Nizhniy Novgorod, Russia
Nizhniy Novgorod, Russia

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Smetankin I.G.,Nizhny Novgorod State Medical Academy | Shlenskaya O.V.,Cheboksary branch | Artemiev N.V.,City Hospital No35
Sovremennye Tehnologii v Medicine | Year: 2011

The results of the corneal wound zone investigations with a confocal microscope have been analyzed. 10 patients after a bimanual and 10 patients after a coaxial phacoemulsification of cataract took part in the study. It seems reasonable to conclude that the revealed alteration rate and character do not depend on a phacoemulsification method (bimanual or coaxial).


Parshikov V.V.,Nizhny Novgorod State Medical Academy | Khodak V.A.,City Hospital No35 | Petrov V.V.,City Hospital No35 | Dvornikov A.V.,Nizhny Novgorod State Medical Academy | And 3 more authors.
Sovremennye Tehnologii v Medicine | Year: 2013

The use of glue compositions to attach synthetic endoprostheses (meshes) to abdominal wall tissues in tension-free repair refers to a new and prospective branch of herniology. The aim of the investigation was to assess the capabilities of abdominal wall plasty with glue fixation of synthetic endoprostheses in experiment. Materials and Methods. We carried out an experimental controlled study on rabbits. The basic group (n=34) was operated using IPOM (intraperitoneal onlay mesh) technique with synthetic endoprostheses fixation by cyanoacrylate adhesive "Sulfacrylate", with no sutures used. In the control group (n=69) there was performed IPOM plasty with mesh fixation using traditional methods - by suturing. The distribution of endoprosthesis types in the groups was comparable. The macroscopic changes were observed on day 14, 21, 28, 90 after the implantation. Results. The strength of mesh fixation to the abdominal wall in both groups was sufficient: 2.625 and 2.725 scores according to a modified Vanderbilt scale, p=0.936. The intensity of adhesive process was 2.125 and 3.823 scores, respectively, p=0.009. The colon was involved in adhesive process in 6.25% of cases in the main group, in the control group - in 33.3%, p=0.049. Conclusion. Glue fixation provides firm and reliable mesh fixation to tissues. The technique significantly decreases the intensity of adhesive process in the abdominal cavity.


Khodak V.A.,City Hospital No35 | Petrov V.V.,City Hospital No35 | Dvornikov A.V.,Nizhny Novgorod State Medical Academy | Mironov A.A.,Nizhny Novgorod State Medical Academy | And 3 more authors.
Sovremennye Tehnologii v Medicine | Year: 2012

Accumulated experience on using synthetic endoprostheses enables to analyze in detail the specific problems and complications related to implantation. The aim of the investigation is to study experimentally the possibilities and advantages of sutureless plasty of abdominal wall using different synthetic meshes. Materials and Methods. There was performed the simulation of intraperitoneal plasty of abdominal wall by synthetic endoprostheses. The operations were performed on rabbits. The results of two groups were studied in 14, 30, 45, 90, 180 days. The 1st group (n=45) underwent sutureless implantation, and the 2nd (n=51) - traditional endoprosthesis. Results. The mesh was from different materials and its fixation to the abdominal wall in both groups was strong enough, had no significant differences, being 2.585 and 2.695, respectively (p=0.282). The omentum was soldered to the implant in the basic group in 44.4% of cases, and in the control group - in 66.7% of cases, p=0.03. The large bowel was fixed to the mesh in 8.9% of cases (the basic group), and in 29.4% (the control group), p=0.012. According to Vanderbilt's scale, the adhesive process in the basic group can be estimated as 2.111, and in the control group - 3.824 (p=0.0005). Conclusion. Sutureless plasty of abdominal wall using different synthetic meshes has a number of advantages compared to traditional mesh implantation. The technique provides adequate implant fixation to abdominal wall tissues and reduces adhesive process.


Parshikov V.V.,Nizhny Novgorod State Medical Academy | Mironov A.A.,Lobachevsky State University of Nizhni Novgorod | Anikina E.A.,City Hospital No35 | Zaslavskaya M.I.,Nizhny Novgorod State Medical Academy | And 2 more authors.
Sovremennye Tehnologii v Medicine | Year: 2015

