Vol 4, No 1 (2011)

The questions of surgical tactics in large and giant postoperative hernia in patients of older age groups. An analysis of the causes of recurrent hernias and postoperative complications identified the need to use algorithmic approach to the selection method of plasty of abdominal wall, defined the criteria for the possibility of operational benefits in patients with severe concomitant diseases, as well as a preoperative preparation program.

Long-term results show a significant superiority of radical organpreserving  operations compared with suturing and stomach resection in elderly patients with perforated gastroduodenal ulcer. Quality of life after radical operations in patients older 60 years is remaining high. The long-term syndromes specific to the patients condition after resection or suturing present in minimal percents of cases.

Structural issues of primary interventions, development frequency, mortality and treatment tactics of postoperative peritonitis after emergency and selective abdominal operations were analyzed on huge clinical material.  The assessment and opportunity of prognostic integral scale application, summery of results, which let to standardize protocols of treatment of patients with postoperative peritonitis, adequately estimate  risk and selection of optimal tactics of reoperation.

The therapy outcome of 258 patients with intra-abdominal surgical site infection has been evaluated, 205 (79,5%) of which developed abdominal sepsis of different severity degrees. In order to assess risk factors of lethal outcome, the severity of illness and related organ dysfunction scores have been calculated by means of APACHE II, SAPS, MODS и SOFA, as well as the procalcitonin levels test laboratory findings (PCT). In the present study, procalcitonin levels evaluation has shown to be a high sensitivity test that provides objective information for an infectious process assessment, correlating to APACHE II scores (R2=0,86). The concomitant liver dysfunction has been revealed be the most unfavorable factor for intra-abdominal infection prognosis, being the direct cause of death in 28,3% cases. The most sensitive values are total bilirubin, alkaline phosphatase, triglyceride levels, with the highest correlation ratio R2=0,92, R2=0,89, R2=0,93, respectively, which allows their application as an early diagnostic procedure for liver dysfunction detection in this group of patients with the perspectives of its correction.

Esophagoplasty in cicatricial narrowing of the esophagus is made postburns 116 patients. Disease duration - from 1 month
to 31 years. Subtotal shunt esophagocolonoplastik left half of the colon made 68, extirpation of the esophagus with a plastic
colon 9, extirpation of the esophagus with a plastic stomach tube in 38 patients. Long-term results of surgical intervention
were studied in all patients during the period from 1 month to 13 years. Study of long-term results and quality of life after
esophagoplasty showed significant benefits extirpation of the esophagus with esophagogastroplasty before esophagocolonoplastik.

Scientific prognostication of distant results in reconstructive surgery in illeofemoral area for patients with obliterating
atherosclerosis using morphometria of the vascular wall. The study investigates 49 patients operated on aortoilliac arterial
segment. Observation period took 5 years. Late thrombotic reocclusions were presented in 16 patients (32,6%). Morphological investigations with morphometria of vascular walls were carried out. During the early and late postoperative period
permeability of reconstructed zones, as well as main artery permeability further than anaestamosis zone were estimated.
Prognostically unfavorable signs in respect of high possibility of thrombotic reocclusions in late postoperative period are as
follows:presence of macrophages in the arteries, intimae hyperplasia with degenerative elements etc. According to this data  a prognostic model for determination of late postoperative thrombotic reocclusions for patients with aortoilliac arterial
surgery was created

An analysis of experimental investigation of 70 male Vistar rates and results of examination and treatment of 30 patients suffered by chronic low limbs ischemia caused by atherosclerosis has been completed. All experimental animals
were divided into three groups: healthy, control, and investigated respectively. A chronic limb ischemia was achieved
by excision of the main vessel such as femoral, popliteal, and upper part of calf vessels. Having achieved an ischemia
a treatment was not done in the control group. Whereas animals of the control group received injection of platelet enriched autoplasm into the calf and thigh muscles. It was discovered that intramascular injection of platelet enriched
autoplasm into the animal’s ischemic limb increases microcirculation level 2,4 times and dicreases area of muscular
necrosis by 2,4 times to 28 experimental day. In patients 500 ml of blood were derived, from which a platelet enriched
plasma was made. 100 ml of the plasma were injected under ultrasound guidance along the deep femoral and popliteal arteries of the more 2nd “b” degree ischemic limb. A contralateral limb was used as a control group. After the treatment a blood flow volume was increased 1,4 times, main 885,08– in 1,3 times, and microcirculation level – in 1,2 times.

