Vol 9, No 3 (2016)
- Year: 2016
- Articles: 13
- URL: https://vestnik-surgery.com/journal/issue/view/35
Original articles
Functional Condition of the Stomach and The Small Bowel after pancreatic resection
Abstract
Relevance. To date, there is no unified approach in selection of the most physiological way to reconstruction phase of operations.
The main methods of the stomach motility and small intestine study to date are X-ray examination of the gastrointestinal tract with
barium suspension, respiratory function tests and wireless electronic systems.
Purpose of the study. Determination of the most physiological methods to the formation of anastomoses in the performance of
radical surgery in patients with neoplastic lesions of the pancreatic head based on an assessment of the functional state of the
stomach and small intestine.
Materials and methods. In a specialized department of the liver and pancreas surgery clinical hospital named after S.P. Botkin
and separation methods radionucleide diagnostics of the clinical hospital №1 named after N.I. Pirogov a prospective clinical
study of the functional state of stomach and small intestine in patients with neoplastic lesions of pancreatic head, who had medical
conditions for radical surgery, was conducted. Patients were divided into two groups. In the first subgroup of 19 patients was
performed pancreaticoduodenal resection with antrum-resection in Child modification was performed, and in second subgroup 18
patients had pelorosaurus pancreatoduodenal resection – surgery Traverso-Longmire. To study the motor-evacuation function of
the stomach, small intestine, and the functioning of the hepatobiliary system simultaneous intravenous and oral administration of
two radiopharmaceuticals – technephyte and bromezid with the subsequent registration on a two detector gamma-camera were
used. Assessment of biliary-enteric anastomoses were carried out using intravenously administered drug bromezid containing
120 megabecquerel (MBk) isotope of technetium TC-99m, and for the evaluation of the gastroenteroanastomosis 10% semolina,
labeled TC-99m by technetium, with a dose of 40 MBk TC-99m, was used. The study of the movement of labelled compounds by
biliary tract and gastrointestinal tract was recorded in the computer memory for 120 minutes.
Results and their discussion. In the group of patients after radical surgery at the preoperative stage the study of motorevacuation
function of the upper gastrointestinal tract was made for all patients. 21 patients had a slight slowing of passage of the
radiopharmaceutical from the stomach (up to 50 min.), 6 had half-life period more than 80 minutes, at a rate of T1/2 of 30 min,
which testified to the violation of food evacuation from the stomach. 10 patients had no revealed pathology.
Second study revealed slow excretion of the radiopharmaceutical from the stomach in all patients. In first subgroup the half-life of
the radiopharmaceutical from the stomach during the second study was 126.7 min±89 min, significantly exceeding the norm (T1/2
= 30 min). That slowing of evacuation was caused mainly not by a decrease of gastric motility, but by entero-gastric reflux, mostly
marked from 90 minutes of study. During the third injection of the radiopharmaceutical T1/2 of the stomach amounted to 75.3 per
min±17 min.
Patients of the second subgroup who was made PPDR had the following indicators of half-life of the radiopharmaceutical from the
stomach: during the second procedure - 118,8±44 min., during third - 46,2±8 min.
Conclusion. Application of radionucleid method in patients with neoplastic lesions of the pancreatic head allows not only
early and comprehensive diagnosis of motor-evacuation activity of the stomach, small intestine and bile ducts, but also more
physiological planning of one or another surgery way.
Practical application of presented diagnostic techniques shows objective data availability in patients undergoing PGDR "false"
gastrostasis by entero-gastric reflux, and in patients undergoing PPDR - "true" gastrostasis caused by anastomositis or violation of
innervation wall outlet of the stomach after its mobilization.
Keywords: Neoplastic lesions of the pancreas head, radical surgery, gastroenteroanastomosis, biliodigestive anastomosis,
pancreaticoduodenectomy resection.
176-181
VARIANT ANATOMY OF THE INTERCOSTAL NERVES IN UMBILICAL REGION OF ANTERIOR ABDOMINAL WALL
Abstract
Purpose. To study features of topography intercostal nerves in umbilical region of the anterior abdominal wall.
Materials and methods. There were studied 88 floating corpses of both sexes without pathology of the anterior abdominal wall. Among them there were 45% of corpses of males (mean age – 53,8±11,9 years) and 55% – females (51,9±13,2 years). On each corpse was performed topographic anatomical dissection of the intercostal nerves in umbilical region of the anterior abdominal wall with determination level of penetration of the rectus abdominis with relatively to the bone of the bottom edge of the costal arch and the outer edge of the rectus abdominal muscle.