The aim of the investigation was to study the course of the reparative process in the early postoperative period after the abdominal wall prosthetic repair using light and ultra-light materials in bacterial contamination in experiment. Materials and Methods. Retromuscular abdominal wall repair was modeled on rats using light (ultra-light) endoprostheses contaminated by Staphylococcus aureus and Escherichia coli in the Central Research Laboratory of Nizhny Novgorod State medical Academy. The course of the early postoperative period has been studied, characteristic features of the inflammatory reaction depending on the microorganism cultures and mesh used have been evaluated with the help of the original rating scale. Results. Prosthetic repair in bacterial contamination in experiment is accompanied by a marked inflammatory reaction. Changes are statistically more significant after infecting by E. coli culture. The most intensive inflammation is observed on day 3 (S. aureus) and day 5 (E. coli) after the intervention with the regression of the process by day 14. On day 3-7 after the operation in group E. coli the inflammatory reaction was more expressed after Timesh implantation relative to PP Light application, whereas in group S. aureus it was more significant in case of PP Light application. Conclusion. Using light and ultra-light mesh in a compromised area of surgical intervention in abdominal wall prosthetic repair is possible by stringent indications taking into account potential usefulness and high risk, possessing adequate experience, and observing a number of conditions. Endoprosthesis should not be placed in contact with the zone of maximum contamination. © 2015, Nizhny Novgorod State Medical Academy. All rights reserved.


Parshikov V.V.,Nizhny Novgorod State Medical Academy | Chebotar I.V.,Nizhny Novgorod State Medical Academy | Khodak V.A.,City Hospital No35 | Samsonov A.A.,City Hospital No35
Sovremennye Tehnologii v Medicine | Year: 2012

The aim of the investigation is to study the bacterial growth characteristics in vitro on the surface of synthetic macroporous mesh endoprostheses used in modern surgery for abdominal wall plasty in case of hernias, and biofilms formation. Materials and methods. We studied endoprostheses made of polypropylene biofilms (standard, light), polyvinyliden fluoride, reperen, composite materials (polypropylene and polyvinyliden fluoride) used in hernial surgery. Meshes were contaminated by Staphylococcus aureus, Staphylococcus epidermidis, Pseudomonas aeruginosa. After incubation the preparations were studied under microscope in dark field, and biofilm formation was assessed using special scale. Results. Microbial biofilm forms within 48 h in vitro on endoprostheses surfaces. Ps. aeruginosa has the maximum capacity to form a microbial film, St. aureus - small capacity, St. epidermidis - the minimum capacity (p=0.027). Ps. aeruginosa significantly mildly contaminates light polypropylene meshes than any other meshes (p=0.009), and colonizes more intensively standard polypropylene meshes than smooth surface of reperen endoprostheses (p=0.024). There is no such relation for St. aureus. Reperen is maximally contaminated by St. epidermidis (p=0.044). Conclusion. Biofilm formation is a universal mechanism of mesh infection, and it can be realized in vitro on any endoprosthesis. The mechanism characteristics depend on the material, mesh type, surface microrelief, and microbial strain. To perform operations using synthetic materials under bacterial contamination conditions it is necessary to design special endoprostheses capable to resist colonization and biofilm formation.


Firsova V.G.,City Hospital No35 | Parshikov V.V.,Nizhny Novgorod State Medical Academy | Gradusov V.P.,City Hospital No35
Sovremennye Tehnologii v Medicine | Year: 2011

There has been considered the pathogenesis of acute pancreatitis. Various mechanisms have been shown to lead to pancreatic cell damage of the same type. Intracellular activation of proteolytic and other enzymes (elastase, phospholipases A2) lead to the release of preexisting cytokines - interleukins IL-1β, IL-6, IL-8, platelet-activating factor, tumour necrosis factor (TNF-α), some of which through the system of receptor-interreacting protein kinases cause the activation of the nuclear factor κβ that is responsible for the synthesis of pro-inflammatory and anti-inflammatory cytokines, as well 128 the apoptosis. TNF-α, IL-1β, intracellular adhesion-1 molecule, and probably, IL-18 have the marked local and remote damaging effect on organs and tissues. Phospholipase A2 takes part in the metabolism of fatty acids Omega-6 and Omega-3, the metabolites of the former (leukotriene B4 and thromboxane A2) enhance an inflammatory reaction, while the metabolites of the latter (leukotriene B5 and thromboxane A3) are responsible for an anti-inflammatory response. Matrix metalloproteinase-9 of neutrophils causes the rupture of basal membrane of the endothelium of capillaries of the pancreas, lungs, liver, kidneys, adrenals, the blood components coming into interstitium. The present enzyme is a mediator of neutrophils migration into various organs and their adhesion. The endothelial barrier destruction leads to mast cells activation and the release of biogenic amines that is accompanied by multi-organ dysfunction. Intraluminal accumulation of leukocytes is a potentially lifesaving mechanism and depends on the expression of certain genes. The severity of experimental pancreatitis is directly correlates with necrosis extent and conversely - with apoptosis intensity mediated by cytochrome C release into cytosol.


