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Khirurgii

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Year 2018 Vol. 26 No 5

SCIENTIFIC PUBLICATIONS
EXPERIMENTAL SURGERY

T.A. STUPINA, M.A. STEPANOV, N.I. ANTONOV

STRUCTURAL REORGANIZATION OF THE KNEE ARTICULAR CARTILAGE IN DISTRACTION
FEMORAL OSTEOSYNTHESIS COMBINED WITH BONE PLATE

Russian Ilizarov Scientific Center “Restorative Traumatology and Orthopaedics”, Kurgan,
The Russian Federation

Objective. To analyze the dynamics of changes in the knee articular cartilage in the distraction femoral osteosynthesis combined with a bone plate.
Methods. The articular cartilage of the knee joint was studied experimentally using X-ray, histological and quantitative methods techniques in six mongrel dogs in the distraction femoral osteosynthesis with the rate of 1 mm for four times combined with bone plate. The studies were carried out 30 and 90 days after the plate fixation.
Results. In the distraction femoral osteosynthesis combined with a bone plate, an active osteogenesis was observed with forming a typical normoplastic regenerated bone. The period of fixation with the bone plate was 90 days. The knee function in the period of lengthening and up to 30 days of fixation was limited to 90°, the range of motion by the end of the experiment was 130-140° with presenting active static-and-dynamic function of the limb. The destructive changes in the articular cartilage manifested themselves in the zonal structure disorder, fibration visualization of the intercellular substance of the intermediate zone superficial and top parts, substantial decrease in the intercellular substance thickness, volumetric density and chondrocyte area, cell death, while proliferation was suppressed. Disturbance of basophilic line integrity was noted, as well as penetration of vessels into the cartilage, and phenomena of the osteoclastic resorption in the subchondral zone.
Conclusions. When performing distraction femoral osteosynthesis combined with a bone plate destructive changes were revealed in the articular cartilage of the knee joint. The low value of isogenic group proportion and the penetration of vessels into the cartilage evidenced of regressive hyaline cartilage changes and unfavorable functional prognosis. The degree of manifestations of the articular cartilage changes with the studied method of femoral lengthening leads to the conclusion that the development of the technologies optimal for functional rehabilitation should be continued in further experimental studies.

Keywords: combined osteosynthesis, femur, knee joint, cartilage, histomorphometry, experiment on animals
p. 519-525 of the original issue
References
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  2. Sun XT, Easwar TR, Manesh S, Ryu JH, Song SH, Kim SJ, Song HR. Complications and outcome of tibial lengthening using the Ilizarov method with or without a supplementary intramedullary nail: a case-matched comparative study. J Bone Joint Surg Br. 2011 Jun;93(6):782-87. doi: 10.1302/0301-620X.93B6.25521
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  6. Pavlova VN, Pavlov GG, Shostak NA, Slutskii LI. Sustav: Morfologiia, klinika, diagnostika, lechenie. Moscow, RF: Med inform agenstvo; 2011. 552 p. https://www.ozon.ru/context/detail/id/5664881/ (in Russ.)
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  14. Kim HK, Bian H, Aya-ay J, Garces A, Morgan EF, Gilbert SR. Hypoxia and HIF-1alpha expression in the epiphyseal cartilage following ischemic injury to the immature femoral head. Bone. 2009 Aug;45(2):280-88. doi: 10.1016/j.bone.2009.03.665
  15. Kawcak CE, McIlwraith CW, Norrdin RW, Park RD, James SP. The role of subchondral bone in joint disease: a review. Equine Vet J. 2001 Mar;33(2):120-26. doi: 10.1111/j.2042-3306.2001.tb00589.x
Address for correspondence:
640014, The Russian Federation,
Kurgan, M. Ulyanova Str., 6,
Russian Ilizarov Scientific Center
“Restorative Traumatology and Orthopaedics”,
Laboratory of Morphology.
Tel. office: +7 3522 41 52 27,
e-mail: StupinaSTA@mail.ru,
Tatyana A. Stupina
Information about the authors:
Stupina Tatyana A., MD, Senior Researcher of the Laboratory of Morphology, Russian Ilizarov Scientific Center “Restorative Traumatology and Orthopaedics”, Kurgan, Russian Federation.
http://orcid.org/0000-0003-3434-0372
Stepanov Mikhail A., PhD, Leading Researcher of the Experimental Laboratory, Russian Ilizarov Scientific Center “Restorative Traumatology and Orthopaedics”, Kurgan, Russian Federation.
http://orcid.org/0000-0002-4930-625X
Antonov Nicolai I., PhD, Researcher of the Experimental Laboratory, Russian Ilizarov Scientific Center “Restorative Traumatology and Orthopaedics”, Kurgan, Russian Federation.
http://orcid.org/0000-0002-8627-2749

V.D. SHYSHCHUK1, S.I. REDKO1, M.N. OGIENKO2, D.V. OVECHKIN1, L.V. TOMIN1

DISTURBANCES OF REPARATIVE OSTEOGENESIS IN THE HYPOVOLEMIA AND THEIR CORRECTION IN EXPERIMENT

Sumy State University 1,
Sumy City Clinical Hospital ¹5 2, Sumy,
Ukraine

Objective. To study reparative osteogenesis features in a long tubular bone of rats with moderate isoosmolar dehydration and the determination of the possibility to correlate the morphofunctional changes, caused by dehydration using the drug Actovegin.
Methods. In male Wistar rats in the control (n=21) and experimental (n=21) groups, the trauma was simulated by applying a perforated defect in the middle third of the both tibia bones diaphysis. Moderate dehydration was achieved by total water deprivation for 6-7 days until 6-10% animal weight loss was reached. In the experimental group, Actovegin was administered 2 mg intramuscularly every other day. The introduction of the drug began immediately after the injury and continued until the end of the experiment. On the 3rd, 15th and 24th day, histological examination, morphometry and scanning electron microscopy was carried out to study morphological changes in rat tibial reclaims.
Results. Moderate isoîsmolar dehydration caused a disruption of cellular and tissue balance which slowed down the bone regeneration process without changing the staging of their course. As a result, a normal bone callus did not have time to form in expected terms. Actovegin stimulated the reparative bone regeneration, the ratio of tissue components of the regenerate changed, the area increased and the qualitative properties of coarse-fiber and lamellar bone tissues were improved in comparison with the indices of animals in the control group. An increase in the total area and diameter of the vessels in the regenerate was registered.
Conclusions. The use of the drug Àctovegin permitted to optimize the blood circulation in the damaged segment and to accelerate the processes of bone restructuring and maturation resulting in the formation of a full-blown bone callus.

Keywords: actovegin, dehydration, bony callus, morphometry, raster microscopy
p. 526-534 of the original issue
References
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  11. Logosha AI, Slisarenko AV, Ogienko MN, Bumeister VI, Prikhod’ko OA. Reparativnyi osteogenez trubchatykh kostei v usloviiakh narusheniia vodno-solevogo obmena. Georgian Medical News. 2013;(10):80-86. http://www.geomednews.org (in Russ.)
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Address for correspondence:
40018, Ukraine,
Sumy, Sanatornaya Str., 31,
Medical Institute of Sumy State University,
Department of Orthopedics
and Traumatology,
Tel. mob.: 380 066 08 27 869,
e-mail: redko-03@ukr.net,
Sergiy I. Redko
Information about the authors:
Shyshchuk Volodymir D., MD, Professor, Head of the Department of Orthopedics and Traumatology of Medical Institute, Sumy State University, Sumy, Ukraine.
https://orcid.org/0000-0003-3077-5651
Redko Sergiy I., Assistant of the Department of Orthopedics and Traumatology of Medical Institute, Sumy State University, Sumy, Ukraine.
https://orcid.org/0000-0001-8711-0429
Ogienko Maksym N., PhD, Physician, Sumy City Clinical Hospital ¹5, Sumy, Ukraine.
https://orcid.org/0000-0002-3208-4160
Ovechkin Denys V., PhD, Associate Professor of the Department of Orthopedics and Traumatology of Medical Institute, Sumy State University, Sumy, Ukraine.
https://orcid.org/0000-0003-1969-9272
Tomin Lubov V., Post-Graduate Student of the Department of Orthopedics and Traumatology of Medical Institute, Sumy State University, Sumy, Ukraine.
https://orcid.org/0000-0002-7239-6388

