[MINIINVASIVE TECHNOLOGIES IN TREATMENT OF POSTOPERATIVE ABDOMINAL HERNIAS].

Methods and results of treatment of 119 patients, suffering postoperative abdominal hernia, were analyzed. There was established, that application of laparoscopic miniinvasive technologies permits to improve the results of treatment in patients in comparison with those after open operative interventions, due to shortening of the operation duration, better visualization during viscerolysis conduction, shortening of rehabilitation period, the patients postoperative quality of life improvement.

[CLINICO-EXPERIMENTAL SUBSTANTIATION OF INTRAABDOMINAL PLASTY FOR UMBILICAL HERNIAS].

The impact of various methods of plasty, using net implants, on results of umbilical hernias treatment was studied in experimental and clinical investigation. The umbilical hernias plasty was performed in accordance to the IPOM (intraperitoneal on lay mesh) method, application of which have permitted to reduce a hospital stay of the patients as well as their period of social rehabilitation, and to guarantee the best cosmetic effect in comparison with such while making umbilical hernias plasty in accordance to a sub lay method.

[MORPHOLOGICAL CHANGES OF GASTRIC MUCOSA AFTER INSERTION OF INTRAGASTRIC BALLOON].

Morphological changes in gastric mucosa were studied, optimal terms of bariatric operations performance after intragastric balloon (IGB) insertion were determined. Before the IGB insertion in 10 (35.7%) patients, in accordance to histological investigations, the changes in gastric mucosa were not revealed, and in 18 (64.3%) - chronic gastritis was established. In accordance to endoscopic investigation results, immediately after the IGB removal in 23 (82.1%) patients a pronounced erythematous gastropathy was noted, and in 5 (17.9%) - erosive gastropathy. While investigating the gastric mucosa biopsies in all the patients a prominent inflammatory changes were revealed, including significant edema, pronounced lymphocytic infiltration. In accordance to esophagogastroduodenoscopy data on the 14-th day of endoscopic monitoring in 6 (21.4%) patients pathological changes of gastric mucosa were not revealed, in 22 (78.6 %) - erythematous gastropathy was noted, and in accordance to histological investigation - chronic gastritis. Persistence of IGB in gastric cavity during 6 mo caused a morphological changes in gastric mucosa - a significant inflammation, what was confirmed by endoscopic and histological investigations data. The gastric mucosa structure normalization was observed in 14 days after the IGB removal, that's why a radical bariatric intervention is recommended to perform not earlier the term established.

[ASSESSMENT OF POSTOPERATIVE PAIN SYNDROME AT SINGLE-PORT TRANSUMBILICAL LAPAROSCOPIC CHOLECYSTECTOMY COMPARED TO TRADITIONAL LAPAROSCOPIC CHOLECYSTECTOMY].

The article analyzes the dynamics of postoperative pain at single-port transumbilical laparoscopic cholecystectomy compared to traditional laparoscopic cholecystectomy. It is shown that the intensity of pain in patients who have undergone laparoscopic procedures through a single transumbilical access was significantly less than in patients with traditional laparoscopic intervention. Furthermore, the use of a single-port transumbilical laparoscopic cholecystectomy accompanied by a smaller increase in the concentration of proinflammatory cytokines compared with patients who had laparoscopic procedures through four trocar accesses.

[Research of the durability of connective tissue complexes formed in the implantation area of various types of allograft during the experiment].

The aim of the study is to examine in the experiment on the animals the mechanical properties of connective tissue complexes formed in alloplasty area using the intraperitoneal on lay mesh and sublay methodologies with further comparison of them. The experiment has been conducted on 12 rabbits of Russian chinchilla breed. Animals were distributed in the following way: the first group--operated by intraperitoneal on lay mesh methodology (n = 6) through implantation of composite grid Proceed with one-side celullose coating produced by "Ethicon" company. The second group--performed modeling of preperitoneal plastic using two-component composite grid with large-pores Ultrapro produced by "Ethicon" company (n = 6). For the tensometric evaluation of the strength of implant integration into the red wall was used entire area of anterior red wall together with the implanted transplant. According to the deflection diagrams and dynamometer rates defined the maximum burden rates which is equivalent of muscular tissue budge against polymeric matrix. Statistically significant distinctions during 14 days were not detected; however strength during 30 days in the first group was 3 times higher than in the second group. We consider that the methodology of intraperitoneal on lay mesh can be considered as operation of choice of surgery treatment of the umbilical hernias.

