Novosti
Khirurgii
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indexed in Scopus









Year 2019 Vol. 27 No 6

SCIENTIFIC PUBLICATIONS
GENERAL & SPECIAL SURGE

DOI: https://dx.doi.org/10.18484/2305-0047.2019.6.615   |  

V.I. RUSYN, V.V. KORSAK, V.V. RUSYN, F.V. HORLENCO, V.M. DOBOSH

ANGIOARHITECTONICS AND MORPHOMETRY OF THE DEEP FEMORAL ARTERY

Uzhhorod National University, Uzhhorod,
Ukraine

Objective. To study the surgical anatomy of the deep femoral artery.
Methods. The study of angioarchitectonics of the deep femoral artery was carried out on 20 cadavers. On one side of the lower extremity, the deep femoral artery was isolated over 17 cm, all branches of the deep artery were taken on handles, their number was fixed as well as the diameter at the level of the main trunk and distal to 17 cm, variants of the union of the medial and lateral enveloping branches, variants of the anatomical structure of the deep femoral artery and the location of the orifice relatively to the common femoral artery. After that, the superficial femoral artery at the level of the orifice was ligated and puncture-catheter angiography of the deep femoral artery was performed on a PXP-40HF mobile unit (52-58 kV, 1.8-3.2 mas) at a focal length of 1 m. For an angiographic study, 20 ml of a 76% triombrast solution was used.
Results. Based on the data revision, three main options for the structure of the deep femoral artery trunk were determined. The first variant occurred in 11 (55%) cases, where the presence of the only one trunk of the deep femoral artery from which the lateral and medial circumflex femoral arteries clearly departed. In the second variant, the lateral and medial circumflex femoral arteries and the deep femoral artery diverged separately from the common femoral artery. A feature of the anatomical structure of the deep femoral artery for the third variant was the lack of a clear distinction between the main trunk of the deep femoral artery and its branches.
Conclusions. The deep femoral artery has three main options of formation and separation from the common femoral artery. According to the divergence of the deep femoral artery from the common femoral artery, it was found out that in 50% of observations the influx of the deep femoral artery is located on the lateral semicircle, in 25% of observations on the posterior-lateral semicircle, in 15% on the posterior semicircle and in 10% on the posterior medial semicircle.

Keywords: chronic limb ischemia, deep femoral artery diameter, anatomy of the deep femoral artery; femoral artery/surgery; arterial occlusive diseases
p. 615-621 of the original issue
References
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Address for correspondence:
88000, Ukraine,
Uzhhorod, Kapushanskaya Str., 22,
Uzhhorod National University,
Department of Surgical Diseases.
Tel. +8 099 73-68-098,
e-mail: v.dobosh@gmail.com,
Viktoria M. Dobosh
Information about the authors:
Rusyn Vasyl I., MD, Professor of the Department of Surgical Diseases, Uzhhorod National University, Uzhhorod, Ukraine.
http://orcid.org/0000-0001-5688-9951
Korsak Vyacheslav V., MD, Professor of the Department of Surgical Diseases, Uzhhorod National University, Uzhhorod, Ukraine.
http://orcid.org/0000-0002-4866-1882
Rusyn Vasyl V., MD, Associate Professor of the Department of Surgical Diseases, Uzhhorod National University, Uzhhorod, Ukraine.
http://orcid.org/0000-0002-0794-6777
Horlenko Fedir V., PhD, Associate Professor of the Department of Surgical Diseases, Uzhhorod National University, Uzhhorod, Ukraine.
http://orcid.org/0000-0002-0496-2069
Dobosh Viktoria M., Post-Graduate Student of the Department of Surgical Diseases, Uzhhorod National University, Uzhhorod, Ukraine.
http://orcid.org/0000-0003-2485-8266
DOI: https://dx.doi.org/10.18484/2305-0047.2019.6.622   |  

S.N. EROSHKIN 1, L.A. FRALOU 1, Y.I. RATOMSKI 2, S.P. BABKOV 3, K.G. TSYPLAKOV 4, K.O. CHEPIK 1

EFFICACY OF PERIPHERAL ARTERY DISEASE TREATMENT BY CRUS TUNNELING IN COMBINATION WITH BONE MARROW TRANSPLANTATION DEPENDING ON THE SEVERITY OF LOWER LIMB ISCHEMIA

Vitebsk State Medical University1,
Vitebsk Central City Clinical Hospital2,
Vitebsk Regional Clinical Hospital3,
Vitebsk Regional Clinical Specialized Centre4, Vitebsk,
The Republic of Belarus

Objective. To determine the effect of bone marrow auto transplantation combined with the limb soft tissues tunneling in treatment of peripheral artery disease depending on the grade of chronic limb ischemia.
Methods. 62 men with peripheral artery disease of the lower limbs were included in the study and they were divided into three groups according to the Pokrovsky-Fontaine classification: the 1st group IIb (15 patients), the 2nd III grade (27 patients), the 3rd IV grade (20 patients). In all patients, bone marrow auto transplantation combined with tunneling of the crus soft tissues was used as method of indirect revascularization. Results were assessed by the amount of amputations in every group, distance increase of painless walking, temperature of the operated limb and ankle-brachial index. The data were collected 6 and 12 months after surgery.
Results. The number of high-level amputations in the third group was more than in the first and the second ones during examinations 6 and 12 months after surgery (p=0.0001). Distance increase of painless walking in the third group was reliably less than in other groups 6 months (p=0.001) and 12 months (p=0.0001) after treatment. Furthermore, during second half year of observation distance of painless walking increased in the first (=0.011) and the second (=0.009) groups but it decreased in the third group (=0.003). Temperature of the operated limb during the second half year of observation had similar dynamics: it increased in the first and second groups but did not change in the third one. Reliable changes of ankle-brachial index were absent in all examined groups 6 and 12 months after
Conclusions. Bone marrow auto transplantation combined with tunneling of the crus soft tissues is more effective in patients with IIb and III grades of limb ischemia and it may be applied in these categories of patients in the case when direct revascularization is impossible.

