Search

In the Strategic Academic Leadership Program, the number of publications included in the 1% of the most cited ones in the Web of Science Core Collection database over previous 10 full years is used as an indicator of research potential of universities and scientific centers. The purpose of this study was to analyze the segment of Highly Cited Papers and Hot Papers on surgery using the Essential Science Indicators (ESI) analytical application. According to ESI data, relevant for March 2020, highly cited publications on medicine have formed 2.425 research fronts including 211 ones in surgery. We have analyzed the directions of researches in surgery characterized by the greatest number of citations.

The paper is a narrative review of the literature on the use of direct oral anticoagulants (DOACs) for the VTE treatment in challenging patients: senile age (≥75 years), impaired renal function (estimated glomerular filtration rate ≤50 ml/min), fragility (one of the previous characteristics and/or bodyweight ≤50 kg). The paper discusses the studies of EINSTEIN DVT and PE (rivaroxaban), AMPLIFY (apixaban), HOKUSAI-VTE (edoxaban), RE-COVER I and II (dabigatran) in the focus of the secondary analysis in the pre-specified patient's subgroups, as well as their pooled analyzes and meta-analyzes. Based on the results of this review, it was concluded that in a subgroup of senile age patients, dabigatran increases the risk of major bleeding by 4.8 times and has no advantages over vitamin K antagonists (VKA); rivaroxaban and apixaban retain superiority over VKA on the safety outcomes and reduce the risk of major bleeding by 73% and 77%. In the subgroup of patients with impaired renal function, the use of apixaban and dabigatran is associated with an increase in the risk of major bleeding by 6.5 and 7.3 times, and these DOACs do not have advantages over VKA; rivaroxaban retains its superiority over VKA and reduces the risk of major bleeding by 78%. For fragile patients, a secondary analysis is available only for rivaroxaban, which remains superior to VKA on safety endpoints and reduces the risk of major bleeding by 73%. In the absence of direct comparisons between the available DOACs, the presented data can be used as a rational approach for the choice of appropriate treatment for VTE in challenging patients.

The purpose of this study was to efficacy of mexidol in the prevention of toxic damage to the heart in acute pancreatitis., Material and Methods: The paper presents the results of experimental studies conducted on 30 adult mongrel adult dogs, which simulated acute focal pancreatic necrosis. We studied the influence of mexidol in the complex therapy for changes in the qualitative and quantitative composition of the lipid tissue structures of the heart, the intensity of processes of lipid peroxidation, antioxidant capacity, phospholipase A 2 activity and morphofunctional state of the heart muscle in experimental acute focal pancreatic necrosis. Th., Results and Discussion: The preventive use of antioxidant drug mexidol in complex treatment of acute focal pancreatic necrosis, which limits the development of endogenous intoxication, increased intensity of lipid peroxidation and restores antioxidant capacity, reduces leading to phospholipase activity in tissue structures of the heart, corrigiruet lipid metabolism and morphofunctional state of the heart, and, consequently, toxic damage to the heart during endotoxic.

The urgency of the problem. The incidence of various thromboembolic complications in patients with oncopathology reaches 5-12%. When treating VTE in patients with oncology it is necessary to choose between two generally recognized alternatives. The recommended two-component scheme of the initiating phase of anticoagulant therapy with subsequent long-term admission of VKA is fraught with the development of clinically significant bleeding during the initial selection of the dose of warfarin and an increased risk of recurrence of VTE. Long-term parenteral use of LMWH is often negatively treated by patients and adversely affects compliance. For these reasons, enteral administration of new oral anticoagulants is promising for prolonged anticoagulant therapy in this category of patients. The paper cites three clinical cases of treatment of patients with acute venous thrombosis of deep veins against a background of different oncological processes. In the first case - the operated previously for cancer, in the second case - to be treated over oncological process and in the third case - in the primary cancer detection., Discussion: The results of the studies of EINSTEIN-DVT and EINSTEIN-PE allow us to consider the use of rivaroxaban in the treatment of patients with VTE on the background of oncopathology. The possibility of its use from the first day, in our opinion, is a significant advantage, since it allows us to reveal the clinical effectiveness of anticoagulant therapy already during the first stage of treatment, since NOAKs does not imply the possibility of laboratory monitoring.

