the head of the Department of Hospital Surgery of the 2nd Moscow Medical Institute (1953) after returning from the PRC, simultaneously (1952-1964) was deputy chief surgeon and then - chief surgeon of the 4th Main Directorate of the Ministry of Health of the USSR (until 1974). He developed a new method of phalloplasty, the classification of gunshot joint injuries. He prepared 14 doctors and 47 candidates of medical sciences, published over 250 scientific papers. He is author of 3 monographs, including on the topic: "Carotid artery surgery" (1966), which was awarded the Burdenko Prize. V. Mayat was Honorary member of the Moscow (1973), Georgian (1976), All-Union (1978) scientific surgical societies, a member of the International Society of Surgeons. He was awarded the Order of Lenin, the Red Banner of Labor, the Second World War, and several foreign orders and medals.
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Justin Ivlianovich JANELIDZE – Chairman of the all-Union society of surgeons, Chief surgeon of the Soviet Navy, chief editor of the journal "Bulletin of surgery" (135th anniversary of birth)
Abstract
Justin Ivlianovich Janelidze was doctor of medicine. G. I. Janelidze made a successful operation a patient with a wound of the right ventricle of the heart in 1911. World's first he stitched the wound of the ascending aorta in 1913. I. Janelidze is the author of over 100 scientific works, including monographs: "The wounds of the heart and their surgical treatment", "Free skin grafting in Russia and the Soviet Union," "Bronchial fistula gunshot origin." He developed methods of surgical treatment of wounds of the heart, mediastinum, arterial and arteriovenous aneurysms of the carotid, subclavian and femoral arteries, plastic surgery, methods of reduction of dislocated shoulder and hip. Most famous was his monograph "Bronchial fistula gunshot origin", for which he was awarded the State prize of the USSR (1948). He was awarded several orders and medals.
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140-th anniversary of the birth of the first in Russia head of the department of surgery, a well-known radiobiologist, geneticist and oncologist, Professor Nadezhda Alekseevna Dobrovolskaya (on the 100th anniversary of the Voronezh State medical university)
Abstract
Dobrovolskaya Nadezhda Alekseevna is professor, head of the Department of surgery, well-known radiobiologist, geneticist and oncologist. N.A. Dobrovolskaya suggested method of joining vessels of different diameter, "end-to-end" crossing them obliquely in 1912. She applied the hair to perform a vascular suture. In 1919, Dobrovolskaya described the symptom that got her name – a decrease in heart rate when digital occlusion of the artery proximal to arteriovenous fistula. She described the brachyury mutation in mice. N.A. Dobrovolskaya creates several pure lines of mice as models of human diseases.
Nadezhda was a member of the boards of the society of Russian doctors of Mechnikov, Russian academic group, Russian section of the International Federation of University women, Association of Russian doctors abroad and collaborated with the Brotherhood of the Martyr Albania and St. Sergius. N. Dobrovolska is author more over one hundred scientific papers. She was awarded the French Academy of Sciences for research in the field of hereditary cancer in 1937.
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