Novosti
Khirurgii
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Year 2015 Vol. 23 No 5

SCIENRIFIC PUBLICATIONS
EXPERIMENTAL SURGERY

DOI: http://dx.doi.org/10.18484/2305-0047.2015.5.491   |  

N.I. ZHERNAKOVA1, A.A. DOLZHIKOV1, S.V. SHKODKIN1,2, K.A. BOCHAROVA1, A.J. KOLPAKOV1, V.N. DMITRIEM1

ASSESSMENT OF CYTOTOXICITY OF CARBON-CONTAINING NANOSIZED COATINGS

FSAEE HPE "Belgorod State National Research University"1,
SBEH "Belgorod Regional Clinical Hospital of Saint Joasaph"2
The Russian Federation

Objectives. To study bioinertness of new nanosized carbon-containing in compounds in experiment.
Methods. The pulsed vacuum arc method was used to deposite the coating of nitinol wire. Nitinol wire stents were implanted in the parenchymal organs (kidney and liver) and in the choledoch of sexually mature Wistar rats. The animals were taken out of the experiment on the 14th and 30th day after implantation. The thickness of developing reactive tissue areas was measured; the cytoarchitectonics around the implants was evaluated.
Results. In the cases of implantation in the parenchymal organs the quantitative and qualitative characteristics depended on the implantation site have been defined. Inflammatory changes around implants in the liver proved to be 1,5-2 fold more intensive than in the kidneys the same period of observation. Qualitative analysis of cytoarchitectonics around the implants in different groups has not revealed statistically significant differences depending on the implant material. The quantitative assessment of inflammatory infiltration in the group with nanostructured coating based on amorphous carbon matrix with including of silver nanoscale clusters was less intense regardless of the implantation site. Implantation of new carbon nanoscale materials into the rat choledoch lumen has not followed by necrobiotic changes and perforation of its wall; no mortality was observed in the study groups. The reaction of the extrahepatic biliary tract to the introduction of implant such homologous when it implanted in parenchymal organs.
Conclusion. The materials being developed for implantation showed no cytotoxicity. The best indicators of bioinertness were registered in the group of implants with nanostructural coating based on amorphous carbon matrix with inclusions of nanoscale clusters of silver. This result can be explained by the inertia of the carbon to the tissues and by antiproliferative properties of silver.

Keywords: biomedical materials, implant, pulsed vacuum arc method, stent, antiproliferative properties of silver, inflammation, cytotoxicity
p. 491-499 of the original issue
References
  1. Fedelini P, Verze P, Meccariello C, Arcaniolo D, Taglialatela D, Mirone VG. Intraoperative and postoperative complications of laparoscopic pyeloplasty: a single surgical team experience with 236 cases. J Endourol. 2013 Oct;27(10):1224-9. doi: 10.1089/end.2013.030.
  2. Maruschke M, Kram W, Nebe JB, Vollmar B, Zimpfer A, Hakenberg OW. Development of a rat model for investigation of experimental splinted uretero-ureterostomy, ureteral stenting and stenosis. In Vivo. 2013 Mar-Apr;27(2):245-49.
  3. Chepurov AK, Zenkov SS, Mamaev IE, Pronkin EA. Dlitel'noe drenirovanie mochetochnikovymi stentami: sovremennoe sostoianie voprosa i perspektivy [Prolonged drainage of ureteral stent: the present state of and prospects]. Andrologiia i Genital Khirurgiia. 2009;(2):32-40.
  4. Volova TG. Sintez biorezorbiruemykh polimerov. Struktura i svoistva [Synthesis of bioresorbable polymers. The structure and properties]. Izvestiia Vysshikh Uch Zavedenii. Fizika. 2013;(56)12-3:27-32.
  5. Nau P, Liu J, Ellison EC, Hazey JW, Henn M, Muscarella P, Narula VK, Melvin WS.Novel reconstruction of the extrahepatic biliary tree with a biosynthetic absorbable graft. HPB (Oxford). 2011 Aug;13(8):573-78. doi: 10.1111/j.1477-2574.2011.00337.x.
  6. Canena JM, Liberato MJ, Rio-Tinto RA, Pinto-Marques PM, Romão CM, Coutinho AV, Neves BA, Santos-Silva MF.A comparison of the temporary placement of 3 different self-expanding stents for the treatment of refractory benign esophageal strictures: a prospective multicentre study. BMC Gastroenterol. 2012 Jun (12);12:70.
  7. Fu WJ, Xu YD, Wang ZX, Li G, Shi JG, Cui FZ, Zhang Y, Zhang X. New ureteral scaffold constructed with composite poly(L-lactic acid)-collagen and urothelial cells by new centrifugal seeding system. J Biomed Mater Res A. 2012 Jul;100(7):1725-33. doi: 10.1002/jbm.a.34134.
  8. Griffiths EA, Gregory CJ, Pursnani KG, Ward JB, Stockwell RC. The use of biodegradable (SX-ELLA) oesophageal stents to treat dysphagia due to benign and malignant oesophageal disease. Surg Endosc. 2012 Aug;26(8):2367-75. doi: 10.1007/s00464-012-2192-9.
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  10. Hämäläinen M, Nieminen R, Uurto I, Salenius JP, Kellomäki M, Mikkonen J, Kotsar A, Isotalo T, Teuvo Tammela LJ, Talja M, Moilanen E. Dexamethasone-eluting vascular stents. Basic Clin Pharmacol Toxicol. 2013 May;112(5):296-301. doi: 10.1111/bcpt.12056.
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  12. Brotherhood H, Lange D, Chew BH. Advances in ureteral stents. Transl Androl Urol 2014;3(3):314-319. doi: 10.3978/j.issn.2223-4683.2014.06.06.
  13. Yin Y, Zhang Y, Zhao X. Safety and efficacy of biodegradable drug-eluting vs. bare metal stents: a meta-analysis from randomized trials. PLoS One. 2014 Jun 19;9(6):e99648. doi: 10.1371/journal.pone.0099648. eCollection 2014.
Address for correspondence:
308015, Rossiiskaia Federatsiia, g. Belgorod, ul. Pobedy, d. 85, kor. 10, kom. 3-12 dekanat lechebnogo dela i pediatrii Meditsinskogo instituta FGAOU VPO "Belgorodskii gosudarstvennyi natsional'nyi issledovatel'skii universitet", tel. +7 (4722) 30-12-85,
e-mail: zhernakova@bsu.edu.ru,
Zhernakova Nina Ivanovna
Information about the authors:
Zhernakova N.I., MD, professor, a dean of the medical affairs and pediatrics Medical Institute FSAEI HPE "Belgorod State University."
Dolzhikov A.A., MD, professor, a head of the department of histology of the Medical Institute FSAEI HPE "Belgorod State University."
Shkodkin S.V., PhD., an assistant professor of surgery hospital of the Medical Institute FSAEI HPE "Belgorod State University", department of urology, resident of OSBEH "Belgorod Regional Clinical Hospital of Saint Joasaph".
Bocharova K.A., PhD, an associate professor of faculty therapy Medical Institute FSAEI HPE "Belgorod State University."
Kolpakov A.Y., PhD, Professor, a head of a research laboratory of the problems of development and introduction of ion-plasma technology FSAEI HPE "Belgorod State Nationsal research University."
Dmitriev V.N., PhD, an associate professor of the chair of faculty surgery of Medical Institute FSAEI HPE "Belgorod State University."

