Novosti
Khirurgii
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indexed in Scopus









Year 2019 Vol. 27 No 4

SCIENTIFIC PUBLICATIONS
EXPERIMENTAL SURGERY

DOI: https://dx.doi.org/10.18484/2305-0047.2019.4.369   |  

D.B. AUZHANOV 1, M.ZH. AYMAGAMBETOV 1, ZH.A. ZHAGIPAROVA 1, Y. NOSO 2

EFFECT OF AZATHIOPRINE ON THE FORMATION OF ADHESIVE PROCESS OF THE ABDOMINAL CAVITY IN EXPERIMENT

Semey State Medical University, The Republic of Kazakhstan 1,
Shimane University, Faculty of Medicine, Izumi, Japan 2

Objective. Study of the azathioprine antimetabolite effect on the formation of postoperative adhesions in experiment on a rat model.
Methods. The main experiment was performed on 30 (4-5-month-old) male Wistar rats. The operation of Bloor was conducted in all animals for the initiation of the adhesive process. The rats were divided into 2 groups (15 in each): the main group (MG) animals received azathioprine in a dosage of 1 mg/100 g of weight orally 1 time per day for the first 3 days (starting from the day of surgery). The control group (CG) did not receive any medications. On the 7th day, all rats were removed from the experiment. Adhesion assessment was performed by the criteria: macroscopic (quantitative assessment of adhesions the Moreno scale, qualitative assessment - the Binda scale), histological examination. The effect of the studied method on some indicators of the immune status (leukocytes, lymphocytes, CD, CD4, CD8, PN, PI) was also studied.
Results. In CG adhesions were reported in 100% (15 rats), G 80% (12 rats). While evaluating adhesions on the Moreno and Binda scales in CG, the number of adhesions was greater 38 versus 13 (p <0.001). Also, in CG, the thickness of adhesions and their strength prevailed (p<0.001). The volume of connective tissue, the proportion of collagen fibers, the degree of vascular proliferation, fibrosis in the adhesions in OG are less pronounced (p=0.029). The immune status indicators in MG after the treatment on the 7th day were reduced slightly.
Conclusions. Immunosuppression with azathioprine significantly reduces the frequency and severity of the adhesive process in the abdominal cavity. The use of the drug in a therapeutic dose for 3 days does not lead to a significant inhibition of some of the immunity important indicators (a slight decrease in leukocytes and lymphocytes by 0.3 and 0.9, a moderate decrease in T-lymphocytes by no more than 2.0, a decrease in phagocytic activity by 5.8).

Keywords: postoperative adhesions, prevention, experiments on animals, immunosuppression, rat, azathioprine
p. 369-378 of the original issue
References
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  17. Sufiyarov IF, Lalipov RZ, Sibiryak SV, Shafikov RM. Influence of immtnosl ppression indited by cyclophosphamll) on development postoperative adhesion deseases. Med Vestn Bashkortostana. 2009;4(4):64-67. https://cyberleninka.ru/article/n/vliyanie-immunosupressii-indutsirovannoy-tsiklofosfamidom-na-razvitie-posleoperatsionnyh-bryushinnyh-spaek( In Russ.)
Address for correspondence:
071400, The Republic of Kazakhstan,
Semey, Abay Kunanbayev Str., 103,
Semey State Medical University,
Hospital Surgery Department.
Tel.: +7 777 264-89-42,
e-mail: daurenchik@mail.ru,
Dauren B. Auzhanov
Information about the authors:
Auzhanov Dauren B., Applicant for Doctors Degree of Semey State Medical University, Semey, Republic of Kazakhstan.
https://orcid.org/0000-0001-8378-0054
Aymagambetov Meyrbek Zh., MD, Associate Professor, Head of the Surgery Internship Department of Semey State Medical University, Semey, Republic of Kazakhstan.
https://orcid.org/0000-0002-8344-4445
Zhagiparova Zhanar A., PhD, Head of the Department of Special Disciplines of Pavlodar Branch of Semey State Medical University, Semey, Republic of Kazakhstan.
https://orcid.org/0000-0002-5619-3505
Noso Yoshihiro, MD, PhD, Professor of the General Medicine Department of the Faculty of Medicine, Shimane University, Izumi, Japan.
https://orcid.org/0000-0003-3477-1260

GENERAL & SPECIAL SURGERY

DOI: https://dx.doi.org/10.18484/2305-0047.2019.4.379   |  

E.A. ILICHEVA 1,3, D.A. BULGATOV 1,2,3, A.V. ZHARKAYA 1,3, V.N. MAKHUTOV 3, L.B. KORYAKINA 1,3, S.V. RYZHIKOVA 3, A.N. ZAGORODNYAYA 3, T.V. IVANOVA 3

EVALUATION OF FGF23 LEVEL BEFORE AND AFTER SURGICAL TREATMENT OF SECONDARY HYPERPARATHYREOSIS

Irkutsk Scientific Center of Surgery and Traumatology 1,
Irkutsk State Medical University 2,
Irkutsk Regional Clinical Hospital 3, Irkutsk,
The Russian Federation

Objective. To study the level of FGF23 before and after thesecondary hyperparathyroidism surgical treatment and in the comparison groups in patients receiving hemodialysis divided by the level of parathyroid hormone and in healthy people.
Methods. The level of FGF23; pg/ml in the blood was simultaneouslystudied before and after surgical treatment for secondary hyperparathyroidism in patients undergoing renal replacement therapy. In the comparison groups, the level of FGF23 in the blood was studied in patients receiving dialysis for the terminal stage of chronic kidney disease (CKD). The groups were divided according to the level of intact parathyroid hormone (PTH) in the blood: with hypoparathyroidism (PTH less than 130 pg/ml), with an acceptable level of PTH (130-600 pg/ml), and hyperparathyroidism (PTH more than 600 pg/ml). The level of FGF23 in healthy individuals was also studied. A total of 77 people were examined (33 females and 44 males). To assess the mineral-bone disorders, the standard laboratory examination was performed: a biochemical blood test with electrolytes (albumen, total calcium with albumin correction, phosphorus), PTH in blood.
Results. Data have been obtained that the level of FGF23 in the group of healthy individuals is statistically lower than in the other groups (pU = 0.001). Between groups of people with terminal stage of CKD, the difference in FGF23 is not statistically significant (pU > 0.05).
Conclusions. All patients receiving dialysis, regardless of the severity of secondary hyperparathyroidism before and after surgical treatment, have an increased level of FGF23 in comparison with healthy people. Statistically significant differences in level of FGF23 depending on the presence or absence of secondary hyperparathyroidism and the result of surgical treatment of SHPT were not detected. According to the data obtained, further research is needed to identify the role of FGF23 in the pathogenesis of secondary hyperparathyroidism.