Keywords: revascularization, critical ischemia, peripheral artery disease, tunneling, bone marrow auto transplantation
p. 622-629 of the original issue
References
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Address for correspondence:
210027, The Republic of Belarus,
Vitebsk, Frunze Ave., 27,
Vitebsk State Medical University,
General Surgery Department.
Tel.: +375 33 611-19-75.
e-mail: sergionik2014@gmail.com,
Sergey N. Eroshkin
Information about the authors:
Eroshkin Sergey N., PhD, Associate Professor of the General Surgery Department, Vitebsk State Medical University, Vitebsk, Republic of Belarus.
https://orcid.org/0000-0003-3617-8719
Fralou Leanid A., PhD, Associate Professor, Head of the General Surgery Department, Vitebsk State Medical University, Vitebsk, Republic of Belarus.
http://orcid.org/0000-0003-3357-4409
Ratomski Yury I., Head of the Surgery Unit, Vitebsk Central City Clinical Hospital, Vitebsk, Republic of Belarus.
http://orcid.org/0000-0002-1175-3193
Babkov Siarhei P., Angiosurgeon of the Endovascular Surgery Unit, Vitebsk Regional Clinical Hospital, Vitebsk, Republic of Belarus.
http://orcid.org/0000-0001-6073-4629
Tsyplakov Konstantin G., Head of the Proctology Unit, Vitebsk Regional Clinical Specialized Centre, Vitebsk, Republic of Belarus.
http://orcid.org/0000-0001-7995-9019
Chepik Kiryl O., Assistant of the General Surgery Department, Vitebsk State Medical University, Vitebsk, Republic of Belarus.
http://orcid.org/0000-0001-8499-0248
DOI: https://dx.doi.org/10.18484/2305-0047.2019.6.630   |  

V.YA. KHRYSHCHANOVICH 1, 2, I.P. KLIMCHUK 1, 3, R. PROCZKA 4, N.. ROGOVOY 1, 3, S.S. KALININ 1, 3, S. MAZUR 4, .V. NELIPOVICH 3

RESULTS OF TRUNCAL ENDOVENOUS MECHANO-CHEMICAL ABLATION IN VARICOSE DISEASE

Belarusian State Medical University 1,
City Clinical Emergency Hospital 2,
4th City Clinical Hospital named after N.E. Savchenko 3, Minsk,
The Republic of Belarus,
Center OF Cardiology and Vascular Surgery Jozefow 4, Warsaw,
The Republic of Poland

Objective. To study the long-term (12-months follow-up) results of endovenous mechano-chemical ablation (MOCA) with FlebogrifTM occlusion catheter system for varicose veins (VV) in three vascular centers.
Methods. The study is based on the treatment results of 139 patients with VV. Surgeries were performed using the FlebogrifTM catheter. 123 patients (88.5%) were operated on for incompetence of the great saphenous vein (GSV) on the one side, 6 (4.3%) for bilateral lesions of the GSV, and 8 (5.8%) for the small saphenous vein (SSV) and 2 (1.4%) due to reflux in GSV and SSV. The average diameter of the target GSV and SSV segments was 8.21.3 mm and 4.21.2 mm, respectively (Mσ). Control examinations of patients were carried out 1, 3, 6 and 12 months after surgery.
Results. One month after the operation, the GSV was completely occluded in 132/136 (97.1%) veins and SSV completely closed in 10/10 (100%) veins. Six months after the endovenous mechano-chemical ablation, the GSV was completely occluded in 99/111 (89.2%) veins and SSV completely closed in 5/6 (83.3%) veins. 12 months after surgery, GSV and SSV occlusion rates were 72/85 (84.7%) and 5/6 (83.3%). There were no significant thrombotic and neurological complications related to the procedure. Skin hyperpigmentation was found in 30/137 GSV treated (21.9%), and along the varicose tributaries in 22 legs (15.2%). Transient superficial phlebitis was reported in 7 of 145 (4.8%) legs. Ecchymosis from the puncture site was reported in 26/145 legs (17.9%).
Conclusions. FlebogrifTM MOCA device is safe and effective method to eliminate the truncal venous reflux for varicose veins, associated with low perioperative pain and minimal complication rate.

Keywords: varicose veins, treatment, endovenous mechano-chemical ablation, truncal reflux, Flebogrif
p. 630-639 of the original issue
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  6. Ciostek P, Kowalski M, Wozniak W, Miłek T, Myrcha P, Migda B. Phlebogriffe a new device for mechanochemical ablation of incompetent saphenous veins: a pilot study. Phlebological Review. 2015;23(3):72-77. doi: 10.5114/pr.2015.57466
  7. Zubilewicz T, Terlecki P, Terlecki K, Przywara S, Rybak J, Ilzecki M. Application of endovenous mechanochemical ablation (MOCA) with Flebogrif to trea varicose veins of the lower extremities: a single center experience over 3 months of observation. Acta Angiologica. 2016; 22(4):137-42. doi: 10.5603/AA.2016.0012
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Address for correspondence:
220116, The Republic of Belarus,
Minsk, Dzerzhinski Ave., 83,
Belarusian State Medical University,
2nd Department of Surgical Diseases.
Tel.: +375 17277-11-55,
e-mail: scienceprorektor@bsmu.by,
Vladimir Ya. Khryshchanovich
Information about the authors:
Khryshchanovich Vladimir Ya., MD, Professor, Vice-Rector for Scientific Work, Professor of the 2nd Department of Surgical Diseases, Belarusian State Medical University, Angiosurgeon, City Clinical Emergency Hospital, Minsk 4th City Clinical Hospital named after N.E. Savchenko, Minsk, Republic of Belarus.
http://orcid.org/0000-0001-5353-205X
Klimchuk Ivan P., PhD, Head of the Department of Vascular Surgery, Minsk 4th City Clinical Hospital named after N.E. Savchenko, Assistant of the General Surgery Department, Belarusian State Medical University, Minsk, Republic of Belarus.
http://orcid.org/0000-0001-9793-0084
Proczka Robert, MD, Head of Centre of Cardiology and Vascular Surgery Jozefow, Warsaw, Poland.
http://orcid.org/0000-0003-2910-2951
Rogovoy Nickolay A., PhD, Assistant of the General Surgery Department, Belarusian State Medical University, Angiosurgeon of the Department of Vascular Surgery, Minsk 4th City Clinical Hospital named after N.E. Savchenko, Minsk, Republic of Belarus.
http://orcid.org/0000-0002-8386-1791
Kalinin Siarhei S., PhD, Angiosurgeon of the Department of Vascular Surgery, Minsk 4th City Clinical Hospital named after N.E. Savchenko, Assistant of the General Surgery Department, Belarusian State Medical University, Minsk, Republic of Belarus.
http://orcid.org/0000-0003-3180-0409
Mazur Stanislaw, Angiosurgeon, Centre of Cardiology and Vascular Surgery Jozefow, Warsaw, Poland.
http://orcid.org/0000-0002-0747-9363
Nelipovich Evgenij V., Angiosurgeon of the Department of Vascular Surgery, Minsk 4th City Clinical Hospital named after N.E. Savchenko, Minsk, Republic of Belarus.
http://orcid.org/0000-0002-2921-6601
DOI: https://dx.doi.org/10.18484/2305-0047.2019.6.640   |  