GENERAL & SPECIAL SURGERY

DOI: http://dx.doi.org/10.18484/2305-0047.2015.5.500   |  

I.V. SAMSONOVA, V.A. KLOPOVA, I.S. SHEVCHENKO

COLLAGEN IV AND VI EXPRESSION IN PANCREAS AT CHRONIC PANCREATITIS

EE "Vitebsk State Medical University"
The Republic of Belarus

Objectives. To study collagen IV and VI expression in pancreas at chronic pancreatitis (CP).
Methods. Using morphological, immunohistochemical, morphometric and statistical methods the pancreatic tissue specimens of 28 patients with CP, stained with lyophilised monoclonal antibodies Collagen Type IV and Collagen Type VI (Novocastra) have been investigated. Control group included 7 pancreatic head specimens without any pathology of pancreas takon from people died due to by accidents.
Results. Collagen IV-positive reaction was determined as different intensity brown staining of basement membrane in the wall of vessels, ducts and in acini of all pancreatic specimens. At CP the expression level was 750,22,86, that corresponded to 1093297,223340,36 mkm2 total expression area. In control group the expression was significantly higher 924,118,5, but total expression area was significantly lower 751045,1110096,45 mkm2.
In pancreas without pathologic changes expression of collagen VI was mainly determined in the connective tissue cells and was almost absent in the acinar cells. At CP collagen VI positive expression was mainly determined in the basal part of acinar cell and duct epithelium cytoplasm as well as in the connective tissue cells. In control group expression was 615,15 19,34 mkm2, at CP 85524,08 3433,07 mkm2. The expression total area at CP was 241506 2, that was 2,8 fold more high comparing with control group.
Conclusion. The chronic pancreatitis is characterized by changes of the Collagen Type IV and Collagen Type VI expression degree, character of distribution and expression area in the pancreas. It is supposed the revealed changes of Collagen Type IV and Collagen Type VI expression to result from collagen synthesis disturbances at chronic inflammation, that can explained by activation of mesenchimal cells, their proliferation and changes of epitheliocytes activity.

Keywords: pancreas, chronic pancreatitis, collagen IV, collagen VI, immunohistochemical investigation, proliferation, epitheliocytes activity
p. 500-505 of the original issue
References
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  13. Rühl M., Sahin E, Johannsen M, Somasundaram R, Manski D, Riecken EO, Schuppan D. Soluble collagen VI drives serum-starved fibroblasts through S phase and prevents apoptosis via down-regulation of Bax. J Biol Chem. 1999 Nov 26;274(48):34361-68.
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  15. Sabatelli P, Bonaldo P, Lattanzi G, Braghetta P, Bergamin N, Capanni C, Mattioli E, Columbaro M, Ognibene A, Pepe G, Bertini E, Merlini L, Maraldi NM, Squarzoni S. Collagen VI deficiency affects the organization of fibronectin in the extracellular matrix of cultured fibroblasts. Matrix Biol. 2001 Nov;20(7):475-86.
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Address for correspondence:
210023, Respublika Belarus',
g. Vitebsk, pr. Frunze, d. 27, UO Vitebskii
gosudarstvennyi meditsinskii universitet,
kafedra patologicheskoi anatomii,
e-mail: victoriya_06@tut.by,
Klopova Viktoriia Aleksandrovna
Information about the authors:
Samsonova I.V. PhD, an associate professor, a head of the chair of pathological anatomy EE "Vitebsk State Medical University."
Klopova V.A. PhD, an associate professor of the chair of pathological anatomy EE "Vitebsk State Medical University."
Shevchenko I.S. A senior lecturer of the chair of pathological anatomy EE "Vitebsk State Medical University."
DOI: http://dx.doi.org/10.18484/2305-0047.2015.5.506   |  

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

COMPLEX DIAGNOSTICS AND CURRENT PRINCIPLES OF PHEOCHROMOCYTOMA TREATMENT

Republican Scientific Center of Cardiovascular Surgery1,
Avicenna Tajik State Medical University2,
Dushanbe
The Republic of Tajikistan