In the article provides an analysis of own of clinical experience peculiarities of carrying out of anesthesia, when performing 466 various tracheo-bronhoplastiс of operations for the period from 1979 to 2014 the year a one team of surgeons. Preoperative preparation, anesthesia and postoperative management of patients are key to improving treatment outcomes. Full arsenal of modern methods of ventilation lets you choose for each stage of surgery is most convenient for the surgeon and patient-safe way to maintain gas exchange. Presented in this paper our anestiology experience allows you to discuss and elect the proposed management of patients through the selection and optimization of the method that best meets modern requirements.

Aim: To summarize the data of 'no-touch isolation technique' (NIT) for pancreatoduodenectomy and radical antegrade modular pancreato-splenectomy (RAMPS) for pancreatic malignancies., Material and Methods: We looked through Pubmed and Cochrane databases for scientific papers published from January 2000 until September 2014., Results: Eight studies were included. There were 7 retrospective cohort studies and one randomized controlled trial (RCT). Mean operation time and blood loss were 267 min (198-386 min) and 132 ml (331-744 ml) respectively. Mean morbidity rate was 35% (17-58%). There was no 30-day mortality. Mean incidence of R0-resection varied from 50% to 97% with average value 84%. Median survival was reported in 3 studies (17, 18 and 26 months). Five-year actuarial overall survival was reported in 4 studies (31, 36, 40 and 53%)., Conclusion: Positive results of NIT and RAMPS might justify further evaluation of the method in pancreatic cancer. Prospective randomized controlled trials needs to be done to demonstrate the oncological value of this novel surgical technique.

The paper analyzes the results of a survey of 37 patients with acute ulcerative gastroduodenal hemorrhage. During endoscopy found that 7 patients the cause of bleeding was gastric ulcer, duodenal ulcer in 27 and 3 concomitant ulcer. Hemostasis was evaluated by J. Forrest and the severity of blood loss was assessed by the A.A. Shalimov: with blood loss was mild in 11 patients, the average degree--12 and with severe--14. In all patients on admission in the peripheral blood were studied state of cellular, humoral and cytokine profile: CD3+, CD4+, CD8+, CD4+/CD8 + and CD19+, FI, FF, CEC, IgA, M, G, TNF-α, IFN-γ, IL-1, IL-2, IL-4, IL-6, IL-8 and IL-10. In general patients with on admission revealed significant changes in the immune and cytokine status. In cellular immunity occurs immunosuppression. Disturbances in humoral immunity manifests itself in increased levels of lymphocytes in blood loss and hardships of all multi-directional changes in the concentration of immunoglobulins depending on the amount of blood loss. When there is an imbalance in cytokine status, the depth of which depends on the degree of blood loss.

Aim: Developing an algorithm of diagnosis and treatment of wound defects in patients with neuroischemic form of diabetic foot syndrome, study of the effectiveness of collagen implants in closing of wound defects., Material and Methods: The paper describes the diagnostic algorithm for patients with wound defects in neuroischemic form of DFS. Wound cleansing from areas of necrosis, purulent-fibrinous plaque, biofilm of the wound was conducted on the day of hospitalization using hydrosurgery ultrasonic cavitation. We propose the method of closing the wound defect with high-tech biomaterials based on type I collagen., Results: Implantation of type I collagen increased the relative rate of wound healing, reduced the amount of high amputation, and significantly reduced the average time of patients' stay in hospitals and their transfer to outpatient treatment., Conclusions: 1. Patients with neuroischemic form of diabetic foot syndrome should be timely and promptly pass the diagnostic phase. 2. Ultrasonic debridement is most effective method of wound preparation before its closure. 3. The use of bioplastic material Collost in patients with neuroischemic form of diabetic foot syndrome increases the rate of wound healing that leads to decrease the average patient's stay in hospital and reduce high amputations. 4. The average patient's stay in hospital reduced up to 20% that decreases the treatment costs of such category of patients.

In this paper we compared the efficacy of proton pump inhibitors (PPIs) and H2 receptor antagonists on the morphogenesis of the marginal zone of gastric and duodenal ulcers in 56 patients withacute gastroduodenal bleeding. It is shown that the antisecretory drugs in the treatment of patients with acute ulcerative bleedingnot only affect on the secretory activity of the glands in gastroduodenal zone, but it also modulates inflammatory reparative process and the status of mucous and bicarbonate barrier. A greater anti-inflammatory effect of PPI in comparison with H2-receptor antagonists has been proved. Appointment of PPIs had more pronounced stimulation of angiogenesis and cell proliferation of the surface epithelium.

