Vol 7, No 3 (2014)

Metastatic lesion of the pancreas is an extremely rare disease, which occupies 2-5% of all pancreatic tumors, and these figures rise to 11% according to autopsies of patients with malignant tumors. Metastatic lesion of the pancreas from primary renal cancer occurs most often (65-74%).
The purpose of the study Differential diagnosis of metastatic lesions of the pancreas
Materials and methods 6 patients with histologically confirmed diagnosis - metastatic renal cell cancer in the pancreas were treated in the period from 2009 to 2013 in " A.V. Vishnevsky Institute of Surgery. Nephrectomy in history was performed in 4 (66.7%) patients in the period from 4 to 16 years. Tumor of the left kidney in conjunction with metastatic pancreatic cancer was detected in 2 (33.3%) patients.
Results and their discussion Solitary metastases were detected in 4 (66.7%) patients. Tumors were located in the head of the pancreas in 3 patients, in the body - in 1. Multiple multifocal lesion of the pancreas was in 2 (33.3%) patients. Dimensions secondary structures ranged from 10 mm to 56 mm.
The most informative diagnostic method in detecting of focal lesions of the pancreas is computed tomography with bolus contrast enhancement . Significant difficulties for interpretation are small tumors that are similar in structure to hormonally active neuroendocrine neoplasm.
Conclusion Revealed solitary or multiple focal disease of the pancreas in patients after nephrectomy for renal cell carcinoma should be regarded primarily as secondary.

Relevance The use of biologically active (usually antimicrobial) suture materials in surgical operations has positive impact for tissue regeneration. Among antibacterial surgical threads issued in Russia there are no bioresorpable ones that does its development an actual problems of modern surgery and medical industry.
The purpose of the study Experimental investigation of new antimicrobial bioresorpable suture material influence for reparation processes in wounds sutured with it.
Material and methods In 60 white rat males the healing of wounds sutured with a new antimicrobial bioresorpable suture material was investigated. To control the research results the cytological and histological methods were used.
Results and their discussion It turned out that use of a new bioresorpable suture material activates the wound process both in an inflammation phase and in a proliferation and regeneration phase. It is shown by fast migration of cellular blood elements into the damage zone, by high rates of granulations formation and epithelization of wound defect. The possible mechanisms of the suture material influence for wound healing are discussed.
Conclusion The results show that the new suture material is prospective and can be used in clinical practice.

Relevance The urgency is not due to a tendency to reduce the number of patients with acute mediastinitis. An important moment of the correction of endotoxemia, which is celebrated by introducing diseases is enterosorption. unlike hemosorption plasma-pheresis eneterosorbtion is noninvasive and does not require specially trained per-sonnel, has no absolute contraindications, clinically significant side effects.
The purpose of the study Is to assess enterosorbtion patients with acute mediastinitis using enterosorbent "Li-tovit."
Materials and methods In the treatment of 29 patients with acute mediastinitis in 13 addition to the primary treatment method used enterosorbtsii drug "Litovit." All patients underwent incision and drainage of the mediastinum vneplevralnym way. Enterosorbent "Litovit" appointed for 2 - 3 days after surgery, up to the transfer of the patient from the intensive care unit in the profile department. The route of administration through a nasogastric tube or gastrostomy.
Results and their discussion Inclusion in a comprehensive program of treatment in the early postoperative period enterosorption using drugs such as "Litovit" in the treatment of patients with acute mediastinitis increased the effectiveness of intensive therapy. Application enterosorbtion accelerated the rate of decline in the inflammatory process and improve liver function. Application enterosorbtion reduced the rate of final products lopoperoxidation and increase the antioxidant system.
Conclusion Use as a sorbent "Litovit" accelerated the rate of decline in the inflammatory process, improve the treatment of patients with acute mediastinitis.