I.A. KRYVORUCHKO 1, V.V. BOYKO 1, 2, N.N. HONCHAROVA 1, I.A. TARABAN 1, O.V. ARSENYEV 3, JU.V. IVANOVA 1, 2, D.A. SMETSKOV 4, 5, A.G. DROZDOVA 5

EVALUATION OF INTESTINAL BARRIER BIOMARKER I-FABP AND SEVERITY OF PATIENTS IN ACUTE PANCREATITIS

Kharkiv National Medical University 1,
V.T. Zaytsev Institute of General and Emergency Surgery 2,
National University of Pharmacy 3,
Kharkiv Regional Clinical Hospital 4,
Kharkiv Medical Academy of Postgraduate Education 5, Kharkiv,
Ukraine

Objective. To determine the possibility of using I-FABP together with indicators of the abdominal cavity perfusion pressure to diagnose damages of digestive tract and to assess the acute pancreatitis severity.
Methods. A prospective, single-center controlled study was conducted in 58 patients. The dynamics of clinical and laboratory parameters, APACHE II score, AGI grade and parameters of the abdominal perfusion pressure in all patients were evaluated as well as I-FABP changes in 27 (46.6%) on admission and 48 hours after their complex treatment.
Results. The level of I-FABP in the serum after 48 hours increased by 69.8% on average, showed good accuracy for predicting the damage severity to the digestive tract after 48 hours compared with the initial level of AGI grade (area under the ROC curve 0.913) at the threshold value I-FABP 1350 pg/ml with a sensitivity of 0.95 and a specificity of 0.9. A good predictive value was found between the APACHE II score and the level of perfusion pressure in the abdomen when patients were admitted (area under the ROC-curve 0.889) and after 48 hours (the area under the ROC-curve 0.929) for complex treatment. It is established that the severity of the patients condition on the APACHE II scale can be predicted by the level of perfusion pressure when patients are admitted (threshold value 72.1 mm Hg, sensitivity 0.82, specificity 0.83) and after 48 hours of complex treatment (threshold 62 mm Hg, sensitivity 0.86, specificity 0.92).
Conclusions. Serum I-FABP is a valuable, convenient, objectively early predictor of the digestive tract damage in acute pancreatitis. The severity of patients condition can be predicted not only by using the APACHE II score, but also by evaluating the perfusion pressure in the abdominal cavity in the course of complex intensive therapy.

Keywords: acute pancreatitis, I-FABP, APACHE II score, AGI grade, abdominal perfusion pressure, surgery
p. 640-649 of the original issue
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  13. Boiko VV, Krivoruchko IA, Shevchenko RS, Smachilo RM, Pesotskii ON. Ostryi pankreatit. Patofiziologiia i lechenie. Kharkov, Ukraina: Tornado; 2002. 258 p. http://www.booksmed.com/hirurgiya/515-ostryj-pankreatit-patofiziologiya-i-lechenie.html (In Ukr.)
  14. Kitai T, Kim YH, Kiefer K, Morales R, Borowski AG, Grodin JL, Tang WHW. Circulating intestinal fatty acid-binding protein (I-FABP) levels in acute decompensated heart failure. Clin Biochem. 2017 Jun;50(9):491-95. doi: 10.1016/j.clinbiochem.2017.02.014
  15. Grimaldi D, Guivarch E, Neveux N, Fichet J, Pène F, Marx JS, Chiche JD, Cynober L, Mira JP, Cariou A. Markers of intestinal injury are associated with endotoxemia in successfully resuscitated patients. Resuscitation. 2013 Jan;84(1):60-65. doi: 10.1016/j.resuscitation.2012.06.010
  16. Sekino M, Funaoka H, Sato S, Okada K, Inoue H, Yano R, Matsumoto S, Ichinomiya T, Higashijima U, Matsumoto S, Hara T. Intestinal fatty acid-binding protein level as a predictor of 28-day mortality and bowel ischemia in patients with septic shock: A preliminary study. J Crit Care. 2017 Dec;42:92-100. doi: 10.1016/j.jcrc.2017.07.012
Address for correspondence:
61022, Ukraine,
Kharkiv, Nauki Ave., 4,
Kharkiv National Medical University,
Surgery Department 2.
Tel.: +38-050-301-90-90,
+38-057-705-02-45,
e-mail: ikryvoruchko60@gmail.com,
Igor A. Kryvoruchko
Information about the authors:
Kryvoruchko Igor A., MD, Professor, Head of the Surgery Department 2, Kharkiv National Medical University, Kharkiv, Ukraine.
https://orcid.org/0000-0002-5525-701X
Boyko Valeriy V., Corresponding Member of NAMS of Ukraine, MD, Professor, Director of V.T. Zaytsev Institute of General and Emergency Surgery, Head of the Surgery Department 1, Kharkiv National Medical University, Kharkiv, Ukraine.
https://orcid.org/0000-0002-3455-9705
Honcharova Natalya N., MD, Associate Professor, Professor of the Surgery Department 2, Kharkiv National Medical University, Kharkiv, Ukraine.
http://orcid.org/0000-0001-5031-7311
Taraban Igor A., MD, Professor of the Surgery Department 1, Kharkiv National Medical University, Kharkiv, Ukraine.
https://orcid.org/0000-0002-5842-2551
Arsenyev leksandr V., PhD, Associate Professor of the Pharmacokinetics Department, National University of Pharmacy, Kharkiv, Ukraine.
https://orcid.org/0000-0002-9807-0853
Ivanova Julia V., MD, Leading Researcher, V.T. Zaytsev Institute of General and Emergency Surgery, Professor of the Surgery Department 1, Kharkiv National Medical University, Kharkiv, Ukraine.
https://orcid.org/0000-0001-8773-6827
Smetskov Dmytro A., PhD, Head of the Operative Unit of Kharkiv Regional Clinical Hospital, Associate Professor of the Department of Endoscopy and Surgery of Kharkiv Medical Academy of Postgraduate Education, Kharkiv, Ukraine.
https://orcid.org/0000-0002-5004-2255
Drozdova Anastasiya G., Post-Graduate Student of the Surgery Department 2, Kharkiv National Medical University, Kharkiv, Ukraine.
https://orcid.org/0000-0002-4401-8048
DOI: https://dx.doi.org/10.18484/2305-0047.2019.6.650   |  

