The aim — to improve the immediate and long-term surgical treatment results in patients with Helicobacter pylori — associated perforating pyloroduodenal ulcers.

Materials and methods. The study involved 158 patients with Helicobacter pylori-associated perforating pyloroduodenal ulcers, which were divided into two groups. The patients of the main group (82 (51.89 %) persons) obtained antibiotics for peritonitis and proton pump inhibitors in the postoperative period, control group patients (76 (48.10 %) oral anti- H. pylori therapy additionally. The gastroduodeno-plasty techniques for giant perforated duodenal ulcers, including those combined with tubular stenosis of the duodenum were offered

Results and discussion. In 74.42 % of patients operated with the proposed methods of gastroduodeno-plasty, from 7 — 10th postoperative day the gastroduodenal passage evacuation functions violations of easy degree was noted, in 23.58 % middle degree violations was revealed in the absence of signs. In 4 — 6 months normal results it is noted in 83.72 %. Helicobacter pylori eradication was achieved in 70 (85.37 %) in the treatment group and in 67 (88.15 %) — the control group. Complications of antibiotic therapy occurred in 34.15 and 78.94 %, respectively.

Conclusions. Use of improved gastroduodeno-plasty methods reduced gastroduodenal passage evacuation functions severe violations incidence to 24.32 %. Usage of the standard schemes of antibacterial therapy of peritonitis with proton pomp inhibitors in the early postoperative period doesn’t concede by efficiency of Helicobacter pylori eradication to additional appointment of standard eradication schemes.

Keywords: perforated ulcer, peritonitis, Helicobacter pylori.

The aim — to carry out the analysis of acute duodenal ulcerative bleedings (ADUB) conservative and operative treatment, and to estimate treatment tactical approaches in patients with this pathology.

Materials and methods. Results of treatment of 2285 patients aged 13 to 96 years with ADUB were analyzed. They were divided into two groups: basic — 1630 (71.33 %) patients (2004 — 2008 yrs) and control — 665 (28.66 %) patients (1994 and 1996 yrs). Treatment was based on the principles of active and individualized surgical approach, taking into account clinical and endoscopic assessment of local hemostasis and prognostic early re-bleeding risk (ERB) criteria, a differentiated approach to the choice of surgery timing, extension and techniques.

Results and discussion. In the basic group the surgical activity was 3.25 %, postoperative mortality rate — 11.32 %, the overall mortality rate — 4.36 %. Emergency surgery performed at an altitude of bleeding was 1.89 % of the number of operated patients, urgent — 20.75 %, at an altitude of emergency re-bleeding — 45.28 %, delayed — 32.08 %. In the control group of surgical activity was 47.33 %, postoperative mortality rate — 2.9 %, the overall mortality rate — 5.95 %. Emergency surgery performed in 8.71 % of bleeding patients, urgent — 26.45 %, at an altitude of emergency re-bleeding — 9.68 %, delayed — 55.16 %.

Conclusions. Treatment tactics in patients with ADUB is currently active and individualized. Radical organ-preserving operations should be preferred among the methods of surgical interventions. ADUB surgical treatment and ERB prognostic system changing has reduced the operations frequency at the bleeding height in 4.61 times and to select a patients group with high risk of ERB, which should underwent urgent (preventive) surgery (in terms of up to 12 hours, sometimes — to 24 hours after admission) to recurrence of duodenal ulcer bleeding. Transformation the tactics of surgical treatment DUB and the systems of bleeding relapse risk prognosis allows to reduce frequency of operations at bleeding height in 4.61 times, and to allocate group of patients with high bleeding relapse risk, which should to urgent (preventive) operative intervention (till 12 o’clock, sometimes till 24 o’clock from the moment of receipt) before ADUB relapse development.

Keywords: duodenal ulcer bleeding, peptic ulcer hemorrhage, surgical tactics.

The aim — assessment of intra-gastric pH monitoring in patients with complicated duodenal ulcer during examination.

Materials and methods. In 32 patients with complicated duodenal ulcer (aged 34 to 52 years) with clinical evidence of duodenogastric reflux, confirmed by endoscopic and radiological examination, the intra-gastric pH monitoring using pH-meter AG-1рН-М with electrode gastroenterological system was performed before the operation.

