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.

Piezoelectric Accelerator.

Here we propose the conception of small-size piezoelectric accelerator of charged particles that operates due to the piezoelectric effect at varying mechanical force applied to piezoelectrics in vacuum. The accelerating voltage and the energy of accelerated particles are estimated. In the proof-of-principle experiment we demonstrate the effect of the emission of X-ray radiation at the mechanical compression of piezoelectric ceramics in vacuum. The compression leads to the appearance of charges and potentials on the surfaces of the piezoelectrics and also to the arising of the electric field in vacuum. Electrons are accelerated in the electric field, strike the matter and produce the X-ray radiation. In the experiment, we have observed emission of the characteristic and bremsstrahlung X-ray radiation of energy up to 60 keV due to the compression of piezoelectric ceramics in vacuum. This means that electrons are accelerated in the piezoelectric accelerator up to the energy at least of 60 keV. The agreement of calculated and experimental data confirms the conception. Advantages of the piezoelectric accelerator and possibilities of its development and applications are discussed.

[Fibrinolytic activity of duodenal mucosa in elderly and senile patients with the ulcer hemorrhage]. / Fibrynolitychna aktyvnist' slyzovoï obolonky dvanadtsiatypaloï kyshky u khvorykh pokhyloho ta starechoho viku z vyrazkovoho krovotecheiu.

The duodenal mucosa fibrinolytic activity was investigated in elderly and senile patients with chronic ulcer, complicated by hemorrhage. In noncomplicated duodenal ulcer the mucosal fibrinolytic activity of anterior intestinal wall prevailed such an activity of posterior wall. It preserved in the hemorrhage occurrence also. Maximal meaning of indices were noted on the second-fourth day after hemorrhage beginning in anterior duodenal wall and on the first day in posterior one. In term up to 8 days fibrinolytic activity had lowered, but in mucosa of anterior duodenal wall it exceeded by 44% the index in control group and of posterior wall--by 28%. Treating the patients it is necessary to take into account the results obtained, especially in presence of endoscopic signs of unstable hemostasis.

[Clinical sequelae of blood remaining in the intestinal inlet after the hemorrhage]. / Naslidny perebuvannia krovi v prosviti kyshechnyku pislia krovotechi.

In experiment there were revealed significant changes of composition of aerobic and anaerobic microorganisms in the jejunum and ileum mucosa after hemorrhage of middle severity. While application of antibiotics these changes were more pronounced, demanding serious substantiation of its application.

[Surgical treatment of bleeding duodenal ulcer in elderly and senile patients with intraoperative verification of the diagnosis]. / Khirurhichne likuvannia vyrazky dvanadtsiatypaloï kyshky z krovotecheiu u khvorykh pokhyloho ta starechoho viku z intraoperatsiinoiu veryfikatsiieiu diahnozu.

The method of duodenotomy performance for duodenal ulcer with hemorrhage was proposed. Duodenum was dissected longitudinally across the ampulla lower edge going all over medial edge of pars descendens, permitting not only doing the revision but revealing the hemorrhage source, securing homeostasis. The rules of local hemostasis performance were elaborated. Application of the above mentioned access prevents damage of nervi vagi duodenal anterior brunch, guaranteeing the duodenal motor-evacuation function preservation.

[Proteolytic activity of duodenal mucosa in elderly and senile patients in the presence of duodenal hemorrhage from ulcer]. / Proteolitychna aktyvnist' slyzovoï obolonky dvanadtsiatypaloï kyshky u khvorykh pokhyloho ta starechoho viku za naiavnosti vyrazkovoï duodenal'noï krovotechi.

During investigation of proteolisis of duodenum mucosa in patients of elderly and senile age with duodenal ulcer, complicated by hemorrhage, in terms up 8 for days there was revealed considerable increase of proteolytic activity, especially of high-molecular proteins and collagens, maximum--on the first day of hemorrhage. In all terms the revealed activity of anterior wall of duodenum was higher, than posterior.

[The Helicobacter pylori role in origination of hemorrhage in elderly and senile patients with duodenal ulcer disease]. / Rol' Helicobacter pylori u vunyknenni krovotechi pry vyrazkovii khvorobi dvanadtsiatypaloï kyshky u patsiientiv pokhyloho ta starechoho viku.

