Vol 13, No 1 (2020)

Importance. Functional results of treatment of the ventral hernias of the medial localization after endoprosthetics of the abdominal wall by the standard polypropylene prosthesis remain unsatisfactory because of the limited flexibility of the abdominal wall.

Purpose. To improve   functional results of treatment of patients with ventral hernias of the medial localization by applying a light strengthened endoprosthesis.

Materials and methods. There was done a comparative analysis of the results of treatment of 60 patients with medial hernias of the anterior abdominal wall. Patients were divided into two groups with 30 people in each group. In the first group over-aponeurotic endoprosthetics of the abdominal wall defect was provided with the use of a standard polypropylene prosthesis with the thread diameter 120 micron, while in the second group there was used a light strengthened endoprosthesis with the thread diameter in the basic zones 90 micron and in the strengthened zones 120 and 90 micron. Effectiveness of treatment in the nearest post-operative period was evaluated by the degree of severity of inflammatory implantation response, and in the long-term period evaluation was done on the base of functional  state of the abdominal muscles, quality of life of patients and results of treatment by four point scale.

Results and their discussion. Inflammatory exudative response on implantation of the light strengthened endoprosthesis was less and reparative response was 1,1 times higher compare to a standard prosthesis.  Endoprosthetics of the abdominal wall with a light strengthened endoprosthesis improved contractility of the abdominal muscles in 1,2 times. Restoration of the functions of the abdominal muscles had a positive influence on quality of life, namely, physical component of health improved by 4,5%, as well as on long-term results of treatment by the increased number of excellent and good results of treatment  by 20% and reduction of satisfactory results by 20%.

Conclusions. The use of a light strengthened endoprosthesis enables to improve the functional results of treatment of ventral hernias of the medial localization.

The high probability of permanent loss of professional fitness and a significant risk of disability of the injured as a result of limb injuries with peripheral nerve damage contribute to both the continuous improvement of surgical techniques on the peripheral nerves, and the implementation of experimental and anatomical studies aimed at developing new ways to restore the lost innervation. Various types of peripheral nerve injuries are observed in peace and wartime victims in 2-6% and 9.8% of cases, respectively. The high degree of disability of patients with the consequences of peripheral nerve injuries requires improvement of diagnostic and reconstructive plastic approaches in this category of patients. A promising method of restoration of the distal part of the crossed nerve with extensive defects of the nerve trunk is its connection with the lateral surface of the intact donor nerve by the «end-to-side» neurorraphia. The lack of unambiguous views on the nature of reinnervation in this case, even in the presence of single publications on the positive outcomes of such interventions allow us to use this method only in the absence of the possibility of using autonerval transplants to replace extensive defects of peripheral nerves.

The purpose of the study: in experiments on laboratory animals to determine the features of modeling trauma of nerve trunks in relation to the development of the main stages of recovery of lost innervation by connecting peripheral nerves by the «end-to-side» neurorraphia and to determine the range of simple and demonstrative methods of clinical and instrumental control of the functional state of the restored peripheral nerves in a long-term experiment on laboratory animals.

Methods. A comprehensive experimental surgical and clinical-instrumental study was performed on 61 laboratory animals (Chinchilla rabbits of both sexes, phenotypically healthy individuals). In the experimental operating room under intravenous anesthesia, modeling of peripheral nerve defect was performed by resection of the total peroneal nerve with a length of 1 cm at the level of the middle third of the thigh. In animals of the studied group (n=39) to restore innervation, the "end-to-side" neurorraphia of the distal portion of the crossed common peroneal nerve with a specially formed defect of the perineural membrane on the lateral surface of the tibial nerve was performed. In the comparison group (n=22) no replacement of the defect of the common peroneal nerve was performed. The follow-up period after experimental interventions ranged from 1 to 290 days. Morphofunctional state of restored nerve trunks was determined by clinical, radiological and electrophysiological methods.