GENERAL & SPECIAL SURGERY

O.F. SOVTUS, R.V. SABADOSH

USE OF ENDOVASCULAR AND COMBINED INTERVENTIONS IN OBLITERATING OCCLUSIVE-STENOTIC ARTERIAL DISEASES OF THE LOWER LIMBS

Ivano-Frankivsk National Medical University, Ivano-Frankivsk,
Ukraine

Objective. To improve the results of treatment in patients with lower limb artery occlusive-stenotic diseases, where open operations are impossible or involve a high risk, by using endovascular interventions.
Methods. 53 patients have been treated, they underwent endovascular revascularization of lower limb artery different segments (I group – aortoiliac with or without femoropopliteal; IIÀ – femoropopliteal; IIB – femoropopliteal and infrapopliteal; III – infrapopliteal) with/without of the additional open operations on other segments. During the year a technical success of the procedures, the primary and secondary patency of intervention zones, the frequency of conservation and the degree of limb ischemia were assessed.
Results. The technical success was achieved in 94.3% of patients, 1-year secondary patency was achieved in 92.5%, the preservation of the lower limbs was achieved in 96.2%. In group I, where 60% of patients underwent hybrid operations (endovascular stage - on aortoiliac segment), a positive technical result was obtained in all the patients; stent thrombosis, necrotic processes, ischemia above grade IIA (Fontaine) were not observed during one year. Identical results were obtained in the IIA group. In the III group, which was based on patients with total occlusion of the lower leg and foot main arteries or total circular calcification of their post-occlusal segments, the technical success was 84.6%, the one-year primary patency was 76.9%, and limb salvage was 100%. In Group IIB these indicators were 91.7, 75.0 and 83.3%, respectively.
Conclusions. The careful application of endovascular interventions in stenosis and occlusions of the lower limbs arteries allows achieving technical success, primary and secondary patency of the revascularization zone and one-year limb salvage in 88.7-96.2% of patients. Endovascular treatment can be recommended as the method of choice in complete occlusion of the lower leg and foot main arteries, total circular calcification of their post-occlusal segments and for revascularization of aortoiliac segment in case of its combined lesions with the femoropopliteal segment at hybrid operations.

Keywords: peripheral arterial disease, critical limb ischemia, lower limb balloon angioplasty, stenting, hybrid procedures
p. 535-546 of the original issue
References
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  2. Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FG; TASC II Working Group, Bell K, Caporusso J, Durand-Zaleski I, Komori K, Lammer J, Liapis C, Novo S, Razavi M, Robbs J, Schaper N, Shigematsu H, Sapoval M, White C, White J, Clement D, Creager M, Jaff M, Mohler E 3rd, Rutherford RB, Sheehan P, Sillesen H, Rosenfield K. Inter-society consensus for the management of peripheral arterial disease (TASC II). Eur J Vasc Endovasc Surg. 2007;33 (Suppl 1):S1-75. doi: 10.1016/j.ejvs.2006.09.024
  3. Tendera M, Aboyans V, Bartelink ML, Baumgartner I, Clément D, Collet JP, Cremonesi A, De Carlo M, Erbel R, Fowkes FG, Heras M, Kownator S, Minar E, Ostergren J, Poldermans D, Riambau V, Roffi M, Röther J, Sievert H, van Sambeek M, Zeller T. ESC Guidelines on the diagnosis and treatment of peripheral artery diseases: Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries: the task force on the diagnosis and treatment of peripheral artery diseases of the european society of cardiology (ESC). Eur Heart J. 2011 Nov;32(22):2851-906. doi: 10.1093/eurheartj/ehr211
  4. Aboyans V, Ricco JB, Bartelink MLEL, Björck M, Brodmann M, Cohnert T, Collet JP, Czerny M, De Carlo M, Debus S, Espinola-Klein C, Kahan T, Kownator S, Mazzolai L, Naylor AR, Roffi M, Röther J, Sprynger M, Tendera M, Tepe G, Venermo M, Vlachopoulos C, Desormais I. Editor’s Choice – 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2018;55(3):305-68. doi: 10.1016/j.ejvs.2017.07.018
  5. Stoner MC, Calligaro KD, Chaer RA, Dietzek AM, Farber A, Guzman RJ, Hamdan AD, Landry GJ, Yamagu DJ. Reporting standards of the Society for Vascular Surgery for endovascular treatment of chronic lower extremity peripheral artery disease. J Vasc Surg. 2016 Jul;64(1):e1-e21. doi: 10.1016/j.jvs.2016.03.420
  6. Mills JL Sr, Conte MS, Armstrong DG, Pomposelli FB, Schanzer A, Sidawy AN, Andros G. The Society for Vascular Surgery Lower Extremity Threatened Limb Classification System: risk stratification based on wound, ischemia, and foot infection (WIfI). J Vasc Surg. 2014 Jan;59(1):220-34.e1-2. doi: 10.1016/j.jvs.2013.08.003
  7. TASC Steering Committee, Jaff MR, White CJ, Hiatt WR, Fowkes GR, Dormandy J, Razavi M, Reekers J, Norgren L. An update on methods for revascularization and expansion of the TASC lesion classification to include below-the-knee arteries: a supplement to the inter-society consensus for the management of peripheral arterial disease (TASC II). Ann Vasc Dis. 2015;8(4):343–57. doi: 10.1177/1358863X15597877
  8. Olin JW, White CJ, Armstrong EJ, Kadian-Dodov D, Hiatt WR. Peripheral artery disease: evolving role of exercise, medical therapy, and endovascular options. J Am Coll Cardiol. 2016 Mar 22;67(11):1338-57. doi: 10.1016/j.jacc.2015.12.049
  9. Clair DG, Beach JM. Strategies for managing aortoiliac occlusions: access, treatment and outcomes. Expert Rev Cardiovasc Ther. 2015 May;13(5):551-63. doi: 10.1586/14779072.2015.1036741
  10. Antoniou GA, Georgiadis GS, Antoniou SA, Makar RR, Smout JD, Torella F. Bypass surgery for chronic lower limb ischaemia. Cochrane Database Syst Rev. 2017 Apr 3;4:CD002000. doi: 10.1002/14651858.CD002000.pub3
  11. Goloshchapov-Aksenov RS, Shugushev ZKh, Matveev DV, Maximkin DA, Lakunin KYu. Evaluation of the effectiveness of endovascular treatment of patients with obliterating atherosclerosis of lower limb arteries with long occlusions of the superficial femoral artery. Vestn RUDN. Ser Meditsina.2017;21(2):234-45. doi: 10.22363/2313-0245-2017-21-2-234-245 (in Russ.)
  12. Gray BH, Diaz-Sandoval LJ, Dieter RS, Jaff MR, White CJ. SCAI expert consensus statement for infrapopliteal arterial intervention appropriate use. Catheter Cardiovasc Interv. 2014 Oct 1;84(4):539-45. doi: 10.1002/ccd.25395
  13. TASC Steering Committee, Jaff MR, White CJ, Hiatt WR, Fowkes GR, Dormandy J, Razavi M, Reekers J, Norgren L. An update on methods for revascularization and expansion of the TASC lesion classification to include below-the-knee arteries: a supplement to the inter-society consensus for the management of peripheral arterial disease (TASC II). Vasc Med. 2015 Oct;20(5):465-78. doi: 10.1177/1358863X15597877
Address for correspondence:
76018, Ukraine,
Ivano-Frankivsk, Galitskaya Str., 2,
Ivano-Frankivsk National Medical University,
Surgery Department of the Stomatological Faculty,
Tel. +38-097-933-52-94,
e-mail: r.sabadosh@gmail.com,
Rostyslav V. Sabadosh
Information about the authors:
Sovtus Oleg F., Post-Graduate Student of the Surgery Department of the Stomatological Faculty, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine.
http://orcid.org/0000-0001-9125-7570
Sabadosh Rostislav V., MD, Professor of the Surgery Department of the Stomatological Faculty, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine.
http://orcid.org/0000-0001-9770-5960