During examination of 37 patients with duodenal ulcer disease aging more than 60 years it was established that while presence of the ulcer complicated by bleeding the revelation frequency of Helicobacter pylori (HP) in gastric antrum is increasing up to 74% and in cases of noncomplicated ulcer--70%. HP was revealed most frequently in patients with "senile" ulcer. For an "inveterate" ulcer the presence of S-like forms is typical. The absence of HP in 41.6% patients with "senile" ulcer testifies the presence of other mechanisms of occurrence and support of bleeding.

[Surgical treatment of giant posterior ampullar duodenal ulcer with bleeding in the elderly and senile patients]. / Khirurhichne likuvannia hihants'koï zaampul'noï vyrazky dvanadtsiatypaloï kyshny z krovotecheiu u khvorykh pokhyloho ta starchoho viku.

There was experimentally elaborated and introduced to clinical practice the method of surgical treatment of giant retroampullar ulcer of duodenal posterior wall with hemorrhage in elderly and senile patients. Physiological exteriorization of ulcer out of duodenal borders and original method of tamponage using the small intestine wall with complete coverage of duodenal lumen and restoration of intestinal passability performing gastroenteroanastomosis antecolica anterior and Brown anastomosis are the main advantages of this method. The method guarantees the ulcer healing, prophylaxes the recurrency rise due to distribution of the contents motion in two streams.

[The surgical treatment of perforated bleeding duodenal peptic ulcer in middle-aged and elderly patients]. / Khirurhichne likuvannia penetruiuchoï krovotochyvoï vyrazky dvanadtsiatypaloï kyshky u khvorykh pokhyloho ta starechoho viku.

The surgical hemostasis method was elaborated and introduced in the clinic according to the data of morphological investigation of bleeding penetrating ulcer of the duodenal ampulla posterior wall in elderly and senile patients.

[Classification and selection of treatment of chronic gastroduodenal ulcer complicated by hemorrhage in elderly and senile patients]. / Klasyfikatsiia i vybir taktyky likuvannia khronichnoï hastroduodenal'noï byrazky, uskladnenoï krovotecheiu u khvorykh pokhyloho ta starechoho viku.

The classification of chronical bleeding gastroduodenal ulcer in elderly and senile patients, considering the blood loss severity and concurrent pathology, was proposed. The tactics of treatment--conservative, operative, or actively-waiting one--was determined according to the classification adduced. The proposed classification application and the tactics of treatment also have permitted to reduce mortality from 15.7 to 11.2%.

[Performance of organ salvaging intervention for duodenal ulcer with bleeding in elderly and senile patients]. / Vykonannia orhanozberihaiuchykh vtruchan' z pryvodu vyrazky dvanadtsiatypaloï kyshky z krovotecheiu u khvorykh pokhyloho ta starechoho viku.

An experimentally elaborated and introduced in clinical practice organpreserving methods of surgical treatment of the bleeding duodenal ulcer, localized on the ampullar posterior wall in elderly and senile patients, mentioning the ulcer tamponade with complete duodenal inlet overlapping and the gut passability restoration using gastroenteroanastomosis antecolica anterior formation with anastomosis according to Brown, were proposed. The secure stoppage of bleeding is guaranteed by the application of the method, what is simple in application.

[The formation of a small intestine-large intestine anastomosis: the end to the side method]. / Sposib formuvannia tonko-tovstokyshkovoho anastomozu kinets' u bik.

The longitudinal ileotransversostomy forming method according to which the ileum is divided at an angle of 45 degrees to the mesentery edge, forming a single layer anastomosis end to the side at an angle of 45 degrees in isoperistaltic mode, was elaborated. Clinico-experimental investigations were conducted on 45 mongrel dogs. Method was applied in 6 patients with malignant tumor of caecum and colon ascendens.

[The rehabilitation of compensatory changes after right side hemicolectomy]. / Vidnovlennia kompensatornykh zmin pislia pravobichnoï hemikolektomiï.

Macro- and microscopic changes in the anastomosis region, motor-emptying function of the small bowel, and immunological changes also, were experimentally investigated after the right-sided hemicolectomy conduction. Compensatory dilation of colon, transversum for the absorbtion square increase with simultaneous wall thinning was revealed. The stump may reduce or dilate. Lymphoid follicles appear in the small bowel submucosa. The accelerated emptying of the small bowel contents become slower after its circular division up to submucosa on 20 and 40 cm distance from anastomosis. General T-lymphocytes quantity, T-helpers/T-suppressors ratio reduces abruptly on the third day with gradual increase on the 5th, 7th and 30th day. At the same time the IgM, IgG, IgA levels, the index of spontaneous and stimulated NBT-test rises on the third day, stabilizing slowly before the 30th day.