[Morphological substantiation of laparoscopic suturing of stomach ulcer with formation of a covered perforation]. / Morfologicheskoe obosnovanie laparoskopicheskogo sposoba ushivaniya probodnoi yazvy zheludka s formirovaniem prikrytoi perforatsii.

OBJECTIVE: Morphological substantiation of laparoscopic suturing of gastric ulcer with formation of a covered perforation. MATERIAL AND METHODS: To analyze morphological tissue reaction in surgical area, we used 12 Chinchilla rabbits. All animals were divided into 2 groups by 6 animals. The main group enrolled rabbits undergoing suturing of perforated gastric ulcer with formation of a covered perforation by anterior stomach wall. In the control group, gastric perforation was sutured by conventional double-row suture. For histological analysis, 2 animals in each group were withdrawn from the experiment after 7, 14 and 21 days. We excised gastric wall within the area of perforation closure. Morphological data on healing process were compared between both groups. RESULTS. S: Tomach deformation after 7 days was more severe in the main group compared to simple suturing. However, these differences were absent after 21 days. Morphological analysis revealed postoperative transmural necrosis after 7 days. Signs of early epithelialization were more obvious in the main group. After 21 postoperative days, we observed almost completely restored differentiation of stomach wall layers in both groups of animals.

[Modern opportunities and prognosis of physical rehabilitation of children with cerebral palsy]. / Sovremennye vozmozhnosti i prognoz fizicheskoi reabilitatsii detei s tserebral'nym paralichom.

OBJECTIVE: To evaluate the results of traditional and high-tech physical rehabilitation in cerebral palsy and in modeling of rehabilitation prognosis. MATERIAL AND METHODS: One hundred and twenty-six patients with cerebral palsy (spastic diplegia); mean age 7.0±1.3 years, the duration of inpatient treatment 28 days, were studied. Forty patients received conventional treatment, 86 - a high-tech physical rehabilitation (robotic mechanic therapy with «Lokomat¼, «Armeo¼ and electric stimulation of the brain with «Brain-port¼ device). RESULTS AND CONCLUSION: The advantage of more significant therapeutic effects of high-tech physical rehabilitation over traditional treatment is established. This effect consists in improving coordination and independent movement. On the basis of the regression analysis, mathematical models of the prognosis of the rehabilitation potential are constructed. High-tech physical rehabilitation has a significantly more pronounced therapeutic effect than traditional treatment.

[Endovascular surgery for acute mesenteric ischemia]. / Éndovaskuliarnaia khirurgiia ostrogo arterial'nogo narusheniia mezenterial'nogo krovoobrashcheniia: podkhody k lecheniiu.

OBJECTIVE: To demonstrate the results of endovascular treatment of 15 patients with acute mesenteric ischemia. MATERIAL AND METHODS: There were 15 patients with acute mesenteric ischemia who underwent surgery (9 men and 6 women). Mean age was 77±11 years. Acute intestinal ischemia was caused by thromboembolism of superior mesenteric artery (9 patients), thrombosis of superior mesenteric artery (5 patients) and critical stenosis of the ostia of superior mesenteric artery and celiac trunk (1 patient). Mean time from clinical manifestation of disease to admission to the hospital was 13 hours (range 2-72 hours). In-hospital development of acute mesenteric ischemia was noted in 2 patients. Indications for endovascular intervention and techniques of endovascular revascularization of superior mesenteric artery are described in the article. RESULTS: Blood flow restoration in superior mesenteric artery was achieved in 14 (93%) out of 15 patients. Laparotomy was required in 4 (27%) patients for extensive resection of necrotic intestine (n=1, 6.7%), local resection of small bowel (n=2, 13%). In another (6.7%) patient, intestine was recognized as viable after laparotomy. A bulk of intestine was preserved in most patients (n=14, 93%). In-hospital mortality rate was 47% (7 patients died). The main cause of nosocomial death (6 cases) was reperfusion syndrome followed by respiratory distress syndrome and multiple organ failure. CONCLUSION: New methods of prevention and treatment of reperfusion syndrome can improve the results of treatment of acute mesenteric ischemia.

[An influence of combined use of electromyostimulation and static postures on the main characteristics of postural balance]. / Vliianie sovmestnogo primeneniia élektromiostimuliatsii i staticheskikh poz na osnovnye kharakteristiki postural'nogo balansa.

