MICROBIOLOGICAL FEATURES OF A LAPAROTOMY WOUND COMPLICATED BY POSTOPERATIVE EVENTRATION AGAINST THE BACKGROUND OF AN ONCOLOGICAL PROCESS.

This article presents the results of a study of the qualitative and quantitative microflora content of the wound exudate of a laparotomy wound complicated by eventration in patients with malignant neoplasms of the abdominal cavity. This study aimed to investigate the peculiarities of the qualitative and quantitative composition of the laparotomy wound microflora in cancer patients with postoperative eventation. After all, postoperative event is always accompanied by the occurrence of purulent-septic complications from the laparotomy wound. These microbiological features should be taken into account in order to timely prevent or treat postoperative event in cancer patients, that is, in the appointment of antimicrobial therapy, features of purulent wound treatment, etc. We studied 34 patients with surgical diseases of the abdominal cavity with postoperative eventration. We studied the species content of microorganisms, their population level, the index of constancy, the frequency of species detection, the index of significance, and the index of quantitative dominance. The microbiological spectrum of laparotomy wound exudate, in case of postoperative eventration in patients with malignant neoplasms of the abdominal cavity, is characterized by a probable predominance of the number of cultivated strains of the genus Proteus, Pseudomonas aeruginosa, the appearance of yeast-like fungi of the genus Candida and the absence of S. aureus growth in the early stages. There was an increase in the population level of E. coli, Pseudomonas aeruginosa, and microorganisms of the genus Proteus, with a prevalence of the latter compared to non-cancer patients, and a lower number of Staphylococcus aureus colonies. The dominant microorganisms of wound exudate are E. coli and Enterococcus faecalis; in patients with malignant abdominal neoplasms, the highest coefficient of quantitative dominance is observed in microorganisms of the genus Proteus. The presence of secondary immunodeficiency, cachexia, anaemia, etc. in patients with malignant neoplasms of the abdominal cavity causes a 'sluggish' purulent-inflammatory process in the laparotomy wound area in the event of postoperative eventration.

THE INFLUENCE OF THE ONCOLOGICAL PROCESS ON THE MECHANICAL STRENGTH OF THE POSTOPERATIVE SCAR OF THE LAPAROTOMY WOUND.

The aim - to examine mechanical strength of the postoperative scar of the laparotomy wound depending on the stage of oncological process at various terms after surgery performed. Examined 194 physical bodies of deceased persons, according to the protocols of the pathological examination (in which the card numbers of the patients are indicated) and who underwent surgical intervention on the organs of the abdominal cavity. Summarizing the results of the study, it should be noted that on the 1st day after surgery, the mechanical strength of the postoperative scar of the laparotomy wound does not depend on the stage of the oncological process and the type of surgery performed, which proves that there is no significant difference in the above-mentioned study groups. Reduced mechanical strength of the postoperative scar was found in the main group on the 1st day of the study. Similar to the 1st day situation is seen on the 2nd and 3rd days of the research. This confirms the morphological experimental studies carried out earlier, which indicate that malignant neoplasm in the body considerably inhibits and slows down the processes of maturation of the granulation tissue. The study once again proves the negative influence of the presence of a malignant neoplasm on the mechanical strength of the postoperative scar of a laparotomy wound. Oncological process negatively affects the mechanical strength of the postoperative scar. Mechanical strength of the postoperative scar of the laparotomy wound is directly proportional to the stage of oncological process and the size of the tumor removed.

THE ROLE OF ONCOLOGICAL PROCESS IN OCCURRENCE OF POSTOPERATIVE EVENTRATION.

