Vol 10, No 2 (2017)

Presented clinical case laparoscopic decompression of celiac trunk syndrome of Dunbar. In most cases, the diagnosis of syndrome of compression of the celiac trunk is by exclusion of other gastrointestinal diseases. Sure, it tells about lack of awareness among the medical community about this specific and rare pathology, as well as a possible skeptical attitude towards it related professionals. The main methods of diagnostics of a syndrome of Dunbar are: ultrasonic duplex scanning of the abdominal aorta, multislice computed tomography and angiography with a respiratory samples. The indication for surgical treatment is the ineffectiveness of conservative therapy, the preservation of the leading symptoms of abdominal ischemia on the ground proved critical in compression of the celiac trunk. Currently, laparoscopic decompression of celiac trunk syndrome Dunbar is the operation of choice. The obvious advantages of laparoscopic surgery are less blood loss, a slight pain syndrome in the postoperative period, short hospital period and better cosmetic effect. In the clinic, where surgeons proficient in the technique of laparoscopic procedures, the surgery can be performed quickly, safely, and efficiently. Additional intervention in the form of endovascular correction is not required in all patients and can be performed in a delayed order.

Relevance. Currently, there is no single common approach to the treatment of postoperative median hernias
Objectives. To develop an algorithm for choosing the method of surgical treatment of patients with postoperative median rectifiable abdominal hernias based on a noninvasive assessment of changes in intra-abdominal pressure by determining oxygen saturation.
Materials and methods. The research was performed in 65 patients with postoperative median, rectifiable hernia of various sizes. All patients are divided into three main groups. We used an indirect technique for determining changes in intra-abdominal pressure by examining the saturation of blood with oxygen. Four methods of plastics were applied to patients with median postoperative hernias:
1) plastic by own tissues in the form of duplicate (according to Sapezhko);
2) plastic in the form of duplicate with immobilization of the wound on surgical bridges [9];
3) two-stage hardware operation method, developed by Professor Lyubykh EN [9];
4) prosthetics of the abdominal wall with a mesh prosthesis.
Results and its discussion. In the first group of patients with small hernias, when modeling the postoperative situation (immersion of the hernial contents in the abdominal cavity with the help of a pelot, and simultaneous approach of the hernial gates with the help of a bandage), the saturation was reduced insignificantly (97,1 ± 1,5% (p <0,05), which allowed us to recommend plastic by own tissues in the form of dublication.
In the second group of patients with medium-sized hernias, the saturation was moderately reduced during the simulation (95,4 ± 1,4% (p <0,05). Plastics in the form of dublication with immobilization of the wound on the surgical bridge has been recommended these patients.
In the third group of patients with extensive and giant hernias, blood oxygen saturation was significantly reduced (91,5 ± 1,5% (p <0,05). Such patients with extensive and giant hernias and a and long term hernia has been recommended prosthetic abdominal wall with mesh prosthesis. If the hernia disease is less than 5 years of age and patients of working age, two-stage hardware method of treatment hernias created by professor E. N. Lyubykh has been recommended. [9]
Conclusion. The proposed algorithm for choosing a method of plastic surgery for postoperative median repaired hernias based on preoperative determination of oxygen saturation with oxygen under different conditions allows for a differentiated functionally oriented approach to the treatment of patients and a reduction in the number of relapses.

Relevance. Gastroduodenal ulcer bleeding is one of the most complex problems of emergency abdominal surgery. An endoscopic hemostasis is a crucial importance during the treatment of patients with gastroduodenal bleeding. The using of biologically active draining sorbents in combination with local haemostatic drugs is a promising direction in the endoscopic hemostasis.
Objective. The aim of the investigation is to improve the results of treatment of patients with acute ulcerative gastroduodenal hemorrhages by application of biologically active draining of sorbent Asepticob-A in combination with platelet-rich plasma for endoscopic hemostasis as an important component of complex therapy.
Materials and methods. The study is based on the results of treatment of 112 patients with peptic ulcer bleeding. They were treated in the specialized city centre for the treatment of patients with gastrointestinal bleeding of Voronezh state hospital of emergency medical care №1. During the treatment of patients of the main group (n=57 persons) was used individual complex approach with the using of biologically active draining of sorbent of new generation – Asepticob-A and platelet-rich plasma in endoscopic treatment of bleeding complications of gastroduodenal ulcers. In the comparison group (n=55 persons) was used the well-known traditional methods of endoscopic hemostasis without the use of granular sorbents and platelet-rich plasma.
Results and discussion. The effectiveness of treatment of patients with ulcerative gastroduodenal bleeding was assessed according to the criteria of reliability of hemostasis, assessment of dynamics of reparative processes in ulcerous defects, the frequency of recurrence of bleeding on the background of treatment using endoscopic techniques, prevention, emergency operations and mortality rate. The methods of treatment of gastroduodenal bleeding with the combined use of biologically active draining sorbents and platelet-rich plasma for the reliability of endoscopic haemostasis, that was developed and introduced into clinical practice, reduces the number of emergency operations in 2.6 times, mainly due to the reduction of recurrent bleeding and, as a consequence, leads to lower postoperative mortality.
Conclusions. The use of biologically active draining of sorbent Asepticob-A and platelet-rich plasma in complex endoscopic treatment of patients with ulcerative gastroduodenal bleeding allows to reduce the frequency of recurrence of bleeding from 10.9% to 3.5% (3.1 times), to reduce the number of emergency surgical interventions at the height of bleeding from 9.1% to 3.5% (2.6 times), to reduce postoperative mortality from 5.45% to 1.75% (3.1 times) and reduce the duration of inpatient treatment from 9.0 to 6.0 days (p<0.05).