AIM: To study the effectiveness of the combined use of electromyostimulation (EMS) and static exercises to correct postural balance (PB). MATERIAL AND METHODS: Seven healthy adolescents performed the static exercise 'tilt to the side' together with EMS (main group), 7 age-matched adolescents (control group), performed only the exercise. EMS was performed by the device 'Bellatronic'; current 5 A, pulse frequency 20 Hz. Stimulation was carried out for a minute, alternating 2-second exposure to electric current with a 2-second pause of rest. PB was assessed using stabilometric tests on the MBN platform. RESULTS AND CONCLUSION: The tested static exercise 'tilt to the side' together with EMC has a controlled and significant effect on the displacement of the projection of the General center of mass of the body (CMT) in the frontal and sagittal planes, provided an individual approach. No significant improvements to travel speed and area of statokinesigram in the short term are, probably, due to the unfamiliarity of the exercise and prolonged fixation of a static posture. The use of EMS on stretching muscle fibers can enhance the effect of relaxation, which can be used both independently and for the correction of the static exercises. The change in muscle tone caused by the tested static pose with the use of EMS controls and corrects in the short term the projection of CMT in the frontal and sagittal planes, an important indicator of PB.

[Dynamic of cerebrovascular disorders in patients with carotid stenosis]. / Techenie tserebrovaskuliarnoi patologii u bol'nykh so stenoziruiushchim porazheniem sonnykh arterii.

AIM: To study the state of cerebral hemodynamics and platelet hemostasis in patients with carotid stenosis (CS). MATERIAL AND METHODS: The prospective study included 123 patients with atherosclerotic CS. The 1st group included 53 patients (mean age 52±12.5 yrs) who underwent carotid endarterectomy (CEA); the 2nd group - 70 patients who were treated conservatively (mean age 58.5±15.9 yrs). The state of blood flow through the main arteries of the head (Doppler flowmetry), platelet aggregation induced by adrenaline, the frequency of acute cardiovascular events that occurred during 12 months were evaluated. RESULTS AND CONCLUSION: The severity of neurological deficits and cognitive impairment increased with increasing of the degree of CS. CEA leads to an improvement of cerebral hemodynamics and stabilization of cognitive functions. The adverse course of the disease occurred in 23.6% of patients (stroke/heart attack during the year in 5.7%, progression of cerebral ischemia in 20%, restenosis within 5 years after CEA in 15%). Hyperaggregation of platelets induced by ADP and epinephrine and decreased aggregation of platelets induced by collagen in patients receiving ASA were identified in 53% of the operated and in 60% of non-operated patients. The use of combined antiplatelet therapy normalize the platelet hemostasis and reduce the frequency of acute cardiovascular events.

[Fast track rehabilitation in perforated duodenal ulcer]. / Uskorennaia reabilitatsiia pri probodnoi iazve dvenadtsatiperstnoi kishki.

AIM: To analyze the outcomes of fast track rehabilitation program in patients with perforated duodenal ulcer (PDU). MATERIAL AND METHODS: For the period 2013-2016 at the Department of Surgery and Endoscopy 206 PDU patients have been treated. Inclusion criterion for the main group (n=77) was duodenal ulcers, their dimension up to 1 cm, laparoscopic suture of perforated ulcer, fast track rehabilitation program implementation. The control group consisted of 129 patients who underwent open suturing of perforated ulcer followed by conventional treatment in postoperative period. RESULTS: In the main group (n=77) laparoscopic suturing of ulcerative defect with the use of Fast Track program was performed. Postoperative complication i.e. sutures failure was observed in 1 (1.3%) case. There were no lethal outcomes in the main group. Mean length of hospital-stay was 4.8 days. In 129 patients of the control group open suturing of the perforated ulcer and conventional postoperative therapy were applied. Postoperative surgical complications were absent in the control group; mortality rate was 2.3%. Mean length of postoperative hospital-stay was 8.1 days. CONCLUSION: Laparoscopic treatment of perforated ulcers facilitates application of fast track rehabilitation program in emergency patients. Fast track rehabilitation protocol after laparoscopic suturing of the perforated ulcer creates conditions for early discharge and is followed by good clinical and economic effects. Recurrent peptic ulcers are noted if antiulcer therapy is absent.

[Endovascular interventions for acute ischemia of intestine].

It is presented 5 clinical observations of acute ischemia of intestine in which different endovascular interventions including isolated superior mesenteric artery stenting, rheolytic and aspiration thrombectomy and combination of techniques were applied. Surgical success with blood flow restoration in superior mesenteric artery was achieved in 4 of 5 patients. 2 patients have required laparotomy and intestinal resection. In 1 case extent of resection was significantly reduced after previous endovascular thrombectomy. There were no deaths. It is concluded that endovascular interventions may be considered as independent method of treatment of patients with acute mesenteric ischemia.

[Possibilities of endovascular surgery in treatment of acute arterial impairment of mesenteric blood circulation].

