Year 2021 Vol. 29 No 1

SCIENTIFIC PUBLICATIONS
EXPERIMENTAL SURGERY

A.A. EMANOV, M.V. STOGOV, E.A. KIREEVA, N.V. TUSHINA

CONSOLIDATION OF FEMORAL FRACTURES AT APPLICATION OF DIFFERENT TREATMENT METHODS TAKING INTO CONSIDERATION DURATION OF THE PERIOD FROM TRAUMA TO OSTEOSYNTHESIS

National Ilizarov Scientific Center for Traumatology and Orthopedics, Kurgan,
The Russian Federation

Objective. To study the characteristics and healing duration of the diaphyseal femoral fractures, depending on the technologies used for osteosynthesis and the time between trauma and osteosynthesis.
Methods. The study was performed on bred dogs (n=24). In the operating theatre all animals were modeled the transverse fracture of the femoral diaphysis in the middle third using a chisel. The animals were divided into 4 groups (6 per group). Animals of group 1 (one hour after the fracture) underwent transosseousosteosynthesis with a pin-rod external fixation device (PREF). In group 2, PREF was performed on the fourth day after the injury. In group 3 (one hour after the injury) blockable intramedullary osteosynthesis (BIOS) was performed. In group 4, the similar BIOS was performed on the fourth day after the fracture. To assess the results of treatment, the clinical, radiological and laboratory research methods were used. The duration of post-operative observation of the animals was 100 days.
Results. It has been found out that the dynamics of osteoreparative processes in the studied groups was similar and did not depend on the time between trauma and osteosynthesis.
The median time for the femoral shaft fracture healing in animals of group 1 was 46 days (Q1-Q3: 38-57), in group 2 73 days (Q1-Q3: 71-78) (differences between groups are significant at p=0.004); in group 3 49 days (Q1-Q3: 44-60), in group 4 72 days (Q1-Q3: 70-93) (differences between groups are significant at p=0.008). It is shown that the reason for the increase in fixation terms in dogs with the delayed osteosynthesis is the long-term persistence of the acute phase reaction caused by trauma (using the growth of C-reactive protein as an example).
Conclusion. The healing terms of a femoral shaft fracture with the use of PREF technology and BIOS technology are comparable, both in the conditions of urgent and delayed osteosynthesis.

