[Laparoscopic versus laparoscopy-assisted suturing of perforated peptic ulcers (meta-analysis)]. / Laparoskopicheskoe i laparoskopicheski assistirovannoe ushivanie probodnoi yazvy (metaanaliz).

OBJECTIVE: To compare laparoscopic and laparoscopy-assisted repair of perforated peptic ulcer using evidence-based methods. MATERIAL AND METHODS: A systematic review and meta-analysis were carried out in accordance with the recommendations of the Ministry of Health of Russian Federation and Cochrane Handbook for Systematic Reviews.Data searching was carried out in Russian and English languages using the E-library, Cochrane Library and PubMed databases. We analyzed titles and references in specialized journals and thematic reviews, respectively. Clarifying information was obtained via personal contacts with the heads of surgical hospitals. The RevMan 5.4 software was used for statistical analysis. RESULTS: We found no randomized trials devoted to comparison of laparoscopic and laparoscopy-assisted surgeries in patients with perforated peptic ulcer. Meta-analysis was based on non-randomized trials with satisfactory methodological quality according to the I-ROBINS formalized assessment. Overall clinical material included 478 observations: 229 (47.9%) laparoscopic surgeries and 249 (52.1%) laparoscopy-assisted procedures via minimally invasive access. There were no conversions. Incidence of postoperative complications was 4.36 and 8.83% (OR=0.39, 95% CI 0.08, 1.87), postoperative mortality 0.87 and 0.81%, respectively (OR=1.26, 95% CI 0.08, 8.24). Laparoscopic surgeries were shorter (MD= -8 min, 95% CI -9.7, -6.4). Length of hospital-stay was also shorter after laparoscopic surgery (MD= -4.6, 95% CI -9.7, -6.4). CONCLUSION: Laparoscopic operations are shorter and accompanied by lower incidence of postoperative complications and less hospital-stay. Large statistical power is required to confirm these differences.

[Koblenz algorithm for open abdomen management]. / «Koblentsskii algoritm¼ lecheniya bol'nykh s laparostomoi.

The issue of laparostomy treatment is still controversial, since there are insufficient evidence-based data. German military surgeons have developed and implemented the «Koblenz algorithm¼ of laparostomy treatment into everyday practice. The algorithm was developed at the Bundeswehr Central Hospital in Koblenz (Germany). Today, approximately 50% of German civilian hospitals use the «Koblenz algorithm¼. The database for laparostomy treatment was created on the basis of international platform European Registry of Abdominal wall Hernias (EuraHS) in May 2015. These data will be valuable for further multipla-center studies. This manuscript is devoted to analysis of clinical effectiveness of the «Koblenz algorithm¼ in the treatment of patients with laparostomy. Searching of Russian, English and German studies devoted to «Koblenz algorithm¼ in the treatment of patients with laparostomy was carried out in the eLIBRARY, Elektronische Zeitschriftenbibliothek, the Cochrane Library and the PubMed databases. The authors comprehensively described «Koblenz algorithm¼. Mortality in the group of VAC - therapy was 57% (31/54), in case of «Koblenz algorithm¼ - 33% (33/100). Between-group differences were significant (OR 0.36, 95% CI 0.18-0.72, p=0.003). However, an efficacy of «Koblenz algorithm¼ should be confirmed in further multiple-center studies including national evidence-based trials.

[Results of video-assisted technologies in colorectal surgery]. / Rezul'taty vnedreniia éndovideokhirurgicheskikh tekhnologii v kolorektal'noi khirurgii.

AIM: To analyze immediate outcomes of 286 laparoscopic and robot-assisted interventions on the colon and rectum. MATERIAL AND METHODS: There were 256 (89.51%) laparoscopic and 30 (10.49%) robot-assisted procedures. 233 (81.46%) operations were performed for rectum and colon cancer. Postoperative complications after colon cancer surgery were revealed in 11.11%, including anastomosis failure in 2.08% of cases. Postoperative complications after rectal cancer surgery occurred in 32.58% of cases including anastomosis failure after anterior rectectomy in 11.67%. CONCLUSION: Robot-assisted surgery is not advisable for colon diseases according to price-effectiveness ratio due to available laparoscopic approach. Preventive intestinal stoma in endoscopic low and ultra-low anterior rectal resection allows you to avoid clinically significant inconsistency of colorectal anastomosis. Laparoscopic procedure should be performed with Contour stitching-cutting device in low and ultra-low anterior rectal resection if there is technical complexity of one-stage rectum intersection below the tumor. Robot-assisted operations for rectal cancer have advantages due to three-dimensional imaging and better orientation, greater freedom of manipulation in confined spaces, and simplicity of lymphadenectomy.

[Endovascular interventions in true and false aneurysms of hepatic, splenic and renal arteries].

