FEASIBILITY AND EFFECTIVENESS OF GENERAL ANESTHESIA WITH OPIOIDS VERSUS OPIOID-FREE ANESTHESIA PLUS TRANSVERSUS ABDOMINIS PLANE BLOCK ON POSTOPERATIVE OUTCOMES AFTER MINI GASTRIC BYPASS SURGERY.

Opioid-free anesthesia (OFA) is increasingly used at present in surgical practice by many hospitals as a new and very promising anesthesiologic regimen. This study aimed to compare the efficacy of standard general anesthesia with opioids with so-called opioid-free anesthesia on postoperative outcomes of patients who underwent gastric bypass surgery. This randomized, single-blind clinical study enrolled 103 patients scheduled for elective gastric bypass surgery. They were assigned randomly to receive either general anesthesia without opioids plus transversus abdominis plane (TAP) block (Group 1: 53 patients) or general anesthesia with opioids (Group 2: 50 patients). 21.4% (22/103) males and 78.6% (81/103) females were operated. The average age of patients was 40.9 and the average BMI - 48.4. Patients from both groups (patients who received general anesthesia + TAP and patients who received general anesthesia with opioids) were assessed for postoperative pain at rest using a 0-to-10 visual analog pain scale (0 = no pain, 5 = moderate pain, and 10 = the most severe pain possible). In group 1 - 34% (18/53) of patients did not receive any medication against pain and 66% (35/53) received Dexalgin Inject 25mg/ml 2 ml. There was no need in opioids. In group 2 - 10% (5/50) of patients did not receive any medication against pain, 38% (19/50) received Dexalgin Inject 25mg/ml 2 ml and 52% (26/50) received Dexalgin Inject 25mg/ml 2 ml + Promedol 20mg/ml 1ml. Type of anesthesia is a significant predictor of postoperative outcomes, such as pain intensity, extubation time, intensive care stay, and hospital length of stay in patients undergoing gastric bypass surgery. Patients, who received (OFA) plus (TAP) block had better pain control than those who received general anesthesia with opioids. No opioids were used in group 1. In addition, the duration of hospital stay in group 1 was shorter, and the average cost for postoperative hospital stay was 2.39 times lower than in group 2. OFA can be used as a reliable and effective anesthesiologic technique in patients scheduled for bariatric surgery.

EFFECT OF INHALED OXYGEN CONCENTRATION ON PULMONARY GAS EXCHANGE DURING OFF-PUMP CORONARY BYPASS GRAFTING.

Aim of study - supra-physiologic level of PaO2, securing oxygen reserves and preventing perioperative hypoxia, may offset the reduced oxygen delivery during cardiac surgery. However, high FiO2 will speed up gas absorption in low V/Q regions, promote atelectasis formation and increase pulmonary shunt fraction. PaO2/FiO2, P(a-Et)CO2 and PEtCO2/PaCO2 are the variables linked to CO2 and O2 exchange impairment. The aim of our study was to assess pulmonary gas exchange performance while ventilating patients with different FiO2 during OPCABG. The seventy patients were randomly equally distributed in two groups: H (High) and L (Low). The patients in the group H were ventilated with FiO2 0.8 and the patients in the group L _ with FiO2 0.5. PaO2/FiO2 ratio, P(a-Et)CO2 gradient and PEtCO2/PaCO2 ratio were checked at the start and the end points of operations. PaO2/FiO2 decreased, P(a-Et)CO2 increased and PaCO2/PEtCO2 decreased at the end of operations compared with the start values in both groups. PaO2/FiO2, P(a-Et)CO2 and PaCO2/PEtCO2 ware different between H and L groups. The difference became statistically significant at the end of operations. (PaO2/FiO2 326±65 vs 290±63 p=0.020; P(a-Et)CO2 5.7±2.3 mmHg vs 7.5±2.4 mmHg p=0.003; PaCO2/PEtCO2 0.84±0.05 vs 0.80±0.06 p=0.001). The groups were comparable according to the outcomes such as hemodynamic and laboratory data, duration of postoperative mechanical ventilation and ICU length of stay. FiO2 0.8 was associated with more derangements of pulmonary gas exchange compared with FiO2 0.5. Although FiO2 did not have an impact on the outcomes we studied, using FiO2 0.5 seems to be safer in patients undergoing OPCABG.

MEDICATIONS FOR ERADICATION OF HELICOBACTER PYLORI (REVIEW).

