Vol 8, No 1 (2015)
- Year: 2015
- Articles: 17
- URL: https://vestnik-surgery.com/journal/issue/view/26
Original articles
New Data on the Typical and Variant Anatomy of the Inguinal Gap
Abstract
Relevance In a Herniology prediction problem of inguinal hernias is still actual. For many decades studying of prerequisites of emergence of inguinal hernias is conducted. However, not enough attention is drawn to the typical characteristics of a person and surgical anatomy of the anterior abdominal wall. The purpose of the study To study sexual, age and sample features of a structure of an inguinal gap. Materials and methods Work done on the 123 floating corpses of both sexes. Has been determined by body type, shape of the abdomen and the form of inguinal gap. Also measured the length of the inguinal gap, its angles, the thickness of the abdominal muscles. Performed histological examination of biopsy specimens of the internal oblique abdominal muscles. Results and their discussion Has been concretized the structure of inguinal gap depending on its shape. Noted that the frequency of the triangular shape of the inguinal gap over the last three decades has increased from 5.3 to 20.8 % for men and from 0% to 12.5% - women. Proved that with age inguinal gap increases, crescent aponeurosis narrows, and the thickness of the muscle decreases. In the structure of muscle fiber degeneration occurs, the disorganization of the extracellular matrix and venous stasis with perifocal edema. Studied typical features of the structure of inguinal gap. Determined that the triangular shape of the inguinal gap often observed at persons with brachymorphic body type. Oval-transitional form of inguinal gap was typical for persons with dolihomorphic and slotted-oval – for persons with mesomorphic body type. At the male shape of the abdomen all forms of inguinal gap observed equally often. At the persons with the female shape of the abdomen prevailed slotted-oval and oval forms of inguinal gap, the triangular shape was observed in only 8.3%. At the oval shape of the abdomen was noted in half of the cases oval - transitional form of inguinal gap. Conclusion Identify new patterns in the structure of the inguinal gap, which can be used in clinical practice for predicting the occurrence of inguinal hernias. Key words Inguinal gap, variant anatomy, body type, shape of the abdomen
Journal of Experimental and Clinical Surgery. 2015;8(1):11-20
11-20
Analysis of Results of Antergrade and Retrograde Endoscopic Papillotomy after Cholecystectomy
Abstract
Relevance Frequency of occurrence of recurrent and residual choledocholithiasis is about 20%. We assign a special part to antegrade sphincterotomy (ST) in the treatment of intraductal pathology after cholecystectomy. It should be noted that reports about the above mentioned method are scarce (both in national and in foreign literature). The purpose of the study Size the possibilities of antegrade ST, when the pathology of major duodenal papilla (MDP) has been determinated after cholecystectomy. Materials and methods We have studied the results of treatment of obstruction of the extrahepatic bile duct after cholecystectomy in 166 patients. Study group comprised of 60 patients, who have undergone antergrade ST after cholecystectomy. The comparison group consisted of 106 patients who have undergone endoscopic retrograde PST after cholecystectomy. Results and their discussion Choledocholithiasis (43,5%), MDP stenosis (19,2%) and their combination (35,9%) dominate among the causes of intraductal pathology, requiring occasional surgical measures. Recovery after antegrade ST noted by 11,1% more, complications by 4,2% less and by 5,1% less of non-effective interventions were observed in comparison with retrograde ST. Occasional ST after antegrade ST required in 1,7%, which is 13,4% less in comparison with retrograde ST (p<0,001). Antegrade access allows to applicate intraductal interventions to stabilize the bile passage through the usage of transfistule manipulations in comparison with the isolated retrograde access.