R.E. KALININ, I.A. SUCHKOV, N.D. MZHAVANADZE, E.A. KLIMENTOVA, O.N. ZHURINA, S.A. ISAKOV

INTRINSIC COAGULATION CASCADE FACTORS AND HEMOSTATIC MARKERS OF ENDOTHELIAL DYSFUNCTION IN PATIENTS WITH PERIPHERAL ARTERY DISEASE

Ryazan State Medical University named after Academician I.P. Pavlov, Ryazan,
The Russian Federation

Objective. To assess the activity of intrinsic coagulation cascade factors of coagulation and hemostatic markers of endothelial dysfunction in patients with atherosclerotic peripheral artery disease (PAD) before and after endovascular treatment.
Methods. The study included 80 patients with PAD in the stage IIB-III of the disease according to Pokrovsky-Fontaine classification. 40 patients with PAD underwent endovascular interventions on the femoropopliteal segment (group A) and 40 patients underwent the conservative treatment (group B). Patients underwent physical examination, ankle-brachial index measurement (ABI), duplex ultrasound (DUS) and digital substraction angiography. 3 and 6 months after treatment patients underwent the same procedures. At inclusion of patients in the study and 3 months after the surgery, peripheral venous blood samples were collected to assess the activity of VIII, IX, XI, von Willebrand factor (VWF), protein Ñ (PrC) and metabolites of nitric oxide II (NO).
Results. In patients of the group À mean values of activity VIII, IX, XI factors and VWF were increased in comparison with the norm before the surgery. After 3 months the results shown a greater increase in activity VIII, IX, XI factors, the elevated levels of VWF remained in the reduction of NO metabolites. In patients of the group B the mean activity values of IX, XI factors and VWF were increased with normal levels of NO metabolites and PrC.
Conclusions. The analysis of the initial state of the hemostasis system in patients with atherosclerotic peripheral artery disease allows us to conclude that the hypercoagulable state develops against the background of a normal anticoagulation potential. Operative procedures provide a further shift towards a hypercoagulable state and impaired functional activity of endothelium

Keywords: atherosclerosis, intrinsic coagulation cascade, hemostatic markers of endothelial dysfunction, nitric oxide II, von Willebrand factor
p. 547-554 of the original issue
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  13. Kazantsev AV, Korymasov EA. Diagnostika progressiruiushchego techeniia obliteriruiushchego ateroskleroza bedrenno-podkolenno-bertsovoi lokalizatsii. Fundam Issledovaniia. 2011;(1):62-67. https://www.fundamental-research.ru/ru/article/view?id=15809 (in Russ.)
  14. Gogia S, Neelamegham S. Role of fluid shear stress in regulating VWF structure, function and related blood disorders. Biorheology. 2015;52(5-6):319-35. doi: 10.3233/BIR-15061
  15. Vischer UM. Von Willebrand factor, endothelial dysfunction, and cardiovascular disease. J Thromb Haemost. 2006 Jun;4(6):1186-93. doi: 10.1111/j.1538-7836.2006.01949.x
Address for correspondence:
390026, The Russian Federation,
Ryazan, Vysokovoltnaya Str., 9,
Ryazan State Medical University
Named after Academician I.P. Pavlov,
Department of Cardiovascular,
X-Ray Endovascular,
Operative Surgery
And Topographic Anatomy,
Tel. mobile: +7 4912 46 08 03,
e-mail: Suchkov_med@mail.ru,
Igor A. Suchkov
Information about the authors:
Kalinin Roman E., MD, Professor, Rector, Head of the Department of Cardiovascular, X-Ray Endovascular, Operative Surgery and Topographic Anatomy, Ryazan State Medical University named after Academician I.P. Pavlov, Ryazan, Russian Federation.
http://orcid.org/0000-0002-0817-9573
Suchkov Igor A., MD, Associate Professor, Vice-Rector for Research and Innovative Development, Professor of the Department of Cardiovascular, X-Ray Endovascular, Operative Surgery and Topographic Anatomy, Ryazan State Medical University named after Academician I.P. Pavlov, Ryazan, Russian Federation.
http://orcid.org/0000-0002-1292-5452
Mzhavanadze Nina J., PhD, Assistant of the Department of Cardiovascular, X-Ray Endovascular, Operative Surgery and Topographic Anatomy, Ryazan State Medical University named after Academician I.P. Pavlov, Ryazan, Russian Federation.
http://orcid.org/0000-0001-5437-1112
Klimentova Emma A., Post-Graduate Student of the Department of Cardiovascular, X-Ray Endovascular, Operative Surgery and Topographic Anatomy, Ryazan State Medical University named after Academician I.P. Pavlov, Ryazan, Russian Federation.
http://orcid.org/0000-0003-4855-9068
Zhurina Olga N., PhD, Head of Clinical and Diagnostic Laboratory of the Clinical Research Center for Hematology, Oncology and Immunology, Ryazan State Medical University named after Academician I.P. Pavlov, Ryazan, Russian Federation.
http://orcid.org/0000-0002-6120-4678
Isakov Sergey A., MD, Professor of the Dermatovenereology Department, Ryazan State Medical University named after Academician I.P. Pavlov, Ryazan, Russian Federation.
http://orcid.org/0000-0002-0694-1309

L.A. LICHMAN, S.E. KATORKIN, P.S. ANDREEV, O.E. DAVYDOVA, A.P. MIHAYLICHENKO

PILONIDAL SINUS: NEW APPROACH TO OPERATIVE TREATMENT

Samara State Medical University, Samara,
The Russian Federation

Objective. To improve the results of treatment in patients with the pilonidal sinus by developing and implementing a new method of surgical treatment.
Methods. By random sampling, patients (n=111) were divided into two groups. In the control group (n = 68), a conventional technique was used – the excision of the pilonidal sinus with sutures according to Moshkovich. In the main group (n=43) the developed operative technique – the excision of the pilonidal sinus with wound closure by the method of marsupialization with a continuous suture – was used.
Results. The average duration of immediate surgical treatment: the excision of the pilonidal sinus with closure of the wound by the method of marsupialization with a continuous suture made up 21.9±4.3 min., the excision of the pilonidal sinus with Moshkovich sutures – 30.9±5.4 min., statistically significant differences were not found. With ultrasound of soft tissues in the area of the postoperative wound, the infiltration zone in the main group was 5.3±1.0 mm, in patients of the control group 10.7±0.92 mm, statistically significant differences were found, p <0.05.
In the postoperative period, the patients of the main group showed less intensity of the pain syndrome. Severity of pain in the area of a postoperative wound by VAS for the first day in the main group was 3.6±0.4 and in the control group 5.6±0.6; on the third day, 2.07±0.35 and 4.7±0.6, respectively; on the fifth day 0.96±0.33 and 3.9±0.63; on the tenth day – 0±0.005 and 0.45 ± 0.33. Statistical processing of the obtained results revealed statistically significant differences for the first (p<0.05), the third (p <0.05), the fifth (p < 0.05) day. A statistically significant (χ2=14.8, p<0.05) decrease in the number of early postoperative complications (suppuration of the postoperative wound, inconsistency of cutaneous sutures) in the main group to 4.6% was obtained.
Conclusions. The use of a continuous suture combined with marsupialization to close the wound defect after excision of the pilonidal sinus is an effective method of surgical treatment and allows improving the results of treatment in patients with this pathology.

