[Endoscopic vacuum therapy in minimally invasive treatment of esophageal perforations]. / Effektivnost' endoskopicheskoi vakuumnoi terapii v kompleksnom minimal'no invazivnom lechenii perforatsii pishchevoda.

OBJECTIVE: To compare the results of endoscopic vacuum therapy (EVT) and open surgery for esophageal perforations. MATERIAL AND METHODS: The study included 60 patients with esophageal perforations between 2010 and 2022. The main group included 29 patients who underwent minimally invasive treatment with EVT, the control group - 31 patients after open surgical interventions. RESULTS: Pneumonia occurred in 21 (72%) and 14 (45%) patients (p=0.04), esophageal stenosis within the perforation zone - in 4 (13.8%) and 1 (3.2%) patient, respectively (p=0.188). Chronic esophageal fistulas were significantly more common in the control group (6 (20.7%) versus 15 (48.4%) patients, p=0.032). The overall duration of treatment (median) among survivors was significantly shorter in the main group: 33 (23; 48) versus 71.5 (59; 93.7) days (p=0.5). However, length of ICU-stay was slightly higher (11 (6; 16) versus 8.5 (5; 12.75) days, p=0.32). Mortality rate was 13.8% (n=4) and 29% (n=9), respectively (p=0.213). Minimally invasive technologies decreased the risk of fatal outcome by 10 times (OR 10.123, 95% CI 1.491-124.97, p=0.035) compared to traditional surgery. CONCLUSION: EVT in complex minimally invasive treatment of patients with mechanical esophageal injuries is an effective method significantly reducing mortality and duration of inpatient treatment compared to traditional surgical approach.

[Adventitial cyst of the popliteal artery]. / Adventitsial'naya kista podkolennoi arterii.

Vascular cystic adventitious degeneration (CAD) is a rare disease of unclear etiology that affects mainly the popliteal artery (up to 85-90% of cases). Clinical manifestations are similar to aneurysm of the popliteal artery. CAD occurs mainly in males of the 4th and 5th decades of life (range 10-77 years). These patients usually have no risk factors of cardiovascular diseases. Unilateral symptoms prevail. We report a review and a 46-year-old patient with CAD of the popliteal artery.

[Videolaparoscopic and morphological parallels in diagnosis of different forms of acute appendicitis].

AIM: To compare results of macroscopic assessment and materials of histological examination of 1635 appendices removed using videolaparoscopy in patients with acute appendicitis. All patients have been treated in N.V.Sklifosovsky Research Institute of Emergency Care for the period from 2002 to 2014. MATERIAL AND METHODS: Intraoperative macroscopic assessment of appendix's inflammatory changes was performed using some conventional signs. Сatarrhal, phlegmonous and gangrenous changes were suspected in 77 (4.7%), 1432 (87.5%) and 126 (7.7%) cases respectively. RESULTS: Histological examination revealed catarrhal, phlegmonous and gangrenous changes in 86 (5.3%), 1338 (81.8%) and 115 (7.0%) cases respectively. In 65 (4.0%) patients changes were estimated as chronic, 31 (1.9%) patients had not inflammation. Intraoperatively suspected diagnosis of different forms of appendicitis was confirmed by histological survey in 94.1%. Most cases of matched intraoperative and histological diagnosis were observed in case of phlegmonous appendicitis (88.2%). Only 5.9% of patients had not acute inflammation of appendix that may be explained by overdiagnosis and excess of indications for appendectomy.

[Surgery of pancreatic injuries]. / Khirurgiya povrezhdenii podzheludochnoi zhelezy.

AIM: To estimate different approaches to treatment of victims with pancreatic trauma with pancreatic trauma. MATERIAL AND METHODS: It was analyzedthe results of treatment of 342 victims with pancreatic trauma in N.V. Sklifosovskiy Research Institute of Emergency Care for the period 1991-2012. RESULTS: It was concluded that for the las decade curative and diagnostic tactics for pancreatic injury in victims with combined abdominal trauma has been changed; current diagnostic markers of pancreatic lesion and adequate intraoperative diagnosis are used. All of this together with timely specific therapy and adherence to guidelines of surgical treatment decreased mortality rate from 17.0 to 11.1% and suppurative complications incidence from 43.8 to 19.9%.

[Features of severe surgical infections of soft tissues].