Journal of Experimental and Clinical Surgery. 2015;8(1):21-28
21-28
Transpapillary Intervention with Choledocholithiasis and Its Complications
Abstract
The purpose of the study To improve and evaluate the results of interventions at transpapillary choledocholithiasis and complications. Material and methods We analyzed treatment results 202 patients with gallstone disease (GSD), choledocholithiasis and its complications. In the first group were 112 (55%) patients and in the first stage was carried out endoscopic treatment of choledocholithiasis, then executed videolaparoscopic cholecystectomy (LCE). In the second group, 90 (45%) patients was used one-step treatment - LCE performed with simultaneous APT. Results and their discussion The two-stage method of treatment of choledocholithiasis with using minimally invasive technologies in 9% was unsuccessful due to the inability transpapillary treatment choledocholithiasis and stenosis MDP; in 11,6% of cases endoscopic papillosphincterotomy (EPT) is fraught with the development postmanipulyatsionnogo pancreatitis; antegrade papillosphincterotomy (PLA) during videolaparoscopic cholecystectomy (VLHE) in 95,5% enables one stage of cholelithiasis and choledocholithiasis allow its complications, excluding the possibility of developing pancreatitis after manipulation. Conclusion 1. The results of surgical treatment of first and second groups showed that at one stage treatment of choledocholithiasis and its complications preference should be given videolaparoscopic interventions with simultaneous APT. 2. One-step treatment of choledocholithiasis have economic advantagesby allowing to reduce duration of hospital treatment up to 5±2.4 bed days in comparison with 14±2.3 for the two-stage treatment. Key words Choledocholithiasis, transpapillary intervention
Journal of Experimental and Clinical Surgery. 2015;8(1):29-33
29-33
Effect of Violations Regional Hemodynamics and Microcirculation of the Intestinal Wall on the Occurrence of Acute Perforation of the Small Intestine
Abstract
Relevance One of the main causes of postoperative diffuse peritonitis (PDP) are acute perforation of the various divisions of the small intestine and failure interintestinal enteroenteroanastomosis. The occurrence of these complications significantly reduces the severity of the patients and contributes to mortality up to 60 – 90%. The purpose of the study To study the influence of hemodynamic mesenteric circulation and microcirculation of the intestinal wall on the occurrence of acute perforation of the small intestine. Materials and methods For registration of normal blood flow values 16 volunteers routinely performed transabdominal ultrasound duplex scanning of the celiac trunk (TC), the superior mesenteric artery (AMS) and its branches (ram). In comparison, 20 patients with PDP duplex scanning of the same pools performed intraoperatively during the first sanation relaparotomy, including 6 before and after intestinal intubation. Subsequently, the dynamics of changes of blood flow in the specified pools in all patients with PDP was carried out with repeated intraoperative ultrasound duplex scanning (IUDS) during 2 or 3 programmed rehabilitation abdomen. The second stage using laser doppler flowmetry intraoperative (ILDF) were determined normal microcirculation wall of the small intestine. For this were examined in 10 patients operated on in a planned way and no signs of peritonitis. In comparison, the same investigation was carried out with 10 patients during the first PDP relaparotomy (including 6 before and after intestinal intubation), and the dynamics during programmed sanations abdomen. Results and their discussion Transabdominal and intraoperative ultrasound duplex scanning visceral abdominal vessels of volunteers and patients with PDP showed that the maximum values of blood flow velocity (Vmax, Vd, TAMAX) in both groups recorded at TC and AMS with a significant reduction of the periphery against the background of increasing peripheral resistance index (RI). When comparing the same levels of blood flow in volunteers and patients with PDP at AMS and ram it was noted a significant decrease significantly peak systolic (Vmax), increase in end-diastolic (Vd) blood flow velocity, TAMAX, as well as reduced RI in patients with PDP. However, the IUDS level branches AMS performed after intestinal intubation in patients with PDP, revealed a significant increase in RI and reduced TAMAX. These changes are interpreted as microcirculation disturbances manifested visual appearance petechial hemorrhages in the intestinal wall overstretched, with a reduction in central hemodynamics during this period due to reperfusion syndrome. In assessing ILDF wall of the small intestine in patients with PDP compared with the volunteers