Helicobacter pylori is a pathogenic microorganism that causes gastritis, duodenitis, peptic ulcer disease of the stomach and duodenum. Recent data confirm the close association of Helicobacter pylori with the development of gastric cancer. Due to the failure of standard H. pylori eradication regimens, intensive studies are being conducted to develop targeted local delivery and prolonging activity drug forms. Based on scientific studies, sufficient knowledge has been accumulated on the inhibitory action of biologically active substances of plant origin: peptides, polyphenols, terpenes, fatty acids on Helicobacter pylori, which allows developing an alternative treatment scheme. It is especially important today to create local and long-acting, high-density, mucoadhesive, floating and swelling systems. Unlike other forms of medicine, foam systems are interesting in this respect. They are distinguished by a large touch surface, high bioavailability and rapid therapeutic effect. Foam provides economical dosing, better contact with the mucous membrane, and give the drug a prolonged action. Under the influence of body temperature the foam increases in volume, filling all free spaces and channels. However, the foam can provide high concentrations of the medicinal substance for up to 4 hours.

REDO LAPAROSCOPIC ANTIREFLUX SURGERY IN PATIENTS WITH HIATAL HERNIA.

The purpose was to study the features and results of redo laparoscopic antireflux surgery. For the period from 2008 to 2019, in Odessa Regional Hospital laparoscopic antireflux operations were performed in 1164 patients. 57 patients underwent laparoscopic reoperation during the study period based on the following indications: recurrence of hiatal hernia (n=37), recurrent reflux (n=4), dysphagia (n=8), severe pain (n=5), esophageal stricture (n=3). All patients underwent repeated examinations in our clinic, telephone interviews, mailing of special questionnaires. All complaints were recorded, the quality of life was determined according to the GERD-HRQL questionnaire. All redo operations were performed laparoscopically without conversion to laparotomy. Intraoperative complications were observed in 11.11% of patients. Long-term follow up from 6 months to 6 years was observed in 90.74% of patients. The quality of life of patients according to the GERD-HRQL questionnaire significantly improved in long-term follow-up (p<0.001). Good results were observed in 91.84% of patients after redo operations. The third operation was needed in 5.6% of patients. Redo laparoscopic antireflux operations are technically difficult surgical interventions and provide good long-term results in 90% of patients.

USING OF NOVEL DOUBLE INVAGINATED PANCREATOJEJUNOSTOMY TECHNIQUE WITH TRANSANASTOMOTIC STENTING AND EXTERNAL PANCREATIC DUCT DRAINAGE: PRELIMINARY REPORT.

Following the pancreatoduodenectomy the pancreatic anastomosis, which is still "Achilles" heel of pancreatic surgery, carries the highest risk of leak and cause of morbidity and mortality. More than 80 different methods of reconstruction have been proposed, illustrating the complexity of surgical techniques as well as the absence of the "ideal" pancreatic anastomosis and gold standard up to date. Here, we describe the novel method of double invaginated pancreatojejunostomy with transanastomotic stent and external pancreatic duct drainage. The preliminary results obtained with the described method are very encouraging and indicate that this technique is less complicated and time consuming,very safe, simple, easy to perform and also applicable almost to all situations.

[HERNIOPLASTIC MORFOLOGICAL FEATURES (EXPERIMENTAL STADY)].

Despite many years of experience in the field of hernia surgical treatment there still exist many unsolved problems such as a safe and non infected closure of defects of abdominal cavity wall. The aim of the study was to improve the result of treatment of abdominal wall hernias with the use of new antiseptic polymer, bio-composite protective mesh membrane covered with coladerm+chlorhexidine. Experimental study involved 21 rabbits. Meshes were fixed on anterior abdominal wall according to the following schewe: Option I: mesh size 10-20mm was put into both the groin area of the rabbits. Option II: A light standart mesh grid size 10-20mm covered with coladerm was placed on both sides of abdominal wall of the rabbits. Option III: A light mesh, covered with oladerm+Chlorhexidine was placed in to the abdominal wall of the rabbits. Removal dates of taking the animals from experiments were 14th, 30th, 45th, 90th and 180th days for further histomorpological and bacteriological research. The best result from these options was when implants we covered with coladerm+Chlorhexidine, which was shown on follow up period. In third control group experessed strong connective tissue formatting stromis picture,wich is the main task of modern hernia plastic. It is expected that new bio-composite meshes, covered with coladerm+Chlorhexidine, may be succesfuly used in clinical practice, which will reduce infectious complications of meshes and problems associated with them.

[CLINICAL EVALUATION OF THE NEW ANTISEPTIC MESHES].

