Vol 7, No 2 (2014)

The purpose of the study This study was aimed to determine the structure and identify risk factors associated with the development of embolic events in surgical patients with left-sided infective endocarditis. Materials and methods The cohort includes 238 patients with left-sided infective endocarditis who underwent valve replacement surgery. All thromboembolic events which have occurred before, during and after surgery were studied. The influence of the basic epidemiologic, clinical, microbiological, echocardiographic, and laboratory data on the cases of embolism was analyzed. Results and their discussion In-hospital mortality in general cohort was 9.24%; in the group of patients with embolic events it was 11.54%, and in the event-free group it was 8.60%. The mortality in the sub-group with pre-surgical embolic events was 8.33%, and in the sub-group with post-surgical embolic events it was 18.75% (all deaths occurred in this sub-group were related to embolisms). In patient group with embolic events and in the event-free group mitral valve impairment was reported to occur in 44.23% and 31.72% of cases, respectively. Vegetations were reported in 93.28% of patients. Transesophageal echocardiography showed higher sensitivity in comparison with transthoracic echocardiography for vegetations located on mitral valve only (p≤0.05). The relation was confirmed between pre-surgical embolic episodes and bulky mobile vegetations (p<0.05). In 43.75% of cases thromboembolic episodes in post-surgical period took place after both mitral and aortic valves replacement, most post-surgical embolisms occurred within the first three days after the surgery. Conclusion Major risk-factors associated with pre-surgical embolic events in patients with left-sided infective endocarditis were: active infective endocarditis, mitral valve lesion, and large mobile vegetations. The embolic events which have occurred before surgery did not affect hospital mortality. Intra- and post-surgical embolic events in left-sided IE patients were not related to the risk factors associated with pre-surgical embolisms and were found to increase in-hospital mortality risk. The highest risk of postoperative embolism appeared to be in early post-surgical period. Key words Infective endocarditis, surgical treatment, embolic events, risk factors.

The purpose of the study Another option, proposed by the author, is a parallel combination of antibiotic prophylaxis and varying lymph stimulation. Materials and methods The study was conducted on 36 Wistar male rats. The effectiveness of antibiotic prevention in the conditions of new model of infectious complications in surgical area was studied in groups of 6 animals. Results and their discussion It is experimentally proved that for a given simulation of postoperative complications ABP is really effective, i.e. the number of operations undergone by animals increases. Means, this model takes place on existence and can be used to study various methods of ABP. The condition of a lymphatic drainageis oppressed during the development of pyoinflammatory complications in regional and distal lymph areas concerning a surgery zone. Conclusion Antibiotic dose used in the ABP does not affect the frequency of development of SSIs (p> 0,05), but severity of other complications depends on it (peritonitis, death) p≤0,05. Combining it with lymphostimulation using minimal doses improving its efficiency p ≤ 0,05. The isolated lymphostimulation in the experiment is prevention of development of SSIs

The purpose of the study To analyse results of treatment of patients with sharp destructive pancreatitis and to define the most effective methods of various draining operations with the purpose of reduction of number of complications, decrease in a lethality and improvement of outcomes of a disease. Materials and methods The basis of research was made by results of inspection and treatment of 256 patients by destructive forms of sharp pancreatitis, the postupivkshikh on treatment in No. 23 GKB of "Medsantrud" during the period with 2010 on 2014гг concerning sharp pancreatitis. In studied group didn't include biliarny and postoperative панкреонекрозы because of features па- тогенеза and a clinical current. The age of patients varied from 18 to 90 years and averaged 51,0±15,2. It was more senior than 60 years of 27,4% of the patients who had a serious accompanying illness among which pathology prevailed from serdechnoksosudisty (at 66,3%) and respiratory systems (at 37,4%) that is considerable отягощало their state and a current of the postoperative period. Results and their discussion Sharp destructive pancreatitis develops in 45% of cases within a pancreas and parapankreatichesky cellulose also has focal character. At 37,7% of patients destruction gains massive character with distribution on zabryushinny cellulose. Lightning techekny diseases total and subtotal destruction of a pancreas and involvement in process of all bodies and systems meets at 17,3% of patients. The medical and diagnostic laparoscopy and low-invasive methods of research with the subsequent "closed" drainage of the centers of destruction allows to reduce manifestation of endogenous intoxication at patients with sharp pancreatitis. At focal панкреонекрозе the medical and diagnostic laparoscopy and mininvazivny methods of drainage is a zaverkshayushchy type of expeditious treatment and allows to reduce number of purulent complications to 11,1%, all-somatic - to 6,6%, and a lethality to 1,1%. Conclusion The differentiated approach to surgical tactics of treatment of patients by destructive pancreatitis, depending on the scale of initial damage of a pancreas, allowed to reduce on the average number of purulent complications by one patient by 4 times (from 9,8% to 2,2%), to lower a lektalnost from purulent complications by 3 times (from 15,3% to 5,5%), and, as a result, to lower a postoperative lethality by 2,5 times (from 25,0% to 9,8%).

