Novosti
Khirurgii
This journal is
indexed in Scopus









Year 2010 Vol. 18 No 6

GENERAL AND SPECIAL SURGERY

DOVNAR R.I., SMOTRIN S.M., VASIL’KOV A.YU., ZHMAKIN A.I.

ANTIBACTERIAL AND ANTIFUNGAL EFFECT OF THE BANDAGING MATERIAL CONTAINING SILVER NANOPARTICLES

Objectives. To study antibacterial and antifungal effect of the bandaging material on the basis of medical gauze bandage containing silver nanoparticles obtained by means of the metal vapor synthesis method.
Methods. In the research the strains of microorganisms and fungi of Candida genus were used which had been isolated from the purulent wounds of the surgical patients. Determination of the antibacterial and antifungal effect of the bandaging containing silver nanoparticles was performed on Petri dishes with agar. A usual medical gauze bandage was used for control. Sensitivity to antibiotics and antibacterial preparations had been previously revealed in these strains of microorganisms. The correlation analysis of antibacterial action of the bandaging containing silver nanoparticles was carried out as well as the analysis of microorganisms’ sensitivity to antibiotics.
Results. Medical gauze bandage containing silver nanoparticles was found out to have antibacterial and antifungal action. The performed correlation analysis showed that there was no any link between microbes’ resistance to antibiotics and resistance to silver nanoparticles.
Conclusions. Nanocomposite material silver/bandage has a marked antimicrobial action in relation to gram-positive and gram-negative bacteria and Candida. Microorganisms’ resistance to silver-containing bandaging doesn’t correlate with the range and level of their sensitivity to antibiotics.

Keywords: silver nanoparticles, antibacterial and antifungal effect, medical gauze bandage
p. 3 – 11 of the original issue
References
  1. Schofield, W. C. A substrate-independent approach for bactericidal surfaces / W. C. Schofield, J. P. Badyal // ACS applied material & interfaces. – 2009. – Vol. 1, N 12. – P. 2763-2767.
  2. Абаев, Ю. К. Хирургическая повязка / Ю. К. Абаев. – Минск: Беларусь, 2005. – 150 с.
  3. Silver, S. Bacterial heavy metal resistance: new surprises / S. Silver, L. T. Phung // Annual review of microbiology. – 1996. – Vol. 50. – P. 753-789.
  4. Fox, C. L. Silver sulphadiazine – a new topical therapy for pseudomonas in burns. Therapy of pseudomonas infection in burns / C. L. Fox // Archievs of surgery. – 1968. – Vol. 96, N 2. – P. 184-188.
  5. Lansdown, A. B. Silver 2. Toxicity in mammals and how its products aid wound repair / A. B. Lansdown // Journal of wound care. – 2002. – Vol. 11, N 5. – P. 173-177.
  6. Park, S. J. Preparation and characterization of activated carbon fibers supported with silver metal for antibacterial behavior / S. J. Park, Y. S. Jang // Journal of colloid and interface science. – 2003. – Vol. 261, N 2. – P. 238-243.
  7. Designing surfaces that kill bacteria on contact / J. C. Tiller [et al.] // Proceedings of the national academy of science. – 2001. – Vol. 98, N 11. – P. 5981-5985.
  8. Goldstein, A. N. Handbook of nanophase materials / A. N. Goldstein. – New York: Marcel dekker inc., 1997. – 370 р.
  9. A versatile strategy to fabricate hydrogel–silver nanocomposites and investigation of their antimicrobial activity / V. Thomas [et al.] // Journal of colloid and interface science. – 2007. – Vol. 315, N 1. – P. 389-395.
  10. Merisko-Liversidge, E. M. Drug nanoparticles: formulating poorly water-soluble compounds / E. M. Merisko-Liversidge, G. G. Liversidge // Toxicologic pathology. – 2008. – Vol. 36. – P. 43-48.
  11. Chen, X. Nanosilver: a nanoproduct in medical application / X. Chen, H. J. Schluesener // Toxicology letters. – 2008. – Vol. 176, N 1. – P. 1-12.
  12. Sun, T. Silver clusters and chemistry in zeolites / T. Sun, K. Seff // Chemical reviews. – 1994. – Vol. 94, N 4. – P. 857-864.
  13. A silver colloid produced by reduction with hydrazine as support for highly sensitive surface-enhanced Raman spectroscopy / U. Nickel [et al.] // Langmuir. – 2000. – Vol. 16, N 23. – P. 9087-9094.
  14. Электронные и магнитные свойства кластерных нанокомпозитов на основе Fe-Au, приготовленных бинарным металло-паровым синтезом / И. П. Суздалев [и др.] // Рос. нанотехнологии. – 2008. – Т. 3, № 1-2. – С. 76-81.
  15. Ultrahigh molecular weight polyethylene modified with silver nanoparticles prepared by metal-vapour synthesis / A. Vasil’kov [et al.] // AIP Conference Proceeding. – 2008. – Vol. 1042. – P. 255-257.
  16. Антибактериальный эффект наночастиц золота и серебра / С. М. Смотрин [и др.] // Современные технологии в лечении ран и раневой инфекции: сб. науч. cт. Респ. науч.-практ. конф. ГГМУ, Гомель, 19–20 марта 2010 г. – Гомель, 2010. – С. 59-60.
  17. A mechanistic study of the antibacterial effect of silver ions on Escherichia coli and Staphylococcus aureus / Q. L. Feng [et al.] // Journal of biomedical materials research. – 2000. – Vol. 52, N 4. – P. 662-668.
  18. The influence of platinum on the performance of silver-platinum antibacterial coatings / A. J. Betts [et al.] // Materials & Design. – 2005. – Vol. 26, N 3. – P. 217-222.
  19. Effects of halides on plasmid-mediated silver resistance in Escherichia coli / A. Gupta [et al.] // Applied and environmental microbiology. – 1998. – Vol. 64, N 12. – P. 5042-5045.
  20. Metal oxide nanoparticles as bactericidal agents / P. K. Stoimenov [et al.] // Langmuir. – 2002. – Vol. 18, N 17. – P. 6679-6686.

SHESTIUK A.M., KARPITSKY A.S., PANKO S.V., BOUFALIK R.I.

DETERMINATION OF THE VIDEOTHORACOSCOPY APPROACH PARAMETERS TO THE EPIPHRENIC SEGMENT OF THE ESOPHAGUS

Objectives. Determination of the videothoracoscopy approach parameters to the epiphrenic esophagus segment through the left pleural cavity in men with different kinds of the constitution.
Methods. The areas for optics and manipulators introducing to nake the epiphrenic esophagus segment are determined on the basis of the anropometric measurings and X-ray peculiarities of 106 patients.
Results. It is established that introducing of the optical trocar in the area of the 7th intercostal space on the posterior axillary line on the left is an optimal one at videothoracoscopic surgeries on the epiphrenic esophagus segment regardless of the body constitution. Instrumentation ports should be placed in the 5th intercostal space on the mid-axillary line and in the 8th intercostal space on the posterior-axillary line for dolichomorphic men, in the 5th intercostal space on the mid-axillary line and in 8th intercostal space on the shoulder line for normomorphic men, in the 6th intercostal space on the posterior-axillary line and the 9th intercostal space on the shoulder line for bradimorphic men.
Conclusions. Preparing for the videothoracoscopic intervension on the epiphrenic esophagus segment should be accompanied by previous modelling of trocars imposition areas to introduce optics and instruments which differ depending on the constitution.

Keywords: esophagus, videothoracoscopy, access
p. 12 – 20 of the original issue
References
  1. Созон-Ярошевич, А. Ю. Анатомо-клиническое обоснование хирургических доступов к внутренним органам / А. Ю. Созон-Ярошевич. – Л.: Медгиз, 1954. – 180 с.
  2. Веретенников, С. И. Топографо-анатомические аспекты выбора техники эндоскопической спленэктомии / С. И. Веретенников, М. В. Крамаров, Н. В. Островский // Эндоскопич. хирургия. – 1997. – № 1. – С. 53-54.
  3. Петришин, В. Л. Адаптация параметров оперативного действия в видеоэндохирургии / В. Л. Петришин // Эндоскопич. хирургия. – 2000. – № 6. – С. 25-27.
  4. Шнитко, С. Н. О некоторых параметрах оптимального доступа при эндоскопических операциях / С. Н. Шнитко, А. Л. Стринкевич // Эндоскоп. хирургия. – 1999. – № 2. – С. 75-76.
  5. Устинов, О. Г. Критерии оценки эндоскопических доступов / О. Г. Устинов, Ю. М. Захматов // Эндоскоп. хирургия. – 2003. – № 1. – С. 39-42.

KHRYSHCHANOVICH V.YA., TRETYAK S.I., BOGOMAZOVA E.V.

HYPOTHYROIDISM AFTER HEMITHYROIDECTOMY: INCIDENCE, RISK FACTORS, TREATMENT

Objectives. To estimate the incidence and factors influencing hypothyroidism development after hemithyroidectomy.
Methods. A retrospective review of 251 patients in the nearest postoperative period who underwent hemithyroidectomy was performed. The incidence of postoperative hypothyroidism was based on thyrotropin values and clinical symptoms. The relationship between hypothyroidism, age and the character of thyroid pathology was investigated using correlation analysis.
Results. 37 of 214 patients (17%) became biochemically hypothyroid postoperatively. 163 patients (76%) became euthyroid without intervention or with low doses of thyroxine. More often postoperative hypoparathyroidism developed at patients with autoimmune thyroiditis. Thus the correlation analysis has shown the inverse relationship serum ТSH from the age of patients.
Conclusions. A minority of patients become hypothyroid after hemithyroidectomy. Some patients with biochemical hypothyroidism will become euthyroid without intervention. Development of postoperative hypothyroidism is influenced by the age of patients and in a greater degree by the inflammatory character of the thyroid gland pathology.

Keywords: hypothyroidism, hemithyroidectomy, thyroiditis, surgery
p. 21 – 28 of the original issue
References
  1. Buchanan, M. A. Thyroid auto–antibodies, lymphocytic inltration and the development of postoperative hypothyroidism following hemithyroidectomy for non–toxic nodular goiter / M. A. Buchanan, D. Lee // J. R. Coll. Surg. Edin. – 2001. – Vol. 46. – P. 86-90.
  2. The inuence of different degrees of chronic lymphocytic thyroiditis on thyroid function after surgery for benign, non–toxic goiter / J. Berglund [et al.] // Eur. J. Surg. – 1991. – Vol. 157. – P. 257-260.
  3. Hedman, I. Need for thyroxine in patients lobectomised for benign thyroid disease as assessed by follow–up on average fteen years after surgery / I. Hedman, S. Jansson, S. Lindberg // Acta Chir. Scand. – 1986. – Vol. 152. – P. 481-486.
  4. Hypothyroidism following partial thyroidectomy / J. C. Keogh [et al.] // Ir. Med. J. – 1977. – Vol. 70. – P. 261-262.
  5. McHenry, C. R. Hypothyroidism following hemithyroidectomy: Incidence, risk factors, and mana-gement / C. R. McHenry, S. J. Slusarczyk // Surgery. – 2000. – Vol. 128. – P. 994-998.
  6. Sequential changes in serum thyroglobulin, triiodothyronine and thyroxine following partial thyroidectomy for nontoxic nodular goiter / C. Shigemassa [et al.] // Metab. Clin. Exp. – 1988. – Vol. 37. – P. 677-682.
  7. Preventive effect of levothyroxine in patients operated for non–toxic goiter: A randomized trial of one hundred patients with nine years follow–up / C. Bistrup [et al.] // Clin. Endocrinol. – 1994. – Vol. 40. – P. 323-327.
  8. Indications for thyroxine therapy after surgery for non–toxic benign goiter / J. Berglund [et al.] // Acta Chir. Scand. – 1990. – Vol. 156. – P. 433-438.
  9. Detecting and dening hypothyroidism after hemithyroidectomy / G. Hannah [et al.] // The American Journal of Surgery. – 2005. – Vol. 189. – P. 587-591.
  10. Impaired cardiac reserve and exercise capacity in patients receiving long–term thyrotropin suppressive therapy with levothyroxine / B. Biondi [et al.] // J. Clin. Endocrinol. Metab. – 1996. – Vol. 12. – P. 4224-4228.
  11. Effects of TSH–suppressive therapy on cardiac morphology and function: Benecial effects of the addition of beta–blockade on diastolic dysfunction / S. Gullu [et al.] // Eur. J. Endocrinol. – 2004. – Vol. 150. – P. 665-661.
  12. Bone mineral density in women receiving thyroxine suppressive therapy for differentiated thyroid carcinoma / C. H. Chen [et al.] // J. Formosan. Med. Assoc. – 2004. – Vol. 103. – P. 442-447.
  13. Study of the pituitary–thyroid axis in euthyroid goiter after partial thyroidectomy / G. Lombardi [et al.] // J. Endocrinol. Investig. – 1983. – Vol. 6. – P. 485-487.
  14. Lipid and thyroid changes after partial thyroidectomy: Guidelines for L–thyroxine therapy? / L. Campion [et al.] // Clin. Chem. – 1995. – Vol. 41. – P. 473-474.
  15. Cheung, P. Thyroid function after hemi-thyroidectomy for benign nodules / P. Cheung, J. Boey, J. Wong // World J. Surg. – 1986. – Vol. 10. – P. 718-723.
  16. Thyroid function after resection for non–toxic goiter with special reference to thyroid lymphocytic aggregation and circulating thyroid autoantibodies / U. Bang [et al.] // Acta Endocrinol. – 1985. – Vol. 109. – P. 214-219.

