Vol 11, No 4 (2018)

Original articles

A comparative study of volatile fatty acids in the blood and in the drainage from pancreatic fistula in pancreatic necrosis

Мetelev A.S., Akayzin E.S., Gagua A.K.

Abstract

Relevance. The informative value of the content of volatile fatty acids (VFA) in the fistulous drainage from pancreas not been studied in the diagnosis of pancreonecrosis (PN). The informative value of the indices of the content of VFA in the blood has not been studied sufficiently in the diagnosis of PN.

Aim of the study is to compare the content of VFA in the blood and in the fistulous drainage from pancreas in patients with pancreatic necrosis.

Materials and methods. Samples of blood and fistulous drainage from pancreas isolated from patients with a confirmed diagnosis of PN were studied (n = 18). There was analysis of the concentrations of VFA: acetic, propionic, butyric and isovaleric acids by gas-liquid chromatography on an automated gas chromatograph "Crystallux-4000" with a capillary column "HP-FFAP" Agilent Technologies and a flame ionization detector. The anaerobic index and sum of VFA were calculated.

Results. Higher values of the content of acetic, propionic and butyric acids, the sum of VFA and lower values of the content of isovaleric acid and anaerobic index were found in patients with PN in comparison with those of practically healthy donors. Higher values of the content of acetic, propionic and isovaleric acid, the sum of VFA and anaerobic index were noted in the fistulous drainage from pancreas in comparison with the same parameters in blood in patients with PN. The correlation of pairwise conjugated parameters of the content of propionic and isovaleric acids, anaerobic index and the sum of VFA in fistulous drainage from pancreas and blood are discovered in patients with PN.

Conclusions. The concentration of acetic, propionic and isovaleric acids, the sum of VFA were higher in the fistulous drainage from pancreas than in the blood in patients with PN. The analysis of the parameters of the VFA can be used as additional criteria for the early diagnosis of PN.

Journal of Experimental and Clinical Surgery. 2018;11(4):232-236
pages 232-236 views

THE USE OF MATHEMATICAL MODELING TO DETERMINE THE ANGLE OF SPATIAL ORIENTATION OF THE VIEWING LAPAROSCOPY DURING CHOLECYSTECTOMY

Musina Y.S., Nuzova O.B., Kolosova N.I., Kagan I.I.

Abstract

Relevance. Treatment of patients with calculous cholecystitis is an important task of modern surgery. Laparoscopic cholecystectomy become the "gold standard" for the treatment of cholelithiasis. The safety of laparoscopic cholecystectomy can be ensured by rational approach to the placement of laparaports.

The aim of the study is to improve the results of laparoscopic cholecystectomy on the basis of determining the optimal angle of spatial orientation of the viewing laparoscope during cholecystectomy with the help of mathematical modeling.

Materials and methods. Clinical studies were based on data of 122 patients with acute and chronic calculous cholecystitis who underwent endovisual analysis of anatomy of the structures and organs of the upper sector of abdominal cavity, depending on the spatial orientation of the viewing laparoscope during cholecystectomy.

Results. As result of the multiple regression analysis, there has been developed the model that makes it possible to calculate the optimal angle of spatial orientation of the viewing laparoscope during cholecystectomy, which is important for preventing complications and improving the results of laparoscopic cholecystectomy.

Сonclusion. Using the obtained model, it is possible to determine the optimal angle of spatial orientation of the viewing laparoscope for cholecystectomy, which is an important condition for improving the results of laparoscopic cholecystectomy and for the prevention of complications. The above model makes it possible to reduce the duration of inpatient treatment and the rebilitation period.

Journal of Experimental and Clinical Surgery. 2018;11(4):237-241
pages 237-241 views

Topographic-anatomical changes in bifurcation of the trachea after lobectomy

Vasyukov M.N.

Abstract

Relevance. The study of the topographic-anatomical changes in the tracheobronchial complex and tracheal bifurcation after lobectomy is an actual subject of clinical anatomy and surgery.

