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Khirurgii

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Year 2018 Vol. 26 No 4

HISTORY

A.V. VARABEI 1, D.A. CHEPIK 2, E.I. VIZHYNIS 1, A.M. MAKHMUDOV 1

HISTORY OF CREATION OF A VIABLE INTESTINAL GRAFT FOR BRIDGING ESOPHAGOPLASTY. PART II

Belarusian Medical Academy of Postgraduate Education1
Minsk Regional Clinical Hospital2, Minsk,
The Republic of Belarus

The article is devoted the history of anatomical, experimental and clinical trials permitting the prognosis and improvement the blood flow in the cervical part of the intestinal grafts to perform the one-stage shunting esophagoplasty.
In the second half of the twentieth century, on the corpses, and then during angiography using the method of Seldinger, the architectonics of the basins of the upper and lower mesenteric arteries, supplying the colon, was studied in detail. Based on the results obtained, original methods for the prevention of ischemia and venous stasis in the retrospective esophagocolotransplant were proposed.
Almost simultaneously H. Shumacker and J. Battersby in London, and A. Shalimov in Kiev developed in 1950-1951 in the experiment and introduced into the clinic the technique of «training» of the vascular collaterals of the jejunal graft. It found application in the twenty-first century. A. Carrel in 1907 in Baltimore, and E. Kramarenko in 1921 in Odessa carried out in experiment the direct revascularization of the intestinal graft. In the clinic, this idea was embodied by W. Longmire in Baltimore in 1946. P. Androsov in Moscow since 1950 has begun to form direct arterial anastomoses with V. Gudov mechanical vasoconstrictor apparatus. In 1976 in Minsk I. Grishin performed a direct revascularization of the jejunal graft from the thoracic aorta. Due to the development of microvascular technologies, the hypervascularization of the esophagus is finding more and more supporters. Today, Belarusian surgeons widely use this technology in difficult anatomical situations to perform a one-step retrosternal esophagogastroplasty.

Keywords: esophagoplasty, mesenteric vessels, esophagocolotransplant, intravascular graft hypervascularization
p. 389-401 of the original issue
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Address for correspondence:
223040, The Republic of Belarus,
Minsk region, Lesnoy-1,
Minsk Regional Clinical Hospital,
Department of Surgery,
Tel. office.: +375 17 265-22-13,
e-mail: dept-surg@hotmail.com,
Aliaksandr V. Varabei
Information about the authors:
Varabei Aliaksandr V., Corresponding Member of NAS of Belarus, MD, Professor, Head of the Deparment of Surgery, Head of the Republican Center for Reconstructive Surgical Gastroenterology and Coloproctology, Belarusian Medical Academy of Postgraduate Education, Minsk, Republic of Belarus.
http://orcid.org/0000-0003-4710-5996
Chepik Dmitriy A., Head of the Surgical Unit ¹1, Minsk Regional Clinical Hospital, Mihsk region, Borovlyany, Republic of Belarus.
http://orcid.org/0000-0001-6299-5486
Vizhinis Egi I., PhD, Associate Professor, the Department of Surgery, Belarusian Medical Academy of Postgraduate Education, Minsk, Republic of Belarus.
http://orcid.org/0000-0002-9185-7119
Makhmudov Anvar M., Associate Professor, the Department of Surgery, Belarusian Medical Academy of Postgraduate Education, Minsk, Republic of Belarus.
http://orcid.org/0000-0001-7833-5829

SCIENTIFIC PUBLICATIONS
EXPERIMENTAL SURGERY

B.S. SUKOVATYKH 1, YU.YU. POLEVOY 1, A.A. NETYAGA 1, YU.YU. BLINKOV 1, V.A. ZHUKOVSKIY 2

COMPARATIVE EXPERIMENTAL-MORPHOLOGICAL RESEARCH OF LIGHT AND LIGHT STRENGTHENED ENDOPROSTHESIS FOR HERNIOPLASTY

Kursk State Medical University 1, Kursk
Saint-Petersburg State University of Industrial Technologies and Design 2, Saint-Petersburg,
The Russian Federation

Objective. To study the changes of anterior abdominal wall tissues in experimental animals with implantation of new light strengthened endoprosthesis for hernioplasty.
Methods. Experimental studies were conducted on 60 rabbits of “Chinchilla” breed. All animals were divided into 2 series of experiments. In the first (control) group animals were implanted with a light polypropylene endoprosthesis, in the second (experimental) group animals were implanted a new net endoprosthesis from monofilament polypropylene, which consisted of the basic and strengthened zones in the form of horizontally located stripes, alternating with each other mono-thread with a larger diameter. In the experiment the tissue response of abdominal wall with implantation of endoprosthesis in the position “onlay” was studied on the 7th, 30th, 60th, 90th and 180th days.
Results. It was found out, that the light strengthened endoprosthesis was identical to the light endoprosthesis by the severity and amount of inflammatory response in late periods (90 and 180 days), as well as by cellular structure and cellular index, reflecting the character of wound process during the whole experiment (from the 7th till 180th day). Histological study showed that the use of the both materials does not lead to deterioration of morpho-functional condition of the muscle layer of the abdominal wall. Using morphometrical study from the 7th till the 30th days we detected that cellular infiltration area decreased by 3.9 times in a control group and by 4.1 times in an experimental group. From the 30th till the 180th days the size of the capsule area increased by 1.6 times in a control and by 1.2 times in experimental series. At late periods (on the 90th and 180th days) statistically significant differences of all these indicators between the series of experiment were not detected.
Conclusions. Introduction of the strengthened zone to the structure of the light endoprosthesis, including monofilaments of the larger diameter, does not lead to deterioration of abdominal tissue response to the implanted material, that presents prospective for its use in hernioplasty.

