MODERN SURGICAL TACTICS IN CROHN’S DISEASE IN COLOPROCTOLOGICAL CENTRE OF UKRAINE
А. I. Poyda, V. М. Меlnik, N. D. Kucher, V. А. Zhelman, М. I. Krivoruk
Surgical tactics in Crohn’s disease (CD) was elaborated by the authors, basing on analysis of modern views on pathogenesis, peculiarities of clinical course, possibility of diagnosis and experience of treatment of the disease. It envisages a modern diagnosis of the disease, prognostication of the recurrence and postoperative complications occurrence, the indications optimization, the choice of surgical treatment method. Application of the surgical tactics elaborated for CD in 121 patients have permitted to improve objective estimation of the disease severity, to prognosticate the complications occurrence, to optimize indications for surgical treatment and the choice for method of conditionally radical, restorational, reconstructive-restoration stages of operative intervention, to reduce the disease recurrence rate, postoperative complications and postoperative lethality.
Klinichna khirurgiya. – 2015. – N 2. – P. 13–15.
GASTRODUODENAL MUCOSA SENSITIVITY TO ЕSTROGEN IN ULCERS, COMPLICATED BY HEMORRHAGE
І. D. Duzhiy, А. М. Romanyuk, S. V. Kharchenko, Р. А. Москаленко, G. І. Pyatykop, М. S. Lyndin
Expression of alpha-receptors of estrogen (ER) in accordance to immunohistochemical (IHC) labeling in gastroduodenal mucosa cells was studied up in patients, suffering the ulcer disease and without it. In 4 patients (І group) a gastroduodenal mucosa affection was revealed, they were operated on for hemorrhage from gastroduodenal ulcers; in 3 patients (group ІІ) gastroduodenal mucosa affection was not observed; in 4 patients (group ІІІ, control), a mammary gland cancer was diagnosed, a positive reaction on аlpha–ER was noted. In groups І and ІІ the biopsies were studied, obtained from pylorus and gastric fundus, аs well as from duodenal ampula, and in a group ІІІ – obtained from the tumor. In a control group a positive labeling of nuclei was revealed in biopsies. In patients of groups І and ІІ the аlpha–ER expression by cellular nuclei was not revealed, but, the lots of positive ІHC labeling of cytoplasm in glandular and stromal mucosal cells of the investigated gut were noted. Positive ІHC labeling of cytoplasm for аlpha–ER witnesses about sensitivity to them in norma and pathological processes. But, a trustworthy difference of аlpha–ER expression by cellular nuclei was not noted. For confirmation or denial of this hypothesis further clinical and ІHC investigations are needed.
Klinichna khirurgiya. – 2015. – N 2. – P. 16–19.
TREATMENT OF PATIENTS FOR STENOSING DISEASES OF THE ESOPHAGUS
E. V. Shaprynskiy
The results of operative treatment of 122 patients for stenosing diseases of the esophagus during 1993 – 2014 yrs period were analyzed. The expediency of application of the technology proposed was proved.
Klinichna khirurgiya. – 2015. – N 2. – P. 20–21.
NEW APPROACHES IN SURGICAL TREATMENT OF ACUTE PARAPROCTITIS
М. М. Маmedov, М. F. Mustafayeva
The results of treatment of 77 patients, ageing 18 – 71 yrs old, for an acute paraproctitis in 2010 – 2014yrs were analyzed. A preventive puncture-flush enzymosanation of purulent foci, using immobilized bacterial proteinases (imozimase), metrogyl-P in conjunction with low-intensive laser irradiation have permitted to conduct the optimal preoperative preparation of patients, to improve their state, to reduce the local inflammatory reactions intensity significantly.
Klinichna khirurgiya. – 2015. – N 2. – P. 22–24.
IMPORTANT ESTHETIC ASPECTS OF CORRECTION OF ANTERIOR ABDOMINAL WALL
І. V. Yatsyshyn
Effective surgical technology of the umbilicus and the near-umbilicus zone formation was proposed, basing on compilation of experience, concerning performing of esthetic abdominoplasty in 209 patients. Results were estimated in 4 groups of patients? In whom a standard and improved methods of umbilicus formation were applied.
Klinichna khirurgiya. – 2015. – N 2. – P. 25–28.
THE CHOICE OF SURGICAL TACTICS IN INCARCERATED POSTOPERATIVE ABDOMINAL HERNIAS
F. N. Ilchenko, N. N. Derkach, N. V. Lyashenko, М. М. Serbul
The results of surgical treatment of 82 patients, suffering incarcerated postoperative abdominal hernia, were analyzed. Optimal surgical tactics, depending on presence of the risk factors for postoperative complications occurrence, was proposed. The choice of operative method in patients with different operative risk, was substantiated.