YU.S. VINNIK, R.A. PAKHOMOVA, L.V. KOCHETOVA, G.E. KARAPETYAN

ELECTRONIC MICROSCOPY OF ERYTHROCYTES IN PATIENTS WITH SEVERE OBSTRUCTIVE JAUNDICE OF BENIGN GENESIS

Krasnoyarsk State Medical University named after Prof. V.F. Voino-Yasenetski, Krasnoyarsk,
The Russian Federation

Objective. To study chemical composition and morphology of an erythrocyte in patients with severe obstructive jaundice.
Methods. Erythrocyte electron microscopy was performed on Hitachi 5500 scanning electron microscope (Japan), the spectral analysis of the peripheral blood erythrocyte composition was calculated using the QUANTAX 70 program in 17 patients with the severe obstructive jaundice and 14 conditionally healthy individuals. The severity of obstructive jaundice was determined by E.I. Halperin (2012). The study included the patients with severe obstructive jaundice, with clinical signs of endotoxemia and hepatic cell failure. The level of bilirubin in the studied patients was higher than 180 μmol / L, the level of alanine and aspartic transaminases was 2-3 times higher than normal.
Results. In patients with severe obstructive jaundice, the erythrocyte cytoskeleton changed: from a biconcave spherocyte, it turned into a domed stomatocyte. The oxygen concentration in the cell significantly decreased and reached its minimum value, 14.9%. Hypokalemia increased inside the cell, the content of sodium increased to 7.1% and calcium ions to 2.9%, which made the cell heavier, retaining water in it and, most likely, led to a change in the shape of the red blood cell and its functional capabilities. Significant changes in the concentration of carbon and nitrogen inside the cell were not detected.
Conclusions. In patients with severe obstructive jaundice with marked phenomena of endogenous intoxication, a cascade of biochemical reactions is launched. An increase in the content of chemical elements inside the cell holding water, apparently, leads to a change in the morphology of the red blood cell, its molecular structure and functional capabilities. A change in the erythrocyte cytoskeleton disrupts its oxygen transport function, and a decrease in the oxygen content in the cell exacerbates tissue hypoxia.

Keywords: obstructive jaundice, intoxication, electron microscopy of a red blood cell, chemical elements, oxygen-transport function of a red blood cell
p. 650-655 of the original issue
References
  1. Mamoshin V, Alyanov AL, Borsukov AV. Miniinvasive technologies in the treatment of patients with the syndrome of obstructive jaundice. Uchenye Zap Orlov Gos Un-ta. 2013;(6):228-231. http://oreluniver.ru/public/file/archive/201306.pdf (In Russ.)
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  7. Papakostas C, Bezirtzoglou E, Pitiakoudis M, Polychronidis A, Simopoulos C. Endotoxiemia in the portal and the systemic circulation in obstructive jaundice. Clin Exp Med. 2003 Sep;3(2):124-28. doi: 10.1007/s10238-003-0015-y
  8. Skorkina MIu, Cherniavskikh SD, Fedorova MZ, Zabiniakov NA, Sladkova EA. Metodika otsenki morfometricheskikh parametrov nativnykh kletok krovi s ispolzovaniem atomno-silovoi mikroskopii. Biul Eksperim Biologii i Meditsiny. 2010;150(8):238-40. (In Russ.)
Address for correspondence:
660022, The Russian Federation,
Krasnoyarsk, Partizan Zheleznyak Str., 1,
Krasnoyarsk State Medical University
Named after Prof. V.F. Voino-Yasenetski,
Department of General Surgery.
e-mail: yuvinnik@yandex.ru,
Yurii S. Vinnik
Information about the authors:
Vinnik Yurii S., MD, Professor, Head of the Department of General Surgery named after Prof. Gulman, Krasnoyarsk State Medical University named after Prof. V.F. Voino-Yasenetski, Krasnoyarsk, Russian Federation.
https://orcid.org/0000-0002-8995-2862
Pakhomova Regina A., MD, Assistant of the Department of General Surgery named after Prof. Gulman, Krasnoyarsk State Medical University named after Prof. V.F. Voino-Yasenetski, Krasnoyarsk, Russian Federation.
https://orcid.org/0000-0002-3681-4685
Kochetova Lyudmila V., PhD, Professor of the Department of General Surgery named after Prof. Gulman, Krasnoyarsk State Medical University named after Prof. V.F. Voino-Yasenetski, Krasnoyarsk, Russian Federation.
https://orcid.org/0000-0001-5784-7067
Karapetyan Georgii E., MD, Professor of the Department of General Surgery named after Prof. Gulman, Krasnoyarsk State Medical University named after Prof. V.F. Voino-Yasenetski, Krasnoyarsk, Russian Federation.
https://orcid.org/0000-0002-1216-2029
DOI: https://dx.doi.org/10.18484/2305-0047.2019.6.656   |  

I.R. TERLETSKYI 1, M.R. VERKHOLA 1, I.V. TYMCHUK 2, V.S. ZHYKOVSKIY 2, YU.H. OREL 2

VACUUM-ASSISTED THERAPY FOR PATIENTS WITH DIABETES MELLITUS AND CHRONIC FOOT ULCERS

Lviv Regional Clinical Hospital 1,
Danylo Halytsky Lviv National Medical University 2, Lviv,
Ukraine