Improving the results of hernia treatment and prevention of complications became a goal of our research which included two parts - experimental and clinical. Histomorphological and bacteriological researches showed that the best result out of the 3 control groups was received in case of covering implant "Coladerm"+ with chlorhexidine. Based on the experiment results working process continued in clinics in order to test and introduce new "coladerm"+ chlorhexidine covered poliprophilene meshes into practice. For clinical illustration there were 60 patients introduced to the research who had hernioplasty procedures by different nets: I group - standard meshes+"coladerm"+chlorhexidine, 35 patients; II group - standard meshes +"coladerm", 15 patients; III group - standard meshes, 10 patients. Assessment of the wound and echo-control was done post-surgery on the 8th, 30th and 90th days. This clinical research based on the experimental results once again showed the best anti-microbe features of new antiseptic polymeric biocomposite meshes (standard meshes+"coladerm"+chlorhexidine); timely termination of regeneration and reparation processes without any post-surgery suppurative complications. We hope that new antiseptic polymeric biocomposite meshes presented by us will be successfully used in surgical practice of hernia treatment based on and supported by expermental-clinical research.

Laparoscopic surgery of hiatal hernia and gastro-esophageal reflux disease.

About 10% (per cent) of world population have Hiatal hernia and gastro-esophageal reflux diseases of different forms. From this amount of people 1/5 need required surgical treatment. The goal of the thesis is to show the results and effectiveness of laparoscopic surgical treatment of this disease. In 2005-2013. at out clinics (Thoracoabdominal clinic and Caraps Medline) had been performed 145 laparoscopic fundoplications. Were used as Nissen Method with its modifications (Floppy Nissen, Classic Nissen and Nissen Rosset), as well as "Toupet" and "Dor" methods of fundoplication. From 145 cases were 84 - female, 61 - male. Age ranged from 24 to 76. From performed 145 operations in 97 cases was done Floppy Nissen Fundoplication, 23 cases - Nissen-Rosset modification, 5 cases - Classic Nissen. Toupet method Partial Fundoplication was done in 17 cases and anterior Fundopexia - Dor method - was done in 3 cases. Using various methods of laparoscopic fundoplication, due to the analysis of our results, the perfect positive result was achieved in 93.2% (per cent).

Pancreatoduodenectomy as classic and pylorus-preserving variant: single center experience.

It is presented and discussed the experience of pancreatoduodenectomy for pancreatic head and ampullary tumors. Of 7 cases of pancreatoduodenectomy 3 were performed as classic Whipple procedure and 4 as modified pylorus-preserving variant (PPPD). It was observed 2 cases of mild pancreatic and biliary leak and 1 patient developed abdominal wall dehiscence after the surgical site infection. There was no operative mortality and overall postoperative morbidity rate was 42,8%. It is concluded,that "end-to-end" pancreaticojejunostomy with stent placement and the PPPD variant are the most optimal and preferred operative procedures at pancreatoduodenectomy cases.

Miniinvasive surgical management of cholelithiasis for elderly and senile patients: a retrospective study.

The aim of the present study is to analyze outcomes after laparoscopic cholecystectomy (LC) and minilaparotomy cholecystectomy (MC) for gallstone disease and determine the algorithm of treatment for elderly and senile patients according to the age, severity of disease and comorbid conditions. This is a multicenter retrospective review of 906 elderly and senile patients who underwent LC or MC between January 1, 2002 and December 31, 2008. The patients were categorized into LC (444) and MC (462) groups. When preoperative examination data were not reliable, we performed abdominal wall lifting with the retractors to visualise abdominal cavity with laparoscope during minilaparotomy. There were statistically significant differences in mean operating time (82 and 60 minutes in LC and MC, respectively) (р<0.001), mean duration of usage of non-narcotic analgesics postoperatively in elderly patients (1.5 and 1.1 days in LC and MC, respectively) (р<0.001), intraoperative complications (11 LC and 2 MC cases) (p=0.02), postoperative complications in senile patients (36 LC and 22 MC cases) (p=0.039) and in mean hospital stay for elderly patients (1.7 and 1.3 days in LC and MC, respectively) (p=0.025). MC is an attractive alternative of LC, especially for elderly and senile patients, with their high incidence of acute cholecystitis. MC is effective, safe and optimal operative procedure. Especially, it is important for countries with lower economic capacity.

[Modern aspects of surgical treatment with gastroesophageal reflux desease: our experience and literature review].

