Year 2015 Vol. 23 No 2

SCIENTIFIC PUBLICATIONS
EXPERIMENTAL SURGERY

I.I. PIKIRENIA 1, .N. ZEMLYANIK 1, V.V. KHOMCHENKO 2

THE ABILITY TO REGENERATE THE LIVER IN EXPERIMENTAL ANIMALS WITH INDUCED CIRRHOSIS UNDER THE INFLUENCE OF THE SPATIALLY MODULATED ERBIUM LASER

SBE "Belarusian Medical Academy of Post-Graduate Education" 1,
Ltd. "Linline Medical Systems"2, Minsk,
The Republic of Belarus

Objectives. To study the possibility of the liver regeneration with induced cirrhosis using micro-ablation method with spatially modulated erbium laser radiation (wavelength of 2,936 μm) in experimental animals.
Methods. In the experiment the liver cirrhosis was modeled in 70 albino outbred rats by means of carbon tetrachloride. Cirrhotically changed left liver lobe was treated by micro-ablation method (erbium laser, wavelength of 2,936 μm, impulse duration of 0,3 ms, packed with SMA (Space Modulated Ablation), the right lobe was a control one. The repeated operations with the treating of the liver have been carried out on the 15th, 30th, 60th days, followed by exclusion from the experiment and histological examination of the liver.
Results. After a single treating of the rats liver with spatially modulated erbium laser radiation at microscopy on the first day of exposure the signs of pre-existing liver cirrhosis in the hepatic tissue so as on the depth of exposure (from 5,5 to 6,0 μm) the destruction of some hepatocytes were revealed. Starting from the 30th day the regeneration signs of cirrhotically changed liver were established, including the reduction of the connective tissue amount and signs of the portal hypertension. At the same time no signs of regeneration in the right liver lobe not subjected to laser radiation were revealed. On the 60th day after double liver treating neoangiogenesis, proliferation of the bile ducts, reduction of the number of false lobules and connective tissue structures have been registered compared to the right lobe of the liver, which treating is not performed.
Conclusion. The impact of the micro-ablation method on the cirrhotically changed liver causes active process of regeneration that may be indicated for application Bridge-therapy prior to liver transplantation.

Keywords: liver cirrhosis, high energy radiation, liver regeneration, liver transplantation, connective tissue, cell proliferation, Bridge-therapy
p. 131-137 of the original issue
References
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  2. Mustafin AK, NartailakovMA, Galimov II, MuslimovSA, MusinaLA. Morfologicheskie izmeneniia pecheni posle ee rezektsii i vvedeniia biomateriala Alloplant [Morphological changes in the liver after resection and application of biomaterial biomaterials Alloplant]. Morfolog Vedomosti. 2008;(3-4):5861.
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  11. Ivashkin VT, Maevskaia MV. Alkogol'no-virusnye zabolevaniia pecheni [Alcohol-viral liver disease]. Moscow, RF: Litterra. 2007. 176 p.
  12. Bataller R, Gäbele E, Parsons CJ, Morris T, Yang L, Schoonhoven R, Brenner DA, Rippe RA.Systemic infusion of angiotensin II exacerbates liver fibrosis in bile duct-ligated rats. Hepatology. 2005 May;41(5):1046-55
  13. Martínez AK, Maroni L, Marzioni M, Ahmed ST, Milad M, Ray D, Alpini G, Glaser SS.Mouse models of liver fibrosis mimic human liver fibrosis of different etiologies. Curr Pathobiol Rep. 2014 Dec 1;2(4):143-53.
  14. Kotiv BN, Dzidzava II, Alent'ev SA. Portokaval'noe shuntirovanie v lechenii bol'nykh tsirrozom pecheni s sindromom portal'noi gipertenzii [Portocaval shunt in the treatment of patients with liver cirrhosis with portal hypertension]. Annaly Khirurg Gepatologii. 2008;13(4):76-84.
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Address for correspondence:
220013 Respublika Belarus,
g. Minsk, ul. P.Brovki, d. 3, korp. 3,
GUO "Belorusskaya meditsinskaya akademiya
poslediplomnogo obrazovaniya",
kafedra transplantologii,
tel. mob: 375 29 275-07-50,
e-mail: pik-med@tut.by,
Pikirenia Ivan Ivanovich
Information about the authors:
Pikirenia I.I. PhD, an associate professor, a head of the transplantology chair of SEE "Belarusian Medical Academy of Post-graduate Education".
Zemlyanik A.N. An extramural post-graduate student of the transplantology chair of SEE "Belarusian Medical Academy of Post-graduate Education".
Khomchenko V.V. A director of Ltd. "LINLINE Medical Systems".

B.S. SUKOVATYKH, A.Y. GRIGORYAN, A.I. BEZHIN, T.A.P ANKRUSHEVA, S.A. ABRAMOVA

EFFECTIVENESS OF IMMOBILIZED FORM OF CHLORHEXIDINE IN TREATMENT OF PURULENT WOUNDS

SBEE HPE "Kursk State Medical University"
The Russian Federation

Objectives. To justify experimentally the possibility of chlorhexidine bigluconate immobilized form application in the treatment of the first phase of purulent wounds course.
Methods. The analysis of the results of experimental studies of wound healing process (120 Wistar rats) has been carried out in the treatment of the following ointment composition: chlorhexidine bigluconate 0,5% 30,0; methyluracil 2,0; polymethylsiloxane polyhydrate 70,0.
Animals were divided into two statistically homogeneous groups of 60 animals each. In the control group the local wound treatment was carried out by application of Levomecol ointment, while in the experimental one an immobilized form of chlorhexidine bigluconate. The dynamics of the wound healing process was studied by means of planimetric, bacteriological and histological methods.
Results. In the main group the reduction percentage of the wound area was higher than in the control group on the 3rd day by 14,2%, on the 5th day 9,1%, on the 10th day 12,8%, on the 15th day 11,1%.
In the experimental group of animals the microbial contamination of wounds (CFU in 1 g. of tissue) was lower in the control group on the 3rd day of treatment on 7×106, on the 5th day on 4,3×105, on the 8th day on 6,2×104, and on the 10th day on 62,5×103. At the same period the number of fibroblasts (cells of reparative series) in the wounds of the main group was higher on 0,5%, 10,6%, 12,1% and 9,4%.
Conclusion. The use of an immobilized form of chlorhexidine bigluconate in the treatment of the first phase of purulent wounds is considered to be pathogenetically justified and effective.

Keywords: purulent wound, wound process, research methods, wound healing, wound treatment, ointment "Levomecol", immobilized form of hlorhexidine bigluconate
p. 138-144 of the original issue
References
  1. Kallstrom G.Are quantitative bacterial wound cultures useful? J Clin Microbiol. 2014 Aug;52(8):2753-56.
  2. Eriukhin IA. Khirurgicheskie infektsii: novyi 5 uroven' poznaniia: i novye problemy [Surgical infections: new 5 level of knowledge: new challenges]. Infektsii v Khirurgii. 2003;(1):2-7.
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  7. Chekmareva IA, Blatun LA, Terekhova LP, Zakharova OA, Kochergina E V, Agafonov VA. Morfofunktsional'nye aspekty regeneratsii ran pri lechenii iod-soderzhashchimi maziami [Morphological and functional aspects of wound healing in the treatment of iodine-containing ointments]. Khirurgiia. 2014;(1):54-58.
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  12. Tanaka K, Akita S, Yoshimoto H, Houbara S, Hirano A. Lipid-colloid dressing shows improved reepithelialization, pain relief, and corneal barrier function in split-thickness skin-graft donor wound healing. Int J Low Extrem Wounds. 2014 Sep;13(3):220-25.
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  14. Plotnikov FV. Kompleksnoe lechenie patsientov s gnoinymi ranami v zavisimosti ot sposobnosti mikroorganizmov-vozbuditelei formirovat' bioplenku [Complex treatment of patients with purulent wounds depending on the ability of microorganisms to form a biofilm agents]. Novosti Khirurgii. 2014;22(5):575-82.
  15. Blatun LA. Mestnoe medikamentoznoe lechenie ran [Local medical treatment of wounds]. Khirurgiia. 2011;(4):51-59
Address for correspondence:
305041, Rossiyskaya Federatsiya,
g. Kursk, ul. K. Marksa d. 3,
GBOU VPO "Kurskiy gosudarstvennyiy meditsinskiy universitet",
kafedra obschey khirurgii,
tel.office : 7 (4712) 52-98-62,
e-mail: SukovatykhBS@kursksmu.net,
Sukovatykh Boris Semenovich
Information about the authors:
Sukovatykh B.S. MD, professor, a head of the general surgery chair of SBEE HPE "Kursk State Medical University".
Grigoryan A.Y. PhD, an assistant of the operative surgery and topographic anatomy chair of SBEE HPE "Kursk State Medical University".
Bezhin A.I. MD, professor, a head of the operative surgery and topographic anatomy chair of SBEE HPE "Kursk State Medical University".
Pankrusheva T.A. MD, professor, a head of the pharmaceutical technologies chair of SBEE HPE "Kursk State Medical University".
Abramova S.A. PhD, an assistant of the surgical diseases chair 2 of SBEE HPE "Kursk State Medical University".

GENERAL AND SPECIAL SURGERY

.N. SADRIEV 1, .D. GAIBOV 1,2

JUSTIFICATION OF SURGICAL APPROACH CHOICE TO ADRENALECTOMY

Avicenna Tajik State Medical University 1,
Republican Scientific Center of Cardiovascular Surgery 2,
Dushanbe
The Republic of Tajikistan

Objectives. To justify the choice of surgical approaches to adrenalectomy based on the data of instrumental findings.
Methods. Comparative results of adrenalectomies through different surgical approaches in 51 patients with adrenal tumors have been analyzed. To choose an optimal surgical approach to adrenalectomy its necessary to take into consideration the depth of the adrenal tumor location, the angle of surgical action, the size of adrenal tumor, its location, presence of an accompanying pathology requiring surgical treatment. The parameters mentioned above were determined by means of ultrasonography (US), computer tomography and multislice computed tomography (MSCT). All data obtained from this run compared with the intraoperative findings.
Results. The depth of adrenal location was measured by means of US, CT, MSCT from various surgical approaches made up from 5,70,5 up to 12,90,6 and from 5,60,7 up to 12,80,9 cm (̱σ), respectively. The surgical action angle determined by means of CT and MSCT varied from 36 up to 142 in all cases coinciding with intraoperative findings. The length of mini-lumbotomic approach (n=19) was from 4,8 up to 6,5 cm, (the average 5,40,2 cm (̱σ). Only 5,9% of cases there are data inconsistency in comparison the results of US, CT and MSCT with intraoperative one. Adrenalectomy from thoraco-phrenico- lumbotomic (TPL) approach was performed in 30 (58,8%) patients, from mini-lumbotomic (ML) approach in 21 (41,2%) patients. Conversion frequency of ML approach made up 9,5%. Intraoperative complications at TPL approach were registered in 6,7% cases, at ML approach in 4,8%.
Conclusion. Application of US, CT and MSCT permitted to determine maximally accurately the size and location of the adrenal tumor, to establish the tumor location, required different surgical approaches as well as the expected angle of surgical action thus to contribute to the optimal choice of surgical approach.