Objective. To determine the bacterial load of wounds at the application of vacuum-assisted therapy for patients with diabetes mellitus and chronic foot ulcers.
Methods. The object of the research was patients with diabetes mellitus with chronic superficial (skin, subcutaneous tissues) wounds of the foot with the signs of mild infection according to the classification for determination of presence and severity of infection of IWGDF/IDSA. Oncopathology, heavy concomitant pathology and lesions of the osteoarticular apparatus were the criteria of exception. Patients were treated as out-patients and did not get system antibiotic therapy. Therapy of wounds was conducted by negative pressure 125 mm Hg in the continuous mode. The first stage of work was conducted to find out the level of the bacterial load of wounds before and 3 days after the vacuum-assisted therapy (the group was of 10 patients). The second group (10 patients) was selected to determine the dynamics of changes of the wound bioburden level after every 24 hours of vacuum-assisted therapy, the observation was performed during 96 hours of the bandage exposure. The level of the bacterial load was controlled according to the changes of index of colony-forming units in the gram of tissue (CFU/g) of the wound biopsy material.
Results. The average bioburden level of wounds for the 1st group patients after the removal of bandage was 8.111.27 lg CFU/g, this exceeds the initial level by 31.9 % (<0.05). The investigation of the material from the wounds of the 2nd group patients established a considerable increase of the average bioburden level of wounds in 24, 48, 72 and 96 hours after the beginning of the therapy, 10.8 %, 16.4 %, 38.9 % and 58.6 % accordingly (<0.05).
Conclusions. In patients with diabetes mellitus and chronic wounds of the foot with signs of infection, vacuum-assisted therapy does not provide essential control of the bioburden level and should be used in combination with systemic antibiotic therapy.

Keywords: vacuum-assisted therapy, diabetes, wound, bacterial load, infection
p. 656-661 of the original issue
References
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Address for correspondence:
79010, Ukraine,
Lviv, Chernihivska Str., 7,
Lviv Regional Clinical Hospital,
Surgical Department 1.
Tel. mobile: +380 98 449-11-61,
e-mail: teriva86@gmail.com,
Ivan R. Terletskyi
Information about the authors:
Terletskyi Ivan R., Surgeon, the Surgical Department 1, Lviv Regional Clinical Hospital, Lviv, Ukraine.
http://orcid.org/0000-0002-8751-0489
Verkhola Markiian R., Surgeon, the Surgical Department 1, Lviv Regional Clinical Hospital, Lviv, Ukraine.
http://orcid.org/0000-0002-9762-4236
Tymchuk Iryna V., PhD, Assistant, Microbiology Department, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.
https://orcid.org/0000-0002-9290-2954
Zhykovskiy Volodymyr S., PhD, Assistant, Department of Disaster Medicine and Military Medicine, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.
https://orcid.org/0000-0002-0594-5316
Orel Yuriy H., MD, Professor, the Surgery Department 2, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.
http://orcid.org/0000-0002-2283-7843

UROLOGY

DOI: https://dx.doi.org/10.18484/2305-0047.2019.6.662   |  

Y.A. NAKONECHNYI 1, A.M. HAVRYLYUK 1, A.Y. NAKONECHNYI 1, V.V. CHOPYAK 1, M.. KURPISZ 2

IMMUNOPATHOGENETIC PROGNOSTIC MARKERS OF THE FERTILE POTENTIAL IN MEN WITH LEFT-SIDED VARICOCELE

Danylo Halytsky Lviv National Medical University 1, Lviv,
Ukraine,
Institute of Human Genetics Polish Academy of Sciences 2, Poznan,
Poland

Objective. To determine immunopathogenetic prognostic markers of the fertile potential in men with varicocele by the nature of changes in the induces of congenital and acquired immunity, to assess their trends after varicocelectomy in the context of maintaining the risk of infertility development.
Methods. 36 patients with the left-sided varicocele grade II-III and 25 patients after laparoscopic varicocelectomy underwent an immunological study. The control group consisted of 23 healthy men. The participants age was 19-33 years. The cytokines concentration in the blood and seminal fluid were determined by ELISA. Flow cytometry was used for immunophenotyping of peripheral blood lymphocytes (absolute and relative numbers).
Results. In patients with the left-sided varicocele grade II-III concentration of cytokines in the peripheral blood and seminal fluid significantly differed from the subjects of the control group. Statistically significant differences were found in the concentration of various cytokines and quantitative indicators of the cellular level of acquired immunity in comparison to practically healthy men. Levels of the most cytokines in the serum of the peripheral blood and seminal fluid, quantitative indicators of lymphocyte populations, subpopulations of T-lymphocytes and their activation markers in the peripheral blood normalized three months after laparoscopic varicocelectomy.
ROC analysis of cytokine levels in the peripheral blood serum and seminal fluid in patients with varicocele grade II-III revealed a number of patterns. Significant immunopathogenetic prognostic markers of the fertile potential could be an increase of IFN-γ levels more than 12.4 pg/ml in the peripheral blood serum, as well as levels of interleukins in the seminal fluid: for spIL-1β 50.4 pg/ml and less, for spIL-6 more than 49.5 pg/ml.
Conclusions. Cytokine regulation changes in the reproductive and immune systems, determined by the imbalance in concentrations of the pro/anti-inflammatory cytokines at the local and peripheral levels, synthesized by T-lymphocytes and macrophages is a crucial immunopathogenetic factor in the development of immune-depended infertility in patients with varicocele.

Keywords: varicocele, varicocelectomy, infertility, immunophenotyping, cytokines
p. 662-673 of the original issue
References
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Address for correspondence:
79010, Ukraine,
Lviv, Pekarskaya Str., 69,
Danylo Halytsky Lviv National
Medical University,
Department of Urology
Of the Post-Graduate Education Faculty.
Tel. mobile +38 097 633-57-27,
e-mail: nyosyf@ukr.net,
Yosyf A. Nakonechnyi
Information about the authors:
Nakonechnyi Yosyf A., Post-Graduate Student of the Department of Urology of the Post-Graduate Education Faculty, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.
https://orcid.org/0000-0002-6872-1889
Havrylyuk Anna M., MD, Associate Professor of the Department of Clinical Immunology and Allergology, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.
http://orcid.org/0000-0001-9808-8896
Nakonechnyi Andrii I., MD, Professor of the Pediatric Surgery Department, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.
http://orcid.org/0000-0003-1402-6642
Chopyak Valentyna V., MD, Professor, Head of the Department of Clinical Immunology and Allergology, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.
http://orcid.org/0000-0003-3127-2028
Kurpisz Maciej M., MD, Professor, Head of the Department of Immunobiology, Reproduction and Stem Cells, Institute of Human Genetics Polish Academy of Sciences, Poznan, Republic of Poland.
http://orcid.org/0000-0003-3275-3245

