Vol 6, No 4 (2013)

Relevance At present, the frequency of operations on the gallbladder and biliary tract is constantly increasing. However, the results after removal of the gallbladder are contradictory and not always accompanied by a pronounced positive effect. The purpose of the study To study the results of cholecystectomy on the basis of data дуоденометрии, ultrasound hepatopancreatobiliary zone, estimates of the spectrum of bile acids in the blood plasma and secretory activity of the pancreas. Matherials and methods The results of cholecystectomy were traced for 10 years after the operation. The consequences of cholecystectomy were assessed by measuring plasma levels of bile acids, the levels of pressure in the stomach and duodenum, by evaluating the changes in the pancreas and stomach. Results and their discussion We detected that plasma levels of lithocholic, deoxyholic and taurodeoxyholic acids were increased by 44% during ten years after cholecystectomy. At the same time, proportions of glycocholic and tauroursodeoxyholic acids decreased by 21.5% in 5 years after the surgery. The changes in plasma levels of bile acids were accompanied by the changes of pressure in the stomach and duodenum. It was established that the most pronounced deviations were observed in the distal duodenum. The level of pressure in this area exceeded the norm by more than 2.8 times. The increase of the intestinal pressure was accompanied by the widening of pancreatic ductals in 9.5% of cases and by the increased ultrasound echogenicity of the structure in 93% of cases. In all the cases, lymphofollicular hyperplasia of gastric antral mucosa with a high degree of helicobacter pylori contamination was detected. Conclusion Сhange in the spectrum of bile acids in the plasma and blood pressure in the duodenum, apparently, is one of the factors in the pathogenesis of chronic pancreatitis after cholecystectomy. The results presented here to a certain extent can be considered as criteria for medical correction of violations occurred in the late postoperative period.

Relevance Surgery for clavicular shaft fractures is becoming more common but incisional and chest wall numbness reportedly occurs in 79%-89% of patients. This may be the result of iatrogenic injury to the supraclavicular nerve branches. Purpose of the study We determined if there was a predictable branching pattern of the supraclavicular nerve at the anterior clavicular border and determined the distances to these nerves from clavicular landmarks. Matherials and methods We performed an anatomic dissection along the anterior border of the long axis of the clavicle in 10 cadavers. The branches of the supraclavicular nerve were identified at the anterosuperior clavicular border and the distances from these nerves to palpable bony landmarks were measured. Results and their discussion 50 percent of specimens had a medial and a lateral branch of the supraclavicular nerve. 50 percent had a medial, medium and a lateral branch of the supraclavicular nerve. No branch was found within 2.7 cm of the sternoclavicular joint or within 1.9 cm of the acromioclavicular joint. Between these two positions, there was wide variability in nerve branch location. Conclusions There were two or three branches of the supraclavicular nerve crossing the clavicle 100% of the time and a wide variability of the location of these branches outside the safe zones. Clinical Relevance. There are safe zones within 2.7 cm of the sternoclavicular joint and 1.9 cm of the acromioclavicular joint. Between these safe zones, the location of the nerve branches is variable and the surgeon must use meticulous dissection if he or she wishes to prevent transection

Relevance Patients with pancreatic necrosis revealed a high incidence of infection and extention of non-delimiting suppurative destructive process onto parapancreatic fat. These complicated forms of the disease are characterized by severity and high postoperative mortality. Purpose of the study Experimental basis and clinical testing of an original method aimed to form a fibrin delimiting barrier with pancreatic necrosis. Materials and methods For a series of test-tube experiments the following was used : stabilized native plasma, a blood product — plasma cryoprecipitate, standardized preparations: thrombin and thromboplastin, calcium gluconate, aminocaproic acid. As a lysis factor the following was used: native pancreatic juice and officinal drug – himopsin. Experiments to create a fibrin delimiting barrier were being performed on 6 mongrel dogs weighing 15-25 kg. Simulation of focal pancreatic necrosis was performed with intrapleural anesthesia through laparotomic access. Next, parapancreatic fiber in the area of necrosis was infiltrated with a mixture of cryoprecipitate, aminocaproic acid and calcium gluconate (original technology) through puncture. In the chronic experiment, intraoperative biopsies of the gland and the zones of fibrin block were collected with the following histological examination. The results of surgical treatment of 581 patients with necrotizing pancreatitis for the period since 2007-2011 is being researched now. Patients with infected pancreatic necrosis account for 54,8%, out of which – the ones with retroperitoneal phlegmon - 34.4% respectively. Postoperative mortality with phlegmons of retroperitoneal fat was equal to 50,2%. Throughout 2012 in the clinic the patients with necrotizing pancreatitis were being treated by an method of creating a delimiting fibrin barrier — with 19 patients. Four patients had a sterile pancreatic necrosis and were operated endoscopically. In 15 cases - patients having infected necrotizing pancreatitis complicated by the phlegmona of retroperitoneal fat we resorted to open laparotomy. Results and their discussion In the postoperative period data from laboratory studies and special investigation techniques (ultrasound, MSCT) for 13 patients demonstrated regression of phlegmona and the formation of the demarcation zone from the tissue in the form of an inflammatory infiltrate, transforming after 3-4 weeks of observation into a typical area of rumen delimitation (walled-off pancreatic necrosis). Postoperative mortality in this group was 11,8% whereas, in the basic group of patients — 50,2%. Conclusion Laboratory and experimental methods developments have proved the efffectiveness of the use of blood product (plasma cryoprecipitate donors) as implanting artificial source of fibrinogen / fibrin to form fibrin parapancreatic barrier. In the clinic this method was used in the surgical treatment of 19 patients with necrotizing pancreatitis. The use of original technology is more shows in the group of patients suffering from the most severe complications pancreatic necrosis and phlegmon of retroperitoneal fat (15 cases), Postoperative mortality rate was 11,8%.