Keywords: adrenal tumors, adrenalectomy, surgical treatment, thoraco-phrenico-lumbotomy, mini-lumbotomy, approach, complications
p. 145-153 of the original issue
References
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  3. Emel'ianov SI, Kurganov IA, Bogdanov DIu, Matveev NL, Sadovnikov SV. Vozmozhnosti laparoskopicheskoi adrenalektomii u patsientov s novoobrazovaniiami nadpochechnikov bol'shikh razmerov [The opportunities of laparoscopic adrenalectomy in patients with adrenal tumors larger]. Endoskop Khirurgiia. 2011;(4):39.
  4. Gagner M, Pomp A, Heniford B T, Pharand D, Lacroix A. Laparoscopic adrenalectomy: lessons learned from 100 consecutive procedures Ann Surg. Sep 1997; 226(3): 238-47. PMCID.
  5. Sergiiko SV. Takticheskie i tekhnicheskie aspekty otkrytoi maloinvazivnoi khirurgii nadpochechnikov [Tactical and technical aspects of open minimally invasive surgery of the adrenals]. Izvestiia Cheliab Nauchn Tsentra. 2004;3(24):151-54.
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  8. Maksimov AV, Zakirov RKh, Plotnikov MV. Primenenie komp'iuternoi tomografii dlia kliniko-anatomicheskogo obosnovaniia sredinnogo transperitoneal'nogo minidostupa k infrarenal'noi aorte [The use of computed tomography for clinical and anatomical study of the median transperitoneal minimal access to the infrarenal aorta]. Kazan Med Zhurn. 2010;91(5):625-30.
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  10. Emel'ianov SI, Kurganov SS, Oganesian DIu, Bogdanov IA. Rol' trekhmernogo virtual'nogo modelirovaniia i intraoperatsionnoi navigatsii pri laparoskopicheskikh vmeshatel'stvakh na nadpochechnikakh [The role of three-dimensional virtual simulation and intraoperative navigation in laparoscopy on the adrenal glands]. Endoskop Khirurgiia. 2009;15(5):41-47.
  11. Sazon-Iaroshevich AIu. Anatomo-klinicheskoe obosnovanie khirurgicheskikh dostupov k vnutrennim organam [Anatomic and clinical substantiation of surgical approaches to the internal organs]. Leningrad, USSR. Medgiz, 1954. 180 p.
  12. Tsukanov IuT, Tsukanov AIu. Bokovoi vnebriushinnyi mini-dostup dlia adrenalektomii [Lateral extraperitoneal mini access to adrenalectomy]. Khirurgiia. 2003;(9):7-10.
  13. Henry JF, Denizot A, Puccini M, Kvachenyuk A, Ferrara JJ. Laparoscopic surgery of adrenal glands: indications and limits. Ann Endocrinol (Paris). 1996;57(6):520-25. [Article in French].
  14. Shen WT, Grogan R, Vriens M, Clark OH, Duh QY. One hundred two patients with pheochromocytoma treated at a single institution since the introduction of laparoscopic adrenalectomy. Arch Surg. 2010 Sep;145(9):893-97. doi: 10.1001/archsurg.2010.159.
  15. Nikonenko AS, Zavgorodnii SN, Podluzhnyi AA, Vil'khovoi SO, Gaidarzhi EI. Opyt primeneniia simul'tannykh operatsii u bol'nykh s opukholiami nadpochechnikov [Experience in the use of simultaneous operations in patients with adrenal tumors]. Zaporozh Med Zhurn. 2010;12(1):17-18.
  16. Borisov AE. /red. Videoendoskopicheskie vmeshatel'stva na organakh zhivota, grudi i zabriushinnogo prostranstva [Videoendoscopic intervention on the abdominal, pectoral and retroperitoneal organs]. Saint-Petersburg, RF: Ianus. 2012. 416 p.
Address for correspondence:
734003, Respublika Tadzhikistan,
g. Dushanbe, prospekt Rudaki, d. 139,
Tadzhikskiy gosudarstvennyiy
meditsinskiy universitet imeni Abuali ibni Sino,
kafedra khirurgicheskih bolezney 2.
tel.: 992 915 25 00 55;
e-mail: sadriev_o_n@mail.ru,
Sadriev Okildzhon Nemadzhonovich
Information about the authors:
Sadriev O.N. A post-graduate student of the surgical diseases chair 2 of Avicenna Tajik State Medical University.
Gaibov A.D. Corresponding member of Medical Sciences academy of the Ministry of Health and Social Protection of the Population of the Republic of Tajikistan, MD, professor of the surgical diseases chair 2 of Avicenna Tajik State Medical University, professor and tutor of the vascular surgery department of the Republican Scientific Center of Cardiovascular Surgery.

I.A. KRIVORUCHKO, I.A. TARABAN, I.V. SOROKINA, N.N. GONCHAROVA

MORPHOLOGICAL FEATURES OF CAVITARY FORMATIONS IN ACUTE PANCREATITIS

Kharkov National Medical University of the MH of Ukraine
Ukraine

Objectives. To study the features of the morphological structure of the wall of cavitary formations in acute destructive pancreatitis at different stages of development using immunohistochemical methods.
Methods. The features of the wall microstructure of cavitary formations and adjacent pancreatic parenchyma have been studied on the biopsied material (81 cases) depending on the morphology of the connective tissue component using histological, histochemical and immunohistochemical methods.
Results. It was established that in patients both as with complicated and not complicated delimited pancreatic necrosis foci at the morphological study a similar pattern has been observed. The wall of formation and glandular interstice were presented by a loose fibrous connective tissue with primary predominance of cellular elements and small volume of fibers, thus both focal (non-complicated course), and diffuse (complicated one) inflammatory infiltration of the formation wall was registered. The presence of dense connective tissue, the localization of the inflammatory infiltrate in the inner layers of the wall, prevalence of type I collagen in the capsule of pseudocysts as well as cells producing IL-2 and IL-6 testified to the reduction of the inflammatory process activity. Loose connective tissue, diffuse inflammatory infiltration in all layers of the wall, the predominance of type III collagen and reduction of the number of cells producing IL-2 and IL-6 manifested the inflammatory activity retention. Taking into account the commonality of morphological changes in patients with complicated pseudocysts and delimited foci of pancreatic necrosis, all forms of cavitary formations were considered as initially unfavorable course of the pathological process, requiring surgical correction.
Conclusion. Growth factors and cytokines are thought to be the triggers of the pancreatic fibrogenesis. IL-2 and IL-6 promote the intracellular matrix synthesis rich of collagen type I and III, thus promoting fibrosis in pancreatitis. It was established that in pancreatitis not only the content synthesis of the extracellular matrix is increased, but also its degradation is inhibited by reducing the specific activity of metalloenzymes.

Keywords: acute pancreatitis, acute liquid collections, pseudocysts, pathomorphology, fibrogenesis, metalloenzymes, degradation
p. 154-159 of the original issue
References
  1. Vinokurov MM, Savel'ev VV, Ammosov VG. Khirurgicheskie vmeshatel'stva pri infitsirovannykh formakh pankreonekroza [Surgery for infected pancreatic necrosis forms]. Khirurgiia: Zhurn im NI Pirogova. Moscow, RF: Media Sfera. 2009;(11):23-26.
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  3. Huber W, Schmid RM. Diagnosis and treatment of acute pancreatitis. Current recommendations Internist (Berl). 2011 Jul;52(7):823-30, 832. doi: 10.1007/s00108-010-2796-x. [Article in German].
  4. Tenner S, Baillie J, DeWitt J, Vege SS. American College of Gastroenterology American College of Gastroenterology guideline: management of acute pancreatitis. Am J Gastroenterol. 2013 Sep;108(9):1400-15; 1416. doi: 10.1038/ajg.2013.218.
  5. Kondratenko PG, Vasil'ev AA, Kon'kova MV. Ostryi pankreatit [Acute pancreatitis]. Donetsk, Ukraina: 2008. 352 p.
  6. Nechitailo ME, Snopok IuV, Bulik II. Kisty i kistoznye opukholi podzheludochnoi zhelezy [Cysts and cystic tumors of the pancreas]. Kiev, Ukraina: Poligrafkniga. 2012. 544 p.
  7. Dumonceau JM, Andriulli A, Deviere J, Mariani A, Rigaux J, Baron TH, Testoni PA. European Society of Gastrointestinal Endoscopy.European Society of Gastrointestinal Endoscopy (ESGE) Guideline: prophylaxis of post-ERCP pancreatitis. Endoscopy. 2010 Jun;42(6):503-15. doi: 10.1055/s-0029-1244208.
  8. Hut'an M, Rashidi Y, Novák S, Hut'an M Jr. [How long to wait with operations for necrotizing pancreatitis?]. [Article in Slovak] Rozhl Chir. 2010 Aug;89(8):513-17.
  9. Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, Tsiotos GG, Vege SS; Acute Pancreatitis Classification Working Group. Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013 Jan;62(1):102-11. doi: 10.1136/gutjnl-2012-302779.
  10. Ojo EO, Babayo UD.Pancreatic pseudocyst in Federal Medical Centre, Gombe and review of literature. Niger J Med. 2010 Apr-Jun;19(2):223-29.
  11. Kopchak VM, Kopchak KV, Khomiak V, Duvalko OV, Pererva LO. Tereshkevich S, Moshkvs'kii GIu, Kondratiuk VA. Suchasn pdkhodi do lkuvannia uskladnenikh psevdokst pdshlunkovo zalozi [Current approaches to the treatment of complicated pancreatic pseudocyst]. Naukovii Vsn Uzhgorod Un-tu. 2014;1(49):106-10. Available from: http://nbuv.gov.ua/j-pdf/UNUMED_2014_1_27.pdf
  12. Kon'kova MV, Smirnov NL, Iudin AA. Ul'trazvukovaia diagnostika i diapevtika ostrogo pankreatita [Ultrasound diagnosis and diapevtics of acute pancreatitis]. Donetskii nats med un-tet im M Gor'kogo. Ukr Zhurn Khirurgii 2013;3(22):132-35
Address for correspondence:
61022, Harkov, Ukraina, pr. Lenina, d. 4,
Harkovskiy natsionalnyiy meditsinskiy universitet,
kafedra khirurgii 2,
tel. office 38 050 301-90-90,
e-mail: dr_tia@mail.ru
Taraban Igor Anatolevich
Information about the authors:
Krivoruchko I.A. MD, professor, a head of the surgery chair 2 of Kharkov National Medical University.
Taraban I.A. MD, professor of the surgery chair 1 of Kharkov National Medical University.
Sorokina I.V. MD, professor of the pathologic anatomy chair of Kharkov National Medical University.
Goncharova N.N. PhD, doctoral candidate of the surgery chair 2 of Kharkov National Medical University.

