[Treatment of ventral hernias in patients with morbid obesity]. / Taktika lecheniya ventral'nykh gryzh u patsientov s morbidnym ozhireniem.

The review is devoted to the treatment of ventral hernias in patients with morbid obesity. This issue is important due to significant number of such patients and no unambiguous clinical recommendations. The advantages of simultaneous surgery (with bariatric intervention) are obvious, i.e. lower risk of postoperative hernia incarceration and no need for re-hospitalization with another intervention. High risk of bariatric population makes it necessary to minimize surgery time and surgical trauma. A staged approach with reducing body weight surgically or conservatively before hernia repair is often chosen. Hernia repair should be performed using laparoscopic or robotic techniques with obligatory use of mesh implants. Panniculectomy or abdominoplasty as the main surgery is a valid option. Currently, it is necessary to develop clear criteria for selecting patients with morbid obesity for staged and simultaneous treatment of ventral hernias.

[Abdominal pseudohernia: diagnosis and treatment]. / Abdominal'nye psevdogryzhi: diagnostika i lechenie.

OBJECTIVE: To present an effective treatment strategy for abdominal pseudohernia considering own clinical experience and literature data. MATERIAL AND METHODS: The authors report surgical treatment of 2 patients and therapeutic management of 1 patient with abdominal pseudohernia. Moreover, current state of this problem is analyzed according to literature data in Pubmed, Google and e-library databases. RESULTS. P: Seudohernia is followed by asymmetrical protrusion of abdominal wall, prolapsed site is not involved in breathing; patients cannot tense muscles in the affected area. T8-L2 skin sensitivity impairment or hyperesthesia may be observed. Denervation is confirmed by electroneuromyography. Ultrasound, CT and MRI reveal no defect in abdominal wall. However, its thinning within denervation area is visualized. Treatment is determined by the cause and reversibility of denervation. If mechanical damage (intersection) of T8-L2 nerves following trauma or any manipulation is absent, the main cause is herpes zoster neuropathy. Surgical treatment is not indicated. Antiherpetic therapy and physical therapy result functional restoration of abdominal wall muscles within 2-4 months. In case of mechanical cause of pseudohernia, it is advisable to wait at least a year after denervation for real assessment of situation. Partial or complete re-innervation is possible throughout this period. Surgical treatment is indicated if re-innervation is absent. An effective technique presented in this manuscript is reconstruction of the prolapsed area with several imbrication sutures in several planes up to symmetry with contralateral area with subsequent reinforcement with a mesh implant if necessary. There were no relapses in 2 our patients within 5 and 7 years, respectively. CONCLUSION: In our opinion, this report is the first manuscript devoted to systematic analysis of diagnosis and treatment of abdominal pseudohernia in available literature. Surgical treatment is not indicated for postherpetic pseudohernia. It is carried out for pseudohernia persisting for more than 1 year if its cause is trauma or any manipulation.

[Cancer of terminal part of common bile duct in a patient with heterotaxy syndrome]. / Rak terminal'nogo otdela obshchego zhelchnogo protoka u patsienta s sindromom geterotaksii.

Case report is devoted to successful pancreatectomy for cancer of terminal part of common bile duct in a patient with heterotaxy syndrome. The main difficulties during dissection of pancreaticoduodenal complex arose due to anatomical disorientation and the lack of standard topographic and anatomical landmarks. Preoperative computed tomography with assessment of visceral vessel anatomy is essential in all patients with biliopancreaticoduodenal tumors. If heterotaxy syndrome is suspected, additional examination is required to detect other potential abnormalities and prepare for unusual situation.

[Simultaneous surgery for complicated giant post-traumatic phrenic hernia in a patient with morbid obesity and diabetes mellitus type II]. / Opyt vypolneniya simul'tannoi operatsii po povodu oslozhnennoi gigantskoi posttravmaticheskoi diafragmal'noi gryzhi u patsienta s morbidnym ozhireniem i sakharnym diabetom II tipa.

Surgical treatment of post-traumatic right-sided phrenic hernia is associated with certain technical difficulties due to topographic and anatomical features. Morbid obesity combined with diabetes mellitus type II is one of the main factors complicating any surgical thoracic or abdominal surgery and further rehabilitation. We report simultaneous surgery for complicated post-traumatic right-sided phrenic hernia in a patient with morbid obesity and diabetes mellitus type II. Surgical correction of giant phrenic hernia facilitated further effective treatment of morbid obesity and concomitant diabetes mellitus type II.

[Multidisciplinary approach to surgical treatment of patients with superficial abdominal obesity]. / Mul'tidistsiplinarnyi podkhod k khirurgicheskomu lecheniyu patsientov s poverkhnostnym abdominal'nym ozhireniem.

