Vol 12, No 4 (2019)

The urgency of the problem: Pancreatitis is one of the most severe complications of transpapillary interventions. It is not always possible to predict the occurrence of pancreatitis. Mortality from this complication reaches 3%.

 Research objective: To substantiate the prognostic significance of risk factors for the development of acute pancreatitis in patients undergoing transpapillary interventions. To establish the probability of complication development depending on a different combination of PEP risk factors.

Materials and methods: 418 transpapillary interventions was performed on the base of NGHCI «Railway Clinical Hospital on Samara station OAO «RGHD» for 2 years. Acute pancreatitis was observed in 41 (9%) cases. Patients treated during the listed period were stratified into two groups: active treatment group (retrospective) and control group (prospective). Based on the analysis of the first patients group the following PEP were identified: female sex, young age, cholelithiasis, uneven cannulation of  MPD, atypical PST. It was found that patients didn’t have one isolated risk factor. A combination of various risk factors was observed in all cases. Prediction of acute pancreatitis by applying the selection of patients with a high risk of complications is used in practice at the control group. The sensitivity of the PEP predictive method on the basis of identifying a risk group, on the basis of a factors combination which affect on the complication development was 96.6%. The specificity of this method is 97.1%.

            Results:  The frequency of pancreatitis in the active treatment group and control group was 9% and 14% after ERCP performing. At the same time, the method of the determining the high risk of PEP, which was identified retrospectively, allowed predicting the complication development in most cases. Acute pancreatitis developed in 22 patients out of 27 who had a risk of developing this complication. Complex medicamentally prevention was performed for all patients with high risk of PEP. The group of patients most susceptible to the pancreatitis development which has the following combination of risk factors was selected: female sex, age from 20 to 40 years old, litoextraction with choledocholithiasis , atypical PST, cannulation of MPD. The risk of complications in a patient who has these risk factors is 88.8% according to our data.

Conclusion: The identification of risk factors for the development of acute pancreatitis among patients undergoing transpapillary interventions allows to identify the group of patients most susceptible to complication. It allows starting a complex prevention of the complications development. Conservative prevention with Octreotide’s solution, infusion and antibacterial therapy is low-efficiency and does not reduce the risk of developing PEP. The introduction of other types of acute pancreatitis prevention, which have a more favorable effect and can prevent the pancreatitis development into clinical practice, is necessary.

Objective. To analyze minimally invasive treatment methods (puncture-draining intervention and laparoscopic) of liver echinococcosis and to develop an optimal treatment algorithm.
Methods. The results of 120 clinical observations of patients with liver echinococcosis who were treated from 2002 to 2018 are presented. based on SOKB them. V.D. Seredavina (Samara). The comparison group (n = 68) consisted of patients with PDV and laparoscopic intervention in the period from 2002 to 2008, the main group (n = 52) - patients with PDV and laparoscopic intervention in the period from 2009 to 2018.
Results. The starting points of the choice of treatment for echinococcosis in patients of the main group were the stage of life and the diameter of the hydatid cyst. Evaluation of the results of surgical treatment was carried out on the basis of a list of criteria that were assigned the values ​​of "good", "satisfactory", "unsatisfactory". With the right choice of surgical treatment tactics, as well as the priority of echinococcectomy in patients of the main group, 94% of clinical observations (n ​​= 52) achieved positive results.
Conclusion. The proposed differential algorithm of surgical tactics of echinococcosis using minimally invasive techniques answers questions regarding the choice of access and method of surgical treatment based on the size of cysts, their number and localization, as well as the period of the parasite's vital activity.

Relevance. Throat cancer is the most widespread malignant tumor of a throat and makes about 3% of all malignant tumors of the person. Bleedings at throat cancer is the most difficult and dangerous complication posing direct threat to life of the oncological patient. An intervention is usually characterized by the expressed painful syndrome in a zone of surgical access for patients with surgical pathology of ENT organs. For that reason, using of gel polymeric dressing means is the most modern and effective. Analgesic action is noted in the area of a postoperative wound within the first 60 - 90 minutes after imposing of such bandage.

Aim of research is to determine efficiency of multifunctional depot-system of the prolonged action on a gel basis of Kolegel-ADL of various degree of viscosity at a tamponade of a throat and trachea for elimination of a local hemorrhage.