Keywords: pilonidal sinus, method of wound suturing, continuous suture, surgical treatment, new method
p. 555-562 of the original issue
References
  1. Vorob’ev GI, red. Osnovy koloproktologii. Rostov na Donu, RF: Feniks; 2001. 416 p. https://www.avito.ru/novosibirsk/knigi_i_zhurnaly/osnovy_koloproktologii._uchebnoe_posobie_15624 68083 (in Russ.)
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  3. Magomedova ZK, Chernyshova EV, Groshilin VS. Advantages and application of a new method of surgical treatment of patients with recurrent pilonidal sinus. Ul’ian Med-Biol Zhurn. 2016;(2):98-105. http://medbio.ulsu.ru/images/numbers/2016/2_2016.pdf. (in Russ.)
  4. Dul’tsev IuV, Rivkin VL. Epitelial’nyi kopchikovyi khod. Moscow, SSSR: Meditsina; 1988. 128 p. http://med-books.by/hirurgiya/2913-epitelialnyy-kopchikovyy-hod-dulcev-yuv-rivkin-vl-1988-god-128-s.html (in Russ.)
  5. Lichman LA, Katorkin SE, Andreev PS. Results of surgical treatment of patients with epithelial coccygeal cyst. Vrach-Aspirant. 2017;81(2):19-24. https://elibrary.ru/item.asp?id=28407303 (in Russ.)
  6. Anderson AW. Hair extracted from an ulcer. Boston Med Surg J. 1847;36:74-76.
  7. Denisenko VL. Optimizatsiia lecheniia epitelial’nogo kopchikovogo khoda, oslozhnennogo abstsessom. Novosti Khirurgii. 2008;16(1):55-61. http://www.surgery.by/pdf/full_text/2008_1_7_ft.pdf (in Russ.)
  8. Gulov MK, Zubaidov TN. Choice of surgical treatment of patients with pilonidal fistula. Vestn Avitsenny. 2012;(3):34-39. http://vestnikavicenna.tj/web/upload/global/pdf/2012/3_2012.pdf (in Russ.)
  9. Buie L. Practical proctology. Philadelphia: WB Saunders; 1937. 451 ð.
  10. Gecim IE, Goktug UU, Celasin H. Endoscopic Pilonidal Sinus Treatment Combined With Crystalized Phenol Application May Prevent Recurrence. Dis Colon Rectum. 2017 Apr;60(4):405-407. doi: 10.1097/DCR.0000000000000778
  11. Harris C, Sibbald RG, Mufti A, Somayaji R. Pilonidal Sinus Disease: 10 Steps to Optimize Care. Adv Skin Wound Care. 2016 Oct;29(10):469-78. doi: 10.1097/01.ASW.0000491324.29246.96
  12. Dessily M, Charara F, Ralea S, Allé JL. Pilonidal sinus destruction with a radial laser probe: technique and first Belgian experience. Acta Chir Belg. 2017 Jun;117(3):164-68. doi: 10.1080/00015458.2016.1272285
  13. Isik A, Idiz O, Firat D. Novel Approaches in Pilonidal Sinus Treatment. Prague Med Rep. 2016;117(4):145-52. doi: 10.14712/23362936.2016.15
  14. Cherkasov MF, Galashokyan KM, Startsev YuM, Cherkasov DM. Vacuum therapy in treatment of the pilonidal sinus disease. Koloproktologiia. 2016;(1):35-39. http://www.gnck.ru/pdf/journal_1_55_2016.pdf (in Russ.)
Address for correspondence:
443079, The Russian Federation,
Samara, Karl Marks Ave., 164 B,
Clinic of Samara
State Medical University,
Department and Clinic of Hospital Surgery,
Tel. office: +7 927 900 88 58,
e-mail: lichman163@gmail.com,
Leonid A. Lichman
Information about the authors:
Lichman Leonid A., Surgeon, Surgical Unit, Clinic of Hospital Surgery, Samara State Medical University, Samara, Russian Federation.
https://orcid.org/0000-0002-4817-3360
Katorkin Sergey E., PhD, Associate Professor, Head of the Department and Clinic of Hospital Surgery, Samara State Medical University, Samara, Russian Federation.
https://orcid.org/0000-0001-7473-6692
Andreev Pavel S., PhD, Assistant of the Department of Hospital Surgery, Coloproctologist, Coloproctology Unit, the Clinic of Hospital Surgery, Samara State Medical University, Samara, Russian Federation.
https://orcid.org/0000-0002-0264-7305
Davydova Olga E., Coloproctologist, Coloproctology Unit, the Clinic of Hospital Surgery, Samara State Medical University, Samara, Russian Federation.
https://orcid.org/0000-0002-2403-1990
Mikhailichenko Alena P., Ultrasound Diagnostic Doctor, Samara State Medical University, Samara, Russian Federation.
https://orcid.org/0000-0002-9927-9587

S.V. SHAKHRAY, Y.M. GAIN, M.Y. GAIN, D.V. KUDRYTSKI

EFFICIENCY ASSESSMENT OF COMPLEX TREATMENT OF ANAL CONDYLOMATOSIS

Belarusian Medical Academy of Post-Graduate Education, Minsk,
The Republic of Belarus

Objective. To evaluate the clinical efficacy of the combined method of anal condylomatosis treatment, based on laser tumor destruction and immunomodulatory therapy.
Methods. The study included 2 stages. At the first retrospective stage the analysis of 60 patients with anal condylomatosis treatment using laser and electrosurgical destruction methods was performed, immune therapy was not used. The duration of the wound epithelialization, recurrence rate were studied. In the second, prospect study 60 patients were observed; the physical methods of condyloma destruction were supplemented with the therapy of human recombinant interferon α2b and imiquimod.
Results. According to the data obtained during the study, laser and electrosurgical destruction are effective methods of anal condylomatosis treatment. Laser destruction has certain advantages: higher epithelialization rate in the area of exposure (ANOVA, p=0.00001) and fewer recurrences of the disease in terms of 2 years’ follow-up (Pearson’s chi-squared test, χ2 = 4.89; p=0.0270). The separate use of physical methods in the treatment of this pathology leads to a much greater number of relapses compared with the complex approach, where laser and electrocoagulation destruction is supplemented with immune and antiviral treatment by human recombinant interferon α2b and imiquimod (Cochran’s Q test, Q=9.591549, p = 0.022378). Also the time interval without the disease progressing was longer in this groups (Kaplan-Meier test, p=0.01528).
Conclusions. The results of the study allow us to state that the use of laser radiation for the destruction of anal condylomas has several advantages over electrocoagulation: a lower risk of recurrence, a shorter period of epithelialization of the wound. The use of immunomodulatory therapy with human recombinant interferon α2b and topical application of imiquimod significantly reduces the frequency of the disease recurrence.

