Vol 9, No 2 (2016)

Relevance. The сholelithiasis frequency is high in Russia, many operations on bile system are carried out, however possibilities of
an ursotherapy are used not fully as there are no accurate diagnostic criteria for it.
The purpose of the research is searching for effective methods of diagnostics of a microcholelithiasis for a definition of indications
of medical tactics. The main task is practical realization of methods of an impedansometry and microscopy of bile in patients with
microcholelithiasis.
Materials and methods. Work is performed on material from 112 patients with various diseases of a bile system and 4 almost healthy
persons. The bile received at continuous fractional duodenal sounding and also the bile received by carrying out ERHPG from the
general bilious channel by its canulation was estimated. The analysis of bile was made on RGG9-01 reogastrograf; bile microscopy
was made by means of a usual and polarizing light microscope.
Results. Among all crystal structures of bile, crystals of monohydrate of cholesterol, a granule of a bilirubinat of calcium and
crystals of a carbonate of calcium have the greatest value. Corellation between types of crystals matches to components of gallstones
(microlithiasis).For various options of cholelithiasis current the impedance of bile and its coefficient of a lithogenicity of bile are
defined.
Conclusion. At a stage of increasing of a lithogenicity of bile and the appearing of biliary sludge the ursotherapy is pathogenetic
reasonable; at the emergence of bile destabilization and the emergence of crystal structures (microcholelithiasis) it is possible to put
indications to surgical treatment.
Key words: microlithiasis, impedancemetry and microscopy of bile.

Relevance It is well recognized that gastroduodenal bleedings continue to remain one of the most relevant problems of modern
emergency surgery. It is reasonable to make the best use of endoscopic hemostasis in treatment of patients with gastrointestinal
bleedings. In our opinion, local hemostatic agents as well as hydrophilic granular absorbents seem to be potentially effi cient for
endoscopic treatment of gastroduodenal hemorrhages.
Objective. The research objective is to improve outcomes of patients with gastrointestinal bleedings by means of optimization of
complex therapy and endoscopic hemostasis techniques.
Materials and methods. The study involved 107 patients with acute gastroduodenal bleedings who underwent medical treatment
at the specialized gastrointestinal center affi liated with the State-Funded Healthcare Facility «Voronezh City Clinical Emergency
Hospital #1». The treatment group (56 patients) received the experimental treatment based on optimization of local and systemic
hemostatic agents administration combined with endoscopic pneumo-insuffl ation of absorbents. The control group (51 patients)
received the treatment specifi ed by the established instructions meeting the standards accepted for gastroduodenal patients’ care.
Results and discussion. The treatment outcomes were assessed with reference to the following indices: fi nal hemostasis percentage,
recurrent bleedings rate, number of emergent operations, mortality rate.
Conclusions. The developed optimized program of treatment involving local and systemic hemostatic agents administration makes it
possible to lower the repeated hemorrhage rate from 11.9% to 7.1% (1.7 times), to reduce the number of emergent operations from
7.8% to 3.6% and to decrease postoperative mortality from 3.9% to 1.8% (2 times).
Key words: ulcerous gastrointestinal bleedings, optimization of treatment, local and systemic hemostatic agents, granular absorbents,
Diotevin, Diovin, NovoSeven, fi brinolysis inhibitors

Relevance The tactics of fluid collections management in acute pancreatitis is controversial. Evaluation of treatment results based
on unified classification criteria will allow to define more clearly the indications for various surgical procedures in these patients.
Aim. Analysis of the results of treatment of patients with fluid collections in acute pancreatitis according to the revised Atlanta
classification.
Materials and methods 109 patients with acute pancreatitis and fluid collections formation were divided according to the revised
Atlanta criteria (2012). Interstitial pancreatitis was in 7 patients, necrotizing pancreatitis – in 102. Acute peripancreatic fluid 

