[Surgical treatment of a patient with mine blast abdominal injury complicated by damage to the duodenum]. / Khirurgicheskoe lechenie patsienta s sochetannymi povrezhdeniyami pri minno-vzryvnoi travme.

The authors describe successful treatment of a patient with consequences of a mine-explosive wound of the right thigh and abdomen, including damage to the duodenum. Staged surgical treatment made it possible to identify and eliminate defects in primary surgical treatment in time. Thus, favorable treatment results were obtained.

[Immediate outcomes of pancreatoduodenectomy after different digestive reconstruction procedures]. / Blizhaishie rezul'taty pankreatoduodenal'noi rezektsii posle razlichnykh variantov rekonstruktsii pishchevaritel'noi sistemy.

OBJECTIVE: To study the immediate results of pancreatoduodenectomy depending on digestive reconstruction procedure. MATERIAL AND METHODS: We analyzed 242 patients who underwent pancreatoduodenectomy for the period from January 2013 to December 2019. There were 32 combined procedures: 28 (11.6%) with portal vein resection and 8 (3.3%) simultaneous operations (right-sided hemicolectomy - 4, right-sided adrenalectomy - 2, gastrectomy with splenectomy - 2). Pancreatic stump was inserted into the jejunum in 156 (64.5%) patients, into the stomach - in 86 (35.5%) cases. RESULTS: Postoperative period was uneventful in 180 (74.4%) patients. Eighty postoperative complications were observed in 62 (25.6%) patients; 221 (91.3%) patients were discharged, 21 (8.7%) patients died. Pancreatic necrosis was the most common postoperative event and provoked 65 (82.5%) various complications (38 (72.1%) in patients with pancreaticojejunostomy and 20 (71.5%) in those with pancreaticogastrostomy). Incidence of complications was similar in both groups. However, pancreaticojejunostomy was followed by severe pancreatic fistula type C in 12 (23.1%) patients, type B in 24 (46.1%) cases. In case of pancreaticogastrostomy, pancreatic fistula type C occurred in 4 (14.3%) cases, type B - in 8 (28.6%) patients. CONCLUSION: Pancreatic necrosis was the most common postoperative event after pancreatoduodenectomy. Fewer severe pancreatic fistulae (type C) were recorded after pancreaticogastrostomy although these patients had lower density of the pancreas and unclear pancreatic duct. Choice of pancreatic-digestive anastomosis should be determined by features of pancreatic parenchyma, pancreatic duct diameter. Nevertheless, final decision is a prerogative of surgeon. Pancreaticogastrostomy is especially advisable in minimally invasive PDEs that will simplify inclusion of the pancreas into digestive system and reduce the incidence of complications and mortality.

METABOLIC, ENZYMATIC AND MINERAL MAINTENANCE OFREPARATIVE OSTEOGENESIS OF FACIAL CRANIUM INJURIES.

Aim - study of marker enzymes, hormonal and carbohydrate-protein indicators of the state of reparative osteogenesis in patients with complicated and uncomplicated course of injuries of facial cranium. The study included 81 patients with injuries of facial cranium, which were divided into 2 groups, depending on the presence of complications. The following enzyme indicators were studied: the level of excretion of hydroxyproline in daily urine; alkaline and acid phosphatase activity; the percentage of bone isoenzymes of alkaline phosphatase. To assess the mineral metabolism, the level of total and ionized calcium and inorganic phosphorus in the blood serum, as well as their excretion in the urine, were determined. To assess the state of metabolism, the concentration of glycosaminoglycans and their fractions in the blood serum were studied. To study the structural and functional state of the bone tissue the densitometry was performed. In patients with complicated course of injuries of facial cranium assosiated with traumatic brain injury there was revealed the increase (р<0,05) of: excretion of phosphorus, uronic acids and oxyproline, while the excretion of calcium was not disturbed (р>0,05), and excretion of magnesium was decreased (р<0,05). It was found out that the level of calcium of blood serum in patients with complicated course is significantly (р<0,05) lower than in the control group and does not depend on the presence of craniocerebral injury (р>0,05). The decrease of the level of ionized calcium content in blood serum can be the confirmation of lower metabolic activity of reparative osteogenesis processes, first of all at the expense of damage of central mechanisms. When studying the content of carbohydrate-protein metabolites by complicated course of injuries of facial cranium, the absolute increase (р<0,05) of concentration of chondroitin-6-sulfates was revealed, and during the analysis of results it was found out that in absolute values, as well as in structural indexes, the specific weight of various fractions changes, that can be the evidence of instability of mechanisms of osteogenesis and of damage of physiological mechanisms of reparative osteogenesis. Densitometric equivalents of forming of complicated course of injuries of facial cranium are the increase of broadband ultrasonic attenuation and the decrease of its spreading speed on the background of low levels of chondroitin-6-sulfates.