Results. In this study, in umbilical region of the anterior abdominal wall were identified from 1 to 4 pairs of intercostal nerves. At females it was significantly more frequent 2 pairs of intercostal nerves (71%), whereas at males statistically significant differences were no found. Intercostal nerves penetrated the rectus abdominis often through their outer edges (52%), more rarely – by their rear surface (39%). At males were significantly more common variant of the lateral penetration of the intercostal nerves in the rectus abdominis (60%), while the females are statistically significant differences were no found. To reduce the risk of intraoperative traumatization of intercostal nerves were determined the levels of their penetration into the depth of the rectus abdominis muscle. It is found that the distance from the bottom edge of the costal arch to the point of penetration of the intercostal nerves in the rectus abdominis significantly higher in females. The distance from the outer edge of the rectus abdominis muscle to the point of penetration of the intercostal nerves in the muscle thickness significantly greater in males.
Conclusion. The obtained data can be used to predict the topography of the intercostal nerves in prosthetic hernia repair of umbilical hernias.
Keywords: umbilical hernia, retromuscular hernia repair, intercostal nerves, chronic pain.
182-188
Forecast Possibilities and Prophylaxis of Surgical Site Infections in TKA
Abstract
A retrospective review of 814 Total Knee Replacements, performed in NWSMU named after I.I. Mechnikov had been conducted for the study. It had shown 20 significant criteria which can influence the occurrence of surgical site infections in postoperative period. Among these factors 15 can be identified pre-surgery, 4 -intraoperatively and 1- postoperatively. The criteria are: age, gender, host optimizations, preoperative management quality, duration of surgery and operating room (OR) conditions, intraoperative complications, amount of blood lost etc.
All these factors were estimated and included in a scaling system. A specific software was created based on this system that can forecast the complications in the area of surgical intrusion in early post-operative period. Afterwards a forecast and prevention algorithm for preventing septic complications in Total Knee Replacement had been developed and applied. In prospective study (174 clinical observations) the application of the forecast and prevention algorithm had resulted in significant decrease rate of septic site complications compared to the cases of retrospective research (decrease of 5.3% in the prospective cases and 2.3% - in retrospective).
189-195
The Effectiveness Of Local Hemostasis After Endovascular Interventions
Abstract
196-203
"New look" on antioxidant systems in various diabetes mellitus complications
Abstract
Actuality. At the present time is an issue of earlier diagnosis and prognosis of complications related to diabetic macro- and
microangiopathy. Early detection of violations of the antioxidant system, which appear at the stage of pre-clinical manifestations,
will prevent or improve during the complications associated with diabetes mellitus.
The Aim. To assess the state of the antioxidant system in patients with various vascular complications of diabetes, such as diabetic
retinopathy (DR) and angiopathy of legs.
Materials and methods. Three groups of patients were involved in the study, only 75 people at the age of 55 ± 6,0 years. The first
group of patients (n = 25) included patients with type diabetes (non-insulin dependent) with the presence of diabetic retinopathy. In
the second group of patients (n = 25), to have of angiopathy of legs. The third group consisted of 25 healthy people. Determination
of the studied parameters was performed by HPLC methods developed in our laboratory.
Results and discussion. These data suggest that the antioxidant capacity of plasma (Cysfree / Cys-S-S-Cys) when the blood vascular
complications of diabetes decreases and the redox state of GSH / GSSG varies depending on various types of vascular complications
of diabetes.
Conclusions. With the development of vascular complications of diabetes suffers as the antioxidant capacity of plasma and cells
directly, resulting in a significant decrease in the reduced forms of defined indicators. With the progression of the disease and the
presence of diabetic angiopathy factors Cys free / Cys-S-S-Cys and GSH / GSSG was significantly different from those in the control
group. Based on this, we can confidently say that in patients with diabetes require a full assessment of the antioxidant system,
the study of the various factions, not only glutathione and cysteine for the timely pharmacological correction and prevention of
premature morbidity.
Key words: cysteine, glutathione antioxidant system, diabetes mellitus.
204-208
Experimental Substantiation Efficiency of new Polymer Membrane for Sealing the Suture Line During the Formation of Colonic Anastomoses
Abstract
In modern abdominal surgery the problem of finding new ways and methods to prevent anastomotic leak joints when applied to the
colon remains open and constantly requires new improvements. The use of polymeric film materials can improve the mechanical
strength and tightness biological intestinal anastomosis.
The purpose of this study was to assess the effectiveness of the sealing seams, single line of colonic anastomoses using new models
of film implants based on carboxymethyl cellulose polymers.