had significant microcirculatory disorders, manifested by reduced microcirculation, standard deviation, performance index microcirculation bypass indicator. In evaluating these parameters in patients with PDP 36 hours during programmed relaparotomy had significantly their growth. At the same time, the analysis of the amplitude - frequency spectrum ILDF performed after intestinal intubation in patients with first relaparotomy in patients with PDP index was decreased with increasing the efficiency of microcirculation index bypass due to an increase of neurogenic and myogenic tone of blood vessels, which indicates a lean microvasculature and worsening of metabolic disorders in the intestinal wall. Conclusion Using IUDS ILDF and visceral arteries in patients with PDP reveals significant violations mesenteric circulation and microcirculation, more pronounced at the level of branches of the AMS. Registration of changes in mesenteric blood flow in patients with PDP after intestinal intubation allows to fix the further deterioration of microcirculatory pool associated with the occurrence of reperfusion syndrome. On the background of the planned sanations abdomen in patients with PDP, along with relief of the inflammatory process, there is significant improvement in the mesenteric circulation and microcirculation. Key words Acute bowel perforation, postoperative peritonitis, microcirculation, intraoperative duplex scanning, intraoperative laser doppler flowmetry
Journal of Experimental and Clinical Surgery. 2015;8(1):34-44
34-44
N.B. Еffectiveness of Methods of Clinical Biomechanics at the Diagnosis and Treatment of Patients with Combined Lesions of the Venous and Musculoskeletal Systems of the Lower Limb
Abstract
The purpose of the study Optimize the medical rehabilitation of patients with comorbidity pathology of venous and musculoskeletal systems of lower extremities through the application of biomechanical techniques in diagnosis and treatment. Materials and methods Analyze the results of а comprehensive survey of 452 patients C3-C6 classes. Clinical analysis of movements included podometry, goniometry and functional electromyography in dynamics. Evaluation of life quality of patients was done using the questionnaire «SF-36 Healf Status Survey». Evaluation of long-term results of surgical treatment (up to 3 years) was made. Results and their discussion Combined non-traumatic pathology of the locomotor system was detected in 404 (89%) patients. Clinical analysis of movements revealed the abnormalities of the step cycle and functional insufficiency of the lower limbs. A combined pathology of the venous and musculoskeletal systems leads to the development of congestive arthrogenic syndrome. At C5-C6 classes the formation of chronic venous compartment syndrome is considered to be possible. Lack of orthopedic correction is the main reason for the decline of quality of life during the late postoperative period. Conclusion Application of biomechanical techniques in the diagnosis and functional approach in treatment can help to improve long-term outcomes and quality of life of patients with combined lesions of the venous and musculoskeletal systems of the lower extremities. Key words Сhronic venous insufficiency, functional diagnostics, сlinical analysis of the motion
Journal of Experimental and Clinical Surgery. 2015;8(1):45-51
45-51
Optimization of Anesthesia in Urgent Coronary Stanting
Abstract
Relevance The article presents the data of the original research to assess the clinical effectiveness of prevent and eliminate intraoperative pain syndrome program during coronary stenting in patients with nonstable angina pectoris (acute coronary syndrome). The purpose of the study Improving the efficiency of complex anti-stress protection of the organism in the surgical treatment of acute ischemic heart diseases with coronary syndrome by improving intraoperative anesthetic management. Materials and methods Clinical supervision included 200 cardiology patients (with concomitant acute coronary syndrome) with indications for coronary artery stenting. Among the investigated contingent highlighted two contrasting groups. 100 patients were included in the control group (using traditional program of analgesia). Other 100 patients were included in the basic group (using the developed program of analgesia). Methods of the research: assessment of the intensity of pain using modern analogue scales (visual analogue scale, digital rating scale) to assess the level of stress voltage of the autonomic nervous system by cardiointervalography with mathematical analysis of cardiac rhythm; descriptive and variational statistical methods to determine the level of significance of intergroup differences. Results and their discussion In the basic group identified the best level of analgetic protection and neurovegetative stabilization. Proved possible to complete prevention of intraoperative pain in the studied conditions. All identified intergroup differences have a high level of statistical significance. Conclusion The obtained results allow us to: statistically reasonably considered developed program of analgesia as a means of optimizing the anti-stress support for coronary stenting (with concomitant acute coronary syndrome), recommend it to practical application. Key words Intra-operative pain syndrome, acute coronary syndrome, coronary stenting, preemptive and multimodal analgesia, surgical stress, neurovegetative status