SARAP P.V., VINNIK YU.S., OSTANIN A.A.

SCALE OF OUTCOME PREDICTION IN PATIENTS WITH URGENT SURGICAL PATHOLOGY CONSIDERING IMMUNE STATUS INDICATORS

Objectives. To work out a surgical immune-associated factor evaluation scale (SIAFE) to predict the outcome in patients with urgent surgical pathology, to estimate its informativeness, sensitivity and specificity.
Methods. Training data consist of 440 patients (930 examinations). The control group consisted of 80 patients with diffuse peritonitis. To calculate the SIAFE indicators of patients’ condition and the characteristic of immune system organization clusters were used. The SIAFE scale considers severity of peritoneal inflammation, SAPS II score, CD20+ lymphocytes count, parities of CD25+, CD38+ and CD95+ lymphocytes and a distance from the immune status cluster centre.
Results. According to the results of the dispersive analysis, the SIAFE scale is more informative in comparison with traditionally used scales, permits to estimate probability of a lethal outcome statistically authentically. The ROC-analysis confirms high sensitivity and specificity, «excellent» characteristics (AUC=0,95) of SIAFE scale.
Conclusions. The basic advantage of SIAFE is its universality at the estimation of disease outcome prediction in patients with urgent surgical abdominal pathology in various terms from the moment of hospitalization.

Keywords: urgent surgery, immunity, estimation of the condition severity
p. 29 – 39 of the original issue
References
  1. Buttenschoen, K. Effect of major abdominal surgery on the host immune response to infection / K. Buttenschoen, K. Fathimani, D. C. Buttenschoen // Curr. Opin. Infect. Dis. – 2010. – N 3. – P. 259-267.
  2. Esposito, S. Immune system and surgical site infection / S. Esposito // J. Chemother. – 2001. – Spec. N 1. – P. 12-16.
  3. Plasma cytokine measurements augment prognostic scores as indicators of outcome in patients with severe sepsis / A. Oberholzer [et al.] // Shock. – 2005. – N 6. – P. 488-493.
  4. Авдеев, С. Н. Применение шкал оценки тяжести в интенсивной терапии и пульмонологии / С. Н. Авдеев, А. Г. Чучалин // Пульмонология. – 2001. – № 11. – С. 77-91.
  5. Современные представления о классификации перитонита и системах оценки тяжести состояния больных / В. Д. Федоров [и др.] // Хирургия. – 2000. – № 4. – С. 58-62.
  6. Zweig, M. H. ROC Plots: A Fundamental Evaluation Tool in Clinical Medicine / M. H. Zweig, G. Campbell // Clinical Chemistry. – 1993. – Vol. 39, N 4. – P. 146-160.
  7. Fawcett, T. ROC graphs: notes and practical considerations for researchers / T. Fawcett // Kluwer Academic Publishers. – 2004. – Printed in the Netherlands.
  8. Fawcett, T. Using rule sets to maximize ROC performance / T. Fawcett // Proceedings of the IEEE International Conference on Data Mining. – Los Alamitos, 2001. – P. 131.
  9. Пригожин, И. Порядок из хаоса: новый диалог с природой / И. Пригожин, И. Стенгерс. – М.: Прогресс, 1986. – 432 с.
  10. Self-organization of chaos synchronization and pattern formation in coupled chaotic oscillators / X. Zhang [et al.] // Phys. Rev. E. Stat. Nonlin. Soft. Matter. Phys. – 2006. – Vol. 7. – P. 1520-1522.
  11. Bernardes, A. T. Immune network at the edge of chaos / A. T. Bernardes, R. M. dos Santos // J. Theor. Biol. – 1997. – Vol. 2. – P. 173-187.
  12. Manian, F. A. Modern medicine and chaos theory / F. A. Manian // JAMA. – 1997. – Vol. 17. – P. 1399-1400.
  13. Леончик, Е. Ю. Кластерный анализ. Терминология, методы, задачи / Е. Ю. Леончик, О. В. Савастру. – Одесса: изд-во Одес. нац. ун-та, 2007. – 208 c.
  14. Kaiser, H. F. The Varimax criterion for analytic rotation in factor analysis / H. F. Kaiser // Psychometrika. – 1958. – N 23. – P. 187-200.
  15. Способ прогноза исхода заболевания пациентов с ургентной хирургической патологией органов брюшной полости: пат. 2352948 РФ, МПК G01N 33/53 / П. В. Сарап, Ю. С. Винник; заявитель Краснояр. гос. мед. акад. – № 200122617; заявл. 15.06.2007; опубл. 20.04.2009 // Изобретения. Полезные модели. – 2009. – № 11. – С. 492.

KHRYSHCHANOVICH V.YA., TRETYAK S.I., MOKHORT T.V., BOGOMAZOVA E.V.

WELL–BEING AND CALCIUM-PHOSPHORUS HOMEOSTASIS IN PATIENTS WITH HYPOPARATHYROIDISM RECEIVING STANDARD TREATMENT WITH CALCIUM AND VITAMIN D

Objectives. To study calcium homeostasis and well-being of the patients with hypoparathyroidism by comparison of the obtained results with those in the patients who underwent thyroid surgery but with saved parathyroid function.
Methods. Cross-sectional controlled study in 69 patients with the postsurgical hypoparathyroidism (the period of the postoperative observation made up 38,7±10,3 months (S.D.) on stable treatment with calcium and vitamin D (or analogs) and in 26 control patients with a history of thyroid surgery but saved parathyroid function, who were matched for sex, age and time since surgery. Assessment of well–being and parathyroid homeostasis were studied using validated questionnaires (SF–36 v. 2ФМ, NAIF), serum calcium/phosphorus homeostasis, and in the hypoparathyroid patients also screening for secondary disease by means of kidney ultrasound and ophthalmological split lamp examination.
Results. Serum calcium was in the accepted therapeutic range in 10 of hypoparathyroid patients, in the majority cases calcium/phosphorus homeostasis was clearly non–physiological. Nephrolithiasis was detected in 6 and cataracts in 3 of 69 hypoparathyroid patients. As compared with controls, hypoparathyroid patients had signicantly lower parameters of quality of a life in SF–36 v. 2ФМ (р < 0,05), NAIF (р = 0,048) with predominant decreases in the scale scores for vitality, physical and social functioning, role–physical/emotional functioning.
Conclusions. Current standard treatment in hypoparathyroidism is not only associated with an altered calcium/phosphorus homeostasis but also fails to restore well–being in these patients. Future studies need to address the impact of more physiological treatment options like parathyroid hormone (1–34) or parathyroid transplantation on well–being and mood in these patients.

Keywords: thyroidectomy, life quality, hypoparathyroidism, management
p. 40 – 49 of the original issue
References
  1. Experience in a specialist thyroid surgery unit: a demographic study, surgical complications, and outcome / N. N. al–Suliman [et al.] // European Journal of Surgery. – 1997. – Vol. 163. – P. 13-20.
  2. Total compared with subtotal thyroidectomy in benign nodular disease: personal series and review of published reports / G. Pappalardo [et al.] // European Journal of Surgery. – 1998. – Vol. 164. – P. 501-506.
  3. Rimpl, I. Surgery of nodular goiter: postoperative hypocalcemia in relation to extent of resection and manipulation of the parathyroid glands / I. Rimpl, R. A. Wahl // Langenbecks Archiv der Chirurgie Supplement Kongressband. – 1998. – Vol. 115. – P. 1063-1066.
  4. Multivariate analysis of risk factors for postoperative complications in benign goiter surgery: prospective multicenter study in Germany / O. Thomusch [et al.] // World Journal of Surgery. – 2000. – Vol. 24. – P. 324-329.
  5. Prevalence of goiter in the Aachen area. Ultrasound volumetry of the thyroid gland of 1336 adults in an endemic goiter region / J. Riehl [et al.] // Ultraschall in der Medizin. – 1995. – Vol. 16. – P. 84-89.
  6. Well–being, mood and calcium homeostasis in patients with hypoparathyroidism receiving standard treatment with calcium and vitamin D / W. Arlt [et al.] // European Journal of Endocrinology. – 2002. – Vol. 146. – P. 215-222.
  7. Avioli, L. V. The therapeutic approach to hypoparathyroidism / L. V. Avioli // American Journal of Medicine. – 1974. – Vol. 57. – P. 34-42.
  8. Haussler, M. R. Metabolites and analogues of vitamin D. Which for what? / M. R. Haussler, P. E. Cordy // Journal of the American Medical Association. – 1982. – Vol. 247. – P. 841-844.
  9. Rizzoli, R. Vitamin D treatment of hypoparathyroid patients / R. Rizzoli, J. P. Bonjour // European Journal of Endocrinology. – 1997. – Vol. 136. – P. 25-27.
  10. Schilling, T. Current therapy of hypoparathyroidism – a survey of German endocrinology centers / T. Schilling, R. Ziegler // Experimental and Clinical Endocrinology and Diabetes. – 1997. – Vol. 105. – P. 237-241.
  11. Nordin, B. E. Role of kidney in regulation of plasma calcium / B. E. Nordin, M. Peacock // Lancet. – 1969. – Vol. 2. – P. 1280-1283.
  12. Dual X-ray absorptiometry of the proximal femur: normal European values standardized with the European Spine Phantom / J. Pearson [et al.] // Journal of Bone and Mineral Research. – 1995. – Vol. 10. – P. 315-324.
  13. Ware, J. E. SF–36 Health Survey Update / J. E. Ware // Spine. – 2000. – Vol. 25, N 24. – P. 3130-3139.
  14. Banks, M. H. Validation of the General Health Questionnaire in a young community sample / M. H. Banks // Psychological Medicine. – 1983. – Vol. 13. – P. 349-353.
  15. Популяционные показатели качества жизни по опроснику SF–36 (результаты многоцентрового исследования качества жизни «МИРАЖ») / В. Н. Амирджанова [и др.] // Науч.-практ. ревматология. – 2008. – № 1. – С. 36-48.
  16. Dehydroepiandrosterone replacement in women with adrenal insufciency / W. Arlt [et al.] // New England Journal of Medicine. – 1999. – Vol. 341. – P. 1013-1020.
  17. Kowdley, K. V. Cognitive impairment and intracranial calcication in chronic hypoparathyroidism / K. V. Kowdley, B. M. Coull, E. S. Orwoll // American Journal of Medical Sciences. – 1999. – Vol. 317. – P. 273-277.
  18. Neuropsychological alterations in patients with computed tomography–detected basal ganglia calcication / D. Lopez–Villegas [et al.] // Archives of Neurology. – 1996. – Vol. 53. – P. 251-256.
  19. Usdin, T. B. Identication and functional expression of a receptor selectively recognizing parathyroid hormone, the PTH2 receptor / T. B. Usdin, C. Gruber, T. I. Bonner // Journal of Biological Chemistry. – 1995. – Vol. 270. – P. 15455-15458.
  20. TIP39: a new neuropeptide and PTH2–receptor agonist from hypothalamus / T. B. Usdin [et al.] // Nature Neuroscience. – 1999. – Vol. 2. – P. 941-943.
  21. Cloning of human 25–hydroxyvitamin D-1 alpha–hydroxylase and mutations causing vitamin D–dependent rickets type 1 / G. K. Fu [et al.] // Molecular Endocrinology. – 1997. – Vol. 11. – P. 1961-1970.
  22. Duan, Y. Parathyroid hormone deciency and excess: similar effects on trabecular bone but differing effects on cortical bone / Y. Duan, V. De Luca, E. Seeman // Journal of Clinical Endocrinology and Metabolism. – 1999. – Vol. 84. – P. 718-722.
  23. Bone histomorphometry in hypoparathyroid patients treated with vitamin D / B. L. Langdahl [et al.] // Bone. – 1996. – Vol. 18. – P. 103-108.
  24. Parathyroid allotransplantation without immunosuppression / C. Hasse [et al.] // Lancet. – 1997. – Vol. 350. – P. 1296-1297.
  25. Winer, K. K. Synthetic human parathyroid hormone 1–34 vs calcitriol and calcium in the treatment of hypoparathyroidism / K. K. Winer, J. A. Yanovski, G. B. Jr. Cutler // Journal of the American Medical Association. – 1996. – Vol. 276. – P. 631-636.