R.R. KASIMOV 1, A.S. MUKHIN, 2, D.A. ELFIMOV 1, A.M. SHELEH 1, A.I. MAKHNOVSKY 3

ULTRASOUND DIAGNOSTICS OF ACUTE APPENDICITIS

FSPE "422 Military Hospital" of the Ministry of Defense of Russia, N. Novgorod1,
SBEE HPE "Nizhny Novgorod State Medical Academy of the Ministry of Health" 2,
FSPE "422 Military Hospital" of the Ministry of Defense of Russia, St. Petersburg3
The Russian Federation

Objectives. To assess effectiveness of sonography in the diagnosis of acute appendicitis.
Methods. The analysis of ultrasound diagnostics effectiveness of acute appendicitis in the multidisciplinary in-patient general surgical military hospital has been performed. Sixty-five patients were enrolled in the analysis, sixty-four younger men, one woman, thirty-four of them were operated on with a confirmed diagnosis of acute appendicitis. In one case, the histological examination verified catarrhal inflammation of the appendix (3%), the rest a destructive acute appendicitis.
Results. The indices of informativeness of this method: sensitivity 79%, specificity 87%, overall accuracy 68%, false negative response 20%, false positive response 13%, positive predicted value 87%. Such characteristics of the appendix ultrasound as noninvasiveness, sufficient informativeness and the ability to perform research in dynamics, lack of radiation exposure to both a patient and staff provide undeniable advantages over the other methods of study. The application of the sonography of appendix in the clinical practice permitted to improve reliably the results of diagnosis and treatment of patients without any invasion as well as to reduce the incidence of unreasonable appendectomies.
Conclusion. Sonography of the appendix is an effective screening method for diagnosing acute appendicitis. High operator dependence can be considered as a disadvantage of this method. Currently, unjustified appendectomy is the most common diagnostic error, determining to a great extent the state and combatant value of patients operated on with acute appendicitis. A necessity to review some principles of specialists training for diversified general surgical hospitals has been appeared. It is expedient for surgeons to complete basic professional retraining with mastering of related specialties, particular ultrasound diagnostics and endoscopy.

Keywords: acute appendicitis, ultrasound diagnostics, endoscopy, unjustified appendectomy, destructive appendicitis, ultrasound examination of the appendix, diagnostic algorithm
p. 160-164 of the original issue
References
  1. Izrailov RE, Lemeshko ZA. Ul'trazvukovoe issledovanie v diagnostike i lechenii ostrogo appenditsita [Ultrasound examination in the diagnosis and treatment of acute appendicitis].Moscow, RF: GEOTARMedia, 2009. 72 p.
  2. Piskunov VN, Zavadovskaia VD, Zav'ialova NG. Ul'trazvukovaia diagnostika ostrogo appenditsita [Ultrasound diagnosis of acute appendicitis]. Biull Sib Meditsiny. 2009;(4):140-49.
  3. Magomedova SM, Abduldzhalilov MK. Ekhosonografiia v diagnostike ostrogo appenditsita pri atipichnom raspolozhenii cherveobraznogo otrostka [Echosonography in the diagnosis of acute appendicitis at atypical location of the appendix]. Sovr Naukoemkie Tekhnologii. 2010;(2):99-100.
  4. Bakker OJ, Go PM, Puylaert JB, Kazemier G, Heij HA. Guideline on diagnosis and treatment of acute appendicitis: imaging prior to appendectomy is recommended. [Article in Dutch] Werkgroep richtlijn Diagnostiek en behandeling van acute appendicitis. Ned Tijdschr Geneeskd. 2010;154:A303.
  5. Gökçe AH, Aren A, Gökçe FS, Dursun N, Barut AY. Reliability of ultrasonography for diagnosing acute appendicitis. [Article in Turkish] Ulus Travma Acil Cerrahi Derg. 2011 Jan;17(1):19-22.
  6. Toorenvliet BR, Wiersma F, Bakker RF, Merkus JW, Breslau PJ, Hamming JF.Routine ultrasound and limited computed tomography for the diagnosis of acute appendicitis. World J Surg. 2010 Oct;34(10):2278-85. doi: 10.1007/s00268-010-0694-y.
  7. Kukosh MV, Gomozov GI. Puti snizheniia letal'nosti pri ostrom appenditsite [The methods to reduce mortality in acute appendicitis]. Nizhegorod Med Zhurn. 2006;(6):71-76.
  8. Borisov AE, Levin LA, Peshekhonov SI, Chistiakov DB, Shikhllagolledov ShA, Kim AE, Khlopov VB, Kornienko BL, Pikin IV. Laparoskopicheskaia appendektomiia [Laparoscopic appendectomy]. Oshibki i oslozhneniia. SPb MDPO, Saint-Petersburg, RF. Endoskop Khirurgiia. 2009;(1):91-92.
  9. Ukhanov AP, Kovalev SV, Iashina AS, Ignat'ev AI. Vozmozhnosti ul'trazvukovoi diagnostiki ostrogo appenditsita [Possibilities of ultrasound diagnosis of acute appendicitis]. Endoskop Khirurgiia. 2009;(1):84-85.
  10. Kasimov RR, Mukhin AS, Elfimov DA, Sokolov LV. Lechebno-diagnosticheskii algoritm pri ostrom appenditsite u voennosluzhashchikh [Diagnostic and treatment algorithm for acute appendicitis in military personnel]. Novosti Khirurgii. 2014;1(22):89-95.
Address for correspondence:
603105, Rossiyskaya Federatsiya,
g. N. Novgorod, ul. Izhorskaya, d. 25, k. 3,
Nizhegorodskiy voennyiy gospital,
khirurgicheskoe otdelenie,
tel. mob.: 7 (920) 035-06-19,
e-mail: rusdoc77@mail.ru,
Kasimov Rustam Rifkatovich
Information about the authors:
Kasimov R.R. PhD, a surgeon of FSPE "422 military hospital" of the Ministry of Defense of Russia.
Mukhin A.S. MD, professor, a head of the surgery chair of the faculty of advanced training of SBEE HPE "Nizhny Novgorod State Medical Academy of the Ministry of Health".
Elfimov D.A. A surgeon of FSPE "422 military hospital" of the Ministry of Defense of Russia.
Sheleh A.M. A head of the ultrasound diagnostic unit of FSPE "422 military hospital" of the Ministry of Defense of Russia.
Makhnovsky A.I. A chief surgeon of Western Military District of FSPE "422 military hospital" of the Ministry of Defense of Russia (St. Petersburg).

V.V. DOROFEYKOV, T.A. SHESHURINA, D.I. KURAPEEV, V.O. KABANOV, N.S. PASCAR, I.V. SUHOVA, A.V. VOROBYOVA, T.V. VAVILOVA, E.V. KULESHOVA

DYNAMICS OF TROPONIN I IN DIFFERENT TYPES OF CARDIAC SURGERY AND APPLICATION OF ESC/ACCF/AHA/WHF 2012 RECOMMENDATIONS IN DIAGNOSTICS OF POSTOPERATIVE MYOCARDIAL DAMAGE

FBSE "Federal Medical Research Center named after V.A. Almazov", Saint-Petersburg,
The Russian Federation

Objectives. To compare the degree of troponin I concentration elevation in patients after various cardiac surgeries. To assess the applicability of international ESC/ACCF/AHA/WHF 2012 recommendations for diagnostics of postoperative myocardial infarction (MI).
Methods. The patients were divided into three groups. In the first group the percutaneous coronary intervention (PCI) has been performed (n=112). In the second group the patients (n=62) were subjected to the isolated aorta-coronary bypass grafting (ACBG). In the third group (n=18) the combination of aorta-coronary bypass grafting with the left ventricular aneurysm plasty has been carried out. The measurement of serum concentrations of cardiac troponin before treatment and then 24 hours after the surgery.
Results. It is shown that the volume and nature of surgical intervention significantly affect the extent of myocardial damage, and also on the dynamics of postoperative troponin level. Exceeding the recommended ESC / ACCF / AHA / WHF diagnostic troponin level (99 percentile) for the diagnosis of myocardial infarction after percutaneous coronary intervention (PCI) 5-folds was observed in 26 (23,8%) patients, exceeding 10-folds in 13 (11,4%), exceeding 20-folds 4 (3,5%), in excess of 50-folds or more in 21 (18,8%) patients. After isolated coronary artery bypass grafting (ICABG) the diagnostic level of MI determination is equal to 10-folds exceeding of 99 percentile. In the group with ICABG 20-folds exceeding was observed in 1 (1,7%), 50-folds and more exceeding in 25 (40,3%), 100-folds and more exceeding in 36 (58%) patients. In the combined surgery a significant exceeding of the troponin concentration has ben noticed: exceeding of 99 percentile in 50-100-folds in 2 patients (11,2%), more than 100-folds exceeding in 16 (88,8%) patients.
Conclusion. Troponinemia while carrying out of the extended cardiac surgical procedures is not accompanied by the signs of myocardial ischemia has demonstrated in the most cases. Accepted criteria of the postoperative MI diagnostics require in reviewing and optimization to exclude cases of unjustified diagnostics of MI.

