[Pancreatic isthmus intersection with preliminary suturing of arteries in this area]. / Sposob peresecheniya peresheika podzheludochnoi zhelezy s predvaritel'nym proshivaniem arterial'nykh sosudov dannoi oblasti.

OBJECTIVE: To analyze the early results of pancreatoduodenectomies with different methods of pancreatic isthmus transection. MATERIAL AND METHODS: There were 82 pancreatoduodenectomies for cancer of pancreatic head or major duodenal papilla for the period 2010-2019. The control group comprised 38 patients with pancreatic isthmus transection and no preliminary suturing of local vessels. The study group consisted of 44 patients who underwent preliminary intersection of pancreatic isthmus vessels. Inclusion/exclusion criteria were used for grouping. We evaluated total intraoperative blood loss and blood loss following pancreatic isthmus transection, incidence and structure of postoperative complications. RESULTS: Total intraoperative blood loss was 755.12±108.61 vs. 698.45±92.87 ml, respectively (p>0.05). Intraoperative blood loss following pancreatic isthmus transection was 48.21±9.11 vs. 7.83±1.72 ml, respectively (p<0.01). Incidence of postoperative complications and redo surgeries was similar. Postoperative bleeding occurred in 5 (13.15%) patients of the 1st group (class A - 2.63%; B - 5.26%; C - 5.26%) and 2 (4.54%) patients of the 2nd group (A - 4.54%; B and C - 0%). There were no significant differences in the incidence of other complications and postoperative mortality. CONCLUSION: Pre-stitching of arterial vessels of the pancreatic isthmus reduces blood loss following intersection (p<0.01), as well as the incidence of postoperative bleeding class B and C (p<0.05).

[Modern aspects of the complex treatment of perforated gastric and duodenal ulcer]. / Sovremennye aspekty kompleksnogo lecheniya perforativnoi yazvy zheludka i dvenadtsatiperstnoi kishki.

OBJECTIVE: To study the effectiveness of pharmacotherapy for perforated gastric ulcer in a surgical hospital. MATERIAL AND METHODS: A retrospective analysis of the treatment of 693 patients with perforated gastric and duodenal ulcers was carried out. Laparoscopic and open surgeries were performed. Statistical analysis was performed using the Statistica and MS Excel software packages. Student t-test was applied for independent samples and Fisher's F-test was calculated. RESULTS: Combined therapy included surgical treatment (suturing of the ulcer as a rule) and medication with proton pump inhibitors, antibacterial drugs. Over the past 5 years, postoperative quality of life has been significantly improved in patients with perforated ulcers. Stomach resection and vagotomy for perforated ulcers will become historical in the near future. Laparoscopic and open procedures ensure similar periods of ulcer closure. CONCLUSION: Currently, successful treatment of perforated gastric and duodenal ulcers requires an integrated approach at all levels of specialized care and is impossible without modern pharmacotherapy.

[Surgical treatment of a patient with liver endometriosis]. / K voprosu ob endometrioze pecheni.

Endometriosis is a functioning endometrial tissue outside the inner layer of the uterine wall. Liver endometriosis is one of the rarest forms of atypical endometriosis. In this article, we report a patient with this disease. A 59-year-old patient complained of heaviness and periodic pain in the right hypochondrium for more than a year. Previous contrast-enhanced CT revealed signs of cystic-solid hypovascular mass lesion in the right liver lobe. Histological examination revealed no reliable signs of tumor growth. According to control CT after 8 months, no significant changes were observed. Surgical treatment was indicated and atypical liver resection was performed. Histological examination revealed cystic endometrioid lesion. Liver endometrioma is a rare disease with unclear pathogenesis. Diagnosis is difficult due to uncharacteristic clinical manifestations and no specific markers. Liver endometriosis should be considered in differential diagnosis of liver lesion. Surgical treatment is preferable due to the risk of malignant transformation.

[The state of microhemodynamics and oxygenation in the mucous membrane of the alveolar ridge after gingival contouring during dental implantation]. / Sostoyanie mikrogemodinamiki i oksigenatsii v slizistoi obolochke al'veolyarnogo grebnya posle konturnoi plastiki desny pri dental'noi implantatsii.

The results of a comparative assessment of the state of hemomicrocirculation and oxygen metabolism in the mucous membrane of the alveolar crest after contour plastics of the gums during dental implantation using a connective tissue graft from the upper jaw, a connective tissue transplant from the palate and the collagen matrix collagen matrix are presented. During contouring with the use of connective tissue graft (CTG) from the upper jaw and collagen matrix in the mucous membrane of the alveolar mandible, the level of tissue blood flow decreases, which characterizes the development of ischemia, which is stopped after 3 weeks, when using a connective tissue graft (CTG) from the palatine, the level of tissue blood flow rises, which indicates the development of hyperemia, which is stopped for more than 3 weeks. According to oximetry data after contouring with the use of various surgical techniques, the level of oxygenation and oxygen metabolism is reduced by 8-38%, which characterizes the development of hypoxia, which is stopped after 3 weeks when using CTG from the hillock of the upper jaw and collagen matrix for more than 3 weeks when applying CTG from the palatine.