It is an urgent issue of practical hepatology to find and to use means possessing the tissue protective properties to increase the potential of the own antioxidant system in conditions of the vascular liver exclusion which have to satisfy the practical medicine.

The purpose of the present study is to research the influence of intraperitoneal injections of the sodium dichloroacetate on the course of the ischemic-reperfusive syndrome in conditions of the modeled vascular liver exclusion.

Materials and methods. The study has been performed on 105 non-linear male rats divided into 7 groups. After the laparotomy animals have undergone the intraperitoneal injection of the sodium dichloroacetate in dosage 300 mg/kg under the general anesthesia, then the hepatoduodenal ligament has been clamped for 10, 15 and 20 minutes. The comparison groups have been formed from animals that have undergone the same manipulations without injections of the sodium dichloroacetate. The control group has been made up of 15 rats only laparotomy has been performed on. After 15 minutes of reperfusion the blood sampling from the caudal vena cava and liver has been carried out to perform further laboratory analysis. In the blood plasma the activity of lactate dehydrogenase, aspartate aminotransferase and alanine aminotransferase has been determined as well as the content of general thiol groups. In erythrocytes and liver homogenate the activity of catalase and superoxide dismutase have been determined. To evaluate the endotoxicosis level the content of substances of medium and low molecular mass in erythrocytes and the blood plasma has been studied.

Results and discussion. It has been revealed during the performed study that the sodium dichloroacetate significantly decreases the manifestation of the cytolytic syndrome. The increase of transaminase activity in the blood plasma by injection of the sodium dichloroacetate has fallen behind for 5 minutes in average in comparison with the groups without metabolic correction. The activity of lactate dehydrogenase in the blood plasma has been lower than the indices of the comparison groups by 2-3 times. The activity of enzymes of antiradical protection by injections of the sodium dichloroacetate has increased both in erythrocytes and the liver homogenate against the background of the lowering in the comparison groups. The content of thiol groups in the blood plasma within 10-20 minutes of the vascular exclusion has decreased by 25-38% and has persisted on this level while in the comparison groups the concentration decrease by 51.2% has been revealed to the 20^th minute. By the correction the significantly lower level of endotoxicosis has been developing. One of the possible mechanisms of cytoprotective action of the sodium dichloroacetate is the activation of antioxidant system due to the development of oxidative stress as the leading damage factor by reperfusion.

Conclusion. The received data demonstrate the cytoprotective properties of the sodium dichloroacetate in conditions of the developing ischemic-reperfusive syndrome on the model of the vascular liver exclusion in experimental conditions. The results of the study perspectively allow expanding the usage possibilities of the vascular liver exclusion in its various types in the field of surgical hepatology.

Rationale: puerperal endometritis is the major cause of formation of incompetent uterine scar and spread of infection. By contrast, reparative processes concerning uterine walls are the basis for formation of a competent uterine scar. In the past decades, there have been observed significant changes in the clinical course of puerperal endometritis. Apart from other factors, they are caused by improper antibiotics prophylaxis and antibiotic treatment. The key factors responsible for uterine scar incompetence also include improper surgery methods, namely: application of uninterrupted, continuous suture of uterus, reactogenic material, inappropriate hemostasis, pathological blood loss, surgery duration over two hours, using technique of manual fetal exteriorization.

