Journal of Experimental and Clinical Surgery

Background. Currently, advanced endoscopic imaging techniques allow obtaining highly detailed images previously unavailable for white light endoscopy, but the operator-dependent nature of their interpretation is an obstacle to their successful application in practice. The development of standardized criteria using computer technology and simplification of classification systems will reduce the impact of the learning curve of an endoscopist, as well as consolidate the results obtained and evaluate the effectiveness of a single option in numerical values.

The aim of the study was to evaluate the effectiveness of blue light imaging technology in gastroesophageal junction pathology.

Materials and methods. The study included 100 patients who underwent video esophagogastroduodenoscopy using blue light imaging and targeted biopsy. The color contrast of the BLI mode and examination in white light findings were compared.

Results. The study revealed samples of hyperplasia, intestinal and gastric metaplasia of the esophagus combined with inflammation.

Conclusions. Based on the conducted study, it can be stated that BLI, used as an additional mode in standard esophagogastroduodenoscopy, has a high color contrast, which can be helpful in the diagnosis of hyperplasia and other epithelial abnormalities of the upper gastrointestinal tract.

Background. Currently, the number of relapses after performed prosthetic hernioplasty techniques of the anterior abdominal wall, including those due to severe wound infection and rejection of the mesh prosthesis, reaches 5-10%. In this regard, the use of bioengineered transplants deprived of immune properties due to decellularization is a promising direction. The use of extracellular matrix promotes better engraftment of the material in the area of the hernial gate and, thereby, reduces the likelihood of wound complications in the postoperative period. However, in clinical practice, biological analogues of polypropylene mesh have low availability and high cost.

The aim of the study was to experimentally evaluate the local and general reaction of the body to the implantation of a bioengineered heterograft into a simulated defect of the anterior abdominal wall in an infected wound.

Materials and methods. The study was conducted on 90 male Wistar rats. The study objects were divided into three groups, comparable in number of observations (n=30 each) – the main group (onlay+bioengineered heterotransplant), the comparison group (onlay+polypropylene mesh, Lintex Esfil) and the control group (autoplasty). All animals were first formed a hernial defect along the white line of the abdomen, after which a staphylococcal suspension was injected into the wound to simulate an infected wound, and then the hernial defect was plasticized. In each group, the general and local reactions of the body to a particular material were evaluated on days 1, 5, 10, 30, and 180 after surgery.

Results. Based on an assessment of the local and general body response to various types of plastic surgery of a simulated hernial defect of the anterior abdominal wall of rats in an infected wound, it was found that a bioengineered heterograft promotes more effective wound healing (n=30-100%) compared with a polypropylene mesh (n=25 - 83.3%), which is confirmed by laboratory and objective data. with data.

Conclusion. The data obtained in the experiment allow us to consider the potential using bioengineered material in clinical practice, especially under increased risk of wound infection.

Backgraund. Metastatic lesions of the cervical vertebrae occur, on average, in 15% of patients with metastases to the spine. Compression of the spinal cord by tumor masses in this part of the spine leads to rapid progression of neurological deficits, decreased quality of life, and death. Currently, no single option of surgical treatment for this cohort of patients has been proposed.

The aim of the study was to evaluate the results of surgical treatment of patients with metastatic lesions of the cervical vertebrae.

Materials and methods. An ambispective single-center study included patients who underwent surgical treatment for metastatic lesions of the cervical spine between 2010 and 2023. The study included patients over 18 years of age who were admitted to surgical treatment based on their somatic status. Patients with vertebral lesions caused by a primary tumor or lymphoproliferative disease, and patients with severe neurological deficit were excluded. The traumatic nature of the surgery, the dynamics of pain syndrome and neurological symptoms, and changes in the patient's functional status 1 and 3 months after surgery, as well as at various points during life after surgical treatment, were assessed. The study involved 80 patients who were divided into groups depending on the method of surgical treatment: in group "A" - orthotics with biopsy, ablation, vertebroplasty of the affected vertebrae in various combinations were performed, in groups B (retrospective) and C (prospective) - decompressive stabilizing intervention without metastasectomy, in groups D (retrospective) and E (prospective) - metastasectomy, decompression of neural structures and stabilization of the spine.

Results. The results of the study showed regression of neurological symptoms and pain syndrome in all operated patients throughout the entire observation period. Survival of patients in prospective groups was higher than in retrospective ones, especially with metastasectomy.

Conclusions. Surgical treatment of metastatic lesions of the spine leads to regression of existing neurological symptoms and pain control, regardless of the chosen surgical treatment option. The survival rate of patients with metastasectomy within 5 years after surgical treatment is higher than among patients in other groups.

Introduction. The pathogenesis of the mutual negative effects of chest injury and musculoskeletal system is based on complex mechanisms in which damage to one system aggravates the condition of the other. The results of numerous studies show that early stabilization of chest injuries and concomitant fractures of the musculoskeletal system can significantly improve the prognosis of treatment for patients.

Materials and methods. The epidemiological and clinical-topographic features of combined injuries of the chest and musculoskeletal system are given. The clinical case of a 44-year-old patient admitted to the hospital with multiple thoracic trauma accompanied by a hip fracture is described. A systematic review of the literature on the research topic is presented.

Results and discussion. In the analyzed group, 38.8% of those hospitalized had a combined injury. A combination of groups of these injuries in the form of severe polytrauma with ISS>16 points was noted in 5.1% of hospitalized patients. The presented clinical case was treated without complications both at the inpatient and outpatient stages.

Conclusion. The presented clinical case clearly supports the effectiveness of minimally invasive surgical stabilization of the chest skeleton and damage to a large segment of the musculoskeletal system in a patient with a combined thoracic injury.

Enterocutaneous fistulas (ECFs) are a severe and potentially life-threatening complication that occurs primarily after abdominal surgery or inflammatory diseases of the gastrointestinal tract, such as Crohn's disease, diverticulitis and complicated forms of ulcerative colitis. ECF is accompanied by pronounced disorders of the water-electrolyte and protein-energy balance, the development of infectious complications, sepsis, as well as severe nutritional insufficiency. The latter is one of the key factors determining the prognosis in this category of patients, significantly affecting the outcome of treatment, the duration of hospitalization, terms of the fistula healing and the mortality rate.

This review examines in detail modern approaches to nutritional support for patients with ECF at various stages of treatment. The article highlights the diagnosis options for nutritional deficiency, including clinical and laboratory parameters, scales for assessing nutritional status and instrumental control options. Special attention is paid to the indications for parenteral, enteral and combined nutrition, the choice of route and composition of nutritional mixtures, as well as the potential use of special substrates (glutamine, omega-3 fatty acids, etc.) to modulate the metabolic response and reduce inflammation.

The data from leading clinical studies on the effectiveness of various nutritional support strategies in patients with enterocutaneous fistulas, including those in specialized centers, are analyzed. The review provides an overview of current recommendations from international expert communities, including ESPEN, ASPEN, the experience of Chinese colleagues and Russian experts. The need for an individualized approach to the choice of nutritional tactics is emphasized, taking into account the localization, the volume of intestinal discharge losses, the general condition of a patient and the phase of the disease.