The aim – developing and adoption of the medical tactic and the program of clinical-endoscopic monitoring among patients with acutely bleeding benign non-epithelial tumors (ABBNT) of the stomach and duodenum in the clinical practice.

Materials and methods. At the basis of work there is the analysis of treatment of 51 patients with ABBNT of stomach and duodenum, marking out 2 periods: I period (16 patients) – 1992–2004; II period (16 patients) – 2005–2009. Urgent diagnostics was provided with endoscopic research with identification of localization, morphological characteristic of substrate of bleeding, the state of hemostasis according to the classification of activity of bleedings Forrest J.A.H., which were amplified with roentgenological, ultrasonic, laboratory methods.

Results and discussion. After holding endoscopic research, we divide the patients into groups with identification of criterions of indications and terms of holding operative intervention, taking into account the burdening factors of prognosis of risk of development of the relapse of the tumorous bleeding. I group (FIA, FIx) – patients with an active bleeding, which isn’t stopped with endoscopic methods. II group (FIA, FIx) – patients with an active bleeding, which is stopped with endoscopic methods. The risk of development of relapse of bleeding – high. III group (FIB, FIIA, FIIB) – patients with signs of spontaneously stopped bleeding, for which there were held measures, directed at the prevention of development of relapse of bleeding. The risk of development of relapse of bleeding – medium. IV group (FIIC, FIII) – patients with signs of spontaneously stopped bleeding, which don’t need the measures, directed at the prevention of development of relapse of bleeding. The need for holding preventive endoscopic haemostatic procedures is indicated individually. The risk of development of relapse of bleeding – low. Each main group is divided into 3 subgroups: a) no contraindications for holding operational treatment; b) there are contraindications for holding operational treatment; c) patients, that refused to have an operation. Patients of the Ia group, with signs of an active bleeding, which isn’t stopped with endoscopic measures and with high risk of development of relapse of bleeding, are liable to operative treatment in urgent order by vital indications at the next 1–2 hours. Patients of the IIa group, with an active bleeding, which is stopped with endoscopic methods, are liable to operative treatment in urgent, during 6–24 hours, or early-delayed order, during 2–7 days, after holding preoperative preparation, depending on totality of burdening factors in the plan of projection of the risk of development of relapse of bleeding. Patients of the IIIa and IVa groups, with signs of spontaneously stopped bleeding, for which there were held measures, directed at the prevention of development of relapse of bleeding with medium, and comparatively low risk of development of relapse of bleeding, are liable to operative treatment at the early-delayed order, during 2–7 days, after holding the needed preoperational preparation. According to the definite groups in terms of projection of the risk of development of relapse of bleeding, patients are liable to hold prolonged clinical-endoscopic monitoring with interval of examination with Ib, Ic, IIa, IIb, IIc groups every 2–4 hours, with IIIa, IIIb, IIIv – 4–6 hours, with IVa, IVb, IVc – 12–24 hours. In case of the relapse bleeding origin among patients, who are at the stage of prolonged clinical-endoscopic monitoring, it is indicated to hold an urgent operative treatment by vital indications, excepting patients with evident accompanying pathology, and patients, who refused an operation. These patients are liable to the further clinical-endoscopic monitoring with intervals of examinations every 2–4 hours and repeated holding of methods of endosurgical hemostasis.

Conclusions. Effective endoscopic hemostasis and endoscopic prevention of development of relapse of bleeding with further clinicalendoscopic monitoring provide stable course of post-hemorrhagic period, which considerably has an influence on the decrease of frequency of urgent operations, which are held with undue risk, accompanied by high frequency of postoperative complications and lethality. This is reached by the developing of new medically-tactical approaches among patients with ABBNT of the stomach and duodenum, notably holding active endoscopic tactic with selective using of mini-invasive methods of endosurgical hemostasis, localization of the tumor and its morphological characteristics. Using the worked out algorithm of surgical tactic at the II period of treating the patients with ABBNT of the stomach and duodenum allowed, comparatively to the I period, to decrease the number of urgent operations from 17.9 % to 7.1 %, at the same number at the level of bleeding from 10.7 % to 7.1 % and at the level of its relapse from 7.1 % to 0 %, lethality after urgent operations, postoperative and general from 20.0 %, 3.6 %, 2.9 % accordingly to 0. Along with this, there was reached the increasing of surgical activity from 80.0 % to 87.5 % and accomplishment with 14.3 % patients if holding urgent endoscopic research of primary-urgent endoscopic submucous ablation of tumors.

