Vol 11, No 2 (2018)

OBJECTIVES: This study aimed to assess mitral valve function after repair of ventricular septal defect (VSD) combined with mitral regurgitation (MR) in the mid-term follow-up period, to evaluate the clinical utility of simultaneous mitral valve repair (MVR).

METHODS: From June 2005 to March 2014, 60 patients with VSD and MR underwent surgical treatment. After performing propensity score analysis (1:1) for the entire sample, 46 patients were selected and divided into 2 groups: those with VSD closure and MVR - 23 patients and those with VSD closure without mitral valve intervention - 23 patients. The follow-up period - 32 (28;40) months.

RESULTS: There was no postoperative mortality in either group. There was no significant difference in the duration of the postoperative period between groups. Mean cardiopulmonary bypass time and aortic cross-clamping time were significantly longer in the 'VSD + MVR' group (cardiopulmonary bypass, P=0.023; aortic cross-clamp, P< 0.001). There was no significant difference in regurgitation area (P=0.30) and MR grade (P= 0.76) between groups postoperatively. There was no significant difference in freedom from MR ≥ 2+ between groups (log-rank test, P= 0.28). The only significant risk factor for recurrent MR ≥ 2+ during the follow-up period was mild residual MR in the early postoperative period ( P=0.037).

CONCLUSIONS: In infants with VSD combined with MR, simultaneous MVR has no benefits simultaneous MVR provided no advantage over that of isolated VSD closure. We found that the presence of mild residual MR in the early postoperative period predisposes the development of MR ≥ 2+ in follow-up period.

The problem of determining indications for surgical treatment of adhesive peritoneal disease is relevant in connection with the lack of reliable criteria that allow us to detect intestinal obstruction at early stages. The authors studied the x-ray picture of chronic adhesive peritoneal disease in two groups of patients, without obstruction (6 patients) and in the group of patients with obstruction (5 patients). X-ray computer tomography diagnostics was carried out using the Aquilion RXL, Toshiba Japan, VitreaAdvanced software was used to build the virtual model. For the comparative analysis, nonparametric statistics were used to calculate the Pearson criterion, with the Yates correction. The authors proposed the criteria of X-ray tomographic examination, which allow differentiating the adhesive intestinal obstruction from exacerbation of peritoneal adhesion. To these signs, the authors refer, pneumatized loops of the intestine, the presence of fluid in the lumen of the small intestine, the accumulation of fluid more than 200.0 ml, in two or more areas, thickening of the intestinal wall more than 2.1 mm. It was shown that the use of the developed complex of symptoms in the diagnosis of the disease positively affects the results of surgical treatment.

Despite the active development and introduction into clinical practice of new groups of antibacterial drugs, the basis for the treatment of purulent-septic diseases of soft tissues is the opening and surgical treatment of a purulent focus. When we analyzing the literature data on the treatment of purulent soft tissue diseases, the following factors can be identified that determine the progression of the purulent-inflammatory process even with an adequately uncovered purulent focus: the presence of common co-morbid diseases that reduce the body's resistance (infectious diseases and metabolic disorders) and attachment to the pathological process multidrug-resistant virulent hospital flora [1, 2]. Progression of the purulent-necrotic process takes place along anatomically determined paths of pus spread, and therefore the absolute necessity of firm knowledge of the topographic anatomy of the human body is obvious. Perhaps the most complete and thorough description of the clinical picture and methods of surgical treatment of phlegmon of the upper limb and thorax, based on anatomical principles, is given in the classic work of V.F. Voino-Yasenetsky [3], since the first publication of which it has been almost a century. Currently, due to the prevalence of antibiotic resistance even of "wild" microorganisms, the prevalence among infectious diseases affecting the immune status of the organism (hepatitis, tuberculosis, HIV), as well as the pandemic of diabetes, the urgency of surgical treatment of common purulent processes in the region upper extremity and thorax again increased.

We present the clinical case of progression of the purulent process on the left upper limb from the lower third of the arm in the distal direction to the Pirogov-Paron space and in the proximal direction to the submentoral and pre-lobular cell spaces.

Relevance. Transverse platypodia takes up to 80% of feet deformities, and more than 400 methods for its correction have been developed. The most common in Izhevsk are Shede, Scarf + Akin and the method of Fedorov VG.

Aim: to evaluate the results of these operating tactics on the AOFAS scale.

Materials and methods. The study involved 50 patients, 48 women and 2 men, operated in Republican Clinical Hospital №1 at the Ministry of Health of Udmurtia, the FBHI of Udmurt Republic 'City Clinical Hospital at the Ministry of Health of Udmurtia №6', the FBHI of Udmurt Republic 'City Clinical Hospital at the Ministry of Health of Udmurtia №3' in the period from 2015 to 2016.