Relevance Application of laser and nanotechnologies is considered to be one of the most current and promising trends in modern experimental medicine. The purpose of the study To develop the method of infected skin burn wound modelling and to substantiate experimentally the effectiveness of copper nanoparticles’ and low-intensity laser radiation (LILR) combined application in the treatment of infected burn wounds of the skin. Materials and methods On the basis of the experiment on 50 white laboratory rats of 190-200g. weight there was developed and patented the method of skin burn wound simulation; the effect of copper nanoparticles’ and low-intensity laser radiation combined application in the treatment of infected burn wounds was studied in the experiment on 50 similar animals Results and their discussion Using the developed laser radiation method, skin burns of controlled damage depth and area were modelled. Peculiarities of the simulated wound process development in skin burn wound infection, markedness of antibacterial effect of various copper nanoparticles’ concentrations and laser radiation parameters were detected. Combined local application of LILR and copper nanoparticles in experimental animals of the group under observation provided by the 7th day of treatment discontinuation of pathogenic microflora inoculation, by the 4th day – appearance of granulations, and by the 14th day of treatmentwound epithelization. Conclusion The obtained findings of experimental studies with the use of planimetric and microbiological methods of investigation suggest rather high efficiency of combined application of copper nanoparticles and laser radiation, the effect surpassing that of standard methods of treatment in duration and adequacy of wound epithelization

The purpose of the study By morphological methods to estimate results of specific bacteriophage use for treatment of the experimental pneumonia caused Pseudomonas Aeruginosa. Materials and methods The changes of rat lungs, liver and spleen after bacteriophage application for treatment of the pneumonia caused Pseudomonas Aeruginosa were studied by method of light microscopy. Results and their discussion It was revealed that specific phagetherapy leads to disappearance of signs of respiratory insufficiency, the general intoxication, the pneumonia and sepsis phenomena, the increase in survival rate of animals. However, in the lungs after treatment there were signs of formation of abscessis, in liver - dystrophic changes of hepatocytes, and in spleen - hypertrophy and hyperplasia of lymphoid nodules. These complications, which can as well as be pneumonia consequences and phage use, demand working out and application of specific measures of preventive maintenance and treatment. Conclusion Survival of animals as a result of only a phagetherapy of the acute septic pneumonia caused by Pseudomonas aeruginosa, without application of antibacterial drugs, even in the presence of various complications, certainly, is positive result. Further researches for specifica-tion of a dosage, ways of application, indications and contraindications, complications of bacteriophage use for treatment of surgical infections are required

The purpose of the study By morphological methods to investigate reactions of mucous membrane in rat oral cavity at the renal insufficiency. Matherials and methods The changes of a mucous membrane in rat oral cavity at the chronic renal insufficiency (CRI) of various degrees were studied by methods of light microscopy. Results and their discussion It was revealed that in 6 months after modeling of easy or mild CRI the mucous membrane in an oral cavity was diffuse infiltrated by leukocytes, the volume density of blood and lymphatic vessels was in-creased. Rats with high grade of CRI have an atrophy and hyperkeratoses of mouth epithelium, sclerosis of a mucous membrane was detect, the number of leukocytes considerably increased, first of all, neutrophils, monocytes, macrophages, small leukocytic infiltrates were formed. Besides, at mild or high grade of CRI in mucous membrane of an oral cavity the quantity of eosinophils and plasmatic cells increases that points to possible presence of a considerable allergic component in initiation and maintenance of inflammation in mouth tissues at CRI. Conclusion CRI, even easy degree, leads to considerable changes of a mucous membrane of the rat oral cavity, consisting in an atrophy of an epithelium, sclerous transformation of a mucous membrane, stomatitis and gingivitis, a being accompanied diffusion and focal leukocyte infiltration and vascular disturbances. Key words Chronic renal insufficiency, mucous membrane