Keywords: medical tactic, clinical-endoscopic monitoring, benign non-epithelial tumors, gastrointestinal bleedings, endoscopic hemostasis, surgical treatment.

The aim – a comparative assessment of different phylum of prostheses of mammary glands (MG) concerning the prevention capsular prosthesis contractures (CPC) at correction of cosmetic defects after excision of gel in patients with polyacrylamid mammary syndrome (PAMS).

Materials and methods. In study held from 1999 to 2010, 128 women at the age from 18 till 52 years (middle age – (35.63 ± 0.67) year) with PAMS by which it has been MG prosthesis was executed after polyacrylamid gel excision (PAAG) have taken part. Term after PAAG introduction has averaged (7.39 ± 0.44) year. Patients have distributed on two groups: the first – 95 patients who did not have an acute inflammatory process in MG, the second – 33 patients with acute inflammatory process in MG. The control group was compounded by 71 women to whom prosthesis after MG post lactation involutions was made. In group I endoprosthesis was made to one stage PAAG excision, in group ІІ – the second stage, after elimination of an acute inflammation. We have applied two phylum of MG prostheses: with textured surface (TS) – 126 women, with a micropolyurethane surface (MP) – 73 women. Prostheses were implanted in subglandular (82 women), submuscular (107), subfascial (10) space. Frequency of CPC was estimated within three years by means of a method Kaplan–Maer, a comparative assessment of two prostheses was made with the use of regression analysis of Cox and Log-Rank.

Results and discussion. In three years after endoprosthesis in patients with PAMS were revealed authentically smaller (p < 0.05) frequency of CPC in case of MT prosthesis application in comparison with TS ones: after one-stage (7.3 % vs. 38.0 %) and the postponed implantation (5.9 % vs. 25.5 %), submammar (11.8 % vs. 34.2 %) and submuscular (3.7 % vs. 15.8 %) locating of prostheses. It is not positioned authentic differences concerning CPC frequency in patients with MT-prostheses and control group and with PAMS. subgroups of MT was differed from patients in TS subgroups, smaller gravity CPC as it has not been diagnosed any case of a contracture of a sheath ІІІ–IV degrees whereas in subgroup ТП their lobe compounded 44.4 % (р < 0.05). At implantation of MT CPC frequency was equally low both in the absence of a microflora – 9.4 %, and at its presence – 9.9 % (p > 0.05), unlike patients with TS – accordingly 16.8 and 44.7 % (p < 0.05).

Conclusions. MT-prosthesis have advantage before TS ones – smaller frequency of CPC in MG endoprosthesis after gel excision in patients with PAMS. Low, similar control, three-year percent of CPC at MT prosthesis use does not depend on a prosthesis locating (submuscular or submammar), staging of operation and microflora presence in tissues near PAAG. All it causes a priority of use of made mention prostheses at patients with ПАМС.

Keywords: a plasty of mammary glands, capsular prosthesis contracture, polyacrylamid mammary syndrome, treatment

The aim – to improve surgical treatment in patients with retroperitoneal nonorganic neoplasm (RNN) basing on the surgical treatment latest results; to determine optimal degree of surgical interventions radicalism depending on the stage of tumor.

Materials and methods. 96 patients with RNN have been involved in study, including 80 patients with malignant RNN; a comparative analysis of patients with RNN has been conducted. Calculation of the survival rate has been performed by Kaplan-Meier’s method.

Results and discussion. It has been discovered that the average life expectancy after radical surgery was greater than 79 ± 10.3 months and it had the tendency to increasing, since 7 patients (35 %) were alive and had no clinical symptoms of relapse during last medical examination. The average life expectancy of patients who have undergone the partial removal of the tumor was 19.5 ± 5.8 months. The average life expectancy of patients after palliative surgery has not exceeded 5.3 ± 1.1 months and this figure corresponds to life expectancy of patients who have not been operated on, which is 4.1 ± 1 month.

Conclusions. Since the disease in it’s early stages is asymptomatic, it makes radical surgical treatment of RNN impossible. For these patient partial exscision remains the only method of life prolongation. The execution of exploratory laparatomy has been justified by diagnostic purposes as well as palliative surgical interventions.

Keywords: retroperitoneal nonorganic neoplasm, diagnosis, surgical treatment.

The aim – to evaluate the efficacy of H2-histamine receptor blockers and proton pump blockers in the prevention of stress-dependent damages of gastric and duodenal mucosa (SDDGDM) in patients with significant operational and anesthetic risk.