NEUROSURGERY

DOI: https://dx.doi.org/10.18484/2305-0047.2019.6.674   |  

V.A. BYVALTSEV 1, 2, 3, 4, I.A. STEPANOV 1, V.E. BORISOV 1, M.A. ALIEV, V.V. SHEPELEV 1

RISK FACTORS FOR SURGICAL SITE INFECTIONS AFTER POSTERIOR LUMBAR FUSION IN ELDERLY PATIENTS

Irkutsk State Medical University 1,
Irkutsk Scientific Center of Surgery and Traumatology 2,
Irkutsk State Medical Academy of Continuing Education 3,
Irkutsk Railway Clinical Hospital at Irkutsk-Passazhirskiy Station 4, Irkutsk,
The Russian Federation

Objective. To identify risk factors for the development of surgical site infections in elderly patients after posterior lumbar fusion surgery, by analyzing the preoperative, intraoperative, and postoperative parameters.
Methods. An open non-randomized single-center retrospective study was performed. The medical records analysis of patients who underwent surgery of the posterior lumbar fusion in the period from February 2012 to May 2018 was performed. According to the criteria of compliance, 437 (192 women, 245 men, the average age was 57.69.3 years (data are presented as Mσ)) elderly patients were included in the retrospective study. To compare the differences between groups of patients with diagnosed cases of surgical site infections and without them, the study included patients of the older age group without postoperative adverse events.
Results. In 11 (2.5%) cases, surgical site infections were verified (4 women, 7 men, the mean age was 59.910.1 years. The risk factors for the development of surgical site infections after performing the operation of the posterior lumbar fusion in the study group of patients are: diabetes mellitus (p=0.031), low preoperative calcium level of blood plasma (p=0.008), low preoperative and postoperative albumin levels (p=0.019 and p=0.027), a high glucose concentration in the early postoperative period (p=0.036), a low postoperative hemoglobin level (p=0.013), a posterior lumbar fusion in three or more spinal segments (p=0.005), and the duration of surgery of more than 3 hours (p=0.036), the amount of blood loss over 1000 ml (=0.014) and long-term drainage of the postoperative wound (<0.001).
Conclusions. These risk factors must be taken into account by a neurosurgeon, when conducting posterior lumbar fusion surgery in patients of the older age group, in order to minimize them and reduce the risk of surgical site infections developing.

Keywords: surgical site infections, elderly patients, risk factors, lumbar spine, posterior lumbar fusion, minimally invasive techniques
p. 674-682 of the original issue
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Address for correspondence:
664003, The Russian Federation,
Irkutsk, Krasnogo Vosstaniya Str., 1,
Irkutsk State Medical University,
Department of Neurosurgery
And Innovative Medicine.
Tel. +7 (3952) 638 528,
e-mail: vadimabyvaltsev@gmail.com,
Vadim A. Byvaltsev
Information about the authors:
Byvaltsev Vadim A., MD, Professor, Head of the Department of Neurosurgery and Innovative Medicine of Irkutsk State Medical University; Chief Neurosurgeon of Irkutsk Railway Clinical Hospital at Irkutsk-Passazhirskiy Station, Deputy Director for International and Innovative Activities of Irkutsk Scientific Center of Surgery and Traumatology; Professor of the Department of Traumatology, Orthopedics and Neurosurgery of Irkutsk State Medical Academy of Continuing Education, Irkutsk, Russian Federation.
http://orcid.org/0000-0003-4349-7101
Stepanov Ivan A., Post-Graduate Student of the Department of Neurosurgery and Innovative Medicine, Irkutsk State Medical University, Irkutsk, Russian Federation.
https://orcid.org/0000-0001-9039-9147
Borisov Vladislav E., Post-Graduate Student of the Department of Neurosurgery and Innovative Medicine, Irkutsk State Medical University, Irkutsk, Russian Federation.
https://orcid.org/0000-0001-7409-2196
Aliev Marat A., PhD, Doctoral Student of the Department of Neurosurgery and Innovative Medicine, Irkutsk State Medical University, Irkutsk, Russian Federation.
https://orcid.org/0000-0002-7676-1127
Shepelev Valeriy V., PhD, Doctoral Student of the Department of Neurosurgery and Innovative Medicine, Irkutsk State Medical University, Irkutsk, Russian Federation.
https://orcid.org/0000-0001-5135-8115

EXCHANGE OF EXPERIENCE

DOI: https://dx.doi.org/10.18484/2305-0047.2019.6.683   |  

SH. V. TIMERBULATOV, M.V. TIMERBULATOV, A. R. GAFAROVA, V. M. TIMERBULATOV

EFFECTIVENESS EVALUATION OF THE WHO SURGICAL SAFETY CHECKLIST

Bashkir State Medical University, Ufa,
The Russian Federation

The article presents the literature review concerning the results of applying the surgical safety checklist recommended by the World Health Organization in 2008 (SSC WHO). These recommendations are aimed primarily at the prevention of so-called preventable complications, and also can significantly affect the reduction of mortality. The influence of the checklist on the reduction of surgical complications (surgical infections, bleeding, cardiorespiratory complications), inpatient treatment terms, treatment cost is studied. The use of the checklist improves communication, preparedness for the operation, teamwork of the operations and anesthesiology staff, increases responsibility for security issues. The review notes the exceptional importance of the implementation of all three stages of the checklist, the preliminary conduct of the educational program for its implementation. The results of the recommendations use are mainly associated with the implementation strategy, not its formal implementation. It is noted that the checklist is an effective method of reducing intra- and postoperative complications and contributes to improving the quality of surgical care. In a number of publications, there was a decrease in the postoperative mortality from 1.9 to 0.2%, the frequency of surgical complications by 40% or more, infection of the surgical area (from 7.4 to 3.6%), hospitalization periods, the frequency of intra- and postoperative bleeding (from 2.6 to 1.0%), respectively, with a decrease in the cost of blood transfusion, plasma by 40%.

