Vol 8, No 2 (2015)
- Year: 2015
- Articles: 16
- URL: https://vestnik-surgery.com/journal/issue/view/27
Original articles
The Analysis of Influence of Chronic Diffuse Liver Pathology at the Risk of Intra- and Postoperative Complications in the Resectional Interventions on the Liver
Abstract
Relevance
Improvement of the technical aspects of performing liver resections allowed to neutralize the risk of many specific postresection complications. However, among the last until now, post-resection hepatic failure (PHF) remains a difficult problem, which on the background of diffuse changes in the liver, significantly complicates the postoperative period.
The purpose of the study To evaluate an influence of concomitant chronic diffuse liver disease on the results of resections performed for benign and malignant focal lesions of the liver.
Materials and methods To assess the impact of chronic diffuse liver process in the frequency of complications of liver resections analyzed a control group of patients (81 patients), operated in the department of surgery of the liver and biliary tract and in the department of surgery of portal hypertension and pancreatoduodenal zone during the period from 1998 to 2009. Patients were divided into a group with concomitant diffuse liver disease (chronic viral hepatitis and steatosis) - 53 patients (65.4%) and a group of 28 patients without concomitant liver pathology.
Results and their discussion Study the frequency of PHF showed that the development of severe complications in the early postoperative period is clearly correlated with the presence of diffuse liver disease. Thus, in patients without chronic liver diseasePHF occurred in 2 cases against the background of extensive liver resections, which amounted to 7.1% (2/28). In patients with hepatic pathology, the incidence of PHF of varying severity amounted to 18.9% (10/53). The overall incidence of PHF in the study group was 14.8% (12/81). On the background of extensive liver resections PHF complicated the postoperative period, more than twice as often in the presence of chronic liver disease, 28.6% versus 13.3% (8/28 vs. 2/13). At segmental resections PHF occurred only in patients with chronic pathologies in the liver and was 8.0%. The presence of concomitant chronic diffuse liver disease causes a significant decrease in functional status of hepatocytes, which represents a decline of hepatic extraction fraction at 17,1% (67,5 ± 2,3% against 81,4 ± 1,9%) and an increase in half-life of the radiopharmaceutical drop to 26 5% (37,2 ± 1,7 min vs. 29,4 ± 1,2 m) (P <0,001) relative to the group without parenchymatous processes.
Conclusion Performing of resection interventions in focal liver disease with chronic diffuse pathology of a liver increases the risk of PHF, which is associated with reduced functional reserve of hepatocytes and slowing compensatory regeneration process.
Journal of Experimental and Clinical Surgery. 2015;8(2):142-150
142-150
About Diagnostics of Obstruсtive Cholelithic Intestinal Impassability
Abstract
The purpose of the study
To study results of diagnostics obstructive gallstone intestinal obstruction.
Material and methods The analysis of 1357 case histories of patients with acute intestinal obstruction were hospitalized in clinics Ufa. Among them, 43 patients (3.2%) were the cause of intestinal obstruction gallstones, and among 18 965 patients operated on for gallstones in clinics Ufa (1973-2014gg.) Patients with obstructive gallstone ileus was 0.2%. The age of patients was 55 to 85 years, the average age of patients was 64,2 ± 5,3 years, so most of the patients were at an old age. Of these men was - 8 (18.6%) women - 35 (81.4%).
Results and their discussion The article presents results of diagnostics obstructive gallstone intestinal obstruction in 43 patients. The role of fuzzy clinical symptoms caused by advanced old patients, diagnostic errors and detailed clinical picture biliarnogoileusa bearing intermittent character. Emphasis is placed on the role of history in the diagnosis of biliary search. The authors present results of the strategic use radiological, endoscopic and ultrasonic diagnostic methods. Refined ultrasound kriteriiobturatsionnoy intestinal obstruction caused by gallstones. Biliarnogoileusa important in the diagnosis, authors say, is the detection of radiological symptom "aeroholii." It is shown that the most informative method is a diagnostic laparoscopy, wity following is the value of ultrasound imaging.
Conclusion The targeted exclusion of biliary ileus due to a balanced approach to the assessment of clinical symptoms, correct choice of algorithm instrumental studies, accumulation of facts in most cases, correct diagnosis obstructive gallstone intestinal obstruction.
Journal of Experimental and Clinical Surgery. 2015;8(2):151-157
151-157
Acute Adhesive Bowel Obstruction
Abstract
Among the causes of acute intestinal obstruction the colon obstruction takes 29-40%. Non-neoplastic colonic obstruction develops in the presence of predisposing factors, due to variations of the anatomical structure of the colon. They are - increased mobility, due to the extended mesentery, which creates conditions, predisposing to the development of bloat and strangulated intestinal obstruction. We analyzed clinical cases - patients with acute colon adhesive obstruction, operated in an emergency or delayed order. These clinical examples show that involvement of colon in adhesive process occurs over a long period of time and flows through the obstructive type, which greatly complicates the diagnosis. To prevent the development of adhesions in the abdominal cavity, the authors recommend to perform preventive measures. These methods are strongle recommended to apply in patients with peritonitis, and after surgery, accompanied by extensive damage to the leaves of the peritoneum. Selecting a method of prevention is determined by the urgent character of surgery, the duration and degree of traumatization of the peritoneum. Preventative measures can improve the outcomes of surgical treatment and reduce the incidence of early postoperative complications, reduce the cost of treating patients with adhesive disease and prevent its development.