Keywords: femoral fracture, osteosynthesis, fracture fixation, external fixators
p. 5-12 of the original issue
References
  1. Dagneaux L, Allal R, Pithioux M, Chabrand P, Ollivier M, Argenson JN. Femoral malrotation from diaphyseal fractures results in changes in patellofemoral alignment and higher patellofemoral stress from a finite element model study. Knee. 2018 Oct;25(5):807-13. doi: 10.1016/j.knee.2018.06.008
  2. Gelalis ID, Politis AN, Arnaoutoglou CM, Korompilias AV, Pakos EE, Vekris MD, Karageorgos A, Xenakis TA. Diagnostic and treatment modalities in nonunions of the femoral shaft: a review. Injury. 2012 Jul;43(7):980-98. doi: 10.1016/j.injury.2011.06.030
  3. Ng AC, Drake MT, Clarke BL, Sems SA, Atkinson EJ, Achenbach SJ, Melton LJ 3rd. Trends in subtrochanteric, diaphyseal, and distal femur fractures, 1984-2007. Osteoporos Int. 2012 Jun;23(6):1721-26. doi: 10.1007/s00198-011-1777-9
  4. Rupp M, Biehl C, Budak M, Thormann U, Heiss C, Alt V. Diaphyseal long bone nonunions - types, aetiology, economics, and treatment recommendations. Int Orthop. 2018 Feb;42(2):247-58. doi: 10.1007/s00264-017-3734-5
  5. Sipahioglu S, Zehir S, Sarikaya B, Isikan UE. Comparision of the expandable nail with locked nail in the treatment of closed diaphyseal fractures of femur. Niger J Clin Pract. 2017 Jul;20(7):792-98. doi: 10.4103/1119-3077.212452
  6. Vicenti G, Bizzoca D, Carrozzo M, Nappi V, Rifino F, Solarino G, Moretti B. The ideal timing for nail dynamization in femoral shaft delayed union and non-union. Int Orthop. 2019 Jan;43(1):217-22. doi: 10.1007/s00264-018-4129-y
  7. Wolinsky PR, Lucas JF. Reduction Techniques for Diaphyseal Femur Fractures. J Am Acad Orthop Surg. 2017 Nov;25(11):e251-e260. doi: 10.5435/JAAOS-D-17-00021
  8. Bondarenko AV, Gerasimova OA, Goncharenko AG. For the question about optimal terms of general fracture osteosynthesis in patients with multitrauma. Travmatologiia i Ortopediia Rossii. 2006;(1):4-9. https://cyberleninka.ru/article/n/k-voprosu-ob-optimalnyh-srokah-osteosinteza-osnovnyh-perelomov-pri-sochetannoy-travme (In Russ.)
  9. Polat G, Balci HI, Ergin ON, Asma A, Şen C, Kiliçoğlu Ö. A comparison of external fixation and locked intramedullary nailing in the treatment of femoral diaphysis fractures from gunshot injuries. Eur J Trauma Emerg Surg. 2018 Jun;44(3):451-55. doi: 10.1007/s00068-017-0814-6
  10. Shapkin Y G, Seliverstov PA. Risk factors of fracture nonunion in polytrauma. Kuban Nauch Med Vestn. 2017;24(6):168-76. doi: 10.25207 / 1608-6228-2017-24-6-168-176 (In Russ.)
  11. Medda S, Unger T, Halvorson J. Diaphyseal Femur Fracture. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan. 2020 Jun 30. https://www.ncbi.nlm.nih.gov/books/NBK493169/
  12. Denisiuk M, Afsari A. Femoral Shaft Fractures. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan.2020 Mar 14. https://www.ncbi.nlm.nih.gov/books/NBK556057/
  13. Litvishko VA. Treatment of long bones comminuted fractures using external fixation device. Ortopediia, Travmatologiia i Protezirovanie. 2016;(4):40-46. http://otpjournal.com.ua/article/view/88542/84389 (In Russ.)
  14. Koso RE, Terhoeve C, Steen RG, Zura R. Healing, nonunion, and re-operation after internal fixation of diaphyseal and distal femoral fractures: a systematic review and meta-analysis. Int Orthop. 2018 Nov;42(11):2675-83. doi: 10.1007/s00264-018-3864-4
  15. Zuev PP. Comparative analysis of surgical outcomes for patients with femural ununited midshaft fractures. Sarat Nauch-Med Zhurn. 2019;15(3):641-43. http://ssmj.ru/system/files/2019_03_641-643.pdf (In Russ.)
  16. Barabash AP, Shpinyak SP, Barabash JA.. Comparative characteristics of osteosynthesis techniques in patients with comminuted diaphyseal femoral fractures. Traumatology and Orthopedics of Russia. 2013;(2):116-24. doi: 10.21823/2311-2905-2013--2-116-124 (In Russ.)
Address for correspondence:
640014, Russian Federation,
Kurgan, M.Ulyanova Str., 6
National Ilizarov Scientific Center
for Traumatology and Orthopedics,
Ministry of Health of Russia,
tel. +7 352 245-05-38,
e-mail: stogo_off@list.ru,
Stogov Maxim V.
Information about the authors:
Emanov Andrei A., PhD(Vet) Leading Researcher of the Experimental Laboratory, National Ilizarov Scientific Center for Traumatology and Orthopedics, Kurgan. Russian Federation.
https://orcid.org/0000-0003-2890-3597
Stogov Maxim V., DS(Biol) Associate Professor, Leading Researcher of the Biochemistry Laboratory, National Ilizarov Scientific Center for Traumatology and Orthopedics, Kurgan. Russian Federation.
https://orcid.org/0000-0001-8516-8571
Kireeva Elena A., PhD(Biol), Senior Researcher of the Biochemistry Laboratory, National Ilizarov Scientific Center for Traumatology and Orthopedics, Kurgan. Russian Federation.
https://orcid.org/0000-0002-1006-5217
Tushina Natalya V., PhD(Biol), Researcher of the Biochemistry Laboratory, National Ilizarov Scientific Center for Traumatology and Orthopedics, Kurgan. Russian Federation.
https://orcid.org/0000-0002-1322-608X

