[Ultrasonic geometry of synthetic endoprostheses after transabdominal preperitoneal hernioplasty of inguinal hernias]. / Ul'trazvukovaia geometriia sinteticheskikh éndoprotezov posle transabdominal'noi preperitoneal'noi gernioplastiki pakhovoi gryzhi.

OBJECTIVE: To assess position of mesh endoprosthesis in retroperitoneal space after TARR hernioplasty using ultrasound in early and long-term postoperative period. MATERIAL AND METHODS: There were 30 patients with inguinal hernias after TARR procedure. Standard technology of laparoscopic transabdominal preperitoneal hernioplasty was used in all patients. In all cases, a large-pore monofilament polypropylene mesh 10x15 cm was used. Control examination and ultrasound of the mesh implant were performed the next day, in 1, 3, 6, 12 months after surgery. Correct position of the implant was determined by its placement at the level of pubic bone with complete overlap of posterior wall of the inguinal canal and inner ring. RESULTS: US-image of the implant is present in two geometric forms - linear and sinusoid. The shape of prosthesis varies depending on postoperative period and the use of fixing elements. Thus, sinusoidal shape of prosthesis was observed in patients without fixation of prosthesis the next day and in 1 month after TARR. Geometry of the implant acquired the form of a straight line after 3 months and became almost a straight line in 12 months after surgery. Linear shape of prosthesis in early postoperative period was found after intraoperative fixation of endoprosthesis. Sinusoidal shape is noted after 3 months. Ultrasonic pattern of endoprosthesis looked as a thin hyperechoic band with thickness of 1.2-3.9 mm. Mean thickness of prosthesis was 2.2±0.1 mm the next day after surgery, 2.8±0.2 mm after 1 month and 1.6±0.05 mm after 12 months. CONCLUSION: Geometry of synthetic implants after TARR hernioplasty undergoes significant changes and depends on duration of postoperative period and fixation of the prosthesis.

[Complicated appendicitis during pregnancy]. / Oslozhnennye formy ostrogo appenditsita u beremennykh.

AIM: To analyze incidence, diagnosis and treatment of complicated appendicitis in pregnant women and to determine the optimal surgical approach. MATERIAL AND METHODS: Retrospective cohort analysis included 338 pregnant women who underwent appendectomy in 2012-2016. Complicated appendicitis (abscess, local or common peritonitis and their combinations) was diagnosed in 22 cases. The main perioperative variables (duration of the disease, time of surgery, length of hospital-stay, incidence of wound complications, etc.), clinical and laboratory symptoms, results of ultrasound diagnosis and pregnancy outcomes were analyzed. Statistical analysis was carried out in Stata 14.2. Fisher's exact test, Mann-Whitney-Wilcoxon's U-test and multivariate regression analysis were used to compare data. RESULTS: The incidence of complicated appendicitis in pregnant women was 6.51%. There are no clinical symptoms which would be significantly more common in complicated appendicitis during pregnancy. Complicated course prolongs surgery and hospital-stay, however duration of postoperative analgesia depends on surgical technique as a rule. There were 27% of laparoscopic interventions that is lower compared with women with uncomplicated appendicitis. The percentage of conversions was higher too. CONCLUSION: Clinical diagnosis of complicated appendicitis during pregnancy even by using of ultrasound is not satisfactory and requires the involvement of other objective methods, such as MRI. Laparoscopic intervention is not contraindicated in pregnant women with complicated appendicitis and determine better treatment outcomes than open surgery.

[Acute appendicitis during pregnancy]. / Ostryi appenditsit u beremennykh.

Acute appendicitis is the most frequent surgical disease complicating pregnancy. Accurate diagnosis is difficult due to atypical and misleading clinical manifestations. Surgeons frequently do not know about advantages and disadvantages of different diagnostic methods applied during pregnancy. Treatment of acute appendicitis in pregnant women remains the real challenge for surgeons. There are enough researches indicating on benefits and risks of both open and laparoscopic operations. The main risk is due to fetal loss after laparoscopic procedure. Safety of diagnostic techniques and laparoscopic procedures, surgical tactics and independent risk factors of pregnancy loss are touched in the article.

[Possibilities of local phlebectomy in correction of pelvioperineal venous reflux]. / Vozmozhnosti lokal'noi flebéktomii v korrektsii pel'vio-perineal'nogo venoznogo refliuksa.

The work was based on the results of examination and treatment of 43 female patients presenting with varicose transformation of pelvic, perineal, and lower-limb veins. The inclusion criteria were as follows: the presence of visually determined varicose transformation of the veins of the external genital organs, perineum, posterior surface of the thighs, as well as valvular insufficiency of the mentioned veins by the findings of ultrasonographic angioscanning (USAS). The following exclusion criteria were applied: the presence of pregnancy, symptoms of pelvic venous plethora (PVP), and varicothrombophlebitis. In 33 women correction of the pelvioperineal reflux (PPR) was performed with the help of local phlebectomy on the large pudendal lips and perineum, with the maximally possible mobilization of the vessel within the limits of the operative wound. Miniphlebectomy with the use of Varady phleboextractors was performed in 10 women presenting with isolated varicose transformation of the subcutaneous veins of the posterior femoral surface. The duration of follow up of patients amounted to 3 years. The criteria for efficiency of the carried out treatment were as follows: freedom from varicose syndrome both in the perineum and on the lower extremities, as well as no PVP symptoms during the whole term of follow up. Varicose syndrome of the external genital organs, perineum and posterior surface of the femurs was successfully eliminated in 100% of patients. Meticulous mobilization and removal of the veins of the labia majora, perineum and subcutaneous femoral veins is a reliable method of removing pathological reflux of blood from the intrapelvic to superficial veins of the perineum and lower limbs. 100% of our patients were found to be free from relapses of either vulvar or perineal varicosity, with no evidence of lower limb varicose veins. Local phlebectomy is an efficient method of elimination of varicose syndrome induced by PVP in patients with dilatation of intrapelvic, vulvar and perineal veins.