OBJECTIVE: To analyze an effectiveness of laparoscopic surgery with simultaneous abdominoplasty in patients with superficial abdominal obesity. MATERIAL AND METHODS: Laparoscopic abdominal, retroperitoneal and pelvic surgery with simultaneous abdominoplasty was performed in 25 patients with body mass index >40 kg/m2. RESULTS: Surgery time and intraoperative blood loss were significantly higher after simultaneous surgery (p<0.05). However, these differences did not influence postoperative period. Duration of analgesic therapy, activation of patients and length of hospital-stay, as well as overall postoperative morbidity were similar in both groups (p>0.05). Simultaneous abdominoplasty resulted significantly better quality of life according to almost all parameters (p<0.05). CONCLUSION: According to certain indications, abdominoplasty is advisable as the first stage of simultaneous surgery in patients with large subcutaneous fat apron after bariatric surgery or in those with primary superficial abdominal obesity. The positive aspects of abdominoplasty are simplification of laparoscopic stage, reduced intra-abdominal pressure in postoperative period, excellent and good aesthetic effect and improved quality of life.

[Injected non-absorbable fillers in large volumes]. / In''ektsionnye nerassasyvaemye fillery miagkikh tkanei v bol'shikh ob''emakh.

AIM: To present treatment strategy for large volumes of injectable non-absorbable 'shell-less' soft tissue fillers (vaseline, synthol, silicone etc.). MATERIAL AND METHODS: The authors present an experience of surgical treatment of 8 patients who underwent injections of medical vaseline (breast augmentation, n=5) and synthol (muscles enlargement, n=3) and review of the current literature devoted to this problem. RESULTS: Injection of large amounts (over 50 ml) of non-absorbable fillers into soft tissues is unacceptable and leads to numerous complications. Oil-based 'shell-less' fillers cannot be removed by minimally invasive techniques (puncture, mini-incisions, etc.) due to multiple diffuse lesions in the form of oleogranulomas (cysts of different size) and surrounding widespread inflammation and fibrosis of tissues. Surgery is the only adequate method. However, this approach is followed by scars and often tissue contour deformation. Migration of these fillers to other anatomical areas (from the neck to the lower extremities) significantly complicates the situation, treatment and results. In case of categorical refusal of patients from surgical treatment and no complaints, they should be properly informed about possible consequences and complications and dynamic medical supervision is necessary. Intraoperative ultrasound examination is useful for the control of radical removal of pathological areas. Timely removal of non-absorbable fillers allows to avoid serious complications and to achieve good aesthetic results.

[Advanced skull defect repair]. / Rekonstruktsiia obshirnogo kombinirovannogo defekta cherepa.

It is presented case report of successful repair of advanced combined defect of parietal-temporal-occipital scalp over one-half of skull vault with an excellent cosmetic result. To do this, the authors used a staged expander dermal tension, i.e. repeated stretching of the remaining scalp tissues combined with cranioplasty using mesh titanium implant.

[The role of CO2-laser in scarring management]. / Otsenka vozmozhnostei uglekislotnogo lazera v lechenii rubtsovykh deformatsii.

AIM: To assess the role of CO2-laser in treatment of various scars and to determine the indications for its application. PATIENTS AND METHODS: It has been carried out a prospective analysis of treatment of 218 patients with scars of different duration, locations and anatomic areas with the use of CO2-laser for the period 2011-2017. POSAS scale and sonography were used for analysis. RESULTS: 1. Laser therapy is not effective for scarring-related functional defects (contractures, ectropion, microstomia), when surgery is indicated. 2. The outcomes of treatment (both surgical and laser) depend on the time of existence of the scars rather their cause and anatomical region. 3. Laser therapy is not effective enough for formed scars existing over 12 months. 4. Laser therapy is effective for immature scars, especially indicated for cicatricial deformation when the aesthetics cannot be repaired with traditional surgery. CONCLUSION: Application of CO2-laser in scars treatment with regard to its real efficiency determines the effectiveness of therapy.

[STUDYING SOME PHARMACOLOGICAL EFFECTS OF NEW 3-HYDROXYPYRIDINE DERIVATIVE].

It was established that a new 3-hydroxypyridine (3-HP) derivative, 2-ethyl-6-methyl-3-hydroxypyridine L-aspartate (3-HP), in small doses (1 and 5 mg/kg) increased physical performance in treadmill and swimming tests on rats. The new substance showed greater or equal effects compared to the reference actoprotector drugs metaprot and ladasten in much higher doses. The gluconeogenesis inhibitor tryptophan significantly (74 ± 5%, p < 0.01) prevented this stimulatory effect of 3-HPA in the treadmill test on rats. 3-HPA at a higher dose (30 mg/kg) had marked antiamnesic effect on various models of amnesia in mice. It was more effective than reference drugs mexidol (another 3-HP derivative) in a dose of 30 mg/kg and nootropic drug piracetam in a dose of 200 mg/kg, but had equal effect with these drugs in doses of 50 and 800 mg/kg, respectively. 3-HPA (30 mg/kg per day) had neuroprotective effect in rats with brain ischemia and decreased the neurologic deficiency more effectively than mexidol (50 mg/kg per day).