The authors demonstrate herein their experience (3 clinical case reports) in endovascular interventions in the basin of the superior mesenteric artery, performed for its thromboembolism (2 patients) and thrombosis (1 patient). Rheolytic thrombectomy from the superior mesenteric artery turned out inefficient in one patient and he was operated on in the scope of laparotomy, vast resection of the small intestine and the right half of the large intestine and indirect embolothrombectomy from the superior mesenteric artery. Aspiration thrombectomy had only a partial effect in the second patient presenting with thromboembolism of the proximal segment of the superior mesenteric artery: the major blood flow through the artery was restored and the scope of intestinal resection was reduced to 20 cm of the jejunum. Finally, the third patient underwent combined endovascular (rheolytic and aspiration) thrombectomy performed in an isolated manner, with neither laparotomy nor intestinal resection employed. In the last two cases, endovascular thrombectomy was supplemented by selective administration of platelet glycoprotein IIb/IIIa receptor inhibitors injected into the basin of the mesenteric artery. Endovascular intervention is an operation of choice in patients presenting with acute impairment of mesenteric blood circulation at the stage of intestinal ischaemia.

[Sural sinus as the main source of postoperative venous thromboembolic complications in neurosurgical patients].

The authors analysed the results of diagnosis and treatment of venous thromboembolic complications in a total of 239 patients presenting with various-aetiology intracranial haemorrhage and tumours of the central system. The total incidence of venous thromboses in the system of the inferior vena cava amounted to 25.1%. Thromboembolism of pulmonary artery complicated the course of the underlying disease in 3.3% of cases. Operative treatment of the underlying disease resulted in an increased incidence rate of thromboses of deep veins from 18.5 to 36.4% (p=0.015) and that of pulmonary artery thromboembolism from 2.7 to 4.5% (p=0.5). The most frequently encountered localization of thromboses in the postoperative period turned out to be the sural veins of the crus. The level of consciousness (p=0.0001), operative treatment (p=0.002), putaminal and thalamic intracranial haematomas (p=0.01), as well as dislocation syndrome (p=0.05) according to the findings of the univariate analysis were the risk factors for the development of venous thromboses in patients with haemorrhagic stroke. Independent predictors of the development of venous thromboembolic complications in patients with haemorrhagic-type acute impairments of cerebral circulation according to the data of the univariate analysis were the level of consciousness by the Glasgow coma scale scoring 4-5 points (p=0.01) and deep-seated localization of the intracerebral haematoma (p=0.01). Patients with intracranial haematoma having endured operative treatment are a cohort of patients running the highest risk for the development of postoperative venous thromboembolic complications.

[The results of the Lichtenstein's hernioplasty].

The study assumes the results of 1010 Lichtenstein's hernioplasties. The goal of the investigation was to estimate the results in dependence of the type of the polypropylene implant. The "lite" mesh was used in 342 cases, the second group of 668 patients had the so called "heavy" mesh endoprosthesis. Comparing the early postoperative period, it was registered, that the patients of the 2nd group had statistically higher rates of wound inflammatory infiltrate - 2.7% in comparison with 0.6% for the 1st group. The late postoperative period was marked by the higher rate of neuralgia among the "heavy" group - 5.2% in comparison with 1.5% for the "lite" group. Thus, the use of "lite" mesh polypropylene implant proved to be much more preferable for the Lichtenstein's hernioplasty.

[The possibilities of laser Doppler flowmetry for the estimation of the intestine resection volume by the acute mesenteric ischemia].

The results of the surgical treatment of the acute mesenteric ischemia in 2 groups of patients were comparatively analyzed. The control group (n=52) experienced the traditional way and criteria of detecting the volume of intestinal resection (color and peristaltic activity, arterial pulsation). For the main group (n=57) the intraoperative estimation of the intestinal viability was performed with the help of laser Doppler flowmetry. As a result, the postoperative intestinal gangrene rate was 9.1% among patients of the main group, whereas the complication was registered among 48.6% of the control group. The main group of patients demonstrated the overall lower rate of postoperative complications in comparison with the control group: 67.6 and 40.9% (p=0.01), respectively. The same picture was for the lethality rate: 76.9 and 52.6% (p=0.03), respectively.

[Computed tomography and CT angiography in diagnosis of acute disorders impairment of mesenteric circulation].