The article contains dates of the research of efficiency perfluorocarbon emulsions in treatment of pyogenic infections of skin
and soft tissues on the group of 78 patients. After incision of abscesses of soft tissues, dressings of the septic wounds were
made using application of a perftoran. The study revealed the influence of perfluorocarbon at first stage wound healing. It
was revealed a rapid decrease in inflammation, an increase of wound’s healing rate, the reduction of treatment time. As a
result of the study it can be recommended to apply perftoran in treatment of purulent wounds after incision of abscesses in
treatment of pyogenic infections of skin and soft tissues

The method laser Doppler-flowmetria (LDF) carries out research of indicators of a microcirculatory bed at 66 patients with
fractures of long tubular bones the early postoperative period. It was established, that at patients as with an uncomplicated
current, and development of the slowed down consolidation of fractures in the first days of a trauma the microcirculation
indicator, the maximum amplitude of fluctuations of components of a vascular tonus decreases, the neurogenic, myogenetic
tonus raises, the given parametres remain invariable for the second days of the postoperative period. At the slowed down
consolidation reduction of an indicator of microcirculation and augmentation of indicators of components of a vascular
tonus at the tenth days of a postoperative intervention becomes perceptible. Application of method LDF at fractures of long
bones of extremities allows to supervise a current reparation process in the postoperative period and to expect possibility of
development of disturbance of an osseous tissue at the stage of preclinical manifestations

For operation performance on bodies of lumbar vertebras it is possible to use both posterolateral and anterolateral operative
approaches. Accurate criteria of a choice of approache are not present. There are criteria of a quantitative estimation of the
operative approaches, offered by Sozon-Jaroshevich. This article is devoted a comparative estimation of operative approaches
to lumbar vertebras on the basis of values of quantitative criteria of three widespread accesses – on Kornev, on Southwick
and Robinson, on Chaklin. Modelling of this accesses on 18 corpses of various type of a constitution was spent. Topographoanatomic distinctions of the specified approaches are as a result revealed, quantitative distinctions of right- and left-sided  approaches and distinction of criteria for each type of a constitution are proved

Deficiency of immunity after every surgical intervention? Which is accompanied with a serious illness, anesthesia, many
drugs (antibiotics), develop deficiency of immunity. And adhesive disease of peritoneum is the most frequent complication
of surgical operations. In accordance with some scientist, - implantation of the most effective antiadhesive polymeric agents,
can be the cause of development deficiency of immunity too. In experiments in white rats were studies indexes of immunity
in experimental abdominal adhesive process with implantation of prophylactic agent Mesogel. Were proved by experiments,
that immunomodulators. Derinat and Longidasa can correct the disorders of immunity in postoperative period

An experimental study was performed on 120 white Wistar "rats" Animals were divided into 4 groups, each group of 30
animals. When creating models of the CES, flowing mainly on the type of fat pancreatic necrosis was carried out with two
pathogenic FACT (ductal hypertension and activation of phospholipases). The dynamics of development of progressive fatty
pancreatic necrosis with marked cellular infiltration, formation of infiltration, the inflammatory reaction. In the second
series of experiments using crystalline trypsin shows the evolution of hemorrhagic pancreatic necrosis with involvement of
visceral organs, hemodynamic shock, DIC, as a result of uncontrolled proteolysis. Our studies allow us to consider the fat and
hemorrhagic pancreatic necrosis as different morphological units that must be considered in clinical practice

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