Saratov JOURNAL of Medical and Scientific Research

Surgery

A case report of appendicular abscess resulted in hernial sac phlegmon

Year: 2018, volume 14 Issue: №1 Pages: 94-96
Heading: Surgery Article type: Case report
Authors: Shapkin Yu.G., Katalnikov A.E., Starchikhina D.V.
Organization: Saratov City Hospital No6 n.a. V. N. Koshelev, Saratov State Medical University
Summary:

An abnormal clinical case of break of appendicular abscess in incisional ventral hernia complicated phlegmon of
anterior abdominal wall is reported. The observation is of significant importance due to rare frequency of occurrence
in clinical practice, formation of a dangerous complication (phlegmon of anterior abdominal wall), difficult differential
diagnostics (Richter’s strangulatoin bowel or epiploon in hernia with necrosis complicated hernial sac phlegmon or
break of appendicular abscess in incisional ventral hernia). The surgical management was performed followed by a
patient’s recovery.

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Acute varicothrombophlebitis: modern approach to the problem

Year: 2018, volume 14 Issue: №1 Pages: 87-94
Heading: Surgery Article type: Review
Authors: Tsarev О.А., Anisimov A.Yu., Prokin F.G., Zakharov A.A., Lobanov A.V., Senin A.A.
Organization: Saratov State Medical University
Summary:

Acute varicothrombophlebitis, or thrombosis of superficial veins (TSV), is a dangerous complication of lower extremity varicose vein disease, as it is a frequent cause for pulmonary artery thromboembolism. The survey states the modern approach to pathogenesis, diagnostics, clinical findings and therapeutic approach to patients with TSV.

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Primary hyperpara-thyroidism: current state of the problem

Year: 2017, volume 13 Issue: №4 Pages: 849-853
Heading: Surgery Article type: Review
Authors: Kovalenko Yu.V., Tolstokorov A.S., Rossolovsky A.N., Kravchenya A.R., Manakhov G.A., Velikanova M.G.
Organization: Saratov State Medical University
Summary:

 The review is devoted to current state of the problem of primary hyperparathyroidism. One of the important steps in the study of pathology of parathyroid glands and their decision value in development of primary hyperparathyroidism was introduction of automated screening of the ionized calcium of plasma of blood to all patients asking for medical care. Understanding of the nature of this process allowed the doctors of many specialities to unite the efforts in the analysis of results of the already accumulated experience and extend possibilities of early preclinical exposure of this disease.

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A rare cause of small bowel obstruction (case report)

Year: 2017, volume 13 Issue: №4 Pages: 846-848
Heading: Surgery Article type: Case report
Authors: Khmara M.B., Kozlov V.V., Samarina D.V.
Organization: Saratov State Medical University
Summary:

The article presents a rare case of obstructive ileus caused by a silicone cylinder that is installed within a stomach to treat obesity. Purpose: to show the possibility of developing intestinal obstruction by foreign body (silicone balloon) and to draw the attention of professionals involved in intragastric ballooning to the possibility of the development of this complication.

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Sclerosurgical and surgical treatment of patients with lower extremity varicose vein disease: analysis of results in a long-term period of observation

Year: 2017, volume 13 Issue: №4 Pages: 839-845
Heading: Surgery Article type: Original article
Authors: Gafurova D.R., Kulikova A.N., Chabbarov R.G., Pyatnitsky A.G.
Organization: Saratov Regional Clinical Hospital, Saratov State Medical University, Saratov «Omega-clinic»
Summary:

Aim: to analyze and evaluate the long-term results of sclerosurgical and surgical treatment of patients with lower extremity varicose vein disease (VVD). Material and Methods. Diagnostics and treatment findings of 228 patients are presented. The main group consists of 153 patients (189 extremities) after intraoperative trunk catheter sclerotherapy of the great saphenous vein (GSV) with a crossectomy. The comparison group consists of 75 patients (96 extremities) after the GSV phlebectomy by Babcock — Narat. Long-term results (5-9 years) of treatment were evaluated by comparing the quality of life (QL) parameters of patients, the ultrasonic characteristics of venous bed for operated extremities, and the progression of VVD. Results. There was not found any considerable differences in respondents' QL during the comparison. Duplex ultrasound scanning of the lower extremities in most cases revealed a wide spectrum of pathological ultrasound signs (6 of 13 signs, the differences in which are statistically significant, but not specific for stem sclerotherapy and phlebectomy). Investigation of VVD dynamics after correction of the varicose syndrome revealed three variants of the disease course: regression, lack of dynamics, progression. Conclusion. The effectiveness of sclerosurgical interference in the long-term observation period is comparable with the surgical one, which is confirmed by the total number of positive (good and satisfactory) treatment results after using both methods (93.7 and 81.3% respectively), ultrasound diagnosis results, absence of significant differences in QL of patients.

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Variants of clinical manifestation of retroduodenal perforation at endoscopic papillosphincterotomy

Year: 2017, volume 13 Issue: №3 Pages: 544-548
Heading: Surgery Article type: Original article
Authors: Osumbekov R.B.
Organization:
Summary:

Objective: to study clinical manifestations of retroduodenal perforations in conducting ES and instrumental revision of the bile ducts, the study of predisposing factors, determining the optimal equipment trial cannulation. Material and Methods. On the experience of 41 observations was studied manifested symptoms, anatomical features, technology ES. Results. Retroduodenal perforation manifests progressive subcutaneous emphysema in the first 12 hours after EPST, acute dynamic ileus in the same period, pain with preserved peristalsis and more remote: hepatoduodenal ligament abscess, duodenal fistula of retroperitoneal space and pneumomediastinum. The use of conductors reduces the occurrence of perforation in 40%. Conclusion. It is revealed that retroduodenal perforation may occur in 6 clinical variants predisposing factors are atypical anatomical variants, trial cannulations without the use of conductors.

