Vol 11, No 1 (2018)

The aim of the study was a determination of the prognostic significance of a non-invasive preoperative assessment to evaluate the functional state of residual liver parenchyma in order to prevent the development of acute hepatic failure.

76 patients with focal liver formation were examined. The first group included 46 patients, who were examined using the method of a non-invasive preoperative assessment of the functional state of residual liver parenchyma, which developed by the authors. The definition of the "resectional index" (IR) was made using the following formula: IR = Vint / TP (U), where Vint - the volume of intact liver parenchyma (cm3); TP - total protein of blood serum (g /l). The second group consisted of 30 patients, whose results of surgical treatment were analyzed retrospectively. Major hepatic resections were performed in 26 (56.52%) patients in the primary and 20 (66.67%) in the control group. The study conducted a comparative intergroup analysis of the frequency and severity of developing complications in the study groups. The complications were distributed according to the Dindo-Clavien classification scale, according to which the life-threatening complication rate was 8.7% and 26.67%, severe postoperative hepatic-cell insufficiency was detected in 2.17% and 16.67% of patients in the main and control group. The differences were statistically significant. It was defined value of the "resectional index" (more than 20 U), the excessing of which statistically significantly increased the risk of severe postoperative complications, in particular acute hepatic failure.

Relevance. The prevalence of cholelithiasis  increases with age and reaches 25-30% in elderly and senile patients [1]. The "golden standard" of surgical intervention for acute cholecystitis, by right, is considered to be video-laparoscopic cholecystectomy, but with severe concomitant pathology, video-laparoscopic cholecystectomy is limited. Even with the "open" cholecystectomy in patients older than 60 years, lethality is 5-10 times higher than in young people [4]. In connection with this, an alternative method of treatment of OX in patients of older age groups was proposed - thermal mucoclasiа of the gallbladder.

Aim. To carry out complex analysis of the results of laboratory and ultrasound methods of clinical examination in elderly patients with acute cholecystitis (AC) depending on two main types of surgical treatment: video laparoscopic cholecystectomia or thermal mucoclasia of a gall bladder.

Materials and methods. The results of the red and white blood counts, the assessment of biochemical blood parameters, immune markers and the outcomes of ultrasound examination of the gall bladder before operation and after different periods following this treatment were analyzed in elderly patients who were admitted urgently to the surgical units of the Kursk city hospitals.

Results and its discussion. In patients who underwent traditional cholecystostomy with the thermal mucoclasia lower values of erythrocytes, hemoglobin and general protein levels were detected demonstrating the presence of anemia. In this group the secondary immunodeficiency with alterations of the T-cell immunity was noted. These changes are most probably related to aging since the average age of these patients was about 10 years more than in the VLHE group. Patients who were operated by VLHE were admitted to hospitals with more pronounced changes of biochemical blood parameters, i.e. with higher levels of bilirubin, ACT, ALT and amylase.

Conclusions. The results of the present study can be used for the choice of the surgical operation and for the pre-operatory treatment of elderly patients with acute cholecystitis.

Background. Gynecomastia is one of the most famous and common paraneoplastic syndromes. With the growth of equipment clinics with modern diagnostic equipment, including the CT, increases the detection of breast pathology in men. There is the need for a correct interpretation of the data about the state of male breast by radiologists, and the attending physician, oncologist, mammologist, urologist, endocrinologist.

The purpose of the study to identify possible differences in frequency and radiation pattern of gynecomastia in patients with cancer and without it and also to follow the dynamics of the development of gynecomastia in patients with cancer, to identify the probable causes of the progression of gynecomastia in patients with cancer.

Materials and methods. It's data of 400 chest CT of men who were screened and treated for the different oncological pathology in Voronezh regional clinical oncological hospital in 2013-2015. And also data of 150 chest CT of men who were screened and treated for the various diseases (excluding oncological diseases) in the Voronezh regional clinical diagnostic center and Kursk regional clinical hospital in 2013-2015 was used.

Results. The data of the frequency of occurrence various types of gynecomastia in patients with cancer pathology and without it was obtained. The frequency of occurrence of gynecomastia in patients with cancer depending on the localization and morphology of tumor was analyzed. The dynamics of the gynecomastia in patients with cancer was tracked and possible causes of its progression in patients in this group were identified.

Conclusions:

1. Gynecomastia is a frequent pathology revealed by chest CT in men as suffering from oncological disease and without it.
2. Gynecomastia significantly more often found in patients suffering from prostate adenocarcinoma and renal cell carcinoma.
3. Surgical injury may be one of the reasons for the development of gynecomastia.
4. Feature of gynecomastia in patients with cancer is its asymmetry. When the detection of asymmetrical gynecomastia by chest CT is recommend the further examination of patient to exclude him cancer pathology, special attention should be paid to the prostate gland and the kidneys.
5. Upon detection of the progression of gynecomastia in a patient with a history of cancer need further examination to exclude cancer pathology progression.