Keywords: condylomatosis, anogenital warts, laser, electrosurgical destruction, interferons, imiquimod
p. 563-569 of the original issue
References
  1. Prilepskaia VN, Rogovskaia SI, Kondrikov NI, Sukhikh GT. Papillomavirusnaia infektsiia: diagnostika, lechenie i profilaktika. Moscow, RF: MEDpress-inform; 2007. 32 p. (in Russ.)
  2. Aubin F, Prétet JL, Jacquard AC, Saunier M, Carcopino X, Jaroud F, Pradat P, Soubeyrand B, Leocmach Y, Mougin C, Riethmuller D. Human papillomavirus genotype distribution in external acuminata condylomata: a Large French National Study (EDiTH IV). Clin Infect Dis. 2008 Sep 1;47(5):610-15. doi: 10.1086/590560
  3. Narvskaia OV. Virus papillomy cheloveka. Epidemiologiia, laboratornaia diagnostika i profilaktika papillomavirusnoi infektsii. Infektsiia i Immunitet. 2011;1(1):15-22. https://www.iimmun.ru/iimm/article/viewFile/23/22 (in Russ.)
  4. Fleischer AB Jr, Parrish CA, Glenn R, Feldman SR. Condylomata acuminata (genital warts): patient demographics and treating physicians. Sex Transm Dis. 2001 Nov;28(11):643-47. https://journals.lww.com/stdjournal/Fulltext/2001/11000/Condylomata
  5. Desai S, Wetten S, Woodhall SC, Peters L, Hughes G, Soldan K. Genital warts and cost of care in England. Sex Transm Infect. 2011 Oct;87(6):464-68. doi: 10.1136/sti.2010.048421
  6. Östensson E, Fröberg M, Leval A, Hellström AC, Bäcklund M, Zethraeus N, Andersson S. Cost of preventing, managing, and treating human papillomavirus (HPV)-related diseases in Sweden before the introduction of quadrivalent HPV vaccination. PLoS One. 2015;10(9): e0139062. Published online 2015 Sep 23. doi: 10.1371/journal.pone.0139062
  7. Redklif K. Evropeiskie standarty diagnostiki i lecheniia zabolevanii, peredavaemykh polovym putem: per. s angl. Moscow, RF: Med lit; 2006. 272 p. https://www.ozon.ru/context/detail/id/1492842 (in Russ.)
  8. Shakhrai SV, Kudritskii DV, Gain IuM, Gain MIu. Comparative estimation of efficiency of the modern methods of invasive treatment of perianal area condylomatosis. Innovats Tekhnologii v Meditsine. 2018;(1):29-35. (in Russ.) https://elibrary.ru/item.asp?id=32490418
  9. Bencini PL, Guida S, Cazzaniga S, Pellacani G, Galimberti MG, Bencini M, Naldi L. Risk factors for recurrence after successful treatment of warts: the role of smoking habits. J Eur Acad Dermatol Venereol. 2017 Apr;31(4):712-16. doi: 10.1111/jdv.14086
  10. Volkov VG, Zakharova TV. Practice of using CO2-laser surgery in complex therapy of cervical pathology, associated with human papilloma virus. Vestn Novykh Med Tekhnologii. 2000;7(1):95-97. https://elibrary.ru/item.asp?id=25136262 (in Russ.)
  11. Al-Zahrani D, Raddadi A, Massaad M, Keles S, Jabara HH, Chatila TA, Geha R. Successful interferon-alpha 2b therapy for unremitting warts in a patient with DOCK8 deficiency. Clin Immunol. 2014 Jul;153(1):104-108. doi: 10.1016/j.clim.2014.04.005
  12. Yanofsky VR, Patel RV, Goldenberg G. Genital warts: a comprehensive review. J Clin Aesthet Dermatol. 2012 Jun;5(6):25-36. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3390234/
  13. Petersen CS, Bjerring P, Larsen J, Blaakaer J, Hagdrup H, From E, Obergaard L. Systemic interferon alpha-2b increases the cure rate in laser treated patients with multiple persistent genital warts: a placebo-controlled study. Genitourin Med. 1991 Apr;67(2):99-102. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1194640
Address for correspondence:
220013, The Republic of Belarus,
Minsk, P. Brovki Str., 3-3,
Belarusian Medical Academy of Post-Graduate Education,
Department of Urgent Surgery,
Tel.: +375 17 225 88 10,
e-mail: mishahain@tut.by,
Yuri M. Gain
Information about the authors:
Shakhrai Siarhei V., MD, Professor of the Department of Urgent Surgery, Belarusian Medical Academy of Post-Graduate Education, Minsk, Republic of Belarus.
https://orcid.org/0000-0002-9423-9535
Gain Yuri M., MD, Professor, Vice-Rector for Scientific Work, Belarusian Medical Academy of Post-Graduate Education, Minsk, Republic of Belarus.
https://orcid.org/0000-0001-7622-5642
Gain Mikhail Yu., PhD, Associate Professor of the Department of Urgent Surgery, Belarusian Medical Academy of Post-Graduate Education, Minsk, Republic of Belarus.
https://orcid.org/0000-0001-9012-5277
Kudrytski Dzmitry V., Post-Graduate Student of the Department of Urgent Surgery, Belarusian Medical Academy of Post-Graduate Education, Minsk, Republic of Belarus.
https://orcid.org/0000-0001-8581-2494

A.I. RUNDO, V.A. KOSINETS., I.V. SAMSONOVA

PHOTOTHERAPY IMPACT ON THE INTENSITY OF MAC387-POSITIVE MACROPHAGES EXPRESSION IN DIABETIC FOOT SYNDROME

Vitebsk State Medical University, Vitebsk,
The Republic of Belarus

Objective. To study the expression of the inflammatory response marker anti-macrophage antibody MAC387 in the wound zone in patients with diabetic foot syndrome in case of local and combined phototherapy.
Methods. The expression intensity of macrophages marker MAC387 in the serial microscopic biopsy specimens of the wound defect was analyzed in 158 with purulent-necrotic lesions of the feet against the background of diabetes mellitus type 2 at the surgical department of Vitebsk City Emergency Clinical Hospital. Using the randomization method, 3 groups were formed: 1 – control (57 people); 2 – with additional use in the treatment of phototherapy locally over the wound surface (51 people); 3 – with additional use in the treatment of combined phototherapy locally and intravenously (52 people). The effect of phototherapy was assessed by immunohistochemical staining of the biopsy material using monoclonal antibodies to macrophages anti-macrophage antibody MAC387 on 1, 3-5, 7, 14 days from the beginning of treatment.
Results. The wound process in diabetic foot syndrome is accompanied by an increase in the expression intensity of anti-macrophage antibody MAC387, which can serve as a marker of the duration of its course. The use of a local phototherapy is accompanied with an increased level of the macrophages marker ÌÀÑ387 expression intensity, which demonstrates the positive effect of blue and red light on the inflammatory process course. Combined phototherapy promotes a pronounced increase in the macrophage marker expression by the 7th day and a decrease by the 14th day of therapeutic measures, which indicates a faster onset of the wound process proliferative phase.
Conclusions. In diabetic foot syndrome, the expression intensity of macrophage MAC387 marker changes in the area of the wound defect, which can serve as a criterion for assessing the duration of the wound healing process. The use of local and combined phototherapy allows normalizing the course of the wound process and accelerating the healing of the lower limbs trophic ulcers in patients with diabetic foot syndrome.

Keywords: diabetic foot syndrome, phototherapy, MAC387-positive macrophages, wound process, reparation
p. 570-579 of the original issue
References
  1. Saloko OB, Bogdan EL, Shepel’kevich AP, Shchaveleva MV, Yarosh EA. Rasprostranennost’ khronicheskikh oslozhnenii sakharnogo diabeta v Respublike Belarus’ (po dannym Respublikanskogo registra «Sakharnyi diabet»). Lechebnoe Delo. 2016;(5):31-34. http://lech-delo.by/wpcontent/uploads/content_ld_5_51_2016.jpg (in Russ.)
  2. IDF Diabets atlas [Internet]. 8th ed. [cited 2017 Sep 7]. Available from: http://diabetesatlas.org/resources/2017-atlas.html
  3. Bublik EV, Galstian GR. Epidemiologiia i patogeneticheskie faktory sindroma diabeticheskoi stopy u bol’nykh s terminal’noi stadiei khronicheskoi pochechnoi nedostatochnosti, nakhodiashchikhsia na dialize. Sakhar Diabet. 2007;(3):10-17. https://cyberleninka.ru/article/v/epidemiologiya-i-patogeneticheskie-faktory-sindroma-diabeticheskoy-stopy-u-bolnyh-s-terminalnoy-stadiey-hronicheskoy-pochechnoy (in Russ.)
  4. Tellechea A, Leal EC, Kafanas A, Auster ME, Kuchibhotla S, Ostrovsky Y, Tecilazich F, Baltzis D, Zheng Y, Carvalho E, Zabolotny JM, Weng Z, Petra A, Patel A, Panagiotidou S, Pradhan-Nabzdyk L, Theoharides TC, Veves A. Mast cells regulate wound healing in diabetes. Diabetes. 2016 Jul;65(7):2006-19. doi: 10.2337/db15-0340
  5. Umerov EE. Osobennosti morfologicheskoi struktury kozhi pri ishemicheskikh troficheskikh iazvakh s uchetom makrofagal’noi aktivnosti vospalitel’nogo infil’trata. Svit Meditsini ta Biologii. 2013;(4):89-91. https://womab.com.ua/smb-2013-04-1/3938 (in Russ.)
  6. Varyushina EA, Moskalenko VV, Lebedeva TP, Bubnov AN, Simbirtsev AS. Interleukin-1p application for local treatment of purulent and necrotic lesions of lower extremities. Med Immunologiia. 2008;10(4-5):439-48. http://www.spbraaci.ru/files/2008-4-5-439-448.pdf (in Russ.)
  7. Vinnik IuS, Salmina AB, Drobushevskaia AI, Tepliakova OV, Pozhilenkova EA, Kotikov AR. Osobennosti patogeneza dlitel’no nezazhivaiushchikh ran. Novosti Khirurgii. 2011;19(3):101-10. http://www.surgery.by/pdf/full_text/2011_3_16_ft.pdf (in Russ.)
  8. Maruyama K, Asai J, Ii M, Thorne T, Losordo DW, D’Amore PA. Decreased macrophage number and activation lead to reduced lymphatic vessel formation and contribute to impaired diabetic wound healing. Am J Pathol. 2007 Apr;170(4):1178-91. doi: 10.2353/ajpath.2007.060018
  9. Gibson DJ, Schulftz G. Chronic wound diagnostic for matrix metalloproteinase. Wound Healing Southern Africa. 2009;2:68-70. http://www.woundhealingsa.co.za/index.php/WHSA/article/view/51
  10. Sharifian Z, Bayat M, Alidoust M, Farahani RM, Bayat M, Rezaie F, Bayat H. Histological and gene expression analysis of the effects of pulsed low-level laser therapy on wound healing of streptozotocin-induced diabetic rats. Lasers Med Sci. 2014 May;29(3):1227-35. doi: 10.1007/s10103-013-1500-5
  11. de Loura Santana C, Silva D de F, Deana AM, Prates RA, Souza AP, Gomes MT, de Azevedo Sampaio BP, Shibuya JF, Bussadori SK, Mesquita-Ferrari RA, Fernandes KP, França CM. Tissue responses to postoperative laser therapy in diabetic rats submitted to excisional wounds. PLoS One. 2015 Apr 24;10(4):e0122042. doi: 10.1371/journal.pone.0122042
  12. Li Y, Zhang J, Xu Y, Han Y, Jiang B, Huang L, Zhu H, Xu Y, Yang W, Qin C. Effects of 630 nm red and 460 nm blue light emitting diode irradiation on healing of the skin wound in Japanese big-ear white rabbit. Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2017 Jun 20;39(3):301-306. doi: 10.3881/j.issn.1000-503X.2017.03.001
  13. Houreld N, Abrahamse H. He-Ne laser irradiation stimulates proliferation and migration of diabetic wounded fibroblast cells. In: Waynant R, Tata DB. (eds). Proceedings of Light-Activated Tissue Regeneration and Therapy Conference. Springer, Boston, MA; 2008;12. ð. 221-32. https://link.springer.com/chapter/10.1007%2F978-0-387-71809-5_21
  14. Zhang H, Liu S, Yang X, Chen N, Pang F, Chen Z, Wang T, Zhou J, Ren F, Xu X, Li T. LED Phototherapy with gelatin sponge promotes wound healing in mice. Photochem Photobiol. 2018 Jan;94(1):179-85. doi: 10.1111/php.12816
Address for correspondence:
210023, The Republic of Belarus,
Vitebsk, Frunze Ave., 27,
Vitebsk State Medical University,
Department of Operative Surgery
And Topographic Anatomy,
Tel. office.: +375 212 24-08-09,
Tel. mob.: +375 33 645-12-01,
e-mail: qlex2007@yandex.ru,
Aliaksei I. Rundo
Information about the authors:
Rundo Aliaksei I., Assistant of the Department of Operative Surgery and Topographic Anatomy, Vitebsk State Medical University, Vitebsk, Republic of Belarus.
https://orcid.org/0000-0001-8264-3197
Kosinets Vladimir A., MD, Professor of the Department of Hospital Surgery with courses of Urology and Pediatric Surgery, Vitebsk State Medical University, Vitebsk, Republic of Belarus.
https://orcid.org/0000-0001-7127-1877
Samsonova Inna V., PhD, Associate Professor, Head of the Department of Pathological Anatomy with a course of Forensic Medicine, Vitebsk State Medical University, Vitebsk, Republic of Belarus.
https://orcid.org/0000-0002-6634-0935