Keywords: secondary hyperparathyroidism, chronic kidney disease, phosphatonin, fibroblast growth factor 23, FGF23, mineral and bone disorders
p. 379-385 of the original issue
References
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Address for correspondence:
664003, The Russian Federation,
Irkutsk, Krasnoye Vosstaniye Str., 1,
Irkutsk State Medical University,
Hospital Surgery Department.
Tel. 8 (3952) 407809,
-mail: bbd-x@mail.ru,
Dmitriy A. Bulgatov
Information about the authors:
Ilicheva Elena A., MD, Professor, Head of the Scientific Department of Clinical Surgery, Irkutsk Scientific Center of Surgery and Traumatology, Surgeon of the Thoracic Surgical Unit, Irkutsk Regional Clinical Hospital, Irkutsk, Russian Federation.
https://orcid.org/0000-0002-2081-8665
Bulgatov Dmitriy A., Intramural Post-Graduate Student of the Hospital Surgery Department, Irkutsk State Medical University, Surgeon of the Purulent Surgery Unit 1, Irkutsk Scientific Center of Surgery and Traumatology, Surgeon of the Thoracic Surgical Unit, Irkutsk Regional Clinical Hospital, Irkutsk, Russian Federation.
https://orcid.org/0000-0002-2440-0813
Zharkaya Anastasia V., PhD, Junior Researcher, Irkutsk Scientific Center of Surgeryand Traumatology, Surgeon of the Endocrinology Center, Irkutsk Regional Clinical Hospital, Irkutsk, Russian Federation.
https://orcid.org/0000-0002-9337-2369
Makhutov Valerij N., PhD, Head of the Thoracic Surgical Unit, Irkutsk Regional Clinical Hospital, Irkutsk, Russian Federation.
https://orcid.org/0000-0001-7318-7193
Koryakina Larisa B., PhD, Head of the Center of the Laboratory Investigations, Irkutsk Regional Clinical Hospital, Irkutsk, Russian Federation.
https://orcid.org/0000-0002-4545-2049
Ryzhikova Svetlana V., Physician of the Center of the Laboratory Investigations, Irkutsk Regional Clinical Hospital, Irkutsk, Russian Federation.
https://orcid.org/0000-0003-3070-7720
Ivanova Tatiana V., Physician of the Center of the Laboratory Investigations, Irkutsk Regional Clinical Hospital, Irkutsk, Russian Federation.
https://orcid.org/0000-0002-9277-1587
Zagorodnyaya Anna N., Physician of the Center of the Laboratory Investigations, Irkutsk Regional Clinical Hospital, Irkutsk, Russian Federation.
https://orcid.org/0000-0003-0685-2426
DOI: https://dx.doi.org/10.18484/2305-0047.2019.4.386   |  

V.V. BOYKO 1, V.A. VOVK 2

USE OF MINIMALLY INVASIVE INTERVENTIONS IN TREATMENT OF CHOLANGIOGENIC LIVER ABSCESSES

V.T. Zaycev Institute of General and Urgent Surgery of National Academy of Medical Sciences of Ukraine 1,
Kharkiv Regional Clinical Hospital 2, Kharkiv,
Ukraine

Objective. To improve surgical treatment of patients with the liver cholangiogenic abscesses of liver through the introduction of minimally invasive technologies.
Methods. In the proposed study the treatment results of 49 patients with biliary liver abscesses are presented. There were 31 women and 18 men aged 37 to 69 years. Surgical interventions for hepatic abscesses were performed simultaneously with the elimination of the primary pathological process of the biliary system, which caused the occurrence of cholangitis or in the near future (up to 3 days) after biliary drainage.
Results. Drainage under ultrasound guidance was performed in 21 patients with single and 7 patients with two or more cholangiogenic liver abscesses. At the same time, liver abscess and bile duct were drained in 8 patients in the x-ray operating room. Laparoscopic interventions were performed in 21 patients.
Among the patients operated on using minimally invasive technologies, 7 complications (14.3%) developed: 2 patients had bile leakage, 1 had the right-side hydrothorax, 1 had the right-side pleural empyema, 1 had the postoperative wound suppuration, and 2 had remaining stones in the common bile duct. One patient died (2.0%) due to the development of biliary sepsis with the obstruction of the biliary tract of malignant etiology.
Conclusions. Percutaneous drainage of liver abscesses under ultrasound control is appropriate not only for single abscesses, but also for their larger number. The possibility of simultaneous drainage of liver abscess and bile duct was proved. Percutaneous drainage of the liver abscess, drainage of the biliary tract and laparoscopic surgical intervention are complementary components of minimally invasive surgery in the treatment of the biliary origin liver abscesses. In case of localization of abscesses in the marginal segments of the liver, a laparoscopic atypical resection of the liver with an abscess is most desirable.

Keywords: liver abscess, cholangitis, minimally invasive surgical procedure,biliary drainage, liver abscess drainage
p. 386-393 of the original issue
References
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  9. Czerwonko ME, Huespe P, Bertone S, Pellegrini P, Mazza O, Pekolj J, de Santibañes E, Hyon SH, de Santibañes M. Pyogenic liver abscess: current status and predictive factors for recurrence and mortality of first episodes. HPB (Oxford). 2016 Dec;18(12):1023-30. Published online 2016 Oct 3. doi: 10.1016/j.hpb.2016.09.001
  10. Liu CH, Gervais DA, Hahn PF, Arellano RS, Uppot RN, Mueller PR. Percutaneous hepatic abscess drainage: do multiple abscesses or multiloculated abscesses preclude drainage or affect outcome? J Vasc Interv Radiol. 2009 Aug;20(8):1059-65. doi: 10.1016/j.jvir.2009.04.062
Address for correspondence:
61022, Ukraine,
Kharkiv, Nezalezhnosti Ave., 13,
Kharkiv Regional Clinical Hospital,
Surgical Unit.
Tel. +38(050)924-61-56,
e-mail: valery_vals@ukr.net,
Valerii A. Vovk
Information about the authors:
Boyko Valery V., Corresponding Member of National Academy of Medical Sciences of Ukraine, MD, Professor, Director of the V.T. Zaycev Institute of General and Urgent Surgery of National Academy of Medical Sciences of Ukraine, Kharkiv, Ukraine.
https://orcid.org/0000-0001-8675-2702
Vovk Valerii A., PhD, Associate Professor, Surgeon of the Surgical Unit, Kharkiv Regional Clinical Hospital, Kharkiv, Ukraine.
https://orcid.org/0000-0003-0888-1837
DOI: https://dx.doi.org/10.18484/2305-0047.2019.4.394   |  