It is presented our experience and review of literature of pathogenesis, symptomatology, diagnostics and surgical treatment of gastroesophageal reflux desease (GERD). A cohort of 104 patients (67 males and 37 females, median age - 42.5) who underwent "open" A. Chernousov modified Nissen fundoplication was evaluated for an follow-up period more than 10 years. In 23 cases with concomitant duodenal ulcer and gastric hypersecretion selective proximal vagotomy additionally was performed, 3 of them also underwent cholecistectomy and in 1 case - splenectomy because of spleen lymphoma. There were no mortality or major perioperative complication (1 case of iatrogenic splenectomy) in our series. Only 9 patients have transient episodes of mild dysphagia. Postoperative endoscopy an X-Ray revealed a good swallow and functional status of esophagus and stomach. The good and excellent results were achieved in more 90% of cases. No reinterventional surgery was needed.

Surgical services and transformation of civil hospital during "August War 2008" in Georgia.

Structural transformation of a civil hospital into a military one during "August War 2008" (August 8-12) in Georgia is presented. Damage-control principles, such as hemorrhage control, liver-packing and abdominal tamponade, gastrointestinal tract resection without formation of anastomoses, and other temporary interventions were prioritized. This provided a chance to empty the hospital in a short period to provide the admission of an increased number of combat casualties. There were soldiers from Georgian troops, civilians, and captives of war. The number of total admitted patients was 739. Fifty-two patients were operated on in the surgery department. The following operations were carried out: removal of foreign bodies from the neck region, 6 cases; isolated thoracotomy, pulmorrhaphy, and drainage, 2 cases; laparotomy, hepatorrhaphy, gastrorrhaphy, splenectomy, resection of small intestine, and colostomy, 18 cases; combined operations (thoracotomy plus laparotomy), 9 cases; extended debridement and dressing of wounds, 11 cases; angiosurgical operations, 4 cases; and coloplasty, 2 cases. There were 2 cases of mortality, 1 case of rethoracotomy, and 3 cases of relaparotomy: 2 because of intracavital bleeding and 1 because of sanation.

Effects of oxytocin on behaviour and memory in rats subjected to chronic restrained stress.

We studied whether 21 days of restraint chronic stress would affect the contextual fear conditioning, a memory task with hippocampal-dependent components and anxiety- like behavior in the open field, and to determine whether oxytocin treatment could prevent the chronic stress induced memory and emotional disturbances. Restraint-stressed rats were injected daily (21 days) with oxytocin (1 mg/kg) or saline then tested in open field (day 22) and contextual fear conditioning task (days 23-24). Our data demonstrate that chronic restraint stress induces some behavioural changes in both saline-treated and oxytocin-treated animals. Particularly, in the open field the animals both groups were characterized by hyper-locomotion. However, oxytocin-treated animals spent more time in the inner area of the open field, which indicates to decreased anxiety- related behaviour in oxytocin-treated animals versus the saline-treated ones. In additional restraint stress decreased freezing reaction to context, irrespective of whether oxytocin was given or not. Our findings indicate that during stress OT may be involved in the regulation of emotional behavior and memory via different ways. The elucidation of corresponding mechanisms is of great importance.

Treatment of postoperative esophageal leak by active drainage procedure (case report).

Postoperative esophageal leak is still a very serious and complex problem, which is associated with poor results, because of considerable morbidity and mortality rate. We described the case of successful treatment of suture line leak of 53 year old patient after resection of a big size epiphrenic diverticulum. Traditional right-sided transthoracic approach in 7th intercostal space with dissection, exposure and resection of diverticulum by stapler with 40F bougie within the esophagus was performed with reinforcement of suture line. On 6th postoperative day the control water-soluble contrast X-ray examination was done and pleural effusion and suture line disruption was found. Immediately under X-ray control the large diameter chest tube (Ch24) was inserted and periesophageal mediastinum as well as pleural cavity was drained and active aspiration with simultaneously irrigation/lavage procedures was started. Parallel fasting, systemic antibiotic therapy was started and feeding balloon catheter gastrostomy by Stamm was created. The healing process of the leak was controlled every week by water-soluble contrast swallow and the chest drain tubes were twice changed (Ch20 and Ch14) during the treatment. The complete healing and closure of the leak was achieved after 2,5 month of starting the treatment by using this method. Our case have demonstrated, that aggressive conservative treatment approach with combination of: active and adequate drainage of the leak site, systemic antibiotic therapy, nutritional support by feeding gastrostomy with frequent radiologic examinations for monitoring of healing process is the effective and safe treatment of esophageal leaks.

Influence of anticarcinogenic metalloporphyrin Cu(II)TOEPyP(4) on DNA thermostability in vitro.