Objectives. To evaluate the results of complex diagnostics and surgical treatment of patients with pheochromocytoma.
Methods. Treatment results of 25 patients with pheochromocytoma (PCC) have been analyzed (15 (60%) females and 10 (40%) males). The average age of patients was 35,94,2 years. Average duration on the disease was 4,61,7 years. Diagnosis was confirmed by ultrasonography (US), computerized tomography (CT) and determination of metanephrines (MN) and vanillylmandelic acid (VMA) levels. Depending on the preoperative tactics all patients were divided into 2 groups. Α-blockers of short-acting (phentolamine) were used to the patients of the first group (n=8) only during the operation. Α-blockers (doxazosin) were administered to the patiens of the second group (n=17) in the preoperative period.
Results. In all cases a reliable increase of MN and VMA levels was registered. No difference was found in studying MN excretion level depending on the tumor size and disease duration. Sensitivity of US and CT in PCC diagnostics made up 92% and 100%, and specificity 52% and 91,3%, respectively. In the 1st group 2 (25%) patients died due to the development of uncontrolled hemodynamics syndrome. There was no lethal outcome in the 2nd group (<0,05). Complications were observed in 5 (21,7%) patients during the operation (n=2) and in the early postoperative period (n=3). There was 1 (4,3%) lethal outcome after adrenalectomy. In the long-term period (1-8 yrs) good results were obtained in 21 (91,3%) operated patients and satisfactory in 1 (4,3%).
Conclusion. The use of minimally invasive techniques in the treatment of pheochromocytoma can help reduce the incidence of postoperative complications and duration of hospitalization. In all cases the preoperative preparation should be carried out with the use of α-blockers. The patients are required clinical medical examination and proper conduction of hormone replacement therapy to prevent and treat adrenal insufficiency.

Keywords: pheochromocytoma, diagnostics, operative treatment, postoperative complications, metanephrines, α-adrenoblockers, adrenalectomy
p. 506-514 of the original issue
References
  1. Bokeriia LA, Abdulgasanov RA. Feokhromotsitomy: sovremennye metody diagnostiki i khirurgicheskogo lecheniia [Pheochromocytoma: modern methods of diagnosis and surgical treatment]. Annaly Khirurgii. 2011;(2):5-10.
  2. Bel'tsevich DG, Kuznetsov NS, Lysenko MA, Tsalikova AT. Feokhromotsitoma [Pheochromocytoma]. Sonsilium Medicum. 2007;9(9):88-94
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  5. Bel'tsevich DG, Kuznetsov NS. Prichiny retsidivov u bol'nykh s opukholiami khromaffinnoi tkani [Causes of relapses in patients with tumors chromaffin tissue]. Khirurgiia. Zhurn im NI Pirogova. 2002;(8):19-23.
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  11. Tsukanov IuT, Tsukanov AIu. Bokovoi vnebriushinnyi mini-dostup dlia adrenalektomii [Lateral extraperitoneal mini access for adrenalectomy]. Khirurgiia. Zhurn im NI Pirogova. 2003;(9):7-10.
  12. Bondarenko VO, Lutsevich OE. Topograficheskaia diagnostika i khirurgicheskie vmeshatel'stva pri gigantskikh feokhromotsitomakh nadpochechnika [Topographic diagnosis and surgery for adrenal pheochromocytoma giant]. Khirurgiia. Zhurn im NI Pirogova. 2011;(30):13-18.
  13. Dedov II, Bel'tsevich DG, Kuznetsov NS, Mel'nichenko G A. Feokhromotsitoma [Pheochromocytoma]. Moscow, RF: Prakt Meditsina; 2005. 216 p.
Address for correspondence:
734003, Republic of 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 leading researcher of the Republican Scientific Center of Cardiovascular Surgery.
Gaibov A.D. Corresponding member of the Academy of Medical Sciences 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.
DOI: http://dx.doi.org/10.18484/2305-0047.2015.5.515   |  

U.U. ANDRUSHCHUK1, Y.P. OSTROVSKY1, V.V. ZHARKOV2, S.A. KURGANOVICH1, T.T. GEVORKYAN1, M.M. SHASHURO2, N.M. NAVITSKAYA1

ALGORITHM OF COMPLEX SURGICAL TREATMENT OF PATIENTS WITH TUMORS OF THE MAIN LOCATIONS AND CONCOMITANT CORONARY ARTERY DISEASE

Republican Scientific Practical Centre "Cardiology"1,
N.N. Aleksandrov National Cancer Centre of Belarus2
Minsk
The Republic of Belarus

Objectives. To evaluate the results of applying the algorithm of complex surgical treatment of patients with tumors of the main locations and concomitant coronary artery disease (CAD).
Methods. The developed algorithm of complex surgical treatment is based on the determination of the least patient risk of cardio- and radical oncosurgical intervention with the choice of simultaneous or staged approach of treatment and the possibility of their conversion. According to the developed algorithm 93 patients (group 1) and 49 patients (group 2) have been simultaneous and staged operated, respectively. The coronary arteries bypass grafting (CABG) and radical intervention on the tumors of the main locations (lung, esophagus, stomach, kidney, uterus, adnexa of uterus) have been conducted within the period from 2001 to 2014. The patients of the first group seem to have more common malignant of lung (p=0,005), and the patients of the second group gastric (p=0,07), esophageal (p=0,04) and colorectal (p=0,03) cancer. There was no any difference in the degree of heart failure and angina in patients of both groups. In the first group the operations on the working heart were significantly more performed and, accordingly, in the second under cardiopulmonary bypass (p=0,001).
Results. Overall hospital mortality of the first and second groups was 8,60% and 10,20%, respectively (p = 0,76), a major hospital complications 23,66% and 32,65% (p=0,35), from which cardiac ones 6,45% and 11,63% (p=0,34). The five-year survival rate was 39,305,51% and 45,3211,71% (p=0,20), median 33,47 and 60,10 months, respectively. The corrected free survival averaged 72,45 7,86 and 64,0811,14 months (p=0,51).
Conclusion. The developed algorithm of complex surgical treatment of patients with tumors of the main locations and concomitant CAD takes advantages of simultaneous and staged approaches and provides good immediate and long-term results.

