[Compression anastomoses and their creation by SCD devices in experiment and clinical practice]. / Kompressionnye anastomozy i formirovanie ikh apparatami ASK v éksperimente i klinike.

New suture compression device (SCD) is developed and used in 119 patients for formation of esophageal-intestinal (10), esophageal-gastric (4), gastro-intestinal (10), intestinal-intestinal (19), intestinal-colon (18) and colon-colon (58) anastomosis. Insufficiency of sutures was seen in 2 (1.68%) patients after left-sided hemicolectomy (1) and resection of the sygmoid colon. One patient died, lethality was 0.84%.

[Phlegmon of retroperitoneal cellular tissue after endoscopic papillosphincterotomy]. / Flegmona zabriushinnoi kletchatki posle éndoskopicheskoi papillosfinkterotomii.

Phlegmon of retroperitoneal cellular tissue as a complication of endoscopic papillosphincterotomy (PST) was observed in 9 patients. All these patients in the first several hours after PST complained of pains in epigastrium and right hypochondrium. 2 days later the signs of pyogenous intoxication appeared. For diagnosis of complications after PST roentgenological and radionuclide methods as well as US examination and computer tomography were used. For exploration of retroperitoneal phlegmon extraperitoneal approach was employed. The phlegmon cavity was drained by number of tubes TMMK and aspiration-lavage treatment 3 patients died.

[Prophylaxis of postoperative wound complications]. / Profilaktika polseoperatsionnykh oslozhnenii ran.

Etiological factors of postoperative wound complications were studied in experiment on the models of surgical wounds in 1185 white Wistar rats, 28 mongrel dogs, 48 corpses, as well as the role of sutures and suture materials in development of eventrations and postoperative hernias. Morphological and microbiological studies have shown that the key role in etiology of wound complication belongs to morphofunctional substratem of the wound comprises, besides the type of the wound, the degree of traumatization and ischemia of paravulnar tissues, presence of devitalized tissue in the wound, the features and quantity of suture material, pattern and intensity of microbial dissemination, characteristics of sutures, etc. Isolated presence of only one from the mentioned factors in majority of cases does not result in development of wound complication. Thus, wound infection even by critical doses of monocultures and their associations would not in alle cases cause the development of would infection. Thus, critical dose of microbes in fresh wounds could not be considered as an obligatory factor which results in suppuration.

[Apparatus LPK-25 for esophago-intestinal anastomoses in gastrectomy and proximal resection of stomach]. / Apparat LPK-25 dlia formirovaniia pishchevodno-kishechnogo soust'ia pri gastréktomii i proksimal'noi rezektsii zheludka.

New method for performance of compression esophago-intestinal lasso-anastomosis is proposed. Th main point of the anastomosis consists in pressing of bowel walls to esophageal walls at small cuff by latex ring fixed by special apparatus LPK-25 introduced into the lumen of the bowel through additional incision which is anastomosed with the esophagus. Stretched latex ring creates elastic squeesing of tissues on caval cuff and stops blood flow. Cranially to the zone of compression accretion of esophageal walls with the bowel occurs, and caudally to this zone necrosis has appeared, which resulted in rejection of all compressing construction. These experimental and clinical examinations (31 gastrectomies, 1 proximal resection of the stomach) have demonstrated perspective of compressive lasso-anastomosis and its advantages in comparison with mechanical stapling and conventional hand-made intestinal suture with threads.

[Prospects and possibilities of prophylactic washing of surgical wounds by pulsating spurs of liquid under pressure]. / Perspektivy i vozmozhnosti profilakticheskogo promyvaniia khirurgicheskikh ran pul'situiushchimi struiami zhidkosti pod davleniem.

For bathing of surgical wounds as prophylaxis of wound infection, original apparatus which provides running of the liquid into the wound as impulse pulsating liquid spurts under pressure, is proposed. Washing of surgical wounds by pulsating spurs of liquid diminishes primary dissemination 1000 times and does not produce traumatic action on tissues, promotes washing out blood, fibrin and devitalized tissues from the wound which contributed to favourable healing. Prophylactic bathing of surgical wounds was used in clinic during 384 surgical interventions in abdominal cavity, which resulted in decrease of frequency of wound complications more than 5 times and reduction of hospitalization period after surgery.