Keywords: myocardial infarction, myocardial ischemia, percutaneous coronary intervention, isolated coronary artery bypass grafting, myocardial revascularization, postoperative myocardial damage, cardiac troponin
p. 165-170 of the original issue
References
  1. Wheatley DJ.Protecting the damaged heart during coronary surgery. Heart. 2003 Apr;89(4):367-68.
  2. Komitet ekspertov VNOK. Natsional'nye rekomendatsii po diagnostike i lecheniiu bol'nykh ostrym infarktom miokarda s pod"emom segmenta ST EKG [National guidelines for diagnosis and treatment of patients with acute myocardial infarction with ECG ST-segment elevation]. Kardiovaskuliar Terapiia i Profilaktika. 2007;6(8), (Pril 1):424-26.
  3. Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, White HD, et al. Third Universal Definition of Myocardial Infarction. Expert Consensus Document. J Am Coll Cardiol. 2012 Oct 16;60(16):1581-98. doi: 10.1016/j.jacc.2012.08.001.
  4. Miller WL, Garratt KN, Burritt MF, Reeder GS, Jaffe AS. Timing of peak troponin T and creatine kinase-MB elevations after percutaneous coronary intervention. Chest. 2004 Jan;125(1):275-80.
  5. Sheshurina TA, Dorofeikov VV, Kurapeev DI, Bautin AE. Dinamika kardiospetsifichnykh troponinov T i I pri aortokoronarnom shuntirovanii - interpretatsiia rezul'tatov [Dynamics of cardiac troponin T and I at coronary artery bypass surgery - interpretation of the results] (klinicheskie nabliudeniia, obzor literatury). Klin-Lab Konsilium. 2012;3(43):61-65.
  6. Jaffe AS, Babuin L, Apple FS. Biomarkers in acute cardiac disease: the present and the future. J Am Coll Cardiol. 2006 Jul 4;48(1):1-11.
  7. Dorofeikov VV, Sheshurina TA, Ivanov VI, Bautin AE. Vysokochuvstvitel'nyi troponin I i mozgovoi natriiureticheskii peptid u patsientov s IBS pri operatsiiakh aortokoronarnogo shuntirovaniia i plastiki anevrizmy levogo zheludochka, sravnitel'noe issledovanie [High-sensitivity troponin I and brain natriuretic peptide in patients with ischemic heart disease at coronary artery bypass surgery and plastic left ventricular aneurysm, a comparative study]. Biull NTsSSKh im AN Bakuleva. 2012;13(3):133-34.
  8. Holmvang L, Jurlander B, Rasmussen C, Thiis JJ, Grande P, Clemmensen P.Use of biochemical markers of infarction for diagnosing perioperative myocardial infarction and early graft occlusion after coronary artery bypass surgery. Chest. 2002 Jan;121(1):103-11.
  9. Thygesen K, Alpert JS, White HD. Universal definition of myocardial infarction. Circulation. 2007 Nov 27;116(22):2634-53.
Address for correspondence:
194156, Rossiyskaya Federatsiya,
g. Sankt-Peterburg, pr. Parhomenko, d. 15,
FBGU "Federalnyiy meditsinskiy
issledovatelskiy tsentr im. V.A. Almazova",
tel. mob.: 8 911 211-26-12,
e-mail: vdorofeykov@ya.ru,
Dorofeykov Vladimir Vladimirovich
Information about the authors:
Dorofeykov V.V. MD, professor of the clinical laboratory diagnostics and genetics chair of FBSE "Federal Medical Research Center named after V.A. Almazov", St. Petersburg.
Sheshurina T.A. A post-graduate student of FBSE "Federal Medical Research Center named after V.A. Almazov", St. Petersburg.
Kurapeev D.I. PhD, a head of SRL of bioprosthetics and cardioprotection of FBSE "Federal Medical Research Center named after V.A. Almazov", St. Petersburg.
Kabanov V.O. A post-graduate student of FBSE "Federal Medical Research Center named after V.A. Almazov", St. Petersburg.
Pascar N.S. A physician of FBSE "Federal Medical Research Center named after V.A. Almazov", St. Petersburg.
Suhova I.V. PhD, a physician of FBSE "Federal Medical Research Center named after V.A. Almazov", St. Petersburg.
Vorobyova A.V. A physician of FBSE "Federal Medical Research Center named after V.A. Almazov", St. Petersburg.
Vavilova T.V. MD, professor, a head of the clinical laboratory diagnostics and genetics chair of FBSE "Federal Medical Research Center named after V.A. Almazov", St. Petersburg.
Kuleshova E.V. MD, professor, freelancer researcher of FBSE "Federal Medical Research Center named after V.A. Almazov", St. Petersburg.

N. TORMA 1, V. SIHOTSKY 2, I.I. KOPOLOVETS 3, M. FRANKOVITSHOVA 2, F. SABOL 2, M. KUBIKOVA 2, P. STEFANIC 2

RESULTS OF SIMULTANEOUS OPERATIONS IN PATIENTS WITH ATHEROSCLEROTIC LESIONS OF CAROTID AND CORONARY ARTERIES

Vascular Center "IMEA "1, Kosice,
Center of Cardiovascular diseases "VUSCH", P.J. Safarik University, medical faculty 2, Kosice,
The Slovak Republic
HSEE "Uzhhorod National University", medical faculty 3, Uzhhorod,
Ukraine

Objectives. To evaluate the results of simultaneous operations in patients with atherosclerotic lesions of coronary and carotic arteries and an algorithm has been specifically developed for selection patients.
Method. The results of surgical treatment of 78 patients are presented. The patients were divided into 3 groups according to the patients clinical findings and diagnostic outcomes: I group (38 patients) simultaneous operation (carotid endarterectomy and coronary artery bypass grafting (CABG)); II group (16 patients) the first stage carotid endarterectomy, the second stage CABG; III group (24 patients) the first stage CABG, the second stage carotid endarterectomy.
Results. In comparing the immediate results of simultaneous and staged surgical treatment of atherosclerotic stenosis of the internal carotid artery (ICA) and myocardial revascularization no reliable difference has been established (<0,05). Cerebral blood flow disturbance was observed in the 1st group in 2 patients (5,2%), 1 (2,6%) patient died. To improve the results of the treatment of combined coronary and cerebrovascular pathology an algorithm for diagnosis and treatment has been developed. According to the presented algorithm a simultaneous surgery should be performed only for select groups of patients with unstable angina pectoris in patients with symptomatic ICA stenosis more than 60%; asymptomatic ICA stenosis of 70% and greater in case of contralateral ICA occlusion; asymptomatic ICA stenosis of 70% with high embologenic lesion; a two-sided asymptomatic ICA stenosis greater than 70%. In case of severe coronary bed lesion the patients received combined operations coronary artery bypass grafting (CABG) involving carotid endarterectomy (CE) as the second stage in the remote period. In case of stable angina pectoris in patients with symptomatic ICA stenosis of 60% and greater is recommended to perform two stage procedures: CE as the first stage and the second CABG.
Conclusion. In case of combined lesion of coronary and carotid arteries a simultaneous intervention is certainly indicated to appropriately selected patients with unstable angina pectoris (symptomatic ICA stenosis of 60% and greater) and asymptomatic severe carotid artery stenosis. The immediate and delayed postoperative outcomes of simultaneous operations were found to be satisfactory and made up 92,2%.

Keywords: diagnostics, angina pectoris, carotid stenosis, carotid endarterectomy, coronary artery bypass grafting, simultaneous operation, algorithm
p. 171-175 of the original issue
References
  1. Gabrlian AV, Nkul'nkov P, Ratushniuk AV. ta n. Simul'tann operativn vtruchannia z shemchnoiu khvoroboiu sertsia ta mul'tifokal'nogo aterosklerozu [Simultaneous surgery for coronary heart disease and multifocal atherosclerosis]. Arkh Kln Med. 2014:2(20):19-21. Available from: http://issuu.com/glvisnyk.if.ua/docs/akm__2_2014.
  2. Cherniavskii AM, Karas'kov AM, Mironenko SP, Kovliakov VA. Khirurgicheskoe lechenie mul'tifokal'nogo ateroskleroze [Surgical treatment for multifocal atherosclerosis]. Biulleten' SO RAMN. 2006;2 (120):126-31.
  3. Bendov DV, Naimushin AV, Bakanov AIu, Bakanov AIu. Odnomomentnaia karotidnaia endarterektomiia i koronarnoe shuntirovanie u patsientov s dvustoronnim porazheniem sonnikh arterii [Simultaneous carotid endarterectomy and coronary artery bypass grafting in patients with bilateral carotid arteries]. Arterial Gipertenziia. 2009;15(4):502-506.
  4. Rusin V, Korsak VV, Butsko S, Demidiuk DV, Borsenko M. Vibr khrurgchno taktiki pri podnanikh urazhenniakh vntsevikh arteri ta arteri dugi aorti [The choice of surgical treatment of combined lesions of the coronary arteries and aortic arch arteries]. Nauk Vsn Uzhgorod Unversitetu Seria Meditsina. 2012;2 (44):106-10.
  5. Venkatachalam S, Gray BH, Mukherjee D, Shishehbor MH.Contemporary management of concomitant carotid and coronary artery disease. Heart. 2011 Feb;97(3):175-80. doi: 10.1136/hrt.2010.203612.
  6. Naylor AR.Does the risk of post-CABG stroke merit staged or synchronous reconstruction in patients with symptomatic or asymptomatic carotid disease? J Cardiovasc Surg (Torino). 2009 Feb;50(1):71-81.
  7. Santos A, Washington C, Rahbar R, Benckart D, Muluk S. Results of staged carotid endarterectomy and coronary artery bypass graft in patients with severe carotid and coronary disease. Ann Vasc Surg. 2012 Jan;26(1):102-6. doi: 10.1016/j.avsg.2011.10.002
Address for correspondence:
88000, Ukraina, g. Uzhgorod,
ul. Universitetskaya, d. 10,
GVUZ "Uzhgorodskiy natsionalnyiy universitet",
meditsinskiy fakultet,
tel. mob: 380505588211,
e-mail: i.kopolovets@gmail.com,
Kopolovets Ivan Ivanovich
Information about the authors:
Torma N., PhD, vascular surgeon "IMEA ", Kosice, the Slovak Republic
Sihotsky V., PhD, Deputy Head on pedagogical affairs of the Vascular Surgery Clinic, P.J.Safarik University, medical faculty, Kosice.
Kopolovets I.I., PhD, a researcher of HSEE "Uzhhorod National University", medical faculty, Uzhhorod, Ukraine.
Frankovitshova M., PhD, professor, a head of the Vascular Surgery Clinic, P.J.Safarik University, medical faculty, Kosice.
Sabol V, PhD, a director of the Center of Cardiovascular diseases "VUSCH", P.J.Safarik University, medical faculty, Kosice.
Kubikova M., PhD, a head of the vascular surgery department, P.J.Safarik University, medical faculty, Kosice.
Stefanic P., a post-graduate student of the Vascular Surgery Clinic, P.J.Safarik University, medical faculty, Kosice.

E.Y. SOLDATSKY, S.M. YUMIN, A.V. ANDRIYASHKIN, I.A. ZOLOTUKHIN, A.I. KIRIENKO

COMPARISON OF THE LONG -TERM OUTCOMES OF FEMOROPOPLITEAL DEEP VENOUS THROMBOSIS

Russian National Research Medical University named after N.I. Pirogov, Moscow,
The Russian Federation

Objectives. To study the long-term outcomes of femoropopliteal deep venous thrombosis and to compare them with the clinical results after an isolated distal deep vein thrombosis.
Methods. The case-control study with a pair design has been carried out. 88 patients were enrolled in the study treated for deep venous thrombosis (DVT) of the femoropopliteal (the main group, n=44) and distal segments (the control group, n=44). Patients examination included anamnesis taking, physical examination, analysis of available medical records, questioning using questionnaire CIVIQ2 (the quality of life), ultrasound angioscanning of the veins.
Results. According to the incidence of risk factors detection such as trauma, oncological diseases, congenital thrombophilia, air flight, hormonal drugs, no statistically significant differences were found (p>0,05). Overweight was frequently detected in the main group (p=0,039). In the control group the number of patients subjected DVT shortly prior surgery (p=0,039) was 2-fold higher.
The recurrence rate (the same 2-fold higher) in the study group was 9% (p=0,398). There were 14 cases (32%) of pulmonary embolism in the main group and 4 cases (9%) in the control group (p=0,0021). Commitment to treatment was higher in patients of the main group. The incidence of chronic venous insufficiency (classes C3-C6 by CEAP) in the main group was 73% and 17% - in the control group (p=0,001). An additional evaluation criterion was index of venous disease severity by VCSS scale. Its average values was 4,6% in the main group and 3,3% in the control group (p=0,004). The differences were statistically significant. The groups didnt differ statistically according to the level of life quality.
Conclusion. Venous thrombosis of femoropopliteal localization according to its clinical outcomes differs from distal deep vein thrombosis and leads to more expressed manifestation of post-thrombotic diseases. From the point of life quality there are no differences between the femoropopliteal and distal deep vein thrombosis.

