[Perioperative prevention of complications in surgery of ventral hernias]. / Perioperatsionnaya profilaktika oslozhnenii v khirurgii ventral'nykh gryzh.

OBJECTIVE: To improve perioperative algorithm of prevention of complications in patients with ventral and incisional hernias via differentiated choice of mesh implants and hernia repair technique. MATERIAL AND METHODS: The study included 144 patients with abdominal wall hernia, who were divided into two representative groups. RESULTS: Original algorithms for choosing the method of hernia repair depending on type and position of mesh implant, as well as methods of perioperative prevention of complications are proposed. CONCLUSION: These algorithms significantly reduced the incidence of postoperative wound complications after sublay hernia repair and posterior separation with TAR.

[Risk factors of abdominal wound dehiscence in abdominal surgery]. / Faktory riska razvitiya eventratsii v abdominal'noi khirurgii.

OBJECTIVE: To evaluate the role of various perioperative risk factors on the incidence of abdominal wound dehiscence. MATERIAL AND METHODS: A retrospective controlled randomized trial of the risk factors of abdominal wound dehiscence was conducted in 62 patients for the period 2013- 2018. The research was performed at the Perm City Clinical Hospital No. 4. All patients were divided into two groups: the main one (n=31) with abdominal wound dehiscence in early postoperative period and the control group (n=31) without this event. Both groups were comparable by gender, age and surgical abdominal diseases. Between-group differences in numerical indicators were analyzed using Mann-Whitney U-test, qualitative variables were analyzed using contingency tables. Differences were significant at p-value <0.05. RESULTS: Incidence of abdominal wound dehiscence was similar in patients who admitted in emergency and elective fashion (p=0.54). Anemia upon admission (p=0.71), diabetes mellitus type 2 (p=1.00), COPD (p=0.13) and obesity (p=0.76) were not significant predictors of abdominal wound dehiscence. There were significant between-group differences in CRP level (p=0.04). Among intraoperative risk factors, duration of surgery (p=0.78), surgical approach (p=1.00), aponeurosis suturing technique (p=0.39) and stoma (p=0.71) did not significantly affect the incidence of abdominal wound dehiscence. In early postoperative period, abdominal wound dehiscence correlated with peritonitis (p=0.04), SSI (p<0.01) and redo laparotomy (p=0.02). CONCLUSION: Despite the variety of pre-, intra- and postoperative risk factors, only infectious postoperative complications (SSI, peritonitis) and redo surgical interventions influenced the development of abdominal wound dehiscence. Thus, the concept of abdominal wound dehiscence prevention should be inextricably associated with the concept of prevention of postoperative infectious complications from the abdominal wall and abdominal cavity.

[Radiofrequency ablation of the great saphenous vein in lower-limb varicose disease].

The authors herein share their experience gained in comprehensive treatment of patients diagnosed with lower-limb varicose disease treated by means of one the most state-of-the-art technologies, i. e., radiofrequency ablation. The work deals with the outcomes of managing a total of seventy-eight patients suffering from lower-limb varicose diseases with valvular insufficiency of the great saphenous vein. All the patients were subjected to radiofrequency ablation of the compromised great saphenous vein by means of the portable radiofrequency device "Surgitron" manufactured by the Company "Ellman International" (USA). Examination included ultrasonographic duplex and triplex scanning of the veins of the lower extremities. Intraoperative radiofrequency ablation of the great saphenous vein was performed by means of an original appliance consisting of a metallic probe whose length corresponded to that of the lower extremity concerned, with a figure-of-eight olive at the distal end and external plastic tube catheter. The construction of the probe made it possible to maximally free the great saphenous vein from blood through the lateral ports of the catheter, to reduce the risk of complications, to diminish the duration of the intervention, and to increase its effectiveness. Efficacy of radiofrequency ablation of the great saphenous vein amounted to 93.6%, with recanalization of the greater saphenous vein being established in five (6.4%) patients. Good functional and cosmetically pleasing therapeutic outcomes were observed in the majority of the patients (87.2%).