Materials and methods. Koletes-ADL dressing was used at treatment of 39 patients with malignant tumors of a throat. Patients arrived in the emergency order with bleedings from a throat, were on hospitalization in acute hospital No. 1, Voronezh. A morphological variety of malignant tumors of this localization took place. The control group has included 19 people with similar destructive and tumorous processes complicated by bleeding treatment of which was carried out by the standard technique.

Results. As criteria of a convalescence considered the speed of reduction of the reactive phenomena in a wound and maturing of young granulations. Such characteristics like high viscosity of hydrogel dressing means, elastic consistency, entered into its structure antiseptics and local anesthetic allow to use it as tampon for a long period. One of essential advantages of use of Kolegel-ADL is creation a barrier impeding penetration of an infection into a skull cavity. The local anesthetic of Lidokin entered into structure of dressing means allows us stop a pain syndrome for a long time that reduces the need for parenteral introduction of anesthetics.

Gauze-based dressings were used in the control group. There was injury to the wound surface when changing bandages, and the remains of gauze fibers in the wound led to inflammation.

Conclusion. Multifunctional depot-system on a gel basis can be recommended as local antiedematous, haemostatic, antiseptic and anesthetic for local treatment of wound process in otorhinolaryngology, for therapy and prevention of purulent complications of wound surfaces of patients with oncological pathology of the throat complicated by bleeding.

Background. The number of patients with soft tissue wounds does not tend to decrease, which is largely due to the growth of patients with injuries, ulcerative defects, skin tumors, comorbid pathology, including diabetes mellitus, antibiotic-resistant strains and other causes. New methods of local treatment of wounds based on the application of the latest achievements of science are constantly being introduced into the work of surgical departments. High efficiency is demonstrated by the use of sorbents and oxygen, which enhance the reparative processes in wounds.
The aim of the study was to study in experimental conditions the effectiveness of the method of surgical treatment of soft tissue wounds, based on the use of jet oxygen sorption treatment (SCS).
Materials and methods. The study was performed on 150 white Wistar rats in 5 groups of animals. In the 1st control group treatment was not carried out. In the 2nd and 3rd control groups, the wound surface was treated with a jet of air and oxygen, respectively; in the 4th control group, sorbent was applied to the wound surface. In the 1st experimental group conducted scso wound surface. The study of the effectiveness of SCS was carried out using objective, planimetric, histological and histochemical research methods.
Results. The use of sorbent (4th control group) and the method of jet oxygen sorption treatment (1st main group) led to the most pronounced positive changes-acceleration of relief of the studied symptoms by 1.1-1.3 times and 1.2 – 1.5 times, respectively, compared with the data obtained in the 1st control group. Treatment of wounds with oxygen jet (3rd control group) had practically no advantages in comparison with treatment with air jet (2nd control group).
Conclusion. Indirectly, the highest activity of reparative processes during the observation period in the 4th control and 1st main groups was confirmed by the average optical density of RNA and SH-groups, and their desire to normalize to 10 days could indicate the completion of processes of stratification in the wound area. In total, the average area of wounds was minimal in the 1st experimental group, where this figure was by the 3rd and 10th days-74.0% and 99.5% compared to the baseline data.

Background: One of the important unsolved problems of hepatobiliary surgery is to stop the bleeding of the parenchymal organ. The most promising means of local hemostasis are spongy implants made of various materials, the study of which is one of the leading directions in modern surgery. Nevertheless, despite the relevance of the research, there is no uniform classification of the structural features of such hemostatics.
Aims: to study the features of the surface of the application of hemostatic implants based on collagen and Carboxymethylcellulose Sodium.
Materials and methods: the authors performed light microscopy of the samples, photographing and subsequent processing of the photographs obtained using the trial version of the graphic editor Adobe Photoshop CS6 (Adobe Systems, San Jose, United States of America) to obtain black and white images by enhancing the contrast (+400 ), which excluded the possibility of false color definition. The black and white pixels were counted using the Altami Studio 3.4 program (Altami LLC, St. Petersburg, Russian Federation). Then, the real pixel size was converted into percentages using the trial version of Statistica 10.0 (Dell Software Company, Round Rock, United States of America). After that, the ratio of “low” areas of the implant (black pixels) to “high” (white pixels) was determined.