Results. Evaluation of treatment results on the AOFAS scale for a period of one year after the operation was: Shede - 65 points, Scarf + Akin - 80 points. While Fedorov's technique with patent number 2517768 is 95 points.

Conclusion. Due to the combination of the above listed classic techniques plus arthrodesis between the medial sphenoid bone and the base of the first and second instep bones, it is possible to achieve the best results.

Background. Testing a new method of hemostasis in surgery often goes through the experimental stage. The key point is selecting animals, and eligibility of the obtained experimental results extrapolating to humans. Experimental rats are often used for studying the hemostasis system indicates in modeling various pathologies in surgery. The emergence of the low-frequency piezothromboelastography technique in combination with the coagulogram findings, general blood test, protein C and plasminogen indicators has been able to detail the available knowledge about the hemostasis system at these animals and to help avoiding errors in interpreting the results obtained in the experiment.

Aim. To determine the features of the Wistar line rats’ hemostasis system parameters in comparison with the same human ones being important for experimental surgery.

Materials and methods. The research was conducted on Wistar male rats (n=32) weighing 349 ±33 g (M±σ). Blood was taken from the left carotid artery under conditions of anesthesia with tiletamine / zolazepam (20-40 mg / kg intramuscularly) + xylazine (5-10 mg / kg intramuscularly). Eight seconds before blood without citrate in a volume of 0.45 ml was placed in a cuvette of the LFPTEG technique ARP-01M “Mednord” in settings of which the delta was used to take a maximum point equal to 1, and the waiting time of the curve rising was 20 minutes. The next blood sample was collected in a test tube with 3.8% citrate in a volume of 4.5 ml (9:1) for investigating the fibrinogen level at the Thrombotimer 4 Behnk Elektronik semi-automatic coagulometer, the activated partial thromboplastin time (APTT) values, prothrombin time (PT), thrombin time (TT) and antithrombin III at the automatic blood coagulation analyzer Sysmex CA 600, and activity of plasminogen and protein C at the semi-automatic Riele 5010 v5 + photometer with a wave length of 405 nm. Studying the hematocrit indicators and determining the platelet count were performed at the automatic hematological analyzer ABX Micros ES 60. The reagents of Ltd "Tekhnologiya standart" were used for detecting the parameters of the hemostasis system. Parameters of the LFPTEG technique for human had been taken from the cited literature, the other indicators had been obtained from 120 healthy adult volunteers. Statistical processing was implemented in the programming language R with using the statistical packages “VIM”, “mice”, “car”, “sm”, “coin”, “boot”. The LFPTEG technique reference values ​​ in rats were refined by the nonparametric bootstrap method. The comparison between the groups was carried out by Mann- Whitney's test and rechecked by the Permutation test with the level p correction for multiple comparisons by the Benjamin-Yekutili method. The α level was assumed to be 0.05 after correction.

Results and Discussion. Most indicators of the rat hemostasis system differed from the same human parameters, except the hematocrit (p3=0.84, p4=0.98) indicator, and the lysis intensity, and retraction of the clot (p3=0.15, p4=0.067) indices. The I-II coagulation phases were increased at the background of decreasing protein C activity by 29%, increasing the number of platelets and their activity by 69% and 79%, intensification of thrombin activity and acceleration of its formation by 35% and 30% in a rat compared to a person. At the III phase of coagulation the proteolytic stage was noted to become intensified by 37% and the polymerization to become weakened by 44%. The clotting time was shortened by 29%, and the thrombin time was prolonged by 64% that did not contradict the coefficient growth of total anticoagulant blood activity (TAAC) by 62%. Other indicators have clinically differed a little.

Conclusion. The Wistar line rats’ haemostasis system is very similar to human one except significant increasing of the I-II coagulation phases, the III proteolytic phase, and significant weakening of its polymerization stage probably due to increasing the plasmin system activity, the anticoagulant blood activity at this stage, and decreasing the fibrinogen level. Rats evolutionarily must be considered to be better suited to stop bleeding after trauma while performing a surgical experiment.

The surgical stage of treatment remains the main one in the complex therapy of breast cancer. The review of modern reconstructive plastic surgery, performed by single-step and delayed after radical mastectomy, is presented. Against the background of a huge number of existing methods of breast reconstruction, three main types have become the most popular among surgeons to date: the use of own tissues, silicone endoprosthesis and their combination. The final choice of the option of breast reconstruction depends on the volume of cancer surgery, plastic tissue, somatic condition of the patient and her desire. Reconstructive plastic surgery for breast cancer does not affect the course of the disease and are not an obstacle to chemotherapy.