The aim is to study the features of the tracheal bifurcation' topographic-anatomical changes in the different times after lobectomy.

Materials and methods. An analysis of the computer tomograms was performed in the early postoperative period, in 6 and 12 months after lobectomy in 62 patients.

Results. The tracheal bifurcation shifts in the transverse, angular and vertical directions after lobectomy. The degree and nature of the shift depend on the lobectomy type. In most cases, the degree of the tracheal bifurcation' shift is small and statistically insignificant.

Conclusions. There were no statistically significant topographic-anatomical changes of the tracheal bifurcation after lobectomy. It may be associated with other compensatory mechanisms: the elevation of diaphragm level, the shift of heart, the retraction of the thoracic wall.

Journal of Experimental and Clinical Surgery. 2018;11(4):242-246
pages 242-246 views

Solitary Renal Metastasis of Esophageal Squamous Cell Carcinoma

Stepanova Y.A., Chekhoeva O.A., Teplov A.A., Gritskevich A.A., Morozova M.V., Davydenko P.I., Ruchkin D.V., Glotov A.V.

Abstract

Esophageal cancer is the sixth leading cause of death from cancer worldwide. Most patients with esophageal cancer die from relapses or metastases, with a 5-year survival rate ranging from 15% to 25%. The most common places of metastasis are the liver, lungs, bones and adrenal glands. Metastases in the kidney are extremely rare.

We present the clinical case of a 61-year-old patient who was surgically radically treated at the A.V. Vishnevsky Surgery Center about esophageal cancer. The lesion was localized in the middle third of the esophagus along the posterior one, with spreading to the right wall, protruding into the lumen, slightly narrowing it. The situation was complicated by the fact that preoperatively the patient was diagnosed with coronary artery stenosis: the middle third of the anterior interventricular branch (AIB) of 80%, the proximal third of the envelope of the left coronary artery to 70%, the right coronary artery in the middle third to 50%. In this connection, the first stage of treatment was performed by stenting of AIB and the envelope of the left coronary artery. With the dynamic observation of the patient's condition, metastasis to the kidney was revealed in two years, and the patient was also operated on.

This clinical case demonstrates the possibility of using a complex radiology (including X-ray, ultrasound, MSCT and angiography) at the stages of examination and treatment of such category of patients, allowing timely detection and correction of both the manifestations of the underlying pathology and concomitant diseases.

Journal of Experimental and Clinical Surgery. 2018;11(4):247-255
pages 247-255 views

Intracavitary laser obliteration of Baker cyst under ultrasonic navigation

Krochek I.V., Sergiyko S.V., Privalov V.A., Shumilin I.I., Shekunova Y.G., Anchugova A.Y.

Abstract

Relevance. Baker's cyst is the formation in the popliteal region, resulting from the accumulation of synovial fluid in the semimembranous bursa due to anastomosis between the joint cavity and the synovial bursa of the popliteal region. Trauma and/or some inflammatory diseases of the joints are the main causes of these cysts. Despite the success of endoscopic methods of treatment of this category of patients, the frequency of postoperative complications is 3-10%.

The aim is to conduct a comparative analysis of the Baker's cysts treatment results using intracavitary laser obliteration and traditional cyst excision.

Materials and methods. The treatment results of 39 patients with Baker cysts, who entered the clinic for the period from 2012 to 2017, are analyzed. Patients were divided into 2 representative groups. Ultrasound-guided intracavitary laser obliteration of Baker's cyst was performed in 24 (62%) patients of the main group. Traditional radical excision of all cyst elements with application of the primary suture was performed for 15 (38%) patients of the control group. A russian single-wave programmable three-mode laser scalpel LSP - "IRE-Polyus" was used in the work.

Results. The patients of the main group had almost no pain syndrome, the duration of hospital treatment and rehabilitation were 4 times shorter than in the group of traditional operations (p≤0,05). Satisfaction with the laser treatment results of the patients from this group was 83.3%, while in the traditional treatment group - only 66.6%.