Results and discussion. Analysis of the questionnaire, which takes into account the main symptoms of duodenal reflux showed that all 32 patients with complicated duodenal ulcer had pathological reflux clinical signs. At endoscopy in 27 patients on the background of complicated duodenal ulcers revealed the signs of duodenal reflux. Radiologically disorder of motor-evacuation function of the stomach and duodenum were found in 22 patients. During the intra-gastric pH meters conduction in 5 patients normoacidity, 19 — moderate hyperacidity, and 8 — severe hyperacidity were established In the presence of duodenal reflux according to visual observation (pH-wave on the display recorder with an amplitude of 1 — 2 pH units and more) functional test with prokinetic (itopride hydrochloride) were used.

Conclusions. Intra-gastric pH monitoring is a highly informative and clinically important in patients with complicated duodenal ulcer examining, to determine the degree of duodenal reflux, objectively evaluate the effectiveness of drug therapy or surgical treatment.

Keywords: pH monitoring, duodenal reflux, peptic ulcer.

The aim — comparative analysis of the proximal gastric cancer treatment postoperative and long-term results by different types surgical procedures.

Materials and methods. The postoperative and long-term results of surgical treatment in 750 patients with proximal gastric cancer type II and III by Siewert, who underwent total gastrectomy (TG = 417), total gastrectomy with resection of the esophagus lower third (TGRE = 236), proximal stomach resection (PRS = 97) were analyzed in oncology clinic for the period from 1981 to 2012.

Results and discussion. TG performance was accompanied by significantly shorter operation duration — 191.8 ± 31.8 min (TGRE — 251.6 ± 42.8 min, PRS — 245.5 ± 42.7 min), the blood loss volume— 367.4 ± 50.6 ml (TGRE — 450.4 ± 78.2 ml, PRS — 412.9 ± 53.2 ml), the postoperative complications (mortality) rate — 16.5 ± 1.8 % (6.5 ± 1.2 %), TGRE — 34.8 ± 3.1 % (21.6 ± 2.6 %), PRS — 28.9 ± 4.6 % (19.6 ± 4.0 %), all differences between subgroups are statistically significant p < 0.01. TG (p = 0.014) and PRS provides better survival: 1-year — 60.0 (52.8; 67.0) and 59.4 (41.4; 76.1), respectively (median, lower and higher quartil), 3-years 27.8 (21.5; 34.5) and 18.7 (7.0; 34.5), 5-years — 18.9 (13.5; 24.9) and 9.4 (1.7; 22.3) than TGRE, 1, 3, 5-years survival rate 49.4 (38.7; 60.1), 22.4 (14.1; 31.9), 11.8 (5.8; 19.5), respectively. Stratifying the data by stage showed statistically significant differences in the 1, 3 and 5-years survival rate for stage II of disease for TGRE and PRS groups (p = 0.043) and a trend toward statistical differences significance in survival for TG and TGRE (p = 0.089) groups. Survival rate was calculated for patients with different tumor growth type. In case of exophytic tumor growth, the best survival rate results of were obtained after TG (p = 0.011), PRS takes an intermediate position, and TGRE is characterized by worst results.

Conclusions. The best radical surgical procedure performed in case of proximal gastric cancer Т₁—Т₂ stage, exophytic form of growth, without the involvement of the esophageal-gastric junction zone, is total gastrectomy that in comparison with proximal gastrectomy has the best postoperative results and better patient survival rate in the long term. The method of choice in case of infiltrating growth form of proximal gastric cancer, in Т₃—Т₄ stage, including the exophytic form, involving the esophageal-gastric junction zone, despite significantly worse postoperative results, is total gastrectomy with resection of the distal esophagus, as the only variant to improve treatment long-term results in this patients category.

Keywords: proximal gastric cancer, total gastrectomy, gastrectomy with resection of the lower third of the esophagus, proximal resection of the stomach.

The aim — to describe the clinical presentation of esophagus spontaneous rupture in distal third (ESRDT), its differential diagnosis and to provide optimal surgical approach in patients with this disease.

Materials and methods. Results of ESRDT surgical treatment was analyzed, the surgery stages, complications and timing of their appearance on the 17 patients’ data base, prevention of postoperative complications are described.

Results and discussion. Treatment duration for patients in the favorable outcome case was about 1.5 months. Satisfactory and good results were achieved in 59 % of cases. Mortality rate was 41.2 %.

Conclusions. ESRDT diagnosis and treatment should be carried out in multidisciplinary institution, as in the postoperative period in almost half of the cases the complications may require additional surgery. radiological method of study play the central role in the ESRDT temporary ligation of esophageal rupture area and isolation should be performed during surgery. Mortality rate for ESRDT is 41.2 %. Its causes are often pyoseptic complications (in 29.4 % of cases) and erosive bleeding (11.8 %).