The aim of the present research is to identify a group of maternity patients that could avoid being administered perioperative antibiotic prophylaxis and the further antibiotic therapy on condition that their lower uterus segments are processed with interrupted sutures. It also involves the assessment of the early postoperative care period as well as eliminating possible complications. Materials and methods: The article analyses a group of 63 maternity obstetrics patients in early postoperative care period. They had their lower uterus segments processed with interrupted sutures. In all cases we used peritonization with help of plica vesicouterina. Antibiotic prophylaxis was avoided in both perioperative and early postoperative care periods. The article also presents the lab test values, data on thermometry and ultrasound diagnostic. The latter analyzed the following: length, width, thickness and the size of uterus, thickness of the front part of the uterus in the scar area, echoicity and echo structure of the mentioned area. Ultrasound examination allows us to estimate the uterus size, the scar condition, possible pathologic elements in the uterus body. The article also presents data on physical examination and bacteria culturing of the content of the uteri cavity during three days.

The results: the complications were not presented by such nosological forms as endometritis or postoperative peritonitis, as well as inflammatory urinary conditions. No cases of any partial suture line disruption have been observed on the anterior abdominal wall or hyperthermia over 37,5 within the first three days of the postoperative period.

Conclusions: during the rehabilitation period for the lower uterus segments by using synthetic suture material for the low-risk group of obstetrics patients it is not necessary to provide antibiotics prophylaxis and antibiotic treatment in the case of a planned or postponed caesarian section

In modern medicine a great variety of chemotherapeutic agents is used for treating the infection. However, in spite of their improvement, increasing the quality of providing medical aid, development of surgical technique, using new and more thorough technologies for the patients’ treatment, the incidence of purulent complications at surgical clinic doesn’t decrease. Moreover, there is a marked tendency of its increase.
2% of all the initial laparotomies are accompanied by unplanned operations about intraabdominal infection, and approximately 50% of all serious intraabdominal infections appear during the postoperative period, which leads to 2% of lethal outcomes after planned operations.
Needless to say, the problem of surgical infection is actually urgent for our country. Therefore, in our opinion, searching for methods of diagnostics, control and treatment of infection, which could be an alternative to antimicrobial chemotherapy, is very important.
The physical method of treatment, based on using the patient’s own electromagnetic fields and emanations, which is also known as bioresonance therapy (BRT), gained wide application in modern medicine.
BRT method is based on the ideas about the human body being a source of fluctuations of electric nature, which exist in the human body or on its surface and spread across the environment.
The new method of wound surgical infection treatment is analyzed. Theoretical and practical aspects of using multiresonance therapy in surgeon’s work are discussed. The treatment of the patient with polyresistant infection associated with giving medical aid is analyzed in the article. The author draws a conclusion about the expediency of using bioresonance in complex treatment of wound surgical infection.

The early diagnosis, prognosis, complications and mortality Fournier’s gangrene (FG) are discussed. The terms pre-hospital period with FG is amount of 8.0 ± 5.2 days. Cases of misdiagnosis are observed in 70% in the early stages of FG due to nonspecific clinical and laboratory picture, lack of awareness and alertness of doctors. Early diagnosis of FG is based on clinical and laboratory data of the picture. In order to timely diagnosis of FG is used scale laboratory indicators of necrotizing fasciitis (LRINEC), allowing suspect FG in doubtful cases. In diagnostically unclear cases FG used radiation methods. At the slightest suspicion on the FG made explorative operation, including express biopsy of soft tissues. The differential diagnosis is carried out in the early stages of FG with acute diseases anogenital region and is rarely used. As a prognostic criteria discussed the patient's age, the presence and nature of comorbid diseases, severity of the condition, the hospital admission dates, duration of preoperative period, necrosis area, metabolic parameters, the amount of remedial necrectomy, antibiotic regimen, hyperbaric oxygen therapy. For the systematic evaluation of the severity of the patient's condition and prognosis use different scoring systems. Many of the proposed prognostic criteria are controversial. The favorable prognosis in FG is entirely dependent on early diagnosis and timing of emergency surgery. Sepsis and its complications are the main causes of deaths. Mortality in the FG has been a steady downward trend, and is 22.3 ± 8.8%. Prevention of the FG is a timely treatment of infectious and inflammatory diseases of the urinary organs and their complications.

Ivan Ivanovich Grekov (1867-1934) – an outstanding Russian surgeon, a talented organizer and teacher, doctor of medical science (1901), Professor (1915), honorary Chairman of the Surgical society N.I.Pirogov (1920), chief editor scientific medical journal "Vestnik of surgery and border areas" (1922-1934), Chairman of the XVI all-Russian Congress of surgeons (1924), the chief doctor of Obukhovskaya hospital (1927-1934), honored scientist of the RSFSR (1932).

