Vol 10, No 4 (2017)

Purpose. Assess the results of portal systemic shunting (PSSh) in patients with liver cirrhosis (LC) with ascitic syndrome.

Materials and methods. Analyse the results of PSSh in 556 patients operated a year from 2000 to 2015. The basis of the analysis taken all the features related to the development and progression of ascitic syndrome. Depending on the shunt type, research conducted with most frequently performed shunts groups.

Results. Initial decompensated cirrhosis by edema-ascites syndrome significantly increases the risk of specific complications such as hepatic insufficiency from 6.9% to 13.5%, hepatic encephalopathy from 12.1% to 16.2% and increase in ascites from 7.2% to 16.2%, and the mortality rate from 2.1% to 3.8%. The main cause of early mortality after PSSh is a risk of thrombosis of the anastomosis with recurrent bleeding, whereas other specific complications, conservative measures allow neutralizing the difference in the index of satisfactory results of the operation (96.2% — in the group with ascites before PSSh against; 97.9% — in the group without ascites). Quantitative and qualitative analysis of ascites showed that in the coming period after the shunt (3-5 days) the development of this complication depends on the type of bypass surgery, so when the distal splenorenal shunts (DSRS) production of ascites significantly increased (P <0,01), while total protein component fluid significantly (P <0,02) higher than in patients in ascites with central bypass type. This fact is due to the formation of the selective type of bypass on the background of DSRS, and the growth of ascites does not depend on the presence of complications before surgery, indicating that the impact factor of the severity of portal hypertension and therefore the adequacy of decompression of the portal vein system, against which a decrease in blood albumin fraction and increase it in ascites (R2 = 0,57) may be indicative of a high residual portal pressure.

Conclusion. In patients with cirrhosis after PSSh in 70.2% of cases of decompensation of ascites syndrome is caused directly with cirrhotic process and the growth of functional impairment of hepatocytes, the remaining 29.8% of cases, the formation of the complications associated with the progression of PH syndrome on the background of anastomotic thrombosis.

Relevance. Purulent complications occur in 35-45% of patients with surgical diseases, lethality rate from these conditions achieves 25%.

The purpose of the study. To investigate the wound process while treating the purulent wounds with immobilized forms of miramistin and benzalkonium chloride in gel of sodium salt of carboxymetylcellulose.

Materials and methods. There were analysed results of experimental study of the wound process on 108 male Wistar rats. Experimental animals were divided into 3 groups, each group included 36 rats. In a comparison group ‘Levomekol’ ointment was used for treatment. In the first experimental group treatment was done by the ointment with the following composition: 0,01% solution of miramistin — 100 g, metronidazol –1,0 g, sodium salt of carboxymetylcellulose — 4,0 g, while in the second experimental group ointment composition included benzalkonium chloride 0,02 g, metronidazol — 1,0 g, sodium salt of carboxymetylcellulose — 4,0 g, purified water — up to 100,0 g. The wound process was evaluated by planimetric, microbiological and histological methods of investigation.

Results and its discussion. The reduction of wound area in the first experimental group was higher than in a comparison group on the 3rd day of the experiment by 9,7%, on the 5th day — by 7,6%, on the 10th and 15th days — by 10,5%, while in the second experimental group the change was 37,2%, 27,3%, 13,8% and 6,9% respectively. In the first experimental group microbial contamination of the wound was less than in a comparison group by 5,8х106, on the 5th day — by 3,1х105, on the 10th day — by 6,1х104, while in the second experimental group on the 3rd day there were no differences, on the 5th day — by 6,3х105, on the 10th day — 1,1х104. Histological investigations of the wound biopsies on the 10th day of experiment showed that in a comparison group the bottom of the wound was covered by granulation tissue without signs of epithelization, there was full coverage of the wound with a newly formed epithelium in experimental groups.

Conclusions. The use of prolonged quaternary ammonium antiseptics in treatment of purulent wounds is pathogenetically justified and efficient.

Relevance: the method of dosed dermotension as one of the options for plastic reconstruction of the foot with the soft tissue defects of various etiologies (including diabetes mellitus) are widely used in surgery. Local circulatory compensated hypoxia, occurs when dosed dermotension, stimulates proliferation of blood vessels, but to date no proven link between measured growth and the concentration of cytokine HIF-1α.

Aim: the aim was to identify patterns between local circulatory compensated hypoxia created by carrying out the dosed dermotension and cytokine concentration of HIF-1α in stretched the flap when closing the wound of the soft tissues.