Keywords: surgical safety checklist, World Health Organization, surgical complications, quality of surgical care, postoperative mortality, treatment terms
p. 683-690 of the original issue
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Address for correspondence:
450008, The Russian Federation,
Ufa, Lenin Str., 3,
Bashkir State Medical University,
Surgery Department with the Course
Of Endoscopy of the Institute of Continuing Professional Education.
Tel.: +79173577544,
e-mail: timervil@yandex.ru,
Vil M. Timerbulatov
Information about the authors:
Timerbulatov Shamil V., MD, Professor of the Surgery Department with the Course of Endoscopy of the Institute of Continuing Professional Education, Bashkir State Medical University, Ufa, Russian Federation.
http://orcid.org/0000-0002-4832-6363
Timerbulatov Makhmud V., MD, Professor, Head of the Faculty Surgery Department, Bashkir State Medical University, Ufa, Russian Federation.
http://orcid.org/0000-0002-6664-1308
Gafarova Aigul R., Post-Graduate Student of the Surgery Department with the Course of Endoscopy of the Institute of Continuing Professional Education, Bashkir State Medical University, Ufa, Russian Federation.
http://orcid.org/0000-0003-2874-7213
Timerbulatov Vil M., MD, Professor, Corresponding Member of RAS, Head of the Surgery Department with the Course of Endoscopy of the Institute of Continuing Professional Education, Bashkir State Medical University, Ufa, Russian Federation.
http://orcid.org/0000-0003-1696-3146
DOI: https://dx.doi.org/10.18484/2305-0047.2019.6.691   |  

R.E. MAGOMEDBEKOV, M.M. MAGOMEDOV

INGUINAL HERNIAS AND HERNIOTOMY AS A CAUSE OF REPRODUCTIVE FUNCTION DISORDERS IN MALE PATIENTS

Dagestan State Medical University, Makhachkala,
The Russian Federation

The aim of the review is to describe tension and tension-free hernioplasty and its impact over the reproductive function in young men. Recently Russian and foreign authors have confirmed the need in advancing the traditional and new hernioplasty methods for more speedy social rehabilitation. Advances in surgery, development of new medical tools and improvements in new surgery methods havent reduced the percentage of reproductive complications. Use of modern implants in herniology and their impact on the reproductive system makes the problem a relevant one for fertile men. It is known that in almost half of cases, infertility in a marriage is due to a male factor, described in the medical literature as male sterility. A huge number of modern scientific publications demonstrate that a lot of researchers admit the effect of tension hernioplasty on the reproductive function in males. A positive impact of the tension hernioplasty on the reproductive function is shown. Literature sources contain more and more evidences of negative effects in the spermatic duct where it contacts prosthesis and of misperfusion causing venous hypertension. Contemporary literature analysis reveals a lot of problems associated with hernioplasty and confirms the need in comprehensive randomized studies in order to clarify all pathogenic mechanisms of the reproductive disorders in men. It is worth mentioning that the problem of inguinal hernia surgery in fertile men is far from drastic resolution.

Keywords: inguinal hernia, reproductive function, intratesticular blood flow, Desarda method, Doppler ultrasonography
p. 691-699 of the original issue
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Address for correspondence:
367000, The Russian Federation,
Makhachkala, Pirogov Str., 3,
Dagestan State Medical University,
Department of Surgery of the Faculty of Advanced Training
And Professional Training of Specialists.
Tel. office +79282308646,
e-mail: muxuma@mail.ru,
ramazan.magomedbekov@mail.ru,
Muchuma M. Magomedov
Information about the authors:
Magomedbekov Ramazan E., Post-Graduate Student of the Department of Surgery of the Faculty of Advanced Training and Professional Training of Specialists, Dagestan State Medical University, Makhachkala, Russian Federation.
https://orcid.org/0000-0003-4391-3099
Magomedov Muchuma M., MD, Professor of the Department of Surgery of the Faculty of Advanced Training and Professional Training of Specialists, Dagestan State Medical University, Makhachkala, Russian Federation.
https://orcid.org/0000-0002-3335-525X
DOI: https://dx.doi.org/10.18484/2305-0047.2019.6.700   |  

A.M. OVECHKIN, S.V. SOKOLOGORSKIY, M.E. POLITOV

OPIOID-FREE ANAESTHESIA AND ANALGESIA TRIBUTE TO FASHION OR THE IMPERATIVE OF TIME?

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

Opioid analgesia continues to be the gold standard of postoperative analgesia in most developed countries. At the same time, in recent years, evidence has been accumulated indicating the negative impact of opioids on the course of the early postoperative period. In addition to the traditional side effects of these drugs (depression of consciousness, excessive sedation, nausea, etc.), their ability to form opioid-induced hyperalgesia, to have an immunosuppressive effect, to reduce the power of local anesthetics is considered. In addition, opioid analgesia prevents the implementation of the concept of accelerated postoperative patient rehabilitation (fast-track surgery and ERAS). The review examines the modern possibilities of conducting free or low-opioid anesthesia, mainly during laparoscopic surgery. The concept of multimodal analgesia makes it possible to refuse the use of opioid analgesics or to minimize their dosage in the perioperative period. Multimodal analgesia involves the simultaneous administration of two or more drugs that affect different levels of the formation of acute pain. The characteristics of the main components of opioid-free anesthesia and analgesia (NSAIDs, paracetamol, dexmedetomidine, gabapentin, ketamine, lidocaine, dexamethasone) are described from the standpoint of evidence-based medicine. The schemes of opioid-free anesthesia and analgesia in a number of surgeries are presented, in particular, with laparoscopic cholecystectomy and laparoscopic hemicolectomy.

Keywords: opioid-free anesthesia, analgesia, multimodal analgesia, NSAID, dexmedetomidine, gabapentin, lidocaine, ketamine, dexamethasone
p. 700-715 of the original issue
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Address for correspondence:
119991, The Russian Federation,
Moscow, Trubetskaya Str., 8-2,
I.M. Sechenov First Moscow
State Medical University,
Department of Anesthesiology and Resuscitation
Tel.: +7 (916) 143-96-21,
e-mail: ovechkin_alexei@mail.ru,
lexei M. Ovechkin
Information about the authors:
Ovechkin lexei M., MD, Professor of the Department of Anesthesiology and Resuscitation, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
https://orcid.org/0000-0002-3453-8699
Sokologorskiy Sergey V., MD, Professor of the Department of Anesthesiology and Resuscitation, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
https://orcid.org/0000-0001-6805-9744
Politov Mikhail E., PhD, Associate Professor of the Department of Anesthesiology and Resuscitation, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
https://orcid.org/0000-0003-0623-4927

CASE REPORTS

DOI: https://dx.doi.org/10.18484/2305-0047.2019.6.716   |  

K.V. LIPATOV 1, V.K. GOSTISHCHEV 1, A.G. ASATRYAN 1, G.G. MELKONYAN 3, A.V. KIRILLIN 2, I.V. GORBACHEVA 1, E.S. SOLODOVNIKOV 1