Keywords: light endoprosthesis, light strengthened endoprosthesis, hernioplasty, cellular infiltration area, area of connective tissue capsule, cellular index, polypropylene endoprosthesis
p. 402-411 of the original issue
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  13. Sukovatykh BS, Ivanov AV, Valuskaya NM, Gerasimchuk EV. The influence of late implantation fabric reaction on the choice of polypropylene endoprosthesis for preventive subaponeurotic plasty of the abdominal wall. Novosti Khirurgii. 2013;21(5):11-17. doi: 10.18484/2305-0047.2013.5.11 (in Russ.)
  14. Shestakov AL, Fedorov DN, Ivanchik IJ, Boeva IA, Bitarov TT. Comparative evaluation of standard, composite and “lightweight” synthetic prostheses for hernioplasty (experimental work). Kursk Nauch-Prakt Vestn “Chelovek i Ego Zdorov’e”. 2017;(2):81-87. doi: 10.21626/vestnik/2017-2/14 (in Russ.)
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Address for correspondence:
305041, The Russian Federation,
Kursk, K.Marx Str., 3,
Kursk State Medical University,
Department of General Surgery,
Tel. (4712) 52-98-62,
e-mail: SukovatykhBS@kursksmu.net,
Boris S. Sukovatykh
Information about the authors:
Sukovatykh Boris S., MD, Professor, Head of the Department of General Surgery, Kursk State Medical University, Kursk, Russian Federation.
http://orcid.org/0000-0003-2197-8756
Polevoy Yuri Yu., Applicant for Candidate’s degree of the Department of General Surgery, Kursk State Medical University, Kursk, Russian Federation.
http://orcid.org/0000-0002-2683-2521
Netyaga Andrej A., PhD, Associate Professor of the Department of Operative Surgery and Topographic Anatomy, Kursk State Medical University, Kursk, Russian Federation.
http://orcid.org/0000-0003-3686-1358
Blinkov Yurij Yu., MD, Professor of the Department of General Surgery, Kursk State Medical University, Kursk, Russian Federation.
http://orcid.org/0000-0002-0819-0692
Zhukovskiy Valeriy A., DS, Professor of the Department of Nanostructured, Fibrous and Composite Materials named after A.I. Meos, Supervisor of the Laboratory of Polymer Materials, Saint-Petersburg State University of Industrial Technologies and Design, Saint-Petersburg, Russian Federation.
http://orcid.org/0000-0001-7092-9155

A.V. KALASHNIKOV 1, A.A. VOROBYEV 2, D.SH. SALIMOV 3, S.A. KALASHNIKOVA 1, S.SH. AIDAEVA 1

STIMULATION OF ADHESIOGENESIS IN CHRONIC PLEURAL EMPIEMA

Pyatigorsk Medical and Pharmaceutical Institute 1, Pyatigorsk
Volgograd State Medical University 2, Volgograd
Central Military Clinical Hospital named after P.V. Mandryk 3, Moscow,
The Russian Federation

Objective. To substantiate stimulation of adhesiogenesis in the treatment of chronic pleural empyema.
Methods. The results of stimulation of adhesiogenesis in the pleural cavity for the treatment of residual cavities against the background of chronic pleural empyema in 270 nonlinear white male rats divided into 3 groups of 90 animals in each were analyzed. Chronic pleural empyema followed by formation of a residual cavity was modeled by weekly intrapleural injection of 1 billion E. coli suspension during two months. In the control group, no treatment was performed. In the comparison group, doxycycline was administered intracavitary at a rate of 40 mg/kg of body weight, in the experimental group – intracavitary injection of platelet-rich plasma (PRP) was performed The effectiveness of treatment was assessed by changes in biochemical markers of endogenous intoxication, general microbial contamination of pleural exudate. When revising the residual cavity, its volume, intensity of adhesion, histopathography of pleural adhesions with subsequent histological examination were determined.
Results. It was established that stimulation of adhesion using PRP against the background of chronic pleural empyema significantly reduces the severity of endogenous intoxication (by 1.2 times). The number of microorganisms colonizing the pleural cavity in the rats of the experimental group was also significantly less than in the control group, but higher than in the rats of the comparison group. In the study of pleural adhesions in the rats of the experimental group on the 20th day, together with adhesions between the visceral and parietal pleura, multiple interlobar adhesions of different degree of maturity were determined. The technique of PRP injection proved to be more effective method of stimulating adhesion formation in the pleural cavity, so by the end of the experiment obliteration of residual cavities had been recorded in 41.1% of cases, the mature connective tissue was histologically determined.
Conclusions. The method of stimulating adhesiogenesis in the treatment of residual pleural cavities in case of chronic pleural empyema with the use of PRP is pathogenetically substantiated and effective.

Keywords: stimulation of adhesion, chronic pleural empyema, residual pleural cavity, PRP-therapy, pleural cavity adhesions, platelet-rich plasma, thoracic surgery
p. 412-420 of the original issue
References
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  15. Achkasov EE, Bezuglov EN, Ul’yanov AA, Kurshev VV, Repetyuk AD, Egorova ON. Application platelet-rich plasma in clinical practice. Biomeditsina. 2013. (4):46-59. https://cyberleninka.ru/article/n/primenenie-autoplazmy-obogaschennoy-trombotsitami-v-klinicheskoy-praktike (in Russ.)
Address for correspondence:
357532, The Russian Federation,
Pyatigorsk, Kalinin Ave., 11,
Pyatigorsk Medical and Pharmaceutical Institute,
Department of Morphology,
Tel.: +7 928-335-94-30,
e-mail: kalashnikova-sa@yandex.ru,
Svetlana A. Kalashnikova
Information about the authors:
Kalashnikov Anton V., PhD, Associate Professor, Acting Head of the Department of Surgical Disciplines, Pyatigorsk Medical and Pharmaceutical Institute, Branch of Volgograd State Medical University, Pyatigorsk, Russian Federation.
https://orcid.org/0000-0002-9801-5977
Salimov Dmitriy Sh., PhD, Surgeon, II Surgical Department of the General Surgery Center, Central Military Clinical Hospital named after PV. Mandryk, Moscow, Russian Federation.
http://orcid.org/0000-0001-8647-1505
Vorobyev Alexander A., MD, Professor, Head of the Department of Operative Surgery and Topographic Anatomy, Volgograd State Medical University, Volgograd, Russian Federation.
https://orcid.org/0000-0001-8378-0505
Kalashnikova Svetlana A., MD, Associate Professor, Head of the Department of Morphology, Pyatigorsk Medical and Pharmaceutical Institute, Branch of Volgograd State Medical University, Pyatigorsk, Russian Federation.
http://orcid.org/0000-0002-7688-9366
Aidaeva Salihat Sh., Postgraduate Student of the Department of Morphology, Pyatigorsk Medical and Pharmaceutical Institute, Branch of Volgograd State Medical University, Pyatigorsk, Russian Federation.
https://orcid.org/0000-0003-1216-4590

A.V. POPKOV, G.N. FILIMONOVA, N.A. KONONOVICH, D.A. POPKOV

MORPHOLOGICAL CHARACTERISTIC OF THE ANTERIOR TIBIAL MUSCLE IN COMBINED AUTOMATIC LEG LENGTHENING AT AN INCREASED RATE

Russian Ilizarov Scientific Center «Restorative Traumatology and Orthopaedics», Kurgan,
The Russian Federation

