[Aspects of development of surgical service of modem Navy].

The article is devoted to the aspects of a current state of surgical service in the Navy, prospects of development of professianl training for navy surgeons, formation of modern training comlex, united electronic library, containig the issues about combat surgical trauma, software technologies, realizing of the application methodology during the process of training and practical activity for the development of the training system for surgeons of Navy and improvement of effectiveness. Formation of normative technical documents, regulating activity of navy surgians is also among the expectations. The authors also touched on the issues of development of modern technologies in bone grafting with the help of domestic implants based on the osteoinductive nanostructured nonorganic matrices (titanium) with defined structure and composition. Department of navy and hospital surgery participate in this debelopment. Due to increased amount of oncologic patients, it was decided to establish the Cancer Center of the Ministry of Defense based on department of navy and hospital surgery of the Kirov Military Medical Academy. It makes possible to perform the following procedures: canser surgery; surgical repair; plastic repair of major vessels, bone and soft tissue grafting, removal of residual cancer cells with the help of loco-regional methods of hyperthermic intracavitary and intravascular chemoperfusion; diagnostics and treatment of recurrent tumors (surgical and radiation treatment, systemic chemotherapy, loco-regional chemoembolization. Each of the given methods help to develop and improve the innovation technologies.

[Pharmacokinetic substantiation of the preoperative administration of kanamycin and cefazolin to patients with acute ischemia of the small intestine]. / Farmakokineticheskoe obosnovanie predoperatsionnogo vvedeniia kanamitsina i tsefazolina bol'nym s ostroi ishemiei tonkoi kishki.

Kanamycin and cephazolin when injected intramuscularly 1 hour before the operation to patients with acute intestinal obstruction, strangulated hernia and acute occlusions of the mesenterial vessels in the dose of 1,0 mg were shown to easily penetrate into the abdominal organ tissues. Maximum concentrations of kanamycin in the peripheral blood were found during 1-2 h after an intramuscular injection, those of cephazolin--during the first hour. The effect of sephazolin in the prevention of pyoseptic complications was more pronounced than that of kanamycin.

[Enteral detoxication of patients with peritonitis and acute intestinal obstruction]. / Enteral'naia dezintoksikatsiia u bol'nykh s peritonitom i ostroi kishechnoi neprokhodimost'iu.

Detoxicating therapy is necessary to patients with diffuse purulent peritonitis and acute ileus. One of the simplest methods of detoxication is an intraintestinal administration of sorbents, Enterodesis in particular. The application of this drug reduced toxicity of blood serum controlled by protozoa which facilitated rapid recovery of the intestine function. Most pronounced effect of enterosorption was observed in cases with acute ileus. In more severe cases the dosage of the medicine was greater without visible sequellae in the patients. The effect of detoxication was positive as a whole.

[Diagnosis of disorders of the motor function of the duodenum as a cause of chronic biliary pancreatitis]. / Diagnostika narushenii motornoi funktsii dvenadtsatisperstnoi kishki kad prichiny khronicheskogo biliarnogo pankreatita.

Great clinical material presented in the article concerns diseases of the pancreas. The authors prove that the leading role in the appearance of chronic pancreatitis is not infrequently played by disturbances of the motor function of the duodenum. The principal method of diagnosis is thought to remain the roentgenological examination.

[Rare forms of acute intestinal obstruction]. / Redkie formy ostroi kishechnoi neprokhodimosti.

The article analyzes 31 cases of rare forms of acute intestinal obstruction (nodulation and invagination of the intestine, obturation of the small intestine by bile stones and bezoars). Their incidence as compared with all the cases of intestinal obstruction of non-tumor etiology was from 1.0 to 3.3%. These diseases are difficult for diagnosis prior to operation and have different clinical manifestations. The surgeon's tactics should be differentiated and dependent on intraoperative findings. The syndrome diagnosis (intestinal obstruction, peritonitis) and early operation in such diseases are thought to be the correct tactics.

[Visual angiotensometry in operations for acute intestinal obstruction and strangulated hernia]. / Vizual'naia angiotenzometriia pri operatsiiakh po povodu ostroi kishechnoi neprokhodimosti i ushchemlennoi gryzhi.