Materials and methods. The study included 123 patients with surgical pathology of abdominal organs and main arteries who were treated from 2003 to 2010, which had a significant (3.5–5 points) the degree of operational and anesthetic risk in accordance with Classification MSCAR-89. Patients were divided into three groups. In the first group (46 patients) to prevent SDDGDM administered blocker H2-histamine receptor III generation famotidine (Kvamatel production Gideon Richter, Hungary) – Group F, in the second (43 patients) – proton pump inhibitor omeprazole (group O), in control group (34 patients) – prevention SDDGDM by drugs that reduce the acidity was not conducted (group C). Patients from group F and group O drugs were administered to-day operations, and within 6–7 days after surgery. In preoperational period and within 2–5 days after surgery preparations were administered intravenously. After the restoration of peristalsis – orally. Omeprazole administered at a dose of 40 mg 1 time per day. Famotidine – 20 mg 2 times a day. Nature of the changes of gastric mucosa and duodenum were assessed by esophagogastroduodenoscopy for 4–5 days after operation.

Results and discussion. Studies have shown that the appointment of famotidine and omeprazole in patients with significant operational and risk of anesthesia significantly reduced the frequency of SDDGDM. Preventive measures in group F and group O were effective and reduced the frequency of SDDGDM with 79.4 % in group C to 21.7 % and 18.6 % respectively, p < 0.05. At the same time, groups F and O of this index did not differ significantly among themselves, p > 0.05. In addition to reducing the frequency SDDGDM generally in groups of prophylaxis significantly decreased the number of patients with petechias and erosions, and there were no cases of stress ulcers.

Conclusions. Prophylactic by drugs that reduce the acidity in patients with significant operational and risk of anesthesia significantly reduces the frequency of SDDGDM, which makes the feasibility of their use. Among the means of pharmacological prophylaxis of SDDGDM preference should be given to famotidine, which is as effective as omeprazole, but unlike it has some additional cytoprotective effects and does not lead to complications associated with pharmacological hypochlorhydria.

Keywords: stress-dependent damage of gastric and duodenal mucosa, famotidine, omeprazole, prophylaxis.

The aim – to study anamnestic data on the hemorrhagic syndrome in patients with acute abdominal pathology.

Materials and methods. The object of anamnestic screening was 912 patients of both sexes (536 (58.8 %) men and 376 (41.2 %) women) aged 19 to 49 years who were urgently operated for acute abdominal pathology during 2007–2010. For hemorrhagic complications revealing in the anamnesis, concomitant diseases and factors which result in to depression of coagulative potential, we had been developed the questionnaire – hemorrhagic syndrome anamnestic screening questionnaire. The questionnaire filled at the moment of patient reception with an acute abdominal pathology in surgical unit with attention accentuation on: signs of hemorrhagic diseases in the patient and members of his family, presence of factors which result in to disturbance in system of a hemostasis, information concerning the previous inspection and treatment. Questionnaires urgently analyzed and on the basis of screening of the primary information, till operative treatment, we made the decision on additional nosological diagnostics necessity concerning risk of pathology in system of coagulation of blood.

Results and discussion. It was established that the hemorrhagic syndrome of lifelong registered in 156 (17.1 %) patients. In 94 patients were established prior diagnoses coagulopathy who confirmed after nosological characteristics homeostasis system.

Conclusions. Due to the complexity of the nosological diagnosis of latent forms disturbances in the hemostasis should conduct a focused collection anamnestic data, which are most characteristic to hemorrhagic syndrome that at the primary stage of treatment allows the surgeon to focus on availability of light and latent forms of coagulopathies and thrombocytopenia.

Keywords: coagulopathy, hemorrhagic syndrome, anamnestic screening, emergency surgery.

The aim – to analyze application efficacy of the diosmine micronized purified flavonoid fraction with a hesperidin (Detralex by Servier company) in complex treatment of I–II degree hemorrhoids in out-patient conditions.

Materials and methods. Analysis of treatment of 133 patients which have received an ambulatory care for I–II degree chronic hemorrhoids in 2007–2009 is carried out/ patients have been distributed on three groups. In the first group has entered 45 (34 %) patients by whom conservative treatment (a diosmine with a hesperidin and local treatment was used), into the second – 48 (36 %) patients with whom the vacuum ligation of intrinsic hemorrhoid knots by latex rings without appointment of venotropic drugs has been executed, in the third – 40 (30 %) patients with whom the vacuum ligation of intrinsic hemorrhoidal knots has been executed by latex rings and conservative therapy by a diosmine with a hesperidin were prescribed.