Objective. To reveal the anatomic-histological characteristics of the anterior tibial muscle in automatic combined distraction osteosynthesis with a rate of three millimeters (mm) per day.
Methods. The anatomical and histological characteristics of the anterior tibial muscle were studied in the elongation of the tibia of the dogs (n = 8) using the technique of transosseous distraction osteosynthesis according to Ilizarov combined with tibial intramedullary reinforcement with hydroxyapatite-coated titanium rod. Distraction rate: three mm per day for 120 sessions automatically. Consolidation of the distraction regenerated bone occurred after 13.83±4.02 days. The device fixation was discontinued in this period. At the end of the distraction period and 90 days after cessation of fixation with the apparatus, a macroscopic and histological examination of the anterior tibial muscle of the elongated segment and contralateral muscle of the same type was performed. Additionally, the general condition of the animals and the function of the limb were evaluated.
Results. During the experiments, complications of an infectious and neurological nature, the death of animals was not revealed. The supporting function of the limb was preserved. There was no formation of equinus setting of the foot. Under the new conditions of distraction, there were no irreversible destructive changes in the anterior tibial muscle. Histologically, the polygonality of the muscle fiber profiles and transverse striation persisted. There was no pathological increase in the width of connective tissue layers. The signs of activization of angio- and neomyohistogenesis were revealed as evidenced by the presence of myosatellite cells, the appearance of a large number of microvessels, newly formed muscle fibers. Macroscopically, the volume and length of the muscle belly were increased at all the stages of the experiment, and the color corresponded to the not lengthened muscle.
Conclusions. With automatic lengthening of limb bones at an increased rate and with high fractionality in combination with intramedullary bioactive reinforcement, favorable conditions are created not only for osteogenesis, but also for the growth and adaptation of soft tissues.

Keywords: experiment on animals, lengthening, osteogenesis, bioactive implant, skeletal muscle, histology
p. 421-430 of the original issue
References
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Address for correspondence:
640014, The Russian Federation,
Kurgan, M. Ulyanova Str., 6,
Russian Ilizarov Scientific Center
“Restorative Traumatology and Orthopaedics”, Experimental Laboratory,
Tel. office: +7(3522) 41-52-73,
e-mail: n.a.kononovich@mail.ru,
Natalia A. Kononovich
Information about the authors:
Popkov Arnold V., MD, Professor, Chief Researcher of the Laboratory of Correction of Deformities and Lengthening of Limbs, Russian Ilizarov Scientific Center “Restorative Traumatology and Orthopaedics”, Kurgan, Russian Federation.
https://orcid.org/0000-0001-5791-1989
Filimonova Galina N., PhD, Chief Researcher of the Morphology Laboratory, Russian Ilizarov Scientific Center “Restorative Traumatology and Orthopaedics”, Kurgan, Russian Federation.
https://orcid.org/0000-0002-8929-8784
Kononovich Natalia A., PhD, Leading Researcher of the Experimental Laboratory, Russian Ilizarov Scientific Center “Restorative Traumatology and Orthopaedics”, Kurgan, Russian Federation.
https://orcid.org/0000-0002-5990-8908
Popkov Dmitry A., MD, Head of the Clinic of Neuroorthopaedics, Russian Ilizarov Scientific Center “Restorative Traumatology and Orthopaedics”, Kurgan, Russian Federation.
https://orcid.org/0000-0002-8996-867X

GENERAL & SPECIAL SURGERY

E.YU. VASILYEVA, E.E. KASAKOVA, T.V. VAVILOVA

HEART-TYPE FATTY ACID-BINDING PROTEIN AS A PROGNOSTIC MARKER IN PATIENTS WITH ISCHEMIC HEART DISEASE AFTER PERCUTANEOUS CORONARY INTERVENTIONS

Almazov National Medical Research Centre, Saint-Petersburg,
The Russian Federation

Objective. To analyze the concentration of the heart-type fatty acid-binding protein (H-FABP) in patients with cardiovascular disease (CVD) before percutaneous coronary intervention (PCI) and within a year after coronary stenting.
Methods. This article presents the data collected through annual (one-year) observation of 71 patients after they had undergone PCI (58 patients, who didn’t have any complications and 13 with restenosis or clinical significant stenosis of a new localization). All participants of the study had their H-FABP investigated before the operation as well as 3, 6 and 12 months after PCI.
Results. The H-FABP concentration values in the group of patients with CVD were significantly higher than in the control group (p <0.05). Three months after myocardial revascularization H-FABP concentration decreased significantly (p <0.05) in comparison with its initial value. Over one-year follow-up period H-FABP concentration showed the tendency to increase and by the end of the observation exceeded the baseline. In the group of patients with favorable course of postoperative period before the operation this marker level was significantly higher (p<0,05) than in patients with stenting complications. The correlation between the concentration of H-FABP and the accumulation of risk factors (R2=0,8, p<0,05) for cardiovascular diseases has been established. Presurgery period revealed a positive correlation between the concentration of H-FABP and the serum creatinine level (r = 0.36, p <0.05), as well as a negative correlation between H-FABP value and high-density lipoproteins (HDL) (r =-0.31, p<0.05), but none of these correlations were detected during other discreet observation moments.
Conclusions. There is a detected increase in H-FABP value in patients with chronic coronary heart disease, compared to healthy donors. The cumulation of cardiovascular risk factors leads to an increase in this marker level. There is no detected correlation between H-FABP concentration and clinical outcomes for patients after PCA throughout a year period.