Results: According to the data obtained, a classification was developed for the heterogeneity of the surface of the relief of hemostatic implants, according to which all of them can be divided into three groups: with weak, moderate and strong severity of the heterogeneity of the surface relief.
Conclusions:  when correlating the obtained results and selected groups, it was found out that the hemostatic sponge Tachocomb® (Takeda Pharmaceuticals LLC, Linz, Austria) has a slightly pronounced heterogeneity of the surface relief, and the hemostatic collagen sponge (OJSC Luga Belkozin, Luga, Russian Federation) and a Carboxymethylcellulose based hemostatic sponge (developed in cooperation with Linteks LLC, St. Petersburg, Russian Federation) - moderately pronounced surface heterogeneity.

Inguinal hernioplasty is one of the most common surgical procedures, but the long-term results of operations leave much to be desired: there are recurrences of hernias, chronic pain syndrome, violation of testicular function in men. A modern review of the literature on the most common surgical methods of treatment of inguinal hernias is presented. Separately, describes the methods of hernioplasty with using local tissue (autodermaplasty) and with the use of mesh implants (allohernioplasty). Material allohernioplasty set out on the basis of their surgical approaches are used: traditional (open) and laparoscopic. Special attention is paid to the necessary properties of the mesh implant, the choice of the method of its fixation. The advantages and disadvantages of the most common methods of hernioplasty are listed. Currently, there is no single standard for inguinal hernioplasty. The choice of the method is based on the experience of the surgeon, technical capabilities and desires of the patient. The most commonly used methods for autoplasty are Desarda and Shouldies, and among allogernioplasty - Liechtenstein technique (traditional surgical access) and laparoscopic methods (transabdominal preperitoneal hernioplasty, total extraperitoneal hernioplasty).

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Mikhail israelevich was born on December 20, 1924 in Minsk. He lived in the cities of Borisov, Gomel and Vitebsk. With the beginning of the war he went to the Caucasus, where in 1941 he entered the North Ossetian medical Institute (Vladikavkaz), moving to study in Novosibirsk, Yaroslavl. From 1944 to 1951 he worked as an assistant of the departments of normal anatomy, topographic anatomy and operative surgery, hospital surgery of Yaroslavl medical Institute, doctor of the regional station of sanitary aviation. In the summer of 1947 he worked in the hospitals of Kologriv, Rybinsk. From 1954 to 1955-assistant of the Department of operative surgery and topographic anatomy of the 1st Moscow medical Institute, and then associate Professor at the course of surgery of pulmonary tuberculosis at the Department of tuberculosis of the Central Institute of advanced medical. From 1958 to 1962-head of the Department of surgery of the small circle of blood circulation in the research Institute of experimental biology and medicine of the Siberian branch of the USSR Academy of Sciences (Novosibirsk), from 1963 – thoracic surgery research Institute of clinical and experimental surgery of the USSR Ministry of health (now – rsch RAMS), which led for 18 years. In 1964 he was awarded the title of Professor and this year he is a consultant of the 4th Main Directorate of the Ministry of health of the USSR. Since 1966-Chairman of the problem Commission "Thoracic surgery" Of the scientific Council on surgery of RAMS. From 1969 to 1991-General Secretary of the all-Union society of surgeons. Since 1971-member Of the international society of surgeons. In 1980 he was elected a corresponding member, and in 1986 – academician of the Academy of medical Sciences of the USSR. In 1981, he moved to the position of head of the Department, and then Director of the Institute of Phthisiopulmonology of the Moscow medical Academy. I. M. Sechenov, became a consultant Of the Russian scientific center of surgery RAMS. M. I. Perelman author of 24 monographs and books, 32 chapters in domestic and foreign manuals and books, 35 articles in encyclopedias, 250 articles in the Central domestic and foreign journals, author or consultant of 9 scientific and educational films, was the supervisor of 68 candidate and scientific consultant in the preparation of 25 doctoral dissertations. Mikhail was the editor-in-chief of the journal "problems of tuberculosis and lung diseases", Deputy editor-in-chief of the "medical referral journal", a member of the editorial Board of the multi-volume edition of "International Trendsin" General Thoracic Surgery", magazines of" world of Surgery"," Pulmonology "and"world of Surgery". In 2013, Mikhail Perelman died and was buried at Novodevichy cemetery.