collections were in 5 cases, pancreatic pseudocysts – in 2. Acute necrotic collections were in 93 persons. 9 patients were admitted
with walled-off necrosis. Indications for surgery were suppuration of fluid collections, in absence of pancreatic infection – persistence
of pain, rapid growth of the volume of the collections. Comparison of the groups was performed using two-tailed Fisher's exact p, χ2
test, the level of significance of differences was ≤0.05.
Results. Conservative treatment in interstitial pancreatitis resulted in regression of fluid collections in 2 cases including pancreatic
pseudocyst, a significant reduction in the size – in 2 cases. External drainage led to resorption of peripancreatic fluid collections in 2
patients, the recurrence of the pancreatic pseudocyst happened after removal of a drainage. Conservative treatment in acute necrotic
collections resulted in their regression in 20% patients, formation of the walled-off necrosis – in 40%, suppuration or rapid growth
of the volume – in 36%, reduction in the size – in 4%. External drainage of acute necrotic collections using real time ultrasound (US)
guidance was performed in 16 patients, by means of open access – in 17. The comparison of the results of US-guided drainage and
opened procedures did not reveal significant differences in lethality (р=0.224) and regression rate (р=0.728). Walled-off necrosis
(46) was drained by open extraperitoneal access in 12 patients, by US-guidance – in 10. The regression rate was higher in open
surgery compared to US-drainage (p=0.027). Conservative treatment in 24 patients with walled-off necrosis (52%) resulted in
stabilization or decrease in size of the collection, pain and inflammation signs disappearance; of these walled-off necrosis regressed
in period of 4 months to 1 year in 8 patients.
Conclusions. Formation of fluid collections in acute pancreatitis requires continued conservative measures. Surgical treatment is
indicated in most of cases in suppuration. External US-guided drainage is preferred for acute necrotic collections. In walled-off
necrosis open extraperitoneal drainage is more effective.
Key words: acute pancreatitis, fluid collections, conservative treatment, ultrasound-guided drainage, open extraperitoneal access.

Methods: 104 patients with atherosclerotic subclavian artery stenosis received surgical treatment in the Centre of Cardiac and
Vascular Surgery of the Chelyabinsk Region Hospital from March 2007 till December 2012. 30 of them were diagnosed with a
significant ipsilateral carotid artery stenosis. Patients were divided into two groups. A simultaneous subclavian and carotid artery
surgery was performed on the first group of 29 patients. 75 patients from the second group had only an isolated subclavian artery plastic
surgery .In the first group several types of operations were performed : the subclavian carotid transposition (SCT) with concomitant
carotid endarterectomy (CEA) in 13 of cases; carotid subclavian bypass grafting (CSB) with concomitant CEA in 16 cases. 39 CSTs
and 36 CSBs were performed in the second group. Statistic analysis was performed with STATISTICA 6.0 and Microsoft Excel 5.0
Results: There were no deaths or myocardial infarction in the first group. One patient had an ipsilateral ischemic stroke (2,9%), and
another one had a contralateral ischemic stroke (2,9%). In the second group there were no strokes or deaths. In one case the myocardial
infarction occurred (2,5%) on the second day of the postoperative period. There were no significant differences between groups (P>0,05).
Conclusion: concomitant carotid and subclavian surgery is a safe, feasible and effective method of treatment and
could be recommended in such groups of patients. For patients with a significant contralateral subclavian and carotid 

stenosis the staged strategy should be chosen with performing CEA as the first step. In our opinion, the subclavian
carotid transposition is the method of choice in subclavian artery surgery with good immediate and long term results.
Key words: carotid artery, subclavian artery, carotid endarterectomy, subclavian carotid transposition, carotid subclavian bypass
grafting.

Actuality: Introduction: heavy bleeding is developed in case of spleen injury. It often leads to death. At present method of coagulation
by "nonequilibrium plasma" is developed.
Aim: study the effect of "non-equilibrium plasma" on the hemostatic system and morphofunctional state of the spleen.
Materials and Methods: The experiment was carried out on 45 male rabbits weighing 3000 - 3200 g. 1st group (control; n=5) -
intact animals without surgery; 2nd group (experimental, n=40) - animals after atypical resection of the spleen and hemostasis
by "nonequilibrium plasma". The volume of blood loss, FBC, histological data (specific volume of red and white pulp, vessels,
connective tissue, the density of the cellular infiltrate), splenogram analysis (microscopy of spleen impression smears) data were
assessed at defined periods (60 min, 3rd, 5th, 7th, 14th, 30th, 90th, 180th days) after surgery. Them were compared with data of the
control group.
Results and discussions: The volume of blood loss during the resection of the spleen with hemostasis by "nonequilibrium plasma"
was 16,6 [15,98;17,22] ml. Increase of neutrophil to 38 [24; 39] (control group 17 [13, 18], p=0,009), monocytes to 15 [14, 18]
(control group 8 [6, 11], p=0,036) is revealed in the FBC in the early period after hemostasis with nonequilibrium plasma. It is
reduced to the norm on 30 day. Histological examination revealed leukocyte infiltration, edema, microvascular stasis, dilatation of
vessels in the early period. At long-term period structure of the organ is normalized. Splenogramm analysis revealed a statistically 

