Vol 14, No 4 (2021)

Introduction. In diffuse peritonitis, the incidence of intestinal suture incompetence ranges from 5 to 15%, and suppuration of the surgical wound from 15% to 30%.

The aim of research was to study experimentally the course of the wound process in the intestinal wall in diffuse peritonitis using suture material impregnated with miramistin, and to evaluate the effect of this material on the incidence of intestinal suture failure and suppuration of surgical wounds in a surgical practice.

Materials and methods. The experimental study involved 192 male Wistar rats divided into 2 groups, 96 animals each; the clinical study involved 20 patients with traumatic intestinal tube wounds, who were also divided into 2 groups. Peritonitis was simulated by introducing 10% fecal suspension into the abdominal cavity. A laparotomy was performed in 24 hours, then the abdominal cavity was washed with sterile saline and a wound 1 cm long was performed in the colon wall. In animals of the first (control) group the wound was sutured with polyglycolide suture material without an antibacterial coating, in animals of the second (experimental) group the wound was sutured with polyglycolide suture material covered with polymer solution containing 20% Miramistin based on the polymer weight. In 10 patients of the first clinical group, intestinal wounds were sutured with similar suture materials without antibacterial coating, and the abdominal wall was sutured using interrupted stitches with lavsan suture materials. In 10 patients of the second group, wounds of the intestinal tube and the abdominal wall were sutured with suture materials impregnated with 20% Miramistin.

Results. In animals of the first group, the pronounced phase of inflammation of the intestinal wall lasted 7 days, inflammation subsided and start of the proliferative phase was recorded in 14 days, restriction of the intestinal suture by the connective tissue elements was registered in 21 days of the experiment. In animals of the second group, the phase of inflammation lasted 3 days, the proliferative phase ended in 7 days, restriction of the intestinal suture by the new connective tissue with complete restoration of the architectonics of the intestinal wall was recorded in 14 days. In patients of the first clinical group, intestinal suture failure developed in 2 patients (20%), and surgical wound suppuration - in 4 patients (40%) with one lethal outcome. Inpatients of the second clinical group, intestinal suture failure, deaths and suppuration of surgical wounds were not registered.

Conclusion. The use of suture material impregnated with polymer solution containing 20% miramistin by the polymer weight in peritonitis was pathogenetically justified to be effective.

The aim of research is to study posthypoxic transformation of the colon wall using light and electron microscopy in an experimental model of rat offspring.

Materials and methods. Chronic hypobaric hypoxia at different stages of pregnancy was simulated experimentally in 24 female white mongrel rats using a vacuum flow chamber with a rise to a height of 5000 m at a speed of 25 m/sec for 40 minutes. After delivery, the offspring were examined, subjected to hexenal anesthesia, and then removed from the experiment using decapitation. For light microscopy, resected sections of the small intestine and colon were stained with hematoxylin-eosin, and studied on Topic (Belgium, 2000) and Bio Blue (the Netherlands, 2013). Electron microscopic analysis was performed in a Morgagni 268D transmission electron microscope (FEI, USA).

Results. Chronic hypoxia, simulated in the first trimester of pregnancy, led to significant changes in the intestinal mucosa in combination with the growth of the connective tissue component in the muscle layer. The risk of developing dynamic intestinal obstruction occurred in the offspring of all groups, this was supported by an increase in the fibrous tissue of the intestinal wall. Pronounced changes in the microcirculatory bed were detected in animals of groups II and III, as they were predisposed to develop pre-ulcer and ulcerative defects in the wall of the small intestine. At the submicroscopic level, it was detected that both adaptive and destructive processes occurred in the wall ultrastructure of the descending colon of the rat offspring after hypoxic exposure in the prenatal period in animals of all experimental groups. In the microcirculatory bed, there was an increased venous congestion, with the most pronounced changes observed in the third trimester.

Conclusion. Thus, the study of hypoxia in the experiment allows investigating more about all the mechanisms of the pathological process and to translate theoretical knowledge into practical medicine.

Introduction. Clinical and laboratory criteria of the 2^nd Consensus on Sepsis do not consider manifestations of the organ dysfunction and compensatory anti-inflammatory response in septic complications.

The aim of study was to develop laboratory parameters that reflect presence of sepsis at different stages of its course based on a detailed complete blood count; take into account the degree of pro-inflammatory response to infection, an anti-inflammatory component, presence of a particular sign of the multiple organ failure.

Materials and methods. This was a statistical study involving 152 patients with clinical and laboratory manifestations of surgical sepsis who underwent inpatient treatment at the surgical department of the NWSMU clinical hospital. In patients with signs of edogenic intoxication, whose diagnosis sepsis was not confirmed, septicopyemia was verified on autopsy in every 4 cases. The patterns of the score assessment of the sepsis process were determined in accordance with the complete blood count parameters.

Results. The degree of correlation between “the level of procalcitonin and the “scores" was noted at the level of 0.5019309, the degree of correlation between “the level of blood lactate and the “scores” did not exceed 0.542726115.

Conclusions. If the total score is more than 7, the diagnosis of severe sepsis is highly probable. If the total score is less than 4 - presence of severe sepsis including the development of septicopiemia is improbable. If the total score is at the level of 5 -6 combined with long-term disease, the search for distant foci of septicopiemia and assessment of the prognosis of secondary sepsis is a priority.