Firsova V.G.,City Hospital No35 | Parshikov V.V.,Nizhny Novgorod State Medical Academy | Gradusov V.P.,City Hospital No35 | Artifexova A.A.,Nizhny Novgorod State Medical Academy | Potekhina Y.P.,Nizhny Novgorod State Medical Academy
Sovremennye Tehnologii v Medicine | Year: 2011

There has been presented the experience of using ultrasound in urgent abdominal surgery. There have been demonstrated the possibilities of US in difficult cases and urgent situations. Differential and diagnostic criteria in acute disorder of the mesenteric circulation and destructive pancreatitis have been given. Revealed ultrasonographic phenomena have been correlated with the data of clinical examination, infrared thermography (CEM ThermoDiagnostic), computer and magnetic resonance tomography, selective angiography, intraoperative review of abdominal cavity organs, as well as verified morphologically (fine needle and intraoperative biopsy) and assessed together with the results of surgical interference and conservative treatment. Clinical examples of using additional possibilities of the technique (performing diagnostic fine needle biopsy under US control) have been shown.


Romanov R.V.,Nizhny Novgorod State Medical Academy | Fedaev A.A.,Nizhny Novgorod State Medical Academy | Petrov V.V.,City Hospital No35 | Khodak V.A.,City Hospital No35 | Parshikov V.V.,Nizhny Novgorod State Medical Academy
Sovremennye Tehnologii v Medicine | Year: 2012

Tension-free plasty with synthetic mesh use is the method of choice in modern surgery of abdominal wall hernias. In the review the basics variants of mesh implantation with its benefits and drawbacks are presented. The advantages and disadvantages of Lichtenstein, TAPP, TEP, and IPOM techniques are shown. The benefits and drawbacks of intraperitoneal onlay mesh technique (IPOM) are given in detail. Standard tensionfree procedures in surgery of inguinal hernias are described. The important steps in prosthetic repair of medial defects in abdominal wall are estimated. There are considered the features and results of applying sublay, inlay and onlay procedures. The possibilities of preperitoneal, intraabdominal, and retromuscular placement of synthetic endoprostheses are discussed. Adverse sequela of plasty, and its suspected pathogenetic mechanisms are considered. The ways in prophylaxis of complications are shown: mesh isolation, anti-adhesive covering, sutureless and glue fixation of endoprosthesis, development of new synthetic materials. Based on the analysis of literature reports we have concluded that the danger of intraabdominal complications after IPOM is exaggerated. Tension-free intraperitoneal plasty with synthetic endoprostheses in abdominal wall hernias is a simple and reliable surgical approach.


Firsova V.G.,City Hospital No35 | Parshikov V.V.,Nizhny Novgorod State Medical Academy
Sovremennye Tehnologii v Medicine | Year: 2012

There are given modern views on the role of conservative treatment of severe acute pancreatitis and its possibilities. There are considered the most significant aspects of infusion therapy, the use of secretion inhibitors and proteolysis, the choice of antibiotics and antifungal agents, detoxication techniques, and nutrition regimens. Many problems of nonoperative treatment are shown to have no unique solutions. The significance of adequate rehydration is specified. There are presented the advantages and disadvantages of plasmapheresis, hemosorption, thoracic duct flow drainage, venous hemofiltration, indirect electrochemical blood oxidation, ozone therapy, and hyperbaric oxygenation. Limited capacities of using octreotide and antiprotease agents in relation to evidentiary medicine are described. No reliable effect of antibiotic therapy and fungicides on complication rate and mortality in acute pancreatitis is emphasized. The results of nonoperative treatment are demonstrated to depend on the time of initiation of treatment, the adequacy of treatment volume, indications and contraindications, interaction of specialists.


Teremov S.A.,City Hospital No35 | Rotkov A.I.,City Hospital No35 | Gradusov V.P.,City Hospital No35
Sovremennye Tehnologii v Medicine | Year: 2013

In urgent abdominal surgical practice the patients after apendicular abscess drainage are generally thought to require no follow up, since vermix is completely lysed. In the present clinical observation the authors show that in some cases no complete appendiceal destruction occurs, and it can result in a complicated recurrent acute appendicitis. Therefore, such patients, as well as those being treated for appendicular infiltrate are indicated a subsequent examination to reveal a residual appendix. Incomplete appendiceal destruction is to be followed by a planned appendectomy.

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