KATORKIN S.E., YAROVENKO G.V., MYSHENTSEV P.N., SIZONENKO YA.V.

FEATURES OF MUSCELOSKELETAL SYSTEM BIOMECHANICAL CHANGES IN CHRONIC LOWER LIMBS LYMPHATICOVENOUS INSUFFICIENCY

Objectives. Improvement of the functional diagnostics at chronic lymph-venous insufficiency of the lower limbs using the biochemical methods of investigation.
Methods. 116 patients with lymph-venous insufficiency of C4-C6 classes (according to CEAP) and 28 practically healthy people were examined. The clinical movement analysis was performed, applying apparatus-software complex «MBN-Biomechanika» including podometrics, plantography, electromyography and goniometry.
Results. Scoliosis was found out in 56% of the patients; in 28% osteochondrosis was observed; arthrosis-arthritis was diagnosed in 45%; various disturbances of the foot configuration were seen in 89% of all investigations. The most obvious pathology of the skeletal system was noted in the classes C5-C6. Functional insufficiency of the lower limbs with the locomotor function pathology of the talocrural joint was established to develop in the classes C4-C6.
Conclusions. Functional insufficiency and static-dynamic disturbances in patients with chronic lymph-venous insufficiency of C4-C6 testified to the failure of compensatory reactions of the skeletal system that should be taken into consideration while carrying out medical rehabilitation.

Keywords: biomechanics, chronic lymph-venous insufficiency, static-dynamic disturbances
p. 50 – 57 of the original issue
References
  1. Jeanneret-Gris-Iseli, C. 50 years of phlebology / C. Jeanneret-Gris-Iseli, K. Burnand // XVІ World Congress of the Union Internationale de Phlebologie: e-abstract book. – Monaco, 2009. – P. 2-3.
  2. Флебология: руководство для врачей / В. С. Савельев [и др.]; под ред. В. С. Савельева. – М.: Медицина, 2001. – 664 с.
  3. Косинец, А. Н. Варикозная болезнь / Н. А. Косинец, С. А. Сушков. – Витебск: ВГМУ, 2009. – 415 с.
  4. Bergan, J. J. Chronic venous disease / J. J. Bergan, G. W. Schmid-Schonbein, P. D. Coleridge-Smith // Minerva Cardioangiol. – 2007. – Vol. 55, N 4. – P. 459-476.
  5. Risk factor and underlying mechanisms for venous stasis syndrome: a population-based case-control study / A. A. Ashrani [et al.] // Vasc. Med. – 2009. – Vol. 14, N 4. – P. 339-349.
  6. Яровенко, Г. В. Роль биомеханических исследований при хронической лимфовенозной недостаточности нижних конечностей / Г. В. Яровенко, С. Е. Каторкин, П. Н. Мышенцев // Новости хирургии. – 2010. – № 2. – С. 56-63.
  7. Жуков, Б. Н. Инновационные технологии в диагностике, лечении и медицинской реабилитации больных хронической венозной недостаточностью нижних конечностей / Б. Н. Жуков, С. Е. Каторкин. – Самара: Сам. отд. Литфонда, 2010. – 383 с.
  8. Жуков, Б. Н. Медицинская реабилитация больных хронической венозной недостаточностью нижних конечностей: учебное пособие / Б. Н. Жуков, С. Е. Каторкин, Я. В. Сизоненко; ГОУ ВПО «Самар. Гос. Мед. Ун-т». – Самара: Самар. отд. Литфонда, 2009. – 164 с.
  9. Батышева, Т. Т. Современные технологии диагностики и реабилитации в неврологии и ортопедии / Т. Т. Батышева, Д. В. Скворцов, А. И. Труханов. – М.: Медика, 2005. – 256 с.
  10. Скворцов, Д. В. Диагностика двигательной патологии инструментальными методами: анализ походки, стабилометрия / Д. В. Скворцов, Т. М. Андреева. – М., 2007. – 640 с.

NEUROSURGERY

TSITKO E.L., SMEYANOVICH A.F.

NEUROSONOGRAPHY IN THE BRAIN ABSCESS SURGERY

Objectives. To study the lethality rate in case of peritonitis after the abdominal oncologic surgeries and to determine main causes of different outcomes of the postoperative peritonitis.
Methods. 125 patients with the postoperative peritonitis developed after abdominal surgeries were included in the investigation; the lethality rate and causes of different outcomes of a complication were studied. The interventions because of peritonitis are stratified into radical and non-radical surgeries.
Results. Peritonitis outcome is determined by the tumor localization, kind of oncologic surgery, direct cause of a complication and possibilities to eliminate the infection. In 42, 4% of the patients a surgical sanitation was non- radical one. The lethality rate at non-radical elimination of the peritonitis focus was higher (р<0,001) than at radical sanitation. More frequent causes of peritonitis which can’t be corrected by means of radical surgery were infected pancreatonecrosis and esophageal-intestinal anastomosis failure.
Conclusion. Timely diagnostics of the postoperative peritonitis and adequately performed sanitation intervention permit to increase specific gravity of all radical sanitations and thus to improve direct results of treatment at the abdominal oncologic pathology.

Keywords: oncologic patients, postoperative peritonitis, radicalism of surgical sanitation, lethality rate
p. 66 – 74 of the original issue
References
  1. Лебедев, В. В. Абсцессы головного мозга / В. В. Лебедев, Н. В. Хуторной // Нейрохирургия. – 2008. – № 1. – С. 6-12.
  2. Аффи, Мехди. Хирургическое лечение абсцессов головного мозга / Мехди Аффи, А. Ф. Смеянович // Здравоохранение. – 1996. – № 10. – С. 14-16.
  3. The surgical management of infections involving the cerebrum / W. A. Hall, C. L. Truwit // Neurosurgery. – 2008. – Vol. 62, N 2. – P. 519-531.
  4. Thung-Ming, Su. Multiloculated pyogenic brain abscess: Experience in 25 patients / Su. Thung-Ming [et al.] // Neurosurgery. – 2003. – Vol. 52, N 5. – P. 1075-1080.
  5. Current concepts in the management of pyogenic brain abscecc / B. S. Sharma, S. K. Gupta, V. K. Khosla // Neurology India. – 2000. – Vol. 48, N 2. – P. 105-111.
  6. Компьютерная томография в неотложной нейрохирургии / В. В. Лебедев [и др.]. – М.: Медицина, 2005. – 360 с.
  7. Нейрохирургическая навигационная система в лечении объемных образований головного мозга / А. П. Шипай [и др.] // Неврология и нейрохирургия в Беларуси. – 2009. – № 3 (03). – С. 138-142.
  8. КТ-стереотаксические пункции, аспирации и дренирование глубинных объёмных процессов головного мозга / А. В. Меликян [и др.] // Вопросы нейрохирургии. – 1991. – № 6. – С. 1-3.
  9. Значения интраоперационного ультразвукового наведения в нейрохирургической практике при объёмных образованиях головного мозга / А. Р. Зубарев [и др.] // Ультразвуковая и функциональная диагностика. – 2004. – № 4. – С. 92-97.
  10. Гланц, С. Медико-биологическая статистика / С.
  11. Гланц. – М.: Практика, 1999. – 459 с.

ONCOLOGY

SHISHLO I.F.

TYPICAL ABDOMINAL ONCOLOGICAL SURGERIES AND THE POSTOPERATIVE PERITONITIS OUTCOME

Objectives. To study the lethality rate in case of peritonitis after the abdominal oncologic surgeries and to determine main causes of different outcomes of the postoperative peritonitis.
Methods. 125 patients with the postoperative peritonitis developed after abdominal surgeries were included in the investigation; the lethality rate and causes of different outcomes of a complication were studied. The interventions because of peritonitis are stratified into radical and non-radical surgeries.
Results. Peritonitis outcome is determined by the tumor localization, kind of oncologic surgery, direct cause of a complication and possibilities to eliminate the infection. In 42, 4% of the patients a surgical sanitation was non- radical one. The lethality rate at non-radical elimination of the peritonitis focus was higher (р<0,001) than at radical sanitation. More frequent causes of peritonitis which can’t be corrected by means of radical surgery were infected pancreatonecrosis and esophageal-intestinal anastomosis failure.
Conclusion. Timely diagnostics of the postoperative peritonitis and adequately performed sanitation intervention permit to increase specific gravity of all radical sanitations and thus to improve direct results of treatment at the abdominal oncologic pathology.

Keywords: oncologic patients, postoperative peritonitis, radicalism of surgical sanitation, lethality rate
p. 66 – 74 of the original issue
References
  1. Лебедев, В. В. Абсцессы головного мозга / В. В. Лебедев, Н. В. Хуторной // Нейрохирургия. – 2008. – № 1. – С. 6-12.
  2. Аффи, Мехди. Хирургическое лечение абсцессов головного мозга / Мехди Аффи, А. Ф. Смеянович // Здравоохранение. – 1996. – № 10. – С. 14-16.
  3. The surgical management of infections involving the cerebrum / W. A. Hall, C. L. Truwit // Neurosurgery. – 2008. – Vol. 62, N 2. – P. 519-531.
  4. Thung-Ming, Su. Multiloculated pyogenic brain abscess: Experience in 25 patients / Su. Thung-Ming [et al.] // Neurosurgery. – 2003. – Vol. 52, N 5. – P. 1075-1080.
  5. Current concepts in the management of pyogenic brain abscecc / B. S. Sharma, S. K. Gupta, V. K. Khosla // Neurology India. – 2000. – Vol. 48, N 2. – P. 105-111.
  6. Компьютерная томография в неотложной нейрохирургии / В. В. Лебедев [и др.]. – М.: Медицина, 2005. – 360 с.
  7. Нейрохирургическая навигационная система в лечении объемных образований головного мозга / А. П. Шипай [и др.] // Неврология и нейрохирургия в Беларуси. – 2009. – № 3 (03). – С. 138-142.
  8. КТ-стереотаксические пункции, аспирации и дренирование глубинных объёмных процессов головного мозга / А. В. Меликян [и др.] // Вопросы нейрохирургии. – 1991. – № 6. – С. 1-3.
  9. Значения интраоперационного ультразвукового наведения в нейрохирургической практике при объёмных образованиях головного мозга / А. Р. Зубарев [и др.] // Ультразвуковая и функциональная диагностика. – 2004. – № 4. – С. 92-97.
  10. Гланц, С. Медико-биологическая статистика / С.
  11. Гланц. – М.: Практика, 1999. – 459 с.

ANESTHESIOLOGY-REANIMATOLOGY

MAMAS A.N., KOSAREVSKAYA T.E.

INVESTIGATION OF «BURNOUT SYNDROME» OF ANAESTHESIOLOGISTS-REANIMATOLOGISTS

Objectives. To study the degree of intensity of «burnout syndrome» as well as the factors, influencing given syndrome development in the anesthesiologists-reanimatologists.
Methods. 119 anesthesiologists-reanimatologists of various experience length groups were investigated. The intensity degree of «burnout syndrome» and its link with the experience length of the professional activity and the sex of anesthesiologists-reanimatologists were studied.
Results. Significant differences in the intensity degree and the structure of «burnout syndrome» in anesthesiologists-reanimatologists were determined depending on the experience length of the professional activity. The course of «burnout syndrome» has its own peculiarities in males and females.
Conclusions. The obtained data testify to the expediency of practical introducing of special programs aimed to reveal «burnout syndrome» in anesthesiologists-reanimatologists and if necessary to render a psychological assistance to them.