Journal of Experimental and Clinical Surgery. 2015;8(1):52-57
52-57
Experimental Substantiation of the Retraction Mechanism of Diastase Formation of the Nerve Transsection and Addition to Methods Its Treatment
Abstract
Relevance Mechanisms of formation and treatment of the interval space between stumps of sectioned nerve remain one of actual and poorly studied factors of formation of hypercollagen scar of nerve and nevroma. The purpose of the study The goal of the work is study of possibility of retraction of nerve fibers in formation of interval between stumps of sectioned nerve and an attempt at its inhibition. Materials and methods Signs of retraction of nerve fibers on human amputated extremities are studied with aid of silver impregnation of fixed preparations by Bielschowsky-Gros. For experimental study of regularities of contraction of myelinated and myelinles nerve fibers at their section there are used models of living preparations of vertebrate and invertebrate animals. With aid of phase-contrast computerized videomicroscopy, a possibility of participation of contraction of nerve fibers in an increase of space between stumps of sectioned nerve is studied. A possibility of medicament inhibition of this retraction with aid of blockers of cytoplasmic mobility is shown. Electrophysiological methods are used for study of effect of these substances on neuromembranes and a possibility of use of the tested blockers is checked in experiments of treatment of the whole animals. Results and their discussion On fixed histological preparations of nerves of damaged and amputated human extremities there are detected signs of contractile activities of nerve fibers. In experiments on isolated living fibers for the first time demonstrated is dynamics of the bidirectional retraction of myelinated nerve fibers, which accepts their participation in enlargement of diastasis of cross-sectioned nerves. On myelinles axons with preserved neuronal bodies there is studied action of blockers of contractile activity of the cytoplasm: nimodipine, cytochalasin, blebbistatin, and colchicine. There is proved participation in retraction of axons of the main protein polymers of the axoplasmic cytoskeleton and a possibility of use of these blockers for inhibition of posttraumatic retraction of nerve fibers. Electrophysiological experiments have shown a low toxicity of these agents and a possibility of their use for treatment of the traumatic diastasis of nerves in experiments on the whole animals. Conclusion 1. There is shown the capability for retraction in myelin nerve fibers of human and other vertebrates after transaction of nerves. 2. Based on experiments on living single neurons with preserved processes, a hypothesis is formulated about participation of active contraction of axons in mechanism of formation of diastasis. 3. There is analyzed the ability of several main blockers of the axoplasm motility: cytochalasin B, blebbistatin, colchicine, and nimodipine to stop traumatic retraction of neurites. 4. The absence is shown of pathological influences of the studied inhibitors on electrophysiological properties of the neuromembrane, which admits their use for treatment of diastasis at transaction of nerves in the whole experimental animals. Key words Nerve diastase, nervous fibres retraction, mechanism axoplasm retraction, axon retraction inhibitors
Journal of Experimental and Clinical Surgery. 2015;8(1):58-68
58-68
Management for Closed Injuries of the Duodenum
Abstract
