The first assessment of the impact of possible methods for the prevention of pancreatitis in endoscopic transpapillary interventions on the level of amylasemia

The paper is devoted to the assessment of prevention methods of post-ERCP pancreatitis on the analysis of hyperamilasemia in patients with pathology of the pancreatobiliary system, who underwent endoscopic transpapillary interventions.The aim of the study: initial assessment of the impact of possible methods for the prevention of pancreatitis in endoscopic transpapillary interventions on the level of amylasemia.The study is based on a continuous retrospective analysis of 73 case histories of patients undergoing EPST. For analysis, patients were divided into three groups: in the 1st, stenting of the pancreatic duct was performed by plastic stents, in the 2nd group, parapapillary blockade of 0.5% novocaine solution in a volume of 10ml was performed, in the 3rd group the described methods were not used. In the study, in patients with stenting, the development of hyperamilasemia was detected in 22% of cases, with only parapapillary blockade with novocaine solution - in 38% of cases, without the use of the described methods of prevention - in 15%. Amylasemia relief periods were significantly longer with stenting. The study demonstrated the equally low effectiveness of the methods used and the need to continue data analysis of described methods for the prevention of post-ERCP pancreatitis.

The use of endoscopic cryoapplicator in liver and gallbladder surgery

Purpose of the study. To investigate the efficacy of focal destruction tissues of local liver diseases, chole- and hemostasis of created endoscopic cryoapplicator in operations on the liver and gallbladder.Material and methods. Review the results of surgical treatment of 121 patients with various diseases of the liver (tumors, alveococcosis, parasitic and non-parasitic cysts) and gallbladder (chronic and acute cholecystitis) using a new endoscopic porous TiNi cryoapplicator. 49 patients were operated by an open method, 72 - laparoscopically. Hemo-and cholestatic control of the instrument was performed intraoperative and in postoperative period - by clinical condition of patient and by ultrasonography. Efficiency of destruction of focal liver diseases was investigated by histological examinations of surgical materials, is confirmed by the absence of relapses in the period from 4 to 6 years.The results. Cryoapplicator is simple in use, in sterilization, no energy consumption, can be used both in open surgery, particularly in arduous regions of the liver and laparoscopic procedures and, most importantly, patients with artificial cardiac pacemakers.Cryodestruction of the liver stump after its resection and the bed of the gallbladder after cholecystectomy reduces blood loss by 30-40%, and also helps to reduce the number of relapses of the disease. There were not observed bleeding and bile leakage in postoperative period. Histological examination proved picture of avascular necrosis, a violation of tissue structure of subjected to destruction liver focal diseases, death of epithelial lining of non-parasitic cysts and membranes of echinococcal cysts. There were not diseases recurrences in the period from 4 to 6 years.Conclusion. Endoscopic porous TiNi cryoapplicator is simple and convenient in use, it has a good hemo- and cholestatic effects, pronounced effect to local destruction of liver focal diseases, can be recommended for open and laparoscopic operations on liver.

Microsurgical decompression of the supraorbital nerve in the treatment of chronic neuropathic pain in the frontal-temporal area

Chronic headache is common. One of the causes of frontal-temporal pain may be compression of sensory nerves from the trigeminal nerve system, for example, the supraorbital nerve. Our study involved 12 women with symptoms of supraorbital nerve neuralgia resistant to drug correction. He underwent microsurgical decompression of the supraorbital nerve. The results of the operation were assessed by the change in the level of neuropathic pain using the PainDetect questionnaire and the degree of psychosocial maladjustment of the patient according to the MIDAS questionnaire, before and after the operation. The data obtained indicate a significant decrease in the level of neuropathic pain in patients 1 month after surgery and a significant minimization of the effect of headache on the quality of life in patients 3 months after surgery. Two out of 12 women did not notice any improvement, which required repeated delayed revision and extended proximal decompression of the supraorbital nerve with dissection of m. corrugator supercilii fibers. After the myotomy, pain regression was achieved and the patients noted that they were satisfied with the result.