SURGICAL TREATMENT OF THE LOWER EXTREMITY EXTENSIVE PURULENT AND NECROTIC SOFT TISSUE LESIONS IN A PATIENT WITH SYSTEMIC SCLERODERMA

I.M. Sechenov First Moscow State Medical University 1,
I.V. Davidovsky Moscow Clinical Hospital 2,
The 4th Moscow Clinical Hospital 3, Moscow,
The Russian Federation

Systemic scleroderma is an autoimmune condition that is characterized by fibrosis of the skin and visceral organs. Microangiopathy, which is one of the key features of systemic scleroderma, is one of the causes of formation of skin necrosis and ulcers. Widespread suppurative necrotic inflammation of integumentary tissues is quite rare in systemic scleroderma, but it creates significant complications in treatment of the disease. This observation presents the experience of surgical treatment of a patient with extensive suppurative necrotic inflammation of the soft tissues of the lower limb with systemic scleroderma as an underlying disease for which she received immunosuppressive medications. The disease was marked by fast progression and was accompanied by progressive necrosis of the skin and subcutaneous adipose tissue. The signs of systemic inflammation were diagnosed. Emergency surgical debridement was performed with subsequent necrectomyies on the 2, 5, 7, 9 and 15th days of hospitalization. The pathogens isolated from the wound were Staphylococcus aureus, Streptococcus pyogenes. Additionally to the surgical treatment, complex pharmacological therapy, including antimicrobial, detoxification, vascular and immunotherapy, was carried out. This complex treatment led to the wound cleaning and regression of inflammation by the 20th day of hospitalization. Autologous skin grafting was later performed with no complications after a year of follow-up. This case report illustrates a severe bacterial soft tissue infection in a patient with a diffuse form of systemic scleroderma against the background of immunosuppression caused by chemotherapy and glucocorticoids. This complex treatment allowed us eliminating the infection and performing the autologous skin grafting with the extensive wound closure.

Keywords: systemic sclerosis, soft tissue infection, surgical treatment, skin grafting, soft tissue necrosis
p. 716-722 of the original issue
References
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Address for correspondence:
119991, The Russian Federation,
Moscow, Bolshaya Pirogovskaya Str., 2-4,
I.M. Sechenov First Moscow
State Medical University,
General Surgery Department.
Tel. mobile +7 (916) 635-89-88,
e-mail: k_lipatov@mail.ru
Konstantin V. Lipatov
Information about the authors:
Lipatov Konstantin V., MD, Professor of the General Surgery Department, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
http://orcid.org/0000-0002-9902-2650
Gostishchev Victor K., MD, Professor, Academician of RAS, Professor of the General Surgery Department, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
http://orcid.org/0000-0002-8140-7931
Asatryan Artur G., PhD, Assistant of the General Surgery Department, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
http://orcid.org/0000-0002-8409-2605
Melkonyan George G., MD, Professor, Head Physician of the 4th Moscow Clinical Hospital, Moscow, Russian Federation.
http://orcid.org/0000-0001-7234-4185
Kirillin Alexey V., PhD, Deputy Head Physician for Surgery, I.V. Davidovsky Moscow Clinical Hospital, Moscow, Russian Federation.
http://orcid.org/0000-0003-0585-9941
Gorbacheva Irina V., PhD, Associate Professor of the General Surgery Department, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
http://orcid.org/0000-0002-1060-1163
Solodovnikov Egor S., 4th year student, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
http://orcid.org/0000-0002-7006-6641

EXCHANGE OF EXPERIENCE

DOI: https://dx.doi.org/10.18484/2305-0047.2019.6.723   |  

A.E. MURZICH

ARTHROSCOPY IN THE DIAGNOSIS AND TREATMENT OF HIP JOINT PATHOLOGY

Republican Scientific and Practical Center of Traumatology and Orthopedics, Minsk,
The Republic of Belarus

Objective. To estimate the possibilities and results of arthroscopy in different hip joint pathologies in young patients.
Methods. The results of 32 hip joint arthroscopy in cases of cam and pincer types of femoroacetabular impingement, chondromatosis and synovitis of the hip joint, osteoid osteoma of the acetabulum, osteonecrosis of the femoral head were analyzed. In 70% of cases, surgery was performed in adult patients aged 25 to 44 years. Hip arthroscopy was conducted in the patients supine position under general anesthesia through 3 ports: anterolateral, anterior, proximal anterolateral. 30 and 70 telescopes, 180 mm bone drills and aggressive cutters were used.
Results. A positive clinical effect due to the relief of pain and increase range of motion in the hip joint was obtained by arthroscopic treatment of femoroacetabular impingement. In one case the progression of coxarthrosis was observed, which required the total hip replacement in terms of 1.5 years after arthroscopy. In two cases the heterotopic soft tissue ossification in the projection of m. Iliopsoas was noted. Resection of the osteoid osteoma of the acetabulum under arthroscopic control is an effective less traumatic treatment for subchondral localization. Arthroscopic joint debridement in cases of coxarthrosis and osteonecrosis of the femoral head in some cases improves the clinical outcome of treatment by reducing the effusion in the joint and capsular tension. Intraosseous osteoscopy of the femoral head allowed visualizing the site of necrosis and monitoring the process of intraosseous osteoperforation.
Conclusions. The primary analysis of the results of hip arthroscopy showed its high efficiency as a minimally invasive method of diagnosis and treatment in a number of pathological conditions. The development of this direction of arthroscopy is possible only with the availability of specialized equipment and the improvement of surgical skills.

Keywords: hip arthroscopy, femoroacetabular impingement, osteonecrosis, femoral head, osteoid osteoma
p. 723-731 of the original issue
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Address for correspondence:
220024, The Republic of Belarus,
Minsk, Kizhevatov Str., 60/4,
Republican Scientific and Practical
Center of Traumatology and Orthopedics,
Laboratory of Joint Pathology
And Sports Injury.
Tel. +375 17 212 32 88,
e-mail: mae77@list.ru,
Alyaksandr E. Murzich
Information about the authors:
Murzich Alyaksandr E., PhD, Head of the Laboratory of Joint Pathology and Sports Injury, Republican Scientific and Practical Center of Traumatology and Orthopedics, Minsk, Republic of Belarus.
https://orcid.org/0000-0003-1625-7321
Contacts | ©Vitebsk State Medical University, 2007