V.I. KOLOMIYTSEV, O.M. TERLETSKIY, M.M. BUFAN

ANALYSIS OF DIAGNOSTIC CRITERIA OF OLIGOSYMPTOMATIC CHOLEDOCHOLITHIASIS IN PATIENTS WITH ACUTE CALCULOUS CHOLECYSTITIS

Danylo Halytsky Lviv National Medical University, Lviv,
Ukraine

Objective. To identify the diagnostic criteria associated with oligosymptomatic choledocholithiasis in patients with acute calculous cholecystitis based on the combination of laboratory data and instrumental methods of examination.
Methods. The study included 219 patients, treated at the surgical department 1 of Danylo Halytsky Lviv National Medical University in the period of 2007-2017. Patients were divided into 2 groups: the1st group included patients with acute calculous cholecystitis and oligosymptomatic choledocholithiasis confirmed by endoscopic retrograde cholangiopancreatography (169 patients); the 2nd group comprised of patients with acute calculous cholecystitis without choledocholithiasis (50 patients), i.e. the comparison group.
Results. As follows from the single-factor analysis using the method of logistic regression, 5out of 47 factors were determined, indicating the presence of oligosymptomatic choledocholithiasis: the common bile duct diameter (according to transabdominal ultrasonography), alkaline phosphatase activity, alanine aminotransferase, aspartate aminotransferase, and total bilirubin level. The model of the combined effect of the above-mentioned factors on the probability of the oligosymptomatic choledocholithiasis in a patient was elaborated. The ROC curve analysis (The Receiver Operating Characteristic) of the model demonstrated its high-quality prediction for the presence of oligosymptomatic choledocholithiasis (AUC=0.97). According to the results of the analysis of the specificity, sensitivity and accuracy of the proposed model, the optimal threshold for establishing the patient belonging to the group with the oligosymptomatic choledocholithiasis was calculated accounting for 0.62. At a defined threshold, the sensitivity of the test is 93.02%, the specificity is 92.06%, and the accuracy is 92.31%.
Conclusions. Diagnostic criteria for the presence of oligosymptomatic choledocholithiasis (p<0.05) are the following: common bile duct diameter, alanine aminotransferase activity, aspartate aminotransferase, alkaline phosphatase, and total bilirubin level as well. The application of the developed multifactorial model for predicting the presence of oligosymptomatic choledocholithiasis in patients with acute calculous cholecystitis enables to reduce the need for such additional methods of examination as magnetic resonance cholangiopancreatography, computed tomography, endosonography, endoscopic retrograde cholangiography.

Keywords: acute calculous cholecystitis, choledocholithiasis, model for predicting choledocholithiasis, diagnostic criteria, endoscopic retrograde cholangiography
p. 394-401 of the original issue
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  8. Singh A, Mann HS, Thukral CL, Singh NR. Diagnostic accuracy of MRCP as compared to ultrasound/CT in patients with obstructive jaundice. J Clin Diagn Res. 2014 Mar;8(3):103-107. doi: 10.7860/JCDR/2014/8149.4120
  9. Jovanović P, Salkić NN, Zerem E, Ljuca F. Biochemical and ultrasound parameters may help predict the need for therapeutic endoscopic retrograde cholangiopancreatography (ERCP) in patients with a firm clinical and biochemical suspicion for choledocholithiasis. Eur J Intern Med. 2011 Dec;22(6):e110-14. doi: 10.1016/j.ejim.2011.02.008
  10. Isherwood J, Garcea G, Williams R, Metcalfe M, Dennison AR. Serology and ultrasound for diagnosis of choledocholithiasis. Ann R Coll Surg Engl. 2014 Apr;96(3):224-28. doi: 10.1308/003588414X13814021678033
  11. Sherman JL, Shi EW, Ranasinghe NE, Sivasankaran MT, Prigoff JG, Divino CM. Validation and improvement of a proposed scoring system to detect retained common bile duct stones in gallstone pancreatitis. Surgery. 2015 Jun;157(6):1073-79. doi: 10.1016/j.surg.2015.01.005
  12. Kim KM, Lee JK, Bahng S, Shin JU, Lee KH, Lee KT, Lee WJ, Lim JH. Role of endoscopic ultrasonography in patients with intermediate probability of choledocholithiasis but a negative CT scan. J Clin Gastroenterol. 2013 May-Jun;47(5):449-56. doi: 10.1097/MCG.0b013e31827130a7
  13. Rubin MI, Thosani NC, Tanikella R, Wolf DS, Fallon MB, Lukens FJ. Endoscopic retrograde cholangiopancreatography for suspected choledocholithiasis: testing the current guidelines. Dig Liver Dis. 2013 Sep;45(9):744-49. doi: 10.1016/j.dld.2013.02.005
Address for correspondence:
79010, Ukraine,
Lviv, Pekarskaya Str., 69,
Danylo Halytsky Lviv National
Medical University,
Surgery Department 1,
tel. mobile: + 380974655895,
e-mail: olegterletskiy@ukr.net,
Oleg M. Terletskiy
Information about the authors:
Kolomiytsev Vasyl I., MD, Professor of the Surgery Department 1, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.
https://orcid.org/0000-0003-0646-6306
Terletskiy Oleg M., Post-Graduate Studet of the Surgery Department 1, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.
https://orcid.org/0000-0001-6675-6159
Bufan Mariia M., PhD, Associate Professor of the Department of Propaedeutics of Internal Medicine 1, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.
https://orcid.org/0000-0002-4814-0964
DOI: https://dx.doi.org/10.18484/2305-0047.2019.4.402   |  

S.A. PLAKSIN

LATE SEROMAS AFTER IMPLANT-BASED BREAST ENLARGEMENT SURGERY

Perm State Medical University named after Academician E.A. Wagner, Perm,
The Russian Federation

Objective. To evaluate risk factors, clinical history and surgical treatment of late seromas after implant-based breast enlargement surgery.
Methods. Late seromas were diagnosed in 19 cases (1.4%) of 1387 implant-based breast enlargement surgeries in total at the long-term follow-up, 6 months 16 years after the first surgery. Six of these cases underwent the initial surgeries at other hospitals. The incidence of late seromas was 0.9%. Seromas were diagnosed via ultrasound and computed tomography.
Results. The origins of late seromas were related to capsular contracture (n=6), rupture of the implant (n=3), mastitis (n=4), general infection (n=1), lactation (n=1), three were discovered during surgeries, and one had no apparent risk factors for its origin. The accumulation of milk around the breast prosthesis in the early postpartum period was called milkoma. Late seromas were divided into three groups: small with their volume up to 50 ml (29.37.5 ml), discovered in 8 (42.1%) patients, medium ranged in volume between 50 to 150 ml (97.737.8 ml), discovered in 4 (21.1%) patients, and large more than 150 ml (271.4111.3 ml) in volume, discovered in 7 (36.8%) patients. Three patients with small seromas were treated with antibacterial, anti-inflammatory and physiotherapy; one case of milkoma was treated via repeated transcutaneous needle aspiration and lactation suppression, and one case of seroma was treated by drainage. 14 (73.7%) patients required repeat surgeries: 6 patients with small seromas underwent capsulectomy with the replacement of breast implants and drainage; 5 patients with large seromas or signs of mastitis, and/or infected fluid in the presence of medium seromas underwent capsulectomy with implant removal and drainage, and 3 patients required implant removal with drainage. Implants were not replaced until 6 months later.
Conclusions. Risk factors for formation of late seromas include capsular contracture, rupture of implants. Anti-inflammatory therapy or capsulectomy with the replacement of breast implants is effective in cases of small seromas. Implant removal, complete capsulectomy and drainage are required for cases of large seromas or signs of mastitis and/or infected fluid.