Materials and methods: the experiment was carried out on 18 experimental animals, which was simulated wound scapular area and conducted a hardware apparatus dermotension under the control of laser Doppler flowmetry, formed the skin samples and performed enzyme-linked immunosorbent assay to determine the concentration of cytokine HIF-1α after 30 minutes, 24 hours from the beginning of tissue stretching.

Results: the concentration of HIF-1α in the skin before the start of the dermotension was (Me [Q1; Q3]) 110 [98,1; 114,8] ng/ml. A statistically significant increase in the concentration of HIF-1α to 148 [122,2; 221,7] ng/ml (p=0.008) recorded in the group of animals who underwent tissue stretching within 30 minutes, research also showed that the concentration of HIF-1α increased to 330 [246,4; 463,3] ng/ml (p=0.007) after 24 hours from the start of the dosed strains.

Conclusion: the concentration of cytokine HIF-1α in stretched the flap increases with dosed dermotension. Thus, the regulation of adaptation of the skin to stretching is performed by increasing the concentration of the cytokine HIF-1α.

Background. At present time there are few works throwing some light on the details of solving a problem in a field of experimental medicine by the "how to do it" principle which after having studied them give readers a good grasp of reproducing the offered technique on their own. It also concerns blood sampling with the aim of assessing certain indicators at small laboratory animals.

Objectives. To work out the technique of carotid artery catheterization for detecting the referential meanings of biochemical and complete blood tests coagulogram on Wistar male rats. To define more precisely the obtained values by the bootstrap method and to compare them with the data to have published before.

Materials and methods. The research was conducted on Wistar male rats (n=42) weighing 270-380 g. The access to the left carotid artery was implemented with taking into account some anatomic features of an animal being anesthetized with tiletamin/zolazepam (20-40 mg/kg intramuscularly) + xylazine (5-10 mg / kg. intramuscularly). Statistical treatment has been conducted in the programming language R with using the statistical packages "boot", "car", "sm", "coin", "VIM" and "mice". The referential meanings have been defined by the bootstrap method.

Comparing with literature data was executed by the permutational test with p-level correction for multiple comparisons by using the Benjamini-Yekutieli method, the level α was accepted as equal 0,05.

Results and Discussion. The rational access to a carotid artery and its catheterization way have been developed. The referential meanings of biochemical and complete blood tests coagulogram were developed and defined by using the bootstrap method on Wistar male rats. While comparing the indicators to have received earlier from Wistar male rats by other researchers, the statistically significant differences were received in all indicators, except the quantity of leucocytes, thrombocytes, and indicators of hematocrit and total bilirubin. The received differences are likely to be connected with different climatic conditions, the character of anesthesia care, accessing to blood sampling, and wide range of the compared rats’ age. Clinically differences are insignificant.

Conclusion. The developed algorithm for obtaining referential meanings of blood tests samplings from rats can be considered to be rational and reproduced and the received indicators’ values should be considered to be referential.

Relevance. The issue of obstetric bleeding has always been acute. In the last decades, there has been a significant improvement in prophylaxis techniques as well as bleeding control during both vaginal and operative delivery. Yet, hemorrhage complications continue to endanger the mother's life and require a lot of effort from the hospital staff. Thus, it is essential that we develop more efficient prophylaxis techniques when dealing with obstetrics patients with the uterus scar and low insertion of placenta.

The aim of the research was to assess the hemostasis when using hemostatic uterus suture (by Radzinsky modification).

Materials and methods. The surgery process was analysed together with the post-surgical period in relation to obstetrics patients with the second cesarean transection and low insertion of placenta. For prophylaxis of hypotonic hemorrhage, a compression suture (by Radzinsky modification) was applied to the lower uterus segment. Maternity patients were administered perioperative antibiotic prophylaxis and methylergometrine (1,0 ml) immediately after the extraction of infant from uterus. Intraoperative bleeding was assessed gravimetrically. It was followed then by monitoring the postsurgical period, including the temperature reaction, clinical blood analysis, ultra sound diagnosis of the uterus involution and the control of the uterine arteries.

Results. There were no complications during the postsurgical period, as well as nosological consequences, including sub involution and lochiometritis; also, the temperature did not exceed 37,0 С and the blood tests did not show high white blood cell count at the time the patients were released. The uterine arteries had unchanged blood circulation, similar to the condition before pregnancy. All the obstetrics patients under analysis were released with no complications on 4-5 day after the delivery.

Conclusions. The compression suture can be considered an efficient and safe method for prophylaxis of hypotonic hemorrhage in relation to the high risk group of obstetrics patients.