Keywords: chronic venous insufficiency, distal deep venous thrombosis, treatment, post-thrombotic syndrome, long-term outcomes, evaluation criteria, life quality
p. 176-181 of the original issue
References
  1. Zolotukhin IA, Iumin S M, Leont'ev S G, Andriiashkin AV, Kirienko AI. Otdalennye rezul'taty lecheniia patsientov, perenesshikh tromboz glubokikh ven nizhnikh konechnostei [The long-term results of treatment of patients undergoing deep vein thrombosis of the lower extremities]. Flebologiia / Flebologiia 2011;(1):27-33. Available from: http://www.mediasphera.ru/journals/flebo/746/11725/.
  2. Eichinger S, Heinze G, Jandeck LM, Kyrle PA. Risk assessment of recurrence in patients with unprovoked deep vein thrombosis or pulmonary embolism: the Vienna prediction model. Circulation. 2010 Apr 13;121(14):1630-36. doi: 10.1161/CIRCULATIONAHA.109.925214.
  3. Palareti G, Schellong S.Isolated distal deep vein thrombosis: what we know and what we are doing. J Thromb Haemost. 2012 Jan;10(1):11-9. doi: 10.1111/j.1538-7836.2011.04564.x.
  4. Kahn SR, Shbaklo H, Lamping DL, Holcroft CA, Shrier I, Miron MJ, Roussin A, Desmarais S, Joyal F, Kassis J, Solymoss S, Desjardins L, Johri M, Ginsberg JS. Determinants of health-related quality of life during the 2 years following deep vein thrombosis. J Thromb Haemost. 2008 Jul;6(7):1105-12. doi: 10.1111/j.1538-7836.2008.03002.x.
  5. Roberts LN, Patel RK, Chitongo PB, Bonner L, Arya R. Presenting D-dimer and early symptom severity are independent predictors for post-thrombotic syndrome following a first deep vein thrombosis. Br J Haematol. 2013 Mar;160(6):817-24. doi: 10.1111/bjh.12192.
  6. Roberts LN, Patel RK, Donaldson N, Bonner L, Arya R. Post-thrombotic syndrome is an independent determinant of health-related quality of life following both first proximal and distal deep vein thrombosis. Haematologica. 2014 Mar;99(3):e41-3. doi: 10.3324/haematol.2013.089870.
  7. Galanaud JP, Bosson JL, Quéré I. Risk factors and early outcomes of patients with symptomatic distal vs. proximal deep-vein thrombosis. Curr Opin Pulm Med. 2011 Sep;17(5):387-91. doi: 10.1097/MCP.0b013e328349a9e3.
  8. Scarvelis D, Wells PS.Diagnosis and treatment of deep-vein thrombosis. CMAJ. 2006 Oct 24;175(9):1087-92.
  9. Launois R, Reboul-Marty J, Henry B.Construction and validation of a quality of life questionnaire in chronic lower limb venous insufficiency (CIVIQ). Qual Life Res. 1996 Dec;5(6):539-54.
  10. Partsch HA. New classification scheme of chronic venous disease in the lower extremities. The CEAPsystem. Phlebolymphology. 1995;(10):3-8.
  11. Galanaud JP, Quenet S, Rivron-Guillot K, Quere I, Sanchez Munoz-Torrero JF, Tolosa C, Monreal M. Comparison of the clinical history of symptomatic isolated distal deep vein thrombosis vs. proximal deep vein thrombosis in 11 086 patients. J Thromb Haemost. 2009 Dec;7(12):2028-34. doi: 10.1111/j.1538-7836.2009.03629.x.
  12. Baglin T, Douketis J, Tosetto A, Marcucci M, Cushman M, Kyrle P, Palareti G, Poli D, Tait RC, Iorio A.Does the clinical presentation and extent of venous thrombosis predict likelihood and type of recurrence? A patient-level meta-analysis. J Thromb Haemost. 2010 Nov;8(11):2436-42. doi: 10.1111/j.1538-7836.2010.04022.x.
  13. Eichinger S, Heinze G, Jandeck LM, Kyrle PA. Risk assessment of recurrence in patients with unprovoked deep vein thrombosis or pulmonary embolism: the Vienna prediction model. Circulation. 2010 Apr 13;121(14):1630-36. doi: 10.1161/CIRCULATIONAHA.109.925214.
  14. Palareti G, Schellong S.Isolated distal deep vein thrombosis: what we know and what we are doing. J Thromb Haemost. 2012 Jan;10(1):11-19. doi: 10.1111/j.1538-7836.2011.04564.x.
  15. Prandoni P, Lensing AW, Prins MH, Frulla M, Marchiori A, Bernardi E, Tormene D, Mosena L, Pagnan A, Girolami A.Below-knee elastic compression stockings to prevent the post-thrombotic syndrome: a randomized, controlled trial. Ann Intern Med. 2004 Aug 17;141(4):249-56.
Address for correspondence:
117049, Rossiyskaya Federatsiya,
g. Moskva, Leninskiy prospekt d. 10, korp. 5,
"Rossiyskiy natsionalnyiy issledovatelskiy meditsinskiy universitet
im. N.I. Pirogova", kafedra fakultetskoy khirurgii 1,
tel. office: 7-910-474-95-11,
e-mail: netbobr@bk.ru,
Soldatsky Evgeniy Yurevich
Information about the authors:
Soldatsky E.Y. A post-graduate student of the faculty surgery chair N1 of the medical faculty of Russian National Research Medical University named after N.I. Pirogov.
Yumin S.M. PhD, an assistant of the faculty surgery chair N1 of the medical faculty of Russian National Research Medical University named after N.I. Pirogov.
Andriyashkin A.V. PhD, an associate professor of the faculty surgery chair N1 of the medical faculty of Russian National Research Medical University named after N.I. Pirogov.
Zolotukhin I.A. MD, professor of the faculty surgery chair1 of the medical faculty of Russian National Research Medical University named after N.I. Pirogov.
Kirienko A.I. MD, professor, Academician of RAMS, a head of the faculty surgery chair N1 of the medical faculty of Russian National Research Medical University named after N.I. Pirogov.

S.E. KATORKIN, M.V. NASYROV

LOCAL TREATMENT AND PREOPERATIVE PREPARATION OF VENOUS TROPHIC ULCERS USING PHOTODYNAMIC THERAPY

SBEE HPE "Samara State Medical University"
The Russian Federation

Objectives. To optimize local treatment and preoperative preparation of trophic ulcers (TU) in patients with chronic venous diseases (CVD) of C6 class using photodynamic therapy (PDT).
Methods. One hundred and twelve patients with ulcer (class C6) have been examined. All patients subjected to ultrasonic dopplerography and angiographic scanning on the diagnostic apparatus Aloka 4 and Logiq 7. TU planimetry was done using standard contact technique. Photodynamic therapy was applied in 67 (59,8%) patients. Photodynamic therapy was carried out using a semiconductor laser with the application of photosensitizing agents Radahlarin (0,1% gel) on trophic ulcers. Photodynamic therapy efficacy was controlled by means of classical microbiological and cytological methods checking dynamics of microbial spectrum, the level of contamination and regenerative processes in tissues. 45 (40,2%) patients of the 2nd group have been treated by standard methods. 59 (88,1%) patients of the 1st group and 43 (95,6%) of the 2nd group have been operated on. A combined phlebectomy together with a free autodermoplasty by a splitted skin graft has been performed. Assessment of long-term results of combined treatment was carried out within 3 years.
Results. There was a marked reduction in microbial growth and microbial dissemination level from 107-108 up to 104-105 registered in the 1st group on the 4th day after use of photodynamic therapy; inflammatory and regenerative cytograms type was revealed in 73% of observations (p<0,05). In the 2nd group the prevalence of inflammatory and regenerative cytograms type (76%) was achieved on the 20th day. Photodynamic therapy application permitted to reduce the preoperative period by 3 folds and to carry out autodermoplasty of TU on the 5,10,8th days in the 1st group. Complete engraftment of autodermotransplant was observed in 74,6% of patients in the 1st group and in 46,5% in the control group.
Conclusion. Photodynamic therapy appears to be effective, pathogenetically substantiated non-invasive method of local treatment as well as optimization of preoperative preparation of trophic ulcers in patients with CVD (6 clinical class). Photodynamic therapy is considered to manifest marked antibacterial effects and improve microcirculation and epithelialization.