GENERAL & SPECIAL SURGERY

M.ZH. ALIEV 1, L.M. ZUBEKHINA 2, K.I. NIIAZBEKOV 2

SIMULTANEOUS OPERATIONS FOR LIVER ECHINOCOCCOSIS

City Clinical Hospital No1 1
Kyrgyz State Medical Academy named after I.K. Akhunbaev 2, Bishkek
The Republic of Kyrgyzstan

Objective. To evaluate the results and effectiveness of simultaneous operations for echinococcosis of the liver.
Methods. Surgical diseases requiring surgical treatment (cholelithiasis: calculus cholecystitis, choledocholithiasis, nodular goiter, ventral postoperative hernia) were detected in 38 patients with echinococcosis of the liver. 23 patients underwent organ-preserving operations for echinococcosis, and 15 patients underwent radical operations, all operations were perfomed in combined with cholecystectomy, choledocholitotomy, thyroidectomy, and herniotomy (coating of a polypropylenemesh for hernia gate).Immediate and remote results were studied. Patients were reexamined 6 months after surgery within a 3-year period. The examination included the checkup, general blood test, liver and kidney tests, an ultrasound examination of the abdominal organs, and a chest x-ray once a year.
Results. During the immediate postoperative period 4 patients out of 38 (10.5%) had complications. After simultaneous operations using organ-preserving methods of echinococcectomy, 2 patients out of 23 (8.7%) had complications (pleuritis, wound suppuration), and 2 out of 15 had radical operations (bile leakage, pleuritis). All complications had been cured by the time of discharge. The remote results were studied over a period of 6 months to 3 years. 34 patients were examined up to 1 year, 31 from 1 to 2 years, 26 from 2 to 3 years. Within the examination and follow-up periods no recurrence of echinoccosis was observed.
Conclusion. During simultaneous operations and the echinococcectomy of the liver it is necessary to observe accurately the rules of aparasiticity and antiparasiticity.Simultaneous operations for the liver echinococcosis should be performed according to strict indications and by a highly experienced and qualified surgeon. Patients who have undergone simultaneous operations was asked to undergo a medical control examination at least once a year.