Keywords: cancer, algorithm, coronary artery disease, hospital mortality, surgery, survival, results
p. 515-524 of the original issue
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  14. Andrushchuk UU, Ostrovskii IP, Zharkov VV, Kurganovich SA, Kurushko TV, Komarovskii AA, Novitskaia NM. Algoritm simul'tannogo khirurgicheskogo lecheniia patsientov s opukholiami osnovnykh lokalizatsii i soputstvuiushchei ishemicheskoi bolezn'iu serdtsa [Algorithm of simultaneous surgical treatment of patients with tumors of the main locations and concomitant coronary heart disease]. Kardiologiia v Belarusi. 2015;(40)3:6-18.
Address for correspondence:
220036, Respublika Belarus',
g. Minsk, ul. R. Liuksemburg, d. 110,
GU Respublikanskii nauchno-prakticheskii tsentr "Kardiologiia",
laboratoriia khirurgii serdtsa,
tel. rab. +375 17 2088605,
e-mail: heartslight@mail.ru,
Andrushchuk Vladimir Vladimirovich
Information about the authors:
Androshchuk U.U., PhD, a cardiac surgeon of the 2nd cardiac surgery department of SE "Republican Scientific and Practical Center" Cardiology", a fellow worker of the Laboratory of Cardiac Surgery.
Ostrovsky Y.P., MD, professor, an academician of the National Academy of Sciences, a head of the Department of Cardiac Surgery SEE "Belarusian Medical Academy of Postgraduate Education", a chief peripatetic heart surgeon Ministry of Health of the Republic of Belarus.
Zharkov V.V., MD., professor, a head of the surgical department of SE "Republican Scientific-Practical Center of Oncology and Medical Radiology. N.N. Aleksandrova".
Kurganovich S.A., a specialist on ultrasonic diagnosis of SE "Republican Scientific and Practical Center Cardiology", the Laboratory of Cardiac Surgery.
Gevorgyan T.T. a specialist, department of functional diagnosis of SI "Republican Scientific and Practical Center Cardiology".
Shashuro M.M., an assistant of surgical department of SE "Republican Scientific-Practical Center of Oncology and Medical Radiology. N.N. Aleksandrova".
Novitskaya N.M., an assistant of laboratory heart surgery SE "Republican Scientific and Practical Center "Cardiology".
DOI: http://dx.doi.org/10.18484/2305-0047.2015.5.525   |  

V.J. KHRYSHCHANOVICH1,2, I.P. KLIMCHUK1, A.V. EMELYANENKO2, S.S. KALININ1,2

THE RESULTS OF TREATMENT OF PATIENTS WITH INFERIOR VENA CAVA THROMBOSIS

EE "Belarusian State Medical University"1, EH "The 4th City Clinical Hospital named after Savchenko"2,
Minsk
The Republic of Belarus

Objectives. To determine the most common causes, frequency of thromboembolic complications (TEC), results of diagnostics and treatment of patients with inferior vena cava thrombosis (IVC).
Methods. A retrospective study in resident patients (n=22) with the inferior vena cava thrombosis has been carried out. The average age of twenty two patients was 53 2 years. In cases of suspicion for a deep vein thrombosis (DVT) in the IVC system, its causes, character, localization, prevalence and complications were determined by ultrasonography and phlebocavagraphy. IVC thrombosis management included anticoagulants, elastic compression, and phlebotonics. Four (18.2%) patients with embolo-dangerous thrombosis had undergone surgical procedures inferior vena cava thrombectomy with its implication (2 cases), isolated IVC plication, cava-filter implantation.
Results. The reason of the IVC thrombosis in 21 of 22 patients was an upward iliofemoral DVT on the background of cancer pathology (35%), chronic inflammatory diseases (10%) after surgery and childbirth (10%). In two (10%) cases, there was a DVT of the lower extremities in anamnesis. In six (30%) cases the cause of IVC thrombosis has not been established. Infrarenal, renal and suprarenal IVC thrombosis were diagnosed in 19 (86%), 2 (9%) and 1 (5%) patients, respectively. Thrombus flotation with a head length of 2-8 cm in IVC was identified in 4 cases. TEC occurred in three (13,6%) patients. Such complication as cava-filter thrombosis occurred in one case.
Conclusion. In all patients with proximal DVT of the lower extremities IVC involvement in the thrombotic process should be suspected. Early diagnosis and proper treatment of IVC thrombosis is considerd to be guarantee of a favorable outcome of the disease and to prevent complications. Its necessary to continue an examination of compression hosiery and phlebotonics in rehabilitation of patients undergoing IVC thrombosis.

Keywords: aetiology, diagnosis, inferior vena cava, prognosis, thrombosis, compression hosiery, complications, treatment
p. 525-532 of the original issue
References
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Address for correspondence:
210024, Respublika Belarus',
g. Minsk, ul. Kizhevatova, d. 58,
UZ "Gorodskaia klinicheskaia bol'nitsa skoroi meditsinskoi pomoshchi",
2-ia kafedra khirurgicheskikh boleznei,
UO "Belorusskii gosudarstvennyi meditsinskii universitet".
tel. mob.:+375 29 624 55 78,
e-mail: vladimirkh77@mail.ru,
Khryshchanovich Vladimir Ianovich
Information about the authors:
Khryshchanovich V.J. MD, an associate professor of the 2nd chair of surgical diseases of EE "Belarusian State Medical University ", Minsk.
Klimchuk I.P., PhD, a head of vascular and phlebological surgery department of "The 4th CCH named after N.E. Savchenko, Minsk
Emelianenko A.V., a physician-intern of department of vascular and phlebological surgery EH "The 4th CCH named after N.E. Savchenko", Minsk.
Kalinin S.S., an angiosurgeon of Department of Vascular and phlebological surgery EH "The 4th CCH named after N.E. Savchenko", Minsk.
DOI: http://dx.doi.org/10.18484/2305-0047.2015.5.533   |  