Keywords: spontaneous rupture of the esophagus, mediastinitis, sepsis.

The aim — to assess the endosonography role in the esophagus diseases (diverticula, benign tumors, cancer, displacement of the esophagus) diagnosis and surgical treatment.

Materials and methods. Radial echo-endoscope Olympus TJFM120 was used for the endoscopic ultrasonography. Scanning was performed with a frequency of 7.5, 12, 20 MHz, changing it according to the structures (esophageal wall of the, para-esophageal fiber, para-gastric and para-esophageal lymph nodes, thyroid, etc.). The study involved 51 patients with identified during radiological and endoscopic study changes of the esophagus, requiring definitive interpretations and conclusions for a treatment policy decision. The control group consisted of patients without esophagus disease for normal esophagus endosonography characteristics investigation.

Results and discussion. Esophagus displacement causes were detected during endosonography: in 2 patients displacement caused by right-sided aortic arch, in 3 — by diagnosed megakaryoblastoma,in 2 — lymphosarcoma; in 6 esophageal diverticula. In 28 patients with endosonography excluded your cancer of the esophagus. In 20 patients with histologically diagnosed esophageal cancer the invasion depth, tumor extent were detected, lymph nodes, adjacent organs invasion were visualized by endosonography.

Conclusions. Endosonography is a modern, effective esophagus diseases diagnostic method. Ultrasonic sensor direct contact to the inner esophageal wall allows to determine the nature of the disease, its source, development stage, the nearby organs and tissues involved in process. Particularly informative endosonography was in the patients’ with of the esophageal cancer survey. It allows to quickly identify the tumor process, definitely set it stage, to determine the optimal treatment policy, monitor its effectiveness.

Keywords: endosonography, esophagus, diagnosis, treatment.

The aim — to develop the surgical treatment algorithm for patients with chronic hemorrhoids (CH) based on the comparative evaluation of different treatments in a two-years follow-up period.

Materials and methods. 1030 patients with chronic hemorrhoids (CH): 275 (26.7 %) — with the first stage of CH, 303 (29.4 %) — with the second stage, 310 (30.1 %) — with the third and 142 (13.8 %) with the fourth stage were included into the prospective study in a period of 2001 —2010. The infrared photo-coagulation (IRPC) method, the latex rings (LR), transanal hemorrhoidal desarterialization (THD), Longo hemorrhoidectomy procedure and Milligan — Morgan hemorrhoidectomy were used for patients with CH. Phlebotonics (Detralex) were administered in postoperative period (4 — 6 tablets in first 4 days, 3 — 4 tablets — during next week and 2 tablets a day during 2—3 month). The treatment results were estimated in a postoperative two-years follow-up period.

Results and discussion. The recurrence absence after THD was observed in 94.5 % patients with CH of first and second stage vs 75.7 % after the LR technique and 75.0 after IRPC %, p < 0.001. Longo technique provides good results in 96.8 % patients with CH of III — IV stage, satisfactory results in 3.2 % cases in two years after surgery. Milligan — Morgan hemorrhoidectomy results were inferior to Longo method, but significantly superior to THD method (the good, satisfactory and poor results correlation was 81.9 : 11.7 : 7.4 % vs. 67.1 : 0 : 32.9, p < 0.001).

Conclusions. THD treatment method for CH of first and second stage provides significantly better results in two years after surgery than IRPC and LR technique and can be considered as high priority method. IRPC method was similar to LR on the good results frequency in the distant period, but no differences were registered in early postoperative period. IRPC should be regarded as medium priority method, and LR ligation as low priority technique. Longo technique is a high priority treatment method for CH of III—IV stage. Good results without any bad results were observed in 96.8 % in two years after surgery. Milligan — Morgan hemorrhoidectomy results were inferior to Longo method, but significantly superior to THD method. Milligan — Morgan hemorrhoidectomy should be considered as medium priority surgery and THD — as low priority method.

Keywords: chronic hemorrhoids, surgical treatment, long-term results.

The aim — to evaluate the instrumental methods possibilities (angioresistometry, digital capillaroscopy and laser Doppler flowmetry) in a comprehensive assessment of the skin microcirculation (MC) in healthy subjects and in patients with chronic diffuse liver diseases (CDLD) for pentoxifylline effect.

Materials and methods. The study included 30 healthy subjects and 28 patients with CDLD. In patients with CDLD various etiologies (chronic viral hepatitis (chronic hepatitis С — 5, chronic hepatitis B — 7, chronic alcoholic hepatitis — 8, non-alcoholic steatohepatitis — 8) indicators MC before and after intravenous injection of 0.05 % pentoxifylline solution (Latren,Ukraine) in dose 7 — 8 mg/kg body mass were studied.