Keywords: breast implants, late seroma, treatment, risk factors, augmentation mammaplasty, capsular contracture
p. 402-408 of the original issue
References
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  13. Spear SL, Rottman SJ, Glicksman C, Brown M, Al-Attar A. Late seromas after breast implants: theory and practice. Plast Reconstr Surg. 2012 Aug;130(2):423-35. doi: 10.1097/PRS.0b013e3182589ea9
  14. Becker H, Klimczak J. Aspiration of periprosthetic seromas using the blunt seroma cath. Plast Reconstr Surg. 2016 Feb;137(2):473-75. doi: 10.1097/01.prs.0000475795.84725.c4
Address for correspondence:
614990, The Russian Federation,
Perm, Petropavlovskaya Str., 26,
Perm State Medical University
Named after Academician E.A. Wagner,
Surgery Department of the Faculty of
Advanced ProfessionalEducation.
Tel. +7 342 239-29-72,
e-mail: splaksin@mail.ru,
Sergei A. Plaksin
Information about the authors:
Plaksin Sergei A., MD, Professor of the Surgery Department of the Faculty of Advanced Professional Education, Perm State Medical University named after Academician E.A. Wagner, Perm, Russian Federation.
http://orcid.org/0000-0001-8108-1655

TRANSPLANTOLOGY

DOI: https://dx.doi.org/10.18484/2305-0047.2019.4.409   |  

A.V. NOSIK 1, S.V. KOROTKOV 1, 2, V.V. SMOLNIKOVA 2, V.YU. HRYNEVICH 2, M.V. DMITRIEVA 3, A.A. DOLGOLIKOVA 2, I.I. PIKIRENIA 1, 2, S.I. KRIVENKO 2, O.V. KALACHIK 1, 2, A.E. SHCHERBA 1, 2, O.O. RUMMO 1, 2

VALUE OF ASSESSMENT OF LYMPHOCYTES SUBPOPULATIONS NUMBERS IN PERIPHERAL BLOOD FOR DIAGNOSIS OF CELLULAR REJECTION AFTER KIDNEY TRANSPLANTION

Belarusian Medical Academy of Postgraduate Education 1,
Minsk Scientific and Practical Center of Surgery, Transplantology and Hematology 2,
City Clinical Pathologoanatomic Bureau 3, Minsk
The Republic of Belarus

Objective. To study the possibility of assessing the number of peripheral blood lymphocyte subpopulations as biomarkers of late kidney transplant rejection.
Methods. This is a report of retrospective single center case-control study involving 44 patients who underwent kidney transplantation. The first group (AR) includes patients with chronic graft dysfunction, caused by biopsy proven late cellular rejection (22 patients). The second group (STA) contains recipients, who havent any dysfunction in the post-transplant period (22 patients). Flow cytometry of the peripheral blood cells was performed to evaluate the immune status of recipients.
Results. As a result of the research, accurate differences of absolute account of effector memory T cellwere determined, which accounted for in REJ group 0.147 (0.115-0.260)×109 cell/l, and in STA group 0.106 (0.067-0.136)×109 cell/l (=0.0167). Relative and absolute accounts of myeloid dendritic cells were different as well: 0.65 (0.36-0.73) vs 1.05 (0.67-1.4) % and 0.039 (0.028-0.056) vs 0.063 (0.049-0.076)×109 cell/l, respectively (=0.0009, =0.003). Number of plasmacytoid dendritic cells was also different between study groups: absolute account 0.0038 (0.0021-0.0054) vs 0.005 (0.0035-0.007)×109 cell/l (=0.0414), and relative account 0.055 (0.04-0.085) vs 0.09 (0.05-0.12) % (=0.0197).
The evaluation of diagnostic characteristic of revealed biomarkers was performed by using ROC-analysis. The area under ROC-curve (AUC) for absolute number of effector CD4+ memory T cells accounted for 0.711 (95 % CI: 0.55-0.84), =0.007. AUC for relative and absolute number of myeloid dendritic cells was assessed respectively as 0.784 (95% CI: 0.63-0.89) and 0.758 (95 % CI: 0.6-0.87), at significance values respectively =0.0001 and =0.0004. For relative and absolute number of plasmacytoid dendritic cells AUC accounted for respectively to 0.7 (95% CI: 0.55-0.83) and 0.68 (95% CI: 0.51-0.8), at significance values =0.01 and =0.0357.
Conclusions. The received data showed that blood level of dendritic cells and the level of effector helper T memory cells can be reasonably considered as diagnostic markers of kidney transplant cellular rejection in late period after operation.

Keywords: kidney transplantation, kidney allograft, immune monitoring, biomarkers, rejection
p. 409-420 of the original issue
References
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Address for correspondence:
220013, The Republic of Belarus,
Minsk, P.Brovko Str., 3, build. 3,
Belarusian Medical Academy of Postgraduate Education,
Transplantology Department.
Tel. +375 (33) 312-86-24,
e-mail: doctornosik@gmail.com,
Alexander V. Nosik
Information about the authors:
Nosik Alexander V., Assistant of the Transplantology Department, Belarusian Medical Academy of Postgraduate Education, Surgeon of the Transplantation Unit, Minsk Scientific and Practical Center of Surgery, Transplantology and Hematology, Minsk, Republic of Belarus.
https://orcid.org/0000-0002-3500-0866
Korotkov Sergey V., PhD, Associate Professor of the Transplantology Department, Belarusian Medical Academy of Postgraduate Education, Head of the Transplantation Unit (Liver Transplantation and Hepatobiliary Surgery), Minsk Scientific and Practical Center of Surgery, Transplantology and Hematology, Minsk, Republic of Belarus.
https://orcid.org/0000-0002-8536-6911
Smolnikova Viktoryia V., Senior Researcher, the Research Department, Minsk Scientific and Practical Center of Surgery, Transplantology and Hematology, Minsk, Republic of Belarus.
https://orcid.org/0000-0001-5947-8285
Hrynevich Viktoryia Yu., Physician of Laboratory Diagnostics, Clinical-Diagnostic Laboratory, Minsk Scientific and Practical Center of Surgery, Transplantology and Hematology, Minsk, Republic of Belarus.
https://orcid.org/0000-0002-4505-4884
Krivenko Svetlana I., MD, Associate Professor, Deputy Directorfor Science, Minsk Scientific and Practical Center of Surgery, Transplantology and Hematology, Minsk, Republic of Belarus.
https://orcid.org/0000-0002-6813-4465
Dmitrieva Margarita V., Pathologist, City Clinical Pathologoanatomic Bureau, Minsk, Republic of Belarus.
https://orcid.org/0000-0002-2958-9424
Pikirenia Ivan I., PhD, Associate Professor, Head of the Transplantology Department, Belarusian Medical Academy of Postgraduate Education, Surgeon of the Surgery Unit, Minsk Scientific and Practical Center of Surgery, Transplantology and Hematology, Minsk, Republic of Belarus.
https://orcid.org/0000-0001-8907-4601
Dolgolikova Anna A., PhD, Nephrologist of the Nephrology Unit, Minsk Scientific and Practical Center of Surgery, Transplantology and Hematology, Minsk, Republic of Belarus.
https://orcid.org/0000-0003-3576-2235
Kalachik Oleg V., MD, Associate Professor of the Transplantology Department, Belarusian Medical Academy of Postgraduate Education, Deputy Director for the Medical Affairs, Minsk Scientific and Practical Center of Surgery, Transplantology and Hematology, Head of the Republican Center for Nephrology, Renal Replacement Therapy and Kidney Transplantation,Minsk, Republic of Belarus.
https://orcid.org/0000-0002-8993-0292
Shcherba Aliaksei E., MD, Associate Professor of the Transplantology Department, Belarusian Medical Academy of Postgraduate Education, Deputy Director for Surgery, Minsk Scientific and Practical Center of Surgery, Transplantology and Hematology, Minsk, Republic of Belarus.
https://orcid.org/0000-0003-0569-6150
Rummo Oleg O., MD, Professor, Corresponding Member of the National Academy of Sciences of Belarus, Professor of the Transplantology Department, Belarusian Medical Academy of Postgraduate Education, Director, Minsk Scientific and Practical Center of Surgery, Transplantology and Hematology, Minsk, Republic of Belarus.
https://orcid.org/0000-0001-7023-4767