Relevance Among closed injuries of the abdominal cavity trauma duodenum (KDP) holds a special place due to the rare, large traumatic severe complications in 50-70% of operated patients. To date, there is a high mortality rate (30 to 60%) due to develop complications and failure at the seams or phlegmon - up to 100%. The purpose of the study The aim of the study was choice of the method of surgical treatment and analysis results of surgical treatment in patients with closed trauma of the KDP. Materials and methods The paper analyzes results of treatment 35 patients with a closed duodenal injury. The most common cause of damage KDP was closed to road traffic injury (17 pers. - 48.6%), resulting in katatravmy in 6 (17.1%) patients. In 5 (14.3%) patients injury was received in the workplace, in 1 - sports injury in 6 - home injury. Results and their discussion Depending on the timing of the victims to the hospital after the injury, the size of the defect duodenal wall, level of injury, associated injuries pancreatoduodenal zone defines the principles of surgical treatment for injuries of the duodenum. For the prevention and treatment of retroperitoneal phlegmon used 5% glucose solution ozonated, which reduced the number of complications from 52.3% in the control group to 33.3% - in the main group and reduced the risk of an adverse outcome, ie, reduce mortality C60% to 33.3%. Conclusion 1. The volume of surgery at closed duodenal injury must be selected individually, depending on the severity of the injury and status of victim. 2. In the postoperative period is mandatory drug suppression of secretion digestive tract and the appointment of broad-spectrum antibiotics against background of infusion-transfusion therapy. Key words Closed duodenal trauma, surgical technique, complications, mortality
Journal of Experimental and Clinical Surgery. 2015;8(1):69-74
69-74
The Mathematical Justification of Double Ballon Three-Channel Endocaval Catheter Construction for Liver Vascular Isolation During It's Massive Damage by X-Ray Computer Simulation
Abstract
The purpose of the study Was to design a mathematical justification of the three-way double balloon catheter vascular isolation of the liver with its massive traumatic injuries by X-ray computer modeling. Materials and methods The study design consists of four modules: the collection and processing of computer tomograms, information analysis and classification of 3D models, as well as determining lifetime topographic parameters of the inferior vena cava and its tributaries. Results and their discussion As a result of reconstruction simultaneously performed 381 CT examinations of the thoracic and abdominal cavities of patients c intravenous contrast were obtained model the chest and abdomen to the vascular system. The resulting models were divided into three blocks, taking into account the type of constitution. In this study, epigastric angle (between the rib arcs) of less than 85 was considered astenikov °, for epigastric normostenik parameters were determined angle in the interval 85 ° - 95 °, and in hypersthenics - greater than 95 °. Next, simulation was carried Damage "hard» (VII-VIII) and hepatic vein segments by marking them. With the help of mathematical processing of the data have been established options anatomical variability of the inferior vena cava and its tributaries. The data obtained with such high accuracy the basic parameters developed catheter as mezhballonnoe distance, the cylinder diameter and width, as well as to establish patterns of variability depending upon the type of the human constitution. Thus, the following results were obtained: 1. regardless of the type of constitution diameter of the cylinder must not exceed 30.0 mm in all given points, the width of the container - 10.0 mm and mezhballonoe distance depends on the type of constitution and astenikov 50 0 mm, normostenik 65.0 mm and 82.0 mm for hypersthenics. Conclusion Based on the findings, it was suggested three variants of the three-way double balloon catheter, taking into account the type of constitution and allow to produce vascular isolation of the liver. In assisting victims with massive damage "hard" segments of the liver is crucial timely vascular isolation of the liver. Key words Vascular isolation of liver, «hard-to-reach» (VII-VIII) liver segments damage, liver veins damage, X-ray computer simulation
Journal of Experimental and Clinical Surgery. 2015;8(1):75-81
75-81
Substantiation Study of Using Immobilized Cytostatics in Management of Tumors with Peritoneal Canceromatosis
Abstract
Relevance Despite the certain successes in early diagnostics of oncological diseases a considerable number of patients with the late-stage diseases including peritoneal canceromatosis are identified at the initial examination. The cytoreductive surgeries accompanied with injuries of peritoneal mesothelium may promote commissure appearance, commissure-tumor conglomerate formation and may result in developing the acute adhesive intestinal obstruction against the background of peritoneal canceromatosis. The purpose of the study The purpose of the study is to investigate the interaction between “Lintex-Mesogel” (manufactured by “Lintex”, St. Petersburg) and chemotherapy preparations traditionally used in the treatment of peritoneal canceromatosis – Cisplatin, 5-ftuorouracil and Cyclophosphanum Materials and methods The physicochemical