Results and discussion. In І group good results are received in 28 (87.5 %) patients with a І degrees hemorrhoids, satisfactory – in 4 (12.5 %). In 7 (53.8 %) patients with a ІІ degrees hemorrhoids are received good, in 4 (30.7 %) – satisfactory and in 2 (15.3 %) – unsatisfactory results. In ІІ to group good results are received in 40 (85 %) patients, satisfactory – in 6 (12.5 %), unsatisfactory – in 2 (2.5 %). In ІІІ group good results of treatment are received in 36 (90 %) patients, satisfactory – in 4 (10 %).

Conclusions. At long application of a diosmine with a hesperidin in patients with a І degrees hemorrhoids and basic symptoms of a hemorrhoid, frequency of exacerbations decreases. Good drug tolerance, its high efficacy, especially at an early stage of disease is noted. The vacuum ligation of hemorrhoid knots by latex rings in out-patient in a combination with diosmine and hesperidin appointment is highly effective and safe mini-invasive procedure in II degree hemorrhoids treatment that allows to receive good treatment results in 90.0–93.7 % patients, to reduce relapse to 5–10.4 %.

Keywords: hemorrhoids, ligation of hemorrhoid knots, diosmine micronized purified flavonoid fraction with a hesperidin.

The aim – to study frequency and structure in gastrointestinal tract pathology in patients of angiosurgery department.

Materials and methods. 130 patients with occlusive diseases of the abdominal aorta and lower extremity arteries underwent fibroesophahogastroduodenoscopy (FEGDS).

Results and discussion. Inflammation, gastroduodenal ulcers and erosions form in the upper gastrointestinal tract (GIT) were revealed in 29.23 % patients. These diseases may cause serious complications in the intra- and postoperative periods. 47.37 % patients had not special gastric complaints. In the pre- and postoperative periods antisecretion therapy was prescribed to all patients.

Conclusions. Taking into account the clinical, endoscopic aspects of GIT pathology in patients with occlusive diseases of the abdominal aorta and lower extremity arteries we think it reasonable to include FEGDS into preoperative treatment examinations complex for the purpose of early corrections. This will allow to avoid unjustified GIT complications and to choose the correct treatment management.

Keywords: gastrointestinal tract, atherosclerosis, angiosurgery

Keywords: varicose disease, phlebectomy, neurological complications.

The aim – studying of various kinds primary anastomosis features after the urgent intestines resection in patients with acute intestinal obstruction and widespread peritonitis.

Materials and methods. Retrospective study analysis of surgical treatment in 339 patients after urgent radical resection of various segments of a small and large intestine with imposing primary anastomosis. 104 patients were in control group and 235 in basic group.

Results and discussion. In the early postoperative period intraperitoneal complications caused by a resection of various segments of a small and large intestine against acute intestinal obstruction and a widespread peritonitis with imposing primary anastomosis, was revealed in 28 (26.92 %) patients of control group and in 15 (6.38 %) patients of the basic group. An stitches inconsistency of intestinal anastomosis was noted in 17 (13.28 %) patients from 128 with anastomosis end-to-end and 6 (2.91 %) from 206 patients with anastomosis a side-to-side.

Conclusions. At imposing intestinal anastomosis at patients with an urgent resection of intestines form the purpose of preventive maintenance of early postoperative complications expediently use anastomosis on type a side-to-side.

Keywords: urgent resection of intestines, intestinal anastomosis, stitches inconsistency, anastomosis narrowing.

The aim – to conduct the comparative analysis of preventive and late operative interventions efficiency for massive pancreonecrosis.

Materials and methods. The analysis of treatment in 60 people with massive pancreonecriosis was conducted. Patients were divided of two groups: in 1 group patients underwent preventive operative interventions on a 12–14th days with the subsequent closed drainage. In 2d group were patients with late operative interventions on an 18–23 days with the closed drainage.

Results and discussion. Application of late laparotomy results in 100 % development of festering postoperative complications, that in 26.5 % resulted in development of sepsis and steel reason of death. General lethality in this group was 29.6 %. In the group with preventive operations with the subsequent closed drainage of destructive lesions and abdominal region, the number of festering complications diminished to 38.2 %, thus lethality caused by festering complications went down to 9.4 %.

Conclusions. As a result of the conducted research, authors came to the conclusion that application of preventive operations at thus pathology allows to reduce the number of festering complication and lethality in 3 times.

