[Prophylaxis and correction of inflammatory complications in peritonitis, depending on severity of enteral insufficiency].

There were examined 54 patients, in whom peritonitis of various etiology was diagnosed. Clinical, biochemical, immunological and other investigations were conducted for estimation of the enteral insufficiency syndrome severity. Basing on the analysis of the data obtained and criterions of the patient common state there was determined the occurrence risk for inflammatory complications (IC). Complex of prophylactic and therapeutic measures for reduction of the IC rate was proposed.

[Influence of mydocalm on the degree of intra-abdominal hypertension and local blood circulation in the intestinal wall in experiment].

The effect of mydocalm (tolperison, 5 mg/kg single dose) on the dynamics of intra-abdominal hypertension (IAH), blood circulation regulation, and oxygen balance in the tissues of intestinal wall were studied in acute experiments on rabbits. Using a special stand of original design, the initial IAH level was modeled at 200 mm H2O with the subsequent stopping of further receipt of liquid during 3 hours in an elastic container in the abdominal cavity. During 3-h observation without drug administration, no changes in IAH due to the tone of muscles of the frontal abdominal wall takes place, but there is progressive deceleration of local blood flow (-35.33 + 0.99%, p < 0.01), suppressed dilation (-20.02 + 0.54%, p < 0.01) and constriction (-60.45 + 1.17%, p < 0.01) reactivity of vessels, and decreased oxygen tension (-47.18 + 0.75%, p < 0.01) in the intestinal wall at the end of experiment. The introduction of mydocalm reduces the tone of muscles of the frontal abdominal wall, which leads to a decrease in IAH (maximum effect after 1.5 hours, -20.81 + 0.84%, p < 0.01) and prevents decrease in the local blood flow (-26.77 + 0.41%, p < 0.01), suppression of dilation (-16.51 + 0.34%, p < 0.01) and constriction (-37.85 + 0.61%, p < 0.01) reactivity of vessels, and reduction in oxygen tension (-36.60 + 1.18%, p < 0.01) at the end of experiment. The administration of mydocalm can extend the limits of application of a conservative therapy for patients with IAH and to improve the results.

[Inflammatory concept of pathogenesis of postoperative abdominal hernia and prophylaxis of the wound complications after hernioplasty].

The inflammatory concept of postoperative abdominal hernia pathogenesis was proposed, basing on data obtained from clinico-experimental investigations and literature. The concept describes the abdominal wall defect formation, on a background of progressing inflammatory process in a cicatrix area, as an essential factor of risk for the local and systemic inflammatory reaction occurrence after hernioplasty operation, which negatively influences the wound process course. That is why it is necessary to conduct a pathogenetically based measures preoperatively and postoperatively for the wound complications prophylaxis and guaranteeing of the implant optimal integration into tissue of the abdominal wall defect.

[Diagnostic and prognostic value of determination of the endogenic intoxication and functional activity of neutrophils indices in odontogenic phlegmon].

There were studied up the peripheral blood indices in 109 patients, suffering odontogenic phlegmon (OPH), coexistant with severe and of medium severity systemic inflammatory response syndrome (SIRS). In the patients with OPH and severe SIRS (with the complicated course), the blood neutrophils indices, concerning endogenic intoxication and functional activity, differ essentially from those parameters, present in patients, suffering noncomplicated course of the disease.

[Rehabilitation and the quality of life estimation in patients suffering postoperative abdominal hernia before and after performance of reconstructive operation].

The modern approach to rehabilitation and the quality of life securing in patients suffering postoperative abdominal hernia was elucidation. Using the rehabilitation algorrhythm elaborated in 69 (88.5%) patients suffering extent and giant hernia, satisfactory result was achieved after reconstructive operation performance, which had guaranteed the sufficient quality of life level. Poor result was noted in 9 (11.5%) patients, of them in 4 (5.1%) the disease recurrence had occurred, 5 (6.4%) were directed to expert medico-social commission. In these patients the quality of life indices did not differ from their values, presenting before the operation.