PEDIATRIC SURGERY

DOI: https://dx.doi.org/10.18484/2305-0047.2019.4.421   |  

O.A. GOVORUKHINA

CAUSES OF POSTOPERATIVE ENTEROCOLITIS IN HIRSCHSPRUNG DISEASE IN CHILDREN

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

Objective. To analyze the causes for the development of enterocolitis in the group of patients with Hirschsprung disease after radical surgical treatment in order to prevent its occurrence and improve treatment outcomes.
Methods. During the period for 2010-2018, 92 patients with Hirschsprung disease at the age of 1 month up to 16 years were operated at the Center for Pediatric Surgery by the transanal endorectal pull-through (TEPT) method (in various versions). All patients with the signs of postoperative enterocolitis were included in this study. The clinical manifestations of the disease, age of patients at the time of radical surgical treatment, the form of Hirschsprung disease, changes in the morphological picture of bowel biopsy material were assessed.
Results. During the period of 2010-2018, cases of enterocolitis of mild and moderate severity prevailed in the study group (19 patients with postoperative enterocolitis 27.2% of the total number of patients). Surgery was required in 8 cases of severe postoperative enterocolitis. The occurrence of postoperative enterocolitis was established to not depend on the patients age at the time of the radical operation (p>0.05). The main causes for the occurrence of postoperative enterocolitis were the following: a long zone of bowel resection in the extended agangliosis and the presence of previous enterocolitis in the history prior to radical surgery. Also, during the morphological study of the operative material with electron microscopic examination, it was revealed that immune cells (eosinophils, mast cells) and endocrinocytes were subjected to destructive processes during enterocolitis in Hirschsprung disease, which contributed to the occurrence of recurrent enterocolitis after radical surgery.
Conclusions. The identification of the main causes of postoperative enterocolitis permitted to identify the group of patients who are likely to develop this serious complication of Hirschsprung disease. Timely and adequate prevention and treatment of postoperative enterocolitis improved patients treatment outcomes.

Keywords: Hirschsprung disease, agangliosis, colon, enterocolitis, transanal endorectal pull-through, postoperative complications
p. 421-427 of the original issue
References
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Address for correspondence:
220013, The Republic of Belarus,
Minsk, Nezavisimosti Ave., 64,
Republican Research and Practical Center for Pediatric Surgery,
Purulent Unit 2 (Surgical),
Tel. +375 29 772-31-34,
e-mail: govorukhina@mail.ru,
Olga A. Govorukhina
Information about the authors:
Govorukhina Olga A., PhD, Associate Professor, Head of the Purulent Unit 2 (Surgical), Republican Research and Practical Center for Pediatric Surgery, Minsk, Republic of Belarus.
https://orcid.org/0000-0002-1605-7031

INFORMATION TECHNOLOGIES IN SURGERY

DOI: https://dx.doi.org/10.18484/2305-0047.2019.4.428   |  

V.. HUTSULIAK 1, R.D.BORODAJKEVYCH 2, .. HUTSULIAK 1, T.M.KOVALYSHYN 1

DEVELOPMENT AND APPLICATION FEATURES OF 3-D ATLAS OF TRANSOSSEOUS ELEMENTS POSITIONS FOR PRE-SURGERY PLANNING OF THE SHIN BONES OSTEOSYNTHESIS

Ivano-Frankivsk National Medical University 1, Ivano-Frankivsk,
Specialized (special) sanatorium "Girske povitria" 2, Yaremche,
Ukraine

Objective. To improve the pre-surgery planning of transosseous osteosynthesis in the shin bone fractures by developing and applying the 3-D atlas of transosseous elements positions.
Methods. On the basis of transverse computer tomographic scans of the intact lower limb of an adult using the 3-D Doctor software package, three-dimensional simulation models of the shin bones and surrounding soft tissue structures were created in the automatic mode. These models were exported as separate files into the Autodesk Inventor 11 software package. In Part Modeling mode, the division of the model of the soft tissue structures of the shin into 96 parts was carried out - the segments corresponding to the positions for passing the transosseous elements according to the method of the unified marking of transosseous osteosynthesis and their preservation in separate files. In Assembly mode, the assemblage of the shin segments has been performed.
Results. The algorithm for the creation of 3-D atlas of transosseous elements positions was proposed, according to which the three-dimensional simulation models of the shin - external fixation device system were created in the Autodesk Inventor 11 program and the analysis of their possibilities regarding pre-surgery planning of transosseous osteosynthesis was conducted.
As a result of the research, it was found out that the use of the 3-D atlas of positions provides an opportunity for selecting the optimal design and the most efficient layout of the external fixation device in each particular clinical situation; determination of the number and optimal layout levels of the supports; the choice of the type and the most appropriate places for passing of the transosseous elements.
Conclusions. The application of 3-D Atlas of transosseous elements positions permits to approach the solution of the problem of pre-surgery planning from the standpoint of an integrated approach to choosing the type of external fixation device that is adequate to the existing clinical situation, its layout, determining the number of transosseous elements, directions and planes for passing them, which will allow reducing significantly the number of technical errors, reducing the risk of complications and promoting the achievement of positive anatomical and functional results in the vast majority of clinical cases.

Keywords: three-dimensional model, external fixation device, transosseous osteosynthesis, transosseous elements, pre-surgery planning
p. 428-434 of the original issue
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Address for correspondence:
76000, Ukraine,
Ivano-Frankivsk, Galitskaya Str., 2,
Ivano-Frankivsk National Medical University,
Department of Traumatology and Orthopedics.
Tel. mobile+38050-960-59-23,
e-mail: vitaliy.ivf@ukr.net,
Vitalii I.Hutsuliak
Information about the authors:
Hutsuliak Vitalii I., PhD, Associate Professor of the Department of Traumatology and Orthopedics, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine.
https://orcid.org/0000-0003-1041-6424
Borodajkevych Roman D., PhD, Chief Physician of the Specialized (Special) Sanatorium Girske Povitria, Yaremche, Ukraine.
https://orcid.org/0000-0003-2841-7572
Hutsuliak AndriiI., MD, Associate Professorofthe Surgery Department 1, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine.
https://orcid.org/0000-0002-3665-7798
Kovalyshyn Taras M., PhD, Associate Professor of the Department of Traumatology and Orthopedics, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine.
https://orcid.org/0000-0003-2388-1149

REVIEWS

DOI: https://dx.doi.org/10.18484/2305-0047.2019.4.435   |  

F.SH. AKHMETZYANOV 1, 2, V.I. EGOROV 1, 2

CHRONIC PRESACRAL SINUS AS THE OUTCOME OF TOTAL MESORECTUMECTOMY IN RECTAL CANCER

Kazan State Medical University 1,
Republican Clinical Cancer Center 2, Kazan,
The Russian Federation