Presented herein is the first experience in using two instrumental methods (remote contrast- free computed tomography and CT angiography) in a total of twenty-one patients suspected of having acute mesenteric ischaemia. Contrast-free computed tomography allowed of making a correct diagnosis of acute mesenteric ischaemia in 6 of 7 patients (with sensitivity of 85.7% and specificity amounting to 90%). Thrombosis of mesenteric vessels was revealed in all cases on CT angiography, with both sensitivity and specificity of the method equalling 100%. Also described herein is the incidence rate of various CT signs of intestinal lesions depending on aetiology and the stage of the disease. Minimally invasive nature, high spatial resolution of these two methods, high sensitivity and specificity make it possible to recommend them as the first step for instrumental diagnosis of acute mesenteric ischaemia.

[Safety and efficacy of various regimens of heparin-mediated prevention of venous thromboses in patients with intracranial haemorrhage].

Analysed in the article is the incidence rate of the development of venous thromboembolic complications in a total of 79 patients presenting with various-aetiology intracranial haemorrhage in different regimens of heparin-mediated prevention. The authors have revealed that early (on day 2-4 after the onset of the disease) administration of preventive doses of heparin in patients with intracerebral and intracranial haematomas is a safe and efficient regimen, since it decreases the rate of venous thromboses in the system of the vena cava inferior and fatal thromboembolic complications as compared with a later term (on day 5 and more) of initiating heparin-mediated prevention.

[Major intestinal resections and short-bowel syndrome in patients with the acute mesenterial thrombosis].

The study represents the retrospective analysis of major intestinal resections (the length of the left in olace bowel less then 200 sm) and non-major resections in 52 patients operated on the acute mesenterial thrombosis. Major bowel resection was performed in 30 patients (57.7%). 66.7% of those patients (20 of 30) died soon after the operation. Whereas lethality rate among patients with non-major resections was 54.5% (12 of 22). All 10 survived patients demonstrated the short-bowel syndrome during the follow-up period (the median follow-up time was 25 months).

[The ileal and colic microcirculation by the thrombosis and thromboembolism of mesenterial arteries].

Quantitative and functional parameters of regional intestinal blood circulation were intraoperatively investigated with the use of laser Doppler flowmetry. The first group consisted of patients with necrotized parts of the intestine, while the second (control) group consisted of flowmetry data from intact intestine. Such indexes, as basal circulation, variation coefficient, blood oxygen perfusion saturation index, maximal perfusion amplitude of endothelial, neurogenic and myogenic oscillations in the intestinal volume, were showed to be valuable for the intestinal viability assessment. Thus, the method of the intraoperative laser Doppler flowmetry can be useful for determining the volume of intestinal resection.

[Intestinal microcirculation in health and in acute impairment of mesenteric blood flow].

The authors attempted to determine instrumental criteria for vitality and non-vitality of the intestine with the help of laser Doppler flowmetry and absorption spectroscopy. The material used was subdivided into two study groups: in group one, the indices of microcirculation of the viable small and large intestine were determined during elective cavitary operations; group two comprised 20 portions of resected necrotised segments of the large and small intestine, wherein we registered the indices of microcirculation of the non-viable devitalized intestine. We thus obtained instrumental indices of microcirculation of various intestinal portions in health, as well as in the setting of acute impairment of intestinal blood circulation and intestinal gangrene. Statistically significant differences were revealed only for the parameter of microcirculation and the coefficient of variation of the "viable" and necrotized intestine; blood oxygen saturation and volumetric blood filling of tissue between the two groups did not differ significantly. The instrumental criteria for intestinal vitality and non-vitality of may be used while making a decision as to the scorife of resection of the intestine affected which would thus make it possible to decrease the rate of progression of intestinal necrosis in the postoperative period. We believe that this would make it possible to substantially improve the outcomes of surgical management and to decrease lethality in patients presenting with acute impairment of mesenteric circulation.

[Treatment and prevention of thromboembolism in patients with intracranial hemorrhage].

Frequency of venous thromboses and thromboembolic complications was retrospectively analyzed in 95 patients with intracranial hemorrhage of various etiology. Thrombosis of inferior caval vessels was registered in 19 (20%) patients; of them 3 patients had thromboembolism of a pulmonary artery, lethal in one case. The high frequency of venous thromboses indicates the necessity of early use of anticoagulants in treatment dosages and importance of the prophylaxis measures. Cava-filter implantation for pulmonary artery thromboembolism prevention should be considered only in patients with strong contraindications for anticoagulant therapy.

[Programmed relaparotomy in treatment of upper mesenteric artery acute occlusion].

Results of surgical treatment and frequency of intestinal necrosis in 44 patients with acute mesenterial circulation failure were analyzed. Instrumental method of detecting the border of necrosis by the infracted intestine should allow refuse programmed relaparotomies in treatment of such patients and perform a sole operation with intestinal resection and anastomosis.