EVALUATION OF NOVEL PORCINE PERICARDIAL BIOMATERIAL FOR VENTRAL AND INGUINAL HERNIA REPAIR. THE RESULTS OF A NON-RANDOMIZED CLINICAL TRIAL.

Using the mesh for hernia repair is the most common type of hernia surgery. There are many types of meshes made of various synthetic materials, but all of these meshes have their own respective disadvantages. The aim of this study was to provide preliminary results of a non-randomized clinical trial evaluation of novel porcine grafts XI-S+® (Colorado Therapeutics LLC. USA) for ventral and inguinal hernia repair. All patients underwent a standardized surgical procedure. Onlay surgical repair technique has been performed in ten patients with ventral hernia and Lichtenstein tension-free method has been used for ten patients with inguinal hernia repair. The XI-S+® mesh fixation was performed with multiple simple interrupted sutures using prolene thread. The average age of the patients with ventral hernia was 54±14 years, and 30% of patients were female and 70% of patients were male. The average age of the patients with inguinal hernia was 62.5±9.4 years, and 10% of patients were female and 90% of patients were male. The average hospitalization length was 2 days. During three years of observation, no recurrence of hernia was observed in patients. The XI-S + ® mesh has anti-adhesive properties, is extremely resistant to infections, provides favorable conditions for engraftment, early activity and patient rehabilitation. The clinical studies of the patients that underwent ventral and inguinal hernia repair using XI-S+® mesh have shown that the post-operative pain was minimal and easily controlled by the use of analgesics. As for the sensation of the mesh, in some patients it has been present up until 1 month from surgery, but it fully disappeared by the end of the 3rd month.

RECONSTRUCTION OF THE ABDOMINAL WALL DEFECTS USING GELATIN-COATED DECELLULARIZED AND LYOPHILIZED HUMAN AMNIOTIC MEMBRANE.

Ventral hernias, with the incidence of reherniation nearly as high as 50%, still remain to be a real challenge for surgeons worldwide. The use of mesh in the repair of abdominal wall defects reduces the incidence of reherniation; however, using a prosthetic mesh can lead to complications like wound infection, hematoma, seroma, enterocutaneous fistula, small bowel obstruction, recurrent herniation and erosion into adjacent structures including the intestine. The aim of the study was to develop a method for producing gelatin-coated decellularized and lyophilized human amniotic membrane graft and to determine its effectiveness for the reconstruction of the anterior abdominal wall defects. Experiments were conducted on 40 Lewis white laboratory rats. Animals were divided into four equivalent groups. Abdominal wall defects were created in all rats and repaired using the ULTRAPROTM mesh (group I), ULTRAPROTM mesh which was covered by decellularized and lyophilized human amniotic membrane from both sides (group II), mesh from gelatin-coated decellularized and lyophilized human amniotic membrane (group III) and biological surgical mesh XI-S+® (group IV). Three months after implantation, meshes from gelatin-coated decellularized and lyophilized human amniotic membrane were integrated with host tissues so that it was difficult to distinguish it from the surrounding tissues. However, in the second group, ULTRAPROTM mesh was still detectable through the decellularized amniotic membrane. Encouraging results were also observed when using a XI-S+® graft. Three months after implantation, XI-S+® graft was surrounded by a well-defined connective tissue capsule and was tightly fixed to the host tissues. While using gelatin-coated decellularized and lyophilized human amniotic membrane grafts and XI-S+® grafts, all the defects were repaired successfully and none of the rats in these groups showed any evidence of bulging or herniation, development of wound rupture, wound infection or fistula formation in postoperative period. Gelatin-coated Decellularized human amniotic membrane can be used as anti-adhesive barrier in abdominal and pelvic surgery, as well as for the repair of the abdominal wall hernia.

RELATIONSHIP BETWEEN ORAL SQUAMOUS CELL CARCINOMA AND IMPLANTS (REVIEW).