Keywords: professional activity of anesthesiologists-reanimatologists, «burnout syndrome»
p. 75 – 81 of the original issue
References
  1. Абдоминальная хирургическая инфекция: современное состояние и ближайшее будущее в решении актуальной клинической проблемы / И. А. Ерюхин [и др.] // Инфекции в хирургии. – 2007. – Т. 5. – № 1. – С. 45-49.
  2. Неотложная абдоминальная хирургия: справочное пособие для врачей / под ред. А. А. Гринберга. – М.: Триада-Х, 2000. – 496 с.
  3. Ciprofloxacin in primary prophylaxis of spontaneous bacterial peritonitis: a randomized, placebo-controlled study / R. Terg [et al.] // J. Hepatol. – 2008. – Vol. 48, N 5. – P. 774-779.
  4. Circulating mediators and organ function in patients undergoing planned relaparotomy vs conventional surgical therapy in severe secondary peritonitis / N. Zugel [et al.] // Arch. Surg. – 2002. – Vol. 137, N 5. – P. 590-599.
  5. Буренко, Г. В. Новые аспекты интенсивной терапии перитонита, осложненного сепсисом / Г. В. Буренко, М. В. Бондарь, В. М. Мехлин // Клин. хирургия. – 1996. – № 2. – С. 13-14.
  6. Лечение тяжелых форм распространенного перитонита / Б. С. Брискин [и др.] // Хирургия. – 2003. – № 8. – С. 56-59.
  7. Conservative surgical treatment of diffuse peritonitis / C. A. Seiler [et al.] // Surgery. – 2000. – Vol. 127, N 2. – P. 178-184.
  8. Malangoni, M. A. Evaluation and management of tertiary peritonitis / M. A. Malangoni // Am. Surg. – 2000. – Vol. 66, N 2. – Р. 157-161.
  9. Wittmann, D. H. Scope and limitations of antimicrobial therapy of sepsis in surgery / D. H. Wittmann, A. Wittmann-Tylor // Langenbecks Arch. Surg. – 1998. – Vol. 383, N 1. – Р. 15-20.
  10. Demmel, N. Differeentiated treatment strategy for peritonitis: Single stage closure with drainage or open with programmed reintervention lavage? / N. Demmel, G. Osterholzer, B. Gunther // Zentralbl. Chir. – 1993. – Vol. 118, N 7. – P. 395-400.
  11. Послеоперационные осложнения у больных перитонитом / Б. К. Шуркалин [и др.] // Хирургия. – 2003. – № 4. – С. 32-35.
  12. Wittmann, D. H. Management of secondary peritonitis / D. H. Wittmann, M. Schein, R. E. Condon // Ann. Surg. – 1996. – Vol. 224, N 1. – P. 10-18.

KANUS I.I., GRACHEV S.S.

COMPARATIVE CHARACTERISTICS OF ARDUAN, ARCURON AND ESMERON ACTION PARAMETERS AT INTRAABDOMINAL SURGICAL INTERVENTIONS

Objectives. To perform the comparative investigation of the neuromuscular blocking non-depolarizing type agents’ actions at abdominal surgeries.
Methods. 130 patients, at the age of 17 to 78 (ASA I-IV) with a surgical abdominal pathology were included in the investigation. All patients were divided into 3 groups depending on the neuromuscular blocking agent use: the 1st group – 45 patients in whom arduan was used; the 2nd group – 42 patients in whom arcuron was used; the 3rd group – 43 patients in whom esmeron was used.
Results. It is established, that in case of a single or repeated esmeron application, action duration is shorter than similar action parameters of arduan and arcuron for 42–45%. It is proved, that precuraresation reduces the time of all agents in study action start for 0,5–1,0 min. Clinical duration of action, t-90 period, total myoplegia time were increased after precurarezation for 15–22,3%. The data were obtained that succinylcholine decreased arduan, arcuron and esmeron recovery period duration in case of a single or repeated application
Conclusions. Esmeron has the optimal characteristics ensuring the neuromuscular block’s obtainment, maintenance and reversion during an abdominal surgery.

Keywords: neuromuscular blocking agents, accelerometry, neuromuscular block, anesthesia
p. 82 – 89 of the original issue
References
  1. Водопьянова, Н. Е. Синдром «психического выгорания» в коммуникативных профессиях / Н. Е. Водопьянова; Г. С. Никифоров (ред.) // Психология здоровья. – СПб.: Изд-во СпбГУ, 2000. – C. 548-573.
  2. Ронгинская Т.И. Синдром выгорания в социальных профессиях // Психол. журн. – 2002. – Т. 23, №3. – C. 85-95.
  3. Федоровский, Н. М. К вопросу о «синдроме профессионального выгорания» у анестезиологов-реаниматологов / Н. М. Федоровский, О. М. Григорьева // Вестн. интенсив. терапии. – 2004. – № 5. – С. 65-66.
  4. Maslach, C. History and conceptual specificity of burnout / C. Maslach, W. Schaufeli // Recent Developments in Theory and Research, Hemisphere. – New York, 1993. – P. 44-52.
  5. Орёл, В. Е. Феномен «выгорания» в зарубежной психологии: эмпирические исследования и перспективы / В. Е. Орёл // Психол. журн. 2001. – Т. 22, № 1. – С. 90-101.
  6. Бойко, В. В. Энергия эмоций в общении: взгляд на себя и на других / В.В. Бойко. – М.: Наука, 1996. – 154 с.

ILYUKEVICH G.V., SMIRNOV V.M.

LOCAL MICROBIOLOGICAL MONITORING AND ANTIBACTERIAL THERAPY OF NOSOCOMIAL INFECTIONS AT THE INTENSIVE CARE UNITS

Objectives. To improve the results of treatment with secondary infections at the intensive care units by the development of the strategy of the antibacterial treatment based on antibiotics resistance monitoring data.
Methods. 17988 isolates of nosocomial pathogens taken from the biological materials of ICU patients with secondary infections have been analyzed. Structural analysis of nosocomial pathogens and their resistance dynamics has been performed. The scheme of the antimicrobial therapy for nosocomial infections obtained from the performed study has been compared to trivial antibiotic usage strategy in 126 ICU patients in the postoperative period.
Results. It was proved that prophylactic antibiotic therapy refusal and usage of early goal-directed antibiotic therapy reduces 28-day mortality, length of stay at ICU, rate of superinfections and provides quick transition to adequate antibiotic therapy. The economic effectiveness of the method was described as very high.

Keywords: secondary infections, antibiotic resistance, antibiotic therapy, antibiotic prophylaxis, antibiotic usage strategy
p. 90 – 98 of the original issue
References
  1. Лекманов, А. У. Мышечные релаксанты в практике анестезиолога-реаниматолога / А. У. Лекманов. – Смоленск: Альфа-Принт, 1996. – С. 18-89.
  2. Харкевич, Д. А. Фармакология миорелаксантов / Д. А. Харкевич. – М.: Медицина, 1989. – 130 с.
  3. Харкевич, Д. А. Фармакология: учеб. для студентов мед. вузов / Д. А. Харкевич. – 8-е изд. перераб., доп. и испр. – М.: ГЭОТАР – Медиа, 2005. – 736 с.
  4. Миронов, Л. Л. Миорелаксанты: учебное пособие / Л. Л. Миронов, О. Е. Сатишур. – Минск: БелМАПО, 2002. – 42 с.
  5. Рациональная фармакоанестезиология: руководство для практикующих врачей / А. А. Бунятян [и др.]. – М. Литерра, 2006. – 800 с.
  6. Бутров, А. В. Опыт использования акцелографа TOF-GUARD / А. В. Бутров, М. Ф. Дробышев, В. С. Миронов // Вестн. интенсив. терапии. – 1997. – № 4. – С. 27-32.
  7. Бутров, А. В. Технология использования миорелаксантов на основе мониторинга нейромышечной проводимости / А. В. Бутров, М. Ф. Дробышев, В. Е. Кислевич. – М.: Изд-во НЦССХ им. А. Н. Бакулева РАМН, 1999. – 48 с.
  8. Флеров, Е. В. Мониторинг нейромышечной проводимости акселерометрическим методом во время анестезиологического пособия / Е. В. Флеров, И. И. Шитиков, А. Е. Юматов // Анестезиология и реаниматология. – 1997. – № 2. – С. 62-65.
  9. Дарбинян, Т. М. Действие деполяризующих мышечных релаксантов у онкологических больных / Т. М. Дарбинян, Л. А. Вайсберг // Вестн. АМН СССР. – 1968. – № 10. – С. 15-20.
  10. Жоров, И. С. Общее обезболивание / И. С. Жоров. – М.: Медицина, 1964. – С. 427-463.
  11. Марочков, А. В. Опыт применения анестезии с использованием изофлюрана при абдоминальных операциях / А. В. Марочков, В. А. Дудко, М. В. Резников // Новости хирургии. – 2008. – Т. 16, № 2. – С. 116-124.
  12. Многокомпонентная эндотрахеальная анестезия с применением севофлурана в абдоминальной хирургии / А. В. Марочков [и др.] // Новости хирургии. – 2009. – Т. 17, № 3. – С. 137-145.

LECTURES, REVIEWS

ZIARKIEWICZ-WRоBLEWSKA B.

STEPS OF PATHOLOGICAL DIAGNOSIS IN THE DIAGNOSTIC PROCESS ASSOCIATED WITH ADULT LIVER TRANSPLANTATION

Consecutive steps of pathological diagnosis related to adult liver transplantation were shown herein: (1) assessment of liver biopsy taken prior to transplantation from the transplant candidates, (2) examination of donor’s liver biopsy taken prior to and during liver transplantation procedure, (3) assessment of the whole native liver removed during transplantation, and (4) examination of the graft biopsy. Additionally, basic information on pathological diagnostics of the liver transplant with its opportunities and limitations as well as, basing on own experience, the most common problems encountered in pathologist’s practice.

Keywords: liver transplantation, pathomorphological diagnosis
p. 99 – 104 of the original issue
References
  1. Vincent, J. L. EPIC II: sepsis around the world / J. L. Vincent // Minerva Anesthesiol. – 2008. – Vol. 74. – P. 293-296.
  2. Руководство по инфекционному контролю в стационаре: пер. с англ. / Р. П. Венцел; под ред. Р. П. Венцела, Т. Бревера, Ж.-П. Бутцлера. – Смоленск: МАКМАХ, 2003. – 272 с.
  3. Роспотребнадзор. Государственный доклад об эпидемиологической обстановке в Российской Федерации в 2006 г. [Электронный ресурс]. – 2006. – Режим доступа: http://www. rospotrebnadzor.ru/docs/doclad/ Дата доступа 20.05. 2007.
  4. Германович, Ф. А. Есть ли проблема ВБИ в Беларуси и как ее решать? / Ф. А. Германович, Л. П. Титов // Современные подходы к организации инфекционного контроля и микробиологического мониторинга антибиотикорезистентности микроорганизмов: информ. мат. Международ. форума больничной гигиены, Минск, 2002. – С.16-19.
  5. Levy, S. B. Antibacterial resistance worldwide: causes challenges and responses / S. B. Levy, B. Marshall // Nat. Med. – 2004. – N 10. – P.122-128.
  6. Wise, R. Antimicrobial resistance is a major threat to public health / R. Wise, T. Hart, O. Cars // Br. Med. J. – 1998. – Vol. 317. – P. 609-610.
  7. Стандартные определения случаев госпитальной инфекции [Электронный ресурс] / С.-Петерб. мед.-соц. Фонд им. В. А. Башенина. – 2002. – Режим доступа: http://www.zdrav.spb.ru/epid/doc/CDC.doc. – Дата доступа: 20.05.2007.
  8. Clinical and Laboratory Standards Institute. Performance Standards for Antimicrobial Susceptibility Testing; Twentieth Informational Supplement, M100S20. [Электронный ресурс]. – 2010. – Режим доступа: http://www.techstreet.com/cgi-bin/basket?action =add&item_id=4504798. – Дата доступа: 22.05.2010.
  9. Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2008 / R. P. Dellinger [et al.] // Intensive Care Med. – 2008. – Vol. 34, N 1. – P. 17-60.
  10. Prophylactic Antibiotics Adversely Affect Nosocomial Pneumonia in Trauma Patients / H. Jason [et al.] // Journal of Trauma-Injury Infection & Critical Care. – 2003. – Vol. 55, N 2. – P. 249-254.
  11. Chytra, I. The influence of empiric antimicrobial therapy on acquired pulmonary infection in patients with a chest injury on ICU / I. Chytra, E. Kasal, R. Pradl // Critical Care. – 2000. – N 4. – Suppl. 1. – P. 98-106.
  12. Stephen, J. Assessment of pathogens and resistance patterns among intensive care unit patients in North America: initial report from the SENTRY Antimicrobial Surveillance Program (2001) / J. Stephen // Materials of the 42 Intersciense congress of Antimicrobial Agents and Chemotherapy, San Diego, CA, 2002. – Abctr. 2-297.