V.A. SERGEEV 1, A.A. GLUKHOV 2

METHOD FOR PROGRAMMED IRRIGATION-ASPIRATION SANATION IN THE COMBINED TREATMENT OF PATIENTS WITH CHRONIC POSTTRAUMATIC LONG BONE OSTEOMYELITIS

SBEE HPE "Voronezh State Medical University named by N.N. Burdenko",
BME "Orel region clinical hospital"
The Russian Federation

Objectives. To study the efficiency of method for programmed irrigation-aspiration sanation in the combined treatment of patients with chronic posttraumatic long bone osteomyelitis.
Methods. Results of treatment for 112 patients (21-62 yrs old) with chronic posttraumatic long bone osteomyelitis have been analyzed. Depending on the method of suppurative focus sanation after radical osteonecrectomy, the patients were divided into two groups. In the control group drainage and sanation of the osteomyelitic focus were performed by conventional surgical method. In the main group the combined treatment was added by a new method of programmed sanation with the original AMP-01 device. The sequential programmed inclusion of cycles of pumping antiseptic solution into the pus pocket, its exposure and aspiration of spent solution has been applied.
Results. Application of the method for programmed irrigation-aspiration sanation in the combined treatment proved to exactly conforms to the principles of active surgical approach. Good short-term results were observed in the main group in 88,1% cases, in the control group in 73,6% cases, including relevant 2,2-fold reduction of the number of purulence in the main group compared to the control one. After 2-year follow-up the long-term results of the treatment showed a 2-fold reduction of the number of recurrent osteomyelitis. Extremity function in the main group was recovered in 68,5% cases and was limited in 31,5% cases; in the control group in 58,3% and 41,7%, respectively (p<0,05). The number of favourable outcomes increased by 12,3%.
Conclusion. The study conducted confirmed the efficiency of applying the method for programmed irrigation-aspiration sanation in the combined treatment of patients with chronic posttraumatic long bone osteomyelitis, since this method reliably improves the sanation quality, allowing adequately enhancing efficiency of the treatment.

Keywords: pus pocket, active surgical approach, chronic osteomyelitis, osteomyelitic focus, programmed irrigation-aspiration sanation, favourable outcomes, efficiency
p. 533-538 of the original issue
References
  1. Amiraslanov IA, Svetukhin AM, Borisov IV. Sovremennye printsipy khirurgicheskogo lecheniia khronicheskogo osteomielita [Modern principles of surgical treatment of chronic osteomyelitis]. Infektsii v Khirurgii. Moscow, RF: 2004;(2):8-13.
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Address for correspondence:
394000, Rossiiskaia Federatsiia,
g. Voronezh, ul. Studencheskaia, d. 10,
GBOU VPO "Voronezhskii gosudarstvennyi meditsinskii universitet im. N.N. Burdenko",
kafedra obshchei khirurgii,
tel.mob.: 8 905 165-09-92,
e-mail: sergeevdoc60@yandex.ru,
Sergeev Vladimir Anatol'evich
Information about the authors:
Sergeev V.A., PhD, a surgeon of coloproctological department of BME "Orel Regional Hospital".
Glukhov A.A., MD, professor, a head of the department of general surgery, Director of the Institute of Surgical Infection of SBEE HPE "Voronezh State Medical University named after NN Burdenko".

REVIEWS

DOI: http://dx.doi.org/10.18484/2305-0047.2015.5.539   |  

L.M. CHERNUKHA, O.V. KASHYROVA, A.V. TODOSYEV

CLASSIFICATION STRATEGIC APPROACHES IN THE TREATMENT OF CONGENITAL VASCULAR MALFORMATIONS: A VIEW OF A VASCULAR SURGEON

SE "National Institute of Surgery and Transplantology named by O.O. Shalymov" NAMS of Ukraine, Kiev.
Ukraine

The article is devoted to the problems of terminology, classification of different forms of congenital vascular malformations (CVM) or angiodisplasias, basic principles of diagnostics and treatment. The aim of this paper is to improve the classification of congenital vascular malformations and the establishment of diagnostic and therapeutic algorithms to optimize tactics and treatment outcomes.
The advantages and disadvantages of basic preceding domestic and foreign classifications are analysed in details, the necessity of acceptance of uniform terminology, classification with the purpose of providing of universal diagnostic and treatment tactics is marked. On the basis of long-term clinical experience the authors offer their own classification of congenital vascular abnormalities vasc+t and algorithms of diagnostics and treatment of the most widespread forms of CVM.
The offered classification includes points, allowing to define the form of CVM, prevalence of disease, presence of complications with indications to operative treatment: I. Vascular defect of CVM; II. Anatomic defect of CVM; III. Localisation of defect; IV. Complications being absolute and relative indications to treatment; V. Congenital vascular tumours. Possibility of differential diagnostics of congenital vascular tumours is taken into account letting to avoid fatal errors on the stage of diagnostics.