Journal of Experimental and Clinical Surgery. 2015;8(2):158-162
158-162
The Efficiency of Daptomycin Use in Treatment of Surgical Patients with Infective Endocarditis
Abstract
Relevance This purpose of the study was to evaluate the efficacy of daptomycin therapy in surgical patients with infective endocarditis.
Materials and methods The cohort included 39 patients with active infective endocarditis. For antimicrobial treatment, daptomycin was used as monotherapy in 7 patients (group 1); 13 patients received daptomycin in combination with other antibiotics (group 2); in 19 patients other antibiotics were used (group 3). 35 patients had undergone valve surgery with CPB. The demographic, clinical, microbiological, echocardiographic and laboratory data was analyzed.
Results and their discussion In-hospital mortality in general cohort was 18.0%. in the group of patients with daptomycin monotherapy it was 14.3%; patients treated with daptomycin in combination with other antibiotics it was 23.1%; and in patients treated with other antimicrobial agents it was 15.8%. Overall surgical mortality was 14.3%. Criteria for successful treatment were identified in 28 (71.8%) patients: in 6 (85.7%) patients in group 1; in 9 (69.2%) patients in group 2, and in 13 (68.4%) in group 3. The analysis of the laboratory data has shown that preoperative patients in Groups 1 and 2 had more pronounced multiple organ failure in comparison with patients from group 3. In postoperative period, no differences in severity of multiple organ failure markers in groups was determined.
Conclusion The use of daptomycin in perioperative treatment of patients with infective endocarditis was characterized by a high percentage of positive effect of treatment results. In surgical patients with infective endocarditis, complicated by severe multi-organ failure, the use of daptomycin is expedient and leads to the normalization of laboratory parameters.
Materials and methods The cohort included 39 patients with active infective endocarditis. For antimicrobial treatment, daptomycin was used as monotherapy in 7 patients (group 1); 13 patients received daptomycin in combination with other antibiotics (group 2); in 19 patients other antibiotics were used (group 3). 35 patients had undergone valve surgery with CPB. The demographic, clinical, microbiological, echocardiographic and laboratory data was analyzed.
Results and their discussion In-hospital mortality in general cohort was 18.0%. in the group of patients with daptomycin monotherapy it was 14.3%; patients treated with daptomycin in combination with other antibiotics it was 23.1%; and in patients treated with other antimicrobial agents it was 15.8%. Overall surgical mortality was 14.3%. Criteria for successful treatment were identified in 28 (71.8%) patients: in 6 (85.7%) patients in group 1; in 9 (69.2%) patients in group 2, and in 13 (68.4%) in group 3. The analysis of the laboratory data has shown that preoperative patients in Groups 1 and 2 had more pronounced multiple organ failure in comparison with patients from group 3. In postoperative period, no differences in severity of multiple organ failure markers in groups was determined.
Conclusion The use of daptomycin in perioperative treatment of patients with infective endocarditis was characterized by a high percentage of positive effect of treatment results. In surgical patients with infective endocarditis, complicated by severe multi-organ failure, the use of daptomycin is expedient and leads to the normalization of laboratory parameters.
Journal of Experimental and Clinical Surgery. 2015;8(2):163-171
163-171
Imaging Popliteal Artery Aneurysms
Abstract
Relevance Popliteal artery aneurysm is seldom, but very dangerous disease with serious complications. These are the most common peripheral artery aneurysms (80%). Frequency of this disease range between 0.02 – 1%.
The purpose of the study To evaluate the sensitivity of ultrasound, angiography, ankle-brachial index (ABI) in diagnostic of aneurysms and complications.
Materials and methods The 62 patients were included in research work. We have been done 41 ultrasound, 34 angiography, 20 ABI.
Results and their discussion The sensitivity of duplex ultrasound is 97,5% in diagnostic of popliteal artery aneurysms. The angiography has sensitivity about 47%. ABI is useless.
Conclusion Color Doppler Ultrasound is the best method for imaging of popliteal artery aneurysms and complications, non-invasive diagnostic method, hasn’t contraindication. ABI unnecessary. Arteriography in diagnostic of thrombosis of popliteal artery aneurysm aninformative for imagine aneurism, but useful for characterization peripheral artery (autflow).
The purpose of the study To evaluate the sensitivity of ultrasound, angiography, ankle-brachial index (ABI) in diagnostic of aneurysms and complications.
Materials and methods The 62 patients were included in research work. We have been done 41 ultrasound, 34 angiography, 20 ABI.