Spleen damage is one of the most common injuries of the abdomen. Thus, splenectomy is one of the most common embodiments of the surgical procedure. Justified by the desire of surgeons to perform organ save surgery, which was made possible by the emergence of new hemostatic agents. In this paper, an experimental and clinical study of the effectiveness of fibrin-collagen substance (FCC) "Tachocomb" to hemostasis of spleen injuries was submitted.

The comparative analysis by bronchial fistulae closure by hydatid lung cysts in children using two surgical techniques was conducted. All patients were divided in two groups: the first group (n = 98) included cases of fistula closure using the traditional solitary Z-suture; the second group (n = 54) had fistula closure with the use of the original method. The least was thoroughly described in the paper. The were no cases of postoperative complications among patients of the 2nd group, whereas 6 patients of the 1st group had bronchial fistula recurrence after the operation.

Paper is devoted to the safety rules by surgical interventions on patients with permanent pacemaker. Data of 123 operated patients with intraoperative pacemaker instability were analyzed, possible premises of this complications were discussed. The use of monopolar electrocoagulation proved to be the most frequent of reason of pacemaker failure. Strong correlation between rhythm failure and duration of the single electrocautery exposure was revealed.

Results of clinical studies recently became the guidelines in decision making in medicine including surgical practice. Results of each study could be used generally only if all methodological requirements are fulfilled. In this paper the principles of clinical studies design particularly in surgery and medical publications analysis are described and discussed.

The surgical treatment of postoperative ventral hernias (PVH) in patients with high operative-anesthesiologic risk (OAR) still remains a problem. The results of PVH treatment in 150 patients with different degrees of OAR are analyzed in the paper. Autoplastic operations and explantation of synthetic prostheses were performed. The second method demonstrated a range of advantages. The necessity of widening the indications for the planned surgery for PVH is proved, especially in patients with the increased OAR. This will permit avoiding complications of the hernia itself and decrease the frequency of urgent PVH surgery, very undesirable in such patients. The algorithm of the choice of reconstruction and anesthetic management is worked out.

The paper presents 20-year experience in using various devices for tissue dissection and coagulation of such as electrosurgical ones EN-57M, Efa-0201 (Russia), Karl Storz-endoscope (Germany), Force-300, Force-FX, LigaSure ("Valley-lab", USA), Erbotom ICC 350 ("Erbe"), Argo-3000 ("Soring", Germany), a Surgitrone radioknife ("Ellman", USA), ultrasonic Auto Sonix devices ("Auto Suture", USA), a harmonic Ultracision scalpel ("Ethicon Endo-Surgery", USA), laser Scalpel-1 and Romashka-1 devices (Russia), plasma Fakel-01 and Prometey devices (Russia). The results of 424 experimental studies and clinical application of different energies in 1683 patients are analyzed. The influence of different types of energy on tissue and reparative processes were revealed, morphological changes were studied. Advantages and shortcomings of each type of energy are demonstrated, recommendations for their optimum application are formulated.

The paper reports treatment of 52 patients with acute destructive pancreatitis for the period from 1993 to 1999. Up to 1997 conservative policy for management of such patients was used, operative treatment was carried on only in pyoseptic complications (43 patients, group 1). Later on early video-endoscopic procedures (9 patients) aimed at removal of toxic exudate from the abdominal cavity, its sanation and drainage with the use of not less than 5 drainage tubes were employed. From 43 patients of group 1 10 died. There were no lethal outcomes in group 2. The authors believe that early evacuation of the toxic purulent exudate with lavage and drainage of the abdominal cavity promotes more effective elimination of multiorganic insufficiency and decreases the risk for development of pyoseptic complications.

