Vol 15, No 4 (2022)

Introduction. Search for new means and methods of sanitation of the abdominal cavity remains significant related to growing antibiotic resistance of bacterial pathogens in surgical infection. This challenge is of particular relevance in the development of purulent complications of acute pancreatitis due to the complexity of radical control of the inflammation source.
The aim of the study was to evaluate outcomes of microbiological examination of peritoneal exudate, biopsies of the pancreas, arterial blood in the topical application of gaseous ozone for the treatment of experimental infected pancreatic necrosis.
Methods. This prospective experimental study included 43 laboratory animals - Soviet Chinchilla rabbits. Group 1 consisted of 13 animals, groups 2 and 3 consisted of 12 animals each. All animals were infected with pancreatic necrosis simulated using a clinical strain of A. baumannii. Sanitation relaparotomies were performed in 24 hours and 60 hours under anesthesia: with 0.9% sodium chloride solution in animals of group 1, with 0.02% aqueous solution of chlorhexidine bigluconate in animals of group 2, with ozone-oxygen gas mixtures in animals of group 3. The control group included six sham-operated animals. Animals were withdrawn from the experiment in 96 hours with taking samples for microbiological investigations.
Results. Animals of group 1 showed an increased frequency (from 23.1 to 100.0%, p=0.003) and degree (from 3.5 (3.0; 4.5) to 7.0 (5.5; 7. 5) lg COE/ml, p<0.001) of bacterial contamination of peritoneal exudate within 24 to 96 hours. Most parameters in animals of group 2 were not significantly different from those achieved in animals of group 1. Notably, the bacterial count of A. baumannii in the peritoneal exudate in 60 hours (6.0 (5.7; 6.7) lg COE/ml), and the degree of secondary (enterogenic) contamination of the pancreas (5.5 (5 .0; 6.7) lg CFU/g) and peritoneal exudate in 96 hours (7.7 (7.0; 8.0) lg CFU/ml) in animals of group 2 significantly exceeded those in animals of group 1 (p≤ 0.010). Intraperitoneal application of a directed flow of gaseous ozone in 24 and 60 hours allowed achieving elimination of A. baumannii in 80.0% of pancreatic biopsy samples by the end of the fourth day (p=0.002 and p=0.007 when compared with results of groups 1 and 2, respectively), prevent its spread into the peritoneal exudate and systemic circulation. The treatment with gaseous ozone was also accompanied by the decreased bacterial count of A. baumannii and the degree of secondary (enterogenic) contamination by other opportunistic microorganisms in the analyzed samples.
Conclusion. Perspectives for translating the results obtained into clinical practice determine the relevance of studying modern molecular methods of bacteriological analysis. This should be combined with an adequate assessment of the safety of various targeted treatment options of the abdominal tissues and organs with an ozone-oxygen gas mixture.

Pleural empyema (EP) is one of the most complex nosologies of thoracic surgery. Mortality in this disease reaches 28% according to the literature. The causes of the development of nonspecific empyema of the pleura are various purulent-destructive lung diseases, as well as inflammatory diseases, surgical interventions and injuries. The presence or absence of bronchopleural fistula (BPS) is crucial in determining the prognosis of treatment of pleural empyema. This article is devoted to the study of the issues of surgical treatment of BPS against the background of various EP variants.
Objective. To evaluate the effectiveness of using fibrin glue as a regeneration stimulator in the treatment of patients with bronchopleural fistulas on the background of pleural empyema.
Materials and methods. In the I. V. Davydovsky State Clinical Hospital No. 23, for the treatment of patients with EP complicated by the development of bronchopleural fistula, an integrated approach is used using the concept of biological stimulation of tissue repair through the use of fibrin glue obtained by cryoprecipitation.
Results. Our experience based on the study of 136 patients with pleural empyema of various etiologies (post-pneumonic (n=76), post-resection (n=11), covid-associated (n=49)) shows encouraging results. The clinical efficacy of using fibrin glue as a stimulator of tissue repair was 91,89% in the group of post-pneumonic EP, 66,66% in the group of post-resection EP and 90,9% in the group of covid-associated EP. However, the results obtained require further analysis and study.
Conclusion. Despite the achievements of recent decades in antibiotic therapy, the improvement of surgical techniques and new minimally invasive methods of treatment, the problem of the development of bronchopleural fistulas remains relevant to this day. Knowledge of the issues of pathogenesis, risk factors, as well as the improvement of therapeutic tactics in the development of this formidable complication will increase the effectiveness of treatment and improve the prognosis of this category of patients. The use of biological stimulators of tissue repair based on own blood plasma may be a promising direction of treatment of this complex pathology.

Testicular cancer is a rare oncourological disease. Of great significance is the fact of the disease onset precisely at the age when men are planning their future life: education, family, etc. According to current clinical guidelines, the treatment of this disease should be complex, including surgical treatment, polychemotherapy and external beam radiation therapy, which leads to a cure in 90% of cases.
In the presented clinical case, a 25-year-old patient was diagnosed with right testicular cancer stage III, T2N3M1S0 [PUL]. However, despite the significant initial prevalence of the pathological process, as well as the detection of a single retroperitoneal metastasis in the pancreas two years after the last stage of surgical treatment, the applied multi-stage tactics of complex treatment of the patient allowed not only removing the tumor and metastases, but also rehabilitating the patient socially.

