Vol 12, No 2 (2019)

 Rationale. According to recent studies, purulent complications of postoperative wounds are found quite widely in surgical practice.
Objective. To establish the effectiveness of an integrated approach to the treatment of purulent wounds.
Methods. The most popular dressings were investigated in the treatment of purulent cavities in patients with suppurative coccygeal cyst. The studied patients in the experimental groups had various comorbidities, such as diabetes mellitus, obliterating atherosclerosis of the lower extremities. Experimental dressings include a dressing agent with antimicrobial properties (with chlorhexidine digluconate), Hydrotül, Activetex HF.
Results. In the postoperative period, it is necessary to use broad-spectrum antibacterial drugs. However, in addition to the primary methods it is necessary to apply additional methods of treatment. In particular, we are talking about the use of modern dressings, as well as methods of physical impact on the wound. Among the important additional methods of treatment is physiotherapy, which has a positive effect on the vascularization of soft tissues, thereby enhancing nutrition and epithelialization of the wound. The doctor is faced with the difficult task of determining the most appropriate material for a particular patient among a wide range of dressing materials on the medical market.
Conclusion. In patients with an established diagnosis of “abscess pilonidal cyst” who do not have associated diseases, it is most effective to apply a Hydrotül ointment during dressings; in patients with a concomitant diagnosis of atherosclerosis obliterans, the dressing agent with antimicrobial properties (with chlorhexidine digluconate) has the greatest effect; in patients with diabetes mellitus type II - Activetex HF.

The purpose of the study is experimental development of preperitoneal inguinal hernioplasty with synthetic mesh, according assessment of the need of its fixation to the tissues.

Materials and methods. An inguinal hernia was simulated on human cadaveric material. The study used 27 male corpses. Two inguinal hernias were modeled on one corpse: on one side - indirect, on the other - direct. A polypropylene mesh (standard density, 15 x 15 cm) was placed in the preperitoneal space. The endoprosthesis was impacted from the side of the abdominal cavity by a special designed device. The effect of a peak intra-abdominal pressure of 200 mm Hg was simulated. The degree of displacement of the reticular endoprosthesis into the inguinal canal was estimated at the moment of peak pressure on it from inside the abdominal cavity. For a simulated indirect inguinal hernia, two variants of the technique were considered: with fixation of the endoprosthesis to the underlying tissues and without fixation. For the modulated direct inguinal hernia, the following options were considered: non-fixative, with fixation at one point to the pubis and with plasty of the transverse fascia.

Results. When modeling preperitoneal plasty of a direct inguinal hernia, there is a pronounced displacement of the endoprosthesis into the inguinal canal with a non-fixing plasty, unlike the method with transverse fascia plasty or fixation to the pubis. In indirect inguinal hernia, there was no significant displacement of the endoprosthesis in both considered variants.

Conclusions. According to the obtained results, conclusions were drawn on the need for additional plasty of the transverse fascia or fixation of the endoprosthesis at a single point in a direct inguinal hernia. With indirect inguinal hernia in the experiment, no significant difference in the displacement of the mesh endoprosthesis into the inguinal canal was obtained with and without fixation.

The aim is to study and compare the processes of regeneration of bone tissue in animals while grafting titanium nickelide granules in bone cavities and free plastics in experiment.

Methods. Two methods of bone grafting were experimentally reproduced to assess the speed of regeneration of bone tissue of dogs’. The first is traditional method with bone crumbs, and the second one of filling the bone cavity with fine-grain titanium nickelide. The last-named has been developed lately. In the first group consisting of 25 dogs, granules of porous titanium nickelide were placed in the formed cavity of shin bone epiphysis. In the second (control) group (consisting of 10 dogs), bone crumbs were introduced into the cavity of the shin bone.

Results. The experiment showed that fine-grain titanium nickelide use for grafting bone cavity in comparison with bone crumbs demonstrated the formation of bone organo-typical regenerate 3 months faster.

Conclusions. Fine-grain titanium nickelide is a promising material and can be used in the pathology of the skeleton.

The aim of the study is to illustrate the case reports of patients with catamenial pneumothorax and with consecutive discussion about the causes of late diagnosis of endometriosis and recurrence of pneumothorax.
Material and methods. Three own clinical cases of middle-aged women with catamenial pneumothorax who were treated in the surgical thoracic department of the «Samara Regional Clinical Hospital named after V.D. Seredavina» in 2017 had been described.
Results. In all clinical cases the pleuroperitoneal fistula was the direct cause of the development of pneumothorax due to the germination of the endometrial node. The lack of caution regarding endometriosis leads to the fact that the revision of the diaphragm during thoracoscopy is performed rarely and very superficially. The solution about the volume of diaphragm repair is simple: the suturing of the defect is indicated. The definition of gynecological tactics should go parallel to the surgical one immediately, as soon as the assumption of possible endometriosis appeared.
Conclusion. It is important to remember about endometriosis of the diaphragm as a possible reason of spontaneous pneumothorax in women of reproductive age. When performing thoracoscopy, a revision of the diaphragm is necessary to identify its possible fenestration. Prevention of recurrent pneumothorax consists in the induction of pleurodesis and the subsequent treatment of endometriosis by an obstetrician-gynecologist.