Wide introduction of videoendosurgical technologies in all surgical specialties has become a challenge for teachers of medical universities. According to many authors, the use of virtual simulators proved to be unjustified, which compelled us to conduct a study to determine the place of virtual endosurgical simulators in the training program of a specialist of surgical profile. The experiment involved 36 clinical residents who took the training simulation course (108 hours) in the training virtual clinic (simulation training center) of VSMU N. N. Burdenko during 2016-2017. Students were divided into two groups. In the first group, classes were held on the Gross-SMITH simulators, equipped with simulators of laparoscopes ending with cameras with options axis angle 0 and 30 degrees. In the second group, classes were held on a virtual simulator with tactile backlink LapVR. At the end of the course, each resident was asked to do control exercise – to stitch pig's stomach, which had a wound with two markings indicating where to lead the needle. Videoendosurgical simulator Gross-SMITH was used to perform a control exercise. The results of the study confirmed the effectiveness of the use of virtual endosurgical simulators with tactile backlink in the formation of the basic skills of videoendoscopic surgery. The formation of the skill of tying an intracorporal knot proved to be more effective in training with the use of videoendosurgical simulators Gross-SMITH and real surgical instruments.

Yuri F. Isakov was born in 1923 in the city of Kovrov of the Vladimir region. He participated in the great Patriotic war. In 1951 he graduated from the medical faculty, Isakov was attending physician (1951-1953) and post – graduate student of Department of pediatric surgery of the 2nd Moscow medical Institute. In 1955 he defended his Ph.D. thesis on the topic "Intravenous and intraosseous anesthesia in operations on the extremities in children", in 1963 – his doctoral thesis on the topic: "Hirschsprung's disease in children (pathogenesis, clinic, treatment)". He became Professor in 1964 and head of the Department of surgical diseases of childhood of the 2nd Moscow medical Institute in 1966. Isakov was appointed chief pediatric surgeon, head of the Main Department of educational institutions of the Ministry of health of the USSR. A number of progressive reforms were held under his leadership including biennial specialisation, adapted to the tasks of practical health care curricula, was introduced. The all-Union children's surgical centre was created by Isakov' initiative. Since 1981, Yuri F. Isakov was Deputy Minister of health of the USSR, 1989 – Vice-President of Academy of medical Sciences of the USSR (later the Russian Academy of medical Sciences). He was chief pediatric surgeon of the Ministry of health of Russia from 1993 to 2005. He was Chairman of the Presidium of the Russian Association of pediatric surgeons, the Bureau of the scientific Council on pediatric surgery of the Ministry of health of the Russian Federation and the Russian Academy of medical Sciences, editor-in-chief of the journal "Pediatric surgery", Advisor of the Presidium of the Russian Academy of medical Sciences. Yuri Isakov is the author of over 400 scientific works, including 23 monographs, 8 textbooks and manuals, 12 inventions. Yuri F. Isakov died on August 4, 2016 in Moscow.

Vladimir Semyonovich Levit was born in 1883. He studied at the Medical Faculty of the University of Konigsberg (1901-1906). In 1914, Vladimir Semenovich defended his doctoral dissertation, became head of the surgical department of the Simbirsk Province Hospital, and began teaching at a paramedic school. V.S. Levit was elected privat-docent of the faculty surgical clinic of Tomsk University (1919), privat-docent (1922), then professor and head of the department of the faculty surgical clinic, dean of the medical faculty (1922-1926) of Irkutsk University, head of the department of hospital surgery of medical faculty of 2nd Moscow University (since 1926), which was headed for 27 years. V.S. Levit for the first time in the USSR successfully resected cardia (1928), surgery for hernia of the esophageal aperture (1929). He was awarded the title of Honored Scientist of the RSFSR in 1936. During the Great Patriotic War V.S. Levit was appointed chief surgeon of the Moscow Military District, deputy chief surgeon of the Soviet Army (1942), and in 1943 he became a major general of the medical service. Since 1950, V.S. Levit was chief surgeon of the Central Military Hospital named after P.V. Mandrik. He published 120 scientific works, he was the editor of 3-volume manual, 2-volume textbook on surgery, the surgical section of the Great Medical Encyclopedia, the publication "The Experience of Soviet Medicine in the Great Patriotic War of 1941-1945." V.S. Levit was the editor of the magazine "Soviet Surgery" (later "Surgery") (1931-1953), a member of the editorial board of the journals "New Surgery", "Russian Clinic", "Central Medical Journal." He was the head and scientific consultant in the preparation of 23 Ph.D. and 10 doctoral dissertations. V.S. Levit was a member of the International Surgical Society, chairman of the Moscow Surgical Society, a member of the Academic Council of the Ministry of Health of the USSR, and district Soviets of Working People's Deputies. V.S. Leviticus was awarded the Order of the Red Banner, the Patriotic War of the 2nd degree, the Red Star, medals. V.S. Leviticus died in 1961 in Moscow.