Materials and methods. In experiments on rabbits found that on day 1 when sealing the sample polymer membrane-row suture
intestinal anastomosis in 2-fold increase in its mechanical strength compared to the control groups (control group 1 - intestinal
anastomosis using two-row intestinal suture technique - seam Schmid ( first row) and seam Mateshuka (second row); control group
2 -mezhkishechny anastomosis using a single row suture Schmid), where it is not used as an implant in the second row of stitches.
Results and their discussion. During surgery it found that the studied sample polymer film has optimum implant manipulation
properties required for sealing the intestinal suture line (flexibility, strength, adhesiveness, does not require additional fixation suture,
simple overlay membrane, reducing the time of formation of the anastomosis). Increased permeability decreases and increases the
level of the intestinal seam tightness, due to the high degree of adhesion of the polymer membrane, not even at background ensuing
regeneration serosa edges (phenomenon "biological leakage").
Conclusions. These preclinical data support the efficacy of new polymer membranes with sealing seams, single colonic anastomoses.
Keywords: polymer membranes, anastomotic sealing, seam strength, the intestinal seam.
209-213
A New Method of Treatment Achalasia II-III Stage. Experimental Substantiation
Abstract
Purpose of the study To improve immediate and long-term results of the treatment of achalasia cardia II - III stage by
experimental development and introduction to the clinic a new method of surgical treatment of achalasia.
Materials and methods The original way of surgical treatment of an achalasia of the cardia of the II-III stage is developedby
circular removal of serous-muscular layer of the esophagus in the cardia segment of the esophagus and formation areflux
mechanism of the gastroesophageal junction. Method of forming an artificial cardiac valve tested on 20 rabbits chinchilla both
sexes weighing 5-10 kg.The study of anatomy antireflux valve was studied by the method of the isolated organ freezing according to
the canons of "Ice anatomy" for N.I. Pirogov (1851) in the modification of A.A. Sotnikov and I.B. Kazantsev.
Results and their discussion The valve is represented as a circular fold mucosal and submucosal layers.By results of the pilot
study it is shown that the created invaginatedvalve keeps the structure in all terms of supervision, without interfering with a natural
passage of food. Complications, bound to the offered technique in the early and remote postoperative period it is not revealed.
Conclusion Attempted variant surgery contributes to the formation on the border of the esophagus and stomach kind of antireflux
structures. It maintains its anatomical shape at all stages of monitoring.
Key words achalasia, experiment, surgical treatment
214-221
Pharmacological Correction of Violations of Microcirculation, and Ischemic Damage of the Muscle Tissue in Experimental Critical Limb Ischemia
Abstract
Objective. Experimental substantiation of possibility of application of the drug "Myelopid" in the treatment of experimental critical limb ischemia.
Methods. The experiments were conducted in 130 white male rats of Wistar line. Experimental animals were divided into five groups: intact, control, first, second and third experienced. In the intact group consisted of 10 rats, which is evaluated at the normal level of the microcirculation. In the other groups was incorporated on 30 male rats each, which was modeled critical ischemia of the right hind limb by excision of the femoral and popliteal arteries. In the control group, the treatment was not carried out. In the first group of experimental animals received the drug "Myelopid" at 50 µg/kg in thigh muscle after 3 hours after surgery, and then through one, two, three days. In the second group the rats were injected the drugs "Actovegin" and the third "Solcoseryl" intraperitoneally at a dose of 50 µg/kg 3 hours after operation, and then daily for five days. Assessment of the level of microcirculation in the calf muscles of the rats were performed by laser Doppler flowmetry (LDF) on 10-th, 21-th and 28-th day of the experiment, at the same time produced a histological examination of the ischemic muscle, which was determined the dynamics of the mean diameter of the arterioles, capillaries, venules, muscle fibers, the level of arterio-venular shunting, areas of necrosis and density of the capillary network.
Results. The level of the microcirculation in the first group of animals was surpassed on the 10th day of the experiment, the same indicator in the second and third groups of 1.24, on the 21st day - of 1.18, and on the 28th day in the second group of 1.42 and in the third - 1.71 times. Level arterio-venular shunting in animals that were treated with myelopid, was below on the 21st day of the experiment, 8.1%, than in animals treated need to go and 17.3% - treated by solcoseryl. For 10 days the area of necrosis of muscle fibers in animals treated with myelopid, was significantly less by 13.2% than in the group of animals who were injected with Actovegin and 7.5% in the third group of animals treated with Solcoseryl in, on the 21st day respectively by 10.8% and 11.1%, 28 days - 5% and 6%. The density of the capillary network on the 10th day in the first group was superior to 1.25 density in the second group and 1.34 in the third, on the 21st day, respectively, 1.2 and 1.4, on the 28th day – of 1.46 and 1.47 times.
Conclusion. The experimental treatment of critical limb ischemia by the drug "Myelopid" is pathogenetically justified and effective.