Relevance. Adhesive disease is one of the threatening complications with a pronounced symptom complex of the dysfunctions of the organs of the gastrointestinal tract. The frequency of this pathology in the early postoperative period with operations on the abdominal organs reaches 11% among 19-25% of all complications. To date, the search and development of methods and means to strengthen the suture line, as well as improving of the hermeticity of inter-intestinal anastomoses remain relevant. In this regard, the prospects for the use of polymers and the development of such scientific areas as implantology in medical practice are unlimited.

Purpose. The aim of the study was to study the physical and mechanical features of polymer samples in a comparative aspect under the conditions of in vitro experiment.

The materials. Bi-component absorbable film implants based on cellulose polymers.

The methods. Microphotography of polymer film implants was carried out using a laboratory microscope Levenhuk D320L at magnification ×80. The thickness of the experimental samples was measured using an electronic micrometer iGaging 0-1" / 0.00005. Membranes with a size of 10×10 mm weighed using a laboratory balance. The volume and density of samples 10 × 10 mm were calculated. Determination of elasticity was carried out by fixing the angle at the moment of the integrity of the sample of the polymeric film implant in the native state.

The results. It was found that an important feature of these implants is their bilateral structure, which provides a more dense fixation to the damaged area and at the same time sufficient separation from the surrounding tissue. Thus, we selected samples No. 6, No. 1, which can be used for further in vivo studies.

The conclusion. Due to the variety of membrane properties and functions, it is possible to use polymer implants in many ways, which will affect the necessity and importance of using the selected samples in experimental and clinical implantology.

Actuality: A rare combination of a foreign body of the esophagus with Zenker's diverticulum and spontaneous pneumothorax can be mistakenly regarded as clinical and radiologic manifestations of perforation of the cervical esophagus, a dangerous condition requiring emergency surgery.

Objective: On the clinical example, to show the importance of an integrated approach in the examination of patients with foreign bodies of the esophagus to exclude the perforation of the esophagus.

Materials and methods: A rare clinical case of a combination of a foreign body of the esophagus with Zenker's diverticulum and spontaneous pneumothorax on the background of bullous emphysema in a 62-year-old patient is presented.

Conclusions: In a comprehensive examination of patients with both foreign bodies of the esophagus with suspicion of perforation of the latter and spontaneous pneumothorax, an important role is played by performing spiral computed tomography, which allows excluding or confirming the esophagus perforation and determining the primary or secondary nature of pneumothorax, thereby providing an accurate and timely diagnosis and choose the optimal surgical tactics.

Split-skin grafting takes the leading place when closing extensive soft tissue defects. Such defects can be the result of both an acute process (pyoinflammatory soft tissue diseases, surgical interventions) and chronic disorders in the skin and underlying tissues (trophic ulcers of venous and arterial genesis, fistulas, decubitus, complications of the diabetic foot syndrome).

The main criterion for assessing the result of split-skin grafting is the percentage of engraftment of the skin graft. There are several classifications that characterize the degree of closure of the recipient wound (Petrova VI, Rysmana BV, Gostishcheva VK). According to most authors, the successful outcome of split-skin grafting depends on several groups of factors. Systemic factors include the content of the total blood protein, hemoglobin, which should not be below acceptable standards. To the local - the readiness of the recipient wound to skin plasty. Microcirculation in the recipient bed plays an important role. The opinions of the researchers about the bacterial contamination of the wound and its effect on the processes of engrafting the flap are opposite. Some believe that a good engraftment of an autodermotransplant is possible even in the presence of a wounded pathogenic microflora in the wound. In modern works the negative influence of microorganisms on the results of split-skin grafting has been proved. Moreover, the upper limit of bacterial contamination of wounds is determined, the excess of which inevitably leads to unsatisfactory results of the transplantation of the skin.

The method of postoperative donor wound management is a separate issue in plastic and reconstructive surgery. The review examines the criteria for the readiness of a wound for split-skin grafting, various types of preparation of the wound bed for plastic closure, surgical techniques for performing split-skin grafting, and options for closing the donor wound.

The main field of Yu.S. Vinnik’s scientific interests is hepato-pancreatic-biliary surgery: acute pancreatitis, reconstructive biliary surgery, pancreatic injury, cholelithiasis and its complications; mechanical jaundice, surgery of the stomach and duodenum, herniology with the use of reticular endoprosthesis, surgery of the large intestine (x-ray endovascular surgery), purulent surgery, diabetic foot, frostbites (questions of the pathogenesis of cold trauma and the treatment of complications), immunodeficiency, cytokinotherapy, metabolic immunotherapy of surgical diseases, peritonitis; syndrome of systemic inflammatory response, use in surgery of new biopolymers - polyhydroxyalkanoates and medical products on their basis. Yu.S. Vinnik is the founder of the scientific school of abdominal and purulent surgery. Under the direction of Vinnik Yu.S. 47 candidate dissertations, 13 doctoral dissertations were defended. He is the author of more than 800 published works, 40 copyright patents of Russia and 37 monographs.