Research results. Performing unilateral resections of the common peroneal nerve in laboratory animals (rabbits) with subsequent restoration of the distal portion of the crossed nerve by connecting it by the «end-to-side» neurorraphia with a nearby intact donor nerve allows to obtain reproducible in the experiment positive results of tissue reinnervation. Indirect assessment of the functional state of the restored nerves is possible using simple and accessible clinical tests, for example, the amplitude of the abduction of the toes of experimental animals in the study of the unconditional reflex of preparation for landing characterizes the conductivity of the common peroneal nerve. When performing experimental studies with multi-stage reconstructive plastic interventions on the peripheral nerves of laboratory animals, the inclusion of radiological methods in the complex of diagnostic measures allows performing in vivo visualization of the surgical intervention area, the restored nerve trunk, as well as the tissues innervated by its branches, which makes it possible to adjust the plan of subsequent morphological studies.

Conclusions

1. Performing resection of the common peroneal nerve of laboratory animals (rabbits) at the level of the middle third of the femur as a model of peripheral nerve injury allows to practice the technique of restoration of the distal section of the crossed nerve by connecting it with the adjacent intact donor nerve of the «end-to-side» neurorraphia.
2. Performing a simple test with the initiation of an unconditional reflex of preparation for landing allows us to qualitatively assess the functional state of the common peroneal nerve in experimental animals.

3. The inclusion of radiological research methods in the program of comprehensive assessment of the peripheral nerves allows to perform their visualization in vivo with the definition of the main morphological characteristics of the restored in experimental reconstructive plastic interventions of nerve trunks.

Relevance. Traditional treatment of septic wounds of soft tissues often leads to the development of complications, causing more than 30% of deaths after surgery. The oxidative and bacterial components have a key role in the pathogenesis of septic processes.
The aim of the study was to develop a method of treatment of septic wounds, based on a combination of jet technologies, oxygenation and sorption therapy, and also to study the effectiveness of its use.
Materials and methods. Studies were conducted on 120 white Wistar rats with septic wounds of soft tissue. There were 4 groups: 3 control and 1 experimental. There was no treatment in the 1st control group. Bandages and treatment of the wound with oxygen flow were performed in the 2nd control group. In the 3rd control group, bandages were performed, and the sorbent was applied to the wound surface. In the experimental group, in addition to dressings, jet oxygen-sorption treatment of the wound surface was carried out. The study of the effectiveness of the method was carried out using objective, histological, histochemical, bacteriological and statistical methods.
Result. During the jet oxygen-sorption treatment of the wound surface, the disappearance of hyperemia was noted by 23.1%, the end of necrolysis - by 25.7%, the appearance of granulation - by 24.3%, wound epithelization - by 17.0% faster, compared with the data of the 1st control group.
Conclusion. Use of the method the jet oxygen-sorption treatment for the treatment of septic wounds of soft tissues reduced the wound area by 1 day – by 4.8%, 3 day – by 6.7%, to 7-days – 19.1% and to 10-day – 43.9% compared to the 3rd control group.

Relevance. Liver abscesses remain one of the most urgent problems in abdominal surgery, reaching 2-3 cases per 100,000 people. A wide range of causes, the complexity of diagnosis and the imperfection of treatment methods reaching a high mortality, from 2 to 31% according to different authors. The abscesses developing as a complication in the postoperative period are the greatest difficulty in diagnosis and treatment. The advantage of minimally invasive technologies at the present stage of development of surgery is indisputable. However, the question remains of the indications for their use, phasing and technology  of implementation.

Purpose of the study. On the clinical example, to show the possibility, logic and sequence of minimally invasive treatment in a patient with multiple liver abscesses.

Materials and methods. Presented a clinical case of minimally invasive treatment of postoperative complications in a patient receiving primary treatment for multiple primary cancer - cholangiocarcinoma and kidney cancer with the development of multiple liver abscesses of the ambiguous nature (cholangiogenic, pyogenic, traumatic, ischemic).