LEVIN M.D., TROYAN V.V.

PATHOLOGICAL PHYSIOLOGY, DIAGNOSTICS AND PROSPECTS FOR TREATMENT OF THE LOW IMPERFORATE ANUS IN NEWBORNS

Despite enormous interest in the development of an ideal operation procedure to treat congenital anorectal malformations, the situation is as confusing today as it was 30 years ago. The soling or chronic constipation is observed in one third of all postoperative patients, most frequently after the correction of the high or intermediate anomalies. It was shown that anal canal in newborns with low imperforate anus is always normally formed up to the distal 3-5 mm, i.e. at the level of the skin and subcutaneous tissue of the perineum. Closed anal canal does not have any volume and it is not seen in the invertogram. The original method of X-Ray diagnosis of anorectal anomalies makes it possible to discover the anal canal if it exists. Operational findings can not be taken as a criterion for the correct diagnosis because rectal pressure decreases under the influence of anesthetics and the anal canal remains closed. A surgeon bypasses it and takes out the rectum instead. As a result, the muscles and neural connections of the anal canal and rectum are impaired. Then, patient is falsely diagnosed with high or intermediate imperforate anus which «justifies» the unsatisfactory functional results. Two methods of the operation are discussed here. They allow to utilize all elements of the anal canal that take part in the continence and defecation.

Keywords: imperforate anus, low anorectal anomalies, rectal atresia, newborn, bowel perforation, X-Ray diagnosis, invertogram, operation
p. 105 – 114 of the original issue
References
  1. Hashmi, M. A. Anorectal malformation in female children – 10 years experience / M. A. Hashmi, S. Hashmi // J. R. Coll Surg. Edinb. – 2000. – Vol. 45, N 3. – P. 153-158.
  2. Pena, A. Advances in the management of anorectal malformations / A. Pena, A. Hong // Am. J. Surg. – 2000. – Vol. 180, N 5. – P. 370-376.
  3. Social quality of life for adult patients with anorectal malformations / N. Iwai [et al.] // J. Pediatr. Surg. – 2007. – Vol. 42, N 2. – P. 313-317.
  4. Rectovaginal fistula: a common diagnostic error with significant consequences in girls with anorectal malformations / N. G. Rosen [et al.] // J. Pediatr. Surg. – 2002. – Vol. 37, N 7. – P. 961-965.
  5. Долецкий, С. Я. Детская хирургия: руководство для врачей / С. Я. Долецкий, Ю. Ф. Исаков. – М., 1970.
  6. Murugasu, J. J. A new method of roentgenological demonstration of anorectal anomalies / J. J. Murugasu // Surgery. – 1970. – Vol. 68, N 4. – P. 706-712.
  7. Thompson, W. The association of spinal and genitourinary abnormalities with low anorectal anomalies (imperforate anus) in female infants / W. Thompson, H. Grossman // Radiology. – 1974. – Vol. 113, N 3. – P. 693-698.
  8. Cremin, R. J. A rational radiological approach to the surgical correction of anorectal anomalies / R. J. Cremin, S. Cywes, J. H. Louw // Surgery. – 1972. – Vol. 71, N 6. – P. 801-806.
  9. Analysis of 1,992 patients with anorectal malformations over the past two decades in Japan. Steering Committee of Japanese Study Group of Anorectal Anomalies / M. Endo [et al.] // J. Pediatr. Surg. – 1999. – Vol. 34, N 3. – P. 435-441.
  10. Transperineal sonography for determination of the type of imperforate anus.AJR / H. P. Haber [et al.] // J. Am. J. Roentgenol. – 2007. – Vol. 189, N 6. – P. 1525-1529.
  11. Niedzievlski, J. K. Invertography versus ultrasonography and distal colostography for the determination of bowel-skin distance in children with anorectal malformations / J. K. Niedzievlski // Eur. J. Pediatr. Surg. – 2005. – Vol. 15, N 4. – P. 262-267.
  12. Pena, A. Management of anorectal anomalies during the newborn period / A. Pena // World J. Surg. – 1993. – Vol. 17, N 3. – P. 385-392.
  13. McHugh, K. Pre-operative MRI of anorectal anomalies / K. McHugh // Pediatr. Radiol. – 1995. – Vol. 25, N 1. – P. S33-36.
  14. Rectoperineal fistula in newborn boys / L. K. Shanbhogue [et al.] // J. Pediatr. Surg. – 1994. – Vol. 29, N 4. – P. 536-537.
  15. By the Japan study group of anorectal anomalies. A group study for the classification of anorectal anomalies in Japan with comments to the International Classification (1970) // J. Pediatr. Surg. – 1982. – Vol. 17, N 3. – P. 302-308.
  16. Gans, S. L. Congenital anorectal anomalies: changing concepts in management / S. L. Gans, N. B. Friedman, J. S. David // Clin. Pediatr. (Phila). – 1963. – Vol. 2. – P. 605-613.
  17. Левин, М. Д. Рентгенофункциональные исследования актов удержания и дефекации / М. Д. Левин // Педиатрия. – 1983. – № 2. – C. 49-52.
  18. US identification of the anal sphincter complex and levator ani muscle in neonates: infracoccygeal approach / T. I. Han [et al.] // Radiology. – 2000. – Vol. 217, N 2. –P. 392-394.
  19. Мишарев, О. С. Программа обследования и тактика лечения больных с аноректальными пороками развития / О. С. Мишарев, М. Д. Левин, И. Ф. Абу-Варда // Хирургия. – 1985. – № 7. – C. 38-44.
  20. Левин, М. Д. Рентгенологическая диагностика неперфорированного ануса без свища у новорожденных / М. Д. Левин, А. Н. Никифоров // Бел. мед. журн. – 2005. – № 2. – C. 117-120.
  21. Anterior sagittal anorectoplasty for anorectal malformations and perineal trauma / A. Wakhlu [et al.] // J. pediatr. Surg. – 1996. – Vol. 31, N 9. – P. 1236-1240.
  22. Watanabe, Y. Unexpectedly deformed anal sphincter in low-type anorectal malformation / Y. Watanabe, H. Takasu, K. Mori // J. Pediatr. Surg. – 2009. – Vol. 44, N 12. – P. 2375-2379.
  23. Wajsman, Z. Rectal atresia / Z. Wajsman, J. A. Bar-Maor, S. Nissan // Harefuah. – 1972. – Vol. 83, N 9. – P. 357-359.
  24. Левин, М. Д. Рентгенофункциональные исследования при эктопии анального канала у детей / М. Д. Левин // Вестн. Рентгенологии. – 1989. – № 5. – С. 10-16.
  25. Intraoperative measurement of rectouretral fistula: prevention of incomplete excision in mail patients with high-type imperforate anus / H. Koga [et al.] // J. Pediatr. Surg. – 2010. – Vol. 45, N 2. – P. 397-400.
  26. Posterior sagittal anorectoplasty: functional results of primary and secondary operation in comparison to the pull-through method in anorectal malformations / W. Mulder [et al.] // Eur. J. Pediatr. Surg. – 1995. – Vol. 5, N 3. – P. 170-173.
  27. Anorectal function and endopelvic dissection in patients with repaired imperforate anus / C. C. Сhen [et al.] // Pediatr. Surg. Int. – 1998. – Vol. 13, N 23. – P. 133-137.
  28. Constipation is major functional complication after internal sphincter-saving posterior sagital anorectoplasty for high and intermediate anorectal malformations / R. Rintala [et al.] // J. Pediatr. Surg. – 1993. – Vol. 28, N 8. – P. 1054-1058.
  29. deVries, P. A. Posterior sagittal anorectoplasty / P. A. deVries, A. Pena // J. Pediatr. Surg. – 1982. – Vol. 17, N 5. – P. 638-643.
  30. Stevenson, R. J. Percutaneus transperineal pouch localization in low imperforate anus: a new approach / R. J. Stevenson, C. Sheldon, S. T. Ildstat // J. Pediatr. Surg. – 1990. – Vol. 25, N 2. – P. 273-275.

VINNIK YU.S., PERYANOVA O.V., ONZUL E.V., TEPLYAKOVA O.V.

MICROBIAL BIOFILMS IN SURGERY: FORMATION MECHANISMS, DRUG RESISTANCE, WAYS OF SOLVING PROBLEMS

The scientific review is devoted to the meaning of microbial biofilms in forming of surgical infection foci. The mechanisms of forming biological films, peculiarities of structural organization and development of drug resistance are presented. Some examples of participation of microbial communities in the cardiac surgical and urological practice as well as in the initiation of catheter associated infections are given. The problems and the perspectives of the potential therapeutic and non-therapeutic effects to bacterial cells in the composition of biofilms are also discussed.