Results and discussion. Endothelioprotective effect of the pentoxifylline infusion and multi-directional influence on active and passive mechanisms of skin MC regulation, depending on the CDLD etiology was established.

Conclusions. Complex instrumental methods for the structural and functional microvasculature status evaluating in patients with different clinical forms chronic diffuse liver diseases (chronic viral hepatitis, nonalcoholic steatohepatitis and chronic autoimmune hepatitis) is advocated in clinical practice. According to laser Doppler flowmetry significant improvement in patients with viral hepatitis caused by the pentoxifylline infusion is mainly due to vascular endothelial growth component, and in non-alcoholic steatohepatitis by reducing the precapillar tonus. The pentoxifylline treatment for alcohol hepatitis increases activity of myogenic and neurogenic mechanisms with endothelium reduced activity, and also switch-on cardiac flux motion passive mechanism, reflecting the divergent microvasculaturative reactions according to laser Doppler flowmetry. According to the angioresistometry pentoxifylline leads to a significant reduction in the petechias number in 5 minutes after compression removing in patients with chronic diffuse liver disease, which may indicate the pentoxifylline's endotelioprotective properties.

Keywords: micro-circulation, pentoxifylline, chronic diffuse liver disease, angioresistometry, capillaroscopy, laser Doppler flowmetry.

The aim — to improve hemostasis with topical collagen fibrin plate when performing sphincter-preserving operations complicated by intraoperative bleeding in the pelvic region of abdominal cavity in patients with rectal cancer.

Materials and methods. The study included 18 patients (10 men and 8 women) who were treated in the Proctology department of Dnipropetrovsk City Clinical Hospital # 6 for low ampular rectal cancer. All patients underwent sphincter-preserving surgery on rectum and sigmoid, in particular, abdominal anal resection with the sigmoid colon bringing down, complicated by intra-operative bleeding. For hemostasis in all patients collagen fibrin plate was used.

Results and discussion. Collagen fibrin plate application contributed to bleeding stop from tissues array injured during surgeryin all patients, reducing the final hemostasis time to 15 — 30 minutes and blood loss of 200 — 250 ml, the volume of intraoperative blood transfusion has not increased.

Conclusions. The effectiveness of hemostasis during sphincter-preserving operations execution complicated by intraoperative bleeding in the pelvic region in patients with colorectal cancer contributes to the local use of collagen fibrin plate Tachocomb.

Keywords: the sphincter-preserving surgery, bleeding, collagen fibrin plate.

The aim — to examine the bemiparin effects on hemostasis with different starting thromboprophylaxis in planned abdominal surgery.

Materials and methods. 90 patients who underwent abdominal surgery : laparoscopic cholecystectomy or large ventral hernia alloplasty during a total intravenous anesthesia with muscle relaxation and mechanical ventilation were prospectively divided into three groups depending on the thromboprophylaxis type. In the 1st (control) group (n = 30) unfractionated heparin thromboprophylaxis (UFH) was performed at a 5000 IU dose in 2 hours before surgery and 5000 IU twice daily for 7 days after surgery; in the 2nd group (n = 30) bemiparin at a 2500 IU dose in 2 hours before surgery and 2500 units once daily for 7 days; in the 3rd group (n = 30) bemiparin in first dose (2500 IU) was administered 6 h after surgery, followed by 2500 IU once daily for 7 days. Hemostatic parameters studied: prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (APTT), fibrinogen level, factor Xa activity, antithrombin III AT III), protein C, soluble fibrin-monomer complexes (SFMC), blood D-dimer content before surgery, on 1st and 5th day after surgery.

Results and discussion. Before surgery, vascular platelet hemostasis parameters (platelet count), coagulation (PT, INR, APTT, fibrinogen, factor Xa activity), anticoagulant (AT III, protein C) and indirectly — fibrinolytic (D-dimer) systems were within normal limits, the differences between groups was not. SFMC level was above normal at 11.8 %, indicating inhibition of the fibrinolytic system and the risk of blood clots. UFH thromboprophylaxis does not prevent activation of extrinsic coagulation route and the threat of thromboembolic complications, especially on 5th post-operative day. In the case of pre-operative bemiparin thromboprophylaxis, the hemocoagulation balance normalized due to external and internal routes activation with little coagulation fibrinolytic systems activation to the 1st day end. Prevention with post-operative bemiparin start helped compensate for hypercoagulability due to stabilization of anticoagulant and APTT.