Keywords: heart-type fatty acid-binding protein, percutaneous coronary intervention, coronary stenting, coronary artery disease, cardiac markers, cardiovascular disease
p. 431-439 of the original issue
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Address for correspondence:
197341, The Russian Federation,
Saint Petersburg, Akkuratova Str., 2,
Almazov National Medical Research Centre,
Central Clinical and Diagnostic Laboratory,
Tel.+7-921-325-90-12,
e-mail: elena-almazlab@yandex.ru,
Elena Yu. Vasilyeva
Information about the authors:
Vasilyeva Elena Yu., Post-Graduate Student of the Department of Laboratory Medicine and Genetic, Head of the Clinical and Diagnostic Laboratory, Almazov National Medical Research Centre, Saint Petersburg, Russian Federation.
http://orcid.org/0000-0002-2115-8873
Kazakova Evgeniya E., Physician of the Clinical Laboratory Diagnostics, Central Clinical and Diagnostic Laboratory, Almazov National Medical Research Centre, Saint Petersburg, Russian Federation.
http://orcid.org/0000-0002-0141-6986
Vavilova Tatiana V., MD, Professor, Head of the Department of Laboratory Medicine and Genetic, Almazov National Medical Research Centre, Saint Petersburg, Russian Federation.
http://orcid.org/0000-0001-8537-3639

M.A. VOYNOV, B.V. MAGNAEV, A.R. ZOTOVA

EFFICIENCY AND EXPEDIENCE OF ANTIBIOTIC TREATMENT FOR COLONIC DIVERTICULITIS

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

Objective. To study the efficacy and to establish expedience of antibiotic treatment for diverticulitis.
Methods. The retrospective analysis of 141 medical histories was made of patients with acute uncomplicated diverticulitis, who were treated during the period from 2013 to 2016 years. Antibiotics were prescribed to treat 85 (60.3%) patients (the main group), 56 (39.7%) patients (the control group) were not given antibacterial drugs. To assess the treatment effectiveness, a dynamic assessment of the clinical picture and laboratory indicators was performed. In the long-term period, patients were questioned to determine the nature of the course and the occurrence of relapses of diverticulitis.
Results. The duration of hospitalization of the main group patients was 10.8±3.2 days (M±σ), control - 11.2±2.6 days (M±σ), p>0.05. During the treatment, disease progression was registered in none of the patients. In the main group the body temperature was normalized after 1.6 ± 0.4 days, in the control group after 1.7±0.3 days, p>0.05. The level of leukocytes came back to normal in the main group at 2.7±0.8 days, in the control group at 2.9±0.7 days (p>0.05).
Long-term results were evaluated in 82 (96.5%) of patients and 55 (98.2%) in the control group. Use of antibiotic treatment in diverticulitis had no effect in the remote period for redevelopment of complications (OR 1.19; CI 0.58-2.44), the need to seek medical care (OR 1.11; CI 0.52-2.34), need for hospitalization (OR 0.95, CI 0.3-2.96) and surgical treatment (OR 1.36, CI 0.34-7.69).
Conclusions. The use of antibiotic treatment for diverticulitis does not affect the outcome of treatment and does not determine the further course of the disease. Taking into account the increasing resistance of microorganisms to antibiotics and the need to optimize costs with limited funding for health care, it is advisable to exclude the use of antibacterial drugs for the treatment of uncomplicated diverticulitis.

Keywords: acute uncomplicated diverticulitis, anti-bacterial agents, complications, diverticulitis, treatment of diverticulitis, antibiotic-free treatment
p. 440-446 of the original issue
References
  1. Ivashkin VT, Shelygin IuA, Achkasov SI, Vasil’ev SV, Grigor’ev EG, Dudka VV, Zhukov BN, Karpukhin OIu, Kuz’minov AM, Kulikovskii VF, Lapina TL, Lakhin AV, Maev IV, Moskalev AI, Murav’ev AV, Polovinkin VV, Poluektova EA, Stoiko IuM, Timerbulatov VM, Trukhmanov AS, Frolov SA, Chibisov GI, Shifrin OS, Sheptulin AA, Khalif IL, Efron AG, Ianovoi VV. Rekomendatsii rossiiskoi gastroenterologicheskoi assotsiatsii i assotsiatsii koloproktologov Rossii po diagnostike i lecheniiu vzroslykh bol’nykh divertikuliarnoi bolezn’iu obodochnoi kishki. Ros Zhurn Gastroenterologii Gepatologii Koloproktologii. 2017;26(1):65-80. http://www.gastro-j.ru/files/65_80_1458851709.pdf (in Russ.)
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  8. Tursi A, Brandimarte G, Elisei W, Picchio M, Forti G, Pianese G, Rodino S, D’Amico T, Sacca N, Portincasa P, Capezzuto E, Lattanzio R, Spadaccini A, Fiorella S, Polimeni F, Polimeni N, Stoppino V, Stoppino G, Giorgetti GM, Aiello F, Danese S. Randomised clinical trial: mesalazine and/or probiotics in maintaining remission of symptomatic uncomplicated diverticular disease–a double-blind, randomised, placebo-controlled study. Aliment Pharmacol Ther. 2013 Oct;38(7):741-51. doi: 10.1111/apt.12463
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  10. Daniels L, ünlü Ñ, de Korte N, van Dieren S, Stockmann HB, Vrouenraets BC, Consten EC, van der Hoeven JA, Eijsbouts QA, Faneyte IF, Bemelman WA, Dijkgraaf MG, Boermeester MA. Randomized clinical trial of observational versus antibiotic treatment for a first episode of CT-proven uncomplicated acute diverticulitis. Br J Surg. 2017 Jan;104(1):52-61. doi: 10.1002/bjs.10309
  11. Unlü C, de Korte N, Daniels L, Consten EC, Cuesta MA, Gerhards MF, van Geloven AA, van der Zaag ES, van der Hoeven JA, Klicks R, Cense HA, Roumen RM, Eijsbouts QA, Lange JF, Fockens P, de Borgie CA, Bemelman WA, Reitsma JB, Stockmann HB, Vrouenraets BC, Boermeester MA. A multicenter randomized clinical trial investigating the cost-effectiveness of treatment strategies with or without antibiotics for uncomplicated acute diverticulitis (DIABOLO trial). BMC Surg. 2010 Jul 20;10:23. doi: 10.1186/1471-2482-10-23
Address for correspondence:
19027, The Russian Federation,
Moscow, Yauzskaya Str., 11/6, b. 1.,
I.M. Sechenov First Moscow
State Medical University,
Department of General Surgery,
Tel.: +7-967-139-36-96,
e-mail: info@doctorvoinov.ru,
Mikhail A. Voinov
Information about the authors:
Voinov Mikhail A., PhD, Assistant of the Department of General Surgery, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
http://orcid.org/0000-0001-9857-9249
Magnaev Badma V., Clinical Intern of the Department of General Surgery, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
http://orcid.org/0000-0002-7426-7563
Zotova Anna R., Student of the Medical Faculty, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
http://orcid.org/0000-0003-4891-279

UROLOGY

À.À. RYNDZIN, L.À. ZAITSEVA, I.F. SHISHLO, A.V. POLUJANCHIK, S.A. KRASNY

PREDICTION OF SEVERE POSTOPERATIVE COMPLICATIONS OF RADICAL CYSTECTOMY

N.N. Alexandrov National Cancer Center of Belarus, Minsk,
The Republic of Belarus