Since 1995, he has been elected to the present time as a full member of the New York Academy of Sciences, since 1996 he has been an academician of the International Academy of Sciences on Ecology, Human and Nature Safety (MANEB), since 1999 - full member of the Russian Academy of Natural Sciences (RANS) since 2000 - Academician of the Russian Academy of Natural Sciences (RANS), Corresponding Member of the Russian Academy of Natural Sciences (RAE), Academician of the Petrovsky Academy of Sciences and Arts (PANI). Honored Doctor of the Russian Federation. Honored Worker of Science and Education of the Russian Federation. Vinnik is member of the Editorial Board of the journals of the VAK "Annals of Surgical Hepatology", "Bulletin of Experimental and Clinical Surgery", "Surgery News", "Moscow Surgical Journal", "Siberian Medical Review", "Surgical Practice". Member of the Russian Society of Surgeons, the Russian Society of Surgeons-Hepatologists, the Russian Society of Surgeons-Gastroenterologists, the Russian Society of Herniologists, the Association of General Surgeons of the Russian Federation, the Russian Society of Endoscopic Surgeons.

Victor Savelyev was born in 1928 in Tambov region. He studied in the 2nd Moscow medical Institute (now Russian national research medical University named after Pirogov) from 1945 to 1951, after which he worked as an assistant at the Department of faculty surgery. He successfully defended his Ph.D. (1955) and doctoral (1959) dissertations. V. Savelyev for the first time in the Soviet Union fulfilled the prosthesis of bifurcation of aorta and nameless arteries, closed comissurotomy with aortic stenosis, have developed a method of extracorporeal circulation without filling of the apparatus with donor blood, but also the original model of the pacemaker. In 1967, Saveliev was elected head of the Department of faculty surgery and corresponding member of the USSR Academy of medical Sciences, and then -academician of the USSR Academy of medical Sciences (1974). For the first time he fulfilled reconstructive operations in upper Vena cava syndrome, thrombectomy for Paget–von Schrötter disease, surgical interventions for acute thrombosis in the inferior Vena cava system. He was the author of the manual on emergency abdominal surgery, reprinted three times (1976, 1986, 2004). V. S. Savelyev was elected an academician of RAS in 1998. He was chief surgeon of the Ministry of health of Russia for 38 years. V. Savelyev was Chairman of the scientific society of surgeons of Russia, President of the Russian Association of phlebologists, editor-in-chief of the journals "Thoracic and cardiovascular surgery" and "Phlebolymphology", honorary member of a number of foreign medical scientific and surgical societies. He is author of more than 500 scientific works, including more than 19 monographs. Under his leadership, more than 70 doctors and more than 300 candidates of medical Sciences have been trained.

V. Savelyev has a number of state awards. Victor Saveliev died on December 25, 2013 at the age of 86.

Valery Radushkevich was born on 20 Jan 1908 in Irkutsk. After graduating from the medical faculty of Siberian state medical Institute (1926-1931), he studied in clinical residency (1935-1936) and worked in the district hospital and then assistant hospital surgical clinic of the Novosibirsk medical Institute (1937). Also he was Director of the Novosibirsk regional station of blood transfusion (since 1938). During the great Patriotic war Valery Pavlovich – leading surgeon of the Novosibirsk hospital No. 1504, and then chief surgeon of the Novosibirsk (1945-1947). In 1948, he defended his doctoral thesis on the surgical treatment of arteriovenous aneurysms. He worked as the Director of the Voronezh state medical Institute (1950-1954), the head of the Department of hospital surgery (1950-1974), chief doctor of the Voronezh regional clinical hospital (1959-1970). In 1967 V. P. Radushkevich awarded the honorary title of Honored scientist of the RSFSR. For 25 years Valery Pavlovich was the Chairman of the Voronezh regional scientific and practical society of surgeons. He was the author of over 200 scientific works, including monographs: "Cardioversion of atrial fibrillation" (Voronezh, 1966), "Electrical defibrillation with atrial fibrillation and its importance in the surgery of mitral stenosis" (Voronezh, 1977). He was a member of the editorial Board of the journal "Surgery" and "Experimental surgery". V. Radushkevich was awarded the order of Lenin and Labor red banner, medals. Valery died 27 June 1976. The house, in which he lived, a memorial plaque.