Conclusions. UFH thromboprophylaxis does not eliminate the thromboembolic complications risk with maximum threat to 5th postoperative day. Pre and post-operative start of bemiparin thromboprophylaxis prevent hypercoagulability after surgery. Bemiparin that is used in the mode of postoperative start, promotes vascular platelet hemostasis activation in the absence of extrinsic and total coagulation routes and relative fibrinolysis activation lack.

Keywords: thromboprophylaxis, bemiparyn, hemostasis, planned abdominal surgery.

Цель работы — оптимизировать алгоритм диагностики доброкачественных новообразований молочной железы.

Материалы и методы. Исследование выполнено на базе Центра реконструктивной и восстановительной медицины (Университетская клиника) Одесского национального медицинского университета в течение 2010 — 2012 гг. Обследованы 143 женщины: 37 — с морфологически подтвержденным раком молочной железы (1-я группа), 56 — с доброкачественными ново образованиями молочной железы (2-я группа) и 50 здоровых женщин (контрольная группа). Средний возраст женщин — (38,4 ± 1,2) года. Статистически значимых различий между клиническими группами по возрасту и анамнестическим показателям (профессия, местожительство) не выявлено.

Результаты и обсуждение. Наличие делеционного аллеля СG полиморфизма C634G гена VEGF повышает вероятность возникновения рака молочной железы в 9,3 раза (отношение шансов — 9,26; 95 % доверительный интервал — 3,78—22,67). При наличии гомозиготного состояния GG полиморфизма C634G упомянутого гена риск возникновения рака молочной железы увеличивается в 38,6 раза (отношение шансов — 38,56; 95 % доверительный интервал — 0,69—2615,11).

Выводы. Алгоритм комплексной диагностики доброкачественных новообразований молочной железы должен включать оценку полиморфизма гена VEGF. Наличие делеционного аллеля СG и гомозиготного состояния GG полиморфизма C634G гена VEGF повышает риск возникновения рака молочной железы и является дополнительным критерием необходимости проведения оперативного лечения больных.

Keywords: опухоли молочной железы, диагностика, генетическая медицина.

The aim — to develop an automated algorithm based on neural network modeling to calculate the individual breast cancer (BC) risk index.

Materials and methods. The study involved 360 women on the dispensary clinical account for breast cancer, 360 clinically healthy women randomly selected during the oncological prophylaxis medical examination. To check the accuracy of the obtained data basing on the elaborated algorithm, 360 women on the dispensary clinical account for fibrocystic breast disease (FCD) were examined in addition. Examined were aged 18 to 75 years.

Results and discussion. Interview and examination data were entered in developed application. On the first stage the 360 women on the dispensary clinical account for BC were surveyed. On the second stage 12 women from 360 surveyed healthy women were included in the high-risk group; the most of them were in the age group 41 — 50 years old — 75 ± 0.1 %. The proportion of women aged 51—60 years were 16.7 ± 0.1 %, 31—40 years — 8.3 ± 0.1 %. 95 (26.4 ± 0.1 %) women were assigned to the medium-risk group, 253 (70.3 ± 0.1 %) women— to the low-risk group. Among women with high and moderate BC risks, as a result of a comprehensive survey, one woman was revealed a BC suspicion (fibroadenoma by histological examination), FCD for 18 women, for one woman — fibroadenoma. In the low-risk group for BC the FCD was detected in 4 women, nodules were not identified. In the third phase to test the program and developed algorithm based on neural network a group of patients on dispensary clinical account for FCD additionally have been surveyed by questioning method. The attribution to the high-risk group increases the probability of the pathological process in 2.2 times (95 % confidence interval — 1.4—3.5) (p < 0.001). The sensitivity of the model was 79.8 %, specificity 79.0 %.

Conclusions. Statistically significant (p < 0.001) risk factors and their combination for each age group in Bucovina regionwere found. Sensitivity of predictive models for the BC risk groups formation is 79.8 %, specificity — 79.0 %, diagnostic accuracy — 86.3 %.

Keywords: breast cancer, neural network, risk of breast cancer, early detection of breast cancer.

The aim — to study the clinical and morphological changes in the testicle drainage system when edema and to improve surgical approach.

Materials and methods. The material for this research on first (morphological) stage were 71 testicle and appendages selected at necropsy of mature age men (22 — 35 years), 22 testicular membranes samples, selected in vivo as the postoperative material (hydrocele) and 17 testicular biopsies of infertile men with a clinical history of postponed surgery for hydrocele in children age. On second (clinical) study stage 46 boys with the hydrocele who were treated from 2009 to 2013 in the children’s surgical department were examined, 75.2 % were under the age of 7 years.

