Saratov JOURNAL of Medical and Scientific Research

Shapkin Yu.G.

Saratov State Medical University, Head of Department of General Surgery, Professor, Doctor of Medical Science

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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Comparative analysis of assessment methods for operational and anesthetic risks in ulcerative gastroduodenal bleeding

Year: 2015, volume 11 Issue: №3 Pages: 323-327
Heading: Surgery Article type: Original article
Authors: Potakhin S.N., Shapkin Yu.G., Vlasova M.A., Nikitin V.A.
Organization: Saratov State Medical University
Summary:

Aim of the investigation: to conduct a comparative analysis of methods of evaluation of surgical and anesthetic risks in ulcerative gastroduodenal bleeding. Materials and methods. A retrospective analysis ofthe extent of the surgical and anesthetic risks and results of treatment of 71 patients with peptic ulcer bleeding has been conducted in the study. To evaluate the surgical and anesthetic risks classification trees are used, scale ТА. Rockall and prognosis System of rebleeding (SPRK), proposed by N. V. Lebedev et al. in 2009, enabling to evaluate the probability of a fatal outcome. To compare the efficacy ofthe methods the following indicators are used: sensitivity, specificity and prediction of positive result. Results. The study compared the results ofthe risk assessment emergency operation by using these methods with the outcome ofthe operation. The comparison ofthe prognosis results in sensitivity leads to the conclusion that the scales ТА. Rockall and SPRK are worse than the developed method of classification trees in recognizing patients with poor outcome of surgery. Conclusion. The method of classification trees can be considered as the most accurate method of evaluation of surgical and anesthetic risks in ulcerative gastroduodenal bleeding.

Probability of developing severe sepsis in patients of elderly and senile age with necrotic erysipelas

Year: 2015, volume 11 Issue: №2 Pages: 198-201
Heading: Phthisiology Article type: Original article
Authors: Shapkin Yu.G., Khilgiyaev R.H., Mikhailenko K.A.
Organization: Saratov State Medical University
Summary:

Objective: the probable determination of severe sepsis in patients of elderly and senile age with necrotic erysipelas based on a comprehensive assessment (clinical examination using systems — scales and determination of the level markers of SIRS). Material and methods. The analysis of peculiarities of necrotic erysipelas clinical course in 59 patients. The first group consisted of 17 patients with severe sepsis, the second — 18 patients with sepsis without multiple organ failure, in the comparison group —22 patients with local infection. We determined albumin, urea, creatinine, pro-calcitonin of plasma. The scale SAPS III was used to quantify SIRS, scale SOFA —to determine the extent of damage to organs and systems. Results. The most sensitive marker of developing sepsis in patients with necrotic erysipelas was procalcitonin. The second important indicator of SIRS severity in patients with necrotic erysipelas was the blood albumin. Scale SAPS III also allows to select a group of patients with high risk of developing severe sepsis. Use of the SOFA to predict the scale has been found out to be less important. Conclusion. A comprehensive assessment of the severity of the condition by scale SAPS III in combination with determining the levels of procalcitonin and plasma albumin is advisable to apply for prediction the probability of developing severe sepsis in patients of elderly and senile age with necrotic erysipelas. For the last indicator it is important to assess of absolute values and the decrease of its concentration.

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Strategy and tactics of surgical treatment in elderly patients with ischemic form of diabetic foot syndrome

Year: 2015, volume 11 Issue: №1 Pages: 049-052
Heading: Gerontology and geriatrics Article type: Review
Authors: Shapkin Yu.G., Yuanov A.A., Efimov E.V.
Organization: Saratov State Medical University, Regional Hospital for War Veterans, Saratov
Summary:

The article analyzes the Russian and foreign publications on the issue of treatment of elderly and senile patients with critical limb ischemia and diabetes mellitus. It is shown that the topic is relevant, and, despite its wide coverage in the press, does not have the final decision. Currently unresolved issues include the terms and indications for reconstructive surgery, the amount and the method of amputation, postoperative care.

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Evaluation of the operative and anesthetic risk for patients with ulcerative gastroduodenal bleedings

Year: 2014, volume 10 Issue: №4 Pages: 663-669
Heading: Surgery Article type: Original article
Authors: Potakhin S.N., Shapkin Yu.G.
Organization: Saratov State Medical University
Summary:

Aim: to specify operative and anesthetic risk during urgent and preventive operations for patients with ulcerative gastroduodenal bleedings, develop algorithm for prognosis of unfavorable outcomes after operations and point out possible ways to control risks in given pathology. Material and Methods. To specify factors of operative and anesthetic risk during urgent and preventive operations a comparative analysis of two groups of patients suffering from gastroduodenal bleedings, who were treated in the surgery department of "Saratov city clinical hospital Nr.6" was done. The first group consisted of 39 patients, who died after the surgery, the second group of 274 patients with a favorable outcome after the operation. The statistical analysis was done by use of the program Statistica 6.0. Results. The operative and anesthetic risk factors where determined with the help of parametric and non-parametric methods of statistical analysis. An algorithm of evaluation operative and anesthetic risk factors by a tree classification was devised through the use of multidimensional analysis. With the help of this one can predict the outcome of urgent and preventive operations and highlight the risk group with an expected lethality of about 40%. Conclusion. The division of patients according to degree of risk of bleeding relapses as a whole with complex evaluation of patient's condition severity and operative and anesthetic risk allows choosing the right treatment plan and by this as a result increases the chance for a favorable treatment outcome.