Relevance One of the reasons of organic and neurogenic fecal incontinence in children is low resting pressure in the anal canal. The purpose of the study The purpose of this article is to study the possibilities of using bulking agent «DAM+» for increasing resting pressure in the anal canal in children with fecal incontinence, and evaluate the results of this treatment. Materials and methods The study included clinical and experimental parts. Experimental part was done on Rat Model. Bulking agent «DAM+» was introduced into submucosal layer and zone of anal sphincter each rat. All boluses were measured and histological assessment was done at 1, 2, 3 weeks and 1, 3 month. Clinical study has been performed since 2007 for 2012; The 31 patient with organic or neurogenic fecal incontinence were underwent 55 procedure of introduction polyacrylamid gel «DAM+» into submucosal layer. Patients with overflow incontinence were excluded. Assessment of anorectal zone and pelvic floor included anal manometry, irrigografy, ballonoproctografy and in some cases, computed tomography was done for revealing injuries of puborectal muscle. Results and their discussion In the course of experimental study, it turned out that boluses, introduced into submucosal layer remained in stable size. Histological assessment was shown, that «DAM+» fixed into submucosal layer better than in sphincters layer. At 1 month it was detected vascular invasion of boluses, moreover «DAM+» was surrounded by thin layer of granulation tissue. Amount of resting pressure in the anal canal before and after operation also in long-term period were analyzed. The average quantity of resting pressure in the anal canal before operation is formed 20.98 ± 5.17 сm. (H2O), after operation 32.62 ± 6.63 сm. (H2 O), in long-term period 28.07 ± 6.65 сm. (H2 O) Conclusion «DAM+» should be introduced into submucosal layer. At 12 month efficiency of procedure can be decreased, however resting pressure in the anal canal remain higher than before treatment. The clinical efficiency of procedure correlates with values of resting pressure in the anal canal before and after treatment.

Peripheral (lower limb) and central (thoracic duct) lymphodynamics were studied in 40 patients who suffered from chronic lymphovenous insufficiency of the lower limbs using ultrasound (US) scanner in. The other 40 patients (without any pathology of vessels) were under the same control. The findings obtained of lymphatic hypertension in patients who suffered from chronic lympho-venous insufficiency of the lower limbs both in the peripheral and at thoracic duct levels and development of dynamic insufficiency of the thoracic duct orifice. It allowed us to apply variants of draining operations at the cervical part of the thoracic duct to decrease lymphatic hypertension. The series of experiments on the anatomic material, particular on 19 corpses of different constitution were have been performed to improve the method of performing lympho-venous anasthomosis (LVA). Thus the method of surgical treatment of chronic lymphovenous insufficiency of the lower limbs (patent № 2466685) was introduced. Variants of draining operations of the thoracic duct were performed in 30 patients who suffered from chronic lympho-venous insufficiency of the lower limbs. The effect was studied and comparative assessment of the results of treatment with traditional methods was also conducted. The experience of application of draining operations in the thoracic duct and immediate favorable results allowed us to continue our research in a given direction

Relevance Treatment of children with facial bites is known as an unresolved medical and social problem. Questions of surgical tactics are discussed to date. The purpose of the study To study of possibilities of new tactic approach in treatment of children with facial bites. Matherials and methods 84 children with facial bites were observed in Nizhnii Novgorod Regional Children Hospital (2002 – 2012). In the basic group were included children, who was operated in Nizhnii Novgorod Regional Children Hospital (n=70). In the control group were included patients, who were operated in hospitals of us region in the first step, and later were treated in Nizhnii Novgorod Regional Children Hospital (n=14). In the groups were no significant distinction on gender, age, basic trauma and intercurrent diseases. Results and their discussion Complications rate in the basic group was two times lower than in the control. Treatment of children with bite wound of the face in special children hospital with multidisciplinary approach led to decrease of complications and better esthetic results. Conclusion The traditional concept of treatment in children with facial bites, including delivery of the patients to the nearest hospital and perform all the necessary actions in the health primary care, needs to be revised. Transportation of children to involve a multidisciplinary hospital at a cost of time, but does not reflect negatively on the quality of care. Children with facial bites should be delivered immediately after the trauma in the specialized surgical center. In first-aid care should be hemostasis and applying aseptic dressing. Diagnostic and surgical procedures carried out without intermediate steps, directly in the department of oral and maxillofacial surgery, lead to significantly better immediate and long-term results, both clinical and esthetic. This approach is associated with significant reduction of complications rate and reconstructive operations