ACTION OF NEW 3-HYDROXYPYRIDINE DERIVATIVES WITH ANTI-NAUPATHIA PROPERTIES ON CENTRAL NEURONS.

Experiments with cats showed that microinjections into the lung of new 3-hydroxypyridine derivatives SK-119 and IBKhF-27 had a direct action on 50 and 84 % of medial vestibular nucleus (MVN) neurons respectively. The inhibitory response to the compounds was observed 6 and 25 times more frequently than exciting; inhibition by IBKhF-27 was observed 1.9 times more frequently than by SK-119. Also, microinjections of SK-1 19 and IBKhF-27 acted directly on 44 % and 81 % of cat's Purkinje cells, respectively. In case of Purkinje cells, the inhibitory reaction was seen 5.5 and 25 times oftener than exciting, respectively, and inhibition by IBKhF-27 occurred 2.1 times more frequently than by SK-119. Investigations of rat's cerebellum sections evidenced that 5 mM of IBKhF-27 inhibited population responses of Purkinje cells 95 1 3 %. In the presence of specific noncompetitive NMDA-receptor antagonist (MK-801, 100 pM) the depressive effect was annulled almost fully by 96 * 2 %. It follows that IBKhF-27 nearly entirely inhibits synaptic transmission from cerebellar parallel fibers to Purkinje cells, while MK-801 has a similarly strong anti-depression effect that testifies the involvement of the NMDA-receptor complex predominantly.

[STUDIES OF THE ANTIHYPOXIC AND ANTIAMNESTIC EFFECTS OF MELATONIN IN ANIMALS].

Experiments with mice showed that in a multitude of acute hypoxia models (normobaric hypoxic hypoxia with hypercapnia, hypobaric, hemic and histotaxic) the antihypoxic action of a single intra-abdominal dose of melatonin surpasses greatly amtisol, the standard antihypoxic agent. Single melatonin injection produced a strong antiamnestic action on various amnestic models (scopolamine-induced, acute normobaric hypoxia with hypercapnia, and a combination of extreme factors) which was much better than of pyracetame, a well-known nootropic (mind-stimulating) drug. Increase of the melatonin dose from 1 mg/kg to 20 mg/kg amplified both the antihypoxic and antiamnestic effects. Melatonin inhibited orthodromal population responses in surviving sections of rat's hippocampus (by 24 ± 3% at 2 mM; by 72 ± 6% at 5 mM). Besides, the inhibiting action of lusindol, a blocker of melatonin receptors MT1 and MT2--was virtually fully neutralized. Therefore, melatonin inhibits transmission within the Schaffer collateral--CA1 pyramidal neurons synapse by stimulation of melatonin receptors MT1 and MT2; higher melatonin concentrations (0.5 to 5 mM) enhance its effectiveness.

Photochromic processes in di(mercaptoquinolinato)Ni(II) complex and perfluordiphenyl disulfide solutions.

Laser flash photolysis was used to study the nature and reactions of intermediates for a novel photochromic system consisting of perfluorodiphenyl disulfide (F(5)C(6)SSC(6)F(5) = (SBF)(2)) and a flat di(mercaptoquinolinato)Ni(II) (Ni(SC(6)H(3)NC(3)H(3))(2) = Ni(SR)(2)) complex in benzene solutions. Under UV-radiation disulfide dissociates into two sulfur-containing radicals (F(5)C(6)S˙ = ˙SBF) that vanish in recombination. In the presence of the Ni(SR)(2) complex recombination competes with radical coordination yielding the radical (SBF˙)Ni(SR)(2) complex. This complex has an absorption band in the visible region and disappears in the second-order reaction when radical-complex recombines into dimer ((RS)(2)Ni(SBF)(2)Ni(SR)(2)). Subsequent dimer dissociation into initial disulfide and two Ni(SR)(2) complexes completes the photochromic cycle.

Multipole refinement and electron density analysis in natural borosilicate datolite using X-ray diffraction data.

The electron density distribution in the layer silicate datolite, Ca[BOH(SiO4)], was analyzed using high-precision single-crystal X-ray diffraction data (Mo Kalpha, T=293 K). The Hansen-Coppens multipole model and Bader's topological analysis of the electron density provides a basis for the quantitative characterization of the bonded interaction of datolite. The results are presented both in the form of maps of the electron density distribution and its Laplacian, and in a compact way in terms of the critical points of the electron density. The relative electronegativities are also discussed. It was shown that closed-shell type interactions exist between Ca and O atoms, whereas Si-O and B-O bonds exhibit an intermediate nature with a strong covalent component. An analysis of the topology of the electrostatic potential demonstrates the relevance of considering this physical property to obtain a complete picture of structure-forming factors.