ANESTESIOLOGY-REANIMATOLOGY

D.V. OSIPENKO, A.A. SILANAU, A.A. PIACHONKIN

ANATOMIC SUBSTANTIATION OF SELECTION OF THE PLACE OF PUNCTURE AND INTRODUCTION OF THE CENTRAL VENOUS CATHETER IN CARDIOSURGERY PATIENTS

Gomel Regional Clinical Cardiology Center, Gomel,
The Republic of Belarus

Objective. To carry out an ultrasound evaluation of the features of clinical anatomy and the mutual location of the internal jugular vein and common carotid artery at different levels of the neck scanning to determine the optimal point for puncture and introduction of a central venous catheter in patients undergoing surgical interventions on the heart. There is the ultrasonic assessment of features of clinical anatomy and the relative positioning of the internal jugular vein and common carotid artery in cardiac surgery patients at various levels of a neck scanning for selection of the optimum point for puncture of central veins.
Methods. The study included 61 patients who were subjected to ultrasound scanning of the neck vessels from two sides at the following levels: first scanning point – the apex of the triangle formed by the legs of the sternocleidomastoid muscle; the second scanning point is 3-5 cm above the 1st scanning point (approximately at the point of intersection of the external jugular vein with the sternocleidomastoid muscle). The following vessel parameters were recorded: the distance from the skin to the vein wall, the size of the internal jugular vein and its position relative to the common carotid artery.
Results. The distance from the skin to the wall of the internal jugular vein, both on the left and on the right, was significantly greater at the 2nd point of scanning, compared to the 1st scan point. The right internal jugular vein was dominant and had a maximum size at the 1st scan point in the largest number of patients.
The following regularity is described: in the Trendelenburg position with a slope of 15° and a rotation of the head by 45° at the first point of scanning, only in 33 (54%) and 34 (56%) patients left and right classical (lateral) location of the internal jugular vein was observed; at the second point of scanning – respectively, only in 26 (43%) and 28 (46%) patients.
Conclusions. The point of puncture and of the introduction of a central venous catheter located in the region of the apex of the triangle formed by the legs of the right sternocleidomastoid muscle is the most optimal and can be recommended for the internal jugular vein catheterization. Taking into account the considerable variability in the location of the internal jugular vein, the introduction of a central venous catheter is recommended to be performed under ultrasound guidance.

Keywords: ultrasonic scanning, jugular vein, carotid artery, location of the neck vessels, puncture of vessels
p. 580-585 of the original issue
References
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  2. Marochkov AV, Stabletskii AD, Stefanenkova VP. Thrombus formation in venous catheters depending on the site of their disposition in the central veins. Anesteziol Reanimatol. 1985 Mar-Apr;(2):52-55.
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Address for correspondence:
246046, The Republic of Belarus,
Gomel, Meditsinskaya Str., 4,
Gomel Regional Clinical Cardiology Center,
Department of Anesthesiology and Resuscitation
With Intensive Care Wards,
Tel./fax: +375 232 557-925;
e-mail: Osipenko081081@mail.ru,
Dzmitry V. Osipenko
Information about the authors:
Osipenko Dzmitry V., PhD, Anesthesiologist-Resuscitator, Department of Anesthesiology and Resuscitation with Intensive Care Wards, Gomel Regional Clinical Cardiology Center, Gomel, Republic of Belarus.
http://orcid.org/0000-0003-4838-1140
Silanau Aliaksandr A., anesthesiologist-resuscitator, Department of Anesthesiology and Resuscitation with Intensive Care Wards, Gomel Regional Clinical Cardiology Center, Gomel, Republic of Belarus.
http://orcid.org/0000-0002-1849-071X
Piachonkin Aliaksei A., PhD, angiosurgeon, Head of the Vascular Surgery Unit, Gomel Regional Clinical Cardiology Center, Gomel, Republic of Belarus.
http://orcid.org/0000-0003-0526-9183

MAXILLOFACIAL SURGERY

I.O. POHODENKO-CHUDAKOVA1, K.V. VILKITSKAYA1, N.I. POLIAKOVA2, I.M. BAIRIKOV3

DIAGNOSTICS METHODS OPTIMIZATION OF ODONTOGENIC ORIGIN CHRONIC INFLAMMATORY PROCESSES AND MAXILLARY SINUS NEOPLASIA

Belarusian State Medical University 1, Minsk
Maryina Gorka Central Regional Hospital 2, Maryina Gorka,
The Republic of Belarus,
Samara State Medical University 3, Samara,
The Russian Federation

Objective. To improve the diagnostics of chronic inflammatory processes of odontogenic etiology and neoplasia in the maxillary sinus.
Methods. 65 cone-beam computed tomograms of patients with X-ray signs of chronic odontogenic inflammatory processes in the maxillary sinus (main group) and 65 without sinus diseases (control group) were studied. In the main group, the age of patients was 18-74 years (mean – 42.9 years), in the control group were enrolled patients aged 18-76 years (mean – 42.5 years). Based on the data of the three-dimensional ray method, the volume of formation was calculated, the anatomical and topographical features of the structure of sinus maxillaris were studied, which resulted in the development of the severity indices of chronic odontogenic sinusitis and neoplasms extending into the lumen of the maxillary sinus. In all patients, using cone-beam computed tomography, the disease risk and severity of pathological process were determined.
Results. Maxillary sinus volume of the main group patients significantly exceeded the same in the comparison groups (p <0.05), and also depended on the sex of the examined patients. The main risk factors for the development of odontogenic etiology diseases are hyperpneumatization and the first type ratio of the lateral teeth group roots with the bottom of sinus maxillaris. The most common degree of disease is the average severity, according to the indicators of chronic odontogenic sinusitis and the severity of the neoplasm. In 62.3% of cases, the risk of developing the disease of the odontogenic etiology maxillary sinus was revealed in the control group of patients.
Conclusions. The developed severity indices of chronic odontogenic sinusitis and neoplasms extending into the lumen of the maxillary sinus make it possible to supplement the diagnostic capabilities of the three-dimensional radiation methods of the study and optimize their subsequent clinical interpretation, thereby improving the quality of the patients’ examination with the possibility of subsequent individual prophylaxis planning of the development of the disease and its treatment.