Keywords: massive pancreonecrosis, laparotomy, drainage.

The aim – to determine activity of antimicrobials against nosocomial strains Escherichia coli isolated from hospitalized in Ukrainian surgical departments in patients from different regions of Ukraine.

Materials and methods. A total of 5839 clinical strains of E. coli isolated in 2008 from patients hospitalized in 97 medical institutions in different parts of Ukraine. Susceptibility to 35 antimicrobials: ampicillin, oxacillin, ampicillin/sulbactam, amoxicillin/clavulanic acid, cefazolin, cefuroxime, cefoperazone, cefotaximum, ceftriaxone, cefixime, ceftazidime, cefepim, imipenem, meropenem, gentamicin, amikacinum, netilmicin, kanamycinum, clarithromycin, azithromycin, lincomycin, clindamycin, tetracyclin, doxycyclinum, vancomycin, teicoplanin, rifampicin, ofloxacinum, levofloxacin, lomefloxacin, moxifloxacin, gatifloxacin, ciprofloxacin, norfloxacin, chloramphenicol, linezolid was determined by agar dilution method in accordance with the NCCLS recommendations.

Results and discussion. The most potent antimicrobials were imipenem, meropenem, oxacillin, cefotaximum, netilmicin, azithromycin, lomefloxacin, and linezolid. The high rates of resistance were found to chloramphenicol (56.6 %), ampicillin (56.0 %), moxifloxacin (42.7 %), amoxicillin/clavulanic acid (39.5 %), lincomycin (38.9 %), teicoplanin (37.7 %), and to ampicillin/sulbactam (36.9 %).

Conclusions. Resistance of nosocomial strains of E. coli at in-patient medical institutions that are subject to research is a serious therapeutic and epidemiologic issue. Imipenem, meropenem, oxacillin, cefotaximum, netilmicin, azithromycin, lomefloxacin, and linezolid have been the most active to nosocomial strains of E. coli. Taking into account resent changes and resistance levels of nosocomial strains of E. coli, which take place in various regions, constant monitoring over resistance to antimicrobials at every in-patient medical institution is required. Also, hospital record sheets of antibiotics should be elaborated based upon the local data received. Antibiotics utilization policy in each surgical in-patient institution should be determined based in accordance with the local data on resistance to antimicrobials. System of epidemiologic surveillance over microbial resistance should be established on the local, regional, and national level.

Keywords: E. coli, antibiotic resistance, nosocomial infections, surgical unit.

The aim – to estimate possibility of deproteinized hemoderivative of calf blood (DHCB; Solcoseril by Legacy Pharmaceuticals Switzerland GmbH, Switzerland for Meda сompany) application in complex treatment of patients with diabetic foot syndrome (DFS).

Materials and methods. Results of treatment of 117 patients with DFS, treated in surgery unit from 2000 to 2010 are studied. 96.9 % of patients had ІІ type diabetes. Age of patients was from 21 till 82 years. Among patients 15 (12.8 %) were men and 102 (87.2 %) – women. The neuropathic form of the DFS was diagnosed in 17 (14.5 %) patients, neuroischemic – in 88 (75.2 %), ischemic – in 12 (10.3 %). The chronic critical ischemia of extremities was noted in 44 (37.6 %) patients. 24 (20.5 %) of the patient entered in a hospital with foot gangrene V degree by Wagner. At duplex scanning it was revealed, that in the majority of observations (82 % of patients) the magisterial type of a blood flow has been conserved on a hip, in 67 (57.2 %) patients the magisterial and magisterial-variated blood stream has been conserved at level of a popliteal-tibial segment. The blood flow on anterior and posterior tibial arteries was not defined in 39 (33.3 %) patients, on a dorsal foot artery – in 34 (29.1 %). The X-ray inspection has taped presence of a calcification in foot arteries in 29 (24.7 %) patients. Complex conservative treatment included carbohydrate metabolism indemnification, an antimicrobial therapy, and application of antioxidants such as

Keywords: diabetic foot, an ischemia, treatment, deproteinized hemoderivative of calf blood.

Keywords: hemorrhoids, surgical treatment, classification

Keywords: adenomatous polyps, malignancy, hromoendosсopy, intrarectal ultrasonography, welding technology.

Keywords: carcinoid, apudomas, stomach, duodenum, histamine.

Keywords: anal fissure, conservative management, surgical management, sphincterotomy.

Keywords: Jehovah’s Witnesses, bloodless medicine, transfusion alternatives, blood fractions, Hospital liaison committee.