Keywords: photodynamic therapy, chronic venous diseases, venous trophic ulcers, lower extremities, microcirculation, antibacterial effects, epithelialization
p. 182-188 of the original issue
References
  1. Kistner RL.Etiology and treatment of varicose ulcer of the leg. J Am Coll Surg. 2005 May;200(5):645-47.
  2. Zhukov BN, Katorkin SE, Kostiaev VE. Opyt vosstanovitel'nogo lecheniia i meditsinskoi reabilitatsii bol'nykh s zabolevaniiami ven nizhnikh konechnostei [Experience of restorative treatment and medical rehabilitation of patients with venous diseases of the lower extremities]. Flebologiia. 2009;3(3):26-32.
  3. Lazarus G, Valle MF, Malas M, Qazi U, Maruthur NM, Doggett D, Fawole OA, Bass EB, Zenilman J. Chronic venous leg ulcer treatment: future research needs. Wound Repair Regen. 2014 Jan-Feb;22(1):34-42. doi: 10.1111/wrr.12102
  4. Shevchenko IuL, Stoiko IuM, Gudymovich VG, Ivanov AK. Kompleksnyi podkhod v lechenii obshirnykh troficheskikh iazv golenei v mnogoprofil'nom statsionare [An integrated approach to the treatment of extensive trophic leg ulcers in a multidisciplinary hospital]. Vestn Eksper i Klin Khirurgii. 2014;7(3):221-27.
  5. Sushkov SA, Nebylitsin IuS, Samsonova IV, Rzheusskaia M G. Otsenka ispol'zovaniia ranevykh pokrytii pri lechenii troficheskikh iazv venoznogo geneza [Evaluation of wound dressing application in the treatment of trophic ulcers of venous origin]. Khirurgiia Vost Evropa. 2012;(3):181-83.
  6. Serra R, Buffone G, de Franciscis A, Mastrangelo D, Vitagliano T, Greco M, de Franciscis S.Skin grafting followed by low-molecular-weight heparin long-term therapy in chronic venous leg ulcers. Ann Vasc Surg. 2012 Feb;26(2):190-97. doi: 10.1016/j.avsg.2011.04.008.
  7. Pannier F, Rabe E.Differential diagnosis of leg ulcers. 2013 Mar;28 Suppl 1:55-60. doi: 10.1177/0268355513477066.
  8. Rusin VI. Vozmozhnosti primeneniia fotodinamicheskoi terapii v khirurgii [Possible applications of photodynamic therapy in surgery]. Novosti Khirurgii. 2010;18(2):109-14.
  9. Cappugi P, Comacchi C, Torchia D1.Photodynamic therapy for chronic venous ulcers. Acta Dermatovenerol Croat. 2014;22(2):129-31.
  10. Ishchuk AV, Leonovich SI. Ispol'zovanie fotodinamicheskoi terapii lazernym apparatom "Rodnik-1" s fotosensibilizatorom "Khlorofillipt" v lechenii gnoinykh ran i troficheskikh iazv nizhnikh konechnostei [The use of photodynamic therapy by laser apparatus "Rodnik-1" with a photosensitizer "Chlorophyllipt" in the treatment of purulent wounds and trophic ulcers of the lower extremities]. Novosti Khirurgii. 2008;16(1):44-54.
  11. Devirgiliis V, Panasiti V, Fioriti D, Anzivino E, Bellizzi A, Cimillo M, Curzio M, Melis L, Roberti V, Gobbi S, Liteo P, Richetta AG, Calvieri S, Chiarini F, Nicosia R, Pietropaolo V.Antibacterial activity of methyl aminolevulinate photodynamic therapy in the treatment of a cutaneous ulcer. Int J Immunopathol Pharmacol. 2011 Jul-Sep;24(3):793-95.
  12. Calzavara-Pinton PG, Rossi MT, Aronson E, Sala R; Italian Group For Photodynamic Therapy.A retrospective analysis of real-life practice of off-label photodynamic therapy using methyl aminolevulinate (MAL-PDT) in 20 Italian dermatology departments. Part 1: inflammatory and aesthetic indications. Photochem Photobiol Sci. 2013 Jan;12(1):148-57. doi: 10.1039/c2pp25124h.
  13. Morimoto K, Ozawa T, Awazu K, Ito N, Honda N, Matsumoto S, Tsuruta D.Photodynamic therapy using systemic administration of 5-aminolevulinic acid and a 410-nm wavelength light-emitting diode for methicillin-resistant Staphylococcus aureus-infected ulcers in mice. 2014 Aug 20;9(8):e105173. doi: 10.1371/journal.pone.0105173. eCollection 2014.
  14. Zhukov BN, Katorkin SE, Zhukov AA. Venoznye troficheskie iazvy nizhnikh konechnostei. Diagnostika, lechenie i meditsinskaia reabilitatsiia [Venous trophic ulcers of lower extremities. Diagnosis, treatment and medical rehabilitation]: Monografiia. Samara, RF: Meditsina; 2012. 236 p.
  15. Kosinets AN, Sushkov SA. Varikoznaia bolezn' [Varicose disease]: rukovodstvo dlia vrachei. Vitebsk, RF: VGMU, 2009. 415 p.
Address for correspondence:
443079, Rossiyskaya Federatsiya,
g. Samara, pr. Karla Marksa, d. 165 " b",
Kliniki Samarskogo gosudarstvennogo
meditsinskogo universiteta,
kafedra i klinika gospitalnoy khirurgii,
tel. office 8 107 846 276-77-89,
e-mail: katorkinse@mail.ru,
Katorkin Sergey Evgenevich
Information about the authors:
Katorkin S.E. PhD, an associate professor of the chair and clinic of hospital surgery of SBEE HPE "Samara State Medical University".
Nasyrov M.V. A head of the operative unit of clinics of SBEE HPE "Samara State Medical University".

A.V. KOCHETKOV, A.V. FEDULOVA

CLINICAL SIGNIFICANCE OF COLON INJURIES IN POLYTRAUMA IN MOTOR VEHICLE ACCIDENTS

FSBE "All-Russian Center of Emergency and Radiation Medicine named after A.M. Nikiforov of the Ministry of Emergency Situations of the Russian Federation", Saint-Petersburg,
The Russian Federation

Objectives. To study the structure and clinical significance of the colon injury in polytrauma as a result of motor vehicle accidents.
Methods. The retrospective analysis of 101 case histories of motor vehicle accidents victims with the colon injuries of 4 hospitals of St. Petersburg for the period from 1989 to 2014 has been carried out.
Results. In motor vehicle accidents the frequency of the colon injuries and its mesentery are almost identical: 53,1% and 46,8%. Cecum (10,8%), transverse colon (15,3%) and sigmoid (16,2%) were more frequently injured.
The sigmoid was injured more often in pedestrians, in victims inside the vehicle transverse colon. According to the nature of injuries, defects of the serous membrane of the colon (55%) and intramural hematoma (20,3%) were predominant ones. Complete rupture of the colon wall was observed in 18,8%. The damage of the small bowel mesentery, parenchymal organs, closed head injury, damage to the ribs, pelvic bones; lower extremities were occurred frequently in polytrauma.
Deserousive defects of the colon wall were sutured in 51,4% cases, of the mesentery in 49,5%. Colostomy in case of the damaged colon wall was applied in 5,9% cases, in case of the damaged colon mesentery 1%. In laparotomy in 97% of victims, blood loss was revealed, which was not associated with the damage to the colon. Overall mortality is composed 39 people. During traumatic shock period 36,8% of the victims died, in the second period of traumatic disease 29%, in the third period 34,2%. According to the forensic examination, the main causes of death were traumatic shock (92,3%) and hemorrhage (38,5%).
Conclusion. Colon injury is often in polytrauma however, it doesnt determine a severity of the trauma. Shock and bleeding caused by not colonic or mesenteric damage but the injury of the other anatomical regions.
Revealing colon wounds and active surgical tactics allows preventing the development of septic complications in the abdominal cavity in various phases of traumatic disease course in injured persons.

Keywords: polytrauma, blunt abdominal trauma, damage of the colon, injury of the large intestine in motor vehicle accidents, injury of mesentery, laparotomy, hemorrhage
p. 189-193 of the original issue
References
  1. Bagnenko SF, Stozharov VV, Krylov KM, Shlyk IV, Orlova OV, Zakarian AA, Krylov PK. Algoritm deistvii po preemstvennosti okazaniia meditsinskoi pomoshchi postradavshim pri dorozhno-transportnykh proisshestviiakh s ozhogami v usloviiakh uchastkovoi bol'nitsy, tsentral'noi raionnoi bol'nitsy, spetsializirovannogo otdeleniia v mnogoprofil'nom statsionare [The algorithm of action for continuity of care to victims of motor vehicle accidents with burns in a local hospital, central regional hospital, a specialized department in a multidisciplinary hospital]: Metod rekomendatsii. GU SPb NII skoroi pomoshchi im II Dzhanelidze. Saint-Petersburg, RF. 2010. 27 p.
  2. Tulupov AN./ red. Sochetannaia mekhanicheskaia travma [Combined mechanical trauma]: rukovodstvo dlia vrachei. 2012. 393 p.
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  5. Sotnichenko BA, Glushko VV, Kalinin OB, Sotnichenko AB, Salienko SV, Dmitriev ON, Shchepetil'nikova OI. Khirurgicheskaia taktika pri sochetannykh povrezhdeniiakh tolstoi kishki [Surgical tactics in combined injuries of the colon]. Tikhookean Med Zhurn. 2008;(4):4447.
  6. Dedushkin VS, Reminets VV, Solov'ev MM. Tsybuliak GN. / red. Chastnaia khirurgiia mekhanicheskikh povrezhdenii [Specific surgery of mechanical damage]. Saint-Petersburg, RF: Gippokrat, 2011. 570 p.
  7. Georgoff P, Perales P, Laguna B, Holena D, Reilly P, Sims C.Colonic injuries and the damage control abdomen: does management strategy matter? J Surg Res. 2013 May;181(2):293-99. doi: 10.1016/j.jss.2012.07.011.
  8. Zheng YX, Chen L, Tao SF, Song P, Xu SM.Diagnosis and management of colonic injuries following blunt trauma. World J Gastroenterol. 2007 Jan 28;13(4):633-36.
  9. Goettler CE, Rotondo MF. Blunt colon trauma. Semin. Colon and Rectal Surg. 2004;(15):105-11.
  10. Sheianov SD. Povrezhdeniia obodochnoi kishki [Colon damage]. Saint-Petersburg, RF: ELBI-SPb, 2014. 431 p.
  11. Ricciardi R, Paterson CA, Islam S. Independent predictors of morbidity and mortality in blunt colon trauma. Am. Surg. 2004;70(1):75-79.
  12. Bisenkov LN, Zubarev PN, Trofimov VM, Shalaev SA, Ishchenko BI. Neotlozhn khirurgiia grudi i zhivota [Emergency surgery of chest and abdomen]. Saint-Petersburg, RF: Gippokrat. 2002. 560 p.
  13. Andreas M. Kaizer. Shelygin IuA, Uriadova SE. /red. Kolorektal'naia khirurgiia [Colorectal surgery]. Moscow, RF: Binom, 2011. 751 p.
  14. Cleary RK, Pomerantz RA, Lampman RM. Colon and rectal injuries. Dis Colon Rectum. 2006 Aug;49(8):1203-22.
  15. Lazović R, Krivokapić Z. The role of enterostomy in the management of colonic injuries. Acta Chir Iugosl. 2005;52(1):73-82. [Article in Serbian].
Address for correspondence:
194044, Rossiyskaya Federatsiya,
g. Sankt-Peterburg, ul. Akad. Lebedeva, d. 4/2,
FGBU "Vserossiyskiy tsentr
ekstrennoy i radiatsionnoy meditsinyi im. A.M. Nikiforova MChS Rossii"
tel.: 8-911-908-11-00,
e-mail: veter-12@mail.ru,
Fedulova Anastasiya Viktorovna
Information about the authors:
Kochetkov A.V. MD, professor, a chief specialist on surgery of FSBE "All- Russian Center of Emergency and Radiation Medicine named after A.M. Nikiforov of the Ministry of Emergency Situations of the Russian Federation", professor of the general surgery chair of Military Medical Academy named after S.M. Kirov.
Fedulova A.V. A post-graduate student, surgeon of the surgical department of emergency care of FSBE "All- Russian Center of Emergency and Radiation Medicine named after A.M. Nikiforov of the Ministry of Emergency Situations of the Russian Federation".

