[The effectiveness of local application of vancomycin powder in the prevention of surgical site infections in spine surgery: a meta-analysis]. / Effektivnost' lokal'nogo primeneniya poroshka vankomitsina v profilaktike infektsii oblasti khirurgicheskogo vmeshatel'stva v spinal'noi khirurgii: metaanaliz.

OBJECTIVE: To perform a meta-analysis of studies examining the effectiveness of the local application of vancomycin powder for the prophylaxis of surgical site infections (SSIs) in spine surgery. MATERIAL AND METHODS: Retrospective cohort studies and prospective randomized clinical trials were searched for in the Pubmed, EMBASE, Cochrane Library and eLibrary databases published from 2008 to December 2018. For the resulting variables, the odds ratio and 95% confidence interval were calculated using random and fixed effects models. Estimation of the degree of heterogeneity is estimated using the coefficient I2. Statistically significant differences were considered differences p<0.05. RESULTS: The meta-analysis included 28 clinical studies that included the results of the local application of vancomycin powder in 17,469 patients after performing various spinal surgical interventions. Two publications had a prospective, randomized, controlled study design. Topical application of vancomycin powder reduces the incidence of SSIs after spine surgery (p<0.0001). The use of vancomycin powder reduces the incidence of SSIs in patients operated on with stabilizing implants (p=0.004). On the other hand, the topical application of vancomycin powder did not affect the prevalence of SSIs in respondents who were operated on without the use of stabilizing implants (p=0.12) or due to deformities of the spine (p=0.06). CONCLUSION: Topical application of vancomycin powder is highly effective in preventing the development of SSIs in patients after spinal surgical interventions.

[Comparison of the long-term outcomes of total arthroplasty and anterior spinal fusion in the treatment of cervical degenerative disc disease: a metaanalysis]. / Sravnenie otdalennykh rezul'tatov primeneniia total'noi artroplastiki i perednego spondilodeza v lechenii degenerativnogo zabolevaniia sheinykh mezhpozvonkovykh diskov: metaanaliz.

AIM: The study aim was to perform a meta-analysis based on the results of randomized clinical trials comparing long-term outcomes of total intervertebral disc arthroplasty (TA) and anterior cervical spinal fusion (ACSF) in the surgical treatment of cervical degenerative disc disease. MATERIAL AND METHODS: We searched Pubmed, EMBASE, ELibrary, and Cochrane Library databases for randomized clinical trials reported between 2008 and August 2018. The relative risk and 95% confidence interval were calculated for dichotomous variables; for continuous variables, we used the standardized mean difference and their 95% CI with application of a random effects model. RESULTS: The metaanalysis involved 9 randomized controlled clinical trials including the long-term outcomes of surgical treatment in 2,439 patients. A pooled analysis of the data showed that regression of neurological symptoms (p<0.00001), improvement in the quality of life of patients (Neck Disability Index), and lower pain severity (visual analogue scale for upper extremities) were significantly more often observed (p=0.02) in the group of TA patients. In addition, the TA technique was characterized by a statistically significantly lower rate of re-surgery (p<0.0005) and degeneration of the superjacent segment (p<0.0001), with the rate of adverse events being slightly increased (p=0.04). CONCLUSION: Compared to anterior cervical spinal fusion, TA of cervical intervertebral discs is characterized by significantly better clinical efficacy in patients with cervical degenerative disc disease in the long-term postoperative follow-up.

Phase behavior of the thermotropic melt of asymmetric V-shaped molecules.