significant (p = 0,023) decrease in the relative number of small lymphocytes by 28% in animals after hemostasis with nonequilibrium
plasma as compared to control (23.3 [17.9; 26.7] versus 30.8 [29.25; 34.3] in the control group).
Conclusion: treatment of bleeding surface by plasma flow for 1.5-2 min is required order to achieve effective hemostasis during
surgery of spleen injuries in the experiment. After hemostasis by "nonequilibrium plasma" there is minimal damage of the spleen
parenchyma, which manifests itself as "activation reaction" in the first minutes after exposure. At long-term period parenchyma of
the spleen completely regenerates with the formation of cicatrical tissue that does not affect the functioning of organ.
Key words: haemostasis of spleen, nonequilibrium plasma, spleen trauma, morphofunctional changes.

Chronic osteomyelitis remains one of the most difficult problems of purulent surgery, which is associated with a high frequency of
occurrence, up to 6% in the structure of the pathology of the skeletal system and 6,8-12% in the structure of septic diseases, the
development of septic complications and relapses, disability, reaching 55% of cases.
The aim of the study was to improve the results of treatment of chronic osteomyelitis by applying laser technology and aquacomplex
titanium glitserosolvata.
Materials and methods: Experimental studies conducted in 5 groups with 175 white rats with chronic osteomyelitis: 2 controls and
3 experimental. In the 1st control group consisted of untreated animals. In the 2 nd control and experimental groups underwent
surgical sanitation of purulent focus. In the 1st test group reorganization of the bone cavity was complemented by the use of lowintensity
laser irradiation. In the 2nd test group performed the introduction into the bone cavity aquacomplex titanium glitserosolwool.
In the third experimental group - treatment bone cavity laser radiation of low intensity, followed by a titanium glitserosolvata
aquacomplex it. During the execution of the work we studied the clinical, haematological, microbiological and radiological studies.
Results: Simulation of chronic osteomyelitis using the developed technique allows to 31 th day form a pathological process with
fistulas with purulent discharge, which was confirmed by clinical, microbiological and radiological examinations.
Conclusion: The developed method of complex treatment of chronic osteomyelitis, based on the combined use of laser technology
and aquacomplex titanium glitserosolvata contributed to the closure of the wound defect to 14 days; how to reset the general
condition, appetite and motor activity to the 28 days of the study; normalization of hip circumference to the injured limb 90 th day of
observation, indicators of free radical oxidation, these biochemical investigations.
Key words: Laser Technology, Aquacomplex Titanium Glitserosolvat, сhronic osteomyelitis

Plastic surgery is a versatile, very extensive surgery, includes many different areas and subspecialties interacting with the many
related areas of medicine. In 2010, Road clinical hospital at the station Voronezh-1 on the basis of the Department of surgery №2
was established Department of plastic surgery, a reconstructive surgery was done surgery aesthetic direction for correction of agerelated
and congenital and acquired anatomic changes and deformations of the body. In 2015, the Centre was established plastic
surgery who United together and gave the opportunity to maintain continuity in the provision of specialized care to patients in the
section of plastic, reconstructive and aesthetic, as well as bariatric surgery. A special focus of our work is reconstructive breast
surgery after a previous surgery for cancer of the breast. An important role in the rehabilitation process played by the continuity of
our work with cosmetologists. Plastic surgery center actively collaborates with the bariatric surgeons. Over the past 5 years, have
accumulated rich experience in operative interventions concerning morbid obesity. Good results are the experience of joint work of
the two directions of surgery and demonstrate that there is rich potential for further development.
Keywords: plastic surgery, plastic surgery center