Total mesorectumectomy is a risk factor of development and formulation of pathological presacral sinuses. In the result of the rectum resection with total mesorectumectomy, the volumetric cavity is formed in the pelvisbounded by thebone structures. In case of accumulation of the liquid and blood in it, the risk of infection and the formation of presacral abscesses increases. If the pathological cavity does not heal during 12 months, such sinus is considered to be chronic. The chronic presacral sinus is formed in 5-9.5% of patients, those who underwent total mesorectumectomy. The main causes of development are neoadjuvantchemotherapy, high intraoperative bleeding, tumors of large size. The diagnostics includes the following instrumental methods: rectoscopy, proctography, magnetic resonance imaging of the pelvic organs. The basic methods of treatment in small sinuses are the application of fibrin glue and the EndoVac system. Fibringluecloses defects mechanically, stimulates proliferation of fibroblasts and provides matrix for the synthesis of collagen and for the processes of the wound healing. Fibrin glue is most often used as the final stage of the EndoVac system therapy, when a sponge, corresponding to the defect sizes, is placed in the abscess cavity, and is replaced every 48-72 hours. Treatment effectiveness is 66-100%. In the case of a large sinus, drained through a small defect in anastomosis or inefficiency of the EndoVac system, the method of endoscopic marsupialization is appropriate to be used. The given method allows saving the colorectal anastomosis. In patients with symptomatic presacral sinus in whom stoma reversionis impossible, transversal proctectomy with the cavity tamponade by greater omentum is advisable.

Keywords: total mesorectumectomy, colorectal anastomosis, anastomosis leak, anterior rectal resection, rectal cancer, chronic pelvis sinus
p. 435-442 of the original issue
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Address for correspondence:
420000, The Russian Federation,
Kazan, Baturin Str., 49,
Kazan State Medical University,
Department of Oncology, X-ray Diagnostics and Radiotherapy,
Tel. +79274299671,
e-mail: drvasiliy21@gmail.com,
Vasiliy I. Egorov
Information about the authors:
Akhmetzyanov Foat Sh., MD, Professor, Head of the Department of Oncology, X-ray Diagnostics and Radiotherapy, Kazan State Medical University, Head of the Surgery Clinic, Republican Clinical Cancer Center, Kazan, Russian Federation.
https://orcid.org/0000-0002-4516-1997
Egorov Vasiliy I., PhD, Assistant of the Department of Oncology, X-ray Diagnostics and Radiotherapy, Kazan State Medical University, Oncologist, Republican Clinical Cancer Center, Kazan, Russian Federation.
https://orcid.org/0000-0002-6603-1390
DOI: https://dx.doi.org/10.18484/2305-0047.2019.4.443   |  

M.V. YAKIMAVA, K.N. ZHYLIAEVA, A.V. MIADZVEDZ, L.V. NAUMENKO, A.I. SUBACH

MOLECULAR MARKERS OF UVEAL MELANOMA

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

The literature review is dedicated to the molecular aspects of uveal melanoma.
Although uveal melanoma is a rare pathology, it is characterized by poor prognosis associated with a high probability of tumor progression. According to current conceptions, the availability of clinical and pathomorphological criteria is insufficient for making a correct differential diagnosis of the disease, stratification of metastatic disease risk, evaluation of the disease prognosis and the tumor response to therapy. The molecular genetic study is a valuable supplement to the current techniques.
A number of molecular-biological features are characteristic for uveal melanoma, which could be used as diagnostic criteria of this tumor, as well as for evaluation of its metastatic potential. The review presents the current notion of the benefits and limitations in application of cytogenetic markers, gene expression profiling and driver mutations as prognostic factors of uveal melanoma. Nevertheless, despite the considerable number of articles, there is no ambiguity in understanding molecular mechanisms of uveal melanoma carcinogenesis and especially in the disease progression. Today there are neither reliable criteria for predicting the neoplastic process nor the algorithm for the early detection of metastatasis, which makes further research a high-priority task.

Keywords: uveal melanoma, prognostic markers, cytogenetic aberrations, gene expression profiling, mutations
p. 443-452 of the original issue
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Address for correspondence:
223040, The Republic of Belarus,
Lesnoy,
N.N. Alexandrov National Cancer Centre of Belarus,
Republican Molecular-Genetic
Laboratory of Carcinogenesis,
Oncologic Unit (Genetics).
Tel. +375 (29) 667 93 34,
e-mail: helen_suboch@mail.ru,
Elena I. Suboch
Information about the authors:
Yakimava Maryia V., Physician of Laboratory Diagnostics of the Oncology Unit (Genetics) of the Republican Molecular-Genetic Laboratory of Carcinogenesis, N.N. Alexandrov National Cancer Centre of Belarus, Minsk, Republic of Belarus.
http://orcid.org/0000-0002-5522-3223
Zhyliaeva Katsiaryna P., Ophthalmologist of the Consultative-Out-Patient Department, N.N. Alexandrov National Cancer Centre of Belarus, Minsk, Republic of Belarus.
https://orcid.org/0000-0003-2964-6895
Miadzvedz Antanina V., Physician of Laboratory Diagnostics of the Oncology Unit (Cellular Technologies) of the Republican Molecular-Genetic Laboratory of Carcinogenesis, N.N. Alexandrov National Cancer Centre of Belarus, Minsk, Republic of Belarus.
http://orcid.org/0000-0002-5687-1775
Naumenko Larisa V., PhD, Ophthalmologist of the Unit of Head and Neck Tumors, N.N. Alexandrov National Cancer Centre of Belarus, Minsk, Republic of Belarus.
http://orcid.org/0000-0002-1875-9176
Subach Alena I., PhD, Physician of Laboratory Diagnostics (Head) of the Oncology Unit (Genetics) of the Republican Molecular-Genetic Laboratory of Carcinogenesis, N.N. Alexandrov National Cancer Centre of Belarus, Minsk, Republic of Belarus.
http://orcid.org/0000-0002-3939-6597
DOI: https://dx.doi.org/10.18484/2305-0047.2019.4.453   |  

V.P. ZEMLYANOI 1, B.V. SIGUA 1, S.V. PETROV 2, V.A. IGNATENKO 2, P.A. KOTKOV 2

SURGICAL TREATMENT OF PATIENTS WITH TERTIARY PERITONITIS

North-Western State Medical University named after I.I. Mechnikov 1,
St. Petersburg State Health Care Institution "Elizabethan Hospital" 2, Saint-Petersburg,
The Russian Federation

The problems of tertiary peritonitis treating are described in a large amount of scientific papers covering various aspects of this disease. The analysis of the literature shows an increased frequency of persistent peritonitis among patients of surgical units and the lack of unified approaches to its treatment. The diagnostic criteria of tertiary peritonitis are extremely non-specific, which makes it difficult to work out an effective treatment program. This article focuses on adequate sanitation of the abdominal cavity as one of the main therapeutic components. The use of planned and on demand relaparotomies was introduced into clinical practice long ago, however, no clear indications for the use of specific operational tactics were found in the available literature. A comparative assessment is given to different ways of abdominal cavity managing (open, closed, half-open, half-closed). The main ways of operative injury minimizing, that inevitably accompanies repeated surgical interventions and leads to the development of abdominal complication, are considered. Obviously, the problem of tertiary peritonitis is far from its final decision, and further scientific research aimed at surgical approaches upgrade should help to improve the results of treatment.