Patients with acute intestinal obstruction constitute about 6% of all patients with an acute surgical pathology, coming in surgical hospitals. Patients with adhesive small bowel obstruction are 50-50%, and with obstructive ileus (benign nature) 5-6% of the total number of patients with intestinal obstruction. Surgery for acute adhesive intestinal obstruction are accompanied by a significant number of postoperative complications, especially in the case of repeated operations on the occasion of obstruction. From June 2009 to December 2013 at the surgical clinic Reutov Central city clinical hospital made 34 operations for acute small bowel obstruction. In 30 cases, the cause obstruction were postoperative adhesions, in 4 cases, the obstruction was caused by phytobezoars. In 10 cases performed laparoscopically elimination of acute adhesive small bowel obstruction, in 23 cases made laparotomy with the liquidation of the obstruction (20 cases - adhesive, in 3 cases - due phytobezoars), in 1 case performed laparoscopically assisted removal of phytobezoar with the elimination of intestinal obstruction.
The average duration of laparoscopic operations amounted to 68.1±26,min. The duration of operation of the open adhesiolysis was 144,2±50,7 min conversion rate was 23%. In the group of patients who underwent laparoscopic interventions, it was noted 1 complication - coagulative necrosis of the wall of the small intestine, which led to the development of postoperative peritonitis. In the group of patients who underwent open adhesions, in 2 patients was marked postoperative subcutaneous mantrala, 1 patient developed early postoperative adhesive obstruction. In all 3 cases it took the relaparotomy. Yet in 1 patient was noted to be a festering wound. The cost of laparoscopic interventions in acute adhesive small bowel obstruction is 5.2% more than the cost of similar interventions in the open way.
Received initial statistical data testify to the feasibility of laparoscopic the elimination of acute small bowel obstruction in the conditions of the municipal health institutions with satisfactory results compared to open surgery. From the economic point of view the cost of laparoscopic operations above the open intervention. However, reduction of term of stay of the patient in hospital and reducing the cost of treatment of complications after laparoscopic operations allow us to consider favorable prospects for performing laparoscopic interventions in the treatment of patients with acute intestinal obstruction.

Relevance The incidence of postoperative ventral hernias (POVH) after laparotomy reaches according to different authors 4.0 - 18.1% . Results of surgical treatment POVH remain unsatisfactory because of the high recurrence rate, reaching 10 - 45.5%, and according to some authors 50-54 % . Questions of individual choice method of abdominal wall plasty in patients with POVH and the prevention of intra-abdominal hypertension syndrome are not yet fully resolved [2, 7, 9] .
The purpose of the study To improve outcomes in patients with postoperative ventral hernias by a differentiated approach to the choice of operation, based on the investigations of prognostic factors influencing to the occurrence of disease.
Material and methods The results of treatment of 288 patients with postoperative ventral hernias. Men were 92 ( 31,9 %), women - 196 ( 68,1 %). Depending on the applied treatment, all patients were divided into 2 equivalent in number, sex, type of pathology groups - control and basic. In selecting the method of surgical treatment of patients in the control group took into account the localization of hernias, size and shape of hernial ring. To close the hernia rings applied: in 76,4 % of the patients own tissue, at 9.4% - allomaterials, only 8,6% of cases, the defect sutured "edge - to - edge ." Patients of the main group selection method plastics hernial performed taking into account the risk factors POVH, controlled phases surgery tissue and intra-abdominal pressure . Local fabrics with plastic - abolished in 19,4% of patients using allomaterials - in 80,6 %. Comparison group consisted of 106 patients who had postoperative hernia was not. Methods: type definition acetylation of tissue pressure measurement, monitoring intra-abdominal pressure , Quetelet index calculation , the study of phenotypic traits external connective tissue dysplasia syndrome.
Results and their discussion Implemented a differentiated approach to the choice the method of plastic the hernias. Along with the size, shape hernia ring in choosing the method of surgical treatment into account , intra-abdominal pressure developed by the authors and prognostic factors of recurrence of the disease. Indications for auto-and alloplasty was identified. The proposed set of therapeutic and diagnostic measures have reduced the number of early postoperative complications in 2,4 times, recurrence of the disease is 8,5 times, mortality - 3 times.
Conclusions 1. Patients with postoperative ventral hernias W1,W2 when the sum of the scores of the risk factors for recurrence of the disease less than 4.5, the increase in AP test flattening the edges of the aponeurosis of not more than 10% and reaches up to 15 mm RT. column shows autoplastic hernia gate. 2. Patients with postoperative ventral hernias W1,W2 when the sum of the scores of the risk factors for recurrence of the disease more than 4.5 in converging edges of the aponeurosis, shows the stress hernia gate. 3. Patients with postoperative ventral hernias W3,W4 shows the non-pulling stress hernia gate.