The phase behavior of the monodisperse melt of V-shaped molecules composed of two rigid segments of different lengths joined at their ends at an external angle α has been examined within the Landau-de Gennes approach. Each rigid segment consists of a sequence of monomer units; the anisotropic interactions in the system are assumed to be of the Maier-Saupe form. The coefficients of the Landau-de Gennes free-energy expansion have been found from a microscopic model of V-shaped molecule. A single Landau point at which the system undergoes direct continuous transition from isotropic to biaxial nematic phase is found for asymmetry parameter ϕ=1/3 or ϕ=2/3, where ϕ is the number fraction of monomer units in one of the segments. Two Landau points are found in a range 1/3<ϕ<2/3. Only isotropic and nematic states are found to be stable for 0≤ϕ<1/3 and 2/3<ϕ≤1. Regions of stability of isotropic, prolate uniaxial, and biaxial nematic phases are found for ϕ=1/3 and ϕ=2/3. In addition, a stable oblate uniaxial phase is revealed if asymmetry parameter falls in the range 1/3<ϕ<2/3. The region of stability of the biaxial nematic phase becomes smaller as parameter ϕ increases from 1/3 to 1/2 (or decreases from 2/3 to 1/2). Coefficients of the gradient terms have been found; for certain values of asymmetry parameter these coefficients can become negative in some ranges of angles.

The Landau-de Gennes free energy expansion of a melt of V-shaped polymer molecules.

The phase behavior of a monodisperse melt of polymer molecules consisting of two rod-like segments joined at an angle α has been inspected within the Landau theory of phase transitions. The interactions between monomer units were assumed to be of the Maier-Saupe form. The Landau-de Gennes expansion of the free energy of the melt has been obtained up to the sixth order in powers of the nematic order parameter, the coefficients of this expansion have been calculated from the microscopic model of polymer molecule. The phase diagram contains the regions of stability of isotropic, prolate uniaxial, oblate uniaxial, and biaxial nematic phases. The isotropic-uniaxial nematic and uniaxial-biaxial nematic transitions are of the first and second order, respectively. We found two Landau points in the phase diagram at which continuous transition from biaxial nematic state to isotropic phase occurs.

Microphase separation in polydisperse rod-rod diblock copolymer melt.

The stability limits of the isotropic state of melt of rod-rod AB polydisperse diblock copolymer have been studied within weak segregation theory. The number of units in A block is assumed to be a random variable distributed by the Schulz-Zimm distribution. Inspection of the spinodal curves shows that the copolymer melt with polydisperse rigid blocks is less stable with respect to formation of the nematic and microphase separated states than the monodisperse melt. The values of ratios between strengths of isotropic and anisotropic interactions in the system strongly influences the forms of isotropic-nematic boundary curves.

Microphase separation of comb copolymers with two different lengths of side chains.

The phase behavior of the monodisperse AB comb copolymer melt contained the macromolecules of special architecture is discussed. Each macromolecule is assumed to be composed of two comb blocks which differ in numbers of side chains and numbers of monomer units in these chains. It is shown (by analysis of the structure factor of the melt) that microphase separation at two different length scales in the melt is possible. The large and small length scales correspond to separation between comb blocks and separation between monomer units in repeating fragments of blocks, respectively. The classification diagrams indicated which length scale is favored for a given parameters of chemical structure of macromolecules are constructed.

The Landau free energy of a melt of graft copolymers.

New graphical algorithm is proposed to find vertex functions which are the coefficients of expansion of the Landau free energy of polydisperse multigraft copolymers whose macromolecules comprise an arbitrary number of types of side chains. This algorithm imposes no restriction on length distributions of side chains in copolymer macromolecules as well as on distribution of distances between two successive grafting points along the backbone. By way of example, with this algorithm the expressions for the second, third, and fourth order contributions into the free energy have been derived. The obtained results can be used for construction of the phase diagrams of polydisperse multigraft copolymers.

Surgical treatment of complicated abdominal aortic aneurysms.

The clinical data presented in the given work are based on the treatment of 166 patients with complicated abdominal aortic aneurysms, operated on during 20 years, namely between 1984 and 2004. Of these, aneurysmal rupture was identified in 51 (30.7%) and the risk of rupture in 115 (69.2%) cases. Coexistent pathology was present in 150 (90.4%) patients. Coronary artery disease was prevalent - 105 (63.3%) cases. The lethal outcome was recorded in 21.6% of cases (36 pts.). The basic cause of patients' death in the short-term postoperative period was acute cardiovascular insufficiency (9.6%).

