. Effect of the venous outflow ways from pancreatic transplant on carbohydrate metabolism after autotransplantation of pancreas in the experiment

The aims: to compare the state of carbohydrate metabolism in animals after pancreatectomy with autotransplantation of the pancreatic segment and with organization of the venous outflow in the inferior vena or portal vein. Material and methods. Proximal resection of the pancreas (group 1), pancreatectomy with autologous transplantation of the pancreas and with reconstruction of the venous outflow from the transplant into the inferior vena cava (group 2) and pancreatectomy with autologous transplantation of the pancreas and with reconstruction of the venous outflow from the transplant into the portal vein (group 3) were performed in 45 animals in the experiment. Examining the status of carbohydrate metabolism was performed by intravenous test for glucose tolerance. Results. Primary higher increase in glucose concentrations as compared to the values obtained at the intact animals and its slower decrease have been observed in animals after pancreatectomy with autotransplantation of the segment of the pancreas on iliac vessels (group 2), as well as on the mesenteric vessels (group 3). Higher blood glucose compared to animals subjected proximal pancreatectomy after 40 minutes after administration of glucose was detected in animals undergoing autotransplantation of the pancreas on iliac vessels (group 2) and in animals after autotransplantation of the pancreas on mesenteric vessels (group 3)— 11.82 (11,39-12,26) mmol/l and 10.65 (10,03-11,32) mmol/l, respectively. The glucose concentration in the blood plasma was lower in the animals of groups 2 and 3 below in comparison with the animals in group 1 to 120 minutes of the experiment. Significant differences in plasma glucose concentration between animals of groups 2 and 3 were not found. Conclusion. Significant effects of the ways of organization of the venous outflow from pancreatic transplant on the concentration of the glucose in the blood plasma by the carbohydrate load after pancreatectomy with autotransplantation of the pancreas were not found

Clinical results of the complex prevention of the acute postoperative pancreatitis at the surgical gastroenterology

The article aims to study the results of the complex prevention of the acute postoperative pancreatitis in the surgical gastroenterology. Material and methods. 2968 patients with various disorders of the digestive system were operated. Empirical preventing of the acute postoperative pancreatitis was used in the control group. Complex prevention of the acute postoperative pancreatitis in the main group of patients included the use of Dalargin, intravenous infusion of Octreotide, duodenal trypsin enzyme inhibition; intraduodenal reversal of pancreatic secret; intraductal injection of Lidocaine and external transnasal drainage of the pancreatic and biliary ducts. Results. The frequency of acute postoperative pancreatitis was 12.2% in the main group. The frequency of acute postoperative pancreatitis was 36.9% in the control group. Increased frequency of a mild form of the acute postoperative pancreatitis observed in the main group compared with the control. At the same time reducing the frequency of the moderate severity and severity forms of the acute postoperative pancreatitis observed in the main group compared with the control. Reduction of the morbidity (13.6% vs. 25.1%), hospital mortality (1.6% vs. 3.5%), the duration of the postoperative hospital bed-day (12.1±0.4 vs. 16.7±0.6) were identified in the main group patients compared with the control group. Conclusion. The use of the given scheme for the complex prevention of the acute postoperative pancreatitis allowed significantly reduce the frequency and severity of illness, morbidity, reduce the duration of postoperative hospital bed-day and hospital mortality, as well as the frequency of both mild and severity, and fatal postoperative complications in all investigated groups of patients

Influence of antacids operations at histamine concentration in plasma and the risk of malignancies of the colon

Aim; identify communication between antacid operations and malignant tumors of the digestive system. Material and methods. The study was conducted on the 72 Wistar rats. The effect of the stem vagotomy and resection of the distal 2/3 of the stomach and antrumectomy to the concentration of gastrin in plasma were investigated. The effect of intraperitoneal injection of the azoksimetan on the incidence of malignant tumors of the colon was investigated. Re-sults. Increase of the plasma concentration of the gastrin in the postoperative period after stem vagotomy was found. Reduction of the concentration of the gastrin after distal gastrectomy to values close to zero with slight its rise and subsequent stabilization was found. The incidence of colon tumors in animals after stem vagotomy in conjunction with intraperitoneal injection of the chemical carcinogen azoximetan was higher compared to the animals after isolated injection of the azoximetan. The incidence of tumors in animals after resection of the distal 2/3 of the stomach differed not statistically significant from control animals. Conclusion. Vagal denervation of the abdominal cavity leads for significant increase of the concentration of the histamine of the blood plasma. Resection of the 2/3 distal stomach causes a significant reduction in the production of the gastrin. Truncal vagotomy increases the risk of neoplazms of the peritoneal cavity in the rats