Objective. To access the predictors and structure of the postoperative Clavien-Dindo grade ≥3 complications in the bladder cancer patients after the radical cystectomy (RC) and to create the model to predict the likelihood of such complications.
Methods. Results of the radical cystectomy series performed in N.N. Alexandrov National Cancer Center of Belarus during the period from 1999 to 2012 (849 patients) were retrospectively analyzed. The information about postoperative Clavien-Dindo grade ≥3 complications during 30 days after the radical cystectomy was obtained from medical records. By means of uni- and multivariate logistic regression analyses, the relationship of severe postoperative complications with perioperative parameters was assessed.
Results. Postoperative complications were registered in 351 patients from 849 (41%). 116 patients had 128 Clavien-Dindo grade ≥3 complications (13.7%, 95% CI 11.4-16.0). Multivariate regression analysis revealed the statistically significant correlation of complications frequency of Clavien-Dindo grade ≥3 with the following factors: surgeon’s experience (<50 versus >200 RC: OR 3.252; 95% CI 1.297-8.157; p=0.011; 50-200 versus >200 RC: OR 2.61; 95% CI 1,456-4,89; p=0.002), patient’s age (<70 versus ≥70: OR 1.779; 95% CI 0.125-2.815; p=0.014), body mass index (BMI) (<25 versus ≥25: OR 1.779; 95% CI 1.117-2.821; ð=0.04), previous open bladder surgery (OR 3.479; 95% CI 1.055-11.409; ð=0.015), preoperative serum creatinine level (<155 mmol/l versus ≥155 mmol/l, OR 2.762, 95% CI 1.415-5.388; p=0.003).
Conclusions. Complication rate is influenced by patient’s parameters (BMI ≥25, age ≥70 and serum creatinine level ≥155 mmol/l) and surgeon experience, which should be taken into account before planning radical cystectomies.

Keywords: urinary bladder neoplasms, radical cystectomy, severe complications, complication grade classification, prognosis
p. 447-456 of the original issue
References
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  11. Fisher MB, Svatek RS, Hegarty PK, McGinniss JE, Hightower C, Grossman HB, Kamat AM, Dinney CP, Matin SF. Cardiac history and risk of post - cystectomy cardiac complications. Urology. 2009;74(5):1085-89. doi: 10.1016/j.urology.2009.04.103
  12. Krasnyi SA, Sukonko OG, Poliakov SL, Rolevich AI, Minich AA, Mavrichev AS, Volkov AN, Mirilenko LV. Prediktory rannikh tiazhelykh oslozhnenii radikal’noi tsistektomii. Onkourologiia. 2010;(4):42-46. http://oncourology.abvpress.ru/oncur/issue/view/34/showToc (in Russ.)
  13. Ahmed K, Khan SA, Hayn MH, Agarwal PK, Badani KK, Balbay MD, Castle EP, Dasgupta P, Ghavamian R, Guru KA, Hemal AK, Hollenbeck BK, Kibel AS, Menon M, Mottrie A, Nepple K, Pattaras JG, Peabody JO, Poulakis V, Pruthi RS, Redorta JP, Rha KH, Richstone L, Saar M, Scherr DS, Siemer S, Stoeckle M, Wallen EM, Weizer AZ, Wiklund P, Wilson T, Woods M, Khan MS. Analysis of intracorporeal compared with extracorporeal urinary diversion after robot-assisted radical cystectomy: results from the International Robotic Cystectomy Consortium. Eur Urol. 2014 Feb;65(2):340-47. doi: 10.1016/j.eururo.2013.09.042
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  15. Moschini M, Simone G, Stenzl A, Gill IS, Catto J. Critical Review of Outcomes from Radical Cystectomy: Can Complications from Radical Cystectomy Be Reduced by Surgical Volume and Robotic Surgery? Eur Urol Focus. 2016 Apr;2(1):19-29. doi: 10.1016/j.euf.2016.03.001
Address for correspondence:
223040, The Republic of Belarus,
Minsk region, Lesnoy-1,
N.N. Alexandrov National Cancer
Center of Belarus,
Oncourological Unit,
Tel. mobile: +375 29 667-09-10,
e-mail: aryndzin@gmail.com,
Aliaksei A. Ryndzin
Information about the authors:
Ryndzin Aliaksei A., Urologist, the Oncourological Unit, N.N. Alexandrov National Cancer Center of Belarus, Minsk, Republic of Belarus
http://orcid.org/0000-0001-5642-8397
Zaitseva Lidya A., Junior Researcher of the Carcinogenesis Laboratory of the Diagnostic Department, N.N. Alexandrov National Cancer Center of Belarus, Minsk, Republic of Belarus.
http://orcid.org/0000-0001-8004-1942
Shishlo Iosif F., PhD, Oncologist-Surgeon, the Hepatopancreatobiliary Pathology Unit, N.N. Alexandrov National Cancer Center of Belarus, Minsk, Republic of Belarus.
http://orcid.org/0000-0002-3114-3974
Poluyanchik Andrei V., PhD, Head of the Operative Unit, N.N. Alexandrov National Cancer Center of Belarus, Minsk, Republic of Belarus.
http://orcid.org/0000-0003-0718-1548
Krasny Sergey A., MD, Professor, Corresponding Member of NAS of RB, Deputy Director for Research, N.N. Alexandrov National Cancer Center of Belarus, Minsk, Republic of Belarus.
https://orcid.org/0000-0003-3244-5664

ONCOLOGY

YA. A. SHLIAKHTUNOU

CLINICAL IMPORTANCE OF EXPRESSION OF BIRC5 AND HER2-NEU GENES IN CIRCULATING TUMOR CELLS AS MARKERS OF MINIMUM RESIDUAL DISEASE IN SURGICAL TREATMENT OF BREAST CANCER