investigation of the interaction between “Lintex-Mesogel” and chemotherapy preparations– Cisplatin, 5-ftuorouracil and Cyclophosphanum has been conducted by the ultraviolet-visible spectroscopy and infrared spectroscopy. Results and their discussion The research proves the chemical inertness of “Lintex-Mesogel” that allows using the immobilized forms of cytostaticsin managing patients with peritoneal canceromatosisalong withthe simultaneous prevention of commissure formation Conclusions The immobilization of the preparations mentionedabove into the “Lintex-Mesogel” structure promotes the controlled release of medical products providing the prolongation of their antitumoral action. Key words Cytostatics, carboxymethylcellulose, peritoneal canceromatosis
Journal of Experimental and Clinical Surgery. 2015;8(1):82-86
82-86
Extirpation of Esophagus after Stenting
Abstract
Relevance The use of stents in benign diseases of the esophagus gets wide distribution. However, the opinions of the authors based on the results of their application is different. The purpose of the study On the basis of a clinical example to demonstrate the possibility of developing severe complications in long-term presence of the stent in the esophagus. Materials and methods As an example, here the clinical situation: a patient 55 years old, is being treated in hospital after installing self-expanding metal stent with Boerhaven syndrome complicated by pleural empyema left. 6 months after stent placement complained of difficulty in swallowing solid, liquid and semi-liquid food. Examination revealed narrowing of the esophagus to upper edge of the stent, phenomenon of nutritional deficiency. Results and their discussion Delete stent failed. To ensure the supply and preoperative performed probing the narrowed portion of the esophagus with the installation of a probe for food in the stomach. After preoperative preparation underwent extirpation of the esophagus with esophagogastroplasty. The postoperative period was uneventful. In a study of 2 months after surgery no complaints, food through mouth restored. Conclusion In patients with benign esophageal diseases self-expanding nitinol undesirable use of stents in view of the above complications. When attempting to use this category of stents in patients with benign diseases of the esophagus, you must monitor the patient in the dynamics of the evaluation and its standing stent patency. Key words Stenting of esophagus, self-expanding metal stents, extirpation of esophagus, esophageal stenting complications
Journal of Experimental and Clinical Surgery. 2015;8(1):87-91
87-91
N.B. Role of Magnetic Resonance Cholangiopancreatography in Preoperative Diagnostics of Choledocholithiasis in Patients Undergoing Laparoscopic Cholesyctectomy
Abstract
The capabilities of different methods of preoperative diagnostics of choledocholithiasis are considered in the given article. Both routine (transabdominal ultrasound, fibrogastroduodenoscopy and others) and relatively new methods (magnetic resonance cholangiopancreatography (MRCP) and endoscopic ultrasonography (EUS)) are described from the point of view of their role in solving the problem of timely preoperative diagnostics of choledocholithiasis, as well as the role of intraoperative cholangiography (IOC) in its historical perspective. Particular attention is paid to the informativity of combined application of magnetic resonance cholangiopancreatography and endoscopic ultrasonography in detecting hepatobiliary zone pathology. The role of magnetic resonance imaging (MRI) in detecting hepatobiliary zone pathology and its high accuracy in preoperative diagnostics of choledocholithiasis is emphasized. Current statistical data concerning the use of MRI in the health care system of the Russian Federation are provided in the article. Based on the attained results the authors conclude that the complex of diagnostic program for patients with suspected choledocholithiasis, undergoing laparoscopic cholecystectomy, should include magnetic resonance cholangiopancreatography, besides routine diagnostic techniques. Endosonography should complement magnetic resonance imaging when there is need for updating the diagnosis. Retrograde cholangiopancreatography should be used in case of uninformative magnetic resonance cholangiography and endoscopic sonography. This approach improves considerably the diagnostic accuracy of studies and reduces the number of invasive diagnostic procedures. Key words Сholedocholithiasis, magnetic resonance сholangiopancreatography (MCRP), magnetic resonance imaging (MRI), endosonography (EUS), laparoscopic cholecystectomy, mini-invasive technologies
Journal of Experimental and Clinical Surgery. 2015;8(1):92-99
92-99