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The dynamics of main indicators for the treatment of ulcerative gastroduodenal bleedings — the analysis of several years studies

Year: 2014, volume 10 Issue: №3 Pages: 456-460
Heading: Surgery Article type: Original article
Authors: Shapkin Y.G., Potahin S.N.
Organization: Saratov State Medical University
Summary:

The research goal is evaluation of influence of changes in diagnostic & treatment possibilities and surgical approach on the results of treatment of patients with ulcerative gastro-duodenal bleedings (GDB). Material and methods: An analysis of the treatment results of 1885 patients suffering from ulcerative GDB, which have been treated in the surgery department of the "State clinical hospital No.6" in Saratov has been done. The information about the patients suffering from GDB has been retrieved from the digital archives, which were filed from 1991 to 2009. The patients have been divided into five groups according to five periods of work, each one differ by its own diagnostic & treatment possibilities and approaches. The evaluation was based the amount of operations, the number of different types of operations, the efficiency of endohemostasis, the amount of bleeding relapses and the lethality. Results: The introduction of computer prognosis for bleeding relapse, the increase in the number of endoscopic hemostatic methods, the application of Laser Doppler Flowmetry (LDF) for the evaluation of reliability of hemostasis, the use of dynamic endoscopy and testing probe for bleeding relapse in the state of prerelapse syndrome with the combination of preventive measures on the source of bleeding and antisecretory therapy have led to the decrease of overall lethality from 6,5% to 1,9%, and the postoperative lethality from 9,1% to 1,7%. Conclusion: The analysis of treatment results by periods made it possible to have an overview on different factors as they undergo changes during these periods, evaluate weak points in the current treatment tactic and set a direction for further investigations.

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Evaluation of severity and prognosis of the disease course in ulcerative gastroduodenal bleeding

Year: 2014, volume 10 Issue: №2 Pages: 301-307
Heading: Surgery Article type: Review
Authors: Potakhin S.N., Shapkin Yu.G., Chalyk Yu.V., Zevyakina V.A.
Organization: Saratov Clinical Hospital № 8, Saratov State Medical University
Summary:

The systems of evaluation for severity and prognosis of the disease course constitute an important resource for the improvement of treatment parameters in patients with gastroduodenal bleeding. Although in practice more common methods with limited accuracy and high percentage of subjectivity are often used. The work shows the analysis of the situation and possible ways of resolution.

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Evaluation of severity and prognosis of the disease course in ulcerative gastroduodenal bleeding

Year: 2014, volume 10 Issue: №2 Pages: 301-307
Heading: Surgery Article type: Review
Authors: Potakhin S.N., Shapkin Yu.G., Chalyk Yu.V., Zevyakina V.A.
Organization: Saratov State Medical University, Saratov Clinical Hospital N 8
Summary:

The systems of evaluation for severity and prognosis of the disease course constitute an important resource for the improvement of treatment parameters in patients with gastroduodenal bleeding. Although in practice more common methods with limited accuracy and high percentage of subjectivity are often used. The work shows the analysis of the situation and possible ways of resolution.

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Modern issues on the treatment of peptic ulcer bleedings

Year: 2014, volume 10 Issue: №1 Pages: 132-138
Heading: Surgery Article type: Review
Authors: Potakhin S.N., Shapkin Y.G., Klimashevich V.Y., Belikov A.V., Zevyakina V.A.
Organization: Saratov State Medical University
Summary:

Despite the success of therapeutic treatment of peptic ulcer and the introduction of endoscopic technologies, the problem of peptic ulcer hemorrhage remains valid. A large number of publications in foreign literature are dedicated to epidemiology and prevention of bleeding, evaluation of modern tactics and search for new methods of treatment. The works relating to organization of aid to patients with peptic ulcer bleeding are of particular interest. According to the recent data not all clinics even in economically developed countries manage to follow the recommendations of an international consensus-2010 for non-variceal bleeding treatment of upper gastrointestinal tract. Among the causes of non-compliance of international recommendations there are subjective and objective factors, the understanding of which can significantly affect the optimization of aid to patients with peptic ulcer bleeding.

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General surgery in higher medical schools: innovative teaching methods

Year: 2011, volume 7 Issue: №4 Pages: 992-993
Heading: Pedagogics and Education Article type: Author's opinion
Authors: Shapkin Y.G., Kapralov S.V., Khilgiyaev R.H., Belikov A.M., Horoshkevich A.V.
Organization: Saratov State Medical University
Summary:

Educational programmes and computer tests are important in teaching of general surgery. Application of modern computer and Internet technologies in the educational process improves quality of training

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