S.I. KRIVENKO1, V.N. GAPANOVICH2, S.N. PRUSEVICH3, V.V. SMOLNIKOVA1

IMMUNOMODULATORY DRUGS FRUGLYUMIN A AND FRUGLYUMIN B APPLICATION IN COMPLEX THERAPY OF NON-SPECIFIC ACUTE SURGICAL SOFT TISSUE INFECTIONS

ME "9th Municipal Clinical Hospital, Minsk1, RUE "Scientific and Practical Center Lotios"2
ME "2nd Municipal Clinical Hospital", Minsk3,
The Republic of Belarus

Objectives. To evaluate the efficacy of immunomodulatory drugs Frugluminum A and Frugluminum B in the complex therapy of nonspecific acute surgical soft tissue infections.
Methods. Depending on the types f treatment patients with an impaired immune status on the background of nonspecific acute surgical soft tissue infections were divided into 3 groups. In the 1st group (n=10; age (Me) 45 (25-56 yrs) in addition to the antibacterial and anti-inflammatory therapy the quintuple intramuscular injections of Frugluminum A were given; in the 2nd group (n=11; age (Me) 54 (22-62 yrs) Frugluminum B; in the 3rd group (n=12; age (Me) 53 (25-62 yrs) a placebo drug (sodium chloride 0,9%) received. Efficacy assessment was made according to the dynamics of the immune status indices of patients and clinical manifestations of acute surgical soft tissue infections.
Results. In the patients treated with Frugluminum A and Frugluminum B a reduction of local and systemic clinical manifestation of the inflammatory process was registered; in a case of purulent wounds the early development of complete granulation as well as positive results of laboratory parameters have been noticed. It was found out that Frugluminum A and Frugluminum B provide normalization of the total number of leukocytes and lymphocytes through a positive regulation of T-cell level (percentage of T-helper cells increases 6-7 days up to 45,0 (44,0-46,0%) compared to the analogous index prior treatment 28,0 (22,0-31,0)% (p=0,0033) and reduces the concentration of circulating immune complexes from 48,0 (44,0-52,0) to 18,0 (17,0-20,0) (p=0,0033).
Conclusion. Application of Frugluminum A and Frugluminum B in patients with acute nonspecific surgical soft tissue infections normalizes functioning of the immune system and improves the efficiency of the complex antibiotic and anti-inflammatory therapy in general.

Keywords: immunotherapy, immunosuppression, purulent-septic diseases of the skin and soft tissues, Fruglyumin, complex antibacterial therapy, placebo, efficiency, T-helper cells
p. 194-201 of the original issue
References
  1. Gostishchev VK. Obshchaia khirurgiia [General surgery]. Moscow, RF: 2010. 848 p.
  2. Eriukhin IN, Gel'fand BR, Shliapnikova SA. Khirurgicheskie infektsii [Surgical infections]. Saint-Petersburg: Piter. 2003. 864 p.
  3. Grishina TI. Klinicheskoe znachenie narusheniia immuniteta pri khirurgicheskikh vmeshatel'stvakh (obzor literatury) [The clinical significance of impaired immunity in surgical interventions (review)]. Andrologiia i Genital Khirurgiia. 2000;(2):35-38.
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  6. Krivenko SI, Belevtsev MV, Gapanovich VN. Reguliatsiia ekspressii khemokinovykh retseptorov CXCR1 i CXCR2 neitrofil'nykh leikotsitov perifericheskoi krovi cheloveka pod deistviem immunomoduliruiushchikh preparatov na osnove polisakharidov zhivotnogo proiskhozhdeniia [Regulation of expression of chemokine receptors CXCR1 and CXCR2 of human neutrophils in peripheral blood under immunomodulators effect based on polysaccharides of animal origin]. Izvestiia NANB. Seriia Med Nauk. 2007;(3):49-51.
  7. Gapanovich VN, Krivenko SI, Mel'nova NI, Peshniak ZhV, Startseva AIu, Bychko GN. Vliianie gruppospetsificheskikh polisakharidov zhivotnogo proiskhozhdeniia na tsitotoksicheskuiu aktivnost' estestvennykh killernykh kletok krovi cheloveka [Effect of group-specific polysaccharides of animal origin on cytotoxic activity of natural killer cells of human blood]. Med Zhurn. 2005;(4):37-38.
  8. Dobritsa VP, Boterashnili NM, Dobritsa EV. Sovremennye immunomoduliatory dlia klinicheskogo primeneniia [Modern immunomodulators for clinical use]. Saint-Petersburg, RF: Politekhnika. 2001. 251 p.
  9. Korobkova LI, Vel'sher LZ, Germanov AB, Grishina TI, Stanulis AI, Gene GP, Shchepeliaev DO, Izrailov RE. Rol' immunomoduliatora galavit v onkologicheskoi i khirurgicheskoi praktike [The role immunomodulator galavit in oncology and surgical practice]. Ros Bioterapevt Zhurn. 2004;(3):87-92.
  10. Karsonova MI, Pinegin BV, Khaitov RM. Immunokorregiruiushchaia terapiia pri khirurgicheskoi infektsii [Immunocorrective therapy in surgical infection]. Annaly Khirurg Gepatologii. 1999;1(4):88-96.
  11. Plenina LV, Romanovskaia TR, Soroka NF, Chudakov OP, Tret'iak S I, Bykadorova LG, Mit'kovskaia NP, Golynskii AB, Maksimovich A V, Evseenko VM, Ivanovskii GL, Alikevich IN, Drazhina LS, Grak N N, Skuratovskaia LI. Novyi otechestvennyi immunomoduliator Diasplen [New native immunomodulator Diasplen]. Retsept 2008;(57):104-106.
  12. Vinnik IuS, Cherdantsev DV, Pervova OV, Vladimirov D.V. Immunokorrigiruiushchaia terapiia u bol'nykh rasprostranennym peritonitom [Immunotherapy in patients with generalized peritonitis]. Krasnoiarsk, RF: Znak. 2006. 35 p.
Address for correspondence:
210045, Respublika Belarus,
g. Minsk, ul. Semashko, 8,
UZ "9-ya gorodskaya klinicheskaya bolnitsa",
tel. office: 375 172 71-33-63,
e-mail: svtl_kr@tut.by,
Krivenko Svetlana Ivanovna
Information about the authors:
Krivenko S.I. PhD, an associate professor, deputy chief physician on the scientific work of ME "9th Municipal Clinical Hospital", Minsk.
Gapanovich V.N. MD, professor, director of RUE "Scientific and Practical Center Lotios".
Prusevich S.N. Chief physician of ME "2nd Municipal Clinical Hospital", Minsk.
Smolnikova V.V. A senior researcher of the scientific department of ME "9th Municipal Clinical Hospital", Minsk.

NEUROSURGERY

E.L. TSITKO ¹, A.F. SMEYANOVICH ², .S. ASTAPOVICH³, .V. TSITKO4

ROENTGENOMETRIC ANALYSIS OF THE KINEMATICS L4-L5 AND
L5S1 SPINE SEGMENTS AT THE THIRD STAGE OF THE DEGENERATIVE PROCESS

E "Gomel Regional Clinical Hospital"¹,
SE "Republican Scientific and Practical Center of Neurology and Neurosurgery"²,
EE "Gomel State Medical University"³,
SME "Gomel City Clinical Hospital 3"4

Objectives. To study kinematics of the lumbosacral spine according to radiometric parameters of the intervertebral joints in patients at the third stage of degenerative-dystrophic process.
Methods. 25 patients with spinal osteochondrosis at the third stage were enrolled in the study. According to the level of localization of the intervertebral discs hernia the main group was divided into two subgroups. In the 1st subgroup 14 (56%) patients with hernia at the level of L4-L5 were included, in the 2nd subgroup 11 (44%) patients with lesions of the segment L5-S1. The control group consisted of 12 persons without clinical and anamnestic data about the degenerative process. To study kinematics of the lumbosacral spinal level (LSL) the roentgenography in the lateral projection in the horizontal and vertical position has been performed.
Results. In the 1st subgroup in assessing of radiometric indicators of the intervertebral joints the height reduction of the anterior and posterior sections of the intervertebral disc (IVD) at the level L4-L5 (p<0,05), and the wedge angle of IVD from 9,60 (3,10; 11,10)º to 6,15 (3,10; 9,30)º as well as in the horizontal and vertical positions have been registrered. In the 2nd subgroup the values of the wedge angle of IVD L5-S1 in the horizontal position is significantly lower than in the control group (p=0,04), and verticalization the height of the ventral part of IVD L5-S1 (p<0,05) decreases. Analysis of differences of mean values of the parameters studied showed a reduction of the anterior size of IVD and an increase of interspinous angles in the 1st subgroup at L4-L5 and L5-S1 (p=0,03 and p<0,006, respectively), and in the 2nd subgroup at L5-S1 (p=0,001 and p=0,04, respectively).
Conclusion. In patients with spinal osteochondrosis in the III stage of the degenerative process the decrease of height was established as well as of the wedge angle of IVD at the the required level. The radiometric patterns of biomechanics disturbances were determined at the radiography of LSL in horizontal and vertical positions.

Keywords: analysis of kinematics, the degenerative process, herniated disc, violations of biomechanics, spinal motion segment, lumbar osteochondrosis, radiography
p. 202-208 of the original issue
References
  1. Akshulakov SK, Kerimbaev TT, Aleinikov VG. Sovremennye problemy khirurgicheskogo lecheniia degenerativno-distroficheskikh zabolevanii pozvonochnika [Modern problems of surgical treatment of degenerative diseases of the spine]. Neirokhirurgiia i Nevrologiia Kazakhstana. 2013;1(30):7-16.
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  4. Zucherman JF, Hsu KY, Hartjen CA, Mehalic TF, Implicito DA, Martin MJ, Johnson DR 2nd, Skidmore GA, Vessa PP, Dwyer JW, Puccio S, Cauthen JC, Ozuna RM. A prospective randomized multi-center study for the treatment of lumbar spinal stenosis with the X STOP interspinous implant: 1-year results. Eur Spine J. 2004 Feb;13(1):22-31.
  5. Bocharov MI. Chastnaia biomekhanika s fiziologiei dvizheniia [Private biomechanics physiology of movement]. Ukhta, RF: UGTU, 2010. 235 p.
  6. Shchedrenok VV, Sebelev KI., Anikeev NV, Tiul'kin ON, Kaurova TA, Moguchaia OV. Izmeneniia dugootrostchatykh sustavov pri travme i degenerativno-distroficheskikh zabolevaniiakh poiasnichnogo otdela pozvonochnika [Changes of facet joints in trauma and degenerative diseases of the lumbar spine]. Travm i Ortopediia Rossii. 2011;2 (60):114-17.
  7. Li W, Wang S, Xia Q, Passias P, Kozanek M, Wood K, Li G.Lumbar facet joint motion in patients with degenerative disc disease at affected and adjacent levels: an in vivo biomechanical study. Spine (Phila Pa 1976). 2011 May 1;36(10):E629-37. doi: 10.1097/BRS.0b013e3181faaef7.
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Address for correspondence:
246012, Respublika Belarus,
g. Gomel, ul. Bratev Lizyukovyih, d. 5,
U "Gomelskaya oblastnaya klinicheskaya bolnitsa",
neyrokhirurgicheskoe otdelenie,
tel. office: 375 232 48-55-66,
e-mail: fedor30@tut.by,
Tsitko Evgeniy Leonidovich
Information about the authors:
Tsitko E.L. PhD, neurosurgeon of E "Gomel Regional Clinical Hospital".
Smeyanovich A.F. MD, professor, academician of NAS of Belarus, Honored Worker of Belarus, a head of the neurosurgical department of SE "RSPC of Neurology and Neurosurgery".
Astapovich E.S. A 6-year student, EE "Gomel State Medical University".
Tsitko E.V. PhD, Deputy Chief Physician on medical affairs of SME "Gomel City Clinical Hospital 3".