[Effect of drugs of various groups on the course of experimental local pyo-inflammatory processes]. / Vliianie lekarstvennykh preparatov razlichnykh grupp na techenie éksperimental'nykh mestnykh gnoino-vospalitel'nykh protsessov.

To develop new approaches to providing higher efficacy of antibacterial therapy of purulent infection, experiments on 104 rats were performed. A decrease in the inflammation was shown in a series of the experiments with the dermonecrotic test using mono- and mixed cultures of Staphylococcus aureuo, Pseudomonas aeruginosa and Escherichia coli at the background of the animal treatment with anapriline and heparin. The effect of mezatone and dicinone was the opposite one. The drugs had different effects on the host response to the introduction of microorganisms of various species as mono- and mixed cultures. The experiments on a group of animals with wound infection not subjected to the preliminary alteration of the tissues demonstrated that the treatment with gentamicin and anapriline combinations was more efficient than the gentamicin monotherapy. The use of anapriline improved the antibiotic pharmacokinetics, had a favourable effect on the wound reparation, promoted a decrease in the count of viable microbes in the wound secretion and increased the antibiotic concentration gradient.

[Local preventive antibacterial therapy with polymer biocompatible combination]. / Polimernaia biosovmestimaia kombinatsiia dlia mestnoi profilakticheskoi antibakterialnoi terapii.

The paper provides data on the properties of the powdery antimicrobial absorbent Ambipor and the procedure of its use in the prevention of postoperative suppuration, which consists in application of the powder to the wound surface with a broken layer just before wound suture. It shows that a single application of Ambipor to wound suture. It shows that a single application of Ambipor to wound tissues at the end of an operation ensures high paravulnar tissue antibiotic concentrations which are many times higher those used in conventional antibacterial therapy. Implantation of Ambipor to operative wound tissue at the end of an operation aids to reduce the extent microbial dissemination by more than 100-1000 times, to accelerate reparative processes, stimulate early fibroplast activation, fibrillogenesis, scarring tissue maturation. Topical antibacterial therapy with the developed formulations is an effective tool in preventing postoperative wound complications. Its application to clinical practice enables the incidence of complications to be decreased by more than 4.5 times higher than those in the controls.

[Kapromed - antibacterial suture material]. / Kapromed - antibakterialnyi shovnyi material.

The paper gives data on the composition and strength characteristics and experimental and clinical findings of resolving antimicrobial suture materials, such as Capromed-type one, based on the modified caproic fiber coated by the biocompatible polymer PPB-1 which contains antimicrobial drugs. Capromed threads are demonstrated to have high strength characteristics and resolve in the body within 8-9 months. Coating the modified caproic fibers with the biocompatible copolymer imparts them pseudomonfilament characteristics and prevents the penetration of cellular elements to the thickness of threads. The content of antibacterial agents in the polymer coating confers prolonged antibacterial properties on Capromed. Desorption of antimicrobial agents from Capromed is conducive to more favourable healing, prevents the development of ligature fistulas, favours an over 4-fold reduction in the incidence of wound complications, as compared to the controls.

[Hernioplasty in direct inguinal hernia without opening and dissecting the hernial sac]. / Gernioplastika pri priamoi pakhovoi gryzhe bez vskrytiia i issecheniia gryzhevogo meshka.

The many-layers hernioplasty by N. N. Kanshin's method was performed in 533 patients for direct inguinal hernia. In 240 patients no opening and dissection of the hernial sac was performed. These patients had 1.9% of recurrences of hernias. The authors note the absence of negative consequences resulting from this peculiar intervention.

[Prolonged antibacterial action of polymer coated suture materials]. / Prolongirovannoe antibakterial'noe deistvie shovnykh materialov s polimernym pokrytiem.