Relevance. Treatment of patients with surgical complications of oncohematological diseases is difficult due to their inherent critical disorders of blood coagulation, dependence of patients on hormonal drugs taken in connection with the existing pathology, as well as instability of systemic hemodynamics. Such patients are rarely hospitalized in a surgical hospital and can be classified as "difficult patients " because of the polysyndromic nature of the underlying disease and the high risk of death from complications of the disease.

One of the most common oncohematological diseases is chronic idiopathic myelofibrosis, it is characterized by bone marrow fibrosis, hepato-splenomegaly (due to extramedullary hematopoiesis), as well as anemia. The clinical picture of primary (idiopathic) myelofibrosis is diverse and has no pathognomonic syndromes. Centers of extra-medullary hematopoiesis may occur in the liver with long-term disease, and thrombosis of splenic vein is possible, which can lead to subhepatic portal hypertension.

In the available literature, we have found information on the successful treatment of bleeding from varicose veins of the stomach in a patient with splenic vein thrombosis and splenomegaly by performing only splenectomy preserving gastric varices, which does not completely eliminate the risk of re-bleeding. We found no publications on splenectomy with vertical tubular resection of the stomach at the height of bleeding from varicose veins of the stomach in a patient with myelofibrosis of the spleen.

The aim is to show the possibility of performing a simultaneous operation (vertical tubular resection of the stomach and splenectomy) for bleeding from varicose veins of the stomach and splenomegaly against the background of idiopathic myelofibrosis in urgent surgery with impossible endoscopic hemostasis and to draw the attention of specialists in the field of surgery to the risk of bleeding in this group of patients.

Materials and methods. The article describes a clinical case of vertical tubular resection of the stomach and splenectomy for bleeding from varicose veins of the stomach and splenomegaly on the background of idiopathic myelofibrosis in urgent surgery.

Results. Vertical tubular resection of the stomach with splenectomy with impossible endoscopic hemostasis eliminates the risk of gastric bleeding in oncohematological patients and saves the patient's life.

Summary. This clinical observation demonstrates the relevance of timely surgical treatment of patients with bleeding from varicose veins of the stomach. Vertical tubular resection of the stomach along with splenectomy allows to exclude the risk of bleeding in this group of patients in the future.

The modern level of development of surgery can solve the problem of recovery of almost any level and length of traumatic damage to the peripheral nerves. The extraordinary duration of the nerve fibers regeneration leads to morphological and functional losses in target areas, which often causes low efficiency of reconstruction of damaged nerves.

There are a number of areas that increase the effectiveness of recovery processes in patients with peripheral nerve injury. Maintaining muscle tissue in a satisfactory condition is possible due to electrical stimulation and physiotherapy procedures that reduce the severity of denervation atrophy.

Acceleration of target zones reinnervation can be achieved by increasing the rate of growth of regenerating axons under the targeted influence of neurotrophic factors in the innervation area of the restored nerve. However, from the standpoint of etiology and pathogenesis, the main role in this question belongs to the reconstructive surgery, which allows to bring the source of regenerating nerve fibers to the denervated tissues as close as possible. Performing neurotization of the distal segment of the damaged nerve «end-to-end» or «end-to-side» neurorrhaphy from the donor nerve as an alternative to nerve transplantation can reduce the regeneration time for a period which depends on the level of neurotization of the damaged nerve.

The achievement of high functional results of limb recovery after peripheral nerve damage involves the implementation of a complex of therapeutic and preventive measures aimed at the early recovery of the lost innervation. The basic activities of this complex are reconstructive operations based on functional anatomy, corresponding to the basic principles of regeneration of nerve fibers and aimed at creating conditions for tissue reinnervation in the shortest possible time. Active postoperative management of patients is necessary to maintain the functional state of the denervated tissues and accelerate the recovery of the lost innervation and it should include a comprehensive impact on the target tissue.

The article presents data on the high-tech method of treatment-photodynamic therapy (PDT). An overview of the history of the use of photochemical reaction in the treatment of patients is given. The mechanisms of therapeutic action of PDT, the advantages of the method in comparison with other methods of antimicrobial action are described in detail; the indications and contraindications for this method of treatment are given. The article lists used for PDT photosensitizers of different generations and laser devices capable of emitting laser radiation of the required wavelength. The overview contains information about the efficiency of the method of PDT with certain diseases. Based on the literature review, it is concluded that PDT is a modern and promising method of treatment that can significantly improve the quality of care for patients with various diseases, which are based on cell proliferation.