Surgical treatment of incisional hernia is an actual problem of abdominal surgery. Despite the improvement of surgical techniques, the results of surgical treatment cannot be considered satisfactory: the recurrence rate continues to be high and is due to failures in the reconstruction of complex ventral hernia. Although there are many works devoted to various aspects of the surgical treatment of patients with complex incisional hernias, the problem is not sufficiently resolved. The treatment of this category of patients is a difficult task for both surgeons and patients due to the high risk of general and local complications. A clinical case of surgical treatment of a patient with a complex incisional hernia is presented, in which it was possible to carry out a complete reconstruction of the anterior abdominal wall in two stages without "components separation" method.

For a number of centuries, the problem of bleeding arrest from damaged vessels remains the major issue of surgery (alongside with infectious complications and fight against the pain syndrome). The development of vascular surgery began exactly when bleeding from a damaged vessel was arrested by tying it, and the introduction of reconstructive vascular surgery, being one of the most outstanding achievements of the 20th century, was the peak of creation. With the advent and development of this relatively young branch of clinical surgery, it became possible to effectively help patients with various vascular pathologies, previously considered incurable and doomed to death. However, the development of each industry is necessarily associated with the development of technical support. The lack of high-quality suture material and instruments has restrained the development of reconstructive vascular surgery for a long time; this fact forced researchers and surgeons to develop techniques for the seamless connection of blood vessels. Despite the widespread use of manual surgical suture, it is not always possible to use this option due to altered vascular walls. Development of technology for manufacturing synthetic materials allowed for techniques providing fast and high-quality connection of blood vessels, significantly reducing the time required for reconstruction and, as a result, reducing the incidence of complications.

Introduction Total knee arthroplasty is the treatment of choice in orthopedic practice for patients with late –stage knee osteoarthritis. However, arthroplasty has not only benefit results and the service life of the endoprothesis is limited. The use of modern conservative therapy and joint-preserving surgions allowed to delay or to avoid knee arthroplasty.

Purpose. The study purpose is the analysis of publications with negative results of knee arthroplasty in patients with knee osteoarthritis.

Materials and methods.  The electronic Pub-Med/MEDLINE and eLibrary databases were searched for reviews published between 2002 and 2022.  A keyword search was also done using the terms: knee joint osteoarthritis, total knee replacement/arthroplasty, complications, patient satisfaction, indications/contraindications for surgery; related definitions and descriptions were extracted.

Results. The negative consequences of total knee arthroplasty are heterogeneous. Complications can be local and systemic such as surgical site infection, periprosthetic fracture, aseptic loosening (aseptic instability) of the endoprosthesis and its wear and the implant failure. The researcher’s data indicate increasing the number of patients who are not satisfied with the results of arthroplasty both in the short term and in the long-term after the operation, due to the natural wear of the prosthesis. Patients are not satisfied with the results of the operation 8% -30%. In recent years, there have been more publications devoted to the limitation of indication for arthroplasty in pftients with knee osteoarthritis. The replacement of the knee joint with an implant was done unreasonably in great number of cases.A number of patients after total knee arthroplasty require revision surgery within the first 5 years. Currently, the risk of failure of knee arthroplasty with the revision surgery in 10 years after primary arthroplasty is 5-6.8%. The main reasons for revision surgery after primary knee arthroplasty are periprosthetic infection and instability of the implant components, while the results of revision surgery are worse than   the primary arthroplasty.

For Professor Israil Moiseevich Perelman (1892-1954) the events of the second half of 1951 unfolded tragically. The release from the head of the department of general surgery and the appointment to the post of head of the department of topographic anatomy with operative surgery of the Yaroslavl Medical Institute deprived him of the opportunity to practice practical surgery. Such objections were not accepted, and I.M. Perelman was fired from the institute as not starting work. In the spring of 1952, the disgraced professor returned to Belarus. Having visited Minsk and found himself on the banks of the post-war Svisloch, he poignantly felt the atmosphere of Lyakhovka half a century ago. Memory brought him back to the summer of 1905, when he became a student of the Minsk real school – a storehouse of knowledge for those who, following the results of their studies, were willingly enrolled in metropolitan universities. Talented teachers took an active part in shaping the personality of Israil Perelman, including Samoilo I.I., Gurvich O.Ya., Pionier L.O., Skokanek A.I. The period of adolescence was also enriched by the first charm of the soul, when Israil experienced sympathy for the one who became the secret of ardent feelings. Their reciprocity turned out to be fragile, short-lived and irretrievably gone into the distant past. In a real school, fate brought the young man to O.L. Lunts, who served here as a staff doctor. As an experienced clinician and an outstanding public figure, the doctor shared his life experience. His stories strengthened the desire to engage in healing and instilled faith in the correctness of the choice of the future profession. The logical result of seven years of study in a real school was the receipt of a certificate of complete secondary education, bringing Israil Perelman one step closer to achieving his main dream – to be a doctor.

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