The clinical efficacy of the water jet dissection at the thyroid surgery (immediate results; quality of life)

Aim: reduction of the morbidity, disability and improved quality of life after surgery on the thyroid gland. Material and methods. Surgical treatment of the thyroid diseases have been performed to 56 patients. Mobilization of the thyroid gland and the separation of the pretracheal, preguttural and paratracheal tissues were performed by standard techniques using electrocoagulation and blunt separation of tissues in the control group. Mobilization of the thyroid gland and the separation of pretracheal, preguttural and paratracheal tissues were performed using a water-jet dissector ERBEjet 2 and the pressure of the water jet 25 bars in the main group of patients. Violations of voice (dysphonia), swallowing difficulties (dysphagia), the overall incidence of postoperative complications, length of postoperative hospital stay were markers of the effectiveness of the prevention of the damage of the recurrent laryngeal nerve afterthyroid surgery. Assessment of the quality of life of patients after surgery on the thyroid gland was performed before surgery, at 3 and 6 months after surgery. Results. Damage of the recurrent laryngeal nerve was not identified in any of the patient as a result of water jet dissection with pressure of the water jet 25 bars during the operation. Nerve function in the postoperative period were preserved in 100% (p <0.05). Application of the proposed method of preventing damage to the recurrent laryngeal nerve afterthyroid surgery resulted in a leveling of postoperative complications, as well as a statistically significant reduction of postoperative hospital stay. Using of the water jet dissection for mobilize of the thyroid and parathyroid tissues with a pressure of the water jet 25 bars significantly improves the quality of life of patients in the postoperative period. Conclusion. Application of the water jet dissection with pressure of the water jet 25 bars in thyroid surgery is a safe and effective method to prevent damage of the recurrent laryngeal nerve and improves the quality of life of patients in the postoperative period

Safety and Effectiveness of Intraarticular Administration of Adipose-Derived Stromal Vascular Fraction for Treatment of Knee Articular Cartilage Degenerative Damage: Preliminary Results of a Clinical Trial

The incidence of knee osteoarthritis tends to increase every year and constitutes more than 83% of overall OA morbidity. Moreover, the OA morbidity among younger patients is also increasing. However, currently available treatment methods do not provide quite satisfactory outcomes. Purpose of the study - to evaluate safety and efficacy of intraarticular introduction of autologous adipose-derived stromal vascular fraction for treatment of knee osteoarthritis. Material and methods. By the moment of writing the present report, 28 patients were included into the study. All patients underwent tumescent liposuction under local anesthesia. The stromal vascular fraction was isolated from lipoaspirate within 1,5 hours after harvesting and subsequently injected into the articular cavity. Follow-up period was 6 months after injections. The authors report on efficacy data of 10 patients who completed the study according to protocol and safety data of all 28 patients. Efficacy was evaluated basing on laboratory assessments and patient's subjective assessment by validated questionnaires. Results. Neither adverse reactions no adverse events were observed. Significant decrease of pain severity by VAS was noted in one week after injection and pain score continued decreasing during the whole follow up period. The increase of KOOS score was noted starting on the fifth week after injection. KSS part 1 score increased in 8 weeks, KSS part 2 score - in 6 months after injection. Physical health, assessed with SF-36 questionnaire significantly improved in 2 and 6 months after the procedure. There was a clear trend towards improvement of mental health. Conclusion. Preliminary results of clinical study suggest intraarticular injection of autologous adipose-derived stromal vascular fraction to be a safe and efficient method of the treatment of knee osteoarthritis