Keywords: maxillary sinus, odontogenic sinusitis, neoplasms, X-ray methods, cone-beam computed tomography, disease severity, inflammatory process
p. 586-593 of the original issue
References
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  15. Saati S, Kaveh F, Yarmohammadi S. Comparison of cone beam computed tomography and multi slice computed tomography image quality of human dried mandible using 10 anatomical landmarks. J Clin Diagn Res. 2017: Feb;11(2):ZC13-ZC16. doi: 10.7860/JCDR/2017/20637.9253
Address for correspondence:
220116, The Republic of Belarus,
Minsk, Dzerzhinsky Ave., 83,
Belarusian State Medical University,
Department of Surgical Dentistry,
Tel. office: +375 17 254-32-44,
e-mail: drkristin.v@gmail.com,
Kristina V. Vilkitskaya
Information about the authors:
Pohodenko-Chudakova Irina O., MD, Professor, Head of the Department of Surgical Dentistry, Belarusian State Medical University, Minsk, Republic of Belarus.
https://orcid.org/0000-0002-0353-0125
Vilkitskaya Kristina V., PhD, Associate Professor of the Department of Surgical Dentistry, Belarusian State Medical University, Minsk, Republic of Belarus.
https://orcid.org/0000-0001-5344-1465
Poliakova Natalia I., Surgeon-Dentist, Maryina Gorka Central Regional Hospital, Maryina Gorka, Republic of Belarus.
https://orcid.org/0000-0002-2748-9630
Bairikov Ivan M., MD, Professor, Head of the Department and Clinic of Maxillofacial Surgery and Dentistry, Samara State Medical University, Samara, Russian Federation.
https://orcid.org/0000-0002-4943-2619

REVIEWS

A.V. ZAPALIANSKI, O.V. KANDRATSYEVA, A.A. SVIRSKY

SURGICAL METHODS OF TREATMENT OF GIANT OMPHALOCELE IN CHILDREN

Republican Scientific and Practical Center for Pediatric Surgery, Minsk,
The Republic of Belarus

The review describes various options of classical and modern techniques of surgical treatment of congenital malformation of the anterior abdominal wall – the giant omphalocele. The main existing techniques are presented, such as primary, staged and delayed closure of the defect. Particular attention is paid to such perspective areas of the staged surgical treatment as vacuum-assisted closure, using of tissue expanders and systems with active external traction. The advantages and disadvantages of each technique are indicated and a comparative analysis of their effectiveness is carried out. Examples of new surgical options for correction of the malformation are presented, based on the achievements of modern bioengineering researches and innovative technologies. The prospects of the using the biodegradable biomaterials, such as «Alloderm» and submucosal layer of the small intestine for reconstruction of the abdominal wall and primary closure of the defect are analyzed. The review details various approaches of reconstructive surgical treatment of large abdominal wall defects in older children after the formation of ventral hernia in newborns. The application experience of the component separation technique (CST) for abdominoplasty in the period of newborns and older age is analyzed, and also the ways to improve the cosmetic and physiological results of the treatment are outlined.

Keywords: giant omphalocele, newborn, abdominal wall defect, surgical treatment, staged defect closure, delayed defect closure
p. 594-604 of the original issue
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Address for correspondence:
220013, The Republic of Belarus,
Minsk, Nezavisimosti Ave., 64,
Republican Scientific and Practical
Center for Pediatric Surgery,
Pediatric Surgery Unit,
Tel. mobile: +375 29 141 91 29,
e-mail: andrei.zapalianski@gmail.com,
Andrei V. Zapalianski
Information about the authors:
Zapalianski Andrei V., PhD, Pediatric Surgeon, Republican Scientific and Practical Center for Pediatric Surgery, Minsk, Republic of Belarus.
http://orcid.org/0000-0001-6854-7625
Kandratsyeva Volha V., PhD, Pediatric Surgeon, Republican Scientific and Practical Center for Pediatric Surgery, Minsk, Republic of Belarus.
http://orcid.org/0000-0003-1622-9435
Svirsky Aliaksandr A., PhD, Associate Professor, Head of the Pediatric Surgery Unit, Republican Scientific and Practical Center for Pediatric Surgery, Minsk, Republic of Belarus.
http://orcid.org/0000-0001-6323-6537

L.A. BOCKERIA, O.L. BOCKERIA, F.S. GAFUROV

CURRENT STATE OF THE PROBLEM IN PREVENTION OF ATRIAL FIBRILLATION IN THE EARLY POSTOPERATIVE PERIOD AFTER CORONARY ARTERY BYPASS SURGERY

A.N. Bakulev National Medical Research Center of Cardiovascular Surgery,
Moscow,
The Russian Federation

Atrial fibrillation is the most frequent complication of the open heart surgery, including the coronary artery bypass grafting, often leading to a significant increase in the duration of hospital stay, worsening the course of the early and mid-term postoperative period and augmenting the economic costs of treatment.
The aim of the present review is to analyze the data on pharmacological and non-pharmacological approaches to the treatment and prevention of atrial fibrillation in the early postoperative period after the coronary artery bypass grafting. Despite the progressive development of modern antiarrhythmic drugs, the success of sinus rhythm restoration in the postoperative atrial fibrillation does not exceed 50-55%. The literature analysis has shown that biatrial overdrive pacing for the first 72 hours after the surgery is the most effective method to prevent and manage this type of arrhythmia. According to the various studies, biatrial pacing allows achieving 75-85% freedom from atrial fibrillation in the early postoperative period following coronary artery bypass grafting, that is statistically higher than with any other (either pharmacological or non-pharmacological) method of postoperative atrial fibrillation prevention and treatment. In addition, most authors note the safety of biatrial pacing in cardiac surgical patients.

Keywords: biatrial pacing, atrial fibrillation, prevention, coronary artery bypass grafting, antiarrhythmic drugs, postoperative period
p. 605-615 of the original issue
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Address for correspondence:
121552, Russian Federation,
Moscow, Rublevskoye Highway, 135,
A.N. Bakulev National Medical Research
Center of Cardiovascular Surgery,
Department of Surgical Treatment
Of Interactive Pathology,
Tel.: +7 929 647 10 75,
e-mail: furik_med@mail.ru,
Furkatdzon S. Gafurov
Information about the authors:
Bockeria Leo A., MD, Academician of RAS, Director of A.N. Bakulev National Medical Research Center of Cardiovascular Surgery, Moscow, Russian Federation.
https://orcid.org/0000-0002-6180-2619
Bockeria Olga L, MD, Corresponding Member of RAS, Chief Researcher, Department of Surgical Treatment of Interactive Pathology, A.N. Bakulev National Medical Research Center of Cardiovascular Surgery, Moscow, Russian Federation.
http://orcid.org/0000-0002-7711-8520
Gafurov Furkatdzon S., Post-Graduate Student, Department of Surgical Treatment of Interactive Pathology, A.N. Bakulev National Medical Research Center of Cardiovascular Surgery, Moscow, Russian Federation.
https://orcid.org/0000-0002-6226-2984

V.V. HOMOCHKIN, S.S. MASKIN, N.V. HOMOCHKINA, V.V. EROFITSKAYA

LIGATION OF THE INTERSPHINCTERIC FISTULA TRACT IN TREATMENT OF CHRONIC PARAPROCTITIS

Volgograd State Medical University, Volgograd,
The Russian Federation

In the review, a comparative analysis of the use of traditional techniques and organ-preserving ligation of intersphincteric fistula tract (LIFT) in the treatment of chronic paraproctitis was carried out. The use of traditional methods is effective in 60-80% of cases; nevertheless, the risk of anal incontinence formation is, on average, 28%. The ligation of the intersphincteric fistula tract (LIFT) allows achieving convalescence in 82 - 95% of cases, and besides the majority of specialists emphasizes almost complete absence of disturbance of anal competence. In the vast majority of cases, recurrence of the postoperative fistula is formed as intersphincteric type that allows eliminating it without any risk of incontinence. In rare cases of «complete» recurrent fistula formation there is a possibility to perform sphincter-preserving operation. In patients with initially recurrent fistulas, the percentage of recovery is 90% and more. While comparing the classical operation LIFT and LIFT-plus (with the removal of distal part of fistula), the efficiency of LIFT- plus is higher by an average of 4-5%.
The performed analysis proves the advantages of the sphincter-saving operation LIFT in comparison with the classical methods of elimination of the pararectal fistulas. The problem of combining the LIFT with other procedures remains unsolved and demands further investigations.