Keywords: tertiary peritonitis, planned relaparotomy, laparostomy, on demand relaparotomy, sanitation of the abdominal cavity
p. 453-460 of the original issue
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Address for correspondence:
191015, The Russian Federation,
Saint Petersburg, Kirochnaya Str., 41,
North-Western State Medical
University named after I.I. Mechnikov,
Department of the Faculty Surgery named after I.I. Grekov.
Tel. +790626192131,
e-mail: kotkovdr@mail.ru
Pavel A. Kotkov
Information about the authors:
Zemlianoi Viacheslav P., MD, Professor, Head of the Department of the Faculty Surgery named after I.I. Grekov, North-Western State Medical University named after I.I. Mechnikov, Saint Petersburg, Russian Federation.
https://orcid.org/0000-0003-2329-0023
Sigua Badri V., MD, Professor of the Department of the Faculty Surgery named after I.I. Grekov, North-Western State Medical University named after I.I. Mechnikov, Saint Petersburg, Russian Federation.
https://orcid.org/0000-0002-4556-4913
Petrov Sergey V., MD, Professor, Chief Physician of St. Petersburg State Health Care Institution Elizabethan Hospital, Saint Petersburg, Russian Federation.
https://orcid.org/0000-0003-4398-5770
Ignatenko Viktor A., Head of the Surgical Unit 2, St. Petersburg State Health Care Institution Elizabethan Hospital, Saint Petersburg, Russian Federation.
https://orcid.org/0000-0002-6615-3005
Kotkov Pavel A., PhD, Surgeon of the Surgical Unit2, St. Petersburg State Health Care Institution Elizabethan Hospital, Saint Petersburg, Russian Federation.
https://orcid.org/0000-0002-9762-9854

CASE REPORTS

DOI: https://dx.doi.org/10.18484/2305-0047.2019.4.461   |  

E.V. KRASNIKOVA, L.A. POPOVA, R.V. TARASOV, V.K. ALIEV, JU.V. TUROVTEVA, .S. IBRIEV, S.S. SADOVNIKOVA, M.A. BAGIROV

A ASE OF BILATERAL SILICONE PLOMBAGE AND VALVE BRONCHOBLOCATION IN A PATIENT WITH WIDESPREAD FIBRO-CAVERNOUS DRUG RESISTANT TUBERCULOSIS OF THE OPERATED LUNG

Central Tuberculosis Research Institute, Moscow,
The Russian Federation

A case report describes a patient with chronic bilateral drug resistant lung tuberculosis, who had previously undergone an ineffective resection of one lung. For the first time bilateral extrapleural pneumolysis surgery with silicone plombage has been performed. From the side of the operated lung the effect of collapse was boosted by installation of an endobronchial valve. This case demonstrates a typical situation of chronization of the destructive process due to a long-term treatment without taking into account the data of drug sensitivity of mycobacterium tuberculosis and performing surgery without combination with adequate chemotherapy. Resection surgery is ineffective due to the limitation of functional reserves of the patient. The combination of collapse-forming surgical and endoscopic techniques aimed to form compression and artificial atelectasis are being worked out contributing to the preservation of the entire volume of lung tissue and the healing of cavities. Traditional thoracoplasty is traumatic enough, especially in patients with low respiratory reserves and leads to a significant cosmetic damage. The clinic of Central Tuberculosis Research Institute has experience in performing effective and low-traumatic surgery of extrapleural silicone plombage. An indwelling silicone implant is not rejected by human body, provides a high compression effect and does not lead to cosmetic damage.
The use of the collapse-forming techniques led to clinical recovery of the patient, what was proved by the long-term examination data.

Keywords: tuberculosis, multidrug-resistant tuberculosis, collapse surgery, extrapleuralpneumolysis with silicone plombage, bilateral silicone plombage, operated lung
p. 461-468 of the original issue
References
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  11. Lovchev OV, Bgirov MA, Bgdsryan TR, Krsnikov EV, Shergin EA, Gritsy IYu. Use of endobronchial valves and extrapleural sealing for treatment of bilateral massive cavities in a female patient with multiple drug resistant pulmonary tuberculosis. Tuberculosis and Lung Diseases. 2017;95(9):60-67. doi: 10.21292/2075-1230-2017-95-9-60-67. (In Russ.)
Address for correspondence:
107564, The Russian Federation,
Moscow, Yauz Alley Str., 2,
Central Tuberculosis Research Institute,
Surgery Department.
Tel.mobile +7(916) 573-29-76,
e-mail: el.krasn@gmail.com,
Elena V. Krasnikova
Information about the authors:
Krasnikova Elena V., PhD, Senior Researcher of the Surgery Department, Head of the Operative Unit of Central Tuberculosis Research Institute, Moscow, Russian Federation.
https://orcid.org/0000-0002-5879-7062
Popova Lydi A., PhD, Senior Researcher of the Functional Diagnostic Unit of the Clinical-Diagnostic Department of Central Tuberculosis Research Institute, Moscow, Russian Federation.
https://orcid.org/0000-0003-4571-8772
Aliev Vilayat K., Junior Researcher of the Surgery Department of Central Tuberculosis Research Institute, Moscow, Russian Federation.
https://orcid.org/0000-0002-0105-1980
Tarasov Ruslan V., Laboratory Assistant Researcher of the Surgery Department of Central Tuberculosis Research Institute, Moscow, Russian Federation.
https://orcid.org/0000-0001-9498-1142
Turovtceva Julia V., Physician of the Endoscopy Unit of the Clinical Diagnostic Department of Central Tuberculosis Research Institute, Moscow, Russian Federation.
https://orcid.org/0000-0002-7943-7285
Ibriev Adam S., Physician of the First Surgery Unit of the Surgical Department of Central Tuberculosis Research Institute, Moscow, Russian Federation.
https://orcid.org/0000-0002-9712-4442
Sadovnikova Svetlana S., MD, Head of the First Surgery Unit of the Surgical Department of Central Tuberculosis Research Institute, Moscow, Russian Federation.
https://orcid.org/0000-0002-6589-2834
Bagirov Mamed A., MD, Professor, Head of the Surgical Department of Central Tuberculosis Research Institute, Moscow, Russian Federation.
https://orcid.org/0000-0001-9788-1024
DOI: https://dx.doi.org/10.18484/2305-0047.2019.4.469   |  

