Reconstruction of colon continuum is one of the most complicated and actual problems of surgical coloproctology. Composing the basics of medical-social insurance of patients with different kinds of unmanageable colostomas, reconstruction operations promote complete - psychoemotional, physical and labor rehabilitation in them they meaningless improve the living quality of patients suffering from colorectal cancer. Traumatizing affection and technical complicability of colo- plastical events that are accompanying by high rate of supportive septic complications and post-operational mortality dictates neces- sity of search of the ways to improve the results of above-mentioned operations with taking into consideration age peculiarities of patients with temporary colostoma. 

   During the 1978-1999 years time period in Azerbaijan MUNN Surgical diseases N 1 clinic obstructive resections (hemicolectomy) of different segments of colon with creation of one- or 2- caliber ileo - or colo - stomas were performed on 132 patients. 33 patients (25% of all stomed) were in elderly (26) and old (7) ages. 

      Colon cancer complicated by obstruction served as nosological reason of colostoma creation in 18 patients. In 15 cases colostomy performed as the 1-st stage of emergency surgical supply in patients with non-tumor diseases and traumas of large intestine. Among patients with benign diseases of large intes- tine more often was found dolihostoma complicated by volvulus (in 13 cases), ravel unspecific ulcerous colitis complicated by perfo- ration (in 2 cases). One-trunk colostoma was formed in 30 and 2-trunk colostoma was putted in 3 patients. 

      In pre-operation examination program of patients were included roentgenologic and endoscopy investigations of gastrointestinal tract (in order to study morphofunctional condition of acting and dissecting large intestine segments and to determine the condition of rectal obstructive mechanism). 

     Cytologic and hystologic studies of tunica mucosae in colostoma zone, fybrocoloscopy, ultrasonography, as well as nuclear magnetic topography of abdominal cavity and pelvis minor were conducted in patients who were operated before due to stenosing colon cancer (in order to exclude tumor residives and metastases). All operations were conducted by intraabdominal method. During pre-operation period special attention was paid to preparation of large intestine for planned reconstructive event. This procedure was conducted by performance of intestinal lavage. 

      A new model of aspiration - rinzing machine for realization of intraveiga- tion of large intestine was constructed by us for this aim (received authorized License N 99 /001421 of National Expertise of Azerbaijan Republic). 6 month time period upon the moment of artificial anus formulation is considered the optimal for performing of repeated operations in patients with colostoma putted due to non-tumor diseases of large intestine, and 12 month time period - when it putted due to stenosing cancer. Coloplastic operation of II-nd stage difficulty have been performed in all patients. Large intestine continuum was recovered by putting of transverso- anastomosis in 1, sigma- sigma-anastomosis in 31 and sigma-rectal anastomosis in 1 patient. Anastomoses were formed by manual method with 2-raw suture in the most ( 29) patients. Interintestine anastomo- sis was putted by AKA-2 machine in 4 patients. 

       Post-operation complications occurred in 13 (39,3%) patients. The structure of complications was composed from anastomoses sutures insolvency in 6 patients, wound suppuration of colostoma area in 4 patients and large intestine fistula in 1 patient. 8 patients died after operation (24,2%) due to peritonitis: as a result of anastomoses suture insolvency in 5 cases , as a result of acute cardiovascular failure in 5 cases , and as a result of lung artery tromboembolia in 1 case. 

For more information please contact with following address: Sultanov G. A, 

Azerbaijan Medical University named after N.Narimanov Adress: Baku 370001, Tolstoy Street 89 

Tel.: 99412 94 44 69 (home) 

 HYPOTHALAMUS-HYPOPHYSIS-ADRENAL IMMUNE REGULATION IN EARLY AGE GROUP CHILDREN WITH THYMUS-LYMHPATIC STATUS 

Huseynov Sh. K., Kurbanov T.G 

Azerbaijan State Medical University, Department of Histology, Embryology and Cytology 

     Correlation between hypothalamus-hypophysis-adrenal regulation and immune system in children with thymus -lymphatic status is not studied completely. 

     That is why we carried out our investigations in 65 early age group children with TLS, the control group was composed from 28 practically healthy children . 

    Dopamine (DA), serotonine (S), ACTH, cortizole (C), aldosterone (A) levels in blood were studied in the children . 