In our opinion, the score assessment of simple laboratory parameters (detailed complete blood count), reflects, though indirectly, presence and stages of septic complications. The use of the score assessment in practical health care can improve screening of patients with surgical infection complicated by the sepsis development at all stages of medical care.

Introduction. Heart injury can be attributed to one of the most severe traumas. According to the data presented in the literature, such wounds are not common and account for 5-7% of the total number of wounds that penetrate the pleural cavity. However, despite rare incidence, such injuries are accompanied by a fairly large number of complications reaching 47.9%, and lethality at the level of 34.1%. This is due to the fact that diagnosis of such injuries causes some difficulties, and various methods including thoracoscopy are currently proposed to solve them. The issue of diagnostics and treatment of heart injuries has received much attention in the literature, but this problem has not been completely solved, since there are many factors that influence the course of the immediate postoperative period with such injuries.

The aim of the study was to analyse major factors that affect the course of the immediate postoperative period in patients with stab-cut heart injuries.

Materials and methods. The study involves a retrospective analysis of the immediate postoperative period of 86 patients operated for a penetrating chest wound with the heart and pericardium wound. Patients were treated in the surgical department of "Emergency Medical Hospital of Engels" from 1988 to 2019. Of the total number of patients, 76 (88,3%) were male and 10 (11,6%) were female. It should be noted that the majority of males - 47 - were in a state of alcoholic intoxication of varying severity.

Results. According to the analysis, out of 86 patients admitted to the medical facility on an emergency basis, 73,2% were included in group A, 26.7% of the wounded were included in group B. The data demonstrated that the vast majority of the wounded were delivered as soon as possible from the moment of injury, which could not but affect the course of the immediate postoperative period. It should be noted that 72,1% of the wounded were delivered by ambulance, 27,9% of patients by the meeting traffic. In the group of wounded who were delivered by the meeting transport, and who were provided first aid by non-medical workers, the results were significantly worse. In patients of this group, first aid was provided to only 13,9% of the wounded, in all cases it was wound processing and the aseptic bandage application, and in 10.5% of cases the first aid can be described as inadequate. When analyzing the course of the immediate postoperative period, we found that the development of complications was noted in 45,3% of patients. The distribution of the number of complications by groups showed that the largest number was 25,6% in group B, in group A complications were noted in 19,8% of cases. Further analysis showed that the number of complications in two groups directly depends on the severity of the condition of the wounded at the time of admission. The main complication that developed in the postoperative period in operated patients was purulent septic complications, noted in 22,1% of the wounded. The largest number of complications - 12.8% - was detected in group A, in group B such complications developed in 9.3% of cases. Of the total number of patients admitted with heart injuries, 23.2% of patients died. The mortality rate was 6.9% in group A, and 16.3% in group B.

Conclusion. Based on the analysis, it can be concluded that the heart injury is accompanied by a large number of complications in the immediate postoperative period - 45.3% and deaths - 23.2%. Among the major factors contributing to the development of complications and deaths are the following:

1. Timely, complete and competent assistance at the pre-hospital stage.
2. The condition and severity of damage to the wounded at the time of delivery.
3. The use of Damage Control tactics in cases where the condition of the wounded person at the time of admission is severe or extremely severe.

Currently, stenting is an innovative part of the surgical treatment strategy of patients with various types of the esophagus damage and perforation. This article highlights historical aspects of the use of esophageal stents, main indications for their placement in various esophageal defects. The technology of esophageal stenting is described in detail. The analysis of literature data on the effectiveness of stent placement and complications was carried out. It is concluded that there is a need for wider introduction of the stenting technique into clinical practice as an alternative or additional method to the existing conventional surgical treatment of the esophagus damage and perforation, in case a medical facility is technically able to perform it.

The progress achieved in recent years in the treatment of acute pancreatitis (AP) is largely associated with the general views on understanding the key mechanisms of the disease development. The development of modern diagnostic and treatment technologies are based on the Atlanta 2012 classification of acute pancreatitis, which has received a global reach and widespread professional support. The review presents the key provisions of the Atlanta - 2012 classification according to the principles of AP diagnosis, classification of the disease, peculiarities of the radiation methods of examination in determining local complications and their morphological features. The publication emphasized the importance of timely stratification of the severity of AP based on the assessment of organ failure using a modified Marshall scale. Currently, the Atlanta 2012 classification has become a generally accepted international standard for assessing acute pancreatitis, which allows for effective multidisciplinary interaction of various specialists to optimize the results of treatment of this disease.

The Olympiad Student Surgical movement historically arose from the activities of student scientific societies at the surgical departments of medical universities and, foremost, departments of operative surgery with topographic anatomy.  This is the first department where students are taught future surgical manual skills of a medical specialist. The history of the largest Moscow (All-Russian) Student Olympiad in surgery named after an academician M. I. Perelman, held under the authority of First Sechenov Moscow State Medical University, is more than 30 years. Olympiad Student Surgical movement at Voronezh N. N. Burdenko State Medical University appeared in 2008. A long and difficult path has been covered since then. The teams under the guidance of various lecturers and student leaders experienced ups and downs, repeatedly won victories in the qualifying stages of the All-Russian Olympiad and took prizes in the Finals of the All-Russian Olympiad. In 2015, the tradition of holding an intra-university student Olympiad in surgery was started. Since then, 6 intra-university Olympiads have already been held. This allows annually updating the staffing of the team and encouraging students to even better results. The Olympiad surgical movement has a great pedagogical and educational potential and, undoubtedly, is an important stage in training future medical specialists of a surgical profile.