Prophylaxis of complications in operations for cancer of middle and lower thirds of the esophagus

Objective. Improvement of the surgical treatment results in esophageal cancer. Маterials and methods. Results of surgical treatment of 43 patients, having cancer of middle and lower thirds of the esophagus, were analyzed. Lewis operation was performed in 38 patients, and Garlock operation – in 5. Circular suture stapler with second row of a П-like manual sutures was applied in 28 patients. In 15 patients anastomosis was formatted, using hand-sewn two-row suture. The method of anastomosing choice had depended upon local and general factors: the tumor localization, the esophageal wall changes in anastomotic site, degree of the water-electrolyte disorders, the protein balance, concurrent pathology. Prophylaxis of postoperative morbidity consisted of preoperative correction of laboratory indices, treatment of concurrent pathology, choice of the anastomosis formation method, postoperative intensive therapy. Results. Postoperative complications had occurred in 1 (2.3%) patient. Mostly frequent postoperative complication after resection for esophageal cancer constitute insufficiency of esophago-gastric anastomosis, which occurs under impact of general and local factors. General factors: disorders of the blood circulation, caused by cardiac insufficiency, hypoxia due to pulmonary insufficiency, coagulopathy, disorders of the protein and water-electrolyte metabolism. Reduction of influence of general factors on the postoperative morbidity occurrence was achieved using the intensive preoperative preparation conduction. Conclusion. The postoperative morbidity prevention turns effective while its accomplishment on all stages of treatment: during preoperative preparation, intraoperatively and postoperatively.

The arch-like plasty of the left atrium in correction of a mitral valve failure

Objective. Studying the possibilities of the method of the left atrium arch-like plasty while correcting of a mitral failure in combination with the left atrium dilatation. Materials and methods. Into the analysis of the surgical treatment results in 190 patients, suffering mitral failure in combination with the left atrium dilatation, who were operated in the National Institute of Cardio-Vascular Surgery named after N. M. Amosov NAMS of Ukraine in a period from 01.01.2012 to 01.01.2021 yr, were included. The main group consisted of 103 patients, to whom correction of a mitral failure in combination with original procedure of the arch-like plasty of left atrium was performed. Into a control group 87 patients were included, to whom the correction of a mitral valve failure was done without concomitant plasty of left atrium. Results. Of 103 operated patients of the main group on the hospital stage 1 have died (0.9% lethality). Dynamics of echocardiographic indices on the treatment stages was following: definitely-systolic index of the left ventricle - (63.1 ± 11.3) ml/m2 (preoperatively), (58.3 ± 8.4) ml/m2 (postoperatively), (49.4 ± 9.2) ml/m2 (remote period); the left ventricle ejection fraction: 0.52 ± 0.04 (preoperatively), 0.55 ± 0.04 (postoperatively), 0.57 ± 0.03 (remote period). Diameter of left atrium: (58.8 ± 6.4) mm (preoperatively), (41.4 ± 5.3) mm (postoperatively), (43.9 ± 2.3) mm (remote period). Sinus rhythm in a remote period was stable in 75 (78.9%) of 95 patients. Of 87 operated patients of a control group 2 died (lethality 2.3%). Dynamics of the echocardiographic indices on the treatment stages was following: definitely-systolic index of left ventricle- (67.3 ± 11.3) ml/m2 (preoperatively), (60.4 ± 9.3) ml/m2 (postoperatively), (52.7 ± 7.2) ml/m2 (remote period); the left ventricle ejection fraction: 0.52 ± 0.05 (preoperatively), 0.54 ± 0.05 (postoperatively), 0.54 ± 0.03 (remote period). Diameter of left atrium: (59.5 ± 2.3) mm (preoperatively), (57.5 ± 3.7) mm (postoperatively), (68.5 ± 3.4) mm (in remote period). Sinus rhythm was stable in 18 (22.5%) of 80 patients, followed in the remote period. Conclusion. The arch-like plasty of left atrium is a low-traumatic and effective procedure, leading to significant improvement of the left atrium morphometry and accompanied by low risk for postoperative lethality.

Efficacy of intravascular embolization in profuse hemorrhage from complicated duodenal ulcers

Objective. To estimate the efficacy of intravascular embolization in profuse hemorrhage from complicated duodenal ulcers. Materials and methods. Into the investigation 80 patients were included, operated for the profuse hemorrhage complication of duodenal ulcers, penetrating into pancreatic head. The patients were distributed into two groups: the control - 40 patients, in whom the standard methods of the hemorrhage arrest were applied, and the main - 40 patients, in whom the method elaborated was used. Results. In the main group in postoperative period the complications have had occur in 1 (2.5±0.2%) patients (p<0.001) only - the duodenal fistula development. There was verified, that the best results of hemostasis in hemorrhage from penetrating duodenal ulcers were obtained in the patients of the main group, in whom іntraoperative endovascular arrest of the hemorrhage together with the ulcer suturing was applied, because in 100% of patients of this group the definite hemostasis was achieved. Conclusion. The proposed method of intraoperative endovascular arrest of hemorrhage from penetrating duodenal ulcer guarantees a qualitative hemostasis, lowers the rate of the hemorrhage early recurrence and the need for relaparotomy performance, and raises the surgical treatment quality.