Results and their discussion The sensitivity of duplex ultrasound is 97,5% in diagnostic of popliteal artery aneurysms. The angiography has sensitivity about 47%. ABI is useless.
Conclusion Color Doppler Ultrasound is the best method for imaging of popliteal artery aneurysms and complications, non-invasive diagnostic method, hasn’t contraindication. ABI unnecessary. Arteriography in diagnostic of thrombosis of popliteal artery aneurysm aninformative for imagine aneurism, but useful for characterization peripheral artery (autflow).
Journal of Experimental and Clinical Surgery. 2015;8(2):172-175
172-175
Postmortem Tissue Analysis of Opisthorchiasis Papillitis
Abstract
The purpose of the study The research is aimed at examining histologic and morphometric aspects of the major duodenal papilla which has opisthorchiasis invasion.
Materials and methods The research uses cadaveric material taken in the department of morbid anatomy of Surgut regional clinical hospital. All the cases which were included in the study (98 dead patients) had the direct evidence of infection with opisthorchiasis according to post-mortem examination together with information about the length of opisthorchiasis invasion during the life of the patients. The control group included 30 dead patients without the pathology of hepatobiliary tract. The study showed that the opisthorchiasis invasion brings about successive changes in papilla tissues which can be divided into three stages according to morphological criteria - the adenomatous stage, the adenofibrous stage and the sclerotic stage (the names reflect the nature of changes). The analysis of the material was carried out using statistical approach.
Results and their discussion Morphological research with sufficient evidence demonstrated specific changes which take place in the tissues of the major duodenal papilla at different stages of papillitis. It also determined that the luminal diameter of papilla is the indicator of these changes.
Conclusion The general tendency of changes in the major duodenal papilla brought about by opesthorchiasis can be described as progressive degradation of morphological structures that constitute the tissue of the major duodenal papilla, which results in functional failure of the given anatomical structure.
Materials and methods The research uses cadaveric material taken in the department of morbid anatomy of Surgut regional clinical hospital. All the cases which were included in the study (98 dead patients) had the direct evidence of infection with opisthorchiasis according to post-mortem examination together with information about the length of opisthorchiasis invasion during the life of the patients. The control group included 30 dead patients without the pathology of hepatobiliary tract. The study showed that the opisthorchiasis invasion brings about successive changes in papilla tissues which can be divided into three stages according to morphological criteria - the adenomatous stage, the adenofibrous stage and the sclerotic stage (the names reflect the nature of changes). The analysis of the material was carried out using statistical approach.
Results and their discussion Morphological research with sufficient evidence demonstrated specific changes which take place in the tissues of the major duodenal papilla at different stages of papillitis. It also determined that the luminal diameter of papilla is the indicator of these changes.
Conclusion The general tendency of changes in the major duodenal papilla brought about by opesthorchiasis can be described as progressive degradation of morphological structures that constitute the tissue of the major duodenal papilla, which results in functional failure of the given anatomical structure.
Journal of Experimental and Clinical Surgery. 2015;8(2):176-185
176-185
Competitive Efficiency of Local Application Hemostatic Agents in Experimental Parenchymatous and Arterial Bleeding Control
Abstract
Relevance Bleeding control in case of injury and surgery on parenchymatous organs and blood vessels is a serious challenge for surgery. Use of local application hemostatic agents is an innovative solution. Such agents are represented in Russia by foreign producers and Russian developments, but comparative evaluation of their efficiency is poorly known, that makes such research highly relevant.
The purpose of the study To compare efficiency of the Russian application hemostatic agent «Hemoflex® Pro» with foreign analogues on the models of parenchymatous and arterial bleeding.
Materials and methods Comparative efficiency analysis of hemostatic agent «Hemoflex® Pro» (LLC Inmed, RF) and agents «Surgicel® Nu-knit» (Johnson & Johnson, USA), «TachoComb®» (Nycomed Austria GmbH, Austria), «CeloxТМ Gauze Hemostat» (MedTrade Products Ltd, Great Britain) was carried out on the model of experimental parenchymatous and arterial bleeding of rats.
Results and their discussion Conducted comparative analysis of hemostatic agents in experiment on animals shows close time values of bleeding and blood loss of Russian and foreign application hemostatic agents by simulation of experimental parenchymatous bleeding. The agent «Hemoflex® Pro» showed better hemostatic effect by simulation of experimental arterial bleeding from a wound in aorta abdominal region. It also proved bactericidal action of «Hemoflex® Pro», its rapid bio degradation, lack of influence on formation of adhesive process in case of its use in abdominal region.
Conclusion Research marked similar hemostatic effect comparing action of «Hemoflex® Pro» with hemostatic agents «Surgicel® Nu-knit», «TachoComb®» and «CeloxТМ Gauze Hemostat». Moreover it registered bactericidal action of hemostatic agent «Hemoflex® Pro» against E.coli, S.aureus, S.pyogenes, C.albicans, Myc. smegmatis.
The purpose of the study To compare efficiency of the Russian application hemostatic agent «Hemoflex® Pro» with foreign analogues on the models of parenchymatous and arterial bleeding.
