Vol 9, No 4 (2016)

Relevance. Mortality in necrotic pancreatitis ranges from 50-60%.
Purpose of the study. To improve the results of treatment of patients with infected pancreatitis by applying for rehabilitation common bacterial cellulitis immobilized forms of sodium hypochlorite.
Materials and methods. We analyzed the results of the diagnosis and treatment of 94 patients with advanced infected pancreatic necrosis, the treatment of which was carried out by open-programmed landmark sanations necrotic foci. The patients were divided into two groups of statistics by gender, age, reasons of destructive pancreatitis, the degree of intra-abdominal pressure, endotoxemia, multiple organ failure. The control (first) group consisted of 48 patients after necrosectomy for sanitation of purulent foci used "Levomekol" ointment, and the main (second) - 46 patients treated on the same technology, with the introduction of the packing bag of sodium hypochlorite solution in the gel polymers. The effectiveness of treatment in the immediate postoperative period was assessed by the dynamics of systemic endotoxemia, multiple organ failure on the scale of the SOFA, the frequency of complications and mortality, and in the long term the quality of life of patients. To assess the severity of endotoxemia determined dynamics leukocytosis, LII postoperative sanation after each stage.
Results and its discussion. At all stages of the observation systemic endotoxemia indicators in the control group were higher than in the main: readjustment after the first 1.2 times after the second - 1.4 times, after the third and fourth - by 1.5 times. Intensity of multiple organ failure in the first group was higher than in the second: after a first sanitation - 1.1, after 1.4 second after the 3rd and 4th - 1.3 and after 5 minutes - 1 6 times. The first group of early postoperative complications occurred in 22 (45.8%), while the second group - 16 (34.8%). Mortality in the first group was 39%, and in the second - 30.4% .In the late postoperative period, diabetes developed in 29 (47.5%) with the same frequency in both groups. The physical component of health in the first group is 37,86 ± 1,84, and the second 43,63 ± 2,04, and psychological respectively 38,16 ± 1,26 and 41,21 ± 1,25.
Conclusion. The use of immobilized forms of sodium hypochlorite in the treatment of infected pancreatic necrosis pathogenetically justified and effective.
Keywords: infected pancreatic necrosis, programmed open rehabilitation, necrosectomy "Levomekol" ointment immobilized form sodium hypochlorite.

A comprehensive survey of 293 patients with concomitant diseases HZV and SLM. Doppler ultrasound was performed and angioscanning on «Aloka 4" devices, «Logic 7» and «SonoScape». Clinical Analysis of movements performed on a hardware-software complex "MBN-Biomechanics" and included podometrics, goniometer and functional electromyography. Warp stop evaluated digital fotoplantografiey. A typical anatomy of the venous system was detected in 156 (53.2%) patients. In 147 (50.1%) found the relative failure of the valve common femoral (OBV), thigh (PCI) or tibial veins. In 23 (7.8%) patients showed a doubling of the superficial femoral vein (PBB) with a total diameter of WSP 16,3 ± 2,5 mm. Dilatation of deep vein recorded in 31 (10.6%) patients. WSP transposition was observed in 13 (4.4%) patients. The subcutaneous venous system most frequently detected in-shaped division of the great saphenous vein (GSV) at the mouth - 30 (10.2%) patients or doubling - 24 (8.2%). Vienna Leonardo was detected in 10 (3.4%) and Vienna Giacomini in 23 (7.8%) patients. Patients with C3 and C4 classes chronic venous insufficiency nontraumatic strain (CVI) were detected in 59 feet (68.6%) and 51 (79.6%), arthritic joints stop - 25 (29.1%) and 21 (32 ,8%). When classes C5-C6 foot deformities II-III degree in violation of the spring, balancing and jogging diagnosed in 65 (94.2%) cases. This greatly reduces the efficiency of the musculo-venous pump. Formed arthrogenic congestive syndrome. Anatomical features of the lower limbs and associated pathology of the musculoskeletal system contribute to worsening of clinical manifestations of chronic venous insufficiency. When choosing methods of diagnosis and treatment strategy requires an integrated interdisciplinary approach.