Vitebsk State Medical University, Vitebsk,
The Republic of Belarus

Objective. To evaluate the clinical significance of the expression of BIRC5 and HER2-neu genes in circulating tumor cells as markers of minimal residual disease at the stage of surgical treatment of breast cancer.
Methods. 162 patients with the verified breast cancer of the I–IIIC stage aged 58.16±9.98 years took part in the study. All women underwent surgery in the amount of a Madden radical mastectomy – 113 (69.8%) or radical resection – 49 (30.2%). All patients on the day of surgery and also on the 2nd day after the operation were examined for the presence of circulating tumor cells (CTCs) in the peripheral blood. For the identification of CTCs, expression of the BIRC5 and HER2-neu genes was studied using real-time polymerase chain reaction (RT-PCR).
Results. Positive mRNAs BIRC5 and HER2-neu CTCs before the surgery were detected in 115 women (71%). After the operation, CTCs disappeared in 47 (40.9%) patients, in 59 (51.3%) CTCs were preserved, and in 9 (7.8%) CTCs were first identified in the venous blood. After mastectomy the frequency of preservation of CTCs was significantly lower than after radical resection and was 46.9% compared to 61.8% (p=0.039). The frequency of preservation of CTCs after surgery was significantly higher in the early stages (I–IIA) – 66.2% than in more advanced stages (IIB–IIIC) – 45.0%.
Conclusions. Determination of the expression of the BIRC5 and HER2-neu gene in the enriched peripheral blood sample is a reliable identifier of the CTCs and the minimal residual disease marker. Early dissemination of tumor cells helps maintain CTCs in the peripheral blood of patients to 51.3%, despite the surgical intervention.

Keywords: breast cancer, minimal residual disease, circulating tumor cells, survivin, epidermal growth factor receptor
p. 457-464 of the original issue
References
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Address for correspondence:
210023, The Republic of Belarus,
Vitebsk, Frunze Ave., 27,
Vitebsk State Medical University,
Department of Oncology
With the Courses
Of RD, RT, FST and SRT,
Tel. office: +375 212 57-64-16,
e-mail: Evgenij-shlyakhtunov@yandex.ru,
Yauheni A. Shliakhtunou
Information about the authors:
Shliakhtunou Yauheni A., PhD, Associate Professor of the Department of Oncology with the Courses of RD, RT, FST and SRT, Vitebsk State Medical University, Vitebsk, Republic of Belarus.
https://orcid.org/0000-0002-5906-5373

REVIEWS

YU.S. LOBANOV, S.L. LOBANOV, K.G. SHAPOVALOV

CHANGES IN MICROCIRCULATION DUE TO INTRA-ABDOMINAL HYPERTENSION IN SURGERY

Chita State Medical Academy, Chita,
The Russian Federation

The introduction of modern surgical technologies is often accompanied by negative effects. The use of endoscopic techniques can lead to the development of the phenomenon of intra-abdominal hypertension, which is also found in many pathological processes in the abdominal cavity. One of serious complications is hemodynamic disorder, hemostasis system disorders leading to thrombosis and thromboembolism. Long-term hypertension is accompanied by the development of the abdominal compartment syndrome with the development of multiple organ failure. It is important to prevent complications.
This review presents current data on the disorders in the microcirculation system arising when intra-abdominal pressure increases. Pathophysiological reactions in the hemostatic system are studied. The study of the influence of intraperitoneal hypertension, created as a result of pneumoperitoneum, on coagulation and fibrinolysis under general anesthesia, revealed negative changes in the postoperative period, which led to activation of clotting factors and inhibition of fibrinolysis. Studies of the endothelial function in case of intra-abdominal hypertension are presented. Possible markers with the help of which it is possible to predict pathological reactions are considered.
The conducted literature review shows that shifts of hemocoagulation in patients with calculous cholecystitis can contribute to the development of venous thromboembolism. The root cause of endothelial dysfunction can also be a regional disturbance of microcirculation.

Keywords: intra-abdominal hypertension, hemostasis, endothelium, microcirculation, venous thromboembolism
p. 465-472 of the original issue
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Address for correspondence:
672000, The Russian Federation,
Chita, Gorky Str., 39A,
Chita State Medical Academy,
Department of Faculty Surgery
With the Course of Urology,
Tel.: +7(3022)35-43-24,
e-mail: slobanov15@mail.ru,
Sergey L. Lobanov
Information about the authors:
Lobanov Yuriy S., PhD, Assistant of the Department of Faculty Surgery with the Course of Urology, Chita State Medical Academy, Chita, Russian Federation.
http://orcid.org/0000-0002-9398-1447
Lobanov Sergey L., MD, Professor, Head of the Department of Faculty Surgery with the Course of Urology, Chita State Medical Academy, Chita, Russian Federation.
http://orcid.org/0000-0003-1665-3754
Shapovalov Konstantin G., MD, Professor, Head of the Department of Anesthesiology and Resuscitation, Chita State Medical Academy, Chita, Russian Federation.
http://orcid.org/0000-0002-3485-5176

E.V. IVANOV

VARICOSE ECZEMA: CURRENT STATE OF THE PROBLEM

Tyumen State Medical University, Tyumen
The Russian Federation

The purpose of the review is to analyze the literature concerning varicose eczema, to reveal unsolved issues of diagnosis and current trends in the treatment of this pathology.
Varicose eczema, being a frequent dermatological complication of chronic vein diseases, nevertheless remains an insufficiently studied problem. Varicose eczema is not a dangerous disease, but it significantly reduces the patients’ quality of life. The term «varicose eczema», although it has become common, is ambiguous. The problem of varicose eczema is first of all an organizational one: for effective diagnosis and treatment of varicose eczema the cooperation of surgeons and dermatologists is necessary. There is no unified approach to the diagnosis of skin lesions in chronic venous insufficiency. The difficulty lies in the diversity of the skin changes in this pathology. The proposed algorithm and diagnostic criteria can fill this gap. The tactics of treating varicose eczema is mainly developed. Treatment of varicose eczema includes treatment of chronic venous insufficiency (elimination of venous reflux by surgery or sclerotherapy, phlebotonic drugs, elastic compression) and treatment of skin changes (systemic and topical antibacterial remedies, steroid and immunosuppressive therapy). Elastic compression in case of significant exudation is the subject of discussion. If surgical treatment is impossible, the amount of conservative therapy necessary and sufficient to achieve the remission of varicose eczema is unclear.
Conclusions. Further study of the advantages of modern endovenous methods over classical phlebectomy in treatment of varicose eczema is required.
Keywords: chronic venous insufficiency, dermatologic complications, varicose eczema, differential diagnostics, phlebectomy, sclerotherapy, conservative treatment

Keywords: chronic venous insufficiency, dermatologic complications, varicose eczema, differential diagnostics, phlebectomy, sclerotherapy, conservative treatment
p. 473-481 of the original issue
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Address for correspondence:
625023, The Russian Federation,
Tyumen, Odesskaya Str., 54,
Tyumen State Medical University,
Department of Surgical Diseases,
Tel. mobile: +7912 922 3054,
e-mail: ivanov_ev@mail.ru,
Evgeny V. Ivanov
Information about the authors:
Ivanov Evgeny V., PhD, Associate Professor of the Department of Surgical Diseases, Tyumen State Medical University, Tyumen, Russian Federation.
http://orcid.org/0000-0001-7618-2793

