Vol 14, No 3 (2021)

Introduction. Mortality in generalized peritonitis (GP) reaches 30%, and with the development of multiple organ failure, the lethal outcome is observed in 80-90% of cases. Enteral insufficiency syndrome (EIS) plays a leading role in the progression of generalized peritonitis.

The aim of the study was to develop a differentiated approach of enteral insufficiency syndrome correction in patients with generalized peritonitis.

Material and methods. This research was a retrospective – prospective study. The study included 50 patients with GP, who received treatment at the Surgery Department of the Samara Regional Clinical Hospital in the period from 2017 to 2019. Depending on the chosen treatment tactics, the patients were divided into two clinical groups. Group I included 29 patients, admitted in the period from 2017 to 2018, who had received the standard GP treatment. A long-term endogenous intoxication in patients of this group associated with the progressive enteric failure led to the repeated surgeries; at the same time, a high frequency of postoperative complications was preserved. The analysis of the results in patients of Group I necessitated development of the therapeutic and diagnostic algorithm aimed at early diagnostics and timely correction of EIS. Group II included 21 patients with GP, admitted in the period from 2018 to 2019, who was treated using the new algorithm.

Results. The objective criteria for the relief of EIS in GP in patients of the study groups were a decrease in the level of serum albumin and C-reactive protein, a significant decrease in the amount and qualitative change in the intestinal discharge via an intestinal tube, a decrease in the recovery time of the functions of the small intestine and start of defecation. On the 6th postoperative day, in patients of Group II there was no significant albumin level reduction in comparison with the 1st day of monitoring (28.31±0.77 g/l vs 37.33±4.69 g/l). Whereas in Group I the albumin level was significantly lower (19.3±0.51 g/l) than the same parameter in Group II, and in comparison with the 1st day of monitoring (19.3±0.51 g/l vs 39.5±6.05 g/l; р = 0.00001). On the 6th postoperative day, the C-reactive protein level differed significantly between the groups as well: Group I – 104.76±13.49 mg/l, Group II - 58.00±29.05 mg/l, p = 0.003. The control of GP in patients of the Group I was reached after 4.5±2.5 repeated abdominal interventions, while in patients of Group II generalized peritonitis was arrested after 2.3±0.9 surgical interventions (p = 0.000171), which is 1.9 times less.

Conclusions. The proposed algorithm of EIS control is based on the individual approach to the treatment of patients with GP. The developed EIS rating scale allows determining not only the degree and dynamics of the pathological process, but also monitoring the effectiveness of treatment options applied in a particular patient.

Background. The number of elderly and senile people is about 15% in the population. Together they account for 50% of emergency and 85% of planned hospital admissions to surgical hospitals. One of the most common causes for a patient to see a surgeon is manifestations of hemorrhoids, which affect 10-36% of the population (number increases with age).
The aim of the study is to improve results of the outpatient treatment of elderly and senile patients with internal hemorrhoids stages II-III by optimizing the method of sclerotherapy and indications for its application.
Material and methods. The results of outpatient treatment of 60 elderly and senile patients for chronic hemorrhoids stages II-III were analyzed. The patients were divided into 2 groups. In the control group (30 patients) standard treatment was performed, including sclerotherapy of internal hemorrhoids with 2-3% solution of aethoxysklerol. One-percent solution of aethoxysklerol was used to perform sclerotherapy in the main group (30 patients). The indication for its administration was low compliance in patients and/or presence of anemia, inability to cancel antiplatelet drugs, continued bleeding. Groups were valid for comparison.
Results. There was a decrease in the severity of postoperative pain syndrome by 36.8%, postoperative complications from 20,0% to 6,7%, the average period of temporary disability was from 1.8±0.4 to 1.0±0.5 days, the frequency of relapses of the disease in 6 months after sclerotherapy was from 10% to 6.7% in the main group compared to the control one.
Conclusion. The proposed method reduces the intensity of postoperative pain, the percentage of postoperative complications and the frequency of relapses of the disease.

Diabetes mellitus (DM) is the most common and socially significant endocrine disease that leads to early disability and is the most common cause of mortality in patients after cancer and cardiovascular pathology. The cost of managing patients with diabetes can reach 30% of the country's health budget, 90% of which is spent on the treatment of its complications. Diabetic foot syndrome (DFS) is developed in 20-80% of patients and is one of the most dangerous late complications. In clinical practice, various approaches to its treatment are used, but the number of high amputation and mortality rate in this group of patients remains significant. The aim of the study was to improve the results of treatment of patients with diabetic foot syndrome (DFS) by including the bubbling treatment method in the program of therapeutic measures. Forty-eight patients with neuropathic and neuroischemic forms of DFS were treated. The control group consisted of 23 patients receiving conventional treatment, the main group included 26 patients, who were applied bubbling treatment option locally. The analysis of groups of patients showed no significant differences by gender, age, stages of diabetic foot syndrome, depth of necrotic defect, complications and concomitant diseases. The use of the bubbling treatment method in the complex treatment of patients with DFS allowed more effectively arresting symptoms of local (edema, hyperemia, wound exudate, necrolysis) and general inflammation, anemia and intoxication syndromes, contributed to the activation of regeneration processes in soft tissues, which, combined with complex FDS treatment, together, reduced the number of amputations by 18.7%.