Results and discussion. In the study of testicular blood flow in children with hydrocele prior to surgical correction the resistance index recorded an increase in testicular arteries, a significant reduction in peak systolic and end diastolic velocity (p < 0.05) compared with healthy children. Venous blood flow was lower amplitude did not match the tidal waves, had phase character, which, in our opinion, happened due to the blood vessels elasticity violation. The research results indicated the presence of vascular disorders in testicular blood flow in the background of a hydrocele. The proposed method includes the spermatic cord mobilization in the local area at the deep inguinal ring level after the hydraulic dissection and saline solution removal with complete peritoneal processus vaginalis cross intersection. The testicular vascular trauma was minimal. The testicular membranes manipulation was carried by Ross method. After 24 postoperative months the blood flow index improvement in comparison with per-operative ones and those in patients in whom peritoneal processus vaginalis intersection was made by traditional way on all spermatic cord extension, resistance index reduction (0.607 — 0.600), increased peak systolic (11.0—13.0 cm/s) and end diastolic (4.2—5.3 cm/s) blood flow velocity were observed by the ultrasonic scanning data. The magnitude of these figures approaching that of healthy children (p < 0.05).

Conclusions. The clinical and morphological changes in hydrocele testicle drainage systems, which show the blood vessels plethora development, mainly veins, sclerotic changes in the spermatic cord stroma, the ductus deferens deformation, after surgery with the traditional processus vaginalis of the peritoneum mobilization throughout the spermatic cord and demonstrate the current surgical correction methods inadequacy for testicular diseases. Long-term results of hydrocele correction confirmed the high efficiency of the proposed method for peritoneal processus vaginalis elaborating.

Keywords: hydrocele, surgical treatment, children.

The aim — to improve the surgical technique of mediastinal lymph node dissection in patients with lung cancer, a comparative analysis of the effectiveness of the compleate systematic (CSLND) and selective mediastinal (SMLND) lymph node dissection.

Materials and methods. The study involved 263 patients with not-small cell lung cancer stage I—II. All patients underwent surgery — lobectomy (n = 166) or pneumonectomy (n = 97). A statistical analysis of the effectiveness of communication with mediastinal lymph node dissection clinik and morphological factors.

Results and discussion. There was a trend towards improved survival in patients with small cell lung cancer stage I—II, who underwent CSLND (p = 0.07), a statistically significant improvement in survival in patients who underwent pneumonectomy with CSLND, compared with patients who underwent pneumonectomy with SMLND (p < 0.01). The survival rate of men who underwent CSLND was higher than that of men who had SMLND (p = 0.03). After 2 years of data, the figure was an average of (77 ± 5) and (64 ± 4) %. The analysis of the data showed that patients with squamous forms of cancer have been improvements in the performance CSLND survival (p = 0.03).

Conclusions. For safe and effective performance limfodisektsii mediastinum should be used to mobilize tissue and mediastinum with scissors, dissector, bipolar coagulator, electrocautery and aspirator. Lymphadenectomy should start with the mobilization of inferior pulmonary ligament, followed by removal paraesophageal, bifurcation and right paratracheal and para-aortic tissue, subaortic and paratracheal tissue left. CSLND improves survival in male patients (p = 0.03) in patients with squamous form of malignancy (p = 0.03) and patients who underwent pneumonectomy (p < 0.01).

Keywords: lung, mediastinal lymph node dissection, survival.

The aim — to study the characteristics of adhesive process while performing intestinal anastomoses and to evaluate the antiadhesion barrier gel Mesogel efficiency and safety during small intestine resection against the adhesive process background in the abdominal cavity.