Klinichna khirurgiya. – 2015. – N 2. – P. 29–31.
COMPARATIVE ANALYSIS OF APPLICATION OF HIGHLY INTENSIVE LASER IRRADIATION AND ELECTROCOAGULATION WHILE LAPAROSCOPIC CHOLECYSTECTOMY, PERFORMED FOR DESTRUCTIVE FORMS OF AN ACUTE CALCULOUS CHOLECYSTITIS
М. Yu. Nichitaylo, А. М. Bazyak, V. V. Klochan, P. К. Grusha, А. V. Goman
Comparative analysis of results of the laser diode (the wave length 940 nm ) and electrocoagulation application while performing laparoscopic cholecystectomy was conducted .For an acute calculous cholecystitis 52 patients were operated, in whom instead of electrocoagulation the laser was applied, securing reduction of thermal impact on tissues, the complications absence, reduction of the patients stationary treatment postoperatively from (5,2 ± 1,2 ) to (4,9 ± 0,6 ) days.
Klinichna khirurgiya. – 2015. – N 2. – P. 32–34.
CLINICAL AND LABORATORY DIAGNOSIS OF AN ACUTE BILIARY PANCREATITIS
S. М. Vasylyuk, V. V. Іvanyna
In 126 patients, suffering an acute biliary pancreatitis (ABP), clinical examination was conducted. In 65 patients (1–st group) the isolated cholecystolithiasis was noted; in 35 (2–nd group) – cholelithiasis, which did not cause obturation of common biliary duct; in 26 (3–d group) – cholelithiasis, which caused the biliary ways obturation (including calculi, which were incorporated into the duodenal papilla magna mouth). Clinical course of an ABP have differed depending on localization of calculi of extrahepatic biliary ducts. In patients, suffering ABP, a biochemical signs of hepatocytes functional disorders were observed, impacting the need for hepatoprotector preparations inclusion into complex of perioperative conservative therapy. Determination of activity of pancreatic α–аmylase in the blood serum and conduction of the АСТІМ Pancreatitis test constitute the most sensitive and specific methods of the ABP biochemical diagnosis.
Klinichna khirurgiya. – 2015. – N 2. – P. 35–31.
THE ROLE OF MATRIX METALLOPROTEINASES AND THEIR INHIBITORS IN PATHOGENESIS OF PANCREATIC PSEUDOCYSTS
І. А. Кryvoruchko, N. М. Goncharova, S. А. Аndreyeshchev
The investigation was conducted in 47patients, оperated on for pancreatic pseudocysts (PP). Activity of matrix metalloproteinases (ММP–9) and content of their tissue inhibitor (ТІМP–2) were determined in the blood serum for estimation of inflammatory factors, hypoxia severity and state of the pancreatic tissue reconstruction. High activity of ММP–9 and ТІМP–2 in presence ofPP Types І and II was noted in patients, what, probably, is caused by compensation reaction, directed towards inhibition of the collagen system destruction (predominantly of collagen Type IV) and prevention of further reconstruction of pancreatic connective tissue. While progressing of pancreatic fibrosis the ММP–9 activity and the ТІМP–2 level have lowered in comparison with these indices while its absence. In PP Type ІІІ the ММP–9 activity was by 83,6% higher, than in a control group, but, by 51,4 and 35,1% lower, than in PP Types I and II. In all the patients endothelial dysfunction with endothelial injury was observed, witnessed by significant rising of the VEGF content in the blood serum. It have created favorable conditions for pancreatic tissue remodeling while parenchymal defect have been constituted by tissue, owing lower level of organization, including a cicatricial one. In cases of cellular repeated affection more activation of pancreatic and enhancement of production of extracellular matrix component were noted.
Klinichna khirurgiya. – 2015. – N 2. – P. 42–45.
LONGITUDINAL SHIFT OF LEFT VENTRICLE WALLS IN NORM AND WHILE DILATED CARDIOMYOPATHY
Е. М. Тrembovetskaya, G. V. Knyshov, V. P. Zaharova, К. V. Rudenko
Peculiarities of longitudinal shift of the left ventricle (LV) walls were studied in patients in various variants of dilatational cardiomyopathy (DCMP).