Relevance There is a high prevalence of chronic tonsillitis, which is one of the most important problem of otorhinolaryngology and many others clinical disciplines. There is a correlation between chronic tonsillitis as a pathological factor and different diseases of visceral organs and systems. It’s known that in development of chronic tonsillitis except some local complications (lymphadenitis, paratonsillits) there are some general diseases: an intoxication, rheumatic affection of the heart, joints, nephritis, sepsis and others.
Results of completed researches of functional activity and a functional reserve palatal tonsils shows active involvement of palatal tonsils in organization of local (in fauces) and general protection reactions. Considering that children with removed tonsillitis have high morbidity of infection diseases they have severe course of acute respiratory infections, which often complicated of tracheobronchitis and frequently pneumonia. In this connection, indications for the tonsillectomy must be more strictly.
The purpose of the study Improving diagnosis of chronic tonsillitis based on the study of the functional activity and the functional reserve of the tonsils to justify holding tonsillectomy.
Materials and methods We examined 205 people. Surveyed were divided into 3 groups. The first reference group consisted of 20 people (9.7%). Second and third groups consisted of 40 (19,4%) and 145 (70,9 %) patients with compensated and decompensated forms of chronic tonsillitis. To study the functional reserve of the tonsils used Prednisolone trial.
Results and their discussion In difference from other groups, in the third group found a sharp reduction in the migration of lymphocytes in the lacunae of tonsils. Decompensated forms of chronic tonsillitis are characterized by low functional activity of the tonsils and the lack of functional reserve. According to results of completed researches of palatal tonsil’s functional activity and reserve, there are statements for surgical treatment.
Conclusion All patients chemotherapy is necessary to assess the functional activity and the functional reserve of the tonsils, with the aim of determining the extent of compensation and decompensation of the inflammatory process and, therefore, define the indications for surgical treatment.

In the context of any hospital is a risk of infectious complications of surgical intervention after hip arthroplasty. Despite the availability of modern operating, under strict aseptic and antiseptic rules, practically impossible to avoid bacterial contamination of the surgical field during surgery. Therefore, this kind of prediction of complications is important for medical science and practice. In recent years, have become part of everyday life in the system of mathematical modeling course and outcome of disease as therapeutic profile, and surgical pathology. The need for establishment of such systems for the prediction and prevention of postoperative complications during hip arthroplasty great. Among the complications of hip replacement, identified in the area of operations, surgical site infection is most commonly stated - in 2-8% of patients. Several studies have noted the dependence of the frequency of suppuration early on various factors: 71.4% during the intervention marked technical difficulties, 77.7% used additional biological or synthetic materials, 90.0% of the duration of surgery more than 3 hours, 69 2% intra-and postoperative blood loss was more than 1000 ml, with 76.9% of patients pronounced comorbidities. In this case, the observation of deep suppuration in the area of the hip joint is marked in 0.2 - 5% of cases. Presented an overview of the literature allows to navigate in the state of this issue to date.

The liver failure is the actual problem of modern surgery. It is great scientific interest to study the features of liver failure in patients with obstruction of the biliary tract. Abnormal liver function in surgical practice are common, but are treated differently, as in parallel with the progression of cholestasis are always evolving phenomenon of liver failure. Aim of this study was to evaluate the biochemical and morphological criteria of liver failure in patients with obstructive jaundice. The analysis of the clinical data of 23 patients with obstructive jaundice benign and tumor genesis is presented. All patients underwent percutaneus transhepatic cholangiostomy. Patients were devided into 5 groups of comparison. The resulting differences in clinical biochemical indicators and liver biopsy allowed to develop its own classification of liver failure. The presented data demonstrate the primacy of bile ductal changes in patients with obstructive jaundice and can use it as a qualitive change criterion for assessing liver failure.

Endoprosthesis surgery of the abdominal wall remains one of the important problems in the prevention and treatment of ventral hernias, the decease that about 5 million Russians have. This paper contains an analytical overview of current abdominal wall implant methods. Comparative analysis of implants’ scientific biocompatibility shows that among different materials based on polyvinylidene fluoride, polypropylene and polytetrafluoroethylene, polyvinylidene fluoride implants are the most intact. Experimentally proved that the injection of embryo fibroblast cell culture near the implant helps to reduce the inflammation and accelerate the granulation tissue development. It is now possible to predict the progress of implant tissue response based on the cytokine profile dynamics, temperature, leukocyte and exudative reactions. It is shown that the implantation of the prosthesis in the infected wound increases the leukocyte-macrophage response to inflammation, which leads to the prosthesis implantation lengthening during serous inflammation and complete adaptation failure in case of phlegmonous inflammation. For the first time tissue reaction and the propylpropylene implant application for abdominal wall surgery in contact with sterile and contaminated urine were studied. Clinical and ultrasound parameters of the anatomical and functional failure of the abdominal wall were present. The first grade characteristics are abdominal deformation, moderate thinning and muscle expansion of white and semilunar abdominal lines. At the second degree deformation is stronger, and dramatic thinning of the muscles and abdominal lines leads to a complete abdominal press function loss. Absolute indication for preventive abdominal wall implant during surgery on the abdominal and retroperitoneal space is anatomical and functional failure of the second degree, and relative - the first degree in combination with other factors producing postoperative hernias.