complications of this disease. Only in our clinic, the proportion of patients with destructive forms of erysipelas is about 18% of all
patients of the Department of purulent surgery.
The aim of the present investigation is to improve the results of treatment complications associated with erysipelas according to
modern concepts about this problem.
Methods We conducted a randomized controlled trial of 34 patients suffer from erysipelas, associated with purulent complications.
All patients were categorized according to kind of treatment into two groups. The control group (17 patients) included patients treated
with conventional therapy. In the main group (17 patients) in the conventional treatment of erysipelas was included immunomodulator
Derinat. The efficacy of the treatment was monitored through clinical tests with calculation of indexes of intoxication (LII, YII), and
special studies of the immune status.
Results In patients treated with Derinat symptoms of intoxication were stopped in earlier periods (6 ± 0,58 (p<0,5) day, LII and YII
was normalized on the 7th day) in comparison with the control group. After the traditional therapy, in patients was the suppression
of T-lymphocytes and their subpopulations, ingestion rate was lower than in healthy persons. In the main group of patients after
treatment with derinat we are reveal the stimulation of T - and B - immunity with increased ingestion rate.
Discussion The inclusion of Derinat in the conventional therapy of patients with erysipelas allows to correct disorders in the immune
status of these patients, which contributes to their rapid healing and reducing the risk of recurrence of the disease.
Key words: erysipelas, destructive forms of erysipelas, complications of erysipelas, Derinat.

Relevance: in the era of advanced surgical interventions in oncoproctology, such as cylindrical extirpation and resection of the
rectum, surgeons are increasingly faced with the problem of nonhealing postoperative wounds, which involves the removal of a
large array of tissues and the formation of extensive defect of the pelvic floor or abdominal wall. The solution to this problem is
to use the implant to replace the defect. The bioimplant Permacol™, is produced from pig skin by extraction of fat, removal of
cellular components, RNA and DNA, after which the implant is maintained only 3D collagen lattice. Due to its chemical structure
with the formation of intermolecular cross-links with the help of HMDI (hexamethylene of diisocyanate) it is resistant to human
collagenase, which slows down the degradation of biological material.
Objective: to evaluate the possibility of using Permacol implant for replacement of defects of the abdominal wall and pelvic floor
in patients with malignant tumors of rectum and colon in experiment and clinic.
Materials and methods: the experiment was conducted on 15 chinchilla rabbits to study the biological properties of the implant
using histological method. After receiving the results of the experiment, Permacol has been used in the clinic of faculty surgery at
the department of coloproctology of Ryazan Regional Hospital.
Results and discussion: experience of bioimplant Permacol application is described. The experiment on rabbits compared the
biological properties of Prolen and Permacol implants was carried out, which Permacol showed good biocompatibility and high
resistance to tissue enzymes and of the infectious agent. In the clinic of faculty surgery at the department of coloproctology of
Ryazan Regional Hospital Permacol was used to replace the defect of the anterior abdominal wall and substitution of the defect of
the pelvic floor after extended surgical interventions in cancer patients. In both cases the experience proved successful.
Conclusion: the obtained results allow to recommend Permacol for use not in the open wound, and if possible, to close the implant
by the skin.
Keywords: Permacol, bioimplant, plasty, oncoproctology.

The treatment of wounds remains a pressing multidisciplinary problem surgery that requires new high throughput approaches
including, reduction of risks of infectious and cosmetic defects.
The purpose of the study was to develop a method into a software of rehabilitation treatment of wounds soft tissue and studying its
efficiency in the experiment. The studies were performed on 192 male albino rats in 2 units of study.
Materials and methods Research in first and second blocks was aimed at studying the impact of software bubble rehabilitation on
the course of wound healing in aseptic and septic wounds, respectively. In control groups the treatment of wound process was carried
out by applying aseptic dressings. In the main groups were conducted, additionally, software bubbling sanitation in 0.9% sodium
chloride solution for 3 minutes.
Sessions of software bubble rehabilitation was carried out using a special device, which is based on the combined use of gas and
hydrodynamic impacts by passing through a solution of gas bubbles that come into contact with the wound surface, enhance the
quality of rehabilitation and improve circulation. For evaluating the course of the wound process in experimental research was
conducted clinical, macroscopic, histological and histochemical methods.
Results and their discussion Application of the method of PBS under aseptic wounds accelerated the relief of edema and hyperemia
more than 20%, reduce the period of exudation by 50% compared to the control group. In the treatment of purulent wounds of PBS
method made it possible to accelerate the phase change of the hydration and dehydration on the average in 1,5-2 times. In the study
of histoarchitectonic soft tissues in the control group it was observed the prolongation of the inflammatory phase of wound healing, 

long-term preservation of necrosis in the muscular layer and the nonuniform development and maturation of granulation tissue, the
use of bubble rehabilitation led to more rapid and complete cleansing wounds from microorganisms and tissue breakdown products,
to even development of granulation tissue and early closure of the wound.
Conclusion Experimental studies have shown the safety and efficacy of software bubble remediation (PBS) in the treatment of aseptic
wounds of soft tissues.
Keywords: software bubbling debridement, soft tissue wound