A.V. DOGA, D.A. BURYAKOV, B.A. NORMAEV

FLOATERS OF THE VITREOUS BODY: MODERN APPROACHES TO TREATMENT

S. Fyodorov Eye Microsurgery Federal State Institution, Moscow,
The Russian Federation

Vitreous floaters are the structural changes of the vitreous body accompanied by formation of vitreous collagen conglomerates that result in light scattering, umbra formation towards the retina and reducing of patients’ life quality and vision quality.
This article is devoted to modern aspects of the anatomy and physiology of the vitreous body, the etiology and pathogenesis of its structure changes, modern imaging and diagnostic techniques of vitreous floaters, assessment of vision quality in patients with vitreous floaters and treatment approaches based on the literature review. At the moment there is no universal solution to the problem of vitreous floaters treatment. In most cases, dynamic observation is proposed to patients. The efficacy of the conservative therapy has not been proven and the elaboration of alternative treatment methods is needed. The analysis of other authors’ publications concerning this pathology treatment testifies to the fact, that current surgical and laser techniques are highly effective but at the same time they have a number of limitations and peculiarities, therefore a further investigation of efficacy and safety issues is required.

Keywords: vitreous floaters, vitreous body, YAG-laser vitreolysis, quality of life, questionnaire, eye diseases
p. 482-490 of the original issue
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Address for correspondence:
127486, The Russian Federation,
Moscow, Beskudnikovsky Boul., 59A,
S. Fyodorov Eye Microsurgery
Federal State Institution,
Department of the Retinal Laser Surgery,
Tel. mobile +79651896925,
e-mail: normaev.b.a@mail.ru,
Badma A. Normaev
Information about the authors:
Doga Alexander V., MD, Professor, Deputy General Director for Scientific and Clinical Work, S. Fyodorov Eye Microsurgery Federal State Institution, Moscow, Russian Federation.
http://orcid.org/0000-0003-2519-8941
Buryakov Dmitry A., PhD, Junior Researcher of the Department of the Retinal Laser Surgery, S. Fyodorov Eye Microsurgery Federal State Institution, Moscow, Russian Federation.
http://orcid.org/0000-0002-4528-1446
Normaev Badma A., Day-Time Post-Graduate Student of the Department of the Retinal Laser Surgery, S. Fyodorov Eye Microsurgery Federal State Institution, Moscow, Russian Federation.
http://orcid.org/0000-0003-3627-2908

CASE REPORTS

I.M. EFREMOV, F.YA. SIBAEV

MEDULLOSCOPY IN THE TREATMENT OF COMPLICATIONS OF INTRAMEDULLARY OSTEOSYNTHESIS WITH AN ANTIMICROBIAL COATING NAIL (CLINICAL CASE)

Ulyanovsk State University, Ulyanovsk, The Russian Federation

One of the ways to treat patients with open fractures and infected false joints of long tubular bones is intramedullary osteosynthes is with antimicrobial-coated nails. Among the possible complications of this type of osteosynthesisis the rarely encountered and little-lit migration of the antimicrobial coating of the nail.
A clinical case of treatment of a patient with chronic osteomyelitis of the femur is presented, the recurring course of which was caused by the presence of a cement mantle from an intramedullary nail with antimicrobial coating. With the aim of arresting the osteomyelitic process, radical debridement and removal of the cement mantle from the medullary canal were performed. To further "sterilize" the surgical wound, an ultrasonic cavitation of the wound in a solution of gentamicin was performed, as well as treatment with the pulse-lavage system. Additionally, muscular hernia of m. quadriceps femoris was eliminated by mobilizing and suturing the fascia lata. In order to control the sanitation of the medullary canal, the medulloscopy of the right femur was performed by a flexible video endoscope. The endoscope was introduced in the medullary canal through the exposed and treated osteomyelitiscavity in the middle third of the femur. The patient was examined 1.5 years after the operation. As a result of the treatment, a stable remission of chronic osteomyelitis had been achieved.
Medulloscopy of a long tubular bone is a promising method of quality control of surgical sanitation. Migration of cement mantle is a rare complication, which must be taken into account when implanting and removing the intramedullary nail with antimicrobial coating.

Keywords: medulloscopy, intramedullary nail with antimicrobial coating, cement mantle, osteomyelitis, fracture fixation
p. 491-495 of the original issue
References
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Address for correspondence:
432017, The Russian Federation,
Ulyanovsk, Leo Tolstoy Str., 2,
Ulyanovsk State University,
Department of Hospital Surgery,
Tel.: +7 917 612 41 77,
e-mail: efremov-im@rambler.ru,
Ivan M. Efremov
Information about the authors:
Efremov Ivan M., PhD, Senior Researcher, Department of Scientific Research, Associate Professor of the Department of Hospital Surgery, Anesthesiology, Reanimatology, Urology, Traumatology and Orthopedics, Ulyanovsk State University, Ulyanovsk, Russian Federation.
http://orcid.org/0000-0002-4625-8424
Sibaev Farid Ya., Laboratory Assistant Researcher of the Department of Scientific Research, Ulyanovsk State University, Ulyanovsk, Russian Federation.
http://orcid.org/0000-0002-7009-8192

S.P. DOSMAGAMBETOV, B.K. DZHENALAEV, B.N. BISALIEV, A.B. TUSUPKALIEV, A. BATYROV

CONGENITAL CYSTIC LUNG MALFORMATION IN NEWBORNS

West Kazakhstan Marat Ospanov State Medical University,
Aktobe, Kazakhstan

Objective. To assess diagnostic and therapeutic measures in rare malformation of the lungs of a newborn.
Methods. The clinical case of congenital cystic malformation of the lungs in a newborn is given. Clinical symptoms, diagnostics, intraoperative tactics, and postoperative management are described.
Results. The analysis of case history of a newborn with congenital lung malformation denotes the manifestation of respiratory distress syndrome in the first hours of a child’s life. Computed tomography (CT) of the lungs allowed not only to confirm the nature of the changes in the left lung, but also to clarify the localization of the lesion, the condition of not affected areas of the lung, the degree of mediastinum displacement, allowed to make a differential diagnosis with other congenital lung malformations. Removing the affected area of the left lung resulted in a decrease of respiratory failure, elimination of hemodynamic disorders and pulmonary hypertension.
Conclusions. Congenital cystic lung malformation is a rather rare malformation. But if malformation of the lung is not diagnosed during antenatal period, then its diagnostics from the first days of a child’s life could be not a simple task. The manifestation of respiratory distress syndrome in a child with the first days of life, the correct interpretation of the plan X-ray pictures of the chest, CT of the lungs allow to put diagnosis correctly and in proper time. The removal of a faulty lobe of the lung in the neonatal period is a pathogenetically justified method of treatment. In the postoperative period children require long-term follow-up.