ОЦЕНКА БЕЗОПАСНОСТИ И ЭФФЕКТИВНОСТИ ВНУТРИСУСТАВНОГО ВВЕДЕНИЯ СТРОМАЛЬНОВАСКУЛЯРНОЙ ФРАКЦИИ ЖИРОВОЙ ТКАНИ ДЛЯ ЛЕЧЕНИЯ ГОНАРТРОЗА: ПРОМЕЖУТОЧНЫЕ РЕЗУЛЬТАТЫ КЛИНИЧЕСКОГО ИССЛЕДОВАНИЯ

The incidence of knee osteoarthritis tends to increase every year and constitutes more than 83% of overall OA morbidity. Moreover, the OA morbidity among younger patients is also increasing. However, currently available treatment methods do not provide quite satisfactory outcomes. Purpose of the study - to evaluate safety and efficacy of intraarticular introduction of autologous adipose-derived stromal vascular fraction for treatment of knee osteoarthritis. Material and methods. By the moment of writing the present report, 28 patients were included into the study. All patients underwent tumescent liposuction under local anesthesia. The stromal vascular fraction was isolated from lipoaspirate within 1,5 hours after harvesting and subsequently injected into the articular cavity. Follow-up period was 6 months after injections. The authors report on efficacy data of 10 patients who completed the study according to protocol and safety data of all 28 patients. Efficacy was evaluated basing on laboratory assessments and patient's subjective assessment by validated questionnaires. Results. Neither adverse reactions no adverse events were observed. Significant decrease of pain severity by VAS was noted in one week after injection and pain score continued decreasing during the whole follow up period. The increase of KOOS score was noted starting on the fifth week after injection. KSS part 1 score increased in 8 weeks, KSS part 2 score - in 6 months after injection. Physical health, assessed with SF-36 questionnaire significantly improved in 2 and 6 months after the procedure. There was a clear trend towards improvement of mental health. Conclusion. Preliminary results of clinical study suggest intraarticular injection of autologous adipose-derived stromal vascular fraction to be a safe and efficient method of the treatment of knee osteoarthritis.В последние годы отмечается неуклонный рост заболеваемости остеоартрозом коленного сустава. Доля данной патологии составляет 83% от общей заболеваемости остеоартрозом. Результаты лечения существующими методами не вполне удовлетворительные. Цель исследования - оценить безопасность и эффективность внутрисуставного введения аутологичной стромально-васкулярной фракции клеток жировой ткани для лечения остеоартроза коленного сустава. Материал и методы. В исследование включено 28 пациентов. В условиях дневного стационара у каждого пациента забирали жировую ткань (шприцевая липосакция под местной анестезией), из которой в течение 1,5 ч выделяли стромально-васкулярную фракцию клеток и вводили в полость сустава. Наблюдение за пациентами осуществляли в течение 6 мес. после введения клеточного продукта. Нами представлены данные об эффективности, полученные при анализе индивидуальных регистрационных карт 10 больных, которые в соответствии с протоколом завершили участие в исследовании, и данные о безопасности, полученные для всех 28 пациентов. эффективность оценивали при помощи инструментальных методов обследования, а также валидированных вопросников. Результаты. Ни у одного больного не было выявлено нежелательных явлений или реакций. Через неделю после введения стромально-васкулярной фракции клеток жировой ткани отмечалось снижение болевого синдрома, которое продолжалось на протяжении всего периода наблюдения. Оценка качества жизни пациентов по шкале KOOS выявила улучшение качества жизни начиная с четвертой недели после внутрисуставного введения клеток. при клинической оценке функции коленного сустава с использованием части 1 вопросника KSS установлено повышение суммы баллов через 8 нед., а по части 2 вопросника KSS - через 6 мес. после введения клеточного продукта. при оценке качества жизни с помощью вопросника SF-36 выявлено улучшение физического компонента здоровья, статистически значимое на 2-м и 6-м мес. исследования. Не выявлено статистически значимого улучшения психологического компонента здоровья, однако наблюдается отчетливая тенденция к улучшению данного показателя. Выводы. предварительные результаты клинического исследования свидетельствуют о безопасности и эффективности внутрисуставного введения аутологичной стромально-васкулярной фракции клеток жировой ткани для лечения остеоартроза коленного сустава