AIM: To analyze clinical and microbiological examinations in severe soft tissues infections and their significance in predictors of outcomes. MATERIAL AND METHODS: Treatment of 19 patients with severe suppurative infection and suspected non-clostridial anaerobic flora with different causes of soft tissues infection was analyzed. All patients were treated in N.V. Sklifosovskiy Research Institute of Emergency Care for the period 2010-2012. Diagnosis was based on X-ray survey, sonography and CT data. Multicomponent management included surgery, intensive therapy, proteinic and water-electrolyte balance correction, deintoxication, nutritive support and immune therapy.Microbiological diagnosis was performed using Bactec-9050, Multiscan and WalkAway-40 analyzers. Culture mediums and microanaerostats to detect aerobic and obligately-anaerobic pathogens certified in Russia were used. Of 19 patients bacteriological examination was performed in 11 patients. So 107 specimens from wounds predominantly and blood were studied. 91 strains were revealed and identified. RESULTS: 8 of 11 patients in group 1 were operated. Three patients were inoperable due to severe condition and endotoxic shock. Despite complex treatment inflammation progressed in 5 of 8 patients followed by death. The second group consisted of 8 survivors. Staphylococcus aureus played leading role. There were no significant differences related to obligately-anaerobic pathogens. Mixed populations of aerobic and facultative anaerobic pathogens were diagnosed in 45% of specimens sampled from deads that is significantly greater than from survivors (8.7%). Leading pathogens of severe suppurative infections of soft tissues were more frequent revealed in mono-culture. Early diagnosis of tissue infections caused by nonsporeforming microorganisms should be based on clinical instrumental data, microbiological and morphological examinations.

[The difficulties of diagnosis and treatment of non-occlusive mesenteric circulatory disorders].

AIM: To review one of actual problems of emergency surgery - diagnosis and treatment of patients with non-occlusive mesenteric circulatory disorders. MATERIAL AND METHODS: The article presents the clinical observations showing the ambiguity of clinical picture, features and challenges of diagnosis, treatment of disease and opportunities for positive outcomes. Diagnostic methods are x-ray, abdominal ultrasonography according to which acute abdominal ischemia may be assumed. However, in all unclear cases diagnostic videolaparoscopy is mandatory to determine further tactics. Unfortunately diagnostic videolaparoscopy is not always interpreted comprehensively and not a definitive method of diagnosis. Wide surgical access is usually necessary for non-occlusal acute violation of mesenteric circulation and volume of surgery varies from segmental to subtotal intestinal and colic resection with obligatory enteral intubation and decompression. Thus, complex pre- and postoperative treatment is required.

[Morphological changes in the wall of the aorta in its dissecting aneurysm].

The paper describes 144 autopsy materials and 69 biopsy ones and shows possible morphological changes in the wall of the aorta in its dissecting aneurysm. Examinations were made by light and electron microscopy using special stains. Cases of arterial hypertension without aortic dissection were selected as a group of comparison. Varying degrees of structural changes were found in all layers of the aortic wall. In accordance with the predominant involvement of this or that component, the authors identified three types of changes: 1) those with the predominant involvement of the elastic skeleton; 2) necrotic and dystrophic changes in the smooth muscle cells to give rise to medial laminar and focal necroses; 3) nonspecific diffuse changes in all layers of the aortic wall, which are characteristic of aging processes. Comparison of morphological changes with those in the comparison group revealed those that appeared to be caused by previous aortic wall structural damages that gave rise to impaired elastic and collagen formation not only in patients with previously found connective tissue dysplasias.

[Microbiological diagnosis of gas gangrene caused by Clostridium septicum (a clinical case)].

Microscopy of gram-stained impression smears is used for the rapid diagnosis of microorganisms in the wound. The shin tissues of patient P. with suspected gas gangrene of lower extremity soft tissues were microscopically found to have gram-positive spore-forming bacteria that were morphologically similar to C. bifermentans that were identified as C. septicum on cultural diagnosis. The pathogenic C. septicum strain spores were likely to be formed in the macroorganism upon exposure of the pathogen to a patient's defense factors and to a package of therapeutic measures. Microbiological data should be used only in combination with clinical and instrumental findings and the results of other laboratory studies when the optimal technology is chosen to treat gas infection. By keeping in mind that there may be clostridial gangrene in the patients and the experience of clinicians and bacteriologists may be insufficient in diagnosing this pathology, it is necessary to strengthen the training of physicians in the diagnosis of this pathology.

Elevation of the efficacy of antitumor vaccine prepared on the base of lectines from B. subtilis B-7025 upon its combined application with probiotics in vivo.

UNLABELLED: The aim of the work was to evaluate in vivo the possible enhancement of efficacy of antitumor vaccine prepared on the base of cytotoxic lectine from B. subtilis B-7025 by its combination with probiotic mixture of Enterococcus faecium K-50 and Saccharomyces cerevisiae 14K or their metabolic products. MATERIALS AND METHODS: Experiments were carried out on the models of solid sarcoma 37 (S37) and metastatic Lewis lung carcinoma (3LL). Efficacy of treatment was evaluated by parameters of tumor growth, median survival time of experimental animals and volume of metastases. RESULTS: We have shown that combined application of antitumor vaccine with pro-and/or prebiotic resulted in synergistic effect in the therapy S37-bearing mice, whilst in 3LL-bearing animals application of vaccine along with prebiotic inhibited metastasis by 2-2.5-fold compared to animals treated by vaccine only. CONCLUSION: Application of pre- and probiotics (E. faecium K-50 and S. cerevisiae) markedly elevates efficacy of antitumor vaccine in vivo.

