[Laparoscopic techniques in stage abdominal sanation for common pyoperitonitis].

An experience of treatment of 949 patients with common pyoperitonitis demonstrates that effectiveness of surgical tactics depend on stage of multiorgan dysfunction. Laparoscopy decreases traumatism of additional surgery to diagnostic procedure in 68.1% of cases providing compensation of multiorgan dysfunction. 36.7% of patients with multiorgan dysfunction subindemnification need for stage lavage which is performed successfully by using of laparoscopy. 88.8% of patients in this group recovered. It is necessary to remember that carboxy-peritoneum and its removal during laparoscopic lavage are associated with functional strain of cardiovascular and respiratory system in patients with peritonitis and multiorgan dysfunction decompensation. High risk of irreversible function failure does not allow to implement potential of laparoscopic stage abdominal sanitation. In this situation maximal mortality (91.9%) was observed.

[Priority of endovideosurgery in treatment of diffuse purulent peritonitis with subcompensated polyorgan dysfunction].

An analysis of treatment results was made in 474 patients with a diffuse purulent peritonitis. It was shown, that a dynamics of indices of computer phonoenterography (preservation and aggravation of disturbed intestinal motility pattern) and gas-liquid chromatography (the invariable or increased level of acetic, propionic, butyric acid in blood and exudate) significantly supported an evidence objectification to staged sanitization of the abdominal cavity. Recurrent peritoneal lavage was performed in a case of polyorgan dysfunction evidence in the stage of subcompensation in 36, 7 patients. It could be carried out by endovideosurgical method in 82.2% of medical supervisions. The lethality consisted of 4.9% in a case of the application of staged laparoscopic sanitization of the abdominal cavity in complex treatment of patients with diffuse purulent peritonitis.

[Clinical-epidemiological aspects of gastric and duodenum ulcer].

An analysis of reporting and statistical data showed the considerable changes in clinical-epidemiological indices of gastric and duodenum ulcer at the period from 1998 to 2012. The prevalence of the disease and the number of primary patients decreased in 2-3 times. The reduction of the rate of perforations and ulcerous bleeding had been observed. However, the authors noted, that a tendency of frequency of occurrence increased and efficacy indices reduced in the last years. The rate of postoperative lethality raised in the cases of perforated ulcer. On this basis, the authors recommend to reconsider the existing opinion about further extension of out-patient treatment of patients with given pathology.

[The use of exogenous nitrogen monoxide for the prophylaxis of postoperative wound infection].

The study covers treatment results of 220 patients operated on ventral hernia and in vivo experimental treatment of 36 rats proved the nitrogen monoxide (NO) to be the effective means of wound infection prophylaxis. NO potentiates antiseptic effects, minimizing intraoperative wound contamination. It, besides, stimulates endothelial and basal cells of epidermis proliferation. Wound infection was observed only in 9,8% of patients, treated with NO intraoperatively. All cases of infective complications were serous and infiltrative, but not purulent.

[Vacuum-therapy in treatment of festering wounds].

Treatment experience in 112 patients with festering wounds confirms, that vacuum-therapy has marked clinical efficacy at medical process organization on account of trophic ulcers and protractedly nonhealing soft tissue defects. In view of festing wound pathogenesis, vacuum therapy allows to change the course of traumatic process in biologically favorable direction. Influence of low-dosed negative pressure on wound surface allows to clear the wound rapidly and to prepare it for autotransplantation. After skin transplantation use of another type of vacuum-therapy (vacuum bandage) is appropriate. It helps to hold the skin graft safely in recipient until "natural" fixation process occurs, to change blood microcirculation in wound tissues and possess detoxication effect. Thus vacuum therapy allows to get clinically notable effect in the form of complete wound repair in 85.4% of patients with festering wounds.

[Wound healing after vacuum drainage]. / Zazhivlenie ran v usloviiakh vakuumnogo drenirovaniia.

Vacuum therapy was applied in the management of 63 patients with postoperative ventral hernias, 101 patients with a similar pathological conditions were treated by the traditional method for wound healing. From analysis of the results of treatment and with due consideration for the results of additional methods of examination it was established that vacuum prevents accumulation of exudate and blood clots in the wound cavity and removes the risk medium for the development of pyo-inflammatory complications. Moreover, by promoting the coming together of the wound edges and liquidation of the wound cavity, vacuum therapy affects the metabolic reorganizations in the tissues and leads to stabilization of the regeneration mechanisms. The use of vacuum therapy in the postoperative period creates the possibility of regulating the reparative reactions through an active effect on the healing of the wound in the phase of inflammation, protecting in this manner the biology of the wound process and preventing infectious complications.

[Pathogenetic mechanisms of the effect of vacuum therapy on the course of the wound process]. / Patogeneticheskie mekhanizmy vliianiia vakuum-terapii na techenie ranevogo protsessa.

On the basis of the analysed results of treatment of 248 patients with abscesses, phlegmons, and purulent wounds who received vacuum therapy and 215 patients with the same diseases treated by the traditional incision-drainage-method, as well as on the grounds of additional examination findings, the authors show the mechanisms of the effect of vacuum therapy on the course of the wound process. They substantiate pathogenetically the marked therapeutic effect of this method in patients with acute purulent diseases of the soft tissues and purulent wounds.

[Bacteriologic and cytologic evaluation of vacuum therapy of suppurative wounds]. / Bakteriologicheskaia i tsitologicheskaia otsenka vakuum-terapii gnoinykh ran.

Results of the treatment of 438 patients have shown vacuum therapy of purulent wounds to make them clear from pus and microbes in short terms which contributes to the activation of reparative processes and ultimately makes the terms of the treatment shorter. The regeneration-degeneration index proposed allowed to mathematize the cytogram and results in a simpler and more objective orientation in the phases of the wound process.

[Vacuum therapy of acute suppurative diseases of soft tissues and suppurative wounds]. / Vakuum-terapiia v lechenii ostrykh gnoinykh zabolevanii miagkikh tkanei i gnoinykh ran.

The article analyzes results of treatment of 338 patients with abscesses, phlegmons and purulent wounds. A comparative investigation of treatment of 173 patients by traditional incisive-draining methods and 165 patients treated by using vacuum therapy by the method proposed by the authors was made. The advantages of vacuum therapy were shown in the acceleration of reparative processes and in shortening the time of treatment.