Russian consensus on exo- and endocrine pancreatic insufficiency after surgical treatment.

The Russian consensus on exo- and endocrine pancreatic insufficiency after surgical treatment was prepared on the initiative of the Russian "Pancreatic Club" on the Delphi method. His goal was to clarify and consolidate the opinions of specialists on the most relevant issues of diagnosis and treatment of exo- and endocrine insufficiency after surgical interventions on the pancreas. An interdisciplinary approach is provided by the participation of leading gastroenterologists and surgeons.

[Battle-field surgery in the beginning of 21st century].

The authors underwent an analysis of doctrine changes of battle-field surgery. The terminology is specified, the ways of improvement of effectiveness and quality of medical care for the wounded, taking into account the new doctrine, are formulated. In accordance with Federal law No 323-FZ of 2011.11.21 the term < is suggested for description of medical care at medical forward treatment unit instead of equalfied aid>.

[Role and place of the surgical complex "Da Vinci" in treatment for the right half of colon cancer].

Currently there are a large number of publications, in which the data demonstrate advantages of laparoscopy-assisted colectomy against open surgery. These advantages include: fewer complications in the postoperative wounds, reducing the intensity of pain in the postoperative period, a decrease in length of hospital stay, faster recovery of bowel function in the postoperative period as well as the best cosmetic effect. Also it is proved that when performing laparoscopic surgery it is possible to achieve the criteria of oncological radicalism. A number of clinical studies have reported similar rates of a 3-and 5-year survival rate between these two approaches, which makes laparoscopy-assisted colectomy an attractive alternative to traditional open surgery. Despite significant advances in laparoscopic treatment for colon cancer surgeons are still faced limitations inherent to traditional laparoscopic technique. Development and distribution of surgical instruments for a robotic complex in the middle of the 2000s made it possible to overcome limitations through the use of tools with multiple degrees of freedom and stable three-dimensional high-definition images. The use of robotic technologies in laparoscopic surgery has showed their safety and effective alternative to standard laparoscopic surgery.

[VARIANT ANATOMY OF SPLENIC LIGAMENTS AND ARTERIES PASSING THROUGH THEM].

The research was performed on 15 non embalmed bodies and 32 abdominal complexes of adult individuals. The comparative study of variant anatomy of splenic ligaments and architectonics of arteries passing through them was carried out to substantiate the mobilization of splenopancreatic complex. Anatomical and angiographic restudied were carried out using preparation, morphometry, injection of gastric, pancreatic and splenic vascular bed with red lead suspension. It was established that the form and sizes of splenic ligaments and their interrelation with the branches of the splenic artery were variable. The minimal and maximal sizes of gastrolienal, phrenicosplenic and splenocolic ligaments differed 2-3 times. In most cases, spleen was fixed in abdominal cavity by many short ligaments. It was shown that architectonics and topography of main branches of spleen artery were determined by morphometric characteristics of the spleen proper and its ligaments. The knowledge of splenic ligament variant anatomy allows a new perspective to approach to substantiate different methods of the mobilization of spleno-pancreatic complex during surgical operations on organs of the upper part of the peritoneal cavity and organ-preserving surgery of the spleen.

[POSSIBILITIES OF ENDOVASCULAR INTERVENTIONS IN TREATMENT OF BUDD-CHIARI SYNDROME].

The article presents the results of endovascular treatment of 35 patients with Budd-Chiari syndrome. An analysis of efficacy of modern interventions was made. There were shown the. possibilities of balloon dilatation of stenosis of renal veins, the balloon dilatation and stenting with metal self-expansible stents of stenosis an occlusion of intrahepatic section of the postcava and results of transhepatic portsystemic bypass surgery.

[Comparative analysis of immediate results of surgery for colon cancer using laparoscopic and robot-assisted surgical interventions].

In recent decades there has been achieved significant progress in treatment for colorectal cancer. Minimally invasive surgery (including robot-assisted) is rapidly gaining widespread acceptance in treatment of this form of cancer. Today robotic surgery is a revolutionary technology that opens a new stage in the development of surgery of the 21st century. Currently in the world there have been performed more than 2 million surgical interventions of the colon using a robotic surgical complex Da Vinci. To date it was accumulated a large number of single-center studies comparing laparoscopic and robot-assisted interventions in cancer of various parts of the colon for short-term and long-term treatment outcomes, which showed their effectiveness and safety. Modern colorectal surgery could not be imagined without the latest technology, the use of which directly affects the quality of life of patients after surgery.

[100 ROBOTIC-ASSISTED OPERATIONS IN COLORECTAL CANCER (FIRST OUTCOMES)].