[Complications of Lichtenstein's plastic reconstruction of inguinal canal]. / Oslozhneniia plastiki pakhovogo kanala po Likhtenshteinu.

Results of standard strained" methods of hernioplasty are not satisfactory. Laparoscopic methods permit to reduce significantly rate of postoperative complications. Technical difficulty and high cost of videoendoscopic technologies make general use of endoscopic plastic surgery in our country problematic. Lichtenstein's plastic reconstruction of inguinal canal is an alternative method. 350 hernioplasties were performed: 342 in men, 8 in women. Simultaneous bilateral hernioplasty was carried out in 51 patients. 73 patients underwent surgery for recurrent inguinal hernias. Age of patients ranged from 18 to 83 years. Polypropylene net, perforated polytetraphtorlene plate or bilayer perforated polytetraphtorlene plate were used as plastic material. Rate of recurrences was 0.9%. Lichtenstein's plastic reconstruction is the method of choice in the treatment of all type of inguinal hernias.

A new method for surgical treatment of the short bowel syndrome.

This study was aimed to investigate the electrophysiological and morphological characteristics resulting from the structural and functional transformation of gastric tissue transplanted to the small intestine. Twelve adult mongrel dogs were studied up to 3 years. Gastric transplants preserved its main microstructure and minimal compensatory-adaptive processes developed in the mucosa and muscle layers of the graft. A significant influence on the electrical activity of the small intestine was observed, with a 10% reduction of the slow wave frequency (SWF) in the proximal and distal jejunum adjacent to the graft after meals. The SWF of the gastric graft itself, however, corresponded to the frequency of the native stomach, did not depend and was not associated with adjacent intestinal areas. In summary, the stomach graft transplanted to the small intestine keeps the properties of gastric tissue, there are functional adaptations to conditions of digestion in the small intestine and the graft has minimal effects on intestinal motility.

[Homeostasis and its correction in burn patients with gastrointestinal erosive-ulcerative diseases]. / Sostoianie gomeostaza i ego korrektsiia u obozhzhennykh s érozivno-iazvennymi porazheniiami zheludochno-kishechnogo trakta.

Acute erosive ulcerative hemorrhage (EUH) is one of the most grave complications of burn disease, caused by impaired blood rheology, clotting, and protein status. Twenty-three patients with burns of 12-70% body surface were examined, 17-25% of burns being deep. The most pronounced changes in blood rheology and clotting with formation of erythrocyte aggregations, fibrin precipitation and imbalance of visceral proteins were observed during the shock stage (days 1-3), particularly pronounced in patients with acute EUH. Development of septicotoxemia favored secondary increase in blood clotting and rheological parameters, which led to thrombotic complications. The data helped improve the complex of infusion-transfusion therapy for preventing and treating ulcerative and erosive lesions.

Effect of mesodiencephalic modulation on small intestinal mucosa after massive blood loss in rats.

Effect of mesodiencephalic modulation on small intestinal mucosa was studied in rats subjected to massive blood loss. Massive blood loss induced structural changes in intestinal epitheliocytes typical of tissue hypoxia: intraintestinal edema, mitochondrial alterations, and microcirculation disturbances. A single session of mesodiencephalic stimulation carried out 60 min after massive blood loss produced a pronounced adaptive effect, restored disturbed structure of the intestinal villi, and induced compensatory hypertrophy of the mitochondria. This suggests that mesodiencephalic modulation promotes normalization of intracellular energy metabolism, improves the absorption capacity of bordered enterocytes, and restores the disturbed intestinal barrier.

[Morphofunctional disorders in the small intestine in acute occlusive ileus]. / Morfofunktsional'nye narusheniia v tonkoi kishke pri ostroi obturatsionnoi neprokhodimosti.

Activity of liminal and membrane enzymes and morphologic state of small intestinal mucosa were studied in experimental acute occlusive ileus in rats. It was established that degenerative alterations of intestinal mucosa epithelium above the site of obstruction are more pronounced than in the distal part. The activity of membrane enzymes (invertase) remained unaltered during 72 hours after the obturation, however, serious morphologic damage of the intestinal mucosa epithelium and sharp suppression of the liminal digestion were observed.

[The ultrastructural changes in the collagenous-elastic skeleton of the wall of the cerebral vessels in spasm in the acute period of a subarachnoid hemorrhage]. / Ul'trastrukturnye izmeneniia kollagenélasticheskogo karkasa stenki sosudov golovnogo mozga pri spazme v ostrom periode subarakhnoidal'nogo krovoizliianiia.