Impact of the small bowel impassability on expression of the hypoxia-induced factor-1α

Objective. Studying of the hypoxia-induced factor-1α expression and peritoneal oxygenation in experimental small bowel intestinal impassability. Materials and methods. The investigation was done on 18 laboratory animals, in which 62 metrics of direct oxymetry performed with the objective to study the impact of the small bowel impassability on velocity of the mass transduction and partial pressure of oxygen and the hypoxia-induced factor-1α expression, influenced by hypoxia. Results. In experimental ileus, complete or partial one, partial pressure and velocity of the oxygen mass-transduction in peritoneum were statistically significantly lower, than such in a control, indicating on inhibition of cellular structures, utilizing the oxygen, what promotes the adhesive disease occurrence. Experimental ileus have led to lowering of the oxygen partial pressure in peritoneum by 88% - from 28.7 (in a control) to 3.5 mm Hg (p<0.01). The partial (by 277.8%) and the complete (by 248.2%) experimental ileus was characterized by enhancement of the hypoxia-induced factor-1α expression. Conclusion. Ileus, accompanied by change in the parietal and visceral peritoneum oxygenation, stimulates the abdominal cavity adhesive process development.

Application of the immune-correcting therapy in complex treatment of surgical forms of erysipelas

Objective. To investigate the efficacy of immunomodulating and immunostimulating therapy in complex treatment of patients, suffering surgical forms of erysipelas.Materials and methods. Retrospectively and prospectively there were analyzed 284 patients’ hospital charts, who were treated stationary in Centre of Purulent-Septic Surgery of Zaporizhzhya Municipal Hospital №3 in 2016 - 2021 yrs. Results. In patients, suffering erythematous form of erysipelas, disorders in cellular and humoral chains of immunity were not revealed. The immune disorders formula in bullous form was following: CD3 + 1, CD4 + 1, CD8-1, CD16-2, CD22-1, what witnessed about misbalance of the immune system Degree I, of possibly compensatory character; in a phlegmonous one - CD3 + 1, CD4-1, CD8-1, CD16-2, CD22-1, witnessing actuality of the immune disorders of Degree І, while in the necrotic one - CD3-2, CD4-2, CD8-1, CD16-2, CD22-1, trusting presence of the immune disorders of Degree ІІI. Conclusion. Administration of erbisol-extra and laferon for destructive forms of erysipelas is pathogenetically substantiated and may be applied in complex treatment of the disease.

Miniinvasive intramedullary osteosynthesis of clavicular fractures in middle one third with shifted fragments using elastic titanic compressing rod

Objective. To estimate the results of operative treatment of clavicular fractures in middle one third with fragments shifted, using the closed method with application of intramedullary elastic titanic compressing rod. Materials and methods. In the Department of Orthopedics and Traumatology of Kyiv Municipal Clinical Hospital No. 6 («Medgorodok») in 38 patients ageing 18 - 67 yrs with the closed clavicular fractures in middle one third with shifted fragments the closed intramedullary osteosynthesis, using elastic titanic compressing rod, was performed. Methods of the patients examination, indication s for operative treatment, its technique, late results of the operation were studied. Results. While estimating late results in 12 mo postoperatively in accordance to Constant Score (estimation of the brachial joint function) there were (97.1 ± 3.5) points of 100 possible points noted at average. In all the patients the movements in brachial joint were free and painless, they served themselves completely while doing solemn round of industry, coming back to their ordinary profession activity and sport. Conclusion. Intramedullary osteosynthesis of clavicular fractures in middle one third, using elastic titanic compressing rod as method of operative treatment, may guarantee satisfactory late results.