Eventration is one of the rare but the most dangerous postoperative complications in the abdominal surgery registered in 0.5-2.35% of patients. Eventration occurs most frequently after urgent surgery on the abdominal organs of weakened patients of the old and elderly ages with a low immune-biological condition of the body. Examination of certain specific features of eventration occurrence with underlying oncological process will allow better understanding the latter in the development of the postoperative complication. Therefore, the objective of the research was to examine experimentally the effect of malignant neoplasm on the mechanical strength of the laparotomy wound postoperative scar on small laboratory animals, and to study clinically occurrence of postoperative eventration development in patients with malignant neoplasms of the abdominal organs. The experimental studies were carried out on 78 laboratory rats operated on by means of laparotomy 3,0 cm in length. Heren's carcinoma was preliminary grafted under the skin of the external femoral surface in the main group of animals. The mechanical strength of the laparotomy wound scar was determined on the 1st, 3rd and 5th days after surgery by means of measuring abdominal pressure at the moment of scar rupture. 140 were examined who underwent midline laparotomy for surgical treatment of abdominal diseases. The main group included 98 patients with malignant neoplasms of the abdominal organs who were divided into two groups depending on the stages of oncological process. The first subgroup included 46 individuals at the I-II stages of the disease, and the second subgroup of the main group included 52 patients at the II-IV stages of the disease. The group of comparison involved 42 patients with acute surgical non-oncological pathology of the abdominal organs. Both groups of patients were comparable by the age and gender. An average age of patients in both groups of the study was 60.1±0.95 years. An average length of the laparotomy wound was 27.1±0.25 cm. The obtained results were statistically processed on the personal computer by means of electronic tables Microsoft Excel and the package of statistical processing program IBM SPSS Statistics. The results of the experimental studies are indicative of the fact that malignant process in the body results not only in inhibited maturation of the granulation tissue in the laparotomy wound, but in reduced strength of the postoperative scar beginning with the 3rd day after surgery performed. Analysis of the results of our clinical study enables to admit reliable increase of occurrence of "local" postoperative complications including suppuration of the postoperative wound and eventration, especially when oncological process is at the late stages of the disease. This specific feature should be considered when sutures and drainage are applied on the laparotomy wound in this group of patients. Thus, oncological process at the late stages of the disease promotes reduced strength of the laparotomy wound postoperative scar and results in an increased occurrence of eventration and suppuration of the postoperative wound.

FEATURES OF GRANULATION TISSUE MORPHOLOGY AROUND THE NET ALLOTRANSPLANT WHEN APPLYING POSTOPERATIVE RADIATION THERAPY.

The aim of the research was to study experimentally the morphologic peculiarities of the granular tissue around the elements of the reticular allotransplant of the muscular aponeurotic layer of the anterior abdominal wall when using postoperative distant gamma therapy. The experiment has been done on 168 laboratory rats which were implanted with a prolenic mesh allograft into the tissues of muscular aponeurotic layer of the anterior abdominal wall. From the 13th to 19th day after the implantation of the reticular allograft, animals from the main group (96 rats) received irradiation of the site of the last one. Taking of the biological material was carried out on the 20th, 30th, 40th and 50th day after surgery. For optical research at histological examination the samples of biopsy were fixed in 10% neutral formalin. Paraffin sections were stained with hemotoxylin and eosin. To identify collagen fibres the method of histological sections' coloring was applied. The results of the research indicate that the use of distant gamma therapy after reticular allotransplant implantation leads to uneven maturation of the granulation tissue, its edema, probable decrease in the percentage of fibroblasts, increase of lymphoid cells as well as the appearance of plasma cells and macrophages on the 40th and 50th days of observation. At the histologic sections coloring with aquious blue-chromotrope B2, there is a predominance of the specific volume of collagen fibers and an increase in the specific volume of blood vessels on the 50th day of observation. Thus, the use of the postoperative radiotherapy at the plasty of the anterior abdominal wall with a reticular allograft leads to the distortion of the maturation process of the granular tissue, its edema, which shows itself in the probable reduction in the percentage of fibroblasts, increase in lymphoid cells, appearance of plasma cells and macrophages as well as prevalence of specific volume of collagen fibres, increase in the specific volume of vessels.

EFFECTIVENESS OF NONALCOHOLIC STEATOHEPATITIS CORRECTION ON THE BAСKGROUND OF OBESITY WITH CONCOMITANT CHRONIC KIDNEY DISEASE.