Modern clinical and physiological bases of super microsurgery. The view of a physiologist and surgeons

This paper is a retrospective analysis of the long-term work of a large group of Russian scientists representing various Medical Institutions of St. Petersburg (in the past years of Leningrad) in the period from the 70s of the XX century to the present in the field of theoretical clinical lymphology. We aimed to discuss critical studies of a group of anatomists, in the sphere of the structure of lymphangions and lymph nodes in health and lymphedema of the lower extremities in humans. Experimental data of physiologists are presented, which made it possible for the first time to substantiate the functional mechanisms of active lymph transport in health and in lymphedema of the lower extremities. In addition, there are some results of testing biopsy specimens with various pharmacological agents and vasoactive substances. At last, there is an example of the clinical use of theoretical knowledge in the tactics of choice and expediency of surgical treatment of lymph drainage disorders in patients is given.

Postmastectomic lymphedema prevention: modern possibilities

A three-dimensional computer model of the topographic and anatomical variants of the lymph nodes in the axillary fossa gives reason to doubt the indisputability of the known data on the normal anatomy of the lymph nodes. This mainly concerns the presence of a lateral (shoulder) group of axillary lymph nodes (4-6 nodes), which can be located not only on the medial, but also on the posterior surface of the shoulder. In some cases, this group of axillary lymph nodes is generally absent in its typical place and is in close proximity to the central (intermediate) group of lymph nodes. Attention to the lateral (shoulder) group of lymph nodes is due to the fact that through them lymph drainage occurs from the entire superficial (epifascial) lymphatic system of the volar surface of the upper limb (skin and subcutaneous tissue). From the lateral group of lymph nodes, lymph drainage goes either to the central group or to the deltapectoral lymph nodes. In the course of axillary lymph node dissection of I, II and III levels in breast cancer, it is possible to save only the deltapectal lymph node with its afferent and efferent vessels, which provides full-fledged lymphatic drainage from the dorsolateral surface of the upper limb. But in this situation, without lymphatic drainage (superficial and deep) with preserved lymph production, the inner (volar) part of the upper limb remains, where lymphostasis begins to develop. An exception is the variant of localization of the brachial group of lymph nodes on the posterior surface of the shoulder, in which it is possible to preserve the lateral group of lymph nodes, which does not fall into the block of adipose tissue with other regional lymph nodes, and therefore partially preserve the lymph drainage from the medial surface of the ipsilateral upper limb towards the deltapectoral lymph node. Taking into account the topographic and anatomical variability of the lymph drainage collectors in the axillary fossa and the varied nature of the involvement of lymph nodes in the metastatic process, in each clinical case, the standard preoperative mapping of axillary lymph nodes (reverse lymphatic mapping) does not allow predicting the risk and timing of the development of postoperative upper limb lymphedema. The advantage of our technology two-contrast fluorescent lymphography - is the possibility of visual differentiation of all elements of lymph drainage from the mammary gland (indocyanine green - ICG) and the ipsilateral upper limb (methylene blue - MB). According to the results of the study, it will be possible to clarify the localization of the lateral (shoulder) group of axillary lymph nodes, topographic and anatomical features of the lymphatic drainage collectors in the axillary fossa and indications for lymphovenous shunting for primary surgical prevention of postmastectomy lymphedema of the upper limb.

Replantation fingertip without venous anastomoses in children

Objective. Traumatic complete and partial finger amputations are rare in comparison with adults. There are significant differences between mechanism of trauma, principles of treatment children with this type of injury in comparison with adults.Clinical case. A 15-years old child suffered from injury by axe, which caused the traumatic fingertip amputation of III and IV digits of his right hand. Replantation of both amputated parts was performed. Arteries and nerves were repaired with no veins anastomosed. As a result - survival of replanted parts.Discussion. A submillimeter diameter of vessels and potential venous congestion are basic problems that a surgeon deal with when perform the replantation of fingertips. Respectively, a difficulty in post-operative care of patient appears.Conclusion. Replantation of amputated part of finger is a golden standard of treatment of children with a described type of injury. The correct deliverance of amputated parts, the shortest time of ischemia as possible, a qualitive operation and post-operative care play an important role in successful survival of the replanted segments.

Tenosynovial giant cell tumor of the tendon sheat

The review article outlines modern aspects of the nomenclature, etiopathogenesis, diagnosis and treatment of tenosynovial giant cell tumor of the tendon sheath. This is the second most common benign neoplasm of the hand. Non-radical surgical treatment of this disease leads to a large number of recurrence. To avoid tumor recurrence, surgeon must to have the basics of plastic reconstructive surgery, use delicate instruments and optical magnification. In some cases, adjuvant radiation therapy and administration of tyrosine kinase inhibitors may be required.