Conclusion. The minimum number of the disease recurrences after ultrasonic-controlled intracavitary laser obliteration of Baker's cysts, the simplicity and low-traumatism of manipulation, the low level of complications, coupled with the high patient satisfaction with the treatment results, set apart this technology from traditional one, which allows recommending this method for wide application.

Journal of Experimental and Clinical Surgery. 2018;11(4):256-263
pages 256-263 views

Retroperitoneal Tissue Contrast Examination in Different Types of Acute Destructuve Pancreatitis

Imaeva A.K., Mustafin T.I.

Abstract

Acute destructive pancreatitis refers to severe surgical pathology with high mortality. Destructive changes in this case cover both adjacent and distant structures. The aim of the study was to achieve a more accurate injection of the liquid contrast agent to the tissues of the retroperitoneal space affected by the purulent-necrotic process. We have developed a method that involves the use of a special device with a metal goniometer with a gradation of up to 180° with clamps to fix the syringe with a needle. Syringe with a needle is fixed in the device at an angle of 40° to 50° depending on the figure and the nature of the nutrition patients. The paper presents the results of contrast study of retroperitoneal tissue using the proposed device. The results of 63 cases of retroperitoneal space contrasting study through the right and left lumbar regions are considered. The use of the proposed method of contrast retroperitoneal area taking into account the figure and the nature of nutrition allows more accurately determine the variant of lesion of the pancreas and adjacent adipose tissue. The previously proposed methods of retroperitoneal tissues puncture in acute destructive pancreatitis (ADP) did not fully take into account the figure and the nature of nutrition of the subjects. A significant number (35%) of patients have an excess weight, especially among mesomorphs and endomorphs (91,4%). The figure and the nature of the nutrition of the subject should be provided in bringing the contrast into the retroperitoneal tissue, since this determines the angle of fixation of the needle in the device and the depth of its advancement. Puncture through the right lumbar region was carried out at I and II, through the left lumbar region - at III and IV types of ADP. Purulent necrotic lesions often equally cover the right and left parts of retroperitoneal tissue with type V of ADP.

Journal of Experimental and Clinical Surgery. 2018;11(4):264-267
pages 264-267 views

Clinical and experimental substantiation of the effect of hypoxia on the wall of the small and large intestine in newborns

Karpova I.Y., Parshikov V.V., Prodanets N.N., Solovieva T.I., Pyatova E.D., Molchanova D.V., Bebenina A.A.

Abstract

Based on the analysis of morphological and morphometric data, the clinical and experimental results of the effect of hypoxia on the wall of the small and large intestine in newborns are presented. The clinical part is based on the study of 58 case histories of patients with necrotizing enterocolitis, which the operating material (resected sections of the small intestine, large intestine) was studied in detail. The experimental work included the modeling of chronic hypobaric hypoxia in different trimesters of pregnancy in 4 groups of white rats (24 females). The offspring was taken out of the experiment at 4-5 days after birth, followed by collection of the small and large intestine areas to study histoarchitectonics. It is proved that hypoxia affects the number of newborn offspring, its weight. The small intestine is most vulnerable to the effect of this factor. Analysis of the morphological and morphometric picture of the operating and experimental material convincingly proves that under the influence of hypoxia the destruction of the intestinal mucosa occurs and the growth of the connective tissue component in the muscle layer occurs.

Changes from the microcirculation of blood and lymph provoke the development of pre-ulcerative, ulcerative defects and the formation of necrosis. Disturbance of the drainage function promotes the spread of destruction in the intestinal wall.

Journal of Experimental and Clinical Surgery. 2018;11(4):268-274
pages 268-274 views

The effectiveness of the reparative processes stimulation of the platelet-rich plasma in case of the abdominal wall endoprosthetics

Sukovatykh B.S., Zatolokina M.A., Mutova T.V., Valuyskaya N.M., Zhukovsky V.A.