Relevance Portocaval shunting is one of the main methods for prevention of gastroesophageal bleedings at patients with a portal hypertension syndrome. From proposed methods portocaval shunting most frequently used anastomosis with the roots of the portal vein - the splenic and superior mesenteric veins. However, the vascular anastomosis with the roots of the portal vein are often accompanied by complications, including thrombosis of fistulas and recurrence of gastroesophageal bleeding. This is caused by a small caliber of shunted vessels. In addition recurrent gastroesophageal bleeding is caused by excessive high portal pressure, arising as a result of hydrodynamic resistance at the mouth of the anastomosis, flutter blood flow, collapsing walls of the blood vessels, deformation of the inosculate vessels. For improving portocaval shunting results may be the introduction of microsurgical techniques and the operating methods of external fixation the vascular wall, creating a frame mechanism for the prevention of anastomotic valve structures. The purpose of the study The aim of the study was an experimental anatomical study and development of new microsurgical frame end-to-end splenorenal and mesorenal anastomosis in portal hypertension. Materials and methods The section on anatomy justification of microsurgical spleno- and mesorenal anastomosis performed on a section material (54 human cadavers). The study of topography and anatomy features of splenic, renal and superior mesenteric veins were conducted, their morphological characteristics, the histology characteristics of vascular anastomosis, the parameters of their tightness and mechanical strength. Experimental studies carried out on 48 mongrel dogs. There have been five sets of experiments. The analyses of morphological and functional status of improved vascular anastomosis in the short and long periods after surgery were accomplished. Results and their discussion There are developed new ways of microsurgical organ-save splenorenal and mesorenal anastomosis. New data on the dynamics of the vascular healing at various periods after reconstructive surgery, their morphological and functional characteristics were received. Conclusion Results of the study show that the use of microsurgical techniques in combination with an external frame of demineralized bone can create portocaval anastomosis with preservation of the kidney and spleen, to ensure good functioning of the anastomosis without the use of anticoagulants

This article presents the relevant information on the prevalence, etiology and pathogenesis modification factors, as well as evaluation of modern methods of treatment necrotic soft tissue diseases. Special attention is paid to the actively developing method of physical therapy of necrotic process - the low-frequency ultrasonic (LFUS) cavitation. Presented a detailed assessment of the basic properties of ultrasound treatment on the wound process: mechanical wound cleansing cavitation squirt, acceleration of metabolism at the subcellular and tissue levels, bactericidal and bacteriostatic effect on microorganisms , the potentiation of antibacterial and antiseptic , strengthening of regional blood flow , enhancing the repair processes in the wound. Application LFUS cavitation relevant to the outpatient treatment phase necrotic diseases of soft tissues due to its high-performance, ease of use , and also show the best correlation with program implementation of hospital- substituted technologies in outpatient link of health care. The study of literature shows that few studies use LFUS in outpatient practice do not contain explicit organizational and structural features and algorithms for the treatment of patients with purulent-necrotic diseases of soft tissues LFUS cavitation. Matters relating to the definition of optimum conditions , the multiplicity and duration of exposure to wound, the optimum compositions of acoustic mediums, the optimal method of local anesthesia, when used LFUS in patients with different clinical forms of necrotic soft tissue diseases , there remains little known

Acute anal abscess remains the issue of the day of modern surgery, which is due to, in particular, its occurrence in 0.5% of the population, 0.5-4% of surgical and 10-50% of coloproctological patients. In the article, the analysis of the literature on the etiology, classification, clinical picture, diagnosis and treatment of acute anal abscess is performed. The review revealed that 98% of acute anal abscess is caused by mixed microflora - staphylococci, streptococci in combination with E. coli. The clinical picture of acute anal abscess depends on the localization of inflammation, the virulence of microflora and the immunoreactivity of the organism. Diagnostic methods of acute anal abscess are finger and bidigital rectal examination, anoscopy, rectal examination with a mirror and rectoromanoscopy. Endorectal electrical thermometry, ultrasonography, abscessography, chromoabscessography, computed tomography, magnetic resonance imaging and others can be used as well. Once the diagnosis of acute anal abscess is established, urgent surgical intervention must be performed, which consists of the incision and drainage of abscess with the possible elimination of the opening in the zone of the anal crypt. The postoperative management of patients with acute anal abscess may involve the use of ultrasound, laser, phototherapy, oxygen and ozone therapy, wound dialysis, hydrophonophoresis, multicomponent drugs and others. Thus, as the data in the literature reveals, many questions concerning the management of patients with acute anal abscess are not resolved to the full extent. This is evidenced by the development of inflammatory complications in 13-20%, relapses in 1.5-40%, anal sphincter deficiency in 1.5-27.9% of cases, which makes it worthwhile to continue research on developing new methods of treatments for acute anal abscess