Materials and methods Comparative efficiency analysis of hemostatic agent «Hemoflex® Pro» (LLC Inmed, RF) and agents «Surgicel® Nu-knit» (Johnson & Johnson, USA), «TachoComb®» (Nycomed Austria GmbH, Austria), «CeloxТМ Gauze Hemostat» (MedTrade Products Ltd, Great Britain) was carried out on the model of experimental parenchymatous and arterial bleeding of rats.
Results and their discussion Conducted comparative analysis of hemostatic agents in experiment on animals shows close time values of bleeding and blood loss of Russian and foreign application hemostatic agents by simulation of experimental parenchymatous bleeding. The agent «Hemoflex® Pro» showed better hemostatic effect by simulation of experimental arterial bleeding from a wound in aorta abdominal region. It also proved bactericidal action of «Hemoflex® Pro», its rapid bio degradation, lack of influence on formation of adhesive process in case of its use in abdominal region.
Conclusion Research marked similar hemostatic effect comparing action of «Hemoflex® Pro» with hemostatic agents «Surgicel® Nu-knit», «TachoComb®» and «CeloxТМ Gauze Hemostat». Moreover it registered bactericidal action of hemostatic agent «Hemoflex® Pro» against E.coli, S.aureus, S.pyogenes, C.albicans, Myc. smegmatis.
Journal of Experimental and Clinical Surgery. 2015;8(2):186-194
186-194
Long-Term Results of Using of "Cold Plasma" Coagulation in Comparison with Suturing of the Liver
Abstract
Relevance According to statistics, liver injuries occur with a frequency of 15-29,9% of the cases in peacetime. Postoperative mortality ranges from 4-10% to 39.3%. Quick hemostasis of hepatic vessels is a primary task for the surgeon in any kind of surgery. Innovative method of stopping the bleeding of liver is the use of "non-equilibrium plasma" (a synonym for "cold plasma").
The purpose of the study To make a comparative analysis of morphofunctional changes of liver in long-term period after atypical resection of liver and hemostasis by suturing and cold plasma.
Materials and methods Research was performed on 25 laboratory rats. There are 3 experimental groups: 5 intact animals (control group) and 5 animals in each group after liver resection and suturing and liver resection and cold plasma coagulation. Material for research was taken on the 90th and 180th day after surgery. Surgery is resection of liver left lobe, suturing or cold plasma coagulation. The biochemical control (glucose, ALT, AST, thymol test, total bilirubin, direct bilirubin, alkaline phosphatase, total protein, urea, α-amylase, CRP, fibrinogen, aPTT, PTT, INR), morphological study of rat liver were performed.
Results and their discussion Analysis of biochemical markers reveals a slight fluctuation of total protein and glucose in experimental groups relatively the control group. The most significant tendency is observed in plasma group. Analysis of morphological markers reveals, that full restoration of the liver structure is observed in plasma group on the 180th day. In suturing group destructive changes remain. This indicates that pathological effects caused by the suturing were considerably higher than the effects produced by the action of cold plasma.
Conclusion Cold plasma hemostasis leads to fast bleeding control. In this case reparation of morphological picture of the liver and restoration of the internal blood flow occur on 180-th day. Suturing of liver parenchyma leads to dystrophic and necrotic changes of hepatocytes, as well as morphological signs of microvascular thrombosis and perivascular fibrosis that remain up to 180-th day.
The purpose of the study To make a comparative analysis of morphofunctional changes of liver in long-term period after atypical resection of liver and hemostasis by suturing and cold plasma.
Materials and methods Research was performed on 25 laboratory rats. There are 3 experimental groups: 5 intact animals (control group) and 5 animals in each group after liver resection and suturing and liver resection and cold plasma coagulation. Material for research was taken on the 90th and 180th day after surgery. Surgery is resection of liver left lobe, suturing or cold plasma coagulation. The biochemical control (glucose, ALT, AST, thymol test, total bilirubin, direct bilirubin, alkaline phosphatase, total protein, urea, α-amylase, CRP, fibrinogen, aPTT, PTT, INR), morphological study of rat liver were performed.
Results and their discussion Analysis of biochemical markers reveals a slight fluctuation of total protein and glucose in experimental groups relatively the control group. The most significant tendency is observed in plasma group. Analysis of morphological markers reveals, that full restoration of the liver structure is observed in plasma group on the 180th day. In suturing group destructive changes remain. This indicates that pathological effects caused by the suturing were considerably higher than the effects produced by the action of cold plasma.
Conclusion Cold plasma hemostasis leads to fast bleeding control. In this case reparation of morphological picture of the liver and restoration of the internal blood flow occur on 180-th day. Suturing of liver parenchyma leads to dystrophic and necrotic changes of hepatocytes, as well as morphological signs of microvascular thrombosis and perivascular fibrosis that remain up to 180-th day.
