Vol 12, No 1 (2019)

Objective. The compensation of digestive disorder in patients who already had gastric operation by using jejuno(colo)gastroplasty at re-reconstruction of the digestive tract.
Methods. During 2012-17 in Vishnevsky surgery institute 33 repeated operation were conducted on the patients who had already had resection and antireflux gastric operations. As a repeated operation was conducted jejunogastroplasty in 31 (93,9%) cases, after distal gastrectomy - 8 (24,3%) from them; after gastric stump removal - 7 (21,2%), after еsophagojejuno anastomosis resection - в 2 (6,1%). Also 3 (9,1%) patients were operated on using interposition of the discharge loop into the duodenum: 2 - after gastrectomy with Braun and Roux-en-Y и 1 - after Distal gastrectomy, Hoffmeister. Esophagogastro anastomosis resection; jejunogastroplasty in Merendino-Dillard were conducted on 11 (33,3%) patients. A segment of transverse colon as a plastic material was used on 2 (6,1%) patients: у 1 - after gastric stump removal, у 1 - after еsophagojejuno anastomosis resection.
Results. In the early postoperative period 2 (6,1%) patients had surgical complications: one had Partial esophagojejunо anastomosis leakage, the other - under diaphragmatic abscess. One fatal case from progressing multiple organ failure was recorded in the first 24 hours. By the end of the research 28 (84,8%) of 33 patients stayed under the surveillance. The examining of the patients revealed good results after the operation of 21 (75,0%) patients and satisfactory results after the operation of 7 (25,0%) patients. 
Conclusion. We believe that principles proposed of physiological reconstruction of the digestive tract are universal for primary gastric interventions as well as for repeated ones. It is worth noting that the repeated operations don’t always fully remove clinical manifestations diseases of the operated stomach but significantly decrease their severity by strengthening the patients physically by restoration of physiological passage of food and the expansion of the nutrition.

The ratio of the prevalence of the gallstone disease (GSD) in the elderly and senile age groups compared with young and middle-aged patients can reach 3:4. The main complication of the GSD is acute cholecystitis, which is observed in more than 90% of patients. However, the most dangerous complication is considered to be obstructive choledocholithiasis, which leads to the development of mechanical jaundice and cholangitis in 10 - 35% of cases.

The aim of the researchwas to propose an algorithm for the treatment of the GSD complicated by acute cholecystitis and obstructive choledocholithiasis in elderly and senile patients with severe concomitant pathology.

Methods.The study is based on the analysis of the results of examination and treatment of 47 patients with GSD complicated by acute calculous cholecystitis and obstructive choledocholithiasis. All patients were divided into 3 groups. The first group included 17 patients in whom, in addition to acute cholecystitis, choledocholithiasis with concretion infringement in the BSDK was detected. The second group included 24 patients in whom, in addition to acute cholecystitis, obstructive choledocholithiasis and cholangitis were diagnosed. The third group included 6 patients in whom for some reason choledocholithiasis was not diagnosed at the first stage or it occurred later as a complication of cholecystostomy.

Results.For patients of the first group the endoscopic papillosphincterotomy on stone was performed followed by cholangiography to find out the status of the bile ducts. Patients of the second underwent percutaneous transhepatic choledochostomy at the first stage. Patients of the third group were injected a Foley catheter into the cavity of the gallbladder through the cholecystostomy opening and the cavity of the gallbladder was sealed. Saline solution was injected into the lumen of the gallbladder and its ducts under the pressure of 250 mm. aq. art. This led to the dilatation of the lumen of the bile ducts.

Conclusions.The proposed algorithm allows radical treatment of the GSD complicated by choledocholithiasis and cholangitis. The differentiated approach to the transpapillary solution of choledocholithiasis allows to minimize the risk of post-manipulation pancreatitis. AAPST allows to cure choledocholithiasis when endoscopic papillosphincterotomy is dangerous or not feasible.

Relevance. Currently, acute appendicitis occupies a leading position in the structure of surgical diseases that require urgent surgical intervention. A significant part of operations for acute inflammation of the appendix is ​​performed from the laparoscopic approach. But, despite the wide possibilities of modern medicine, it is often necessary to resort to traditional laparotomic access. The classic access to the appendix is ​​the access via Volkovich-Dyakonov through the Mac-Burney point or the Lanz point. In fact, in most cases, the projection of the base of the appendix does not coincide with the Lanz and Mac-Burney points. This is due to differences in the location of the appendix in the abdominal cavity, as well as with individual constitutional parameters, including the presence or absence of obesity. In addition, in women the dome of the cecum and the appendix are slightly lower than in men. Considering these aspects, as well as the inadmissibility of delaying surgical treatment, it becomes necessary to determine the access point to the appendix as clearly and quickly as possible.

Aim is development and implementation of the surgeon’s intellectual decision support system (IDSS) in the definition of operative access to the appendix in people with abdominal obesity.

Materials and methods: for the development of the IDSS of the surgeon, 101 SKT images were analyzed, which were used to build 3D models of the studied areas. 3D modeling allows for more accurate geometric measurements. The program “Inobitec DICOM Viewer” was used to work with images. It was decided to use the development environment “Embarcadero Delphi XE7” to implement the decision support system.

Results: an algorithm was developed to support the surgeon's decision in determining prompt access to the appendix, and the software implementation of the IDSS of the surgeon was completed. The IDSS of the surgeon was tested and showed good results.

Conclusion: the development of the IDSS of the surgeon is designed to speed up preoperative preparation and significantly reduce the number of medical errors in determining prompt access to the appendix, which is important in urgent surgery.

Importance of the topic. Mortality in infected pancreonecrosis varies from 40% to 60%.