The purpose of the study Study of treatment possibilities and summarization of experience of use of minimally invasive technologies in treatment of varicose veins in outpatient and office setting. Materials and methods A two year experience of diagnostics and treatment of varicose disease of 1024 patients in outpatient and office setting is reported. In diagnostics were used routine examination and ultrasound, venous insufficiency was estimated with CEAP classification. Photographic documentation was done with digital SLR camera. We used: conservative treatment, minimally￾invasive ways of treatment, sclerotherapy mostly. Own injection-aspiration method of sclerotherapy was developed and used and it allowed to minimize potential risk of DVT during compression sclerotherapy procedure. Results and their discussion All results of treatment were good and satisfactory. There are not detected complications. Conclusion Treatment of varicose disease within phlebology department of private outpatient medical center always requires an individual approach; introduction of modern minimally invasive cosmetically acceptable methods gives to doctor of office practice serious tool of treatment of almost all stages of chronic venous insufficiency; including usage of developed method of sclerotherapy which allows to treat patient without unacceptable risk for patient

The purpose of the study To study the effects of drugs affecting neurotransmitters - of neuromidin in patients undergoing antiglaucoma surgery. Material and methods 95 patients (190 eyes), operated on for uncompensated primary open angle glaucoma, divided into 2 groups. The first (main) group: 65 patients, which, together with the local hypotensive drugs and traditional therapy was received neiromidin 15 mg (1 ml) intramuscularly, and then in tablets of 20 mg x 2 times daily outpatient as monotherapy, 20 days. The second (control) group: 30 patients (60 eyes), who received similar treatment, but without the neuromidin. All of the patients were made classical surgery fistulizing with peripheral iridectomy modification S.N. Fedorov et al. The paper uses the standard ophthalmological research methods: visometry, tonometry, biomicroscopy, direct and inverse ophthalmoscopy, dynamic and static perimetry, gonioskopia and quantify disk on Heidelberg retina tomograph by laser scanning. The research was carried out before beginning treatment at hospital discharge and in process through 1, 3, 6, 9, 12 months. Results and their discussion Underwent surgical intervention resulted in lowering intraocular pressure in the main and control groups. In the group of patients treated with neuromidin, more marked significant improvement of visual functions, indicators HRT. Conclusion With the purpose of increase of efficiency of treatment of patients with primary glaucoma in the postoperative period it is recommended in complex treatment include neuromidin.The addition of neuromidin to traditional therapy improves visual acuity, the expansion of the field of view and increase the area of neironal rim, thickening peripapillary nerve fiber layer of the retina. Taking into account the decrease received positive effect six months after the operation, courses of drug therapy should be carried out 2 times in year.

Despite the achievements of the modern medicine, diffused peritonitis until the present time remains the urgent problem in the emergent abdominal surgery. According to the data of the leading Russian and foreign clinics, mortality rate in this pathology in the last decades has not showed any reduction tendency and varied in the range of minimum 20-30%, achieving at maximum 50-70%. The article presents analytical review of new approaches to the treatment of the diffused peritonitis. The authors describe in detail their own developed three methods of treatment of peritonitis and indications for their application. In traditional (semi-closed method of treatment) sanitation of the abdominal cavity was conducted with the use of immobilized forms of sodium hypochlorite in the gel of carboxymetilcellulose. Deponent of the antiseptic prolongs its bactericidal action, while the gel of carboxymetilcellulose prevents the gluing of the organs’ surfaces , by which reduces the severity of adhesive process. In surgical-laporoscopic method of treatment video-endoscopic sanitations of the abdominal cavity were done by pulsating irrigation of antiseptic. To close the defects of the abdominal cavity in semi-open method of treatment there was used large-net endoprothesis made from polypropylene. Between the edges of the wound there was left diastases, at which intra-abdominal pressure was below 15 mm. of mercury column. For selection of the appropriate method of treatment there was used the original scale of quantitative evaluation of factors, influencing lethality rate of patients. It was proved that semi-closed method of treatment is reasonable to use in patients without signs of the abdominal sepsis, while programmed video-laparoscopic sanitations should be used in cases of abdominal sepsis without poly-organic dysfunction and intra-abdominal pressure below 20 mm. of mercury column, programmed surgical sanitations are indicated for patients with severe abdominal sepsis with poly-organic insufficiency and abdominal hypertension above 20 mm of mercury column. Introduction of new methods of treatment to practice enabled to decrease the number of post￾operative complications by 10% and lethality – by 8,2%