Electron microscopic study of arteries in spasm and ischemia of the brain revealed substantial ultrastructural changes in the vascular wall. The changes are characterized by varying thickness, edema, dissociation of fibrillar and amorphous components of internal elastic membrane of the arterial wall, by lesion in the network of collagen fibers on its inner surface, by the presence of defibrotic and uncoiled collagenous fibers of the adventitia. The changes are followed by the impairment of the arterial skeleton and hence they lead to their altered elastic properties.

[Choice of optimal policy for treatment of acute pancreatitis]. / Vybor ratsional'noi taktiki lecheniia ostrogo pankreatita.

662 case records of patients with acute pancreatitis are analysed and principles for the choice of optimal treatment of patients with acute pancreatitis (AP) are established. The most justified policy in treatment of AD patients seems to be conservative-expectant. The treatment should satisfy the phases of the course of acute pancreatitis and severity of the disease. At the first stage of the disease the treatment should be aimed at correction of pancreatic toxemia and prophylaxis of pyogenic complications. Surgical interventions at this phase are risky and hardly justified. If there are indications for drainage, laparoscopy and small invasive interventions under US control are preferable. At the second stage conservative-expectant policy should be also used as a method of choice, and treatment should be aimed at prophylaxis of purulent complications. The presence of aseptic necroses are not an absolute indication for surgery if there are no clear signs of suppuration. The presence of purulent complications is an indication for surgical treatment; extraperitoneal approaches to pyogenous areas and their drainage by wide two-lumen tubes for the following use of aspiration--lavage treatment are more preferable.

[The morphology of the vascular spasm in cerebral aneurysm rupture]. / Morfologiia sosudistogo spazma pri razryve anevrizm golovnogo mozga.

The vessels of the basis cerebri were histologically examined in 45 patients who had died from arterial aneurysmal rupture. Angiography had made at the clinic detected cerebral vasospasm of varying severity and extent. All autopsies showed ischemic encephalomalacia in specimens. The findings indicated that arteriostenosis angiographically identified as vasospasm, by causing ischemic events was induced by morphological changes in the arterial wall. The arterial structural changes found were characterized by subsequent changes in the intima, elastic membrane, and medial layer.

[Role of ischemic cerebral infarction in the development of lethal outcomes in ruptured intracranial arterial aneurysm]. / Rol' ishemicheskogo infarkta mozga v razvitii letal'nykh iskhodov pri razryve vnutricherepnykh arterial'nykh anevrizm.

Analysis of 320 autopsy cases of death after the rupture of brain arterial aneurysms (AA) without a surgical treatment is performed. The frequency of ischemic infarction among these cases was 15.3% and in 11.2% the infarction was an immediate cause of death. The lethal outcome due to the infarction occurred at the end of the 1st and during the 2nd week with a maximum at 9-12 days. Ischemic infarction as a cause of death usually had a wide zone of spread involving 2 and more brain lobes. The thrombosis of the big brain artery was a cause of ischemic complications in 19.4% of cases. Morphological alterations of the basis cerebri in such cases consisted of changes in the intima, elastic membrane, medial layer and adventitia resulting in the lumen narrowing.

[Thrombohemorrhagic syndrome in emergency gynecology]. / Trombogemorragicheskii sindrom v neotlozhnoi ginekologii.

The paper presents a clinico-anatomical analysis of 18 autopsy cases of thrombo-hemorrhagic syndrome (THS) in patients operated because of uterine fibromyoma (n = 11) and altered tubal pregnancy (n = 7) and a surgical material (uterus with a tumor) from 21 patients. Multiple thromboembolic and hemorrhagic complications with degenerative visceral alterations after the operation were manifestation of generalized THS. Thromboembolic complications with organ damages dominated among patients with uterine fibromyomas, hemorrhagic complications with diffuse degenerative changes and visceral lesions were observed in patients with tubal pregnancy. Local THS is determined by degenerative and vascular changes in the pelvic organs with primary pathology (fibromyoma, endometrial lesions).

[Non-occlusive dyscirculatory intestinal necrosis ]. / Neokkliuzionnyi distsirkuliatornyi nekroz kishechnika.

70 autopsy cases of NDIN are analysed. Necrosis in 85% of cases was observed against basic pathology, mainly cardiovascular diseases (45.7%) and after surgery in the thoracic and abdominal cavities. NDIN was considered as a main disease in the remaining 15% of cases, with its duration from 1 to 7 days. Morphologically NDIN was revealed in the colon in 71.2% of cases, in combination with the small intestine in 30.5%. Predominance of the small intestine was in 28.8%, ileum 64%. Primary circulatory disturbances in the capillary-venule system of the mucous membrane and submucosa were found histologically.