Result.  In the presented clinical case are presented the possibilities of a staged, minimally invasive treatment of multiple liver abscesses

Массивная локализованная лимфедема (млл) или так называемая «псевдосаркома» - это явление вторичной лимфедемы, развивающейся вследствие ожирения, обусловленного
нарушением лимфодренажа. MLL-это крупное доброкачественное опухолевое образование, связанное с переходом богатой белками жидкости в интерстициальное пространство с последующей активацией пролиферации интерстициальных клеток. Прогрессирующий рост ИИ в конечном итоге может привести к чрезвычайно большой массе, что затрудняет повседневную деятельность за счет ограничения подвижности, а также повышает риск повторного возникновения инфекций.
Псевдосаркома-достаточно редкое заболевание, встречающееся среди населения, но по мере роста распространенности ожирения растет и заболеваемость больных.
Важно учитывать, что клинические, гистологические и рентгенологические картины млл выглядят как злокачественные новообразования. Знание различий между этим состоянием и другими опухолями, помогает врачу быстро дифференцировать псевдосаркому и поставить правильный диагноз.
Введем клиническое наблюдение за млл обработкой всей медиальной поверхности правого бедра с переходом на переднюю и заднюю поверхности

A review of the literature on one of the methods of treatment of unresectable primary and metastatic liver cancer, namely radio embolization, is presented. A detailed description of the procedure for performing radioembolization of the liver vessels, possible complications, indications and contraindications to this method, lists the necessary equipment and tools. Particular attention is paid to the description of the microspheres used in radioembolization. A modern review of clinical studies, including those still unfinished, devoted to the method of radioembolization with unresectable primary and metastatic liver cancer is given.

Vladimir Ivanovich Petrov was born in 1925 in Saransk.  After graduation he works as a teacher of physical education and drawing. In 1942 he was drafted into the Red Army. At the time of evacuation of replenishment Vladimir Ivanovich was shell-shocked and got to hospital. After his recovery he fought on the Samland Peninsula, then in the Baltic States, East Prussia, where the assault on the city of Koenigsberg was wounded and received a disability group II. In 1945 V. I. Petrov entered the 1st Moscow medical Institute named after I. M. Sechenov, which he graduated from in 1951. In 1959, Vladimir Ivanovich defended his candidate's thesis, in 1970 – his doctoral thesis. In 1974-1987 – rector of the 1st Moscow medical Institute named after I. M. Sechenov. Corresponding member of the USSR Academy of Sciences (1978). V. I. Petrov was engaged in the development of repeated operations on the lungs; he was the first to apply the method of ultrasonic cutting and welding of biological tissues in pulmonology, developed the principles of using ultrasound for pneumolysis, lung decortication, scar dissection during operations on the ribs, longitudinal sternotomy, with pleural empyema, treatment of the abdominal cavity. It is also known scientific work on the treatment of atherosclerosis, wasreally hypertension and endarteritis. In 1972 he was awarded the State prize of the USSR. V. I. Petrov is the author of more than 200 scientific works, including 4 monographs, 18 copyright certificates and three foreign patents. Under his leadership, 26 theses on medical and medical-technical subjects were defended. He was awarded the order of Lenin, the October Revolution, the Patriotic war I degree (1945, 1985), the red banner of Labor, "Badge of Honor" medal "For the capture of Koenigsberg" and 12 medals, the sign "Honorary inventor of the USSR." Vladimir Ivanovich died in 2001. About his life and work made a documentary film "Surgeon, scientist, rector" (1983).