Keywords: biofilms, drug resistance, adhesion, ultrastructure, formation of microbial communities, biocides
p. 115 – 125 of the original issue
References
  1. Бухарин, О. В. Теоретические и прикладные аспекты проблемы персистенции микроорганизмов / О. В. Бухарин // Журн. микробиология. – 2000. – № 4. – С. 4-7.
  2. Бухарин, О. В. Фундаментальные и прикладные аспекты проблемы персистенции микроорганизмов / О. В. Бухарин, Б. Я. Усвяцов, Л. М. Хуснутдинова // Журн. микробиология. – 2003. – №4. – С. 3-8.
  3. Габриэлян, Р. И. Функции микрофлоры желудочно – кишечного тракта и последствия её нарушения после хирургических вмешательств / Р. И. Габриэлян, Е. М. Горская, Н. Д. Снегова // Антибиотики и химиотерапия. – 2000. – № 45 (9). – С. 24-29.
  4. Proteom analysis reveals differential protein expression by Batlus cereus during biofilm formation / M. C. Oosthuizen [et al.] // Appl. Environ Microbiol. – 2002. – Vol. 68. – P. 2770-2780.
  5. Изменение антибиотикочувствительности стафилококков в условиях реализации эффекта пептидного антибактериального фактора / В. П. Коробов [и др.] // Антибиотики и химиотерапия. – 2002. – № 47 (2). – С. 11-15.
  6. Мельников, В. Г. Поверхностные структуры грампозитивных бактерий в межклеточном взаимодействии и плёнкообразовании / В. Г. Мельников // Журн. микробиология. – 2010. – № 2. – С. 119-123.
  7. Сидоренко, С. В. Инфекционный процесс как «диалог» между хозяином и паразитом / С. В. Сидоренков // Клин. микробиология и антимикроб. химия. – 2001. – № 4. – С. 301-315.
  8. Литвин, В. Ю. Обратимый переход патогенных бактерий в покоящееся (некультивируемое) состояние: экологические и генетические механизмы / В.Ю. Литвин, А. Л. Гинцбург, В. И. Пушкарёва // Вестн. РАМН. – 2000. – № 1. – С. 7-13.
  9. Бухарин, О. В. Биология патогенных кокков / О. В. Бухарин, Б. Я. Усвяцов, О. Л. Чернова. – М.: Медицина, 2002. – 107 c.
  10. Изучение способности к образованию биопленок у штаммов Yersinia pestis основного и неосновного подвидов / Н. А. Видяева [и др.] // Журн. микробиология. – 2009. – №5. – С. 13-19.
  11. Формирование биоплёнок клиническими штаммами бактерий комплекса Burkholderia cepacia в зависимости от их фенотипических и генотипических характеристик / И. А. Шагинян [и др.] // Журн. микробиология. – 2007. – № 1. – С. 3-9.
  12. Dong, Y. Quenching quorum-sensing-dependent bacterial infection by an N-acyl-homoserine lactonase / Y. Dong, L. Wang, J. Xu // Nature. – 2001. – Vol. 411. – P. 411; P. 813-817.
  13. Haugo, A. J. Vibrio cholerae Cyt R is a repressor of biofilm development / A. J. Haugo, P. I. Watnick // Mol. Microbiol. – 2002. – Vol. 45. – P. 471-483.
  14. Conway, B. A. Biofilm formation and acyl-homoserine lactone production in the Burkholderia cepacia complex / B. A. Conway, V. Venu, D. Speert // Bacteriol. – 2002. – Vol. 184, N 20. – P. 5678-5685.
  15. Donlan, R. M. Biofilms: microbial life on surfaces / R. M. Donlan // Emerg. Infect. Diseases. – 2002. – Vol. 8. – P. 381-390.
  16. Miller, M. Quorum sensing in bacteria / M. Miller, B. Bassler // Annu Rev. Microbiol. – 2001. – Vol. 55. – P. 165-199.
  17. Гинцбург, А. Л. “Quorum sensing” или социальное поведение бактерий / А. Л. Гинцбург, Т. С. Ильина, Ю. М. Романова // Журн. микробиология. – 2003. – № 5. – С. 86-93.
  18. Грузина, В. Д. Коммуникативные сигналы бактерий / В. Д. Грузина // Антибиотики и химиотерапия. – 2003. – Т. 48, № 10. – С. 32-39.
  19. Ильина, Т. С. Биоплёнки как способ существования бактерий в окружающей среде и организме хозяина: феномен, генетический контроль и системы регуляции их развития / Т. С. Ильина, Ю. М. Романова, А. Л. Гинцбург // Генетика. – 2004. – Т. 40, № 11. – С. 1445-1456.
  20. Кузнецов, О. Ю. Бактериальная колония как сложное организованное сообщество клеток / О. Ю. Кузнецов // Журн. микробиология. – 2005. – № 2. – С. 3-7.
  21. Смирнова, Н. И. Эволюция геномов патогенных холерных вибрионов / Н. И. Смирнова, В. В. Кутырев // Молекулярная генетика. – 2004. – № 4. – С. 3-10.
  22. Use in-biofilm expresson technology to identify genes volved in Pseudomonas aeruginosa biofilm development / A. Finelli [et al.] // J. Bacteriol. – 2003. – Vol. 185. – P. 2700-2710.
  23. Kolenbrander, P. Communication among oral bacteria / P. Kolenbrander, R. Andersen, D. Blehert // Microb. Molecular Biology Rev. – 2002. – Vol. 66, N 3. – P. 486-505.
  24. Pseudomonas aeruginosa displays multiple phenotypes during development as a biofilm / K. Sauer [et al.] // J. Bacteriol. – 2002. – Vol. 11. – P. 1140-1154.
  25. Романова, Ю. M. Цитокины – возможные активато­ры роста патогенных бактерий / Ю. М. Романова, А. Л. Гинцбург // Вестн. РАМН. – 2000. – № 1. – С. 13-17.
  26. Biofilms as complex differentiated communities / P. Stoodley [et al.] // Annu. Rev. Microbiol. – 2002. – Vol. 56. – P. 187-209.
  27. Harriott, M. M. Candida albicans and Staphylococcus aureus Form Polymicrobial Biofilms: Effects on Antimicrobial Resistance / M. M. Harriott, M. C. Noverr // Antimicrobial agents and chemotherapy. – 2009. – Vol. 53. – P. 3914-3922.
  28. Влияние микробных метаболитов на активность каталазы и рост S. aureus 6538 р / О. В. Бухарин [и др.] // Бюл. эксперим. биол. мед. – 2000. – № 7. – С. 80-82.
  29. О Toole, G. A. Biofilm formation as microbial development / G. A. О Toole, H. Kaplan, R. Kolter // Annu. Rev. Microbiol. – 2000. – Vol. 54. – P. 49-79.
  30. Davey, M. E. Microbial biofilms: from ecology to molecular genetics / M. E. Davey, G. A. O Toole // Microbiol. Mol. Biol. Reviews. – 2000. – Vol. 64. – P. 847-867.
  31. Donlan, R. M. Biofilms: survival mecha­nisms of clinically relevant microorganisms / R. M. Donlan, J. W. Costerton // Clin. Microbiol. Rev. – 2002. – Vol. 15. – P. 167-193.
  32. Mylonakis, E. The Enterococcus faecalis fsr B gene, a key component of the fsr quorum-sensing system, is associated with virulence in the rabbit endophthalmitis model / E. Mylonakis, M. Engelbert, X. Qin // Infect. Immun. – 2002. – Vol. 70, N 8. – P. 4678-4681.
  33. Zips, A. G. Ultrasound as a means ofdetaching biofilms / A. G. Zips, A. A. Schaule, H. С. Flemming // Biofouling. – 1990. – Vol. 2. – P. 323-333.
  34. Kato, J. Control by A-factor of a metal-loendopeptidase gene involved in aerial mycelium formation in Streptomyces griseus / J. Kato, A. Suzuki, H. Yamazaki // Ibid. – 2002. – Vol. 184, N 21. – P. 6016-6025.
  35. Complex regulatory network controls initial adhesion and biofilm formation in Escherichia coli via regulation of the csd D gene / C. Prigent-Comharet [et al.] // J. Bacteriol. – 2001. – Vol. 183. – P. 7213-7223.
  36. Parkins, M. D. Pseudomonas aeruginosa Gac A, a factor in multihost virulence, is also essential for biofilm formation / M. D. Parkins, H. Ceri, D. G Storey // Mol. Microbiol. – 2001. – Vol. 40. – P. 1215-1226.
  37. O Toole, G. A. The glob carbon metabolism regulator Crc is a component of signal transduction pathway required for biofilm deve opment by Pseudomonas aeruginosa / G. A. O Toole, A. K. Gibbs, P. W. Hager // J. Bacteriol. – 2000. – Vol. 182. – P. 425-431.
  38. Chatterjee, A. Rsm A and the quorum-sensing sig­nal, N-[3-oxohexanoyl]-L-homoserine lactone, control the levels of rsm В RNA in Erwinia carotovora subsp. carotovora by affecting its stability / A Chatterjee, Y. Cui, A. K. Chatterjee // J. Bacteriol. – 2002 – Vol. 184, N 15. – P. 4089-4095.
  39. Duan, K. Modulation of Pseudomonas aeruginosa gene expression by host mi­croflora through interspecies communication / K Duan // Mol. Microbiol. – 2003. – Vol. 50. – P. 1477-1491.
  40. Nonenzymatic turnover of an Erwinia carotovora quorum-sensing signaling molecule / J. Byers [et al.] // J. Bacteriol. – 2002. – Vol. 184, N 4. – P. 1163-1171.
  41. Effects of ultrasonic treatment on the efficacy of gentamicin against established Pseudomonas aeruginosa biofilms / C. T. Huang // Colloids Surfaces В Biointerfaces. – 1996. – Vol. 6. – P. 235-242.
  42. Прозоров, А. А. Феромоны компетентности у бактерий / А. А. Прозоров // Микробиология. – 2001. – Т. 70, № 1. – С. 5-14.
  43. О Toole, G. A. То build a biofilm / G. A. О Toole // J. Bacteriol. 2003. – Vol. 185. – P. 2687-2689.
  44. Conlon, K. M. IcaR encodes a transcriptional repressor involved in environmental regulation of ica operon expression and biofilm formation by Staphylococcus epidermis / K. M. Conlon // J. Bacteriol. – 2002. – Vol. 184. – P. 4400-4408.
  45. A quorum sensing signaling system essential for genetic competence in Streptococcus mutants is involved in biofilm formation / Y. H. Li [et al.] // J. Bacteriol. – 2002. – Vol. 184. – P. 2699-2708.
  46. AHA, an enzyme that inactivates the acyl-homoserine lactone quorum-sensing signal and attenuates the virulence of Erwinia carotovora / Y. Dong [et al.] // Proc. Natl. Acad. Sci. – 2000. – Vol. 97, N 7. – P. 3526-3531.
  47. Davey, M. E. Rhamnolipid surfactant production affects biofilm architecture in Pseudomonas aeruginosa II / M. E. Davey, N. C. Caiazza, G. A. OToole // J. Bacteriol. – 2003. – Vol. 185. – P. 1027-1036.
  48. Blenkinsopp, S. A. Electrical enhancement of biocide efficacy against Pseudomonas aeruginosa biofilms / S. A. Blenkinsopp, A. E. Khoury, J. W. Costerton // Appl. Environ. Microbiol. – 1992. – Vol. 58. – P. 3770-3773.
  49. Johansen, C.P. Enzymatic removal and disinfection of bacterial biofilms / C. P. Johansen, P. Falholt, L. Gram // Appl. Environ. Microbiol. – 1997. – Vol. 63. – P. 3724-3728.
  50. Quorum sensing signals indicate that cystic fibrosis lungs are in­fected with bacterial biofilms / P. K. Singh [et al.] // Nature. – 2000. – Vol. 407. – P. 762-764.

MAGDIEV D.A., CHULOVSKAYA I.G., EGIAZARYAN K.A.

DISTAL RADIOULNAR JOINT. FUNCTIONAL ANATOMY. DIAGNOSTICS OF INJURIES

Functional anatomy of the distal radioulnar joint on the basis of the domestic and foreign literature studying is presented in the paper. Data on the problem urgency of injuries of the distal radioulnar joint ligament system and possibilities of modern examinational methods at diagnostics of these injuries are briefly given. The data of clinical and radiological indicators in norm and in pathologies are provided as well as of computer, magnetic-resonance tomography and ultrasonography. Diagnostic possibilities of the hand and the distal radioulnar joint arthroscopy are described.