     Immune system status was estimated by determination of T-lympho- cytes and sub-populations ( T-suppressors and T-helpers). Levels of cAMF, cGMF were studied in lymphocytes and blood serum. Results of our investigation helped to reveal that in TLS children DA, ACTG, K, GMF, as well as T-lymphocytes, T-suppressors levels were significantly decreased basal levels of A., S., c AMF was significantly increased in blood serum when compared to control group children. At the same time cAMF and cGMF levels investigation in lymphocytes showed that they are significantly decreased in TLS children when compared to healthy ones. 

      These data evident to lack of adaptation processes on cell and molecular levels. The results obtained by us show deviations of immune status regulation on system (immune, mediatorial, endocrine system) levels and cell levels in TLS children. 

    Thus, immune homeostasis in children with TLS presents complex regulatory mechanism, and an important place in it takes hypothalamus- hypophysis-adrenal system reactivity. 

For more information please contact with following address: Gasimov Eldar Kyocherli ogli, 

Azerbaijan State Medical University, Department of Hystology, Embriology and Cytology 

Теl: +99412 952565 (home) +99412 726921 (work) 

SURGICAL TREATMENT OF PATIENTS WITH ANUS SPHYNCTER MUSCLE INSUFFICIENCY 

Aliev E. A. 

Azerbaijan State Medical University 

      Anus sphincter insufficiency is found oftenly . It composes 10% from the structure of all rectum diseases. Study of the methods of anus sphincter insufficiency is composing a great importance because it is causing acute decrease of working ability, making troubles to the patients and bringing them to invalidation. 

     26 patients with anus sphincter insufficiency were under our observation. Age of the patients varied from 21 to 62 years. 15 of the patients were females and 11-males. In 6 patients 1st, in 13 - 2nd and in 7- 3rd stages of anus sphincter insufficiency were diagnosed.

       By aethiology, in 6 patients ( 23.1%) anus sphincter insufficiency was caused after operation on rectum, in 13 (50%) patients after birth and in 7 (26.9%) patients after traumatic injury. 

      All patients undergone the surgical treatment. 14 patients with 1 st and 2 nd insufficiency stage undergone sphincteroplastics, 19 patients - spincterolevatoroplastics. 3 patients with 3rd insufficiency stage undergone sphincteroplastics, 6 patients - sphyncteroglutero- plastics, 4 patients - sphynkteroplastics by femoral adducting muscle. Study of surgical treatment's results showed that shincteroplastics gave good effects without any complications in all 14 patients. Wound purification and suture insolvency had place in 2 patients after sphincterolevatoroplastics and sphincterogluteroplastics. After sphincteroplastics by femoral adducting in 3 cases muscle sphincter muscle function have been improved, in 1 case wound suppuration and muscle necrosis occured. 

For more information please contact with following address:

 Aliev E. A. , 

Azerbaijan State Medical University 

Tel.: 99412 95 21 91

FUNCTIONAL CHANGINGS IN THE LIVER LYMPH SYSTEM DUE TO PERITONITIS

Ragimov V.A, Aghayev I.N, Garayev G.Sh

    In order to find out the pathophysiological changingsin the lymphocirculation of liver due to peritonitis were carried out investigations under 8 dogs weighted 16-24 kg.

    Experimantal model of peritonitis was reached according the method suggested be Usikov.

    Appearence of lymphocyrculation and it's speed in liver were investigated in normal and experimantal model of peritonitis in 3, 6, 12, 24, 48 hours. 

    If to concider those indices in nporma as 100% , after first 3 hours of peritonitis they are 20-25% as much in comparition with initial indices. In 6 hours the indices are as 80% as greater and in 12 hours they reach their highest level, which is 2,5 times as higher in comparition with initial indices.

    After that the presence and speed of limphocirculation in liver is progressively ddecreasing, in 24 hours these indices are only 15-20% of initial showings, and in 48 hours the complete  lymphocirculation block in liver has been registered.

    So, it is determined that, due to peritonitis changings are going on in 2 directions: during the 1-st 12 hours appearence and speed of liver lymphocirculation are progressively decreasing and in its 48th hours we registrate its complete block.

    As a result of mentioned investigations we can come to conclusion that serious disorder of evacuator-transportation function of inner liver lymphocirculation take place due to severe endotoxicosis and there is a necessity of its correction.