[Reconstructive-reparative surgeries on the esophagus in burn cicatricial strictures].

Esophagoplasty was performed in 196 patients. Combined disease of the esophagus and stomach was in 71 patients. Esophagogastroplasty was performed in 122 patients, including 104 with gastric tube, 12 -- with whole stomach, 6 -- by means of lengthening of whole stomach. Insufficiency of cervical anastomosis was revealed in 17.2% cases. Long-term results (from 6 months to 9 years) were studied in 77.9% patients. Lethality was 4.2%. Esophagocoloplasty was performed in 74 patients. Insufficiency of cervical anastomosis was seen in 14.5% cases. Long-term results (from 5 months to 9 years) are available in 87.8% patients. Lethality was 4.1%.

[Adequate gas exchange in two-sided and combined surgeries on thoracic and abdominal organs].

Method of combined artificial lung ventilation during simultaneous two-sided operations on the lungs was studied in 60 patients. This method is based on traditional ALV with parameters calculated according to functional state of the patient's respiratory system, and additional high-frequency jet pulmonary ventilation. The developed method was not accompanied by any severe disorders of gas exchange and mechanics of ventilation.

[Surgical approach in bilateral and combined echinococcosis of the lung].

One hundred and two patients aged from 4 to 65 years with echinococcosis were treated. Solitary cysts in both lungs were diagnosed in 69 patients, multiple cysts -- in 33 patients. In 10 cases small and middle cysts were in the upper parts of both lungs. These patients underwent one-stage operation consisting in lateral thoracotomy, removing of the cyst from one lung, incision of retrosternal mediastinal pleura, removing of the cyst from the second lung, drainage of pleural cavity. Fifteen patients with combined echinococcosis of the upper lobe of the right lung and liver were operated with another one-stage surgical method through thoracotomy in the third and sixth or seventh intercostal space. These methods are characterized by low traumaticity, decreased number of postoperative complications and hospital stay.

[Transbiliary interventions under videolaparoscopic control].

Transbiliary interventions under videolaparoscopic control were performed in 203 patients with benign diseases of bile ducts, in 78 of them the procedures were of purely diagnostic character. Laparoscopic microcholecystostomy was fulfilled in 117 patients. In 11 of them no desirable results were obtained. All of them had been operated upon for emergency indications. In the "cold" period operations were performed on 88 patients.

[The use of low-molecular heparins in reconstructive surgery of ascending aortic aneurysms]. / Primenenie nizkomolekuliartnykh geparinov v rekonstruktivnoi khirurgii anevrizm voskhodiashchego otdela aorty.

This paper analyzes the results of the use of enoxaparin for anticoagulant therapy in reconstructions on the ascending aorta (AA) as compared to unfractionated heparin applied previously in the control group. Between 1986 and 2003 a total of 30 patients with AA aneurysms were operated on at the clinic. Insufficiency of the aortic valve with degree II-III regurgitation was present in 25 (83.3%) cases. Chronic dissection of the AA was identified in 10 (33.3%) cases. The patient's age varied from 24 to 52 years (mean 39 years). The etiological factors of AA aneurysm were: Marfan's syndrome (46.7% of cases), Erdheim's syndrome (26.7%), atherosclerosis (10.0% of cases); previous chest traumas were recognized in 16.6% of patients. All the patients were operated on under extra-corporeal circulation and moderate hypothermia. The patients were distributed into two groups. In the control group, eighteen patients were operated on. Anticoagulant therapy was carried out using unfractionated heparin i. v. in a daily dose 10-15 thousand units. Heparin injection was initiated on the first postoperative day and continued for 6.5 days on the average, with a progressive change over to the use of indirect anticoagulants. In the basic group, twelve operated patients were administered the anticoagulant enoxaparin s.c. in a daily dose 0.7-1.0 mg/kg bw. Enoxaparin therapy was initiated from the first postoperative day and continued for 8.9 days on the average, with a progressive change over to indirect anticoagulants. The postoperative lethality in the control group accounted for 22.2% (4 patients). In two cases, it was induced by heart failure and in two cases, by hemorrhagic complications. In the basic group, the beneficial results were achieved in 91.7%; no hemorrhagic complications were recorded. The data obtained allow the conclusion that the use of enoxaparin significantly facilitates the postoperative management of patients with AA aneurysms, providing for a controllable and safe anticoagulant effect.