In patients, suffering DCMP, the enhancement of the end-diastolic pressure (EDP) and the end-systolic (ESI) indices are noted, as well as of the punch index and expulsion fraction, the pulmonary artery hypertension, moderate insufficiency of mitral and tricuspid valves. These changes are aggravated in complete blockade of left pedicle of atrio-ventricular fascicle (AVF). In cardiac contractions, in normal conditions and in DCMP as well, a maximally pronounced longitudinal myocardial shift is revealed in basal segments of left ventricle, while cardiac apex remains practically immobile. In DCMP a longitudinal shift of the left ventricle myocardium reduces significantly while cardiac insufficiency progression. In complete blockade of left pedicle of AVF, presented by total reduction of amplitude of longitudinal myocardial shift in the left ventricle lateral and posterior walls, aggravation of a mitral valve insufficiency (up to 2+) and raising of pressure in pulmonary artery – up to (60,1 ± 7,5) mm Hg, further progression of the blood circulation insufficiency were noted.
Klinichna khirurgiya. – 2015. – N 2. – P. 46–48.
CELLULAR AND BIOCHEMICAL CONTENTS OF SUSPENSION OF THE LAUNDERED AUTOLOGOUS ERYTHROCYTES, ОBTAINED USING A CELL SAVER APPARATUS
S. О. Кuzmenko
Efficacy of autologous blood and residual blood laundering while cardiosurgical operations performance in a newborn babies for the inborn heart failures in conditions of artificial blood circulation, using a cell saver apparatus, was investigated. In accordance to the investigation data obtained, the efficacy of a free hemoglobin laundering have constituted 71,6%, proinflammatory interleukin – 6 (ІL–6) – 95,8%,loss of thrombocytes – 85,8%.
Klinichna khirurgiya. – 2015. – N 2. – P. 49–51.
EFFICACY OF BALLOON CATHETERS WITH ANTIPROLIFERATIVE COVER IN PATIENTS, SUFFERING AFFECTION OF ARTERIES OF FEMORO-POPLITEAL SEGMENT
А. I. Pityk
Results of treatment of 30 patients, suffering affection of arteries of femoro-popliteal segment, using balloon catheters with treating cover, are analyzed. There was proved, that balloon angioplasty, comparing with routine angioplasty, secures significantly better the indices of primary passability of operated arteries, as well as reduce the rate of restenosis occurrence in late period.
Klinichna khirurgiya. – 2015. – N 2. – P. 52–56.
THE METHODS OF PERIOPERATIVE CORRECTION OF THE ENERGY-STRUCTURAL INTERRELATIONSHIPS IN THE ORGANISM
L. М. Smirnova
In a frame of new conceptual approach to the operative risk lowering,the innovative methods of a personified perioperative support were presented. Among them: dynamical stress-monitoring, аntinociceptive narcose potential, methods of transfusional and the stress-correction.
Klinichna khirurgiya. – 2015. – N 2. – P. 57–59.
МОRPHOGENESIS OF CONNECTIVE TISSUE IN PATIENTS WITH HYDRONEPHROSIS, СAUSED BY STRICTURE OF URETERIC PELVIC SEGMENT OF VARIOUS ETIOLOGY
V. І. Savenkov
In patients, suffering hydronephrosis Stages ІІ–ІІ, caused by the ureteric pelvic segment (UPS) obstruction due to inborn failures of urinary system, the collagens Types I and III ratio reduction, аnd in acquired obstruction – its enhancement, are noted in interstitium, renal parenchyma vessels and the UPS walls. While obstruction in patients due to inborn failures in vascular basal membranes a deficiency of collagen Type IV and appearance of nontypical for vascular basal membranes іntersticial collagen Type ІІІ are observed. In the acquired UPS obstruction the enhancement of content of collagen Type IV is revealed only. These disorders are mostly pronounced in patients with the disease recurrence. There was proposed diagnostic coefficient of ratio between collagens Types І and ІІІ in patients, suffering hydronephrosis, caused by obstruction of various etiology. In hydronephrosis, caused by the UPS stricture, the cytokines disbalance occurs, impacting processes of collagen formation.
Klinichna khirurgiya. – 2015. – N 2. – P. 60–62.
BISEGMENTAL ANTERIOR INTERBODY SPONDYLODESIS, USING RIGID PLATES, IN SURGICAL TREATMENT OF CERVICAL VERTEBRAL COLUMN TRAUMAS AND DISEASES
А. Е. Barysh, S. А. Коzyrev
Results of surgical treatment of 34 patients, suffering cervical vertebral column traumas and diseases, are analyzed. In all the patients bisegmental anterior interbody spondylodesis was conducted, using cervical rigid plates and vertical cylindrical net implants. The existing and newly obtained information about changes in the radiological indices dynamics while the method application by its authors is presented. The interbody synostosis was achieved in 82,4% patients in 1 yr after the operation. The complications rate while the implants application have constituted 23,3%, and the total rate of complications – 29,1%.