The article describes results of an analysis of observations of 66 patients with the syndrome of acute intestinal ileus. In obscure cases transillumination angiotensometry was used in order to establish the viability of the small intestine. The method was shown to be highly informative in determining the viability of the strangulated intestine. No complications resulting from insufficient information of the visual angiotensometry were noted.

[Use of Pervomur for prophylaxis of infectious complications in elective surgeries of abdominal organs]. / Primenenie pevromura dlia profilaktiki infektsionnykh oslozhnenii pri planovykh operatsiiakh na organakh briushnoi polosti.

After the experimental investigations performed, the 0.6-0.8% solution of Pervomur (as irrigation of the operation area or application) was used in 103 patients. As compared with the control group the intraoperative using of Pervomur allowed the frequency of postoperative complications to be reduced from 21% to 15% and the time of treatment was shortened.

[Strangulated internal hernias of the abdominal cavity]. / Ob ushchemlennykh vnutrennikh gryzhakh briushnoi polosti.

Analysis of 8 cases with incarcerated hernias has been made. The incarceration of an internal hernia was first shown to simulate other diseases of abdominal organs followed by the development of symptoms of intestinal obstruction.

[Ileoascendoanastomosis]. / Ileoastsendoanastomoz.

A complex anatomical investigation of the extra- and intra-organic vessels of the ascending colon has shown that the formation of ileoascendoanastomosis is possible and expedient without a preliminary intraoperative assessment of the vascular bed. The indications to such operation are developed. The extirpation of the blind gut and resection of the ascending colon with applying the anastomosis in question was performed on 6 patients with carcinoma of the blind gut and ascending colon. The results of operations were good.

[Kanamycin sulfate and sodium cephazolin pharmacokinetics in experimental strangulation obstruction of the small intestine]. / Farmakokinetika kanamitsina sul'fata i tsefazolina natriia pri éksperimental'noi stranguliatsionnoi tonkokishechnoi neprokhodimosti.

The experimental investigation of pharmacokinetic properties of kanamycin and cephazolin has shown the antibiotic to penetrate well into the blood, lymph, abdominal exudate. Transport of kanamycin in the wall of the strangulated intestine and its mesentery through the lymphatic system and by adsorption from the abdominal exudate is supposed to be possible. Normal concentration of the antibiotic was determined in the tissues around the strangulation zone. The concentration peak of both antibiotics was noted 1 hour after introduction in all the biosubstrates studied which may serve as an orientator for the optimal time of operation.

[Pharmacotherapy in complex treatment of ulcerous stenosis]. / Farmakoterapiia v kompleksnom lechenii iazvennykh stenozov.

The authors present results of the examination and treatment of 64 patients with ulcer disease complicated by stenosis (27 patients had compensated stenosis, 33--subcompensated and 4 patients--decompensated stenosis). The investigation of the dynamics of main pathophysiological disorders and specific action of medicinal preparations has revealed the causes of ineffectiveness of standard antiulcerous therapy. The principles of conservative treatment of ulcer disease with stenosis are developed. The proposed method of treatment resulted in cicatrization of the ulcer, disappearance of the inflammatory edema of the mucosa, reestablishment of patency of the pyloro-duodenal canal and stable remission of the disease in 58 patients (followed up during the period from 6 months till 3 years). Only 6 (9.4%) out of 64 patients were operated upon (2--with decompensated and 4 with subcompensated stenosis). The results obtained show that it is necessary to determine the indications to operations in patients with ulcerous stenosis after complex conservative therapy and the reassessment of the degree of evacuatory disorders.

[Experimental substantiation of a precision technic of creating an interintestinal anastomosis in acute intestinal obstruction]. / Eksperimental'noe obosnovanie pretsizionnoi tekhniki formirovaniia mezhkishechnogo soust'ia pri ostroi kishechnoi neprokhodimosti.