[Von Korff questionnaire in assessment of social disadaptation and therapeutic results in women with pelvic varicose veins]. / Anketa Van Korffa v otsenke sotsial'noi dezadaptatsii i rezul'tatov lecheniia patsientok s varikoznoi bolezn'iu taza.

AIM: The present study was conducted to examine the possibilities of the Von Korff questionnaire in assessing the impact of pelvic pain on social activity and working ability of women with pelvic varicose veins (PVV) and evaluating the results of treatment of the pathology involved. PATIENTS AND METHODS: The Von Korff questionnaire was administered in a total of 80 women presenting with PVV in order to assess the results of conservative and surgical treatment of PVV. RESULTS: Using the Von Korff questionnaire made it possible to objectively evaluate the psychosocial impact of chronic pelvic pain (CPP). It was determined that in 56 patients the presence of PVV and CPP was accompanied by a low level of social disadaptation and formation of grade I disability. 24 women were found to have moderate and high levels of social disadaptation and grade II-IV disability. Studying the outcomes of conservative and surgical treatment of PPV as assessed by means of the Von Korff questionnaire demonstrated high efficacy of the therapeutic techniques used. In patients subjected to surgical interventions, the CPP degree decreased from 7.6±0.9 to 1.6±0.9 points, the level of social disadaptation fell from 2.8±0.6 to 0.5±0.3 points, and the grade of disability decreased from 2.9±0.4 to 0.8±0.4, which may be regarded as complete restoration of social activity. DISCUSSION: The Von Korff questionnaire used in our study made it possible to objectively evaluate the impact of CPP related to pelvic varicose veins on formation of social disadaptation in women and a decrease in their working ability. In the general structure of the disease, 75% of women appeared to have a low level of social disadaptation and grade I disability, with a third having grade II, III and IV disability and a moderate-to-high level of social disadaptation. In 25% of women, the determined degree of disability averagely amounted to 2.9±0.4, thus suggesting their significant social disadaptation. CONCLUSION: The carried out study showed that the Von Korff questionnaire is an objective and demonstrative tool of clinical determination of the severity of pelvic varicose veins, as well as the effect of CPP on both everyday and social activity of women suffering from the pathology concerned.

Morphofunctional changes in hepatopancreatobiliary organs in experimental dyslipoproteinemia.

Dyslipoproteinemia was induced and corrected in 40 Chinchilla rabbits. Lipid metabolism disorders were corrected by Fishant vaseline-pectin emulsion and partial ileoshunting. Experimental dyslipoproteinemia initiated destructive dystrophic processes in the hepatopancreatobiliary organs manifesting by liver stenosis, gallbladder cholesterosis, and focal structural and functional disorders in pancreatic parenchyma. Correction of dyslipoproteinemia normalized the status of hepatopancreatobiliary organs, decreased the severity of destructive processes, and prevented their further development.

Changes in pancreahepatoduodenal organs during experimental acute lipogenic pancreatitis.

Experiments on animals with experimental lipogenic pancreatitis showed that disturbances in lipid metabolism stimulate destructive processes in the pancreas, liver, and spleen. Acute experimental lipogenic pancreatitis is characterized by extensive destructive changes in the pancreatic parenchyma accompanied with fatty necrobiosis of hepatocytes, fatty transformation of the gallbladder wall, and pronounced reaction of the reticuloendothelial stroma in the spleen.

[Morbidity of the peripheral nervous system among the crew of fishing vessels and their treatment under shipboard conditions]. / Zabolevaemost' perifericheskoi nervnoi sistemy plavsostava rybolovnykh sudov i lechenie ikh v sudovykh usloviiakh.

The incidence of diseases of the peripheral nervous system was studied during the voyage in different groups of sea sailors. The diseases due to overcooling and overexercise (cervico-thoracic and lumbosacral radiculosis) appeared to predominate. Methods of electroneurostimulation of acupuncture points and reflexogenic zones, lymphotropic therapy were used in the treatment administered on board the ship.

[Human nutrition under hyperbarism]. / O pitanii cheloveka v usloviiakh giperbarii.

In a 15-day experiment six test subjects were exposed to a hyperbaric environment. Their actual food and water consumption was measured. The consumption of a diet with a caloric value of 3300--3500 kcal did not alter the body weight of exercising test subjects. During decompression the food consumption decreased. Certain food products caused dyspepsia. The total amount of consumed water was not more than 2500 ml/day.

[Nitrogen, carbohydrate and lipid metabolic indices in man during a prolonged stay under hyperbaric conditions]. / Pokazateli azotistogo, uglevodnogo i lipidnogo obmenov pri dlitel'nom prebyvanii cheloveka v usloviiakh giperbarii

Some parameters of the protein, fat and carbohydrate metabolism were examined in men who worked in a nitrogenoxygen atmosphere at 5 ata. Three series of 15-18 day experiments were carried out on two test subjects in each. The test subjects were kept on a well balanced diet. In the first experimental series no additional vitamins were given. In the second and third experimental series the test subjects were given an Undevit vitamin complex. Test subjects of the first group showed changes in nitrogen metabolism and an increased content of sugars in blood. Test subjects of the second and third groups displayed minor, if any, changes of that kind. After the experiments the parameters returned to the normal within different periods of time.