This article analyzed the immediate treatment results of 210 patients, underwent endovideosurgical operative treatment concerning colorectal cancer (106 laparoscopic and 104 robotic-assisted operations). According to the first results, there was no significant difference between two methods in such medical indices as the volume of intraoperative hemorrhage, terms of hospital stay and peristalsis recovery, the rate of conversion and complications in. early postoperative period, quantity of removed lymph nodes, quality of TME. The application of robotics allowed performance of precision work in conditions of limited space of the small pelvis.

[Endobiliary stenting with laparoscopic assistance--hybrid technology in complicated clinical situation].

The authors suggest an original method of endobiliary stenting with laparoscopic assistance for reduction of obstructive jaundice in patients with non-operative tumors of hepatopancreaduodenal zone in the case of impossibility of performance of percutaneous or endoscopic decompression of the bile ducts. A recanalization of tumor stricture was carried out with the aid of laparoscopic assistance. A self-expandable metal stent with polymeric covering was implanted in the bile ducts. The proposed method was applied in 5 cases. An adequate decompression of the bile ducts was noted in all cases. The patient's condition was good after surgery. There weren't any cases of serious complications or hospital lethality.

[Architectonics of gastric arterial bed in norm, after Nissen fundoplication, and its different combination with splenectomy and left gastric artery ligation].

A comparative study of the effect of the combination of Nissen fundoplication, different variants of splenectomy ligation of left gastric artery on stomach wall arterial bed blood fillability was carried out on 40 human corpses in 6 research series. The red lead paint suspension was used for the injection of arterial bed. It was shown that combination of Nissen operation andligation of stomach short arteries during splenectomy and left gastric artery trunk in its intraligamental part resulted in the impairment of the stomach wall blood supply. In the gastric fundus area avascular zones measuring from 2.5 x 3.0 to 5.0 x 10.0 cm and larger, were detected. The stomach wall of the given areas is potentially prone to necrosis. Avascular zones in the stomach wall were not observed when short gastric arteries were preserved.

[Possibilities of surgical treatment of cicatrical stenosis of the trachea].

The treatment of cicatrical stenosis of the trachea was performed in 193 patients at the age 8-65 years (132 of men and 61 women). The length of cicatrical stenosis shaped mainly by growth of granulation tissue and its different combinations consisted of 0.5 to 2.5 cm, getting 3.0 cm and more in 74 cases. The peculiar features of such cicatrical changes were characterized differently depending on its dominating localization on the length of the trachea--in the area of the neck or in the range of the mediastinum. Respiratory distresses, which were the main clinical manifestation of the disease, depended on the degree of stenisis of the trachea opening with the cicatrical process in each case. The decrease of size of the trachea opening with respect to natural size on 1/3 was considered as the first degree of stenosis, on 2/3 - II degree, more than on 2/3 - III degree. The efficiency of endoscopic methods of treatment was the most significant in cicatrical stenosis of trachea with the length not more than 0.5-1.5 cm and dramatically decreased with the increase of length. The cicatrical stenosis of trachea with the length more than 3.5-3.0 cm should be considered as the indication for radical surgical intervention such as resection and plasty of trachea with forming of intertracheal or laryngotracheal anastomosis.

[Promising technologies in surgery].

In modern conditions of local wars and armed conflicts, the basic principle of medical care is to reduce injuries stages of medical evacuation, aimed at accelerating the provision of specialized surgical care. In this regard, significantly increases the need for the development and implementation of new high-tech methods that can improve quality of care, both on the battlefield and on the stages of specialized surgical care. A promising direction is the introduction into clinical practice: minimally invasive technologies, the concept of hybrid navigation surgery, operations with the use of laser technology and robotics, advanced and extremely extensive interventions to cancer patients; technology reduces blood loss, use of cell therapy, transplantation techniques, the development of the concept of organ transplantation, lost in combat trauma, the creation of artificial organs and tissues, the creation of personal protective equipment, integrated with a system of combat, etc.

[Medical-and-economic substantiation of rational antibacterial therapy for patients with pleural empyema in the conditions of military medical institutions].

We have performed a post-hoc analysis of the results of using antibacterial therapy in patients with pleural empyema. The cost-effectiveness analysis of rational and empiric antibacterial therapies was performed. The cost-effectiveness ratio for rational antibacterial therapy was lower than for empiric one (2889 and 4480 rubles for 1 treated patient correspondingly). The use of the rules of rational antibacterial therapy in practice leads to proved saving of economic costs.

[Military postgraduate courses at the Military Medical Academy: history, current state and prospects].