[Early outcomes of open, laparoscopic and robot-assisted pancreatoduodenectomy]. / Blizhaishie rezul'taty otkrytykh, laparoskopicheskikh i robot-assistirovannykh pankreatoduodenal'nykh rezektsii.

AIM: To study immediate results of open, laparoscopic and robot-assisted pancreatoduodenectomy for malignancies. MATERIAL AND METHODS: There were 158 patients with cancer of biliopancreatoduodenal area. Open procedures were performed in 118 cases, laparoscopic in 17, robot-assisted pancreatoduodenectomy - in 23. RESULTS: After 'standard' pancreatoduodenectomy 31 (62.0%) complications were registered, after laparoscopic - 12 (24.0%) and aWfter robot-assisted surgery - 7 (14.0%) complications. Relationship between probability of complications was absent (correlation coefficient 0.10491), however, significant differences in incidence of complications after various surgical approaches were observed (c2=6.8832; df=0.9679; p<0.05). CONCLUSION: Laparoscopic and robot-assisted pancreatoduodenectomy was not followed by advanced early postoperative morbidity. Moreover, minimally invasive approach was associated with improved outcomes.

[The expression of connexin 36 and some neuroglial antigens in human brain astrocytic tumors of different grades].

OBJECTIVE: To reveal the expression of neuronal connexin 36 (Cx36) in gliomas and then to analyze the ratio of expression of Cx36 to that of neuroglial antigens (synaptophysin, neurofilaments, and glial fibrillary acidic protein). MATERIAL AND METHODS: Varying grade human glioma samples and tumor-adjacent tissue fragments were used for immunohistochemical examination. RESULTS: A procedure for immunohistochemical detection of Cx36 in brain tissue was tried out. It was shown that the decreased level of the examined neuronal proteins was accompanied by the impaired coexpression of synaptophysin/neurofilaments and Cx36 in the series of astrocytomas--anaplastic astrocytomas--glioblastomas. The immunohistochemical heterogeneity of glioblastomas was found. CONCLUSION: The findings suggest that it is promising to include anti-Cx36 antibodies in immunohistochemical panels when examining brain tumors. Data on the lower levels of the examined neuronal proteins, on the specific features of their distribution and impaired coexpression expand their idea on the pathogenesis of a brain tumor process and determine an area for further investigations.

[Antitumor action and other regulatory effects of low intensity electromagnetic and chemical factors in experiment].

This paper presents a brief overview of the results of the original researches of biological responses induced by agents of cytostatic and regulatory actions in small doses, as well as weak electromagnetic radiation of different frequency bands. The possibility of obtaining the expressed antitumor, antistress and geroprotective effects has been shown. The question of the relation of system mechanisms of realization of these effects with structural rearrangements in biological fluids, as well as the promising directions for optimizing the therapeutic properties of the informational impacts are discussed.

[Plasty of extrahepatic biliary ducts with the use of ileal autotransplantate].

A method of extrahepatic biliary duct plasty with the use of tubular ileal autotransplantate of 1 sm in diameter was presented in 19 patients with benign strictures. The transplantate on the vascular pedicle was created by resection of the antimesenterial side of the intestinal loop. Distally the anastomosis was performed with the common bile duct, including, thus, papilla Vateri into the bile passage (4 patients). By the impossibility of the latter, the anastomosis was performed with the vertical part of duodenum (16 patients). Postoperative follow-up variated from 1 to 15 years. 18 patients demonstrated good long-term result, 1 patients had a stricture recurrence.

[The treatment of pulmonary thromboembolism in puerperae with pelvic thrombophlebitis]. / Lechenie na belodroben trombembolizum u rodilki s tazov tromboflebit.