Bronchopleural fistula (BPF) is a pathological communication between the bronchial tree and the pleural cavity, the most common complication of anatomical lung resection.
BPF rarely closes spontaneously and almost always requires surgical or bronchoscopic interventions.
The main methods of treatment are sanitation of the pleural cavity with the development of empyema and re-occlusion of the bronchial stump. The development of this complication in the postoperative period is accompanied by an increase in hospitalization time, a high risk of chronic pleural empyema, exacerbation of chronic diseases and death. The mortality rate ranges from 18 to 67%. Most often, BPF is manifested after removal of the right lung (8-13%), compared with the left side (1-5%), which is due to the anatomical features of the main bronchus.
The presented clinical case describes a non-standard surgical approach in the treatment of bronchopleural fistula and chronic empyema of the residual pleural cavity in a young patient.

As a result of the analysis of modern Russian and foreign literature, it was found that in the structure of postoperative complications after liver resections, biliary complications are the leading ones today. The main risk factors for the development of biliary complications and predictors of prognosis were determined at the different stages (preoperative, during the operation and postoperative period). The necessity to apply a complex of instrumental investigation methods in the postoperative period for early detection of bile leakage, clarification of its causes and forms of manifestation is determined; their importance for choosing a method of elimination is emphasized. The ways of improving the results of liver resections due to the prevention and effective elimination of bile leakage are outlined.
Possibilities of prognosis of biliar complications after liver resections were analyzed. The available assessment systems can be considered uninformative, which demands development and implementation of more modern and more effective programs for predicting biliary complications after liver resections.

Two hundred years have passed since the moment when Michael Faraday suggested the existence of substances of the fourth aggregate state. A long way has been spent studying plasma and its properties, searching for possible applications in various directions. Many specialists in various fields of medicine have conducted research on the use of unique properties of plasma for sterilization of equipment, treatment of various diseases and prevention of their complications. However, the potential of plasma use continues to open up novel ways of its application.

Pyotr Alexandrovich was born in 1871 in Florence in the family of Professor A. A. Herzen of the University of Lausanne. In 1896, he studied at the medical faculty of the University of Lausanne and began working at the Caesar Roux Clinic. In 1997, Pyotr Alexandrovich received a Doctor of Medicine degree and, fulfilling his grandfather's will, left for Russia. In 1898, P. A. Herzen received a Russian diploma of a doctor with honors. Then Pyotr Alexandrovich worked as an external doctor until 1900, and then until 1920, with breaks for service in the army as a military surgeon – he was a resident of the surgical department of the Old Catherine Hospital in Moscow. During the Russian-Japanese War, Pyotr Alexandrovich was a surgeon on the Manchurian front, a surgeon in the active army during the First World War, and a consultant at the 151st military hospital during the Civil War. In 1909, he defended his dissertation for the degree of Doctor of Medicine in Russia. In 1917, he became the head of the Department of Operative Surgery, in 1921-General Surgery of the 1st Moscow State University. The clinical base of the department was the Institute for the Treatment of Tumors (now the P. A. Herzen Moscow Research Oncological Institute), the director of which was P. A. Herzen from 1922 to 1934. In 1926, he was first elected chairman of the Surgical Society of Moscow, and in 1929 – the XXI Congress of Russian Surgeons. In 1934, Pyotr Alexandrovich became the head of the Department of Hospital Surgery of the 1st Moscow Medical Institute and in the same year he was awarded the honorary title of Honored Scientist of the RSFSR, and in 1939 he was elected a corresponding member of the USSR Academy of Sciences. He created the world's first pre-thoracic artificial esophagus (1907), was the first in the USSR to perform thoracoscopy for chronic pleural empyema (1925), suturing of a heart wound (1904), liver resection, developed a number of original operations: intra-abdominal fixation of the rectum when it falls out; application of cholecystoenteroanastomosis (1901), cholecystectomy, trans-vesical prostatectomy (1906); omentorenopexy of the lower pole of the kidney (1913); operations for anterior cerebral, inguinal and femoral hernias; developed the principles of surgical treatment of traumatic aneurysms. He also made a significant contribution to solving the problems of vascular surgery, oncology, urology, cardiac surgery, etc. He published 84 scientific papers, including 5 monographs. P. A. Herzen created the largest school of Soviet surgeons, oncologists. He was an honorary member of the French Academy of Surgery, the International Society of Surgeons, chairman of the surgical societies of the RSFSR and the USSR (1926-1928; 1935-1936), the XXI and XXIV All-Union Congresses of Surgeons (1929, 1938). P. A. Herzen was awarded two Orders of the Red Banner of Labor, medals, including "For the Defense of Moscow". P. A. Herzen died in January 1947 and was buried in Moscow. The Moscow Research Oncological Institute, the periodical " Oncology. The journal named after P. A. Herzen". A memorial plaque in his honor is installed in the First Moscow State Medical University named after I. M. Sechenov. His name is given to surgical operations used for anterior craniocerebral and femoral hernias, hydronephrosis, cryptorchidism, the creation of an artificial esophagus from the small intestine, esophagoejunostomy after removal of the stomach, and others.