[Laparoscopic gastric shunting as the surgery of choice in patients with morbid obesity and concomitant methabolic syndrome].

Experience of laparoscopic gastric shunting application in accordance to the Fobi - Capello procedure in 15 patients, suffering morbid obesity (MO), was adduced. The surgical intervention technique was adduced, first results were analyzed, which are witnessing the effective lowering of the excessive body mass while followup to 6 mo postoperatively.

[Surgical treatment of the patients, suffering alimentary--constitutional obesity].

The results of surgical treatment of 105 patients, suffering alimentary-constitutional obesity, using intragastric balloon placement. operative procedures of regulated gastric banding, longitudinal gastric resection, gastric and biliopancreatic shunting, were analyzed. The changes dynamics in the carbohydrate and lipid metabolism indices was estimated. Algorithm of the obesity surgical treatment, depending on the body mass index and concomitant diseases presence, was elaborated.

[Diagnosis and treatment of slippage syndrome after gastric banding operation].

Slippage syndrome after gastric banding operation was observed in 7.1% patients, suffering morbid obesity. The causes of occurrence, the diagnosis peculiarities and methods of the slippage syndrome treatment were analyzed.

[Remote results of gastric banding operation].

The gastric banding remote results, performed in 240 patients, suffering morbid superobesity, were estimated. The results of a guided and nonguided gastric banding were analyzed, the body mass lessening dynamics, postoperative complications character and frequency, the operation impact on concurrent diseases course were studied.

[Clinical immunological characteristics of the pathogenesis of catarrhal gingivitis (Communication 1)]. / Kliniko-immunologicheskie osobennosti patogeneza kataral'nogog gingivita (Soobshchenie 1).

In order to evaluate the relationship between cellular and humoral immunity, washings from the gingival sulcus were analyzed in 15 patients with catarrhal gingivitis and 15 subjects with intact periodontium aged 19-22 years. The results indicate a close relationship between local immunity and humoral and cellular defense factors. It seems that decreased IgA level, complement component, and increased activities of C-reactive protein and antistreptolysin-O are the key factors in the development of chronic gingivitis. Permanent bacterial aggression leads to dysfunction of phagocytic and epithelial cells.

Report on bariatric surgery in the Ukraine.

BACKGROUND: Morbid obesity (MO) is a problem internationally, including in the Ukraine. We present the surgical treatment of MO in the Ukraine over the last 15 years, during which intestinal bypasses and various gastric reduction procedures were performed. METHODS: 198 patients with MO underwent: jejunoileal (JI) bypass 64, non-adjustable gastric banding (NGB) 34, Roux-en-Y gastric bypass (RYGBP) 1, horizontal gastroplasty 1, vertical banded gastroplasty (VBG) 2, and abdominal lipectomy 96. The 96 men and 102 women weighed 160-290 kg (mean 210+/-SD18 kg). Mean body mass index was >60 kg/m2. These patients had a high incidence of hypertension, diabetes, sleep apnea, menstrual disorders, impotency in men and infertility in women. RESULTS: At 1 year, after JI bypass 61 patients lost a mean of 62+/-17 kg and after NGB 11 kg. After JI bypass, 1 patient died in the early postoperative period from acute respiratory insufficiency and 2 died in the first year from acute liver insufficiency. The JI bypass was reversed in 2 patients due to uncontrollable malabsorption syndrome; 1 year after reversal, the weight of these patients exceeded their preoperative weight. In the early postoperative period, 1 patient died after NGB and 1 after RYGBP, from acute respiratory insufficiency. Postoperative weight loss was associated with decrease in the co-morbidities of MO, but after JIB, there was a high incidence of bypass enteritis, excessive malabsorption, formation of renal stones and gallstones. After NGB, no complications have been identified. Isolated lipectomy was performed in 44 patients, lipectomy combined with a bariatric operation in 31, and lipectomy after loss of the excess body weight in 21. CONCLUSIONS: Bariatric surgery was very effective in weight loss, accompanied by reduction or disappearance of the co-morbidities of MO, with considerable improvement in quality of life.