The article presents a theoretical generalization of the research results the effectiveness of heparisin on the state of the carbohydrate-protein components of the extracellular matrix of connective tissue in liver in patients with non-alcoholic steatohepatitis with obesity I-II degree and chronic kidney disease І-ІІ stage. The purpose of the study is to find out the effectiveness of heparisin (glycyrizine 40 mg, glycine 400 mg, L-cysteine hydrochloride 20 mg) on the state of the carbohydrate-protein components of the extracellular matrix in connective tissue of the liver in patients with non-alcoholic steatohepatitis (NASH) with obesity I-II degree and chronic kidney disease (CKD) І-ІІ stage. 98 patients with NASH on the background of obesity of the I-II degree were examined, including: 52 patients with NASH (I group) (without accompanying CKD), 46 patients with NASH with comorbid CKD І-ІІ stage (II group). The control group consisted of 20 practically healthy persons (PHPs) of the corresponding age and sex. Biopsy of the liver was performed on 32 NASH patients with CKD I-II, 28 patients with NASH without CKD. Patients on both groups of NASH received heparisin treatment (glycyrizine 40 mg, glycine 400 mg, L-cysteine hydrochloride 20 mg) (Valartin Pharma) by intravenous administration of 20 ml of the drug for 10 days followed by enteral administration of 2 tablets of heparysin (1 tablet : glycyrizine 25 mg, glycine - 25 mg, methionine - 25 mg) 3 times a day for 80 days. Patients with NASH and a comorbid flow of obesity and CKD of the І-ІІ stages, except for heparisin, received baseline therapy of CKD І-ІІ stage: chronic pyelonephritis. Heparizin therapy for 3 months contributed to the achievement of a collagen anabolic and catabolic balance by activating collagenase, inhibiting the activity of proteolytic inhibitors and collagenase, inhibition of fibroblast growth factor secretion, acute phase inflammation, reducing extracellular matrix fucoglycoproteinsdegradation in liver, and in general, reducing the activation of connective tissue components, by evidence which led to a decrease in the liver fibrosisindex according to the fibrotest in the range of 1.5-2.0 times.

INTENSITY OF THE ANTIOXIDANT PROTECTION SYSTEM AND OXIDATIVE STRESS FACTORS IN PATIENTS WITH NON-ALCOHOLIC STEATOHEPATITIS DEPENDING ON THE FORM OF CHRONIC KIDNEY DISEASE.

The article presents a theoretical generalization of the research results the intensity of the antioxidant protection system and oxidative stress factors in patients with non-alcoholic steatohepatitis depending on the form of chronic kidney disease. The objective of the article - determining the pathogenetic role of the processes of antioxidant protection system in the development and interconnection mechanisms of non-alcoholic steatohepatitis (NASH) and obesity depending on the form and stage of chronic kidney disease (CKD). 177 patients were examined for this purpose, including: 35 patients with NASH with concomitant obesity of І-ІІ degree (1st group), 36 patients with NASH with accompanying obesity of І-ІІ degree and CKD І-ІІ stage: Chronic bilateral pyelonephritis in the phase of exacerbation (2A group), 35 patients with NASH on the background of obesity I-II st. with CKD of the 3rd stage: Chronic bilateral peyelonephritis, exacerbation (2B group), 37 patients with NASH with obesity I-II stage and gouty nephropathy (group 3), 34 patients with NASH, which developed on the background of obesity I-II stages that developed from asymptomatic hyperuricemia (AHU) (group 4). The control group consisted of 30 practically healthy persons (PHP). For the comorbidity of NASH from CKD of the I-III stages. In the form of chronic pyelonephritis, the intensity of oxidative stress increases: the accumulation of intermediate (isolated double bonds, diene conjugates) and terminal (malonic aldehyde, ketodienes and conjugated triines) products of lipids peroxide oxidation, oxidation proteins modification (aldehyde and ketone dinitrophenyl hydrazones of the main and neutral) against the background of the disintegration of the activity of antiradical protection factors (reduction of content in erythrocytes of recovered glutathione, activity of superoxide dismutase, the growth of catalase activity, glutathion-dependent enzymes). Due to the comorbidity of non-alcoholic steatohepatitis with gouty nephropathy and in conditions of asymptomatic hyperuricemia, the degree of oxidative stress is significantly lower due to the strong antioxidant properties of uric acid, but the degree of endotoxicosis predominates in steatohepatitis without kidney damage. The uncontrolled intensification of the processes of free radical oxidation of lipids and proteins in patients with non-alcoholic steatohepatitis that developed on the background of obesity and CKD I-III stages, determines the degree of pathological process activity in the liver and the degree of endotoxicosis.

PECULIARITIES OF THE CLINICAL COURSE OF NON-ALCOHOLIC STEATOHEPATITIS AGAINST THE BACKGROUND OF THE CHRONIC KIDNEY DISEASE OF THE I-III STAGE WITH SECONDARY ARTERIAL HYPERTENSION.