[Comprehensive outpatient treatment of varicose disease of the lower limbs].

The article deals with the findings obtained in examining a total of 8,000 people presenting with varicose disease of the lower extremities. The examination included a clinical (physical) examination and coloured duplex scanning of the lower-limb veins. The examination was carried out in outpatient conditions, whereas surgical treatment was performed either out-patiently, or at a <> hospital. Revealing complete valvular insufficiency of the great saphenous vein was followed by surgical treatment - intraoperative stem catheter scleroobliteration (SSO) or short-term screening and postoperative puncture sclerotherapy. Detecting partial valvular insufficiency of the greater saphenous vein (pathological sapheno-femoral reflux only in the vertical position) was managed by applying the principle of the so-called <>: i. e. the patients were subjected to the procedure of puncture sclerotherapy of varicose veins on the crus in ambulatory conditions to be followed by secondary ultrasonographic scanning with permanent dynamic follow-up. The cases of preserved reflux along the greater saphenous vein were subjected to sclerosurgical management. Valvular insufficiency of perforating veins was coped with by minimally invasive surgical interventions: subtotal endoscopic dissection of incompetent perforating veins, suprafascial ligation from a miniaccess and echosclerotherapy of the perforating veins. Also performed were histological and histochemical studies of the portions the greater saphenous vein and surrounding tissues procured during cross-ectomy of the sapheno-femoral anastomosis in 43 patients, who had endured preliminary puncture sclerotherapy on the crus. Good functional and cosmetically pleasing outcomes were achieved in the majority of cases. In 75% of the patients with partial valvular insufficiency of the greater saphenous vein, we managed to avoid operations since repeat ultrasonographic study revealed no pathological veno-venous shunts.

[Clonorchiasis in the Upper Amur region: biology, epidemiology, clinical presentation]. / Klonorkhoz v regione verkhnego Priamur'ia (biologia, épidemiologia, klinika).

Results of studies of clonorchiasis in the region of the Upper Amur and its tributaries are presented. Biological features of the pathogen and its epidemiology are outlined. Clinical symptoms were studied in 112 patients. In case of death, a pathoanatomic picture is given.

[Surgical treatment of patients with critical ischemia of the lower limbs of atherosclerotic etiology]. / Khirurgicheskoe lechenie bol'nykh s kriticheskoi ishemiei nizhnikh konechnostei ateroskleroticheskogo geneza.

The authors analyze the results of conservative and operative treatment of 546 patients. The results of operative treatment (reconstructive operations on the arteries, osteo-trepanation) were shown to be considerably better in cases of critical ischemia than those of conservative treatment (infusion therapy, hemodilution, plasmapheresis).

[Assessment of qualifications of physicians]. / Otsenka kvalifikatsionnogo sostava vrachebnogo personala.

A methodology of estimating the professional level of physicians with the help of tariff scale is described. The tariff coefficients are determined by the correlation between the official salaries of physicians, having a qualification category, and a background monthly salary taken as a unity. The mean tariff coefficient of physicians can serve for public health bodies and insurance organizations as an assessment indicator of professional possibilities of an institution, complexity of the work performed, the cost and quality of medical services. For the leading staff of the institution the methodology is supplemented by the estimates of a number of intermediate indicators and their integral assessment which helps analyse the basic factors influencing the general level of physicians qualification.

[Extra-peritoneal operations in arteriosclerotic lesions of the abdominal aorta and its branches]. / Vnebriushinnye operatsii pri ateroskleroticheskikh porazheniiakh briushnoi aorty i ee vetvei.