Materials and methods. The research was conducted on 58 white Wistar line rats and consisted of three stages. In the first phase all animals of both groups underwent the small intestine intersection with «end-to-end» anastomosis performing with double-row knotted suture by Toupet. In order to determine the adhesive process dependence on the small intestine intersection place, animals were divided into 3 subgroups. In the first subgroup anastomosis was performed in the upper third of the small intestine, closer to Treitz's ligament, in the second subgroup — in the middle third, in the third — closer to the ileocecal angle. In the second stage, the animals were divided into 2 groups: first — control (20 rats) and second — experimental (38 rats), which were comparable by age, weight, sex,intersection place of of the small intestine in the first stage of the operation, the prevalence and severity of adhesive process, the nature and frequency of postoperative complications. Control group rats were not subjected to any other manipulations. Experimental group animals were injected into the abdominal cavity with anti-adhesion gel Mesogel which covered all bowels and parietal peritoneum, including new anastomotic site. Animals of the experimental group were divided into 2 groups: the first (2A) where drug was dosed in 2.4 ml/kg — in approximately 0.4 — 0.5 ml per animal. At this dose a small amount of free gel remained in the abdominal cavity. Animals of the second subgroup (2B) received the dose sufficient to cover the whole peritoneum with a thin layer — about 0.1 — 0.2 ml, with no free gel in the abdomen. In the third phase — 4 weeks after the second operation — we performed relaparotomies, evaluated the prevalence and severity of the adhesive process, and the presence of complications.

Results and discussion. The incidence of adhesions was significantly higher at the small intestine intersection in the middle and lower third in comparison with the intersection in its upper third (р = 0.005 and р = 0.002 respectively). A statistically significant difference in the prevalence of adhesions at the intersection of middle and distal parts was not observed (р = 0.817). The localization of the anastomotic site did not effect on the severity of adhesive process. We revealed a significant decrease in prevalence (р = 0.003) and severity (р < 0.001) of adhesive process in the experimental group of animals that were injected into the abdominal cavity with anti-adhesion gel Mesogel in comparison with the animals of the control group, that were not applied this gel. In the subgroup 2B the prevalence of adhesive process was significantly lower (р = 0.003) than in the control, in the subgroup 2A difference from the control group was unreliable. The increase of the doze of Mesogel didn’t have influence on the severity of post-operational adhesions. After the second stage the number of purulent-inflammatory complications increased in both groups: from 15 % to 25 % (р = 0.48) in the control group and from 13.2 % to 52.6 % in the experimental (that was statistically significant: р = 0.001). A deal of animals with complications in the experimental group was significantly greater (р = 0.043, χ² = 4.08). Spearman correlation analysis showed the presence of significant positive correlation (ρ = 0.265, р = 0.044) between the fact of the gel applying and the presence of inflammatory complications. In the subgroup 2A complication rate was significantly higher as compared with controls (р = 0.004) and with the subgroup 2B (р = 0.022). No significant differences in this parameter between the subgroup 2B and control were observed (р = 0.49). This shows the high-dose gel negative effect on the inflammatory complications incidence.

Conclusions. Adhesive process had a significantly greater incidence in the anastomoses in the lower and middle third of the small intestine as compared with its upper sections, although the severity of adhesions did not depend on anastomosis localization. Use of anti-adhesion gel Mesogel significantly reduced the incidence and severity of adhesions in the small intestine resection, although the frequency of inflammatory complications in its application also significantly increased. At the recommended dose of Mesogel 2.4 ml/kg incidence of inflammatory complications was significantly higher, whereas its efficiency and anti-adhesion activity was worse than at its minimum dose that was sufficient to cover the peritoneum with a thin layer.

Keywords: anastomosis, Mesogel, peritoneal adhesions, inflammatory complications.

The aim — to define the patella tilt angle and lateral trochlear inclination angle dynamics changes in cases of patellar instability, accompanied by trochlea dysplasia type A and B.

Materials and methods. 9 patients with patellar instability and 2 patients with medial meniscus damage without patellofemoral joint pathology, which were taken as the norm, were examined with dynamic MRI. in 6 ones the trochlea dysplasia type A and in 3 — type B was observed among patients with instability. Patellar dislocation number was greater than 3 (recurred dislocation). On axial tomography the patella tilt angle changes dynamics, lateral trochlea inclination angle at 0, 10, 20 and 30° of knee flexion were assessed.

Results and discussion. In the absence of dysplasia (normal) a tendency to decrease the lateral patellar inclination angle in knee flexion from 0 to 30° was shown. In instability combined with type A dysplasia this figure had a tendency to normalization at 30°, and in the case of instability, which was followed by the femur condyles dysplasia type B, with an angle of knee flexion at 30° decreased but remains abnormal. The of lateral femoral condyle inclination angle changed depending on the knee flexion angle. As with different type dysplasia as with normal femoral condyle the tendency to increase the knee joint inclination angle in flexion from 0 to 30° was fixed. In the type B dysplasia case the inclination angle (> 11°), even if the knee flexion angle was 30°, remained abnormal, and in the dysplasia type A case at an angle of 30° flexion the inclination angle values had a tendency to normalization.