Abstract

Relevance. The number of ventral hernias recurrence after abdominal wall endoprosthetics with the lightweight endoprosthesis is 8-10%.

The purpose of the research is to study the morphological changes of the connective tissue, surrounding a lightweight polypropylene endoprosthesis, at the early stages of implantation at the use of platelet-rich autoplasma.

Materials and methods. The results of experimental research of the course of wound process in the abdominal wall tissues during the implantation of the lightweight polypropylene prosthesis on 50 Chinchilla rabbits divided into 2 groups of 25 animal units each have been analyzed. Subaponeurotic implantation of the prosthesis was carried out in the first group of animals. In the second group, the platelet-rich autoplasma was twice introduced after the implantation of the prosthesis during surgery and on the third day of the postoperative period at the rate of 0,5 ml plasma per 1 cm2 of the endoprosthesis. The animals were taken away from the experiment on the 3rd, 7th, 10th, 14th and 21st day. Morphometric and histological study of reactive changes of tissue surrounding the implanted endoprosthesis was carried out.

Results and its discussion. In the animals of the second group, the inflammatory response to prosthesis implantation was 1,3 times lower on the third day, 1,2 times lower on the 7th day, and 1,1 times lower on the 10th day, than in the first group. Fibroblastic response, on the contrary, has increased into 1,2 times on the third day, into 1,14 during the 7th day and into 1,18 during the 14th day after the introduction of autoplasma. The thickness of the connective tissue capsule in the second group was 1,57 times higher than in the first group on the 21st day of the experiment. At this time, in the first group, the immature connective tissue capsule has been represented by the loose collagen fibers and fibroblastic cells without separation into the layers. In the second group, a dense connective tissue frame has been formed by the mature collagen fibers arranged compactly and in parallel to each other. The layer-by-layer structure of the capsule is well expressed: the inner layer consists of the fibroblastic cells, and the outer layer consists of the mature collagen fibers.

Conclusion. The use of platelet-rich plasma to stimulate reparative processes in the implantation of the lightweight polypropylene prosthesis in the abdominal wall is pathogenetically justified and effective.

Journal of Experimental and Clinical Surgery. 2018;11(4):275-284
pages 275-284 views

The effect of hyperlipidemia on the local content of cytokines in the zone of implantation of synthetic materials

Grigoryuk A.A., Belov S.A., Grigoryuk L.N.

Abstract

Relevance. Abdominal plastic with the use of synthetic materials is a universally recognized method of treating ventral hernias. However, using implants, surgeons have faced the problem of tissue biocompatibility.

The aim of the study was to evaluate the effect of synthetic implants from polypropylene mesh ("Esfil") and polytetrafluoroethylene ("Ecoflon") on local production of cytokines in experimental hyperlipidemia.

Materials and methods. The work was performed on male Wistar rats weighing 250 ± 50 grams (n=54). The method of Meshcherskaya K.A. (1966) was used for the development of hyperlipidemia. The diet consisted of adding to the food of cholesterol powder 1%, 20% margarine and 2.5 IU of vitamin D per kg of body weight of rats for 6 months. The plastic of the anterior abdominal wall was performed by 8 month old animals using the Onlay method using the implants "Esfil" and "Ecoflon". The control group was rats with prosthetics of the abdominal wall on a normal diet. The material of the study was blood plasma and biopsy specimens of the muscle-aponeurotic rumen of the anterior abdominal wall of rats.

Results. It was noticed in the course of the experimental study that the implants used in the reconstruction of the anterior abdominal wall have individual features of the effect on the local production of cytokines. "Ecoflon" has a more pronounced reactogenicity, manifested by hyperproduction of pro-inflammatory cytokines from 10 to 30 days. "Esfil" is characterized by less pronounced influence on local pro-inflammatory activity of cells in dynamics after alloplasty, in comparison with the use of "Ecoflon". Hyperlipidemia leads to a decrease in local production, both of pro-inflammatory and anti-inflammatory cytokines.