Klinichna khirurgiya. – 2015. – N 2. – P. 63–66.
THE PLASTY FOR THE HIP REGION SORES, USING THE FLAP, CONSISTING OF M. TENSOR FASCIAE LATAE
D. А. Pasichniy
The method of plasty for the hip region sores, based on transposition of proximal part of m. tensor fascia latae in content of the flap, using her transsection between place of attachment to spina iliaca anterior superior and place of the main vascular pedicle entry into the muscle,was proposed, what permits to prevent vast mobilization of the muscle and to secure existing in normal conditions and formed in pathological conditions anastomoses between vascular net of the flap and surrounding tissues. The method proposed was successfully applied for plasty of the hip region sores of degrees III – IV in 2 patients.
Klinichna khirurgiya. – 2015. – N 2. – P. 67– 69.
ІNVALIDISM DUE TO TRAUMAS AND DISEASES OF A KNEE JOINT
S. S. Strafun, О. А. Коstogryz, М. М. Rygan, Yu. V. Ilyin, Yu. О. Коstogryz, R. V. Nechyporenko
The invalidism structure was analyzed for patients, suffering consequences of traumas and diseases of a knee joint. The primary invalidism level because of traumas and diseases of a knee joint have constituted in 2013 yr 12,4%. The cause of invalidism in men is predominantly a one-side gonarthrosis, and in women – a bilateral one – due to concurrent aggravating causes (dishormonal changes, excessive body mass). The invalidism indices enhancement is caused by absence of a dispensary follow-up, insufficient treatment on various stages of the disease course, severity and irreversibility of pathological process in a knee joint, socio-economic factors, low rehabilitational potential, prognosticated impossibility to conduct a professional-labour rehabilitation in a prepensionable and pensionable age.
Klinichna khirurgiya. – 2015. – N 2. – P. 70–72.
PROCALCITONIN AS A PREDICTOR OF BACTEREMIA IN PEDIATRIC PATIENTS, SUFFERING ONCOLOGICAL DISEASES WITH FEBRILE NEUTROPENIA
D. А. Аliyev, Z. Sh. Vezirova, Т. F. Geyusheva
Dynamics of procalcitonin level was studied in 75 pediatric patients, in whom on background of polychemotherapy conduction for oncological disease bacteremia and neutropenia have occurred. Determination of procalcitonin level as a rapidly reacting biomarker of generalized infectious process permits to establish its progression, to conduct early diagnosis, to perform timely and adequate treatment measures.
Klinichna khirurgiya. – 2015. – N 2. – P. 73–75.
EXPERIMENTAL SUBSTANTIATION OF POSSIBILITY OF SANATION FOR PURULENT ENTERITIS IN MECHANICAL ACUTE ILEUS
Т. I. Таmm, V. V. Nepomnyashchiy, Е. А. Shakalova
In experiment on the model of mechanical acute ileus (AI) in accordance to morphological and microbiological investigations data there was established, that in intestinal wall, situated above the obstacle place, purulent enteritis occurs, what may constitute the origin of purulent-septic complications after elimination of the AI cause. Application of antibacterial preparations permits to slow down the progression of destructive processes in the affected intestinal wall.
Klinichna khirurgiya. – 2015. – N 2. – P. 76–78.
PECULIARITIES OF HETEROTOPIC TRANSPLANTATION OF ADIPOSE GRAFT, ENRICHED BY ALLOGENIC CRYOCONSERVED STEM CELLS FROM ADIPOSE LIPOASPIRATE
О. Yu. Usenko, R. V. Salyutin, К. М. Zapohlska, S. S. Palyanytsya, L. А. Panchenko
Possibilities of application of the donor cryoconserved cellular material (mesenchymal stem cells, obtained from adipose tissue) for defense of transplanted adipose graft from the tissue resorption were studied. The adipose graft enrichment, using cryoconserved allogenic mesenchymal multipotent stem cells, obtained from adipose tissue, caused activation of destructive-inflammatory processes in adipose graft, the adipocytes survival worsening, and in further – the transplant mass deficiency. We suggest inexpedient to apply in clinical practice the donor cryoconserved stem cells for defense of transplanted adipose tissue from the tissue resorption.
Klinichna khirurgiya. – 2015. – N 2. – P. 79–80.
Оlexiy Viktorovych LIGONENKO
to 60–th anniversary