Keywords: distal radioulnar joint, triangular fibro-cartilage complex, injury, diagnostics
p. 126 – 132 of the original issue
References
  1. Бухарин, О. В. Теоретические и прикладные аспекты проблемы персистенции микроорганизмов / О. В. Бухарин // Журн. микробиология. – 2000. – № 4. – С. 4-7.
  2. Бухарин, О. В. Фундаментальные и прикладные аспекты проблемы персистенции микроорганизмов / О. В. Бухарин, Б. Я. Усвяцов, Л. М. Хуснутдинова // Журн. микробиология. – 2003. – №4. – С. 3-8.
  3. Габриэлян, Р. И. Функции микрофлоры желудочно – кишечного тракта и последствия её нарушения после хирургических вмешательств / Р. И. Габриэлян, Е. М. Горская, Н. Д. Снегова // Антибиотики и химиотерапия. – 2000. – № 45 (9). – С. 24-29.
  4. Proteom analysis reveals differential protein expression by Batlus cereus during biofilm formation / M. C. Oosthuizen [et al.] // Appl. Environ Microbiol. – 2002. – Vol. 68. – P. 2770-2780.
  5. Изменение антибиотикочувствительности стафилококков в условиях реализации эффекта пептидного антибактериального фактора / В. П. Коробов [и др.] // Антибиотики и химиотерапия. – 2002. – № 47 (2). – С. 11-15.
  6. Мельников, В. Г. Поверхностные структуры грампозитивных бактерий в межклеточном взаимодействии и плёнкообразовании / В. Г. Мельников // Журн. микробиология. – 2010. – № 2. – С. 119-123.
  7. Сидоренко, С. В. Инфекционный процесс как «диалог» между хозяином и паразитом / С. В. Сидоренков // Клин. микробиология и антимикроб. химия. – 2001. – № 4. – С. 301-315.
  8. Литвин, В. Ю. Обратимый переход патогенных бактерий в покоящееся (некультивируемое) состояние: экологические и генетические механизмы / В.Ю. Литвин, А. Л. Гинцбург, В. И. Пушкарёва // Вестн. РАМН. – 2000. – № 1. – С. 7-13.
  9. Бухарин, О. В. Биология патогенных кокков / О. В. Бухарин, Б. Я. Усвяцов, О. Л. Чернова. – М.: Медицина, 2002. – 107 c.
  10. Изучение способности к образованию биопленок у штаммов Yersinia pestis основного и неосновного подвидов / Н. А. Видяева [и др.] // Журн. микробиология. – 2009. – №5. – С. 13-19.
  11. Формирование биоплёнок клиническими штаммами бактерий комплекса Burkholderia cepacia в зависимости от их фенотипических и генотипических характеристик / И. А. Шагинян [и др.] // Журн. микробиология. – 2007. – № 1. – С. 3-9.
  12. Dong, Y. Quenching quorum-sensing-dependent bacterial infection by an N-acyl-homoserine lactonase / Y. Dong, L. Wang, J. Xu // Nature. – 2001. – Vol. 411. – P. 411; P. 813-817.
  13. Haugo, A. J. Vibrio cholerae Cyt R is a repressor of biofilm development / A. J. Haugo, P. I. Watnick // Mol. Microbiol. – 2002. – Vol. 45. – P. 471-483.
  14. Conway, B. A. Biofilm formation and acyl-homoserine lactone production in the Burkholderia cepacia complex / B. A. Conway, V. Venu, D. Speert // Bacteriol. – 2002. – Vol. 184, N 20. – P. 5678-5685.
  15. Donlan, R. M. Biofilms: microbial life on surfaces / R. M. Donlan // Emerg. Infect. Diseases. – 2002. – Vol. 8. – P. 381-390.
  16. Miller, M. Quorum sensing in bacteria / M. Miller, B. Bassler // Annu Rev. Microbiol. – 2001. – Vol. 55. – P. 165-199.
  17. Гинцбург, А. Л. “Quorum sensing” или социальное поведение бактерий / А. Л. Гинцбург, Т. С. Ильина, Ю. М. Романова // Журн. микробиология. – 2003. – № 5. – С. 86-93.
  18. Грузина, В. Д. Коммуникативные сигналы бактерий / В. Д. Грузина // Антибиотики и химиотерапия. – 2003. – Т. 48, № 10. – С. 32-39.
  19. Ильина, Т. С. Биоплёнки как способ существования бактерий в окружающей среде и организме хозяина: феномен, генетический контроль и системы регуляции их развития / Т. С. Ильина, Ю. М. Романова, А. Л. Гинцбург // Генетика. – 2004. – Т. 40, № 11. – С. 1445-1456.
  20. Кузнецов, О. Ю. Бактериальная колония как сложное организованное сообщество клеток / О. Ю. Кузнецов // Журн. микробиология. – 2005. – № 2. – С. 3-7.
  21. Смирнова, Н. И. Эволюция геномов патогенных холерных вибрионов / Н. И. Смирнова, В. В. Кутырев // Молекулярная генетика. – 2004. – № 4. – С. 3-10.
  22. Use in-biofilm expresson technology to identify genes volved in Pseudomonas aeruginosa biofilm development / A. Finelli [et al.] // J. Bacteriol. – 2003. – Vol. 185. – P. 2700-2710.
  23. Kolenbrander, P. Communication among oral bacteria / P. Kolenbrander, R. Andersen, D. Blehert // Microb. Molecular Biology Rev. – 2002. – Vol. 66, N 3. – P. 486-505.
  24. Pseudomonas aeruginosa displays multiple phenotypes during development as a biofilm / K. Sauer [et al.] // J. Bacteriol. – 2002. – Vol. 11. – P. 1140-1154.
  25. Романова, Ю. M. Цитокины – возможные активато­ры роста патогенных бактерий / Ю. М. Романова, А. Л. Гинцбург // Вестн. РАМН. – 2000. – № 1. – С. 13-17.
  26. Biofilms as complex differentiated communities / P. Stoodley [et al.] // Annu. Rev. Microbiol. – 2002. – Vol. 56. – P. 187-209.
  27. Harriott, M. M. Candida albicans and Staphylococcus aureus Form Polymicrobial Biofilms: Effects on Antimicrobial Resistance / M. M. Harriott, M. C. Noverr // Antimicrobial agents and chemotherapy. – 2009. – Vol. 53. – P. 3914-3922.
  28. Влияние микробных метаболитов на активность каталазы и рост S. aureus 6538 р / О. В. Бухарин [и др.] // Бюл. эксперим. биол. мед. – 2000. – № 7. – С. 80-82.
  29. О Toole, G. A. Biofilm formation as microbial development / G. A. О Toole, H. Kaplan, R. Kolter // Annu. Rev. Microbiol. – 2000. – Vol. 54. – P. 49-79.
  30. Davey, M. E. Microbial biofilms: from ecology to molecular genetics / M. E. Davey, G. A. O Toole // Microbiol. Mol. Biol. Reviews. – 2000. – Vol. 64. – P. 847-867.
  31. Donlan, R. M. Biofilms: survival mecha­nisms of clinically relevant microorganisms / R. M. Donlan, J. W. Costerton // Clin. Microbiol. Rev. – 2002. – Vol. 15. – P. 167-193.
  32. Mylonakis, E. The Enterococcus faecalis fsr B gene, a key component of the fsr quorum-sensing system, is associated with virulence in the rabbit endophthalmitis model / E. Mylonakis, M. Engelbert, X. Qin // Infect. Immun. – 2002. – Vol. 70, N 8. – P. 4678-4681.
  33. Zips, A. G. Ultrasound as a means ofdetaching biofilms / A. G. Zips, A. A. Schaule, H. С. Flemming // Biofouling. – 1990. – Vol. 2. – P. 323-333.
  34. Kato, J. Control by A-factor of a metal-loendopeptidase gene involved in aerial mycelium formation in Streptomyces griseus / J. Kato, A. Suzuki, H. Yamazaki // Ibid. – 2002. – Vol. 184, N 21. – P. 6016-6025.
  35. Complex regulatory network controls initial adhesion and biofilm formation in Escherichia coli via regulation of the csd D gene / C. Prigent-Comharet [et al.] // J. Bacteriol. – 2001. – Vol. 183. – P. 7213-7223.
  36. Parkins, M. D. Pseudomonas aeruginosa Gac A, a factor in multihost virulence, is also essential for biofilm formation / M. D. Parkins, H. Ceri, D. G Storey // Mol. Microbiol. – 2001. – Vol. 40. – P. 1215-1226.
  37. O Toole, G. A. The glob carbon metabolism regulator Crc is a component of signal transduction pathway required for biofilm deve opment by Pseudomonas aeruginosa / G. A. O Toole, A. K. Gibbs, P. W. Hager // J. Bacteriol. – 2000. – Vol. 182. – P. 425-431.
  38. Chatterjee, A. Rsm A and the quorum-sensing sig­nal, N-[3-oxohexanoyl]-L-homoserine lactone, control the levels of rsm В RNA in Erwinia carotovora subsp. carotovora by affecting its stability / A Chatterjee, Y. Cui, A. K. Chatterjee // J. Bacteriol. – 2002 – Vol. 184, N 15. – P. 4089-4095.
  39. Duan, K. Modulation of Pseudomonas aeruginosa gene expression by host mi­croflora through interspecies communication / K Duan // Mol. Microbiol. – 2003. – Vol. 50. – P. 1477-1491.
  40. Nonenzymatic turnover of an Erwinia carotovora quorum-sensing signaling molecule / J. Byers [et al.] // J. Bacteriol. – 2002. – Vol. 184, N 4. – P. 1163-1171.
  41. Effects of ultrasonic treatment on the efficacy of gentamicin against established Pseudomonas aeruginosa biofilms / C. T. Huang // Colloids Surfaces В Biointerfaces. – 1996. – Vol. 6. – P. 235-242.
  42. Прозоров, А. А. Феромоны компетентности у бактерий / А. А. Прозоров // Микробиология. – 2001. – Т. 70, № 1. – С. 5-14.
  43. О Toole, G. A. То build a biofilm / G. A. О Toole // J. Bacteriol. 2003. – Vol. 185. – P. 2687-2689.
  44. Conlon, K. M. IcaR encodes a transcriptional repressor involved in environmental regulation of ica operon expression and biofilm formation by Staphylococcus epidermis / K. M. Conlon // J. Bacteriol. – 2002. – Vol. 184. – P. 4400-4408.
  45. A quorum sensing signaling system essential for genetic competence in Streptococcus mutants is involved in biofilm formation / Y. H. Li [et al.] // J. Bacteriol. – 2002. – Vol. 184. – P. 2699-2708.
  46. AHA, an enzyme that inactivates the acyl-homoserine lactone quorum-sensing signal and attenuates the virulence of Erwinia carotovora / Y. Dong [et al.] // Proc. Natl. Acad. Sci. – 2000. – Vol. 97, N 7. – P. 3526-3531.
  47. Davey, M. E. Rhamnolipid surfactant production affects biofilm architecture in Pseudomonas aeruginosa II / M. E. Davey, N. C. Caiazza, G. A. OToole // J. Bacteriol. – 2003. – Vol. 185. – P. 1027-1036.
  48. Blenkinsopp, S. A. Electrical enhancement of biocide efficacy against Pseudomonas aeruginosa biofilms / S. A. Blenkinsopp, A. E. Khoury, J. W. Costerton // Appl. Environ. Microbiol. – 1992. – Vol. 58. – P. 3770-3773.
  49. Johansen, C.P. Enzymatic removal and disinfection of bacterial biofilms / C. P. Johansen, P. Falholt, L. Gram // Appl. Environ. Microbiol. – 1997. – Vol. 63. – P. 3724-3728.
  50. Quorum sensing signals indicate that cystic fibrosis lungs are in­fected with bacterial biofilms / P. K. Singh [et al.] // Nature. – 2000. – Vol. 407. – P. 762-764.

MASTER-CLASS

SCHASTNY A.T., SHTURICH I.P., SYATKOVSKY A.R.

DOUBLE DRAINAGE AT TREATMENT OF LARGE PSEUDO CYSTS OF THE PANCREAS

The method of double drainage was suggested to improve the results of surgical treatment in patients with the pancreas pseudo cysts of large sizes (more than 10 cm in diameter) and to widen the indications for internal drainage as the most favorable variant of treatment. The technique of surgery is described; the indications and contraindications to its performance are defined; possible complications are pointed out.
68 patients with pseudo cysts of more than 10 cm in diameter were operated on. In 14 patients the method of double drainage was applied. The usage of the suggested technique of the surgical intervention permits to decrease the number of the postoperative complications and to improve the treatment results of large postnecrotic pseudo cysts.

Keywords: chronic pancreatitis, pancreas cyst, operative treatment, double drainage
p. 133 – 138 of the original issue
References
  1. Данилов, М. В. Хирургия поджелудочной железы / М. В. Данилов, В. Д. Федоров. – М.: Медицина, 1995. – 509 с.
  2. Прокофьев, О. А. Псевдокисты поджелудочной железы: какую тактику избрать? / О. А. Прокофьев, Г. Г. Ахаладзе, Э. И. Гальперин // Анналы хирург. гепатологии. – 2001. – Т. 6, № 2. – С. 100-105.
  3. The size of pancreatic pseudocyst does not influence the outcome of invasive treatments / P. Soliani [et al.] // Dig. Liver Dis. – 2004. – Vol. 36, N 2. – P. 135-140.
  4. Эндоскопическая хирургия в лечении кистозных образований поджелудочной железы / К. Н. Жандаров [и др.] // Сборник тез. XV междунар. конф. хирургов-гепатологов России и стран СНГ, Казань, 17–19 сент. 2008 г. – С. 162.
  5. Тактика лечения кист поджелудочной железы / Т.Н. Чудакова [и др.] // Сборник тез. XV междунар. конф. хирургов-гепатологов России и стран СНГ, Казань, 17–19 сент. 2008 г. – С. 195.
  6. Beger, H. G. Diseases of the pancreas / H. G. Beger, S. Matsuno, J. L. Cameron. – Springer-Verlag, Berlin: Heidelberg, 2008. – 950 p.
  7. Johnson, L. B. The effect of size of giant pancreatic pseudocysts on the outcome of internal drainage procedures / L. B. Johnson, D. W. Rattner, A. L. Warshaw // Surg. Gynecol. Obstet. – 1991. – Vol. 173. – P. 171-174.
  8. Тактика хирургического лечения осложнённых постнекротических кист поджелудочной железы / В. К. Гостищев [и др.] // Cборник тез. XV междунар. конф. хирургов-гепатологов России и стран СНГ, Казань, 17–19 сент. 2008 г. – С. 156.
  9. Бондарук, О. И. Хирургическая коррекция нагноившихся кист поджелудочной железы / О. И. Бондарук, Т. А. Кадощук // Сборник тез. XV междунар. конф. хирургов-гепатологов России и стран СНГ, Казань, 17–19 сент. 2008 г. – С. 153.

IN ASSISTANCE TO PRACTICIONER

TIKHON D.S., OGANESYAN N.A.

FONDAPARINUX AS A NEW EFFECTIVE ANTICOAGULANT FOR VENOUS THROMBOEMBOLISM PREVENTION IN SURGERY

Fondaparinux is the first of a class of selective antithrombin-dependent factor Xa inhibitors, it is a synthetic analogue of the critical pentasaccharide sequence required for binding heparin molecules to Anthitrobin. It does not interact with plasma proteins other than antithrombin, leading to a predictable pharmacokinetics, which renders monitoring and dose adjustment unnecessary. Given subcutaneously, fondaparinux demonstrates 100% bioavailability with a half-life of 17 hours permitting once-daily injection. Fondaparinux is more effective than low molecular weight heparin (LMWH) for prevention of venous thromboembolism (VTE) following major orthopedic surgery and at least as effective as for LMWH following major abdominal surgery. Several thousands of patients have been studied and the substance is safe, although a slightly higher frequency of bleedings is found than in patients on LMWH. Other side-effects are rare. Fondaparinux is cost saving and sometimes cost neutral when compared with enoxaparin. It was recommended with a Grade1A rating for VTE prophylaxis in major orthopedic and abdominal surgery. Moreover Fondaparinux was the only anticoagulant recommended with a Grade 1A rating for hip-fracture surgery.