Distal resection of sacrum for the rectal cancer recurrence

Distal resection of sacrum for the rectal cancer recurrence

Diagnostic and the surgical treatment tactics in the rectal mucosa prolapse with the anal sphincter insufficiency

Objective. To improve the results of diagnosis and surgical treatment of rectal mucosa prolapse, complicated by the anal sphincter insufficiency. Materials and methods. Analysis of the diagnosis and surgical treatment results in the rectal mucosa prolapse with the anal sphincter insufficiency was done in 23 patients, ageing 31 - 65 yrs old and the age median (41.5 ± 1.8) yrs old, of them 17 women-patients. Results. There was revealed, that most frequently and in mostly progressive forms the rectal mucosa prolapse with the anal sphincter insufficiency occurs in women, aged more than 36 yrs old. Conclusion. Miniinvasive transanal operations, submucosal injection procedures and sphincteroplasty “end-to-end” were used predominantly, owing less morbidity potency (26.1%), favorable remote functional results - the recurrence rate lowering (4.3%), the fecal incontinence degree lowering (78.6%), and the patients’ quality of life improvement.

Experimental investigations of application of the water-steam оzone-containing gaseous mixture for prophylaxis and treatment of respiratory infectious diseases

Objective. Determination of the virus-cidal and bacterio-cidal action of the ozone-containing steam-water mixture, which was obtained, using apparatus POS-1, simulated on viral models of transmissive gastroenteritis of pigs of the coronaviruses family and polyresistant clinical strains of bacterial cultures, as well as adjustment of optimal parameters of ozone in the gaseous mixture content, which do not cause pathological changes in the organism’s organs and systems. Materials and methods. Apparatus POS-1, created by collective of Scientific-Methodical Centre «Medical Innovation Technologies»», was applied for production of the ozone-containing gaseous mixture. Virusological investigations were conducted on the base of the Institute of Epidemiology and Infectious Diseases named after L. V, Gromashevskiy. As a working material the models of virus of the pigs transmissive gastroenteritis of the coronaviruses family were applied. The series of bacteriological and experimental investigations were conducted on the base of Shalimov National Institute of Surgery and Transplantology NAMS of Ukraine. Polyresistant cultures in concentration of 108 colony-creating units per 1 ml were applied for bacteriological investigations. The experiment was conducted on white rats to study the gaseous ozone-containing mixture affection on living biological tissues. Results. Virusological investigations have shown, that in the 20 minutes exposition and a contact with extracellular virus the infection titer have lowered in 100 000 times, and in a 30 minutes exposition - a complete deactivation of virus have had occurred. Bacteriological investigations have revealed the complete absence of the cultures development after their processing with the ozone-containing mixture during 20 min. The results of swimming tests and behavioral reactions in white rats of control and experimental groups did not differ. Histological investigations of the respiratory organs tissues as well as of spleen, thyroid gland, kidneys and suprarenal glands did not reveal pathological effects of the ozone-containing mixture. Conclusion. Parameters of the ozone generation and delivery in the gaseous mixture content were studied and optimally selected. Investigations of the ozone-containing mixture affection on a viral strain of the coronaviruses family, as well as bacteriological investigations on polyresistant bacterial cultures have had confirmed its pronounced virus-cidal and bactericidal properties. Application of the ozone-containing mixture do not cause any pathological changes in the living organism organs and systems. This gaseous mixture may be used for prevention and treatment of respiratory infectious diseases of viral and bacterial genesis.

Comparative estimation of a pain syndrome in patients after combined operations for coexistent pathology of anal channel and rectum with application of modern and standard surgical technologies

Objective. Comparative estimation of the pain syndrome in patients with concomitant pathology of anal channel and rectum after performance of combined operations, using modern high-frequency electro-surgical and radio-surgical apparatuses, as well as conventional scalpel. Materials and methods. The results of surgical treatment of 689 patients with concomitant pathology of anal channel and rectum, using apparatuses of a high-frequency electro-surgery and radio-wave surgery, were analyzed, using the pain syndrome estimation on 1-7th postoperative day. The patients were distributed into 4 investigation groups and a control group, consisting of 112 patients, operated on using metallic conventional surgical scalpel. Results. The pain syndrome on the first postoperative day was mostly expressed in patients of control group, for anesthesia they needed (4 ± 1) ml of 2% solution of promedol, while the patients of the first, third and fourth groups investigated, in which, accordingly, apparatus of radio-wave surgery «Surgitron» and high-frequency electro-surgical apparatuses «EFA» and «KLS Martin» were used, needed for anesthesia (2 ± 1) ml of 2% solution of promedol. While application of the electro-surgical high-frequency apparatus «ERBE ICC 200» the necessity for the 2% solution of promedol for anesthesia have constituted (3 ± 1) ml. Conclusion. Combined operations, using modern apparatuses of high-frequency electro-surgery and radio-wave surgery give significantly better results, than application of conventional surgical metallic scalpel, because it produces significantly reduced pain syndrome due to thin layer of coagulation necrosis, promoting formation of delicate elastic cicatrix and preventing development of cicatricial strictures of anal channel in postoperative period.