[Prevention of venous thrombosis of the lower extremities and pulmonary embolism in neurological patients in the intensive care unit using intermittent pneumatic compression]. / Profilaktika trombozov ven nizhnikh konechnostei i tromboémbolii legochnoi arterii u nevrologicheskikh bol'nykh v usloviiakh reanimatsionnogo otdeleniia s ispol'zovaniem preryvistoi pnevmokompressii.

AIM: To assess the efficacy of intermittent pneumatic compression (IPC) in the treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE) in neurological patients. MATERIAL AND METHODS: The study included 101 patients with acute disorders of cerebral circulation: 52 patients underwent IPC for prevention of DVT of the lower extremities, 49 patients received only basic treatment. Clinical examination, venous duplex scan of the lower extremities and telethermography were performed. RESULTS AND CONCLUSION: IPC significantly reduces the risk of DVT of the lower extremities and PE mortality in the first 20 days in patients with stroke and motor deficit. Ultrasound and thermography can effectively assess the dynamics of treatment.

[Antegrade approach for cholangiolithiasis complicated by mechanical jaundice]. / Vozmozhnosti antegradnogo dostupa v lechenii kholangiolitiaza, oslozhnennogo sindromom mekhanicheskoi zheltukhi.

AIM: To improve an efficiency of surgical treatment of patients with cholelithiasis complicated by obstructive jaundice through antegrade interventional approach. MATERIAL AND METHODS: 166 patients aged from 23 to 92 years with cholangiolithiasis complicated by mechanical jaundice were enrolled. Patients were divided into 2 groups: group I (136) - retrograde endoscopic method, group II (30) - antegrade interventional approach. RESULTS: In the first group surgical efficacy was 79.4%. Morbidity and mortality were 13% and 2% respectively. In the second group these values were 96.7%, 10% and 3% respectively. CONCLUSION: Antegrade interventional approach for minimally invasive procedures is technically feasible, has the same effectiveness as the retrograde endoscopic method and also all advantages of minimally invasive techniques.

[Analysis of reasons of "incomplete" colonoscopy].

UNLABELLED: The objective of this study was to determine the reasons for incomplete colonoscopy, as well as evaluation of results preparation of patients for colonoscopy in a variety of ways, informative colonoscopy depending on the quality of preparation of the colon for examination. MATERIAL AND METHODS: The material of this study was the results 104 of colonoscopies drawn from daily clinical practice. To prepare the colon for the study used the most available ways: 1) lavage solutions, 2) castor oil, 2 enemas in the morning and 2 in the evening, 3) enema, which the patients were chosen after consulting a doctor. To assess the preparedness of the colon to the study used a Boston-scale of assessment of quality of preparation of the colon for a colonoscopy". Preparation of the colon was improved by using a water jet pump of the company "Olympus" AFU100. Statistical analysis was performed using IBM SPSS Statistics 19.0. RESULTS: Analysis of clinical specimens showed that in 13 (12.5%) of the observations to intubate the colon was not possible. The main reason is the poor preparation of the colon to the study, which failed to improve even with the aid of a water jet pump.

[Quality of life among patients, operated on the reason of the adhesive ileus].

The long-term follow-up results of the surgical treatment of the adhesive ileus were analyzed in 128 patients after laparotomy and 49 patients after laparoscopic adhesiolisis. The quality of life was assessed with the use of the adopted SF-36 scale. The successful treatment result was registered in 92% of patients after the laparoscopic adhesiolisis and in 69% of patients who had laparotomy. The modified scale of the quality of life assessment can be used for the medico-social expertise.

[Clinico-morphological aspects of diagnostics and treatment of the surgical sepsis].

Treatment results of 63 patients with surgical sepsis (aged 17-92 years) were analyzed. The necessity of intravenous immunoglobulin infusion in the complex treatment of sepsis was proved by the comparative morphological study of immunocompetent tissues of 30 patients, died of sepsis and nonseptic reasons. The rational use of intravenous immunoglobulin should be based on the condition of the patient and defined by the APACHE II and SOFA scores.

[Low-temperature sterilization for the surgical infection prophylaxis].

The comparative characteristic of the accepted methods of low-temperature sterilization of medical equipment is given. Special attention is devoted to the surgical infection prophylaxis. The efficacy, expediency and safety of gas sterilization with ethilenoxide is proved. Plasmic methods of sterilization is recommended for use together with other methods of low-temperature sterilization.

[The immune system disorders by the adhesive abdominal disease].

State of the immune system was analyzed in 30 patients with the adhesive abdominal disease in long postoperative terms out of the attack of the disease. Survey had demonstrated certain disorders in both cell and humoral immune systems. Strong decrease of immunoglobulins G and A, T-lymphocytes and neutrophilic phagocytic activity were registered. Thus, the use of agents, activising T- and B-cell immunity should be considered in patients with the adhesive abdominal disease.

[Immunotherapy in complex treatment of surgical sepsis].