[Explantation of synthetic net-like materials in the treatment of large postoperative abdominal wall hernia]. / Eksplantatsiia sinteticheskikh setchatykh materialov pri lechenii posleoperatsionnoi gryzhi briushnoi stenki bol'shikh razmerov.

The results of explantation of synthetic netted materials in 82 patients with vast and giant postoperative abdominal wall hernia were analyzed. Physical and biological properties of netted explants made from polypropylene permit to apply them while infectioning of the operative field occurs and providing measures of complex prophylaxis for purulent-inflammatory, broncho-pulmonary and cardio-vascular complications. The method of plasty choice depends on clinical situation present, the operative risk degree, the hernial defect size and magnitude and on the stage of prognosticated intraabdominal pressure raising. An early postoperative complications were noted in 14 (17%) of patients. Hernial recurrency had occurred in 3 patients in terms of follow-up from 1 to 5 years.

[Classification criteria and modern principles of surgical treatment for postop abdominal wall hernia]. / Kriterii klassifikatsii i sovremennye printsipy khirurgicheskogo lecheniia posleoperatsionnoi gryzhi briushnoi stenki.

Issues of differentiated choice of hernial defect (HD) plasty in 546 patients with postoperative (PO) abdominal wall hernia (AWH), taking into account the most informative classification signs of the disease (the hernial protrusion size and localization, the HD width, frequency of recurrences) were discussed. Depending on character of topographic disorder in abdominal wall present four types of PO AWH were delineated. Diagnosis of the AWH type according to criterions proposed, using the ultrasonic and computer tomography data, had permitted to determine the technical conditions and to substantiate pathogenetically the expediency of radical hernioplasty performance in 483 patients and of palliative HD correction--in 63. There was stressed the necessity to indicate technique of the hernioplasty performed, while depicting the operation using terminology "hernioplasty without tension" whether the HD edges were confronted side by side or not, what means performance of radical vs palliative procedure. Indications to performance of alloplasty, using synthetic net-like polymeric materials in all the patients with PO AWH were substantiated.

[Application of computer thermography in diagnosis of chronic focus of inflammation and the definition of indications to the use of antibiotics before operation in patients with post-operative hernia of anterior abdominal wall]. / Primenenie komp'iuternoi termografii v diagnostike ochaga khronicheskogo vospaleniia i opredelenii pokazanii k ispol'zovaniiu antibiotikov do vypolneniia operatsii u bol'nykh s posleoperatsionnoi gryzhei briushnoi stenki.

We studied the informative value of computer thermography in diagnostics of inflammatory changes in hernia region in 53 patients with post-operative hernia of anterior abdominal wall. Four variants of thermogram were obtained depending from temperature gradient in symmetric points of hernia hilus. This was used to substantiate preventive antibiotics prescription according to general scheme in pre-operation period in 25 patients and administration of electrophoresis of cefazoline in further 28 patients. The method was effective to reduce inflammatory changes in hernia hilus region in 88.9% of patients, which was defined based on temperature gradient decrease in symmetric regions of hernia. Post-operative complications rate decreased from 15.7 to 12.3%. The suppuration of post-operative wound was not observed.

[The complications of wound healing after an operation for ventral hernia and their prevention]. / Oslozhneniia zazhivleniia rany posle operatsii po povodu gryzhi zhivota i ikh profilaktika.

For abdominal hernia 982 patients were operated. The complications had occurred in 18.6% of patients due to chronic inflammation and the presence of "sleeping" infection in the hiatal gates margins. Application of the elaborated prophylaxis complex of measures had permitted to lower the frequency of the wound healing complications down to 9%.

[Antioxidant application for the correction of endogenic intoxication in patients with complex abdominal hernia]. / Ispol'zovanie antioksidantov dlia korrektsii endogennoí intoksikatsii u bol'nykh so slozhnoí gryzheí zhivota.

In 80 patients with complex abdominal hernia (CAH) the peroxide oxidation of lipids (POL) state was investigated. Increase of the POL products before and after operation, and also the mean molecular weight peptides (MMMP) level revealed witnessed the existence of endogenic intoxication (EI). Application of antioxidants (AO) for correction of the disorders revealed, promoted the intoxication signs demolition and the patients state improvement.