Keywords: fondaparinux, venous thrombosis, venous thromboembolism, surgery, orthopedic surgery, major abdominal surgery, bleeding complications
p. 139 – 150 of the original issue
References
  1. Bick, R. L. Thromboprophylaxis and thrombosis in medical, surgical, trauma, and obstetric/gynecologic patients / R. L. Bick, S. Haas // Hematol. Oncol. Clin. North Am. – 2003. – Vol. 17. – P. 217-258.
  2. Bhattacharyya, T. Rate of and risk factors for acute inpatient mortality after orthopaedic surgery / T. Bhattacharyya, R. Iorio, W. L. Healy // J. Bone Joint Surg. Am. – 2002. – Vol. 84. – P. 562-572.
  3. Prevention of venous thromboembolism: The Eight ed ACCP Conference on Antithrombotic and Thrombolytic Therapy / W. H. Geerts [et al.] // Chest – 2008. – Vol. 133. – P. 387-453.
  4. Meissner, M. H. Venous thromboembolism in trauma: a local manifestation of systemic hypercoagulability? / M. H. Meissner, W. L. Chandler, J. S. J. Elliott // Trauma. – 2003. – Vol. 54. – P. 224-231.
  5. Seagroatt, V. Elective total hip replacement: incidence, emergency readmission rate, and postoperative mortality / V. Seagroatt, H. S. Tan, M. Goldacre // BMJ. – 1991. – Vol. 303. – P. 1431-1435.
  6. Unfractionated Heparin, Low Molecular Weight Heparins, and Pentasaccharide: Basic Mechanism of Actions, Pharmacology, and Clinical Use / R. L. Bick [et al.] // Hematol. Oncol. Clin. N. Am. – 2005. – Vol. 19. – P. 1-51.
  7. Guidelines on the use and monitoring of heparin / T. Baglin [et al.] // BJH. – 2006. – Vol. 133. – P. 19-34.
  8. Treatment and Prevention of Heparin-Induced Thrombocytopenia: Evidence-Based Clinical Practice Guidelines American College of Chest Physicians (8th Edition) / T. E. Warkentin [et al.] // Chest. – 2008. – Vol. 133. P. 340-380.
  9. Dinwoodey, D. L. Heparins, Low-Molecular-Weight Heparins, and Pentasaccharides / D. L. Dinwoodey // Ansell. Clin. Geriatr. Med. – 2006. – Vol. 22. – P. 1-15.
  10. Structure-activity relationship in heparin: a synthetic pentasaccharide with high affinity for antithrombin III and eliciting high antifactor Xa activity / J. Choay [et al.] // Biochem. Biophys. Res. Commun. – 1983. – Vol. 116. – P. 492-499.
  11. Fondaparinux, a synthetic pentasaccharide: the first in a new class of antithrombotic agents - the selective factor Xa inhibitors / K. A. Bauer [et al.] // Cardiovasc. Drug Rev. – 2002. – Vol. 20. – P. 37-52.
  12. Heparin, low-molecular-weight heparins, and heparin pentasaccharide: basic and clinical differentiation / D. Hoppensteadt [et al.] // Hematol. Oncol. Clin. North Am. – 2003. – Vol. 17. – P. 313-341.
  13. The pharmacokinetics of fondaparinux sodium in healthy volunteers / F. Donat [et al.] // Clin. Pharmacokinet. – 2002. – Vol. 41. – Suppl. 2. – P. 1-9.
  14. Bauer, K. A. New pentasaccharides for prophylaxis of deep vein thrombosis: pharmacology / K. A. Bauer // Chest. – 2003. – Vol. 124. – P. 364S–370S.
  15. Samama, M. M. Evaluation of the pharmacological properties and clinical results of the synthetic pentasaccharide (fondaparinux) / M. M. Samama, G. T. Gerotziafas // Thromb. Res. – 2003. – Vol. 109. –
  16. P. 1-11.
  17. Pharmacokinetic and clinical data supporting the use of fondaparinux 1.5 mg once daily in the prevention of venous thromboembolism in renally impaired patients / A. G. Turpie [et al.] // Blood Coagulation & Fibrinolysis. – 2009. – Vol. 20, N 2. – P. 114-121.
  18. In vitro comparison of the effect of heparin, enoxaparin and fondaparinux on tests of coagulation / L. A. Linkins [et al.] // Thromb. Res. – 2002. – Vol. 107. – P. 241-244.
  19. Assessment of three chromogenic and one clotting assays for the measurement of synthetic pentasaccharide fondaparinux (Arixtra) anti-Xa activity / F. Depasse [et al.] // J. Thromb. Haemost. – 2004. – Vol. 2. – P. 346-348.
  20. The role of tissue factor pathway inhibitor in the mediation of the antithrombotic actions of heparin and low-molecular-weight heparin / D. A. Hoppensteadt [et al.] // Blood Coag Fibrinolysis. – 1995. – P. S57-S64.
  21. Greaves, M. Limitations of the Laboratory Monitoring of Heparin Therapy / M. Greaves // Thromb Haemost. – 2002. – Vol. 87. – P. 163-164.
  22. Turpie, A. G. A synthetic pentasaccharide for the prevention of deep-vein thrombosis after total hip replacement / A. G. Turpie, A. S. Gallus, J. A. Hoek. // N. Engl. J. Med. – 2001. – Vol. 344. – P. 619-625.
  23. Postoperative fondaparinux versus preoperative enoxaparin for prevention of venous thromboembolism in elective hip-replacement surgery: a randomized double-blind comparison / M. R. Lassen [et al.] // Lancet – 2002. – Vol. 359. – P. 1715-1720.
  24. Postoperative fondaparinux versus postoperative enoxaparin for prevention of venous thromboembolism after elective hip-replacement surgery: a randomised double-blind trial / A. G. Turpie [et al.] // Lancet. – 2002. – Vol. 359. – P. 1721-1726.
  25. Fondaparinux compared with enoxaparin for the prevention of venous thromboembolism after hip-fracture surgery / B. I. Eriksson [et al.] // N. Engl. J. Med. – 2001. – Vol. 345. – P. 1298-1304.
  26. Fondaparinux compared with enoxaparin for the prevention of venous thromboembolism after elective major knee surgery / K. A. Bauer [et al.] / N. Engl. J. Med. – 2001. – Vol. 345. – P. 1305-1310.
  27. Fondaparinux vs enoxaparin for the prevention of venous thromboembolism in major orthopedic surgery: a meta-analysis of 4 randomized double- blind studies / A. G. Turpie [et al.] // Arch. Intern. Med. – 2002. – Vol. 162. – P. 1833-1840.
  28. Superiority of fondaparinux over enoxaparin in preventing venous thromboembolism in major orthopedic surgery using different efficacy end points / A. G. Turpie, [et al.] // Chest. – 2004. – Vol. 126. – P. 501-508.
  29. New pentasaccharides for the prophylaxis of venous thromboembolism: clinical studies / A. G. Turpie [et al.] // Chest. – 2003. – Vol. 124. – P. 371S-378S.
  30. FLEXTRA: Early vs delayed initiation of postoperative fondaparinux prophylaxis after joint replacement: A clinical outcome study / B. Davidsson [et al.] // Congress ISTH. – 2005. – Abstr.
  31. Venous thromboembolism after orthopedic surgery: implications of the choice for prophylaxis / A. F. Shorr [et al.] // Thromb. Res. – 2007. – Vol. 121, N 1. – P. 17-24.
  32. Eriksson, B. I. Pentasaccharide in hip-fracture surgery plus investigators. Duration of prophylaxis against venous thromboembolism with fondaparinux after hip fracture surgery: a multicenter, randomized, placebo-controlled, double-blind study / B. I. Eriksson, M. R. Lassen // Arch. Intern. Med. – 2003. – Vol. 163. – P. 1337-1342.
  33. The safety and efficacy of extended thromboprophylaxis with fondaparinux after major orthopedic surgery of the lower limb with or without a neuraxial or deep peripheral nerve catheter: the EXPERT Study / F. J. Singelyn [et al.] // Anesth. Analg. – 2007. – Vol. 105, N 6. – P. 1540-1547.
  34. Randomized clinical trial мof postoperative fondaparinux versus perioperative dalteparin for prevention of venous thromboembolism in high-risk abdominal surgery / G. Agnelli [et al.] // Br. J. Surg. – 2005. – Vol. 92. – P. 1212-1220.
  35. Fondaparinux combined with intermittent pneumatic compression vs. intermittent pneumatic compression alone for prevention of venous thromboembolism after abdominal surgery: a randomized, double-blind comparison / A. G. Turpie [et al.] // J. Thromb. Haemost. – 2007. – Vol. 5, N 9. – P. 1854-1861.
  36. Economic and clinical evaluation of fondaparinux vs. enoxaparin for thromboprophylaxis following general surgery / R. Farias-Eisner [et al.] // Curr. Med. Res. Opin. – 2009. – Vol. 25, N 5. – P. 1081-1087.
  37. Nijkeuter, M. Pentasaccharides in the prophylaxis and treatment of venous thromboembolism: a systematic review / M. Nijkeuter, M. V. Huisman // Curr. Opin. Pulm. Med. – 2004. – Vol. 10. – P. 338-344.
  38. Hirsh, J. New anticoagulants / J. Hirsh, M. O’Donnell, J. I. Weitz // Blood. – 2005. – Vol. 105. – P. 453-463.
  39. Treatment of postoperative bleeding after fondaparinux with rFVIIa and tranexamic acid / F. Huvers [et al.] // Neth. J. Med. – 2005. – Vol. 63. – P. 184-186.
  40. Ability of recombinant factor VIIa to reverse the anticoagulant effect of the pentasaccharide fondaparinux in healthy volunteers / N. R. Bijsterveld [et al.] // Circulation. – 2002. – Vol. 106. – P. 2550–2554.
  41. Recombinant factor VIIa partially reverses the inhibitory effect of fondaparinux on thrombin generation after tissue factor activation in platelet rich plasma and whole blood / G. T. Gerotziafas [et al.] // Thromb. Haemost. – 2004. – Vol. 91. – P. 531-537.
  42. Cost and occurrence of thrombocytopenia in patients receiving venous thromboembolism prophylaxis following major orthopaedic surgeries / L. E. Happe [et al.] // J. Thromb. Thrombolysis. – 2008. – Vol. 26, N 2. – P. 125-131.
  43. Thromboembolic Prophylaxis with Fondaparinux in Major Orthopaedic Surgery: Outcomes and Costs / T. D. Szucs [et al.] // Heart Drug. – 2005. – Vol. 5. – P. 121-130.
  44. Reynolds, N. A. Fondaparinux sodium: a review of its use in the prevention of venous thromboembolism following major orthopaedic surgery / N. A. Reynolds, C. M. Perry, L. J. Scott // Drugs. – 2004. – Vol. 64. – P. 1575-1596.
  45. Lobo, B. L. Pharmacoeconomic considerations / B. L. Lobo // Am. J. Health Syst. Pharm. – 2003. – Vol. 60. – Suppl. 7. – P. S11-S14.

JUBILEES

DEYKALO V.P., NIKOLSKY M.A., SIROTKO V.V., ASKERKO E.A.

THE 40TH ANNIVERSARY OF THE CHAIR OF TRAUMATOLOGY, ORTHOPEDICS AND MILITARY SURGERY OF VITEBSK STATE MEDICAL UNIVERSITY

The peroids of formation of the chair of traumatology, orthopedics and military surgery of the educational establishment «Vitebsk state medical university» are described in the article. The role of the chair staff in the development of the chair as well as in the scientific achievements, improvement of the educational process and progress in the orthopedic and trauma service rendering to the citizens of Vitebsk region is shown.

Keywords: Vitebsk state medical university, history, chairs, traumatology orthopedics, military surgery
p. 161 - 169 of the original issue
Contacts | ©Vitebsk State Medical University, 2007