Reconstruction of brachial artery in posttraumatic false aneurysm

In the article were reflected important issues of ethiopathogenesis, diagnostics and treatment of false aneurysm of brachial artery. Literature view and personnel experience of authors are shown that main causes of developing false aneurysm of brachial artery are non-revealing vessels injuries due to diagnostic-treating mistakes. Despite of using modern methods of mini-invasive treatment of aneurysm treatment till now the open surgery is continued to be a gold standard. In the clinical case are shown all features of diagnostics and successful treatment of false aneurysm of brachial artery with good middle-remote results.

Features of minimally invasive ligamentotomy of the thumb A1 pulley (our experience)

Objective. Stenosing tenosynovitis (Nott’s disease, "trigger finger") is one of the most common pathologies of the hand which hand surgeons and orthopedic surgeons have to deal with. A variety of conservative methods are used to treat “trigger finger", including individual splinting and corticosteroid injections. Surgical treatment consists of dissection of the A1 pulley. Traditionally, the operation starts with a small incision. However, in recent years, a number of articles have appeared that report that percutaneous ligamentotomy on II-V fingers is a safe and effective alternative to an open surgery. Due to anatomical features, some authors do not recommend performing a percutaneous ligamentotomy on the thumb, fearing the damage it can cause to the digital nerves.The purpose of this research is to show that the minimally invasive needle ligamentotomy of the thumb A1 pulley is a safe procedure and to conduct the approbation of the offered method.Material and methods. The research consisted of two parts - anatomical and clinical. In the anatomical part of the research (8 upper extremities of 4 unfixed corpses), we proposed the safe accesses in order to conduct percutaneous ligamentotomy of the thumb A1 pulley.In the clinical part of the study we tested a minimally invasive ligamentotomy and analysed the results of treatment in 109 patients with stenosing tenosynovitis of the thumb II-IV stage by Green aged from 28 to 80. All patients received minimally invasive ligamentotomy of the A1 pulley with 18g needle under local anaesthesia (120 surgeries). Average length of the operation was several minutes. All procedures were performed outpatiently. Evaluation of the results of treatment was performed using the Visual Analog Scale (VAS) and Gilberts questionnaire. The observation period was from 12 months up to 24 months.The results. In most cases both clinical and esthetical results were excellent. It was possible to eliminate the “trigger” of the finger intraoperatively for all patients. However, 6 (5.5%) patients complained about the presence of residual clicks due to incomplete dissection of the ligament at the control examination a week later. Percutaneous ligamentotomy was conducted again on all patients with successful outcomes. No recurrence of the disease was noted. 17% of patients tend to complain about pain in the A1 pulley localization during the first week after the operation.Conclusion. The empirical findings prove the efficiency and safety of percutaneous ligamentotomy of the thumb A1 pulley. One of the merits of this technique is a lower risk of postoperative complications and lower treatment expenses. This technique can be successfully used in the practice of hand surgeons in the outpatient setting that have the experience with the conduction of open operations.

One-stage reconstruction of bone defects with fibula perforator flap

At the current stage of reconstructive surgery development, perforator flaps have confidently taken a priority place when choosing a method for wound defects cover. However, wounds with significant volume defects of both soft tissues and the bone skeleton remain especially difficult challenges for the surgeon. The desired result of such defects repair could be a technique that allows surgeons to carry out an effective reconstruction in one step.The paper describes in detail the surgical and vascular anatomy, design, preoperative preparation and surgical technique for the mobilization of the free vascularized fibula perforator flap containing a fragment of the bone di-aphysis. Clinical examples of orthoplastic reconstruction in different locations are presented.The authors conclude that free fibula flap allows effective one-stage reconstruction of extensive wounds after trauma or oncological resections, including extensive defects of the skeleton, without significant loss of support function in the donor area. A chimera-style composite flap, which contains soft tissues and a fragment of the fibula, can already be called as a “workhorse" for orthoplastic reconstruction on the lower extremities and in the field of maxillofacial surgery.