Nikolai Alexandrovich Velyaminov was born in 1855 in St. Petersburg. He studied at the gymnasiums of Wiesbaden and Warsaw. In 1872 he entered the Moscow University in physics and mathematics, and in 1873 transferred to the faculty of medicine. In 1877 he was sent to the army in the Caucasus. In 1878-1879, Nikolai Alexandrovich became ill with typhus, developing a chronic process in the lungs, which requires long-term treatment abroad. After recovery in the years 1880-1881 N. And. Velyaminov works in Central Asia as a surgeon of the Akhal-Teke expedition, develops a system of medical sorting and evacuation of the wounded, writes "Memories of the surgeon from the Akhal-Teke expedition." In 1883 he received the degree of doctor of medicine and worked as an assistant to Professor K. K. Reyer, lectured on operative surgery in Women's medical courses. In 1884 N. Ah. Velyaminov becomes an assistant to the chief physician and surgeon of the Holy cross community of sisters of mercy. In 1885 he founded the first in Russia authoritative scientific surgical journal "Surgical Bulletin". Since 1887 N. Ah. Velyaminov as a Junior doctor of the life guards of the Preobrazhensky regiment heads the surgical Department in Krasnoselsky hospital, since 1893 works as the Director of the Maximilian hospital in St. Petersburg, since 1894 – the senior doctor of the Semenovsky regiment, is appointed the life-physician and honorary surgeon of the Highest Court, and then the senior doctor of the Imperial headquarters. In 1889 he defended his doctoral thesis. In 1894 N. Ah. Velyaminov is elected Professor of the Military medical Academy. In 1896 he designs the device for the first time in St. Petersburg service of "Ambulance", organizing children's sanatoriums. In 1900, Velyaminov was elected an honorary member of the Royal medical College in London, the Chief Commissioner of the Russian red cross society for assistance to the sick and wounded in the far East. In 1905 N. Ah. Velyaminov was awarded the rank of privy Councilor, and in 1907 was awarded the order of St. Anne of the 1st degree. In the same years N. Ah. Velyaminov was the first in Russia to study occupational injuries, insurance of workers and organized the "Bureau of medical examination for workers" (1907). In 1910 – 1912 N. Ah. Velyaminova works as the head of the Imperial Military medical Academy in St. Petersburg. In 1913, the conference of the Military medical Academy elected him academician of medicine. At the beginning of World war I. Ah. Velyaminov took part in the work of the Main Directorate of the red cross, and from the end of August he was a surgeon-consultant at the Headquarters of the commander-in-Chief to inspect the surgical case in the army. By the beginning of 1917 N. Ah. Velyaminov held many positions: Director of the Mariinsky hospital for the poor, Alexandrinsky women's hospital and Maximilian hospital; Chairman of the Medical Commission for reception in the sanatorium "khalila", the Russian Society for the protection of public health, the Interdepartmental Commission for the revision of medical legislation; Vice-Chairman of the Committee of the Community of the Seaside sanatorium for chronically ill children; editor of the magazines "Surgical archive" and "Hygiene and sanitary Affairs"; inspector of the court medical unit; honorary consultant of the Alexander-Mariinsky hospital and hospital for incoming patients; consultant of the Royal office for the institutions of the Empress Maria Feodorovna, member of the Board of the Community. Kaufman red cross and the Medical Council of the interior Ministry. In 1919-1920 he headed the Department of surgical pathology with desmurgy at the Women's medical Institute. In March 1920, he was offered the post of Chairman of the Commission for the reform of medical education, from which N. Ah. Velyaminov refused. By this time the new government took away the Professor's apartment, and he found refuge in the utility room of the Petrograd hospital named after Peter the Great. N. And. Velyaminov – author of over 100 scientific medical works, including 8 monographs. He described thyrotoxic polyarthritis, gave the classification of diseases of the joints and thyroid gland, one of the first pointed to the importance of the endocrine glands in the development of surgical diseases, used phototherapy; opened the first Russian light therapy room. A lot of new N. And. Velyaminov contributed to the doctrine of surgical treatment of bone tuberculosis and abdominal surgery. April 9, 1920 N. Ah. Velyaminov died and was buried at the Volkov cemetery.