Journal of Experimental and Clinical Surgery. 2015;8(2):195-205
195-205
The Possible Ways of Adhesions Prophylaxis in Prosthetic Repair of Abdominal Wall (Experimental Study)
Abstract
Relevance The treatment of patients with incisional hernias of abdominal wall is an actual question of surgery. The introduction of prosthetic repair improved outcomes of incisional hernia treatment and provided good life quality of operated patients. The unsolved problem is the prevention and treatment of complications associated with adhesions in the area of implantation of synthetic prosthesis. Are important works in which were studied the possibility of antiadhesive compositions based on hyaluronic acid.
The purpose of the study Is the study of possibilities of pharmacological compositions based on hyaluronic acid as a means of adhesions prevention in intraperitoneal prosthetic repair of abdominal wall.
Materials and methods In rabbits were implanted polypropylene (PP Std), light polypropylene (PP Light), polyvinylidenfluoride (PVDF) meshes by open IPOM technique. In basic group was used the composition based on hyaluronic acid. In control group the animals were operated without antiadhesive means. The implantation area was analyzed in 30 days.
Results and thier discussion In the control group, each of the implanted material developed an adhesive process. In some cases were observed strong adhesions. Ability endoprosthesis lead to the adhesions formation in the abdominal cavity was maximal in PP Std, medium in PP Light and minimum in PVDF series (non-significant). In the basic group adhesions were significantly low compared to the control. The observed differences were significant when comparing the groups and by comparing the results of implantation of each material separately. The most significant difference between the groups was observed in PP Std series. The most favorable results were noted in PVDF series of basic group.
Conclusion The antiadhesive impact of composition based on hyaluronic acid is confirmed in our experimental study. This effect dependent on the material of mesh. The morphological features of reparative process after prosthetic repair with use of composition based on hyaluronic acid should be studied.
The purpose of the study Is the study of possibilities of pharmacological compositions based on hyaluronic acid as a means of adhesions prevention in intraperitoneal prosthetic repair of abdominal wall.
Materials and methods In rabbits were implanted polypropylene (PP Std), light polypropylene (PP Light), polyvinylidenfluoride (PVDF) meshes by open IPOM technique. In basic group was used the composition based on hyaluronic acid. In control group the animals were operated without antiadhesive means. The implantation area was analyzed in 30 days.
Results and thier discussion In the control group, each of the implanted material developed an adhesive process. In some cases were observed strong adhesions. Ability endoprosthesis lead to the adhesions formation in the abdominal cavity was maximal in PP Std, medium in PP Light and minimum in PVDF series (non-significant). In the basic group adhesions were significantly low compared to the control. The observed differences were significant when comparing the groups and by comparing the results of implantation of each material separately. The most significant difference between the groups was observed in PP Std series. The most favorable results were noted in PVDF series of basic group.
Conclusion The antiadhesive impact of composition based on hyaluronic acid is confirmed in our experimental study. This effect dependent on the material of mesh. The morphological features of reparative process after prosthetic repair with use of composition based on hyaluronic acid should be studied.
Journal of Experimental and Clinical Surgery. 2015;8(2):206-213
206-213
Experience of Rehabilitation Program Using a Device Amp-01 in Treatment of Suppurative Lactation Mastitis
Abstract
Relevance The treatment of suppurative lactation mastitis remains urgent surgical problem. Despite significant advances of modern medicine in the treatment and prevention of surgical infections, mastitis is one of the first places in the structure of postpartum purulent-inflammatory complications, making towards them to 26-67% of cases. Until recently, it remained the most common traditional method of surgery at a mastitis, comprising the wide opening purulent focus one or more radial slits without a radical excision of nonviable tissue. Application of active surgical treatment purulent diseases has improved the results of treatment in this complex surgical pathology. However, its implementation in practical surgery is complicated because absence or imperfection of special technical means for active drainage, which leads to poor-quality sanitation purulent cavity and lengthens treatment time.
The purpose of the study Analysis of immediate and long-term results treatment of suppurative lactation mastitis using a device AMP-01.
Results and their discussion The use of active surgical method for the treatment of patients with GLM (main group, the comparison group 2) have led to a significant reduction in the duration of treatment and get good functional and cosmetic results compared to the comparison group 1 (the traditional method). A comparative study of treatment results in the study group research using the method of rehabilitation program using the device AMP-01 in the comparison group 2 with flow-suction method there are some differences. The use of primary suture in combination with active aspiration of wound and in the creation of a permanent purulent cavity vacuum of 80-100 mm of water. Art. It provides better sanitation of purulent focus and leads to the blocking of its walls and speed up recovery. Therefore, the results of treatment in the study group were slightly better for all the assessment criteria immediate and long-term results compared with a comparison group 2.
Conclusion Application of the rehabilitation program using the device AMP-01 in treatment patients with GLM allows significantly accelerate clearance of the wounds from necrotic tissues, microbial bodies, stimulates regeneration processes, all of which helps to reduce the treatment durstion and getting good immediate and long-term clinical results. Method rehabilitation program using the device AMP-01 had advantages over other methods of active surgical treatment for all the assessment criteria of immediate and late treatment results.