The article addresses the theoretical generalization of the clinical study of non-alcoholic steatohepatitis peculiarities in comorbidity with obesity and chronic kidney disease of the І-ІІІ stage, characterized by higher frequency and intensity of clinical and biochemical syndromes, the manifestation of which is likely to increase the occurrence of secondary arterial hypertension (portal hypertension syndromes, cholestasis, mesenchymal inflammation). Comorbid course of non-alcoholic steatohepatitis with chronic kidney disease is characterized by higher degree of liver steatosis compared to the patients with only non-alcoholic steatohepatitis (p<0.05), and a higher diagnostic threshold of the hepatorenal index values, which correlates with the Steato-test index (p<0.001) with strong interdependence.

CLINICAL EFFICACY OF S-ADENOSYLMETHIONINE IN PATIENTS WITH NON-ALCOHOLIC STEATOHEPATITIS AND CHRONIC KIDNEY DISEASE I-II STAGE.

The article presents a theoretical generalization of the results of the clinical efficacy of S-adenosylmethionine in patients with non-alcoholic steatohepatitis (NASH) in comorbidity with obesity and chronic kidney disease (CKD) of the 1st-2nd stages. The objective of the article was to determine the likely effect of S-adenosylmethionine and Meldonium on the clinical course of non-alcoholic steatohepatitis (NASH) and chronic kidney disease (CKD) of the I-II stages. We examined 75 patients with NASH with comorbid obesity I degree and CKD I and II dgrees. To determine the efficacy of the treatment, 3 groups of patients were randomized according to age, sex, degree of obesity, activity of the cytolytic syndrome of NASH and the stage of the CKD. SAM possesses powerful membrane-stabilizing properties, stably eliminates the manifestations of cytolysis, cholestasis, mesenchymal-inflammatory syndrome, increases the albumin-synthesizing function of the liver in patients with NASH and prevents the loss of albumins in the conditions of CKD І-ІІ st. At the same time, complex therapy of SAM and vazonate is superior to the effectiveness of correction of these syndromes due to the implementation of powerful metabolic, antioxidant, antihypoxant, energy-specific properties of Meldonium and may be recommended for the introduction into the practice of internal medicine and gastroenterology for treatment NASH on the background of obesity and CKD I and II stages. The established nephroprotective properties of SAM that are potentiated by Meldonium are probably due to the ability of these drugs to eliminate endothelial dysfunction, improve microcirculation, and prevent the progression of kidney fibrosis. S-adenosylmethionine (ahepta) in a dose of 600 mg sublingually in patients with non-alcoholic steatohepatitis on the background of obesity and chronic kidney disease of the 1st and 2nd st. produces powerful membrane-stabilizing effects on the affected hepatocytes, stably eliminates the clinical manifestations of the disease, the intensity of cytolysis, cholestasis, mesenchymal-inflammatory syndrome, inhibits the progression of hepatic and renal dysfunction (increases the albumin-synthesizing function of the liver, the velocity of glomerular filtration) by optimizing the control of fibrosis of the liver and kidneys. Complex therapy with S-adenosylmethionine (ahape) and Meldonium (500 mg /day)(vasonate) is superior to the correction of these syndromes NASH and CKD, since the vasonate potentially potentiates the action of S-adenosylmethionine in acute and distant observation periods.

[EEG dynamics in patients with renal failure during treatment with hemodialysis and following kidney transplantation]. / Dinamika EEG u bol'nykh s pochechnoi nedostatochnost'iu pri lechenii gemodializom i posle transplantatsii pochki.

The authors conducted an EEG study of 28 patients with chronic renal insufficiency, 20 of whom were on a programme hemodyalysis and 8 were studied at different periods following kidney transplantation. Background registrations detected mild and moderate changes of the bioelectric brain activity, mainly with disorders of alpha-rhythm. Only in 1/3 of the patients there were moderate slow forms of activity of paroxysmal signs. A worsening of the EEG indices after hemodialysis, seen in 11 of the 20 patients was expressed in abundant polymorphic slow activity or paroxysmal hilateral synchronous discharges of a large amplitude and was combined with an appearance of neurological disorders. In a successful kidney transplantation there was a distinct normalization of the EEG picture, whereas in a rejection of the transplant there were signs of expressed anomalies of brain electrogenesis.