[Migration of the fragment of the subclavian catheter: diagnosis and surgical treatment]. / Migratsiia fragmenta podkliuchichnogo katetera: diagnostika i khirurgicheskoe lechenie.

Results of examination and surgical treatment of 68 patients after migration of foreign body (fragment of catheter) into venous bed were analyzed. Ultrasonic examination including transesophageal echocardiography was the main method of diagnosis. Various surgical approaches were used depending on localization of the foreign body. Policy of surgical treatment was developed. A case is reported.

[Optimization of diagnosis and methods of liver resection in alveolar echinococcosis]. / Optimizatsiia diagnostiki i metodov rezektsii pecheni pri al'veoliarnom ékhinokokkoze.

36 resections of the liver were carried out. 66.7% of them were hemihepatectomies and extended hemihepatectomies due to sever parasitic lesions of the liver parenchyma. During resections of the liver ultrasonic scalpel and high frequency electrocoagulation, compression of the hepatoduodenal ligament under the control of the intraoperative sonography were performed. In 4 patients (11.1%) complications were observed: hepatic insufficiency (2 cases), injury of inferior vena cava (1 case) and infrahepatic abscess (1 case). Lethality made up 3.8% (1 patient died due to development of acute hepatic insufficiency after extended right-sided hemihepatectomy.

[Hepatic echinococcosis and its surgical treatment]. / Ekhinokokkoz pecheni i ego khirurgicheskoe lechenie.

973 patients were operated for the period of 14 years for echinococcosis of the abdominal cavity. Echinococcosis of the liver was revealed in 742 (76.2%) patients. Complicated forms of echinococcosis were registered in 42.3% patients. Suppurative cyst was detected in 138 (43.9%) patients; perforation of the cyst into free abdominal cavity--in 22 (7%), into pleural cavity--in 14 (4.5%) patients, into bile ducts--in 62 cases (19.7%); biliary tracts compressing by the cyst with mechanical jaundice--in 29 (9.2%) patients; bilio-pulmonary bronchial fistula was revealed in 7 (2.3%) patients and calcification of the cysts--in 42 (13.4%). Radioisotope scanning, X-ray, ultrasound, Computed tomography and serological reactions were used for diagnosis. For differential diagnosis of parasitic cysts from non-parasitic cysts laparoscopic video technique was also used in three cases. Radical operations were carried out in 47 patients, 19 patients from them underwent total pericystectomy and 28 patients underwent resection of the liver. For echinococcosis of the liver complicated by mechanical jaundice: in this case echinococcectomia was done with the correction of the continuity of the bile duct. Ultrasound cavitation, CO2 laser, thermal or thermic means (70 degrees C solution of furaciline or instant steam treatment) were used for antiparasitic purposes.

[The effect of pancreatic islet cell implantation on the course of diabetic nephropathy]. / Vliianie implantatsii ostrovkovykh kletok podzheludochnoi zhelezy na techenie diabeticheskoi nefropatii.

The influence of the implanted allo- and xenocultures of the pancreas islet cells upon the course of nephropathy was studied in 61 patients with insulin-dependent diabetes mellitus. These cells were found to have a positive influence upon the functional state of the kidneys in patients with diabetic nephropathy especially at its initial stage.