Sergey Petrovich Fedorov was born in Moscow in 1869. In 1886 he graduated with honors from the gymnasium, and in 1891 - the medical faculty of Moscow University. In 1892, he was the first in Russia to manufacture and put into practice cholera and tetanus antitoxins, in 1893 - tetanus toxoid serum. In 1895, he defended his doctoral dissertation and was appointed as an assistant, and in 1896 - as a privat-docent of the faculty surgical clinic of Moscow University. In 1899 S.P. For the first time, Fedorov performed a single-step trans-vesicular prostatectomy, in 1901 a laparotomy for purulent peritonitis, in 1902 a gastrectomy with resection of the esophagus, resection of the colon. From 1903 to 1936, Sergei Petrovich headed the department of the hospital surgical clinic of the Military Medical Academy. In 1907, on his initiative, the Russian Urological Society was organized in Russia, the chairman of which he was elected (now bearing his name), the Urological Institute was established at the Military Medical Academy. In 1909 S.P. For the first time in the world, Fedorov performed the operation under intravenous hedonal anesthesia, which was the beginning of the widespread use of inhalation anesthesia. In 1909 he was awarded the title of honorary life-surgeon, and at the end of 1912 he was confirmed as a life-surgeon of the imperial family, which he combined with work in the Military Medical Academy. At this time, he wrote "Atlas of Cystoscopy and Rectoscopy" (1911), the monograph "Gallstones and surgery of the biliary tract" (1918). May 2, 1920 S.P. Fedorov was detained and put in prison. September 9, 1920, he was sentenced to a suspended five-year prison term. September 14, 1921 S.P. Fedorov was arrested again and at the end of November under escort sent to Moscow for a free settlement. In 1921 S.P. Fedorov took part in the creation of the first Soviet surgical journal "New Surgical Archive". From 1926 to 1933, he headed the Institute of Surgical Neuropathology (now the Leningrad Research Neurosurgical Institute named after A.L. Polenov, M3 of the RSFSR). S.P. Fedorov proposed new methods and modifications of operations on the nervous system, kidneys, intestines, biliary tract, new tools for their implementation. Under his leadership, the development of blood transfusion problems began for the first time in the USSR. He created the largest surgical school (N.N. Elansky, I.S. Kolesnikov, P.A. Kupriyanov, V.N. Shamov, etc.). In 1928, S. P. Fedorov was awarded the title of Honored Scientist of the RSFSR. In 1933, he was the first of the surgeons to be awarded the Order of Lenin.
Died S.P. Fedorov in Leningrad in 1936 and was buried at the Communist site (now the Cossack cemetery) of the Alexander Nevsky Monastery. He has published over 120 scientific papers, including 11 manuals and monographs. Memorial plaque in memory of SP Fedorov installed on the building of the Faculty Surgery Clinic of the Military Medical Academy. CM. Kirov.

Pyotr Andreyevich Zagorsky was born in 1764 in the Novgorodseversky governorship in the family of a priest. He studied at the Chernigov College, Medical-Surgical School. In 1785, P.A. Zagorsky was promoted to healers and began working as an anatomy prosector at the Department of Anatomy, Physiology and Surgery of the St. Petersburg General Hospital. In 1790 he moved to the Shlisselburg district to the post of city and district doctor, and in 1793 he was transferred as a head-doctor to the Cuirassier Regiment. In 1794-1795 Peter Andreevich took part in the military campaign of Suvorov. In 1797 he was appointed adjunct anatomy. P.A. Zagorsky wrote the first Russian textbook on anatomy (1801), for the first time in Russia he introduced compulsory classes on corpses, suggested Russian anatomical terminology (1802), created a classification of deformities. In 1805, P.A. Zagorsky received the title of adjunct of anatomy and physiology, and since 1807 - an extraordinary academician, in 1809–1833 - academician of the Imperial Academy of Sciences. In 1808, he was appointed rector of the Medical-Surgical Academy. Since 1817, he is an honorary member of the Imperial Moscow Society of Naturalists. His school passed I.V. Buyalsky, P.A. Naranovich, I.D. Knigin, P.S. Kareisha, IB. Petrov, D.M. Vellansky, A.I. Fedorovsky and others. P.A. Zagorsky - the author of more than 150 scientific papers. Peter Andreevich Zagorsky died in 1846 at the age of 82 years.