A New Method of Predicting of the Preoperative Effectiveness of Lymph Node Dissection in Patients with Breast Cancer
Abstract
Relevance About 60% of patients with breast cancer to beginning of the examination and treatment have affected regional lymph node metastases, and 10% of patients with histologically pN0, additional immunohistochemical study reveals presence of micrometastases. On the other hand, low probability of hitting zones regional metastasis, based on data complementary methods of examination, would give the opportunity to evaluate effectiveness the proposed lymphadenectomy. Thus, the identification of regional lymph system in patients with primary operable breast cancer with no visualized on preoperative regional lymph nodes (N0) is an important task. The purpose of the study To improve effectiveness of preoperative prediction lymphodissection in patients with breast cancer. Materials and methods In line with the study goals and objectives were examined and treated 83 patients with primary breast cancer who were treated at the Clinic GBOU DPO RMAPO Health Ministry of Russia, Moscow and MSH Road Clinical Hospital Art. Voronezh-I JSC "Russian Railways". In addition to standard screening patients underwent planar scintigraphy mammary glands and organs of the chest with 99mTc-technetril. All data about patients, including the rating of the medical history were collected and combined into one table in Microsoft Excel format for further analysis. Results and their discussion As a result of multivariate statistical data analysis of patients in the study was a mathematical model consisting of three classifying functions, allowing to predict lymph node metastases in breast cancer. In this case, the data series are calculated each patient in three classifying functions and maximum value in one of the features include the patient to the appropriate group effectiveness lymphadenectomy. On the basis of the developed mathematical model was established and registered computer program "Preoperative evaluation of lymphadenectomy effectiveness " (registration number - 50200901168 from 12.02.2010 years), which allows preoperative patient referred to one of three groups of breast cancer with a certain percentage of probability.Based on the data generated conclusions. Conclusion The results indicate that the developed method of forecasting the number of metastatic regional lymph nodes in the preoperative stage may be included in a clinical algorithm of examination of patients with breast cancer. Specify the place planar 99mTc-MSH with technetril in the general algorithm of diagnosis of breast cancer. This study should be carried out to improve the preoperative diagnosis of breast cancer in patients with N0 or in case of questionable status of regional lymph nodes to evaluate the effectiveness of the forthcoming lymphadenectomy. In the future, the planar 99mTc-MSH with technetril help identify preoperative group of patients at low risk of metastasis to regional lymph nodes. This technique, combined with supporting biopsy "sentinel" lymph node may refuse to allow a certain number of diagnostic lymphadenectomy. Key words Lymphadenectomy, breast cancer, preoperative prediction
Journal of Experimental and Clinical Surgery. 2015;8(1):100-110
100-110
Minimally Invasive Methods of Treatment Patients with Prostate Cancer
Abstract
The incidence of prostate cancer has increased in recent decades. Radical prostatectomy and radiotherapy are the standard methods of radical treatment of patients with prostate cancer. The complications and reduced quality of life of patients often develop after radical treatment. These facts were the basis for the search and implementation of new minimally invasive treatments. Effective treatment of patients and reduce the number of complications there are goals of minimally invasive treatments. Information about modern methods of minimally invasive treatment of patients with prostate cancer, such as cryosurgical ablation, high-intensity focused ultrasound therapy is presented in this article. Furthermore, mechanisms of action, the process of treatment, oncological efficacy and possible complications are described. The article includes information on the experimental methods, such as interstitial thermotherapy and photodynamic therapy. International studies of use of these methods are given. In addition, the method electrochemical lysis is shown in this article, the results of clinical practice in patients with prostate cancer. Key words Prostate cancer, minimally invasive treatments, electrochemical lysis
Journal of Experimental and Clinical Surgery. 2015;8(1):111-119
111-119
Experience of Regeneration Reconstructive Surgeries in Oncological Patients
Abstract