The purpose of the study Analysis of immediate and long-term results treatment of suppurative lactation mastitis using a device AMP-01.
Results and their discussion The use of active surgical method for the treatment of patients with GLM (main group, the comparison group 2) have led to a significant reduction in the duration of treatment and get good functional and cosmetic results compared to the comparison group 1 (the traditional method). A comparative study of treatment results in the study group research using the method of rehabilitation program using the device AMP-01 in the comparison group 2 with flow-suction method there are some differences. The use of primary suture in combination with active aspiration of wound and in the creation of a permanent purulent cavity vacuum of 80-100 mm of water. Art. It provides better sanitation of purulent focus and leads to the blocking of its walls and speed up recovery. Therefore, the results of treatment in the study group were slightly better for all the assessment criteria immediate and long-term results compared with a comparison group 2.
Conclusion Application of the rehabilitation program using the device AMP-01 in treatment patients with GLM allows significantly accelerate clearance of the wounds from necrotic tissues, microbial bodies, stimulates regeneration processes, all of which helps to reduce the treatment durstion and getting good immediate and long-term clinical results. Method rehabilitation program using the device AMP-01 had advantages over other methods of active surgical treatment for all the assessment criteria of immediate and late treatment results.
Journal of Experimental and Clinical Surgery. 2015;8(2):214-221
214-221
Comparative Study of the Antibacterial Activity of Honey Foreign Drugs for the Treatment of Wound Infections and Domestic Native Honey
Abstract
Relevance Increase in the number of multi-drug resistant surgical infections makes us look new evidence in relation to the known natural resources. Honey has the necessary set of properties makes it an antibacterial substance.
The purpose of the study To compare the antibacterial activity of honey products and native honey in relation to the collection of strains with extreme phenotypes of resistance to antimicrobial agents derived from surgical hospitals in Russia.
Materials and methods Investigated the antimicrobial activity of 2 honey samples recommended for clinical use in European countries and 4 samples of honey from different regions of Russia in relation to the 95 extremely resistant strains of bacteria with known mechanisms of resistance.
Results and their discussion Samples of native domestic honey were more effective against various types of microorganisms than manuka honey. Antibacterial activity is not dependent on the mechanism of resistance.
Conclusion Honey from Smolensk could become the basis for creating new effective antibacterial agent for topical treatment of wound infections caused by multidrug-resistant strains.
The purpose of the study To compare the antibacterial activity of honey products and native honey in relation to the collection of strains with extreme phenotypes of resistance to antimicrobial agents derived from surgical hospitals in Russia.
Materials and methods Investigated the antimicrobial activity of 2 honey samples recommended for clinical use in European countries and 4 samples of honey from different regions of Russia in relation to the 95 extremely resistant strains of bacteria with known mechanisms of resistance.
Results and their discussion Samples of native domestic honey were more effective against various types of microorganisms than manuka honey. Antibacterial activity is not dependent on the mechanism of resistance.
Conclusion Honey from Smolensk could become the basis for creating new effective antibacterial agent for topical treatment of wound infections caused by multidrug-resistant strains.
Journal of Experimental and Clinical Surgery. 2015;8(2):222-228
222-228
Mechanism for the Occurrence of Traumatic Instability in Distal Radioulnar Joint in Children
Abstract
Relevance Instability at the level of the distal radioulnar joint in children is considered a rare disease, and poor treatment outcomes achieved 20% or more. Thus there is no data that is a trigger mechanism which leads to instability in the distal radioulnar joint in children, and what types of bias forearm give rise to instability at the distal radioulnar joint.
The purpose of the study Clarify the mechanism of injury in fractures of the forearm bones in children leading to instability at the level of the distal radioulnar joint.
Materials and methods The study authors examined in patients with unstable distal radioulnar joint that has arisen as a result of fracture of forearm and subluxation of the head of the ulna - 29 patients of them 10 patients had chronic type of damage.
Results and their discussion The paper presents the mechanism of instability at the level of the distal radioulnar joint in fractures of the forearm bones in children, which is viewed from the perspective of a closed biomechanical system: consisting of the wrist, forearm, elbow joint anatomical and stabilizing elements. Details describes biasing mechanism of the bone fragments at the fracture, which occurs in three planes: axial, sagittal, frontal - angular and horizontal - rotational. Rotary displacement occurs on two paths: a path of the ulna and radius own trajectory, as the latter has isolated mobility, causing damage occurs and stabilizing the forearm, so the set of anatomical damage leads to destabilization of the elements at the distal radioulnar joint.
Conclusion Children pathogenesis of traumatic instability in the distal radioulnar joint defines a fracture of the forearm bones which results in an angular, axial and rotational displacement of bone fragments at a fracture
The purpose of the study Clarify the mechanism of injury in fractures of the forearm bones in children leading to instability at the level of the distal radioulnar joint.
Materials and methods The study authors examined in patients with unstable distal radioulnar joint that has arisen as a result of fracture of forearm and subluxation of the head of the ulna - 29 patients of them 10 patients had chronic type of damage.