Keywords: congenital malformation of the lung, cystic malformation of the lung, ñystic hypoplasia of the lung, respiratory distress syndrome, pneumothorax, diagnosis, surgical treatment
p. 496-501 of the original issue
References
  1. Karavaeva SA, Nemilova TK, Kotin AN, Patrikeeva TV, Starevskaya SV, Il’ina NA, Borisova NA. Diagnostics and treatment of congenital malformations of the lung and mediastinum in newborn children and infants. Vestn Khirurgii Im II Grekova. 2015;174(1):40-42. https://elibrary.ru/item.asp?id=22943115 (in Russ.)
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Address for correspondence:
030020, Kazakhstan,
Aktobe, Maresyev Str., 68,
West Kazakhstan Marat Ospanov
State Medical University,
Department of Pediatric Surgery,
Tel. mobile: 8-701-559-68-10,
e-mail: dossag2011@mail.ru,
Sagidulla P. Dosmagambetov
Information about the authors:
Dosmagambetov Sagidulla P., PhD, Associate Professor of the Department of Pediatric Surgery, West Kazakhstan Marat Ospanov State Medical University, Aktobe, Kazakhstan.
https://orcid.org/0000-0002-6525-8438
Dzhenalaev Bulat Ê., MD, Professor of the Department of Pediatric Surgery, West Kazakhstan Marat Ospanov State Medical University, Aktobe, Kazakhstan.
https://orcid.org/0000-0001-7494-5072
Bisaliev Baurzhan N., PhD, Associate Professor of the Department of Pediatric Surgery, West Kazakhstan Marat Ospanov State Medical University, Aktobe, Kazakhstan.
https://orcid.org/0000-0002-4875-1140
Tusupkaliev Asylbek B., PhD, Associate Professor, Head of the Department of Pediatric Surgery, West Kazakhstan Marat Ospanov State Medical University, Aktobe, Kazakhstan.
https://orcid.org/0000-0003-2386-2984
Batyrov Ashat, 3rd Year of Study Resident of the Department of Pediatric Surgery, West Kazakhstan Marat Ospanov State Medical University, Aktobe, Kazakhstan.
https://orcid.org/0000-0001-8207-5898

EXCHANGE OF EXPERIENCE

B.Î. ÌATVIYCHUK 1, YU.Y. HOLYK 1, Y.M. KNYSH 2, V.Ò. BOCHAR 1, Ò.Ì. FEDORYSHYN 2

RESULTS OF RENDERING MEDICAL AID TO VICTIMS WITH PENETRATING HEART IINJURIES AT THE GENERAL SURGERY DEPARTMENT

Danylo Halytsky Lviv National Medical University 1,
Communal City Clinical Emergency Hospital 2, Lviv,
Ukraine

Objective. To analyze the results of providing aid to the victims with the heart injuries at the general surgery department.
Methods. The retrospective analysis of the treatment results of 21 victims with penetrating injuries of the heart has been performed. There were 5 (23.8%) patients with stable hemodynamic parameters, 11 (52.4%) – with unstable parameters, 5 (23.8%) were delivered to the hospital in the preagony state. According to the criteria of American Association of Surgery Trauma (AAST), the class I of heart injury was diagnosed in 4 (19%) of the victims, III – in 1 (4.8%), IV – in 5 (23.8%), V – 10 (47.6%), VI – in 1 (4.8%) cases. According to the localization of cardiac trauma the left ventricle was most often damaged – in 10 (47.6%) cases, the left atrium – in 6 (28.6%) and the right ventricle – in 5 (23.8%) cases.
Results. For the access to the heart in 20 patients, the anterolateral thoracotomy in the IV-V intercostal space was applied, only in one case, the bilateral thoracosternotomy («clamshell») was used. 7 (33%) patients died, the cause of death in 4 (19%) was the hemorrhagic shock due to massive blood loss, in 2 (9.5%) - cardiac tamponade, 1 (4.7%) patient died of acute myocardial infarction on the second day after the surgery. Overall postoperative mortality made up 33%. As the analysis demonstrates, the condition of the patient’s hemodynamics determines a differentiated approach to the corresponding diagnostic algorithm. The main method of treatment of heart injuries is emergent thoracotomy, temporary bleeding stop with subsequent suturing the wound of the heart against the background of resuscitation measures.
Conclusions. Survival rate of patients with heart injuries depends on the appropriate evacuation and medical measures at the prehospital stage, compliance with the organizational algorithm of providing medical care and qualification of medical personnel.

Keywords: heart injuries, pericardial wound, cardiac tamponade, hemodynamic stability, hemodynamic instability
p. 502-508 of the original issue
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Address for correspondence:
79010, Ukraine,
Lviv, Pekarskaya Str., 69,
Danylo Halytsky Lviv
National Medical University,
Department of Surgery and Endoscopy
of the Faculty of Post-Graduate Training,
tel. +38 067 977-36-68,
e-mail: bovotar@ukr.net,
Volodymyr B. Bochar
Information about the authors:
Matviychuk Bohdan O., MD, Professor, Head of the Department of Surgery and Endoscopy of the Faculty of Post-Graduate Training, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.
http://orcid.org/0000-0001-5749-0643
Holyk Yurij I., PhD, Assistant of the Department of Surgery and Endoscopy of the Faculty of Post-Graduate Training, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.
http://orcid.org/0000-0002-2367-7204
Knysh Jaroslav M., PhD, Surgeon, the 1st Surgical Unit, Communal City Emergency Hospital, Lviv, Ukraine.
http://orcid.org/0000-0003-0106-3436
Bochar Volodymyr T., PhD, Associate Professor of the Department of Surgery and Endoscopy of the Faculty of Post-Graduate Training, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.
http://orcid.org/0000-0002-5100-8657
Fedoryshyn Taras M., PhD, Surgeon, the 1st Surgical Unit, Communal City Emergency Hospital, Lviv, Ukraine.
http://orcid.org/0000-0002-8683-1221
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