[Histological evaluation of inflammatory response to zinc-oxide-eugenol filling materials in a soft and bone tissues]. / Gistologicheskaia otsenka vospalitel'noi reaktsii miagkikh i tverdykh tkanei polosti rta na vvedenie plombirovochnogo materiala na osnove tsink-évgenol'nogo tsementa v éksperimente.

AIM: To evaluate and to compare the intensity of the inflammatory response to zinc-oxide-eugenol based filling material in rabbit's soft and bone tissue. MATERIAL AND METHODS: The study employed 20 chinchilla rabbits. The artificial defects were formed in jaw and in soft tissues and filled by zinc-oxide-eugenol based filling material. After 14 or 30 days the animals were euthanized, and tissue samples were analyzed with microscope. RESULTS: Histological analysis revealed that zinc-oxide-eugenol based filling material support inflammation reaction in the tissue, but bone tissue showed statistically lower inflammatory response in comparison to soft tissue (p<0,05). CONCLUSION: Extrusion of zinc-oxide-eugenol based filling material from root canal is undesirable as it leads to complex unfavorable tissue reaction for its elimination, more pronounced in soft tissues.

[Technique of invaginative pancreatojejunostomy in pancreatectomy]. / Pogruzhnoi kisetnyi invaginatsionnyi anastomoz pri rezektsionnykh operatsiiakh na podzheludochnoi zheleze.

Pancreatoenterostomy is one of the key moments in pancreatic surgery. It was proposed invaginative pancreatojejunostomy in end-to-side fashion by using of two continuous single-row purse-string sutures. This technique may be used in pancreatoduodenectomy and Beger's procedure. This method will be useful in cases of edematous and erupting pancreatic parenchyma and hard-to-differentiate lumen of pancreatic duct. It is followed by reduced trauma of tissue and bleeding, allows to avoid sutures failure and to achieve sealed anastomosis.

[The study results of the alveolar ridge mucosal microcirculation after bone augmentation using the Tunnel Technique method]. / Rezul'taty issledovaniia mikrotsirkuliatsii slizistoi obolochki al'veoliarnogo grebnia posle vypolneniia tunnel'noi tekhniki kostnoi plastiki.

It reports the results of primary basal blood flow in partially edentulous bone tissue with atrophy, as well as comparative evaluation of haemomicrocirculation level of the alveolar bone mucosa after bone augmentation via tunneling and conventional methods. The results of the initial state of microcirculation in the mucous membrane of the alveolar process in the partially edentulous area show a 45% decrease of blood flow (M), its intensity (s) by 60%. Microcirculatory shifts in blood flow levels indicators, its intensity, vasomotor activity are more evident when using the conventional method, where revascularization takes more than five months. When using the tunnel method, there is an improvement in haemodynamic mechanisms of tissue blood flow regulation. Microcirculation is restored 4 months after surgery.

[Surgical technique in patients with chronic pancreatitis]. / Optimizatsiia tekhniki operatsii u bol'nykh khronicheskim pankreatitom.

AIM: To justify ligation of vascular branches of anterior pancreateroduodenal arterial arch or gastroduodenal artery prior to bifurcation. MATERIAL AND METHODS: This method was tested on sufficient clinical material: 147 patients with recurrent chronic pancreatitis. The interventions are presented by Frey, Beger procedures and its Berne variant. RESULTS: Comparative analysis showed reliable advantages of vascular ligation during pancreatectomy.

[Synthetic osteoplastic materials for alveolar bone augmentation before dental implantation]. / Primenenie sinteticheskikh osteoplasticheskikh materialov dlia uvelicheniia parametrov al'veoliarnoi kosti cheliustei pered dental'noi implantatsiei.

The study presents scientific data about surgical preparation of the alveolar bone before dental implantation by applying synthetic osteoplastic materials. The review analyzed the results of experimental and clinical studies on structural features and the efficiency of these materials, the time for replacement of new-formed bone tissue and contains comparative analysis of the efficiency of synthetic bone substitutes and other types of osteoplastic materials.

[Erbium laser application for oral surgery in patients with platelet hemostatic disorders]. / Primenenie érbievogo lazera pri khirurgicheskom stomatologicheskom lechenii patsientov s narusheniiami trombotsitarnogo gemostaza.

Hemostatic disorders are typically associated with prolonged bleeding after or during surgical procedures. The aim of the study was to increase the efficiency of oral surgery in these patients using erbium laser. Selected 46 patients receiving oral surgery were randomly divided in 2 groups: 43 patients with thrombocytopenia, trombocytemia and other platelet disorders treated with erbium laser and a control group of 43 patients without concomitant pathology determined for conventional surgical treatment. No postoperative bleeding was seen in group 1. Conventional procedures were associated with significantly more postoperative pain and epithelization took 1-3 days longer. Erbium laser radiation is an up-to-date method which can be successfully used for oral surgery in patients with hemostatic disorders.