I.I. Grekov was born on 5 (17) March, 1867, on a farm Tomilino Bogucharsky district, Voronezh province. In 1876 he entered and in 1885 graduated from Novocherkassk men's gymnasium, and was admitted to the Moscow University. In 1890 for participation in student riots Ivan was expelled from the University, but later continued her studies at the medical faculty of Yuryev University, and in 1894 he was awarded the title of doctor.

In 1895 I.I.Grekov worked in the Obukhov hospital in St. Petersburg: first – supernumerary resident since 1905 head of the surgical Department, from 1927 to 1934 – the chief physician. In 1901 he defended his doctoral thesis: "Materials for the issue of bone defects of the skull and their treatment."
In 1903 I. I. Grekov performs world's first successful suturing wounds of the heart. I. I. Grekov for the first time in Russia performed the intraoperative dissection of the cavity of the heart, pankreatectomia, one of the first made expeditious treatment of the stomach the methods of Kocher, Billroth–I and Billroth–II operation to create an artificial esophagus by the method of Roux–Herzen, has developed a technique tamponade of the abdominal cavity, restoration of the cruciate ligaments of the knee joint broad fascia of the thigh; method of resection of the sigmoid and descending colon intestines (Greek I and Greek II).
In 1915, Smith was elected Professor of the hospital surgery chair of the Psychoneurological Institute (from 1930 – 2nd Leningrad medical Institute). From 1918 to 1924 I. I. Grekov was Chairman, and in 1920 Honorary Chairman of the Surgical society N.I. Pirogov. In 1922, on the initiative of I. I. Grekov was resumed publication of the journal "Vestnik of surgery and border areas", whose editor he was from 1922 to 1934. In 1924, Ivan was unanimously elected President of the XVI Congress of Russian surgeons; in 1925, 1927 and 1929 – the Chairman of the congresses of surgeons of North Caucasus. In 1932, I. I. Grekov was awarded the title of honored scientist of the RSFSR.

I.I. Grekov died 11 Feb 1934 and was buried at the Communist platform of the Alexander Nevsky Lavra.

I.I. Grekov is the author of over 150 scientific works, devoted to problems of thoracic, cardiovascular, vascular, and emergency surgery, surgical infection.
In memory of I. I. Grekov since 1934, the journal "Vestnik of surgery and border areas" was renamed to "Vestnik of surgery named by I.I.Grekova"; on the former Obukhovskaya hospital in 1969, a memorial plaque; Department of surgery North-Western state medical University named by I.I.Mechnikov, first head and founder of which he was given the name of I.I.Grekov

Joseph Lister – the largest English surgeon and scientist, the founder of antiseptics, President of the Royal society of surgeons, a member of the house of lords. Joseph Lister was born on 5 apr 1827 in England. In 1844 he graduated from high school, and in 1852, the medical faculty of the University of London and was appointed resident assistant College University hospital. The first scientific work of Lister was published in 1852 and was dedicated to the structure of the iris of the eye and its muscles. Soon Lister began working in the clinic of Professor George. Syme in Edinburgh and published lectures, devoted primarily to ophthalmology. In 1855 he became a member of the Royal College of surgeons and is a Professor in the George. Saimaa. In 1858 Lister became a surgeon of the Royal hospital in Edinburgh and at the same time began to read a course of surgery at the University. On 9 March 1860 he was appointed Professor of surgery in Glasgow. In 1867 in the journal "Lancet" published articles Lister, in which he argued the idea that wound infection is called a living beginning, introduced from the outside; was presented to combat surgical infection, comprising treating hand surgeon, surgical field and instruments, disinfection of the air by atomization of a solution of carbolic acid. In 1869 Lister was transferred to the surgical clinic in Edinburgh, and in 1877 he was given the chair of clinical surgery at king's College London. In 1884 Joseph Lister was given the title of baronet, from 1895 to 1900 he was President of the Royal society of surgeons; in 1897 appointed a member of the house of lords. In 1892 he was 65 years old and, according to the law, he had to leave the Department at the Royal College. Joseph Lister was made an honorary member of numerous universities and scientific societies, was awarded the Royal medal (1880), medal of Comenius (1877), albert (1894), Copley (1902); the order of merit (1902). Died Joseph Lister, on 10 February 1912 in Walmer. In honor of Joseph Lister has been named a genus of bacteria Listeria (Listeria), he is on the English postage stamp, issued in 1966.