The influence of a new anticarcinogenic compound Cu(II)TOEPyP(4) (Cu(II)-Meso-tetra(4-N-oxyethylpyridyl) porphyrin) (the analogue of TMPy4[tetra(N-mrthyl-4-pyridyl)-porphyrin chloride] - an inhibitor of telomerase activity - on the thermostability of calf thymus DNA in vitro has been studied. It has been shown that Cu(II)TOEPyP(4) is a stronger stabilizing DNA agent, which is expressed with an increase of its thermostability by 20 degrees C. It was determined that complex formation does not disturb the DNA double-helix, and the melting enthalpy (DeltaHm) remains unchanged and it is equal to 11.6+/-1.0 cal/gDNA in the range 0.002

Expression of YPEL1 in pancreatic cancer cell lines and tissues.

YPEL1 is a nuclear protein that is suggested to be involved in mesenchymal to epithelial-like transition during tissue development. Recently we have identified YPEL1 as a gene whose expression is deregulation in perineural invasive pancreatic cancer cells. In this study we assessed the expression of YPEL1 in normal and diseased pancreatic tissues and pancreatic cancer cell lines. Quantitative real time polymerase chain reaction was used to analyze the expression of YPEL1 mRNA in nine cultured pancreatic cancer cell lines and pancreatic bulk tissues of the normal pancreas (n=19), chronic pancreatitis (n=19) and pancreatic adenocarcinoma tissues (n=31). Quantitative real time polymerase chain reaction analysis revealed a significant down-regulation of YPEL1 mRNA expression in pancreatic adenocarcinoma tissues compared to normal tissues (54.1+/-5.2 vs. 85.8+/-14.1 copies/10,000 copies cpb) and low expression of this gene indicated a tendency for better survival of pancreatic cancer patients (16 vs. 13 months; p=0.17). Expression of YPEL1 mRNA was present in all tested pancreatic cancer cell lines with comparably low to moderate expression levels of 4.3 - 88.0 copies/10,000 copies cpb. Reduced expression of YPEL1 in pancreatic cancer might be related to perineural invasion. and prognosis. YPEL1 might be an important factor during the development and malignant transformation of tissues. Further studies are required to better assess the role of human YPEL1 in pancreatic cancer pathogenesis.

[Case of successful repair of penetrating cardiac injury].

The penetrating cardiac injury after the chest stab wound in 33 year old patient is described. The following clinical signs indicated suspected cardiac injury: localization of injury to the region of the heart, the signs of acute bleeding and cardiac tamponade, which was also confirmed by echocardiography. During urgent thoracotomy with additional sternotomy the right ventricle injury of 1,5 cm of length was found, which required 5 stitches for repair of defect and complete hemostasis. The temporary cardiac arrest (40-50 sec) has occurred during cardiography and internal cardiac massage was performed to restore the normal cardiac rhythm. Postoperative course was uneventful and patient on the 10th day after admission was discharged from the hospital. The successful outcome of treatment of this severe group of patients could be achieved by maintenance of the following fundamental principles: rapid transport of patients to the nearest hospital, maximum rapidity in establishment of diagnosis and highly qualified urgent surgical intervention. Echocardiography is the most informative and quick method of noninvasive diagnostics of penetrating cardiac injury.

Microcalorimetric study of human blood lymphocytes culture at presence of copper, cadmium and prostamax.

Research goal was study of separate and joint influence of bioregulator prostamax and Cu(II) and Cd(II) ions on the chromatin structure in situ. The thermal characteristics of the denaturation process of blood lymphocytes culture of aging people in the presence of some microg quantities of Cu(II) and Cd(II) ions have been determined. It has been shown that Cu(II) and Cd(II) ions at these low concentrations don't influence on the temperature stability of membrane, nuclear and cytoplasm proteins. It has been shown that Cu(II) ions cause an additional condensation of the heterochromatin, and Cd(II) ions cause decondensation of heterochromatin and its partial denaturation.

Effect of myo-inositol on convulsions induced by pentylenetetrazole and kainic acid in rats.

We studied the effect of myo-inositol on pentylenetetrazole and kainic acid-induced seizures in rats. Myo-inositol significantly reduced seizure activity.

[The influence of myo-inositol on the ultrastructure of hippocampal CA1 area in kainate treated rats].

The ultrastructure of neurons, synapses and astrocytes of hippocampal CA1 area in rats was investigated 14 days after: systemic injection of kainic acid and kainic acid and myo-Inositol. After injection of kainic acid numerous neurons with superficial and deep ultrastructural changes of cytoplasmic organelles were described. Among synapses numerous forms with osmiophilic active zone and single synaptic vesicles, also presynaptic terminals with core vesicles were often seen. After kainic acid + myo-Inositol injection the cells with superficial changes of organelles dominated and the synapsoarchitectonics of the area was close to normal. Thus, electrono-microscopic data indicate possible neuroprotective (antiepileptic?) features of myo-Inositol.