Conclusions. Type of dysplasia affects patellar tracking. Patella tilt is more pronounced in case of patellar instability which is accompanied with trochlea dysplasia type B than type A. Higher dependence of patellar stability from soft tissue stabilizers and femoral lateral condyle integrity was fixed in trochlea dysplasia type B.

Keywords: dynamic MRI, patellar instability, trochlea dysplasia.

The X-ray surgical treatment for maxillofacial area arteriovenous malformations allowing to achieve optimal therapeutic effect with minimal surgical trauma is proposed. The present case report demonstrates the X-ray angiography importance and feeding arteries X-ray endovascular occlusion as a method of choice in the these patients' treatment. Study, diagnosis and treatment algorithm in patient K. should be considered for treatment improvement in patients with maxillofacial arteriovenous malformations.

Keywords: arteriovenous malformation, X-ray angiography, X-ray endovascular occlusion.

The case report describes the successful laparoscopic assisted enterolithotomy that was done in female patient with small bowel obturation obstruction caused by plant’s origin enterolith.

Keywords: enterolith, small bowel obstruction, laparoscopic.

Цель работы — оценить в ранний и отдаленный период эффективность радикальных открытых и лапароскопических оперативных вмешательств у больных с перфоративной язвой двенадцатиперстной кишки (ПЯДПК) и высоким риском рецидива.

Материалы и методы. В исследование привлечено 163 больных с ПЯДПК и факторами риска рецидива язвенной болезни (ЯБ). Пациентов распределили на две группы. Группу паллиативных операций (ПО) составили 67 больных, которым выполняли паллиативные (ушивание язвы) и условно-радикальные операции (высечение язвы с пилоро- или дуоденопластикой). 37 (55,2 %) пациентам проведены лапароскопические операции, 30 (44,8 %) — открытые. В группу радикальных операций (РО) вошли 96 больных, которым выполняли радикальные операции: открытым способом (группа ВРО, 55 больных) или с помощью лапароскопической техники (группа ЛРО, 41 больной). Пациенты прооперированы в сроки до 12 ч с момента возникновения перфорации. Оценивали эффективность оперативного лечения в группах в течение двухгодичного послеоперационного периода.

Результаты и обсуждение. Сроки хирургического вмешательства у больных группы ПО были меньшими, чем у пациентов группы РО, — (66,58 ± 2,84) и (216,87 ± 7,48) мин соответственно (р = 0,001). Радикальные лапароскопические операции требовали больше времени, чем открытые, — (288 ± 54) и (163,45 ± 5,18) мин соответственно (р = 0,001). Однако они ассоциировались с меньшей интенсивностью боли в ранний послеоперационный период и потребностью в назначении наркотических анальгетиков ((2,63 ± 0,41) и (5,18 ± 0,38) дозы), средним сроком возобновления перистальтики ((2,97 ± 0,08) и (3,63 ± 0,08) суток (р = 0,001)), меньшим койко-днем ((5,78 ± 0,88) и (8,22 ± 1,11) суток). Через два года доля отличных и хороших результатов по шкале Visik в группе РО составила 83,5 по сравнению с 52,3 % в группе ПО (р = 0,001) благодаря уменьшению частоты рецидива язвы двенадцатиперстной кишки до 5,4 по сравнению с 38,8 % в группе ПО, отсутствию грыжи пищеводного отверстия диафрагмы (0,0 по сравнению с 11,9 %), частоты эрозивного гастродуоденита (12,5 по сравнению с 30,5 %), эрозивного эзофагита (1,0 по сравнению с 13,4 %).

Выводы. Выполнение радикальных операций у больных с ПЯДПК и высоким риском рецидива ЯБ в течение двухгодичного наблюдения обеспечивает стойкое снижение кислотопродуцирующей функции желудка и достоверно лучшие результаты, чем в случае выполнения нерадикальных операций. Радикальные операции, которые проводят лапароскопическим методом, требуют большего времени по сравнению с теми, которые выполняют открытым методом. Они ассоциируются с меньшей интенсивностью боли в ранний послеоперационный период, меньшей частотой назначения наркотических анальгетиков, средним сроком возобновления перистальтики, меньшим койко-днем. Также преимуществами лапароскопических операций являются лучший косметический эффект и отсутствие послеоперационных вентральных грыж. Частота хороших и отличных результатов через 2 года после радикальных лапароскопических операций и радикальных открытых операций достоверно не отличалась — 82,6 и 84,9 % соответственно.

Keywords: перфоративная язва двенадцатиперстной кишки, хирургическое лечение, лапароскопические радикальные и паллиативные вмешательства.