The antimicrobial activity of capromed, a surgical polymer-coated sutural material containing dioxidine, quinoxidine or gentamicin was studied in vitro and in vivo. Capromed was shown to be active against the hospital strains of S. aureus, E. coli, Proteus spp., Klebsiella spp. and P. aeruginosa. The antimicrobial activity of ADH and AG threads was preserved for 3 to 4 days after implantation. The DH-2 and G-2 threads preserved their activity for 6 to 7 days. It was concluded that the duration of thread antimicrobial activity depended on the properties of the polymer coating the thread. Capromed was applied to 280 operation wounds in 275 patients. There was no wound suppuration in the group of patients after pure operations (n = 62). In the group of patients after conditionally pure operations (n = 130) suppuration was observed in 2 patients (1.3 per cent). In patients with contaminated wounds (n = 88) suppuration in 5 of them (5.7 per cent) was recorded. The total number of the purulent complications after using capromed in surgical operations amounted to 2.5 per cent. In the control group purulent complications were stated in 8.2 per cent of the cases.

[Complications of wound healing after appendectomy. Medical and economic aspects]. / Oslozhneniia zazhivleniia rany posle appendéktomii. Meditsinskie i ékonomicheskie aspekty.

The incidence of hospital and posthospital wound complications was studied in 236 patients, residents of Zelonograd, who underwent operation for acute appendicitis. The material was collected at City Hospital No. 3 and four out-patient clinics of Zelenograd. The incidence of suppuration of the surgical wound in the hospital period was 13.1%, that of nonpurulent complications was 9.3%, and the total incidence of the wound complications was 22.4%. In the posthospital period additional suppuration of wounds was encountered in 23.3% of patients, nonsuppurative wound complications in 17.1%, and the total incidence of posthospital wound complications was 40.3%. The frequency of rehospitalization was 5.5%, the incidence of postoperative hernias was 0.9%. The economical loss due to the development of wound complications in 236 patients operated on for acute appendicitis came up to 56,120 roubles.

[A goal-oriented local approach to the prevention of postoperative suppurative complications]. / Tselenapravlennyi mestnyi podkhod k profilaktike posleoperatsionnykh gnoinykh oslozhnenii.

A goal-oriented local approach to the prevention of postoperative purulent complications includes the use of compression suture devices to establish intestinal anastomoses and a complex of measures aimed at preventing surgical wound suppurations. To form compression anastomoses, use was made of the original AKA-2, AKA-4, IZhKA and SPTU devices fitted with compression clamps and of magnet facilities. The complex of measures to prevent postoperative wound suppurations includes optimal methods of laparotomy wound suture and the use of antibacterial suture materials, bathing of the wound by pulsed douche under pressure, local antibacterial prophylaxis by new dosage forms, preventive aspiration lavage and drainage of the wounds. Comparative clinical investigations carried out in more than 3,000 patients have demonstrated the effectiveness of the preventive methods under consideration and a decrease of the rate of postoperative wound suppurations from 11.7 to 2.3%. The rate of anastomosis failure amounted to 2.7%.

[Use of autologous dermal implants in surgery]. / Ispol'zovanie autodermal'nykh implantatov v khirurgii.

Autogenous dermal implants were used for plastic purposes in 359 patients who underwent operations for inguinal, postoperative, and diaphragmatic hernias, closure of laparotomy wounds and fixation of sutures on the esophagus. Suppuration of wounds occurred in 2% of cases. Recurrences were noted in 1.8% in treatment of inguinal hernias and in 2.9% of patients treated for postoperative hernias. There were no eventrations. Morphological examination showed autogenous dermal tissues to possess good properties as plastic material.

[Various approaches to the suturing of laparotomy wounds]. / Differentsirovannyi podkhod k zashivaniiu laparotomnoi rany.

The differential approach to suturing laparotomy wounds is described with special reference to the kind of operation, disease, state of the tissues in the field of the operation wound. The muscle-aponeurotic layer was sutured with the help of an autodermal strip, a modified method of putting removable stitches on the aponeurosis was used, in critical patients with peritonitis aponeurosis was not sutured. The methods were used in the complex treatment of 80 surgical patients, among them 38 patients had acute purulent peritonitis. The incidence of suppurative postoperative wounds was 3.8%, in patients with peritonitis it was 7.9%. There were no eventrations.