A false aneurysm of visceral arteries is a life-threatening pathology sufficiently difficult to treat. Open operations are characterised by a large scope, considerable surgical injury and accompanied by a high rate of serious complications. The development of the technology of superselective catheterization of blood vessels, creation of specialized microcatheters, glue composites and various types of spirals made it possible to treat this severe pathology without resorting to open operations. The work deals with a brief literature review concerning epidemiology, methods of diagnosis and treatment of pseudoaneurysms of visceral arteries, followed by presenting three clinical case reports concerning successful treatment of posttraumatic false aneurysms of the right hepatic and splenic arteries, as well as an aneurysm of the renal artery. Both immediate and remote results of endovascular interventions in these patients are followed up, demonstrably showing possibilities of endovascular technologies in treatment of the pathology involved.

Altered lacunar and vascular porosity in osteogenesis imperfecta mouse bone as revealed by synchrotron tomography contributes to bone fragility.

Osteogenesis imperfecta (brittle bone disease) is caused by mutations in the collagen genes and results in skeletal fragility. Changes in bone porosity at the tissue level indicate changes in bone metabolism and alter bone mechanical integrity. We investigated the cortical bone tissue porosity of a mouse model of the disease, oim, in comparison to a wild type (WT-C57BL/6), and examined the influence of canal architecture on bone mechanical performance. High-resolution 3D representations of the posterior tibial and the lateral humeral mid-diaphysis of the bones were acquired for both mouse groups using synchrotron radiation-based computed tomography at a nominal resolution of 700nm. Volumetric morphometric indices were determined for cortical bone, canal network and osteocyte lacunae. The influence of canal porosity architecture on bone mechanics was investigated using microarchitectural finite element (µFE) models of the cortical bone. Bright-field microscopy of stained sections was used to determine if canals were vascular. Although total cortical porosity was comparable between oim and WT bone, oim bone had more numerous and more branched canals (p<0.001), and more osteocyte lacunae per unit volume compared to WT (p<0.001). Lacunae in oim were more spherical in shape compared to the ellipsoidal WT lacunae (p<0.001). Histology revealed blood vessels in all WT and oim canals. µFE models of cortical bone revealed that small and branched canals, typical of oim bone, increase the risk of bone failure. These results portray a state of compromised bone quality in oim bone at the tissue level, which contributes to its deficient mechanical properties.

Analysis of sintered polymer scaffolds using concomitant synchrotron computed tomography and in situ mechanical testing.

The mechanical behaviour of polymer scaffolds plays a vital role in their successful use in bone tissue engineering. The present study utilised novel sintered polymer scaffolds prepared using temperature-sensitive poly(DL-lactic acid-co-glycolic acid)/poly(ethylene glycol) particles. The microstructure of these scaffolds was monitored under compressive strain by image-guided failure assessment (IGFA), which combined synchrotron radiation computed tomography (SR CT) and in situ micro-compression. Three-dimensional CT data sets of scaffolds subjected to a strain rate of 0.01%/s illustrated particle movement within the scaffolds with no deformation or cracking. When compressed using a higher strain rate of 0.02%/s particle movement was more pronounced and cracks between sintered particles were observed. The results from this study demonstrate that IGFA based on simultaneous SR CT imaging and micro-compression testing is a useful tool for assessing structural and mechanical scaffold properties, leading to further insight into structure-function relationships in scaffolds for bone tissue engineering applications.

[Modern capabilities of the diagnostics and surgical treatment of tumors of the small bowel].

During the recent 6 years (2004-2010) tumors of the small intestine were diagnosed in 19 patients. Mean age of the patients with benign tumors was 63 years, with malignant tumors--57 years (age variations from 19 to 82 years). There were 16 (84%) men and 3 (16%) women. In 9 patients tumors were localized in the jejunum, in 10 patients--in the ileum. Complications appeared in 11 patients which was the cause of emergency operations. In 33.3% of the patients clinical manifestations of benign tumors of the small bowel were as episodes of intestinal bleedings which were not intensive as a rule, but were of recurrent character. Malignant tumors of the jejunum had clinical manifestations in 87% of patients. Most frequent symptoms were spastic or diffuse pains in the abdomen (63% of the patients), loss of the body mass (50%), intestinal obstruction (27.7%), intestinal bleedings (5.5%).

[Treatment of early stages destructive pancreatitis].

The algorithm of the acute destructive pancreatitis' treatment is based on the analysis of 167 patients data. It includes medical activities on patient's admission, basic medication components and indications to the operative treatment. The application of the algorithm ensured satisfactory results of the treatment in 94% of patients with the destructive pancreatitis on early stages.

[Changes in the activity of the mononuclear phagocytic system in inflammatory diseases and atherosclerosis, as evidenced by radionuclide study].

The purpose of the investigation was to determine the activity of mononuclear phagocytes in inflammatory diseases and atherosclerosis at various predominant sites. The mononuclear phagocytic system was studied using labeled compounds, which determined the functional activity of reticular endothelial elements in all tissues of an organism. The analysis of the results of studying the activity of the mononuclear phagocytic system leads to the conclusion that virtually good agreement of the values of the parameters under study in the groups of patients supports the commonness of the processes of development of inflammatory reactions and atherogenesis.

[Effect of antioxidant use in dietary therapy in patients with chronic athrofic hastritis].