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Clinical and morphological features of diagnosis and treatment of various forms of primary hyperparathyorosis

Year: 2017, volume 13 Issue: №3 Pages: 541-543
Heading: Surgery Article type: Original article
Authors: Kovalenko Yu.V., Tolstokorov A.S., Kravchenya A.R., Khubolov A.M., Manakhov G.A.
Organization: Scientific Research Institute of Traumatology Orthopedics and Neurosurgery of Saratov State Medical University n.a. V.I. Razumovsky
Summary:

Objective: optimization of the diagnostic algorithm and treatment methods for different clinical forms of the primary hyperparathyroidism. Material and Methods. The article presents the results of examination and operative treatment of 59 patients diagnosed with the primary hyperparathyroidism, such patients having symptoms specific for the disease or having no symptoms of the same. Results. We have not revealed intraoperative complications after surgical interference; laboratory findings have been normalized in 96.6% of cases. The patients having undergone the surgery have been followed up for 12 months with no relapse. 11.9% of the patients have been diagnosed with the asymptomatic primary hyperparathyroidism. Conclusions. Parathyroidectomy is the only radical and effective treatment for the primary hyperparathyroidism. Parathyroidectomy performed surgically to the proper extent, prevents the relapse as well as development of diseases resulting from the primary hyperparathyroidism.

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Causes of failures and indications for refundoplication of antireflux surgery

Year: 2016, volume 12 Issue: №3 Pages: 408-411
Heading: Surgery Article type: Original article
Authors: Khubolov A.M.
Organization: Saratov State Medical University
Summary:

The aim is to study reasons for repeated fundoplication and possible variants of cardia correction in patients suffering from hiatal hernia and reflux esophagitis. Material and methods. Results of antireflux correction in 118 patients suffering from hiatal hernia have been studied, such results have been observed for the period of up to 36 months. Results. Most recurrent cases have been characterized by anatomical background for repeat hernia development, such as migration of fundoplication cuff, inconsistency, extreme traction of tissues that form gastric cuff or derived technique of fundoplication during previous operation. It has been found out that the subjective assessment of patients' condition after fundoplication is one of the most important criteria in deciding whether the repeated intervention is needed. Conclusion. Analysis of long-term results of the repeated antireflux surgery has revealed that quality-of-life index of patients having undergone repeated surgery may be compared to that of a healthy person. Traditional fundoplication of Nissen with non-tractional surgical intervention should be the method of choice for treatment of recurrent hiatal hernias.

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Results of repeated antireflux operations on hiatal hernias

Year: 2016, volume 12 Issue: №2 Pages: 191-195
Heading: Surgery Article type: Original article
Authors: Khubolov A.M.
Organization: Saratov State Medical University
Summary:

The research goal: to carry out the retrospective analysis of results of repeated antireflux interventions at the recurrent hernias of an esophageal opening of a diaphragm (HEOD). Material and methods. Results of surgical treatment of 38 patients with recurrence of HEOD in various terms after operation are studied. Results. At the most part of patients at repeated operations anatomic prerequisites to formation of recurrence of HEOD — migration of a fundoplication cuff, insolvency, an excessive tension of tissues when forming the gastric coupling, violation of technology of imposing of a cuff come to light. In this regard, proceeding from these references and the analysis of own research, it has been considered that plasticity of local tissues at recurrent HEOD, is insufficient for reliable elimination of a gastroesopha-geal reflux. Conclusion. The analysis of the results of antireflux surgical treatment of HEOD with a reflux-esophageal phenomenon has shown high efficiency of no tension plasticity, with use of a synthetic artificial limb. The fundoplication technique in antireflux surgery with no tension plasticity may be used as an operation of choice at recurrent hernias of an esophageal opening of a diaphragm.

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Surgical approach to patients with varicothrombophlebitis with undifferentiated dysplasia of connective tissue

Year: 2016, volume 12 Issue: №1 Pages: 66-70
Heading: Surgery Article type: Original article
Authors: Tsarev О.А., Anisimov A.Yu., Zakharov N.N., Korobov A.V.
Organization: Saratov State Medical University
Summary:

Aim: to study the peculiar features of clinical course of acute varicothrombophlebitis and surgical approach to patients with undifferentiated dysplasia of connective tissue. Material and Methods. The features of undifferentiated dysplasia of connective tissue, character of clinical course of acute varicothrombophlebitis, remote results for 94 patients, who had had Troyanov — Trendelenburg's operation, were studied. Results. 70 patients (74,5%) with acute varicothrombophlebitis demonstrated more than four phenotypic characters which showed the presence of undifferentiated dysplasia of connective tissue. 22 patients (31,4%) with acute varicothrombophlebitis with undifferentiated dysplasia of connective tissue were proved to have the discrepancy between localization of acute varicothrombophlebitis clinical evidences and level of proximal part of thrombus in the lumen of great saphenous vein. During the remote observation period, 66 patients (94,3%) with acute varicothrombophlebitis with undifferentiated dysplasia of connective tissue had pheblectomy, as there was vertical and horizontal pathological venous reflux. Out of 24 patients (25,5%) with acute varicothrombophlebitis without undifferentiated dysplasia of connective tissue, only four patients (16,7%) needed thesecond stage of surgical treatment, because 20 patients (83,3%), in 6 months after Troyanov — Trendelenburg's operation, demonstrated the restoration of functional consistency of valves of great saphenous and perforating veins. Conclusion. When determining the indications for urgent disconnection of saphenofemoral junction for patients with acute varicothrombophlebitis and also when choosing surgical treatment approach during remote observation period, it is reasonable to examine the phenotypic characters of undifferentiated dysplasia of connective tissue.

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