Relevance Application of methods of plastic surgery in the treatment of cancer patients continues to be important, because they not only allow to replace extensive defects, but also to correct violations of important body functions. The purpose of the study Identify ways the reconstruction of various body defects resulting from cancer treatment, and optimize their use in the absence of microsurgical techniques. Materials and methods To analyze results of reconstructive and plastic reconstruction when performing 407 operations in 385 cancer patients on the basis of the principles which justified the choice of reconstruction method, depending on the composition of tissue removed, the localization of malignant process. Results and their discussion Submitted surgery using different types of flaps: distant (32.4%), local (35.6%), avascular autograft (29.8%). From distant flaps with axial blood supply to the most frequently used thoracic, trapezoidal, and thoracodorsal deltopektoralny. Conclusion 1. The use of different methods of closing the soft tissue defects allows to achieve optimal functional and cosmetic results while respecting the canons of cancer. 2. Determination of the area of the defect, its location, concomitant somatic pathology allow individualized choice of an adequate method of plastics Key words Plastic surgery, tissue defects, cancer patients, reconstructive intervention
Journal of Experimental and Clinical Surgery. 2015;8(1):120-130
120-130
Main Directions of the Regional Target Program to Reduce Mortality from Malignant Neoplasms
Abstract
The article presents the main methods are based on the formation of regional targeted programmes to reduce mortality from malignant neoplasms. The adaptation of the tools of control theory to Oncology practice, rationale the basics of a new approach to the management of processes of primary, secondary and tertiary cancer prevention, clinical examination precancerous pathology and contingent radically treated patients create he basis for use of the basic principles of purposeful management of regional Oncology service. On this basis it is possible to accurately assess the problems, solutions, priorities, use of Finance, human resources, and medical equipment. A systematic approach to the formation of programs provides an objective analysis of the cancer situation in the region, a separate administrative areas, various forms of cancer. his formed the basis of programmes to reduce mortality. Application of the prediction method in the formation of programs allows you to efficiently focus resources. Thus, target regional programs for decline in mortality from malignant neoplasms are based on use of methods of the systemic analysis, a program goals management, forecasting and provide stage-by-stage control of their realization, necessary financing, possible correction. Key words Mortality, malignant neoplasms, targeted programs
Journal of Experimental and Clinical Surgery. 2015;8(1):131-135
131-135
Organisation of the Student’s Scientific Work in a Surgical Hospital
Abstract
Relevance Student’s scientific work is an obligatory part of education in the medical university as it is stated in modern
requirements of the third generation standard in highest professional medical education.
The purpose of the study The student’s scientific work in a surgical hospital has to be improved.
Materials and methods The student’s scientific society of the general surgery department of the Kursk state medical university is
an investigated object. Scientific motivation, basic trends, types of stimulation, and methods of student’s scientific work are chosen
by authors as an investigated subject. The method of content analysis is placed in the basis of the study.
Results and their discussion Annually, the society has 16 conferences, in which 40 to 50 students take part. In the past five years
the department has completed 228 term scientific works and 15 final course scientific works. They were aimed on diagnosis and
treatment of surgical diseases. It has to be emphasized that the number of accomplished scientific works has increased. So, 38 term
scientific works had been completed in 2008, whereas in 2012 this number had risen to 48. Each year, 10% to 19% of all students
are free of passing final term exams as a result of sufficient education rating. Highest education results are detected in students that
are involved in the term scientific works. As a result the average score mark in final term exams of medical faculty students is 3,8,
whereas those involved in scientific work the score has sored to 4,8.
Conclusion The offered organization of student’s scientific work is effective and sufficient to get additional knowledge in surgery.
Key words Student’s scientific society, organization of work, assessment of efficacy
Journal of Experimental and Clinical Surgery. 2015;8(1):136-140
136-140