A.L. PETRUSHIN, A.V. PRYALUHINA, A.A. SIDOROV

NICOLAU SINDROME

Karpogory Central District Hospital,
The Russian Federation

The objective of this study is the clinical case of the Nicolau syndrome demonstration and a brief review of the literature on its diagnosis and treatment. Nicolau syndrome is a rare post-injection complication, characterized by the development of ischemic necrosis of the skin, subcutaneous tissue, and in some cases, muscle tissue, in the injection zone. The description of the clinical case is presented, in which after intramuscular injection of diclofenac the tissue and subcutaneous tissue of the gluteal region necrosis developed, requiring necrectomy and replacement of a soft tissue defect. The most common cause of Nicolau syndrome development is the non-steroidal anti-inflammatory drugs injections. Predisposing factors are overweight and accidental subcutaneous instead of intramuscular injection. Among the causes of development, most authors call angiospasm, small and medium artery embolism, and subsequent ischemia. Diagnosis based on clinical signs: the appearance immediately after injection of a clearly delineated ischemia patch, followed by the development of necrosis. In the early stages, conservative management, including anticoagulants, disaggregants and corticosteroids, is possible. In the presence of necrosis, their excision and replacement of the defect are indicated. Plastics with local tissues coverage can replace the extensive defects without large scars formation. Prevention of the Nicolau syndrome mainly consists of accidental subcutaneous and intravascular drug administration preventing.
The presented clinical case and a review of the literature suggest that Nicolau syndrome is a rare post-injection complication with unclear etiology and pathogenesis. A typical manifestation of this syndrome is necrosis of soft tissues in the injection site. The local skin-fascial flaps using is the effective method of the defects coverage after debridement necrectomy.

Keywords: Nicolau syndrome, livedoid dermatitis, skin necrosis, intramuscular injection, post-injection complications
p. 469-474 of the original issue
References
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  6. Rygnestad T, Kvam AM. Streptococcal myositis and tissue necrosis with intramuscular administration of diclofenac (Voltaren). Acta Anaesthesiol Scand. 1995 Nov;39(8):1128-30.doi: 10.1111/j.1399-6576.1995.tb04243.x
  7. Kim KK.,Chae DS. Nicolau syndrome: a literature review. World J Dermatol. 2015 May 2;4(2):103-107. doi: 10.5314/wjd.v4.i2.103
  8. Kilic I, Kaya F, Ozdemir AT, Demirel T, Celik I. Nicolau syndrome due to diclofenac sodium (Voltaren) injection: a case report. J Med Case Rep. 2014;8:404. doi: 10.1186/1752-1947-8-404
  9. Silva AMM, Loureiro TF, Ton A, Agrizzi BL. Late development of Nicolau syndrome case report. An Bras Dermatol. 2011;86(1):157-59. doi: 10.1590/S0365-05962011000100026
  10. Okan G, Canter HI. Nicolau syndrome and perforator vessels: a new viewpoint for an old problem. Cutan Ocul Toxicol. 2010 Mar;29(1):70-72. doi: 10.3109/15569520903496753
  11. Nisbet AC. Intramuscular gluteal injections in the increasingly obese population: retrospective study. BMJ. 2006 Mar 18;332(7542):637-38.doi: 10.1136/bmj.38706.742731.47
  12. Park HJ, Kim MS, Park NH, Jung SW, Park SI, Park CS. Sonographic findings in Nicolau syndrome following intramuscular diclofenac injection: a case report. J Clin Ultrasound. 2011 Feb;39(2):111-13. doi: 10.1002/jcu.20743
  13. Chagas C, Leite T, Pires L. Post-injection embola cutis medicamentosa - Nicolau syndrome: case report and literature review. J Vasc Bras. 2016;15(1). doi: 10.1590/1677-5449.008315
  14. Maneshi A, Ravi S, Salehi MR, Hasannezhad M, Khalili H. Nicolau syndrome. ArchIranMed. 2017;20(1):60-64. http://ams.ac.ir/AIM/NEWPUB/17/20/1/0013.pdf
Address for correspondence:
164600, The Russian Federation,
Arkhangelsk region, Karpogory, Lenin Str., 47,
Karpogory Central District Hospital,
Surgery Unit,
Tel.mob. +7 921076-73-29,
e-mail: petrushin.59@mail.ru
Alexander L. Petrushin
Information about the authors:
Petrushin Alexander L., PhD, Head of the Surgery Unit, Karpogory Central District Hospital, Arkhangelsk Region, Karpogory, Russian Federation.
https://orcid.org/0000-0002-3246-7452
Pryaluhina Anastasia V., Gynecologist, Karpogory Central District Hospital, Arkhangelsk Region, Karpogory, Russian Federation.
https://orcid.org/0000-0002-9801-5782
Sidorov Alexey A., Surgeon, Karpogory Central District Hospital, Arkhangelsk Region, Karpogory, Russian Federation.
https://orcid.org/0000-0002-1345-6352
DOI: https://dx.doi.org/10.18484/2305-0047.2019.4.475   |  

S.A. MARKOSYAN, N.S. MARKOSYAN

TERMINAL ILEITIS, COMPLICATED BY DOUGLAS SPACE ABSCESS IN 8-YEAR-OLD CHILD

National Research Ogarev Mordovia State University, Institute of Medicine, Saransk,
The Russian Federation

The report describes a clinical case of a child of 8 years old with terminal ileitis, complicated by Douglas space abscess. With performing ultrasound of the abdominal cavity organs, the appendicular infiltrate was suspected, and therefore the patient was transferred from the infectious diseases hospital to the childrens surgical hospital. After a re-ultrasound examination of the abdominal organs, the diagnosis was confirmed. The child underwent diagnostic laparoscopy, which allowed diagnosing terminal ileitis in the exacerbation stage, and laparoscopic appendectomy. After the operation the girl was observed in the resuscitation and intensive care unit, in which she got pathogenetic and symptomatic therapy. Despite the treatment, carried out in the early postoperative period, Douglas space abscess developed, accompanied by the abdominal pain, increase in body temperature to febrile numbers, appearance of biliary vomiting. Repeated laparoscopic surgery was carried out, aimed at sanitation and drainage of the abscess cavity. In the postoperative period, the intestinal peristalsis was additionally stimulated, physiotherapy treatment was conducted, and antibiotic therapy was corrected. As a result of treatment, the patients condition improved. The patient was transferred to another medical institution to provide her with high-technological medical care.

Keywords: terminal ileitis, small intestine, Douglas space abscess, laparoscopy, child
p. 475-479 of the original issue
References
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Address for correspondence:
430032, The Russian Federation,
Saransk, Ulyanov Str., 26,
National Research Ogarev
Mordovia State University,
Institute of Medicine,
Department of the Faculty Surgery
with the Courses of Topographic Anatomy and
Operative Surgery, Urology and Pediatric Surgery.
Tel. mob. +79176990604,
e-mail: rumarkosyansa@mail.ru,
Sergey A. Markosyan
Information about the authors:
Markosyan Sergey A., MD, Associate Professor, Professor of the Department of the Faculty Surgery with the Courses of Topographic Anatomy and Operative Surgery, Urology and Pediatric Surgery, National Research Ogarev Mordovia State University, Institute of Medicine, Saransk, Russian Federation.
http://orcid.org/0000-0002-9876-4433
Markosyan Natalia S., PhD, Associate Professor of the Department of Infectious Diseases with the Coursesin Epidemiology, Phthisiology, Skin and Sexually Transmitted Diseases, National Research Ogarev Mordovia State University, Institute of Medicine, Saransk, Russian Federation.
http://orcid.org/0000-0003-3563-1075
Contacts | ©Vitebsk State Medical University, 2007