Key words: critical limb ischaemia, treatment, Myelopid, Actovegin, Solcoseryl.
222-230
Ways of Improving the Organization Kombustiologicheskoy Service in Krasnodar Territory
Abstract
The paper presents an analysis of the provision of medical aid to victims of burns in the Krasnodar region, the optimal timing and
types of evacuation of patients with thermal injury, depending on the age of the victims, the area and depth of the lesion. Objects
of research were inpatients with thermal injury in the Krasnodar region in the period 2010-2015. Each year, the province recorded
3,500 victims with burns, receiving hospital treatment. 1300 of them are on the specialized treatment in the Krasnodar regional burn
center, where they performed 2,000 surgical interventions. The burn center have providing all kinds of specialized assistance to
victims, both with thermal injury and the effects of burns.
Lately, a number of trends in burn injuries and health care levels, which requires analysis and the effectiveness of victim assistance
with thermal injury. Over the past decade, progress has been made in the treatment and relief to victims with thermal injury, but the
problem of burns and remains one of the most pressing issues in modern medicine today.
Currently, combustiology remains one of the few medical specialties in Russia, which is not accepted the order to assist the victims.
In particular, the unresolved issues of early registration and early transfer of patients who received burns to specialized burn units
and centers for the provision of early surgical treatment, which is a guarantee of an optimal rehabilitation of victims and improves
the quality of life of patients with thermal injury.
In making the order to assist the victims of burns is necessary to take into account the territoriality of the Russian Federation.
Keywords: thermal trauma, sanitary aviation, medical evacuation Health Organization.
247-253
Review of literature
The modern view on the rare purulent-necrotic diseases of the external genitalia in men (review of literature)
Abstract
The current aspects of epidemiology, etiology, pathogenesis, clinical and laboratory picture, radiology and treatment of rare purulent-necrotic diseases of the male external genitalia, including the scrotum carbuncle, hydradenitis of the pubic region, cavernous and bulbar abscess of the penis, subcutaneous abscess median suture of the penis, scrotal abscess and fulminant gangrene of the scrotum (Fournier's gangrene) are explained in the literature review. These diseases usually occur in males to be socially active and of reproductive age with comorbid immunodeficiency background. New methods of adjuvant treatment of patients with Fournier’s gangrene, such as hyperbaric oxygen therapy and vacuum therapy are discussed. Attention is drawn that the prognosis of purulent-necrotic diseases of the external genitalia depends primarily on the timely diagnosis and timing of surgical intervention.
Key words: purulent-necrotic diseases of the male external genitalia, etiopathogenesis, diagnosis, treatment.
231-246
Memorials
Sergei Yudin (1891-1954). the 125th anniversary of his birth.
254
135th birth anniversary of Alexander Fleming (The beginning of the era of antibiotics is dedicated)
Abstract
In 1999 the magazine «Time» included Alexander Fleming in the list of 100 heroes and idols of the XX century, saying that "the opening of Fleming has created a huge pharmaceutical industry, producing synthetic penicillins, to combat some of the most ancient diseases of mankind, including syphilis, gangrene and tuberculosis. " According to some estimates, antibiotics have saved more than 200 million people, and their discovery has added about 20 years to the average human life expectancy in the developed countries.
Alexander Fleming was born on August 6, 1881. In 1906 he received the degree of Bachelor of Medicine and Bachelor of Surgery with honors and became a member of the Royal College of Surgeons. In 1908 he received a master's degree and a Bachelor of Science in the University of London. In 1922, Alexander Fleming opens lysozyme. In 1928 he became a professor of bacteriology. March 7, 1929, A. Fleming identified and described the properties of penicillin. February 12, 1941, penicillin was first used to treat humans. In 1943, the commencement of commercial production of the antibiotic.
In 1944, Fleming was elevated to the dignity of knighthood. In 1945, the Nobel Prize in Physiology or Medicine was awarded to A.Flemingu, H.U.Flori and E.B.Cheynu "for the discovery of penicillin and its curative effect in various infectious diseases". In 1928-1946 years A. Fleming worked as a professor of microbiology, University of London, in 1947 led the Wright-Fleming Institute, in 1951-1954 was the rector of the University of Edinburgh.
Alexander Fleming was awarded 25 honorary degrees, 26 medals, 18 prizes, 30 prizes and honorary membership in 89 scientific academies and societies including the Royal Society of London (1943), the Paris Academy of Sciences (1946), first president of the society general microbiology.
Alexander Fleming died of a heart attack March 11, 1955. In 2009, Fleming's picture placed on a new bill to £ 5.
255-256
170th anniversary of Anesthesiology dedicated
257