Results and their discussion The paper presents the mechanism of instability at the level of the distal radioulnar joint in fractures of the forearm bones in children, which is viewed from the perspective of a closed biomechanical system: consisting of the wrist, forearm, elbow joint anatomical and stabilizing elements. Details describes biasing mechanism of the bone fragments at the fracture, which occurs in three planes: axial, sagittal, frontal - angular and horizontal - rotational. Rotary displacement occurs on two paths: a path of the ulna and radius own trajectory, as the latter has isolated mobility, causing damage occurs and stabilizing the forearm, so the set of anatomical damage leads to destabilization of the elements at the distal radioulnar joint.
Conclusion Children pathogenesis of traumatic instability in the distal radioulnar joint defines a fracture of the forearm bones which results in an angular, axial and rotational displacement of bone fragments at a fracture
Journal of Experimental and Clinical Surgery. 2015;8(2):229-234
229-234
Experimental Normothermic and Hyperthermic Intraperitoneal Perfusion Chemotherapy of Advanced Ovarian Cancer
Abstract
Relevance The search and development of effective regimens of normothermic and hyperthermic intraperitoneal chemoperfusion (IPEC and HIPEC) in experiment will allow implementing the technology into clinical practice to treat patients with advanced ovarian cancer and therefore increase their survival.
The purpose of the study The development of preclinical model of normo- and hyperthermic chemoperfusion treatment of advanced ovarian cancer and assessment of efficiency of alkylating cytostatics at their intraperitoneal chemoperfusion administration.
Materials and methods The study was carried out in 295 Vistar female rats with ovarian cancer which was inoculated intraperitoneally. IPEC and HIPEC were performed with antitumor drugs cisplatin and dioxadet in maximum tolerated doses (MTD) which were 5−20 times higher than those for the standard intraperitoneal administration of the drugs. Antitumor effects of the treatment were estimated in increase of median survival time (MST).
Results and their discussion Hyperthermic intraperitoneal perfusion (HIPEP) with saline solution showed significant antitumor activity comparable to effects of intraperitoneal administration of cisplatin and dioxadet. HIPEC with the drugs resulted in larger number of side effects compared to IPEC. Potentiation of antitumor effect of dioxadet and hyperthermia was achieved for HIPEC with dioxadet, where increase in MST of rats was the greatest among all experimental groups – 444% compared to the control group (p=0.038).
Conclusion The developed experimental technology of IPEC and HIPEC is recommended for testing of different cytostatic drugs and new methods of intraperitoneal chemoperfusion treatment of malignancies affecting peritoneum.
The purpose of the study The development of preclinical model of normo- and hyperthermic chemoperfusion treatment of advanced ovarian cancer and assessment of efficiency of alkylating cytostatics at their intraperitoneal chemoperfusion administration.
Materials and methods The study was carried out in 295 Vistar female rats with ovarian cancer which was inoculated intraperitoneally. IPEC and HIPEC were performed with antitumor drugs cisplatin and dioxadet in maximum tolerated doses (MTD) which were 5−20 times higher than those for the standard intraperitoneal administration of the drugs. Antitumor effects of the treatment were estimated in increase of median survival time (MST).
Results and their discussion Hyperthermic intraperitoneal perfusion (HIPEP) with saline solution showed significant antitumor activity comparable to effects of intraperitoneal administration of cisplatin and dioxadet. HIPEC with the drugs resulted in larger number of side effects compared to IPEC. Potentiation of antitumor effect of dioxadet and hyperthermia was achieved for HIPEC with dioxadet, where increase in MST of rats was the greatest among all experimental groups – 444% compared to the control group (p=0.038).
Conclusion The developed experimental technology of IPEC and HIPEC is recommended for testing of different cytostatic drugs and new methods of intraperitoneal chemoperfusion treatment of malignancies affecting peritoneum.
Journal of Experimental and Clinical Surgery. 2015;8(2):235-242
235-242
Assessment of Qualification of Surgeons when Carrying Out Recovery Operations at Patients after Obstructive Resections of a Colon and Rectum
Abstract
Relevance Reconstructive operation after obstructive colon resection is complex and high risk of complication and mortality. Appropriate to carry out such operation in specialized department
The purpose of study Analyze results of treatment colostomy patients by different surgeon in specialized center. Determine their rating on the basis of operational activity and results of treatment.
Materials and methods Reconstructive operations after obstructive colon resection were studied in 161 patients. 134 operations were performed by 3 surgeons (category A, B, C) and 27 operations were performed by 9 surgeons (category D).
The treatment outcome was defined on the basis of study intraabdominal complications, excluded somatic and infectious aftereffects. Applying the formula calculation with considering quantity and difficulty reconstructive operation.
Results and their discussion The high rating of category A,B,C group of surgeon is 19-83 point. They specialized on reconstructive surgery of colon and performed from 30 to 47 operation. The leading specialist has many complication and most high rating, because of quantity and difficulty operations. Low rating of group D surgeons (13 points) due to the high level of complications and rare operating.