[Microbiologic and histomorphologic characteristics of experimental Mycoplasma-pneumococcus infection]. / Mikrobiologicheskaia i gistomorfologicheskaia kharakteristika éksperimental'noi mikoplazma-pnevmokokkovoi infektsii.

The specific features of the development of Mycoplasma pneumoniae and Streptococcus pneumoniae infections in mice have been studied in cases of mixed and monoinfections. As shown in this study, mixed infection is characterized by the mutual inhibition of the proliferation of both pneumococci and mycoplasmae in the lungs, the liver and the spleen of the animals, while the associative interaction of these infective agents in isolated mouse lung tissue is characterized by the inhibition of pneumococcal proliferation only. In mixed infection the early activation of cells of the immunocompetent system is observed, which is accompanied by the development of mainly cell-mediated immune processes manifested as delayed hypersensitivity with the late formation of fibrillogenesis. During the development of mixed mycoplasmal-pneumococcal infection the histopathology of mycoplasmal infection prevails, which is probably due to the early formation of delayed hypersensitivity to M. pneumoniae in the animals.

[Morphometric analysis of immunologic deficiency in newborn mice developing after transplacental transmission of live or inactivated influenza A virus]. / Morfometricheskii analiz immunologicheskoi nedostatochnosti u myshat, razvivaiushcheisia v rezul'tate transplatsentarnoi peredachi zhivogo ili inaktivirovannogo virusa grippa.

Morphometric evaluation of the thymus and spleen was used to characterize the complex immunological deficiency in suckling mice developing as a result of transplacental transmission of both live and inactivated influenza virus.

[Accelerated laboratory diagnosis of bacterial pneumonia]. / Uskorennaia laboratornaia diagnostika bakterial'nykh pnevmonii.

The effectiveness of countercurrent immunoelectrophoresis (CIE) used for the accelerated differential diagnosis of pneumococcal, staphylococcal, mycoplasmal and Legionella infections in cases of pneumonia has been shown. The presence of correlation between the results obtained in the bacterial study of sputa and bronchial washings and in CIE has been revealed, which gives grounds for recommending CIE for the accelerated diagnosis of pneumococcal pneumonia on the basis of the analysis of sputa, bronchial washings and blood sera obtained from patients. In Legionella infection the passive hemagglutination test with antigenic diagnostica has proved to be more effective for accelerated diagnosis than CIE.

[Activity of the glycoprotein antigenic fractions of Mycoplasma pneumoniae in immunological reactions]. / Izuchenie aktivnosti glikoproteidnykh antigennykh fraktsii Mycoplasma pneumoniae v immunologicheskikh reaktsiiakh.

Glycoprotein fractions exhibiting pronounced antigenic properties in immunological in vitro reactions have been isolated from sonicated M. pneumoniae cells by extraction with glacial acetic acid and ethanol. Glycoprotein fraction 3 of M. pneumoniae antigen shows the highest blood-sensitive and precipitating activity and may be recommended as a diagnosticum for serological tests.

[Etiological structure of pneumonias in children and adults]. / Etiologicheskaia struktura pnevmonii u detei i vzroslykh.

The bacteriological study of sputa, nasopharyngeal smears and bronchial washings taken from pneumonia patients has shown that the leading etiological agent was Streptococcus pneumoniae isolated in the diagnostic titre (10(7) bacteria per ml) in 78.1% of the cases. Staphylococcus aureus, Haemophilus influenzae, enterobacteria and yeast-like fungi have been found to play an insignificant role in the etiology of acute pneumonia (2.5 +/- +/- 0.9%). The results of the serological diagnosis by means of the complement fixation test have revealed that, alongside S. pneumoniae, the following infective agents are of etiological importance in cases of acute pneumonia: respiratory viruses (more than 50%), Mycoplasma pneumonia (10%), Chlamydia psittaci (6.4%) and Legionella pneumophila (3.8%). The study has first revealed that, under the conditions of Alma-Ata, serotypes 19, 23, 8 and 4 prevail among circulating pneumococci. This study has also shown that the use of M. pneumoniae antibody erythrocyte diagnosticum enhances the detection rate of mycoplasma infections in pneumonia patients.