The study is based on the analysis of the results of examination and operative treatment of 692 patients with atherosclerotic lesions of the aorta, its branches, and the limb arteries. The advantages of the extraperitoneal approach to the aorta over the transperitoneal approach in aorto-femoral reconstructions is proved. Stable postoperative intestinal paresis, peritonitis, intraabdominal bleeding, eventration, and adhesive disease do not occur with this approach. Such operations are not attended by a high incidence of coronary and cerebral vascular complications during and after the operation. The work gives the first appraisal of the results of postoperative plasmapheresis (21 patients) applied for normalization of hemorheological and lipoprotein disorders in different periods after the operation. The suggested complex approach to the treatment of atherosclerosis obliterans facilitates improvement of the immediate and late-term results of reconstructive operations on the vessels.

[Standardization of work in public health services]. / Normirovanie truda v zdravookhranenii.

Data are provided on labour norms, their functions and practical application at public health institutions. The role of labour norms setting under new economic conditions are considered; the determination of the cost of medical services, the number of personnel and salary fund. The necessity of scientific elaboration of the standard cost of medical care is substandiated on the basis of using stable and common economic standards.

[Combined evaluation of work effectiveness of hospital medical personnel]. / Kompleksnaia otsenka éffectivnosti truda meditsinskogo personala bol'nichnykh uchrezhdenii.

A unique methodological approach is proposed which is used for the determination of "index of labour efficiency" of medical personnel and such associated with its elements of financial and economic activity as a saving of the number of posts and salary fund, the cost of health services according to their salary-consuming character and the amount of payment for the labour of health workers. The use of this index in the performance of in-patient institutions would facilitate the rational management of personnel, labour and salary.

[Determination of costs of examinations and paraclinical health service procedures and public health on the basis of their work intensity]. / Opredelenie stoimosti issledovanii i protsedur paraklinicheskoi sluzhby uchrezhdenii zdravookhraneniia na osnove ikh trudoemkosti.

Methodological approaches to the estimation of cost (prices, tariffs) of investigations and procedures of auxiliary curative and diagnostic service according to their technological and complex labour-consuming nature are provided. Using the unified norms of time and production for estimations would help define unified prices for medical services of analogical type and provide performance-related incentives for health workers.

[Vein grafts in situ in surgery of atherosclerotic lesions of the arteries of the lower limbs]. / Venoznye transplantaty in situ v khirurgii ateroskleroticheskikh porazhenii arterii nizhnikh konechnostei.

Reconstructive operations with the use of autologous veins were carried out on 154 patients with occlusive lesions in the femoropopliteal and femorotibial segments. Reversed autologous vein was used to form a shunt in 109 patients and autologous vein in situ in 45 patients. Patency of the shunts, both in the immediate and late-term periods, was higher in the in situ techniques than in the group with a reversed vein (93.3 and 88.8%; 78.9 and 72.4%, respectively). With the use of micro-surgical techniques the number of good results increased by 20.4%. In successful reconstructions in both groups the malleolobrachial index increased from 0.27 +/- 0.02 to 1.03 +/- 0.15. There were no statistically significant differences in the values of the malleolobrachial index in patients of both groups with functioning shunts in the late-term period (of up to 2 years).

[Reconstructive surgery in isolated and concurrent atherosclerotic occlusive lesions of the main blood vessels]. / Rekonstruktivnye opratsii pri izolirovannykh i sochetannykh ateroskleroticheskikh okkliuzionnykh porazheniiakh magistral'nykh sosudov.

The article discusses the choice of operative methods and the stages in the treatment of patients with atherosclerosis of the abdominal aorta and lower limb arteries with consideration for the involvement of the coronary and cerebral arteries in the process. A total of 749 reconstructive operations were conducted on the abdominal aorta, its unpaired branches, arteries of the lower limbs, and coronary and extracranial arteries in 676 patients. The principle of extraperitoneal operations on the abdominal aorta was regarded as the basis in improving the results of treatment of patients with concurrent lesions. The authors substantiate the choice of a one-stage or many-stage type of operations on the vessels of different regions with due account for the localization of the affection, the degree of vascular insufficiency in each channel, and the life prognosis.