Purpose is to study the influence of immobilized form of sodium hypochlorite on the functional condition of internal organs, systemic inflammatory response, oxidative stress, antioxidant protection and endothelium dysfunction in experimental infected pancreonecrosis.

Materials and methods. Experimental studies were conducted on 60 male rats of Wistar line, which were divided into 3 similar groups with 20 animals in each group: control, comparison and experimental ones. Animals did not receive any treatment in control group, Levomekol ointment was applied to the infected area rats from comparison group, and the immobilized form of sodium hypochlorite was used in experimental group. The modeling of the infected pancreonecrosis was conducted by destruction of the pancreas by the liquid nitrogen and contamination with the microbial suspension of the Staphylococcus aureus.  Indicators of the pancreas function, renal function, liver function, vessels’ endothelium, systemic inflammatory response, oxidative stress, antioxidant protection were studied by laboratory methods on the 3rd, 5th, 7th and 10th days of the experiment.

Results and their discussion. Immobilized form of sodium hypochlorite surpassed Levomekol ointment in its positive influence on oxidative stress in 3.8 times, on antioxidant activity – in 1.6 times, on endothelium dysfunction – in 1.5 times, pancreas dysfunction – in 1.3 times, renal dysfunction – in 1.7 times, liver dysfunction – in 1.32 times, in severity of inflammatory response – in 1.5 times by the end of the experiment (p<0.05).

Conclusion. Application of the immobilized form of sodium hypochlorite in infected experimental pancreonecrosis is effective and justified by pathogenesis.

Treatment for achalasia of cardia is multidirectional nowadays and depends on several factors such as patient’s sex and age, type and stage of disease, co-morbidity and complications. However the treatment for end-stage achalasia is still controversial. Ones who advocate organ preservation surgery consider esophagectomy an ultima ration. These authors conceive that esophagectomy is too traumatic for benign disease with low progression. Esophagectomy as a first approach for end-stage achalasia is recommended by others authors who believe that progredient course of disease (nonreversible strongly dilated and atonic esophagus), debilitating  dysphagia, regurgitation, aspiration syndrome and ineffective intervention in cardia make the extirpation of the esophagus necessary. Persistent degeneration of life quality and high possibility of such devastating symptoms as aspiration and esophageal cancer alongside with unacceptable results of myotomy raise questions on the effectiveness of the organ preservation surgery for end-stage achalasia

Joseph Murray was born in 1919 in the USA. He graduated from the College of the Holy Cross and Harvard University Medical School. He developed his own method of kidney transplantation, proposed to reduce the risk of immune rejection of the organ by performing closely related transplants. In 1954, D. Murray completed the first successful kidney transplant in the world from a twin brother, in 1959 from an unrelated donor, in 1962 from a deceased donor. In 1971, Murray returned to the study of plastic surgery, being the chief plastic surgeon at the Children's Hospital of Boston from 1972 to 1985. In 1986, he left the surgical practice, having the honorary title of professor at Harvard University Medical School. In 1990, Joseph Murray, along with Edward Thomas was awarded the Nobel Prize in Medicine. In the same year, Joseph Murray was admitted to the Pontifical Academy of Sciences, in 1993 - the National Academy of Sciences of the USA. Joseph Edward Murray died in 2012 in the city of Boston.

N.S. Korotkov was born in 1874 in the city of Kursk. In 1893, after graduating from high school, he entered the medical faculty of Kharkov University, transferred to the medical faculty of Moscow University, which he graduated in 1898 with a degree in medicine with honors. In 1900, N.S. Korotkov became a supernumerary order of a surgical clinic for a term. Further N.S. Korotkov became a doctor of the sanitary unit of the Iberian Red Cross community. For participation in this trip N.S. Korotkov was granted the right to wear the honorary sign of the Red Cross, and in 1902 he was awarded the Order of St. Anne of the III degree. Nikolai Korotkov again works as a supernumerary, since 1903 - a regular intern at the surgical clinic of Professor A.A. Bobrov, then a supernumerary resident at the surgical clinic of Professor SPPedorov of the Imperial Military Medical Academy.
In 1904, in the St. George community of the sisters of mercy of the Red Cross Society, a sanitary squad was formed to be sent to the Russian-Japanese war, NS was appointed as the senior physician. Korotkov. Systematically listening to the vessels in the wounded, the young surgeon discovered five regular phases of changes in sounds during compression of the brachial artery with a Riva-Rocci cuff, which later formed the basis of his proposed method for determining blood pressure (Korotkov method). November 8, 1905 N.S. Korotkov for the first time made a historical report “On the issue of blood pressure research methods”. At the end of 1905, he left Petersburg for his parents in the city of Kursk. In 1908, N.S. Korotkov successfully passes the examinations for the degree of doctor of medicine and leaves for Siberia in the mines of the Lena gold mining association for the position of doctor at the Andreevsky hospital. In 1910, N.S. Korotkov defends his doctoral thesis on the topic: "The experience of determining the strength of arterial collaterals." Since 1914, N.S. Korotkov worked as a senior physician at the Petersburg Clinical Hospital. Peter the Great, and with the outbreak of World War I, a surgeon in the Charity House for Wounded Soldiers in Tsarskoe Selo. After the Great October Revolution until the death of N.S. Korotkov served as chief physician at the Mechnikovsky hospital in Petrograd. Nikolai Sergeevich died on March 14, 1920 and was buried in the Theological Cemetery of St. Petersburg. The exact burial place of N.S. Korotkova has not been established, in 2011 a cenotaph was installed on the site of the Military Medical Academy. The Korotkov method was the only official non-invasive blood pressure measurement method approved by WHO in 1935. In honor of N.S. Korotkova is named the street in St. Petersburg, the city hospital of Kursk, the Memorial Society in St. Petersburg.