Conclusion Rating surgeons depends on number, difficulty of operations, and quantity of intraabdominal complications. Method of calculation rating objectively shows experience and results of surgeons. With the same qualification (experience, qualification category, scholastic degree), the better result among doctors, that specialized on reconstructive surgery.
The purpose of study Analyze results of treatment colostomy patients by different surgeon in specialized center. Determine their rating on the basis of operational activity and results of treatment.
Materials and methods Reconstructive operations after obstructive colon resection were studied in 161 patients. 134 operations were performed by 3 surgeons (category A, B, C) and 27 operations were performed by 9 surgeons (category D).
The treatment outcome was defined on the basis of study intraabdominal complications, excluded somatic and infectious aftereffects. Applying the formula calculation with considering quantity and difficulty reconstructive operation.
Results and their discussion The high rating of category A,B,C group of surgeon is 19-83 point. They specialized on reconstructive surgery of colon and performed from 30 to 47 operation. The leading specialist has many complication and most high rating, because of quantity and difficulty operations. Low rating of group D surgeons (13 points) due to the high level of complications and rare operating.
Conclusion Rating surgeons depends on number, difficulty of operations, and quantity of intraabdominal complications. Method of calculation rating objectively shows experience and results of surgeons. With the same qualification (experience, qualification category, scholastic degree), the better result among doctors, that specialized on reconstructive surgery.
Journal of Experimental and Clinical Surgery. 2015;8(2):243-247
243-247
Prevalence of Venous Trophic Ulcers of the Lower Extremities at Inhabitants of the Voronezh Region
Abstract
Relevance Various forms of chronic venous insufficiency about 35 million Russians suffer. In the absence of treatment the probability of emergence of trophic ulcers in the distalnykh departments of the bottom extremities reaches 60-90%. In economically developed countries of the world of 2% of adult population have venous trophic ulcers of the bottom extremities. Treatment of trophic ulcers of the bottom extremities because of big prevalence, low tendency to healing, difficulty and high cost of treatment is the complex problem having important social value.
The purpose of the study Study prevalence of chronic venous insufficiency in the Voronezh region, to define quantity of the complicated forms of an illness (in the form of trophic ulcers of the bottom extremities).
Materials and methods Venous Trophic Ulcers methods it was studied on the basis of data of reception of patients by specialists of regional advisory policlinic, surgical activity of offices of the Voronezh regional clinical hospital No. 1, annual reports of the chief regional surgeons of the Voronezh region for 2011-2013.
Results and their discussion The disease meets less than at 1% (on average 0,25%) adult population of the city of Voronezh and the Voronezh region. Thus overwhelming number of patients from this number already have trophic ulcers. Around the world various forms of a varicose illness of veins of the lower extremities meet at 10 — 38% of the working-age population. Simple extrapolation of results of the international epidemiological researches suggests that the data obtained by us are strongly underestimated and the real picture of incidence is unknown.
Conclusion At the heart of prevention of development of venous trophic ulcers correction of chronic venous insufficiency lies. In the Voronezh region now the system of early identification of a varicose illness works insufficiently effectively. As a result of absence of information patients don't take measures on prevention of development of venous trophic ulcers. The main loading on early identification of symptoms of a disease, risk factors, formation of groups for dynamic supervision, to carrying out diagnostic, treatment-and-prophylactic actions has to lay down on surgeons of an out-patient and polyclinic link, family doctors, therapists, gynecologists of female consultations.
The purpose of the study Study prevalence of chronic venous insufficiency in the Voronezh region, to define quantity of the complicated forms of an illness (in the form of trophic ulcers of the bottom extremities).
Materials and methods Venous Trophic Ulcers methods it was studied on the basis of data of reception of patients by specialists of regional advisory policlinic, surgical activity of offices of the Voronezh regional clinical hospital No. 1, annual reports of the chief regional surgeons of the Voronezh region for 2011-2013.
Results and their discussion The disease meets less than at 1% (on average 0,25%) adult population of the city of Voronezh and the Voronezh region. Thus overwhelming number of patients from this number already have trophic ulcers. Around the world various forms of a varicose illness of veins of the lower extremities meet at 10 — 38% of the working-age population. Simple extrapolation of results of the international epidemiological researches suggests that the data obtained by us are strongly underestimated and the real picture of incidence is unknown.
Conclusion At the heart of prevention of development of venous trophic ulcers correction of chronic venous insufficiency lies. In the Voronezh region now the system of early identification of a varicose illness works insufficiently effectively. As a result of absence of information patients don't take measures on prevention of development of venous trophic ulcers. The main loading on early identification of symptoms of a disease, risk factors, formation of groups for dynamic supervision, to carrying out diagnostic, treatment-and-prophylactic actions has to lay down on surgeons of an out-patient and polyclinic link, family doctors, therapists, gynecologists of female consultations.
Journal of Experimental and Clinical Surgery. 2015;8(2):248-251
248-251
252-254