[Tunnel technique in oral surgery]. / Tunnel'naia operativnaia tekhnika v khirurgicheskoi stomatologii.

The article is aimed to analyze the advantages of the tunnel operative approach in dental surgery. It is shown that the application of the tunnel technique can enhance tissue regeneration and revascularization, achieve better aesthetic and functional results, offer higher treatment quality.

[THE DIAGNOSTIC AND TREATMENT ALGORITHM FOR PATIENTS WITH OBSTRUCTIVE JAUNDICE SYNDROME].

The article presents a comparative analysis of therapeutic and diagnostic measures aimed at eliminating jaundice complicating diseases hepatopancreatoduodenal zone as tumor and benign etiology. Patients with obstructive cholestasis were represented by two groups: the main and control, including 858 and 869 patients, respectively. Therapeutic and diagnoctic tactics in the study group was based on the principles of the proposed algorithm. Using the proposed diagnostic and treatment algorithm led to better outcomes: significantly lower mortality and the incidence of postoperative complications

[Monitoring of knowledge level in ambulatory patients with arterial hypertension].

Monitoring results of current awareness level of dispensary patients with arterial hypertension are presented in the article. Awareness-raising activities for patients with arterial hypertension were developed by information and education work and communications increasing; effective target medical and social programs developing and implementing.

[T-cells immunity in oral lichen planus pathogenesis].

In this review the modern ideas of the cell-like immune pathogenesis mechanism of Lichen planus)LP) are described. The special attention is paid to molecular diagnostics methods ( immunohistochemical and others). Communication of emergence of oral LP with infectious diseases is shown.

[Tetrahepaticojejunostomy for the treatment of the high biliary strictures].

The article highlights various techniques of biliodigestive anastomises, used for the treatment of high-level blockages of biliary ducts. The novel author method of tetrahepaticojejunostomy, possessing less insufficiency risk and less traumaticity was suggested. 38 patients have been operated on using the hepaticoenterostomy; 5 patients received the described method of tetrahepaticojejunostomy with positive outcome.

[Anatomical and radiological studies on additional mandible teeth anesthesia considering innervation variability].

The paper presents studies on nutritional foramina of the mandible. Some nutritional foramina located in the frontal mandibular region on the lingual surface and containing significant blood vessels and nerves are found to be more typical for teeth-bearing mandible. In retromolar area in case of third molars presence intraosseous canals were revealed leading to inferior alveolar nerve canal. One should consider intraligamental and lingual anesthesia by lower incisors extraction. Intraosseous anesthesia and retromolar area infiltration significantly increase anesthesia efficiency by third molar extraction.

[Retromolar mandibular anesthesia. Radiological and topographical study of an additional method of lower teeth anesthesia].

The aim of the study was to estimate the clinical efficacy of mandibular third molars anesthesia with various combinations of local anesthesia methods. Anatomical, radiological and morphological methods were used in the study. The topographic features of retromolar triangle were thoroughly examined. The neurovascular bundle revealed its relationship with retromolar area structures. According to the results of the clinical study the most effective combinations of mandibular third molars analgesia were selected.

[The novel method of intestinal anastomosis after the colon resection].

The novel method of the invagination colic anastomosis was suggested and experimentally approved. The results of surgical treatment with the use of the anastomosis in 23 patients were analyzed. The thorough and all-sided analysis permitted to state that the novel way of ileo-colic and colo-colic anastomosis was effective and safe for the surgical treatment of patients with diseases of the colon.

[Prevalence of ulcer disease complications].

The epidemiology of complications of a peptic ulcer is studied: bleedings, perforations and pylorodudenal stenoses. 1799 patients are included in research that were on hospitalisation in 1995-2009. A frequency of all the complications has declined. Middle age of patients with the complicated ulcer enlarged: in case of an ulcerative bleeding--at the expense of reduction of a share of male at the age of 36-60 years, in case of a perforated ulcer--because of appreciable reduction of a percentage of male at the age of 21-35 years.

[Surgical strategy for juxtapapillary ulcers of the duodenum].

Results of surgical treatment of 89 patients with ulcer of the duodenum with postbulbar localization were studied. A classification of postbulbar ulcers was proposed taking into consideration the degree of involvement of bile-excreting pathways and major duodenal papilla into the periulcerous process. In extrapapillary ulcers without involvement of bile-excreting pathways in the cicatricial-ulcerous process resection of the stomach after Bilroth I is recommended with performing gastroduodenal anastomosis with a single layer suture. Resection of the stomach supplemented with biliodigestive anastomosis is recommended in cases with suprapapillary ulcers with the involvement of choledochus. Mechanical jaundice complicated by juxtapapillary ulcer can be cut off by endoscopic papillosphincterotomy. Fulfillment of pancreatoduodenal resection is possible in cases of deep injury of the pancreatic head.