The proven effectiveness of the method of photodynamic therapy and its advantage over other antimicrobial treatments demonstrate the relevance of its wider introduction into clinical practice.

N.N. Elansky was born in 1894 in the Voronezh Province. In 1913 he graduated from the Borisoglebsk gymnasium, in 1917 - the Military Medical Academy and was sent to the South-Western Front as a senior regimental doctor. Since 1918 - the district doctor of the Makaryevsky rural hospital of the Voronezh province. In 1919, N.N. Yelansky, together with V.N. Shamov and I.R. Petrov, prepared the first standard serums in the USSR for determining blood groups. Since 1921, Nikolai Nikolayevich returned to the faculty surgical clinic of the Military Medical Academy, having passed the way from an intern to a senior lecturer. In 1924, he defended his doctoral dissertation, in 1932 - became a professor, in 1934 - head of the department of faculty surgery at the Leningrad Pediatric Institute. In the years 1937-1938. He headed the Department of General Surgery and Military Field Surgery of the Military Medical Academy. Nikolai Nikolayevich participated in the organization of surgical care on the Khalkhin-Gol River (1938) and in the Soviet-Finnish War (1939–1940). During the Great Patriotic War, N.N. Yelansky consistently served as chief surgeon of the North-West, 2nd Byelorussian, 2nd Ukrainian and Trans-Baikal fronts. After the war, Nikolai Nikolayevich continued to work as head of the department of general surgery. In 1942, on the initiative of N.N. Yelansky was created by a special front-line group with the aim of a comprehensive study of traumatic shock. In 1942 he was awarded the title Honored Scientist of the RSFSR. In 1944, N.N. Elansky became lieutenant-general of the medical service. From 1947 to 1955 He was the chief surgeon of the Soviet Army and at the same time the head of the department of faculty surgery I of the Moscow Medical Institute. N.M. Sechenov, which he headed until 1964. From 1955 to 1959 he was a professor and consultant of the Military Medical Administration. He studied specific issues of blood transfusion, gastro-surgery, urology, traumatology, oncology and neurosurgery. In 1959 N.N. Yelansky organizes an artificial kidney department in the faculty surgical clinic I of the Moscow Medical Institute for the treatment of patients with acute renal failure. Nikolay Nikolayevich was a member of the editorial board of the Surgery and Military Medical Journal journals. He edited the 15th and 16th volumes of the multivolume work "The Experience of Soviet Medicine in the Great Patriotic War of 1941-1945."
He was the editor of the Surgery department of the 2nd edition of the Big Medical Encyclopedia, etc. He was a member of the board of the All-Union and All-Russian Scientific Surgical Societies, an honorary member of the International Association of Surgeons, the Surgical Society. N.I. Pirogov, Surgical Society of Czechoslovakia, Vice-President of the Society of Soviet-Belgian Friendship. He trained 9 doctors and over 30 candidates of medical sciences. He has published about 140 scientific papers. For services to the motherland N.N. Elansky was awarded fifteen orders and medals of the Soviet Union. N.N. Elansky died on August 31, 1964 and was buried in Moscow at the Novodevichy Cemetery.

Теодор Бильрот родился в 1829 году. После окончания гимназии Теодор обучался в Грайфсвальдском и Геттингенском университетах. В 1852 году он защитил диссертацию. В 1853–1860 гг. Т. Бильрот работал хирургом в клинике «Шарите», в 1855 году – ассистентом университетской клиники в Берлине. С 1856 года – доцентом Берлинского университета по кафедрам хирургии и патологической анатомии. В 1859 году он получает должность профессора хирургии и директора хирургической клиники в Цюрихе. В это время он опубликовал учебник «Общая хирургическая патология и терапия» (1863), ввел систему медицинской отчетности. В 1867 году Теодор был назначен профессором хирургии в Венском университете и работал хирургом на правах главы Второй хирургической клиники Венского главного госпиталя. С именем Бильрота связаны первые эзофагэктомия (1871), ларингэктомия и простатэктомия (1873), обширное иссечение языка при раке (1874), резекция печени (1875), тиреоидэктомия (1875) и успешная гастрэктомия (1881). Именем Бильрота названы модификация хирургических зажимов, два варианта резекции желудка, уранопластики, артропластики коленного сустава, операция при бедренной грыже. Т. Бильрот – автор 160 научных трудов, в том числе, книги «Общая хирургия» (1863), выдержавшей 15 изданий при жизни Бильрота и переведенной на все европейские языки. Он был редактором нескольких многотомных изданий «Руководство по хирургии», «Немецкая хирургия» и «Архив клинической медицины». Т. Бильрот умер скоропостижно в Абации 6 февраля 1894 года. Его памяти посвящены юбилейные монеты, выпущенные в Австрии в 1929 и 2009 годах. Памятники Бильроту установлены на родине Бильрота в Бергене (при жизни), в стенах Венского университета, медицинского собрания Вены. Его именем названа одна из самых больших улиц Вены.