Keywords: ongenital vascular malformations, angiodysplasia, new classification of vascular abnomalities vasc+t, congenital vascular tumours, complications, terminology, algorithms of diagnostics and treatment
p. 539-551 of the original issue
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Address for correspondence:
03680, Ukraina, g. Kiev, ul. geroev Sevastopolia,
d. 30. GU "Natsional'nyi institut khirurgii i
transplantologii im. A.A. Shalimova"
NAMNU otdel khirurgii magistral'nykh sosudov,
Tel. rab.:+3 8 050 193-05-04,
E-mail: aristosha@list.ru,
Kashirova Elena Vladimirovna
Information about the authors:
Chernuha L.M., MD, a leading researcher of the department of surgery of the great vessels of the National Institute of Surgery and Transplantation named after A.A. Shalimov NAMSU.
Kashirina E.V., a junior researcher of the department of surgery of the great vessels of the National Institute of Surgery and Transplantation named after A.A. Shalimov NAMSU.
Todos'ev A.V., an anesthesiologist-resuscitator of the department of surgery of the great vessels of the National Institute of Surgery and Transplantation named after A.A. Shalimov NAMSU.
DOI: http://dx.doi.org/10.18484/2305-0047.2015.5.552   |  

I.S. VINNIK1, N.M. MARKELOVA1, N.S. SOLOV'EVA1, E.I. SHISHATSKAIA3, M.N. KUZNETSOV2, A.P. ZUEV1

THE CURRENT DRESSINGS FOR WOUND CARE IN THE TREATMENT OF PURULENT WOUNDS

SBEE HPE "Krasnoyarsk State Medical University named by prof. V.F. Voyno-Yasenetsky1"
MSH "Road Clinical Hospital on the station Krasnoyarsk "JSC" Russian Railways"2,
FSEI HPE "Siberian Federal University",
Institute of Biophysics of Siberian Branch of the Russian Academy of Sciences, Krasnoyarsk3
The Russian Federation

Currently, the patients with purulent wounds account for about 40% of the patients of surgical profilt. Since the treatment of septic wounds under the bandage remains the main method, as it is the most convenient and economically beneficial, but not effective enough, the development of new advanced coatings possessing simultaneously by multiple properties, is considered to be relevant. In the process of wound healing a physician faces with many problems including the issue of the selection option of a wound dressing, as they differ significantly in their design and properties. A disadvantage of many wound dressings for wound care is the adherence to wound. This results in the regenerating tissue injury and the dressings become sore. Many of the positive properties of dressings reduced as a result of damage caused by daily dressings. In recent years the biocompatible materials for injuries and wounds contribute to more effective healing and regeneration. In this regard, the paper presents the main types of current wound dressings used in the treatment of purulent wounds, their properties, indications and methods of application.

Keywords: purulent wound, wound covering, wound dressing, biocompatible materials, treatment of wounds, wound process, healing and regeneration
p. 552-558 of the original issue
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Address for correspondence:
660022, Rossiiskaia Federatsiia,
g. Krasnoiarsk, ulitsa Partizana Zhelezniaka, dom 1,
GBOU VPO "Krasnoiarskii gosudarstvennyi meditsinskii universitet im. prof. V.F. Voino-Iasenetskogo",
kafedra obshchei khirurgii,
tel: +7 913 538-38-36,
e-mail: markelova_nadya@mail.ru,
Markelova Nadezhda Mikhailovna
Information about the authors:
Winnick Y.S., MD, professor, a head of a chair of general surgery named after prof. M.I. Gulman Medical University "Krasnoyarsk State Medical University named by prof. V.F. Voyno-Yasenetsky."
Markelov N.M., MD., an assistant professor of a chair of general surgery named prof. M.I. Gulman Medical University "Krasnoyarsk State Medical University named after prof. V.F. Voyno-Yasenetsky".
Shishatskaya E.I., MD (B), professor, a researcher FSEIHPE "Siberian Federal University", the Institute of Biophysics, Siberian Branch of the Russian Academy of Sciences, a head of the department of medical biology in Krasnoyarsk.
Kuznetsov M.N., PhD, a physician of second surgical department MSH "Road Clinical Hospital on the station Krasnoyarsk "JSC" Russian Railways".
Soloviev N.S., a graduate student of the chair of general surgery named prof. M.I. Gulman Medical University "Krasnoyarsk State Medical University named after prof. V.F. Voyno-Yasenetsky".
Zuev A.P., a graduate student of the chair of general surgery named prof. M.I. Gulman Medical University "Krasnoyarsk State Medical University named after prof. V.F. Voyno-Yasenetsky".
DOI: http://dx.doi.org/10.18484/2305-0047.2015.5.559   |  

V.I. LOGINOV1, V.V. PARSHIKOV2, R.R. KASIMOV1, A.B. BABURIN1

CURRENT MECHANICAL METHODS OF INTRAOPERATIVE PREVENTION OF SURGICAL SITE INFECTIONS

FSCE "422 Military Hospital"1 the Defense Ministry of Russia, Nizhniy
Novgorod,
Medical University "Nizhny Novgorod State Medical Academy of
Ministry of Health"2
The Russian Federation

To present the current mechanical methods of prevention of intraoperative surgical site infection and to evaluate their effectiveness. The frequency of inflammatory complications after laparotomy may reach 9,4-27,3%. The lack of the reduction in the number of postoperative complications associates with an increase of the total volume of the complex surgical interventions, against the background of resistance and virulence of nosocomial microflora, as well as the application of synthetic grafts in clinical practice. Intraoperative correction of laparotomic wound using a compensating device showed that has a significant positive effect on the healing process. Suturing wounds after laparotomy with continuous mattress overlay continuous seam and simultaneous formation dublication create the optimal conditions to ensure the formation of an elastic scar. For the prevention of wound complications in prosthetics repair of abdominal wall ventral hernias the new methods of suturing wounds and types of sutures, various techniques of adhesive, spoke, needle, rod, liquid-gel tension of edges of wound from surgical incisions and skin flap have been presented. The necessity of obligatory vacuum wound drainage using devices of constant aspiration after surgery on the postoperative ventral hernia with synthetic implants is confirmed by numerous works of Russian and foreign scientists. The conducted analysis shows the efficiency of various mechanical devices for stretching and drawing wound edges together, adaptive stitches, advanced methods of vacuum drainage to prevent infectious complications of the surgical site and the development of incisional hernias.