Relevance. Trophic ulcers on the background of systemic diseases are characterized by long flow and cause greater difficulties in treatment due to the reduced regenerative capabilities of the body. As a result of taking hormones muscles and skin become atrophic changes. Thinning and dry skin are particularly susceptible to trauma. Trophic ulcers in systemic connective tissue diseases often have no specific signs. Indicate systemic disease can atypical localization (thighs, buttocks, torso, upper extremity, head, mucosa of the oral cavity) wound, long for ulcers, with no tendency to regenerate, the big help in diagnostics renders the identification of syndromes, evidence of systemic autoimmune lesions of organs and tissues (polyarthritis, polyserositis, damage internal organs).

Purpose: description of the case of the treatment of the patient with Sjogren disease.

Materials and methods. In this report a clinical case of treatment of ulcers of the tibia on the background of long-term hormonal therapy. Patient more than 20 years of suffering from Sjogren's disease. Diagnosis of Sjogren’s disease (chronic, moderate activity (II) expressed stage), dry keratoconjunctivitis, parenchymatous parotitis, xerostomia, Raynaud's Syndrome, trophic ulcer of left tibia and varicose disease of the lower extremities, 2.

Sjogren’s disease - a systemic autoimmune disease characterized by involvement of exocrine glands, mainly salivary and lacrimal, with the gradual development of secretory failure, combined with various systemic manifestations. Local treatment of trophic ulcers took place against the background therapy of the underlying disease. In the first stage for cleansing the surface of trophic ulcers used for the contact controlled cryodestruction was carried out hydropressing treatment of the wound. The result - on the 5th day the wound was completely cleansed from necrotic tissue. Further, the local treatment consisted in the creation of optimal conditions for regeneration. After 4 weeks the wound is almost completely epithelization.

Conclusions. When Sjogren's disease treatment of ulcerative defects of the skin of the lower extremities takes place on the background of long-term hormonal medications. An important condition for wound healing is to decrease the dose of hormones to the minimum necessary. In this clinical observation in local treatment was applied the technique of contact controlled cryodestruction of pathological tissues on the surface of the ulcer.

After operations on the abdominal adhesions occur in 80-90% of cases, adhesive disease develops in 12-64% of cases. First about the causes of adhesions said George Punter in 1793. For the first time in the Russian literature on intraperitoneal adhesions mentioned V.P. Dobrovolsky in 1838. According to modern notions, adhesive disease is a separate nosological form, characterized by the formation of intra-abdominal adhesions, as a rule, manifested by recurrent episodes of intestinal obstruction or pain. The basis for the development of peritoneal commissures in abdominal cavity are a complex, diverse violations of the functions of various body systems. Trigger in the development of adhesion formation in abdominal cavity considered: mechanical, physical, infectious, implant, chemical factors and congenital anomalies (bands of lane, membranes of Jackson and others). As a result of inflammation of the peritoneum dystrophic process, accompanied by desquamation of the mesothelium and other connective tissue layers of the peritoneum, there is an allocation of exudate, coagulation of protein components and formation of fibrinous adhesions, which under normal fibrinolytic activity within 24-72 hours lysed. There are four degrees of prevalence of adhesions: grade I – local adhesions, occupying not more than 1/3 of one floor; II degree – additionally determined by single spikes in other areas. III and IV degree – adhesions, occupying 1/3 and 2/3 of the abdominal cavity, respectively. The clinical picture of adhesive disease is expressed aching pain in the abdomen, changing its character with the change of body position; periodic bloating, unstable chair; vomiting during exercise or after violation of the diet, the phenomena of complete or partial adhesive intestinal obstruction. Diagnostic informativeness of traditional x-ray methods is only 50-60%. The most informative is the use of contrast enterography and ultrasound examination of the abdomen with a directed study of problem areas of the abdomen. Prevention of adhesions is an important problem of practical surgery. Methods of preventing the formation of adhesions are the following: reduction of abdominal trauma, reducing inflammation in the area of operations, reducing the likelihood of deposition of fibrin in the free abdominal cavity, the suppression of postoperative paresis of the intestine, delimitation of the damaged serosal surfaces and interfere with adhesion by applying a protective film on the mesothelium. Application drugs does not negate the careful attitude to the tissues and accurate surgical interventions. Conservative treatment includes: electrophoresis lidazy, hydrocortisone, application of paraffin, ozokerite on the anterior abdominal wall, injection antispasmodics, nasogastric drainage, staging of hypertension and cleansing enemas and others. Indications for operative intervention are: absence of effect of conservative treatment, the deterioration of the patient, the symptoms of acute intestinal obstruction. The following types of surgery: enteroclysis, the imposition of intestinal anastomosis with or without bowel resection laparoscopic lysis of adhesions, entropicalia.

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