REVIEWS

S.U. YAKUBOUSKI1, G.G. KONDRATENKO1, L.I. DANILOVA2

MINIMALLY INVASIVE SURGERY FOR NODULAR GOITER

EE "Belarusian State Medical University"1,
SEE "Belarusian Medical Academy of Post-Graduate Education" 2
The Republic of Belarus

Recent years the rapid development and clinical application of minimally invasive methods of thyroid surgery have been marked. This tendency is dictated both by an intention to improve cosmetic results of surgical interventions and a desire to reduce surgical trauma. Accumulated world experience to date allows to make the first conclusions on the results of the different methods application of minimally invasive surgery of the thyroid gland. However, the suggested data are often controversial; there is an absence of standard terminology, classification of these methods; disagreement in assessment of effectiveness and reasonability of clinical application of minimally invasive thyroid surgery is evident.
A review of existing methods of minimally invasive thyroid surgery is presented in the paper; terminology, classification, indications, clinical outcomes and cost-effectiveness of minimally invasive thyroidectomy in nodular goiter are studied. Minimally invasive operations, independently of approach, require more operative time compared with traditional thyroidectomy. Cervical approach shows the same morbidity level and accompanied with less pain and better cosmetic results in early postoperative period. Extracervical approach leaves no scars on the neck, but some of them are accompanied by more postoperative pain and specific complications.
Search for an optimal minimally invasive method, criteria of which are considered to be the relative simplicity, the feasibility of short mastering, safety and economical expediency determines the prospects of further research.

Keywords: minimally invasive surgery, thyroidectomy, nodular goiter, thyroid, criteria, classification, clinical outcomes
p. 209-216 of the original issue
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Address for correspondence:
220116, Respublika Belarus,
g. Minsk, pr. Dzerzhinskogo, d. 83,
UO "Belorusskiy gosudarstvennyiy meditsinskiy universitet",
1-ya kafedra khirurgicheskih bolezney,
tel. office: 375 017 3404133,
e-mail: yakub-2003@yandex.ru,
Yakubouski Sergey Vladimirovich
Information about the authors:
Yakubouski S.U. PhD, an associate professor of the first chair of surgical diseases of EE "Belarusian State Medical University".
Kondratenko G.G. MD, professor, a head of the first chair of surgical diseases of EE "Belarusian State Medical University".
Danilova L.I. MD, professor, a head of the endocrinology chair of SEE Belarusian "Medical Academy of Post-graduate Education".

V.M. BONDARENKO 1, N.I. DOSTA 2, A.A. ZHEBENTYAEV 1

SOME PATHOGENETIC ASPECTS OF ERECTILE DYSFUNCTION

EE "Vitebsk State Medical University"1,
SEE "Belarusian Medical Academy of Post-Graduate Education"2,
The Republic of Belarus

Objectives. To generalize and to systematize the available literature data concerning pathogenetical mechanisms of the erectile dysfunction development that is thought to be a basis for a choice of treatment methods and recommendations for patients suffering from the given problem.
Methods. PubMed database was used to prepare the review (2004-2014 yrs) and an analysis of the main types of publications (original articles, randomized studies, reviews, meta-analyzes, recommendations, consensus).
Results. Previous research has found a high prevalence of metabolic syndrome (MS) and diabetes mellitus among patients with erectile dysfunction as well as the similarity of original causes of erectile dysfunction (ED) and cardiovascular disease (CVD). MS is a complex of risk factors that appears to be determined as potentially dangerous for endothelial dysfunction development resulting in CVD and ED. The adipocytes of the visceral adipose tissue functionate as endocrine cells producing and secreting adipokines as well as a number of biochemical modulators and proinflammatory factors affecting the vascular inflammation that is thought to contribute ED development. ED treatment in patients with MS should be complex and except a specific therapy it should include prompt diagnosis as well as adequate and active treatment of any risk factors that may be revealed.
Conclusion. In the pathogenesis of erectile dysfunction of vascular genesis a key role plays the combination of risk factors that lead to pathological changes of vascular endothelial function and impaired penile blood flow.
In addition to already established and well-known factors, a negative impact of perivisceral adipose tissue may be important and thereby requires further study.

Keywords: erectile dysfunction, visceral adipose tissue, testosterone, metabolic syndrome, adipocytes, endothelial function, prompt diagnosis.
p. 217-225 of the original issue
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Address for correspondence:
210023, Respublika Belarus,
g. Vitebsk, pr. Frunze, d. 27, Usch
"Vitebskiy gosudarstvennyiy meditsinskiy universitet",
kafedra gospitalnoy khirurgii s kursami urologii i detskoy khirurgii
tel. office: 375 212 582436,
e-mail: bondarenko_v@tut.by,
Bondarenko Vladimir Mihaylovich
Information about the authors:
Bondarenko V.M. An assistant of the hospital surgery chair with the course of urology and pediatric surgery of EE "Vitebsk State Medical University".
Dosta N. I. PhD, an associate professor of the urology chair of SBE "Belarusian Medical Academy of Post-graduate Education".
Zhebentyaev A.A. PhD, an associate professor of the hospital surgery chair with the course of urology and pediatric surgery of EE "Vitebsk State Medical University".

CASE REPORTS

S.V. IVANOV, O.S. GORBACHOVA, I.S. IVANOV, G.N. GORYAINOVA, E.G. OBIEDKOV, D.V. TARABRIN, G.N. GAFAROV, I.A. IVANOVA

GIANT INGUINAL- SCROTAL HERNIA

SBEE HPE "Kursk State Medical University",
The Russian Federation

A clinical case of treatment of 57-year-old patient suffering from the irreducible giant inguinal-scrotal hernia is presented. On admission the patient complained on the marked abdominal wall defects, abnormal enlargement of the scrotum and inability to care for self. For the first time hernia protrusion appeared 11 years ago and has been gradually increased. The patient noticed the most intensive growth of the hernia within last 1,5 years.
The left-side inguinal-scrotal herniotomy, Liechtensteins plastics, endoprosthetics of the anterior abdominal wall with the polypropylene surgical net (in-lay method combined with the elements of Ramirez operation) have been performed. There were no complications in the post-operation period. The excision and plastics of the scrotum are planned to perform as the second step in six months. Taking into consideration the peculiarity of the case (giant size of the hernia protrusion and difficulties in surgical treatment) it was decided to use a complex of surgical methods while treating this pathology. Thus the development of compartment syndrome and post-operative complications has been avoided. As a result the efficacy improvement of the performed treatment was achieved. The presented case is interesting as the demonstration option of an operative repair of the giant irreducible inguinal-scrotal hernia.

Keywords: inguinal hernia, surgical treatment, inguinal-scrotal herniotomy, Liechtensteins plastics, inlay plastics, Ramirez operation, compartment syndrome
p. 226-230 of the original issue
References
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Address for correspondence:
305004, Rossiyskaya Federatsiya,
g. Kursk, ul. K. Marksa, d. 3,
GBOU VPO "Kurskiy gosudarstvennyiy meditsinskiy universitet",
kafedra khirurgicheskih bolezney 1,
tel.: 7 904 528-14-28,
e-mail: ivanov.is@mail.ru,
Ivanov Ilya Sergeevich
Information about the authors:
Ivanov S.V. MD, professor, a head of the surgical diseases chair N1 of SBEE HPE "Kursk State Medical University".
Gorbachova O.S. PhD, a head of the general surgery unit of Kursk Regional Clinical Hospital.
Ivanov I.S. MD, an associate professor of the surgical diseases chair N1of SBEE HPE "Kursk State Medical University".
Goryainova G.N. PhD, an associate professor of the histology chair N1of SBEE HPE "Kursk State Medical University".
Obiedkov E.G. A post-graduate student of the surgical diseases chair N1 of SBEE HPE "Kursk State Medical University".
Tarabrin D.V. A post-graduate student of the surgical diseases chair N1 of SBEE HPE "Kursk State Medical University".
Gafarov G.N. A post-graduate student of the surgical diseases chair N1of SBEE HPE "Kursk State Medical University".
Ivanova I.A. PhD, an associate professor of the clinical immunology and allergology chair of SBEE HPE "Kursk State Medical University".

EXCHANGE OF EXPERIENCE

E.V. MISHENINA

EFFICACY OF CATHETER-DIRECTED THROMBOLYSIS IN TREATMENT OF PHLEBOTHROMBOSIS

SE "Institute of General and Emergency Surgery named after V.T. Zaitsev of NAMS of Ukraine", Kharkov,
Ukraine

Objectives. To evaluate the effectiveness of catheter-directed thrombolysis (CDT) in the treatment of patients with acute deep vein thrombosis of the lower extremities and pelvis.
Methods. The study analyzes the results of the examination and treatment of 80 patients with acute deep vein thrombosis. Patients were divided into two groups. The first group consisted of 37 patients subjected to catheter-directed thrombolysis (Streptokinase: initial dose of 250,000 IU/h, total: 1,5-3,0 IU; Alteplase: initial dose of 5 mg bolus, total: 25-75 mg.) The second group included 43 patients subjected to anticoagulant therapy (ACT) as a choice of treatment.
Results. In the patients treated by CDT application a rapid regression of the main clinical signs of acute iliofemoral venous thrombosis had been observed by the end of the first day. In ultrasound and angiographic study a complete (100%) lysis of blood clots was registered in 25 (67,6%) patients, partial lysis (from 99% to 50%) in 8 (21,6%) patients and lysis of blood clots less than 50% in 4 (10,8%) cases. Severe hemorrhagic complications were observed in 4 (10,8%) cases, lesser in 11 (29,7%). No various complications such as pulmonary embolism (PE) as well as lethal outcomes were noted in both groups of patients. Recurrence of venous thrombosis after CDT was observed in 2 (5,4%) patients and after ACT in 5 (11,6%) patients.
Conclusion. Restoration of patency in iliofemoral deep vein thrombosis with catheter-directed is considred to be an effective method.

Keywords: deep vein thrombosis, lower extremities, ultrasonography, thrombolysis, anticoagulation, post-thrombotic syndrome, recurrence
p. 231-236 of the original issue
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Address for correspondence:
61103, Ukraina, g. Harkov, v'ezd Balakireva, d. 1,
GU "Institut obschey neotlozhnoy khirurgii
im. V.T. Zaytseva NAMNU",
otdelenie ostroy patologii sosudov,
tel.: 380 50 212-48-82,
e-mail: dr.mishenina@gmail.com
Mishenina Ekaterina Vladimirovna
Information about the authors:
Mishenina E.V. A post-graduate student of SE "Institute of General and Emergency Surgery named after V.T. Zaitsev of NAMS of Ukraine", Kharkov.
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