In this review, we have discussed the relationships between oral squamous cell carcinoma (OSCC) and dental implants. In the last decade, dental implants have been widely used for the treatment of complete or partial edentulism. Despite the fact that they have seen incredible success and the use of dental implants increases, concerns over safety and efficiency is rising as well. The literature analysis has shown that the number of reported cases when the OSCC development is associated with peri implantitis is gradually increasing. The possibility of squamous cell carcinoma development must be considered when evaluating the peri-implantitis. We highly recommend periodic oral and radiographic examination after the implant placement. The patients with peri-implantitis that do not respond to conventional treatment methods, and the patients who have a severe or rapid progression of peri-implantitis require biopsy. The histopathological examination will aid with the differential diagnosis between peri-implantitis and OSCC, and hence, provide the correct diagnosis.

CURRENT CONDITION AND CHALLENGES IN TREATMENT OF NON-HEALING WOUND AFTER RADIATION THERAPY (REVIEW).

Radiotherapy is a common cancer treatment, but often together with tumor cells, the surrounding normal tissues are damaged as well, which leads to the complications such as skin atrophy, soft tissue fibrosis, desquamation, epithelial ulceration which leads to poor healing of wounds. In this review, our main attention will be paid to the treatment of non-healing wound after radiation therapy. Irradiated wounds are often resistant to conventional treatment modalities and may often require surgical reconstructive intervention. The reconstructive options usually include skin grafts, local and regional flaps. Local flaps may be unreliable, since in some of the cases they are affected by irradiation. However, the complication rate with regional flaps is just as high as that with local flaps, and is not significantly different when analyzed according to the type of reconstructive procedure performed. In addition, such wounds affect not only the physical, but also the mental health of patients and their productivity. Therefore, non-healing wounds represent a significant problem for patients and remain a major challenge in modern medicine. Recently, for the healing of non-healing wound, several novel approaches have been proposed such as using the bone marrow stem cells (BMSC), biologically active dressings, bioengineered skin equivalents and others. Of special interest are bioactive membrane consisting of decellularized human amniotic membrane and BMSC paracrine factors, which may be effectively used for the treatment of non-healing wounds that have developed following the radiotherapy. Despite the positive results achieved in a number of cases, it is early to state that the all of the above methods is an ideal for the treatment of non-healing wounds, since it requires additional experimental and clinical studies for ascertaining positive and negative features.

CHALLENGES AND MANAGEMENT OF CONGENITAL ABDOMINAL WALL DEFECTS (REVIEW).

Management of congenital abdominal wall malformations is still a challenge in paediatric surgery due to visceroabdominal disproportion, large defects of abdominal wall and immature abdominal cavity. Most of the patients treated with primary closure need artificial substitutes like patches or biomaterials for non-permanent abdominal wall closure. Patches represent the source of constant infections and complications like separation of prosthesis from fascia. Removal of these patches and ventral hernia repair is essential afterwards. As for component separation technique, this method helps to restore normal anatomy of anterior abdominal wall, results in good cosmetic appearance, requires only one-stage operation procedure, minimal skin flap advancement and is associated with lower infection risk. Although, while performing component separation technique, perforator branches of epigastric artery (periumbilical perforators) are damaged and puts the vascularization of the skin at the risk. Only pudendal artery branches and intercostal arteries are left to supply the skin with the blood, which from our point of view is insufficient. Accordingly, for successful treatment of congenital abdominal wall defects, further research in order to develop new operation techniques, as well as search for the ideal biomaterials for the closure of the large defects of anterior abdominal wall is essential. These biomaterials should possess unique biological properties that are important for tissue repair, including anti-inflammatory, antimicrobial, antifibrosis, antiscarring, as well as a reasonable cost and low immunogenicity.

BILIARY ATRESIA: CURRENT CONCEPTS AND FUTURE PROSPECTS (REVIEW).

Treatment of biliary atresia is a major challenge in pediatric surgery. Early diagnosis and availability of Kasai procedure with its modern modifications improve outcome of biliary atresia treatment. But Kasai procedure does not fully restore anatomical integrity of biliary tract, because Oddi sphincter is not included in reconstructed system. Constant reflux of intestinal content into the biliary tree is a cause of recurrent cholangitis and change in biliary epithelium that, which is a predisposing factor for cholangiocarcinoma. Various methods have been developed to improve Kasai procedure and prevent the reflux (anti-reflux valve, different enteric conduits, etc.). Many authors used biological grafts made from artery, vein, appendix, urether as well as synthetic materials to restore hepaticocholedochus. Although, neither of these methods were implemented in clinical practice. Nowadays, huge attention is paid to organ and tissue bioengineering. Present advances of tissue bioengineering may assist to create bile duct equivalent, which can be used to restore biliary tract in patients with biliary atresia.