Keywords: ventral hernias, wound complications, wound infection, mechanical devices for drawing together the edges of wounds, drainage, draining device, adaptive suture
p. 559-565 of the original issue
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  52. Timerbulatov MV, Timerbulatov ShV, Gataullina EZ, Valitova ER. Posleoperatsionnye ventral'nye gryzhi: sovremennoe sostoianie problemy [Postoperative ventral hernia: state of the problem.]. Med Vestn Bashkortostan. 2013;8(5):101-107.
Address for correspondence:
603105, Rossiiskaia Federatsiia,
g. N. Novgorod, ul. Izhorskaia, d. 25, k. 3,
FGKU "422 voennyi gospital"' Minoborony Rossii,
khirurgicheskoe otdelenie,
tel. mob.: +7 (920) 035-06-19,
e-mail: rusdoc77@mail.ru,
Kasimov Rustam Rifkatovich
Information about the authors:
Loginov V.E., PhD, an associate professor, intern of the department of surgical FSCE "422 military hospital" of Russian Defense Ministry.
Parshikov V.V., MD, professor, department of hospital surgery named by B.A. Korolev SBEE HPE Medical University "Nizhny Novgorod State Medical Academy of Ministry of Health."
Kasimov R.R., PhD, Colonel m/s, a head of the surgical department, a leading surgeon FSCE "422 military hospital" of Russian Defense Ministry.
Baburin AB, a resident surgical department FSCE "422 military hospital" of Russian Defense Ministry.

CASE REPORTS

DOI: http://dx.doi.org/10.18484/2305-0047.2015.5.566   |  

N.M. LEMEKHOVA, A.L. PETRUSHIN

OSTEOPOIKILOSIS A CLINICAL CASE OF RARE OSTEODISPLASIA

SBEH "Karpogory regional hospital"
Settlement of Karpogory
The Russian Federation

Osteopoikilosis is considered as a rare form of sclerotic osteodysplasia, characterized by the appearance of multiple discrete round or ovoid radio densities in cancellous bones (epiphysis and metaphysis). Osteopoikilosis is symmetrical with a predominant involvement of the hands, feet, pelvis and proximal femur. The disease is usually asymptomatic, benign bone dysplasia; it does not affect the quality of life of the patient and requires no special treatment. Osteopoikilosis may have a hereditary factor, or occurs sporadically. The leading role in diagnostic belongs to the X-ray diagnostic research. The differential diagnosis with metastases is required. The clinical case of osteopoikilosis, genetically determined, in the stage of spreading of lesions in woman (31 yr.) is presented. The disease was suspected in the prophylactic fluorography, revealed some focal changes in the proximal epiphysis of the humerus. Radiographs of hands, hip and shoulder joints are found clearly delineated focal bone compactions (up to 0,8 cm). The foci were located in the epiphysis, metaphysis and apophyses of long and short tubular bones and cancellous bone of the pelvis and wrists, their number ranged from 2 to 60. Subjective and objective clinical examination of pathological changes of the skeleton did not reveal. The similar hand radiographic changes on radiographs of hands were revealed in the mother of a patient.

Keywords: osteopoikilosis, osteodysplasia, osteosclerosis, bone tumors, bone islands, fluorography, radiographs
p. 566-569 of the original issue
References
  1. Il'iushenkova V.V. Lazarikhina L.V. Osteopoikiliia: nabliudenie iz praktiki [Osteopoikilosis: the practical observation]. Tikhookean Med Zhurn. 2007;(3):82-83.
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  4. Benli IT, Akalin S, Boysan E, Mumcu EF, Kiş M, Türkoğlu D.Epidemiological, clinical and radiological aspects of osteopoikilosis. J Bone Joint Surg Br. 1992 Jul;74(4):504-6.
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  8. Chigira M, Kato K, Mashio K, Shinozaki T.Symmetry of bone lesions in osteopoikilosis. Report of 4 cases. Acta Orthop Scand. 1991 Oct;62(5):495-96.
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Address for correspondence:
164600, Rossiiskaia Federatsiia ,Arkhangel'skaia obl., p. Karpogory, ul. Lenina, d. 47.
GBUZ AO "Karpogorskaia TsRB", khirurgicheskoe otdelenie
tel.: +7 818 56 2-11-03,
e-mail petrushin.59@mail.ru Petrushin Alexander Leonidodovich
Information about the authors:
Lemekhova N.M., a radiologist of SBEH "Karpogory CRH". Arkhangelsk region.
Petrushin AL, PhD, a surgeon of SBEH "Karpogory CRH". Arkhangelsk region.

EXCHANGE OF EXPERIENCE

DOI: http://dx.doi.org/10.18484/2305-0047.2015.5.570   |  

Y.V. STRUCHKOV, A.G. KURMANBAEV

ANTEGRADE DRAINAGE OF THE BILIARY TRACT IN PATIENTS WITH UNRESECTABLE TUMORS OF BILIOPANCREATODUODENAL ZONE COMPLICATED BY OBSTRUCTIVE JAUNDICE

SBEE HPE "I.M. Sechenov First Moscow State Medical University",
Moscow
The Russian Federation

Objectives. To evaluate the efficacy of transcutaneous transhepatic biliary drainage in patients with cholestasis of malignant etiology.
Methods. The treatment results of 55 patients with unresectable tumors of biliopancreatoduodenal zone complicated by obstructive jaundice have been analyzed. The antegrade drainage of the biliary tract was performed under ultrasonic and fluoroscopic guidance. The method effectiveness was evaluated according to dynamics of levels of total bilirubin, liver enzymes alanine transaminase (ALT) and aspartate transaminase (AST) according to multiple organ dysfunction score (MODS II), simplified acute physiology score (SAPS II), and a diameter of the common bile duct. These values were analyzed on admission, on the first, fifth and tenth day after application of transcutaneous transhepatic cholangiostomy.
Results. Since the first day of transcutaneous transhepatic cholangiostomy after antegrade drainage of the bile ducts the total bilirubin level reduced from 18522 μmol/l to 11313 μmol/l. On the fifth day the levels of liver enzymes ALT and AST declined from 19822 U/l to 8611 U/l and 16120 U/l to 637 U/l, respectively.
On the fifth day the the condition of patients has improved according to the scale MODS II (from 4,20,3 to 2,20,2 points) and the scale SAPS II (381,7 to 261,5 points). The reduction of hypertension in bile duct characterized by a decrease of the common bile duct diameter from 14,11,2 mm to 8,90,6 mm was registered on the fifth day. No complications and deaths immediately related to the use of transcutaneous transhepatic cholangiostomy were noted.
Conclusion. Transcutaneous transhepatic cholangiostomy allows eliminating the signs of hypertension in the biliary tract. Mortality is due directly to the main oncologic disease, cancer intoxication, and comorbidities.