Timeliness. Prevalence of cholelithiasis and significant public costs of the treatment is among the problems of modern medicine. Up to 10 - 15% adults have this disease. 800000 new cases of cholelithiasis are recorded in Russia annually. patients with Grade III abdominal obesity are especially difficult to treat, as increased subcutaneous fat thickness causes significant technical difficulties emerging during surgery, increases the extent of operative injury and worsen the treatment outcomes in this category of patients.
The study objective. To improve the outcomes of surgical treatment of cholelithiasis in patients with abdominal obesity by decreasing the extent of surgical injury during surgical approach to the gallbladder.
Materials and methods The article describes the results of intravitam topographic anatomical examination of the gallbladder (based on results of spiral computed tomography and 3D modeling) in women of different somatotypes in the setting of abdominal obesity.
Results and discussion. We evaluated anatomical structures of the abdominal wall and abdominal organs located in the right hypochondrium of females based on somatotypes and presence of abdominal obesity. Suggested 3D modeling method allows performing mathematical measuring which might be a basis for derivation of criteria of optimal surgical approach during cholecystectomy.
Conclusions. The presence of abdominal obesity does not cause changes in topographic anatomical characteristics of the gallbladder, however it is located substantially deeper due to significant increase in subcutaneous fat thickness.
Key words. Gallbladder, somatotype, abdominal obesity

А.А.Вишневский – выдающийся хирург с мировым именем, замечательный педагог, известный государственный и общественный деятель, директор Института Хирургии, академик АМН СССР, заслуженный деятель науки РСФСР, лауреат Международной премии им. Лериша, Ленинской и Государственной премий СССР, Герой социалистического труда, Член Международной ассоциации хирургов, почетный член Чехословацкого научного медицинского общества им. Я.Пуркине, общества врачей Швеции, Пьемонтского общества врачей, профессор, генерал-полковник медицинской службы, Депутат Верховного Совета РСФСР 6–8-го созывов. Награждён 3 орденами Ленина, 4 орденами Красного Знамени, 2 орденами Отечественной войны 1-й степени, орденами Красной Звезды, «За службу Родине в Вооружённых Силах СССР» 3-й степени, а также иностранными орденами и медалями.

А.А. Вишневский родился 24 мая1906 г. в Казани, в семье видного отечественного ученого-хирурга Александра Васильевича Вишневского. С 1924 по 1929 гг. учился на медицинском факультете Казанского университета. После окончания университета А.А.Вишневский непродолжительное время работает на кафедре нормальной анатомии Казанского университета. В1931 г. добровольно вступает в ряды Красной Армии и назначается преподавателем кафедры нормальной анатомии Военно-медицинской академии в Ленинграде.

В 1936 годы защищает докторскую диссертацию. С 1939 года Александр Александрович – руководитель хирургического отделения Всесоюзного института экспериментальной медицины; с 1940 по 1941 гг. – профессор Центрального института усовершенствования врачей.

Во время Великой Отечественной войны последовательно занимая должности хирурга армии, главного хирурга Брянского, Волховского, Карельского, Резервного и 1-го Дальневосточного фронтов. После окончания войны – главный хирург Приморского, а с1947 г. – главный хирург Московского военного округа. В1947 г. назначается заместителем по научной работе, а в1948 г. – директором Института хирургии АМН СССР.

С1956 г. одновременно является главным хирургом Министерства обороны СССР. С 1956 года А.А. Вишневский – заслуженный деятель науки РСФСР. С 1957 года – академик АМН СССР. В 1963 году генерал-лейтенанту медицинской службы Вишневскому А.А. присвоено воинское звание «генерал-полковник медицинской службы».

В 1966 году Александру Александровичу присвоено звание Героя Социалистического Труда с вручением ордена Ленина и золотой медали «Серп и Молот». В 1971 г. А.А. Вишневскому присуждена Государственная премия СССР. А.А. Вишневский умер 14 ноября 1975 г.