The results of treatment of 73 patients with confirmed diagnosis of sepsis are analyzed. The most frequent immune disorders in septic patients are: decrease in lymphocyte count, both T (60%) and B (45.7%) populations, decrease of T-helpers and T-suppressors (52.6%) count, increase of C3-complement activator titre (50%) and phagocytic coefficient (52.4%). The more expressed immune depression observed in patients with gram-negative sepsis in comparison with the gram-positive. Standard immunoglobulins were used in the treatment of 38 patients: "Endobulin" (ImmunoAG, Austria)--in 9 cases; "Intraglobin" (Biotest, Germany)--in 14 and "Pentaglobin" (Biotest, Germany)--in 15 cases. Analyze of the control immunogramms showed the reliable improvement of immune indices and normalization of T-cell counts. Lethality among septic patients treated with immunoglobulins was 14.5%.

[Anaerobic gas-producing clostridial endogenic infection in patient with salmonellosis].

Anaerobic gas-producing clostridial infection is one of most severe complications of mainly gunshot wound of war period, in peace time occurs very seldom. The rare clinical case of anaerobic gas-producing clostridial endogenic infection with fulminant course in patient with salmonellosis produced by group B salmonella typhimurium. The disease was finished with fatal outcome in 8.5 hours after appearance of pain syndrome in right thigh with consequent fulminant development of gas gangrene with arterial hypotension on 4th day after onset of gastroenteric form of medium severity salmonellosis. Clinical, microbiological and postmortem data are represented.

[Mini-invasive ways of cholecystectomy for acute cholecystitis in aged patients].

Analysis of radical surgical treatment results by means of laparoscopic cholecystectomy and cholecystectomy from modified mini-access in 203 patients from senior age group with acute cholecystitis is presented. Using experimental studies optimal localization of mini-access on the anterior abdominal cavity was proved. Taking into account the dynamics of stress hormones (prolactin and cortisol) level at mini-invasive radical operations it is proved that pneumoperitoneum is one of the most significant intraoperative aggressive factors. Priority indications for cholecystectomy from mini-access in case of acute cholecystitis are defined. Technical facilities of this treatment mode are shown.

[Long-term results of surgical treatment of commissural intestinal obstruction].

Long-term results of operations for acute commissural intestinal obstruction (ACIO) were studied in 128 patients 2 to 10 years after surgery. Only patients with uncomplicated forms of ACIO (without intestinal necrosis and generalized peritonitis) have been included into the analysis. The results of the treatment were assessed both in the group and individually after 87 operations of total adheolysis and 39 cases of partial comissurotomies. Clinical symptoms of abdominal commissures after elimination of ACIO were seen in 44.2% patients, including recurrence of ileus in 20.3% patients. Interintestinal commissures and conglomerations were the causes of ACIO in 44.5% cases that should be taken into account at adheolysis made laparoscopically. It is demonstrated that long-term results of ACIO treatment depend on surgical trauma and associated recurrence of adhesive process.

[Change in the tone of deep veins of the lower extremities in patients with varicocele]. / Izmenenie tonusa glubokikh magistralei nizhnikh konechnostei u bol'nykh s varikotsele.

Fifty patients with stage II-III varicocele and 47 normal volunteers were examined using an "Aloka-SSD-500" system. Assessments were made of the tonico-elastic properties of the venous wall of the femoral and popliteal veins when their diameter increased at clinostasis in response to the growth of intravenous pressure on the Valsalva test. The changes in the diameter of the same venous fragment were recorded before and at the height of the functional test. The results of the study were as follows: a the diameter of the clinostetic lumen of the common femoral vein in normal volunteers and patients with varicocele was of no statistical power and constituted 8.9+/-1.0 mm and 9.4+/-0.8 mm, respectively, with p=0.01. On the Valsalva test in the control group the relative increment of the femoral vein caliber was 22.6+/-5.7%, with p=0.01. In patients with varicocele,it amounted to 61.1+/-10.0%, with p=0.01. In both groups, the popliteal vein responded to the functional tests equivalently by 19.6+/-6.9 and 17.5+/-5.0, with p=0.01. Dilatation of the femoral vein by more than 1/3 of the initial lumen in response to the Valsalva test was encountered in 84% of cases with varicocele whereas in the control group, it originated in 6% of cases. Assessment of the results of the study allows the conclusion to be drawn that the biomechanical properties of the wall of the common femoral artery are weakened in patients with varicocele, with the popliteal vein being intact. Thus, formation of the "tension chamber" in the femoral vein may be implicated in the pathogenesis of ileospermatic reflux origination. In patients with varicocele, the lowering of the tone of the femoral veins may be linked with the higher incidence of the hemodynamic varicocele type and with the presence of the ileospermatic reflux. The use of micronized diosmine in the given patient group may be substantiated pathogenetically.

[The structure of endogenous intoxication in acute intestinal obstruction and the methods for its correction]. / Struktura éndogennoi intoksikatsii pri ostroi kishechnoi neprokhodimosti i puti ee korrektsii.

The structure of endogenic intoxication by products of the intermediate metabolism was studied in 32 patients with intestinal obstruction. The leading components of the endogenic intoxication are: acetone, propionic aldehyde and ethanol. In cases of a complicated course of the intestinal obstruction the operative treatment by traditional therapy in the postoperative period proved to be insufficient. Sessions of the intravascular laser irradiation of blood reducing the concentration of acetone and propionic aldehyde were performed in 19 patients without any changes in the concentration of ethanol.