In the 1-year double-blind placebo-controlled intervention trial, it was shown that daily supplementation of patients with gastric premalignant lesions (intestinal metaplasia, IM) with a complex, containing Ester-C with antioxidantsand (2100 mg of Ca-ascorbate + 340 mg of bioflavonoids), produced a sharp decrease of abnormally high ornithine decarboxylase activity in IM gastric mucosa that was accom panied by practically total IM regression in 11 of 18 (61%) patients.

[Nah-plasmids of IncP-9 group from natural strains of Pseudomonas].

Use of polymerase chain reaction helped to establish that the most frequent among naphthalene utilizing bacteria, isolated on the territory of Belarus, are Nah-plasmids of IncP-9 incompatibility group and those with indefinite systematic belonging. With the help of classical test of incompatibility, restriction and sequence analyses three new subgroups within the IncP-9 group were discovered (zeta, eta and IncP-9-like replicons). Conducting of restriction analysis for amplification products of nahG and nahAc genes allowed us to reveal, in addition to known sequences of stated determinants, two new types of nahG gene. Restriction analysis performed on amplification products of 16S RNA genes (ARDRA method) showed that native hosts of Nah-plasmids of IncP-9 group are not only fluorescent bacteria from genus Pseudomonas (P. fluorescens, P. putida, P. aeruginosa, P. species), but also non-fluorescent bacteria with indefinite specific belonging.

[Characteristics of natural strains of naphthalene-utilizing bacteria of the genus Pseudomonas].

Sixty-three strains of bacteria capable of utilizing naphthalene as the sole source of carbon and energy were isolated from 137 samples of soil taken in different sites in Belarus. All isolated bacteria contained extrachromosomal genetic elements of 45 to 150 kb in length. It was found that bacteria of 31 strains contained the IncP-9 incompatibility group plasmids, bacteria of one strain carried a plasmid containing replicons IncP-9 and IncP-7, and bacteria of 31 strains contained unidentified plasmids. Primary identification showed that the hosts of plasmids of naphthalene biodegradation are fluorescent bacteria of the genus Pseudomonas (P. putida and P. aeruginosa; a total of 47 strains) and unidentified nonfluorescent microorganisms (a total of 16 strains). In addition to the ability to utilize naphthalene, some strains exhibited the ability to stimulate the growth and development of the root system of Secale cereale.

The effect of high doses of folic acid on the overexpression of ornithine decarboxylase and S-adenosylmethionine content in human colon adenomatous polyps.

It was shown that the 3-month supplementation of patients having colon polyps with folic acid (5 mg/day) led to a 35% decrease in abnormally high ornithine decarboxylase activity in polyps that was accompanied by a 43% increase of S-adenosylmethionine content in polyps.

[The choice of surgical approach in the resection of abdominal aorta]. / Vybor khirurgicheskogo dostupa pri rezektsii anevrizmy briushnoi chasti aorty.

The abdominal aorta aneurism (AAA) surgery experience in 110 patients was analysed. The topographic-anatomic investigations were conducted, a new surgical access to suprarenal and infrarenal AAA parts was proposed.

[Reconstructive surgery on the major vessels. The results of work over 25 years]. / Rekonstruktivnaia khirurgiia magistral'nykh sosudov. Itogi raboty za 25 let.

Principal scientific achievement of the department of vessels surgery staff were presented. They were devoted to fundamental problems of the vessels surgery. Introduction of mentioned achievements in clinical practice improved considerably the results of abdominal aorta aneurysm surgical treatment, long-term complications of reconstructive operations on the main vessels, occlusion diseases of the venous system, what promoted to reduce the lethality and invalidization of patients.

[The use of magnetic resonance tomography in the diagnosis of aneurysm of the abdominal aorta]. / Primenenie magnito-rezonansnoi tomografii v diagnostike anevrizmy briushnoi chasti aorty.

The age anatomy of the abdominal aorta (AA) was studied up using magnetic-resonance tomography (MRT) in 60 patients aging 55-75 years old with diseases of vertebral column and spinal cord. The method advantages were established in diagnosis of the AA aneurysm in 32 patients, aging 55-74 years, for the thrombi detection in aneurysm, for estimation of renal, upper mesenterial and iliac arteries, truncus coeliacus state.

[Experience in delivering specialized surgical care in a large hospital]. / Opyt okazaniia spetsializirovannoi khirurgicheskoi pomoshchi v krupnom gospitale.

Medical troops supply in local armed conflicts demonstrated advantages of fast evacuation of wounded personnel by aviation from the seat of combat actions to the stage of specialized surgical care. Wounded in head, breast, abdomen (particularly in case of multiple and combined character of wounds) are evacuated for treatment to central military hospitals equipped with modern diagnostic and medical equipment, completed with qualified specialists and having the opportunity of prolonged treatment. Surgical care in the zone of combat actions is confined to hemostasis, intensive therapy -to supporting of main vital functions. The article contains the data about terminations of wounded personnel treatment in central military-fleet clinical hospital.