High frequency of complications after pancreatoduodenal resections dictates the necessity to study causes of their origin. This paper provides the results of roentgenologic examinations in early and late postoperative periods in 24 patients who underwent classic pancreatoduodenal resection by Whipple and in 23 patients after pylorus saving pancreatoduodenal resection--operation by Traverzo-Longmire. Conventional method of roentgenologic examination of the operated stomach was used. In early postoperative period disturbances of motor-evacuatory function of upper parts of gastrointestinal tract were revealed in 50% of patients in any modification of pancreatoduodenal resection. In most cases slowering down of the evacuation up to complete gastrostasis was observed. But in long-term follow-up functional results after pancreatoduodenal resection according to x-ray examination data were much better after operation by Traverzo-Longmire (75% patients) than after classic version by Whipple (37% patients). Thus, the results of roentgenologic examination showed that pylorus saving version of pancreatoduodenal resection provides optimal conditions for normal activities of the saved organ.

The paper presents pilot results of clinical application of developed experimintally method of treatment for acute cholecystitis based on demucosation of the gall-bladder followed by obliteration of its lumen. Two modifications of the method-treatment of mucous membrane of the gall-bladder by phenol emulsion (16 patients) and electrocoagulation of the mucosa (49 patients)--were used with good clinical results in patients with high operation risk. Follow-up results are available for up to 3.5 years.

The paper analyzes the use of thin-needle aspiration biopsy in 372 patients with thyroid solitary formations. By the results of clinical and instrumental studies and cytological examination of thyroid puncture specimens groups of patients with individual clinical and morphological types of the disease were identified. Differential surgical policy in each group of patients was shown on the basis of the finding. It is concluded that thin-needle aspiration biopsy should be integrated into the compulsory programme of comprehensive examination of patients with thyroid solitary formations. Having a high efficiency, the above method helps in most cases to make an accurate clinical and morphological diagnosis and to choose the optimal treatment policy for each specific patient admitted to a surgical hospital for an aggregate diagnosis of nodal euthyroid goiter. Some patients may avoid unjustifiable surgical intervention and be on conservative therapy under follow-up.

The paper presents the authors' experience in surgically treating aortic occlusions in 325 patients. A total of 275 reparative operations were made from 1978 to 1991. The authors proposed their own classification of aortic occlusions in terms of pathomorphological changes in the aorta and hence offered types of reparative operations and choice of surgical access. In extensive arterial lesions in the femoropopliteal area in combination with high aortic occlusion, the authors recommend that "two-story" reconstructions should be performed by including the distal arterial bed into blood flow. The intraoperative mortality was 1.4%.

The authors analyse critically postgraduate instruction of surgeons. They indicate the serious faults and shortcomings in the system of postgraduate instruction at the chairs of surgery of the faculties of postgraduate training of doctors and suggest the means and methods for improving this work. They consider tests for basis and final control of the theoretical training of the student-doctor to be obligatory. Among the forms of independent work of the student the authors name work on the course subject drawn up as a thematic paper on the medical history in accordance with the methodical instructions of the chair. The practical skill of the student is appraised in marks after he performs independently operations and manipulations under the control of assistants at the clinic. The total rating of the student is made up of the marks for the test control, appraisal of the study-course work, and appraisal of his skill.

The paper deals with the results of treatment of 32 children aged from 2 to 12 years with injuries to the arteries (n = 7), tendons of the hand and fingers (n = 9), nerves of the fingers (n = 3), cryptorchidism (n = 6), tumour of a finger (n = 1), and traumatic amputation of a finger (n = 1). Drainage of a lymph vessel in the foot for lymph infusion in +suppurative conditions was carried out in 8 patients. Optic magnification, inert suture material, and microsurgical instruments were used in the operations. The anatomical and functional results were excellent and good in 30 patients. In an 8-year-old girl, the results of a restorative operation on the flexor tendons of the ring finger of the left hand were satisfactory. In a boy two and a half years of age, replantation of the index finger of the left hand proved a failure. Microsurgical methods make it possible to attain utmost precision in forming vascular anastomoses, applying sutures to the nerves of the fingers and tendons, and in other operations. Microsurgery holds much promise in pediatric surgery.

The paper discusses the results of study of lipid peroxidation (LP) in patients with various forms of purulent surgical infection. A conclusion is drawn from the analysis of the obtained data that the difference in the forms of the pyoseptic processes is determined to a great measure by the concrete state of free-radical lipid oxidation which acts as a regulatory mechanism of the inflammatory reaction, changing the permeability of biomembranes at the tissue, cell, and organism levels. The conducted research holds promise for the creation of modern and progressive variants of pathogenetic intensive therapy.