Keywords: pararectal fistula, fistula excision, sphincter-saving techniques, incontinence, ligation of the intersphincteric fistula tract
p. 616-623 of the original issue
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Address for correspondence:
400131, Russian Federation,
Volgograd, Pavshikh Bortsov Sq., 1,
Volgograd State Medical University,
Depatrment of Surgical Diseases
And Neurosurgery,
Tel.: +7 988 490 75 00,
e-mail: homochkinS@rambler.ru,
Vitaliy V. Homochkin
Information about the authors:
Homochkin Vitaliy V., PhD, Associate Professor of the Department of Surgical Diseases and Neurosurgery of the Faculty of Advanced Training of Physicians, Volgograd State Medical University, Volgograd, Russian Federation.
http://orcid.org/0000-0003-0144-8264
Maskin Sergey S., MD, Professor, Head of the Department of Hospital Surgery, Volgograd State Medical University, Volgograd, Russian Federation.
http://orcid.org/0000-0002-5275-4213
Homochkina Nataliya V., Clinical Intern of the Department of Surgical Diseases and Neurosurgery of the Faculty of Advanced Training of Physicians, Volgograd State Medical University, Volgograd, Russian Federation.
http://orcid.org/0000-0002-8480-6639
Erofitskaya Victoria V., Assistant of the Department of Hospital Surgery, Volgograd State Medical University, Volgograd, Russian Federation.
http://orcid.org/0000-0001-5767-6034

CASE REPORTS

K.I. SERGATSKIY, V.I. NIKOLSKIY, V.A. SIZOVA, V.V. PETROVA

CLINICAL OBSERVATIONS OF RARE COMPLICATION OF VAGINAL CANCER IN THE FORM OF PARARECTAL CELL AND SOFT TISSUE PHLEGMON OF ADJACENT ANATOMICAL AREAS

Penza State University, Penza,
The Russian Federation

Vaginal cancer is a relatively rare neoplasm, and this pathology is 1-3% of the total number of female genitalia tumors. The incidence of vaginal cancer is 1 per 100,000 women. The peak incidence of vaginal cancer falls on the 6th and 7th life decade. This tumor is detected in less than 15% of patients before 50 years old, and less than 10% of cases occur before 40 years. Almost 90% of all histological types of malignant vaginal tumors occur in squamous cell carcinoma. The most frequent complications of vaginal cancer are the following: bleeding from the tumor, fistula, ulceration and urethral compression. Two cases of vaginal cancer complications by pararectal and soft tissue phlegmon of adjacent anatomical areas was identified in clinical practice. Phlegmon of pararectal tissue and perineum of non-cryptogenic genesis is often observed in the decay and abscessing of rectum malignant neoplasms. The complication of primary vaginal cancer in the form of soft tissue phlegmon in our clinical practice has been seen for the first time. There are no descriptions of such clinical cases in the available literature. Treatment of patients with vaginal malignant tumors complicated by phlegmon of the soft tissues has shown a satisfactory clinical result.

Keywords: vaginal cancer, soft tissue phlegmon, pararectal tissue, surgical treatment, necrectomy
p. 624-628 of the original issue
References
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Address for correspondence:
440026, Russian Federation,
Penza, Krasnaya Str., 40,
Penza State University,
Department of Surgery,
Tel. mobile: 8 902 354-04-68,
e-mail: sergatsky@bk.ru,
Konstantin I. Sergatskiy
Information about the authors:
Sergatskiy Konstantin I., PhD, Associate Professor of the Department of Surgery, medical university, Penza State University, Penza, Russian Federation.
https://orcid.org/0000-0002-3334-8244
Nikolsky Valery I., MD, Professor of the Department of Surgery, medical university, Penza State University, Penza, Russian Federation.
https://orcid.org/0000-0002-2551-8848
Sizova Vasilisa A., 5-Year Student, medical university, Penza State University, Penza, Russian Federation.
https://orcid.org/0000-0002-6539-0500
Petrova Victoriya V., 5-Year Student, medical university, Penza State University, Penza, Russian Federation.
https://orcid.org/0000-0002-1672-4922

I.V. RESHETOV, I.I. BYKOV, A.A. SHEVALGIN, YU.S. KUROCHKINA, T.P. NEKRASOVA, M.S. MIKEROVA

SYNCHRONOUS PRIMARY-MULTIPLE MALIGNANT TUMOR: BIFENOTYPIC SYNONASAL SARCOMA AND COLORECTAL CANCER

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

Primary-multifocal malignant tumors hold a specific place in oncology. Present case report describes the combination of two neoplastic processes with different anatomic localization, the analogues to which have not been found either in the domestic literature or foreign sources.
The article presents the case of a synchronous primary-multiple malignant neoplasm – malignant tumor from the membranes of the peripheral nerves of the nasal cavity with expansion into the right maxillary sinus, the cells of the ethmoidal sinus Ò2bN0M0 and moderately differentiated adenocarcinoma of the sigmoid colon Ò4àN0M0. Physical examination and positron emission tomography combined with the computed tomography confirmed a hypervascular tumor of the posterior cells of the ethmoidal sinus and a nasal cavity without hypermetabolism and the circular tumor of the sigmoid colon with hypermetabolism. Taking into account the primary-multiple character of the lesion and the clinic of intestinal obstruction, a tactic of the treatment was a combined surgery – the removal of the neoplasm of the nasal cavity with resection of the right maxillary sinus with microsurgical technique and a reconstructive-plastic component using a coronary access, laparotomy, resection of the sigmoid colon, lymphadenectomy. The chosen treatment allowed eliminating both of the tumors in a short time and moving on to a further stage of treatment. The patient is under the supervision, there is no recurrence of the disease at the moment.

Keywords: synonasal sarcoma, primary-multiple malignant tumors, colorectal cancer
p. 629-635 of the original issue
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Address for correspondence:
119991, Russian Federation,
Moscow, Trubetskaya str., 8-2,
I.M. Sechenov First Moscow
State Medical University,
Department of Public Health
And Healthcare Named after N.A. Semashko,
Tel. +7 915 225 86 89,
e-mail: masha-med@mail.ru,
Maria S. Mikerova
Information about the authors:
Reshetov Igor V., MD, Academician of RAS, Professor, Head of the Department of Oncology and Reconstructive Surgery, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
https://orcid.org/0000-0002-0909-6278
Bykov Igor I., PhD, Oncologist, Oncologic Surgery Unit of Combined Treatment Methods, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
https://orcid.org/0000-0001-8391-8885
Shevalgin Alexandr A., Oncologist, Oncologic Surgery Unit of Combined Treatment Methods, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
https://orcid.org/0000-0002-7045-5540
Kurochkina Juliya S., Oncologist, Oncologic Surgery Unit of Combined Treatment Methods, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
https://orcid.org/0000-0002-3556-2703
Nekrasova Tatiyana P., PhD, Associate Professor of the Department of Pathological Anatomy named after Academician A.I. Strukov, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
https://orcid.org/0000-0001-6376-9392
Mikerova Maria S., PhD, Associate Professor of the Department of Public Health and Healthcare named after N.A. Semashko, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
https://orcid.org/0000-0003-2718-1895
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