The possibilities of current conservative treatment were studied on parturients with pelvic thrombophlebitis and lung thromboembolism. It was established that performance of total hysterectomy or usage of vena cava filter in parturients with pelvic thrombophlebitis and lung thromboembolism should be made after careful evaluation and after trials of current conservative treatment (venous application of antibiotics from the sixth generation, metronidazol preparations and heparin).

[Statistical analysis of the replacement circuit of the electrode- biological object-electrode system in electric stimulation of the heart]. / Statisticheskii analiz skhemy zameshcheniia sistemy élektrod- bioo''bekt-élektrod pri élektricheskoi stimuliatsii serdtsa.

Methods of topology and numerical parameters determination of electrode-bioobject-electrode equivalent circuit system was developed for electrocardiostimulants (ECS) operating under voltage source regime. It was established that in designing of ECS of the kind the rated value of load impedance be 200-300 omega. Empirical histograms and distribution law curves of RC-parameters of the mentioned equivalent circuit took into account the variability of these parameters both in patients and depending on the position of electrode heart as well.

[20-year experience with continuous endocardial stimulation of the heart]. / 20-letnii opyt primeneniia postoiannoi éndokardial'noi stimuliatsii serdtsa.

Twenty years' experience with continuous endocardial stimulation of the heart is summed up. The bulk of the reviewed data falls to the period of 1980 through 1985, when 1776 primary implantations were performed, whereas more than 3,000 implantations have been performed in the past 6 years. Opinions are voiced on many aspects related to endocardial stimulation. Endocardial application of electrodes is believed to be the principal method, while myocardial stimulation should only be done simultaneously with heart surgery. Electrode application via puncture is discussed with special reference to its advantages (possible application of two electrodes at once, small cosmetic defect) and possible side effects. The results obtained with a borer electrode, designed by the authors, are reported (130 cases). Complications associated with developing rhythm competition are discussed. It is proposed that the manufacture of asynchronous pacemakers be limited considerably, and that they should mostly be implanted in cases of clinically manifest myopotential inhibition.

[Use of the electric stimulation of the heart in sick sinus syndrome (achievements and disputable problems)]. / Primenenie élektricheskoi stimuliatsii serdtsa pri sindrome slabosti sinusovogo uzla (dostizheniia i diskutabel'nye voprosy).

Experience with cardiac electrostimulation for the weak sinus node syndrome is presented. Between 1982 and 1985, 296 primary pacemaker implantations were performed, or 21.44% of all primary implantations performed over that period. The weak sinus node syndrome was diagnosed on the basis of ECG, Holter's monitoring and the atrial stimulation test. Initial atrioventricular conductivity disorders were recorded in 22.1%. Atrioventricular conductivity deteriorated in 16.1% of patients after 2 to 8 years of follow-up. The right ventricle was the principal stimulus application site in 267 patients, right-atrial stimulation was performed in 9, and double stimulation (radio-frequency right-atrial stimulation plus right-ventricular or right-atrial stimulation on demand), in 20. Permanent atrial fibrillation developed in 25% of 144 patients, followed up for 2 to 8 years, and the implant was removed in 5 (14%) patients.

[Hemodynamic aspects of the transvenous electrodestruction of the atrioventricular junction]. / Gemodinamicheskie aspekty transvenoznoi élektrodestruktsii atrioventrikuliarnogo soedineniia.

Transvenous electrodestruction of the atrioventricular junction is an effective method of surgical treatment for supraventricular arrhythmias (paroxysmal tachysystoles) refractory to medication. However, it is central hemodynamic status alone that can be an objective indicator of favorable clinical effect. Major central hemodynamic parameters were examined in 52 patients before and after the operation. Considerable late postoperative improvement of the general condition and normalization of major central hemodynamic parameters were noted in most cases.

[Morphophysiological aspects of closed destruction of the conduction pathways of the heart]. / Morfofiziologicheskie aspekty zakrytoi destruktsii provodiashchikh putei serdtsa.

An experimental study in an electrophysiological model of the human body showed defibrillator discharge current, used for closed electrodestruction of His' bundle in cases of drug-resistant supraventricular tachycardias, to cause a spark discharge and high-energy shock wave around the intracardiac electrode resulting in contusion of the heart. To stop the sparking, it is suggested that impulse voltage should be reduced while its duration should be prolonged in order to maintain local destruction potential. The relationship between the damaging effect of the impulse, and its force and duration was examined so that optimum action parameters could be established.