Two kinds of intestinal sutures performed with the use of a precision technique were investigated on models of acute intestinal obstruction. One-row (serous-muscular-submucosal) and two-row (serous-musculo-submucosal and submucosal-mucosal) sutures provide an exact layer-after-layer connection of the intestinal wall layers and a sufficient mechanical firmness of the anastomosis with little traumatization. The dynamics of microcirculation changes in the anastomosis zone was followed with the help of contact intraoperative biomicroscopy. Symptoms of the traumatic inflammation were cupped off within 5 days and changed by reparative processes.

[The indications and methods for decompression of the gastrointestinal tract in injuries to the abdominal cavity organs]. / Pokazaniia i sposoby dekompressii zheludochno-kishechnogo trakta pri povrezhdeniiakh organov briushnoi polosti.

The article analyses the treatment of 122 patients with injuries of organs in abdominal cavity. One of the most important elements in intra- and postoperative treatment for paresis or paralysis of intestines was an abdominal decompression. Its basic methods were the following: nasoenteral drainage, gastroenterostomy by Iu. M. Dederer's method (31), enterostomy by I. D. Zhitniuk (25), and cecostomy (2). The application of decompression made it possible to treat the patients with severe peritonitis caused by gunshot injuries.

[The characteristics of mine-blast wounds in shoals]. / Osobennosti minno-vzryvnykh ranenii na melkovod'e.

The data obtained in experiments on shoal using plastic charges of 100-50-25 g of equivalent power of antipersonnel mines showed that injuring action on shoal was four times greater than that on land and resulted in considerably graver skeletal traumas and distant injuries. Of special significance in pathogenesis of mine-explosive wounds on shoal is pneumonia followed by arterial air embolism and encephalopathy. Although the undermining on land and on shoal have many common etiopathogenetic features, there are substantial differences first of all due to different mechanisms of their appearance. It must be taken into account while performing evacuatory, diagnostic and medical measures in such patients.

[Comparative characteristics of octreotide and famotidine in the treatment of acute pancreatitis]. / Sravnitel'naia kharakteristika oktreotida i famotidina pri lechenii ostrogo pankreatita.

Antisecretory therapy is an important and integral component of complex therapy of acute pancreatitis. The clinical estimation of efficiency of various antisecterory preparations, sandostatin and famotidin (quamatel) was made in treatment of acute pancreatitis at an early stage of the disease. The results of the research have shown that the efficiency of sandostatin and famotidin (quamatel) in treatment of not severe (mild and medium) forms of acute pancreatitis is approximately identical. But the application of famotidin (quamatel) is economically more favorable (8.3 times cheaper than sandostatin). In treatment of severe acute pancreatitis of paramount importance are the terms of the beginning of antisecretory therapy, the optimum term being the first day of the disease. The preparation of choice is sandostatin, the preparation of reserve--famotidin (quamotel). The duration of a medical course of treatment is the first three days from the beginning of the disease. The application of antisecretory preparations in question is less effective when used in later terms.

[Tumors of the small intestine]. / Opukholi tonkoi kishki.

An analysis of 24 cases with tumors of the small intestine of both benign and malignant origin has been made. Their pathomorphological characteristics are given. Acute intestinal obstruction, hemorrhage and perifocal inflammation are found to be most frequent complications. The topical diagnostics of these tumors before operation is difficult, they manifest themselves by their complications. The operative methods are dependent on intraoperative findings.

[Minimally invasive technologies in the treatment of severe forms of acute pancreatitis at various periods of the disease]. / Maloinvazivnye tekhnologii v lechenii tiazhelykh form ostrogo pankreatita v razlichnye periody zabolevaniia.

The choice of the optimum technique of the sanitation procedure in treatment of acute necrotizing pancreatitis (ANP) is now one of the most disputable problems. Clinical estimation of the efficiency of various operative techniques of treatment of ANP at various stages of disease has been made. In the aseptic phase laparoscopic decompression of the pancreas is indicated when the patient has evident hemorrhagic parapancreatitis. In the phase of septic sequestration of ANP the optimum method of minimally invasive surgical intervention is considered to be minilaparotomy which is expedient for abscesses of small volume, lipid abscesses of any volume with the minimal content of necrotizing tissues as the first step of sanitation in critical patient. High quantity of the necrotizing tissues in the zone of the destructive focus requires traditional laparotomy of the abscess under conditions of preventive maintenance of the endotoxic shock.