Keywords: malignant tumors, biliopancreatoduodenal zone, transpercutaneous transhepatic drainage of choledoch, scales of severity, hyperbilirubinemia, alanine aminotransferase, aspartate aminotransferase, complications
p. 570-576 of the original issue
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  12. Weber A, Gaa J, Rosca B, Born P, Neu B, Schmid RM, Prinz C. Complications of percutaneous transhepatic biliary drainage in patients with dilated and nondilated intrahepatic bile ducts. Eur J Radiol. 2009 Dec;72(3):412-17. doi: 10.1016/j.ejrad.2008.08.012.
  13. Lysenko MV, Savost'ianov VV, Kuzin VV, Efimenko NA, Sukhorukov AL. Sposob opredeleniia tsentral'nogo venoznogo davleniia [A method for determining central venous pressure]. Patent RF RU 2214159.
  14. Tsuyuguchi T, Takada T, Miyazaki M, Miyakawa S, Tsukada K, Nagino M, Kondo S, Furuse J, Saito H, Suyama M, Kimura F, Yoshitomi H, Nozawa S, Yoshida M, Wada K, Amano H, Miura F. Stenting and interventional radiology for obstructive jaundice in patients with unresectable biliary tract carcinomas. J Hepatobiliary Pancreat Surg. 2008;15(1):69-73. doi: 10.1007/s00534-007-1282-x.
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Address for correspondence:
109240, Rossiiskaia Federatsiia,
g. Moskva, ul. Iauzskaia d. 11.
str. 1, GKB im. I.V. Davydovskogo,
GBOU VPO "Pervyi moskovskii go
sudarstvennyi meditsinskii universitet
imeni I.M. Sechenova", kafedra obshchei khirurgii
e-mail: azamatkg.88@gmail.com,
Kurmanbaev Azamat Gul'tashyrovich
Information about the authors:
Struchkov Y.V. MD, professor, a senior researcher of the general surgery chair of SBEE HPE "I.M. Sechenov First Moscow State Medical University".
Kurmanbaev A.G. A post-graduate student of the general surgery chair of SBEE HPE "I.M. Sechenov First Moscow State Medical University".
DOI: http://dx.doi.org/10.18484/2305-0047.2015.5.577   |  

V.P. DEIKALO, A.N. TOLSTIK

THE USE OF CUTANEOUS AUTOPLASTY IN THE REHABILITATION OF PATIENTS WITH AN ACUTE HAND INJURY

EE "Vitebsk State Medical University"
The Republic of Belarus

Objectives. To examine the results, mistakes, and complications, to assess and characterize the capabilities of current methods of skin plasty in hand soft tissue defects.
Methods. In medical rehabilitation the patients who had sustained an acute hand injury accompanied by soft tissue defects, a necessity of skin integrity was occured. In these cases the different methods of autodermoplasty have been used. 289 operations of skin plasty in 248 patients with open hand injuries and (or) their consequences have been performed. There were 218 (87,90%) men and 30 (12,10 %) women. 98,2% of the patients were of working age. 230 (92,74%) patients with the open hand and finger injuries were operated, the dermepenthesis was made to 18 (7,26) patients after repairing of various posttraumatic contracture. In assessing of the long-term results the degree of a flap engraftment, complications and functional outcomes were taken into account.
Results. Analysis of the application of different methods of skin autodermoplasty has allowed to establish that the technique of free skin grafting (64,35%) in specialized care to patients with an acute hand injury was used more frequently. Unsuccessful outcomes (29,50%) after a free skin grafting have associated with mistakes made during surgery and in the postoperative period. To replace the deep defects of an acute hand injury is more expedient to use a non-free skin graft, allowing 100% of engraftment and good cosmetic outcomes.
Conclusion. The application of different skin grafting technique broader and more rational, careful planning and technical performance of operations as well as the proper management in the postoperative period have resulted in improved patient outcomes.

Keywords: hand injury, skin grafting, post-traumatic contracture, skin plasty, medical rehabilitation, engraftment, complications, postoperative period
p. 577-581 of the original issue
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  12. Kimura N, Saito M, Sumiya Y, Itoh N.Reconstruction of hand skin defects by microdissected mini anterolataral thigh perforator flaps. J Plast Reconstr Aesthet Surg. 2008 Sep;61(9):1073-77. doi: 10.1016/j.bjps.2008.02.014.
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  14. Green DP, Hotchkiss RN, Pederson WC./eds. Operative Hand Surgery. 1998;(1-2):2367. Philadelphia: Churchill Livingstone.
Address for correspondence:
210023 Respublika Belarus',
g. Vitebsk, pr-t Frunze, d. 27,
UO "Vitebskii gosudarstvennyi
meditsinskii universitet", kafedra
travmatologii, ortopedii i voenno-polevoi khirurgii.
tel. 8 0212 57-40-84,
Deikalo Valery Petrovich
Information about the authors:
Deikalo V.P., MD, professor of traumatology, orthopedics and field surgery EE "Vitebsk State Medical University".
Tolstik A.N., PhD., an associate professor, a head of a chair of traumatology, orthopedics and field surgery of VSMU EE "Vitebsk State Medical University".
Contacts | ©Vitebsk State Medical University, 2007