Capillaroscopy and ECG parameters in children and adolescents with diabetes mellitus type I.

AIM OF THE RESEARCH: Evaluate ECG parameters and detect changes in capillaroscopy parameters in children and adolescents with Diabetes mellitus type 1 (DMT1). ECG and capillaroscopy were performed in 32 children and adolescents (6-15 years old, 17 boys,15 girls) with DMT1. Disease duration - less than 2 years -13, 2-4 years - 10, 5-10 years - 9 cases. The patients were divided into two groups: I group - 12 patients with no complications of DMT1 (in all them duration of disease was less than 2 years), II group - 20 patients with diagnosed cardiac complications of DMT1 (diabetic cardiomyopathy, angiopathy). Additionally 6 of them had diabetic encephalopathy , 4 - diabetic encephalopathy and peripheral neuropathy, 4 - nephropathy and retinal antipathy. Level of glycosides hemoglobin was 8-11%, level of glucose 4 to 15 mmole/L. Control group included 20 healthy children of the same age. In group I ECG is less informative. Hypertrophies of left ventricle and atrium and disorders of repolarization were mainly found in group II. In 62.5% of cases rhythm and conduction disorders were revealed, which were more often in group II. Capillaroscopy changes (pale and cyanotic background, decreasing of the number of capillaries in sight, dilated and contracted diameter, pathological shape and order of capillaries, slow blood flow) were seen both in I and II groups with more prevalence and intensity in the latter one. In children and adolescents with Diabetes mellitus type 1 ECG and capillaroscopy should be performed on the regular basis in order to reveal early changes and start the appropriate treatment in time.

[Treating bronchoscopy at ventilator-associated pneumonia in critically ill patients].

On the material, based on the experimental treatment of broncho-pulmonary derangements, including ventilator-associated pneumonias, at 105 critically ill patients, the authors recommend methods of prophylaxis and treatment of these types of pathologies, which are based on the suction fibrobronchoscopy with the use of different suction mixtures. The more satisfying evolvement of pathological processes, decrease of the expressing of the degree of clinical appearance and intoxication, the indisputable improvement of dynamics of the condition of the patient and subsidence of the average continuation of treatment prove the advantage of this method. The important economical effect is also achieved with the subsidence of the price of daybeds, decrease of the expenses of the diagnostics and cures. The achieved results give us the permission to recommend the widespread use of the treating suction fibrobronchoscopy when treating patients with acute diseases of lungs, advantages at VAP. The expressed efficiency, reliability and the important economical effect are the base priorities of this method.

[Endoscopic treatment in critically ill patients with upper gastrointestinal bleeding].

The goal of the current research was to ascertain the optimal methods of an endoscopic haemostasis in critical care patients with GDB. The research was conducted on critically ill patients. The different endoscopic methods of treatment: injectional hemostasis, irrigation with local hemostatics, thermo coagulation, and combined method were used. Treatment with injectional hemostasis resulted in hemostasis in 75% of patients. Irrigation with local hemostatics was conducted using the local hemostatic agent caprofer and (or) 10% solution of epsylonaminocapronal acid. The final hemostasis was achieved in the 90% of the cases; bleeding was stopped in 85% of the cases when the hemorrhages occurred from chronic ulcers. The effect of thermo coagulation method was 80-85%. Combined method of treatment (combination of the irrigation with caprofer and thermo coagulation) helped to achieve 95% of the final hemostasis in critically ill patients. The achieved results certify that the combined use of caprofer and method of electro coagulation in critical care patients with GDB is very perspective. Simultaneously with this, it is also recommended to use anti-segregation therapy with blockers of proton pomp and boosting the defense of the mucous tissue with high doses of mucogen.