Training of scientific and scientific-pedagogical staff is one of the most important tasks of any high school. The problem of staff training arose in the Kirov Military Medical (Medical Surgical) Academy before its official foundation. In 1741 first scholars were sent abroad for the preparation of theses. The scholars were supposed to return to the hospital schools for teaching activity. Since 1802 scholars have defended their theses in the Academy. In 1858 special medical institute, the prototype of the Institute for postgraduate military studies was established. Many outstanding scientists studied in the Academy and brought name of the Academy into repute. At the present time, the Institute of postgraduate military studies (postgraduate) of the Kirov Military Medical Academy continues to train scientific staff. The Institute of postgraduate military studies remains one of the most successful institutes in Russia.

[Isolation of Shewanella algae from pleural exudate of patient with pneumonia].

AIM: Clinical-microbiological description of the first case in Russia of isolation of S. algae bacteria from clinical material. MATERIALS AND METHODS: Patient P., 23 years of age, diagnosis: right-sided distal pneumonia, severe course; parapneumonic empyema of pleura. Bacteria isolation, cultural and biochemical tests differentiating S. algae and Shewanella putrefaciens were performed according to Holt H.M. et al., 2005. Identification of bacteria, tests of sensitivity to antibiotics were carried out by automatic system Vitek 2 (bioMerieux) and additionally by disc-diffusion method. RESULTS: S. algae in association with Serratia marcescens were isolated from pleural exudate of the patient with pneumonia. S. algae bacteria had typical taxonomical features and pathogenicity factors (lipase, gelatinase, beta-hemolysin); were resistant to benzylpenicillin, amoxicillin, cefazolin and sensitive to other beta-lactam antibiotics, aminoglycosides, fluoroquinolones, macrolides, tetracycline. CONCLUSION: S. algae bacteria isolated from pleural exudate of the patient with pneumonia are etiologically significant in parapneumonic empyema of pleura.

[The combined treatment of peptic esophagus strictures in patients with gastro-esophageal reflux].

The clinical picture of peptic esophagus strictures in 16 patients with gastro-esophageal reflux was analyzed. The strategy of the combined treatment, including surgery, has been thoroughly substantiated. The method of endoscopic dysphagia elimination has been described. The possibilities and technical features of antireflux gastroesophageal reconstructions were analyzed. Early and long-term follow-up results were obtained and used in practical recommendations.

[Regulation of blood circulation in the surgical correction of portal hypertension].

56 patients with portal hypertension were examined who underwent decompressive shunt surgery. Cardiorhytmography and integral rheography body were performed in different stages. In the late postoperative period, there were positive changes in the autonomic regulation of functions: reduced tension index and sympathetic influence on heart rhythm, increases the value of other indicators of heart rate variability. Due to an increase in heart rate and peripheral vascular resistance normalizes blood pressure while reducing the values of cardiac output. There is a further normalization of the reactivity of blood circulation: arterial pressure and vascular resistance during the functional test remained at a constant level of magnitude of shock and cardiac index significantly increased and then decreased to the level of the original values, which corresponds to the reaction apparently healthy. Disorders of regulation, state and reactivity of blood flow in portal hypertension, manifested: 1. Reduction of heart rate variability with a significant increase in sympathetic activity of autonomic nervous system. 2. Reduction of cardiac output and vascular resistance, heart rate, changes in physiological determination of hemodynamic parameters: Blood pressure is determined only by the vessel resistance. 3. Reduction of blood pressure in response to breath holding test.

[Ivan Stepanovich Kolesnikov--"general of surgery" (the 110th anniversary of his birth)].

The article is devoted to the 110th anniversary of outstanding surgeon, scientist and educator, academician of the USSR Ivan Stepanovich Kolesnikov. During the Great Patriotic War--he was an army surgeon on the Central Front, and then--in Leningrad. As one of the pioneers of thoracic surgery, the first in the Soviet Union began to apply the resection of pulmonary tuberculosis, cancer, and acute and chronic suppurative diseases of the lung and pleura, reflecting the experience of more than 4,000 thousand operations in numerous monographs and published in 1960, major work, "Resection lights". On his initiative in 1961 was the first in the Soviet Union an independent chair of the thermal lesions, and in 1964--the country's first intensive care unit and intensive care. He published over 200 papers on topical issues of surgery, including 28 monographs. Under his leadership were trained 25 Ph.D. and 43 master's theses.

[Long-term results of conservative treatment of pyo-destructive diseases of the lungs and parapneumonic empyema].

An analysis of results and treatment outcomes of 178 patients has been made. The patients were examined 1, 3, 6, 12, 24 months after discharge from hospital. The parameters characterizing residual cavities, pneumofibrosis, pleural fibrosis and changes in the bronchial tree were analyzed. Recovery was noted in 172 patients (96.63%). According to CT scan data positive dynamics in the reparative processes in the lungs and pleural cavity could be seen. No relapses of the purulent processes and development of lung cirrhosis were noted.