Journal of Experimental and Clinical Surgery. 2018;11(4):285-290
pages 285-290 views

Pathomorphological manifestations of ischemic involvement of the small intestine in acute occlusion of the mesenteric artery

Ryabkov M.G., Baleev M.S., Bederina E.L., Romanov I.N., Shakhov A.V., Baleeva M.V.

Abstract

Relevance. Lethality rates (63-95%) among patients with acute intestinal ischemia remain consistently high during the last decades. Despite the high urgency of the problem and numerous works devoted to visualization, early laboratory and instrumental diagnostics of ischemic bowel disease, clinical results have not changed significantly during the last 15-20 years. Pathogenetic mechanisms of various variants of ischemic intestinal lesion and their pathomorphological manifestations should become the basis for the development of surgical tactics and require specification.

The aim is to study pathomorphological manifestations and to clarify on their basis the pathogenetic mechanisms of ischemic involvement of the small intestine in acute occlusion of the mesenteric artery in the experiment.

Materials and methods. An experimental study was performed on 10 laboratory animals - male rats of the Wistar line. Modeling acute mesenteric ischemia was carried out via dressing of the jejunal artery. The ischemic intestine was collected for a stepwise histological study, the morphometry of the layers of the intestinal wall and the prevalence of necrosis.

Results. At the time of the appearance of macroscopic signs of lack of vitality in the central sector of the ischemic intestine, the wall thickness was 47.6% less than normal and in the adjacent peripheral sectors by 40.6%. Thinning of the intestinal wall was due to alteration of the mucosa with a decrease in its share in the total wall thickness from 86 to 82% (p = 0.021) in all sectors. The share of area occupied by necrosis in groups "B" and "C" was not statistically significant (p = 0.872) and amounted to 17.1 [7.3; 64.9]%. The state of the intramural vessels of the intestinal wall had significantly changed in comparison with the intact intestine. Signs of hypoperfusion in the form of sludge in the microvessels of the mucous membrane and the submucosa had been revealed.

Conclusions. Pathomorphological manifestations of ischemic bowel disease in acute occlusive mesenteric ischemia resulted in a decrease in the total thickness of the wall and a change in the ratio of serous-muscular and mucosal-submucosal layers due to a decrease in the proportion of the latter. The severity of necrosis in the central and peripheral parts of the ischemic intestine did not differ.

Journal of Experimental and Clinical Surgery. 2018;11(4):291-296
pages 291-296 views

Memorials

Konstantin Shchepin – doctor of medicine, professor of anatomy, physiology and surgery (1728-1770) (to the 290th anniversary of birth)

Andreev A.A., Ostroushko A.P.

Abstract

Konstantin Shchepin was doctor of medicine, professor of anatomy, physiology and surgery. He defended his work "About plant acid" and became a doctor of medicine in 1758. K. I. Shchepin in the rank of divisional doctor was sent to the front in 1760, where he served in the Bishofbergera field hospital during the Seven years’ war. In 1762, he was appointed to the Moscow hospital school being the first teacher of Russian origin. Konstantin Shchepin prepared in Russian by the two manuscripts "Anatomical lectures" (1763) and "On anatomy in general" (1764). K. A. Shchepin first introduced russian anatomical terms, compulsory study of the anatomy and training of operations on dead bodies, postmortem autopsy, the practice of students in the pharmacy, familiarity of students with mineral waters, practical classes with demonstration patients, repetition of material, optional evening reading. He taught anatomy, physiology, surgery, internal medicine, botany, pharmacology and pharmacy. His graduates operated hernia, blood vessels, skull, eyes, chest and abdomen and was removed from the bladder stones, etc. In 1766-1767, he visited Moldavia, Galicia, Wallachia, where he studied the plant world. In 1770, K. I. Shchepin went to Kiev to fight the plague, but he became the victim of this disease.

Journal of Experimental and Clinical Surgery. 2018;11(4):297-297
pages 297-297 views

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