Keywords: echinococcosis of the liver, simultaneous operations, complication, radical operations, organ-preserving operations
p. 13-19 of the original issue
References
  1. Stancu B, Grad NO, Mihaileanu VF, Chiorescu S, Pintea SD, Constantinescu MI. Surgical technique of concomitant laparoscopically assisted vaginal hysterectomy and laparoscopic cholecystectomy. Clujul Med. 2017;90(3):348-52. doi: 10.15386/cjmed-747
  2. Dronova VL, Dronov AI, Kriuchina EA, Tesliuk RS, Lutsenko EV, Nastashenko MI. Simultannye operatsii pri sochetannykh khirurgicheskikh i ginekologicheskikh zabolevaniiakh. Ukrain Zhurn Khirurgii. 2013;(2):143-51. http://www.ujs.dsmu.edu.ua/journals/2013-02/2013-02.pdf (In Russ.)
  3. Maistrenko NA, Berlev IV, Basos AS, Basos SF. Simultaneous endovideosurgical interventions in gynecological patients with concurrent non-complicated gallstone disease. Zhurn Akusherstva i Zhenskikh Boleznei. 2008;LVII(3):18-23. http://www.jowd.ru/arhiv/JOWD_3_2008/Maystrenko.html (In Russ.)
  4. Fedorov VE, Aslanov AD, Logvina OE, Masliakov VV. Simultaneous surgeries in patients with cholelithiasis (literature review). Vestn Med In-ta Reaviz: Reabilitatsiia, Vrach i Zdorove. 2018;(5):111-16. https://cyberleninka.ru/article/n/simultannye-operatsii-pri-holetsistolitiaze-obzor-literatury (In Russ.)
  5. Makhovskii VZ, Aksenenko VA, Laipanov IM, Iakhia ZhM. Ekstrennye sochetannye operatsii v khirurgii organov briushnoi polosti i malogo taza. Khirurgiia. Zhurn im NI Pirogova. 2012;(9):48-54. https://www.mediasphera.ru/issues/khirurgiya-zhurnal-im-n-i-pirogova/2012/9/030023-1207201299 In Russ.)
  6. Kryger ZB, Dumanian GA, Howard MA. Safety issues in combined gynecologic and plastic surgical procedures. Int J Gynaecol Obstet. 2007 Dec;99(3):257-63. doi: 10.1016/j.ijgo.2007.05.028
  7. Hart S, Ross S, Rosemurgy A. Laparoendoscopic single-site combined cholecystectomy and hysterectomy. J Minim Invasive Gynecol. 2010 Nov-Dec;17(6):798-801. doi: 10.1016/j.jmig.2010.07.006
  8. Ishchenko AI, Aleksandrov LS, Vedernikova NV, Zholobova MN, Shishkov AM, Shulutko AM, Rannev IB. Otsenka klinicheskoi i ekonomicheskoi effektivnosti simultannykh operatsii v ginekologii. Vestn Novykh Med Tekhnologii. 2006;XIII (4):109-12. http://www.medtsu.tula.ru/VNMT/Bulletin/2006/06B4.pdf (In Russ.)
  9. Timerbulatov VM, Timerbulatov MV, Mekhdiev DI, Timerbulatov ShV, Smyr RA, Khabirov DM, Vagapov A.A. Medical aspects and economic efficience of combined surgeries. Annaly Khirurgii. 2016;21(5):306-11. doi: 10.18821/1560-9502-2016-21-5-306-311 (In Russ.)
  10. Celik O, Akand M, Ekin G, Duman I, Ilbey YO, Erdogru T. Laparoscopic radical prostatectomy alone or with laparoscopic herniorrhaphy. JSLS. 2015 Oct-Dec;19(4). pii: e2015.00090. doi: 10.4293/JSLS.2015.00090
  11. Tohma YA, Tezcaner T, Günakan E, Küçüky?ld?z I, Takal MK, Zeyneloğlu HB, Dursun P. Single-port laparoscopy for treatment of concomitant adnexal masses and chole-cystectomy or appendectomy. Biomed Res. 2018 Jan;29(7):1356-60. doi: 10.4066/biomedicalresearch.29-17-3555
  12. Strizheletskii VV, Rutenburg GM, Zhemchuzhina TIu, Altmark EM. Ekonomicheskaia effektivnost simultannykh operatsii v khirurgii i ginekologii. Moskov Khirurg Zhurn. 2008;(1):26-29. http://mossj.ru/journal/MOSSJ_2008/MXG_2008_01.pdf (In Russ.)
  13. Satkeeva AZh. Simultaneous surgery and gynecology operations. Molodoi Uchenyi. 2016;(21):81-84. https://moluch.ru/archive/125/ (In Russ.)
  14. Massenburg BB, Sanati-Mehrizy P, Ingargiola MJ, Rosa JH, Taub PJ. Outcomes and safety of the combined abdominoplasty-hysterectomy: a preliminary study. Aesthetic Plast Surg. 2015 Oct;39(5):667-73. doi: 10.1007/s00266-015-0531-7
  15. Meriwether KV, Antosh DD, Knoepp LR, Chen CC, Mete M, Gutman RE. Increased morbidity in combined abdominal sacrocolpopexy and abdominoplasty procedures. Int Urogynecol J. 2013 Mar;24(3):385-91. doi: 10.1007/s00192-012-1857-1
  16. Iribarren-Moreno R, Cuenca-Pardo J, Ramos-Gallardo G. Is plastic surgery combined with obstetrical procedures safe? Aesthetic Plast Surg. 2019 Oct;43(5):1396-99. doi: 10.1007/s00266-019-01448-9
  17. Abdisamatov B, Aliev MJ, Nijazbekov KI, Maksut UE, Makambay KA. Clinical and experimental basis of the method of disinfection in the liver echinococcosis. Vestn KGMA im IK Akhunbaeva. 2016;(4):50-53. http://library.kgma.kg/jirbis2/images/vestnik-kgma/vestnik-2016/vestnik-4-2016.pdf (In Russ.)
  18. Tsivian A, Konstantinovsky A, Tsivian M, Kyzer S, Ezri T, Stein A, Sidi AA. Concomitant laparoscopic renal surgery and cholecystectomy: outcomes and technical considerations. J Endourol. 2009 Nov;23(11):1839-42. doi: 10.1089/end.2009.0054
Address for correspondence:
720054, Kyrgyzstan, Bishkek,
Yu. Fuchik Str., 15,
City Clinical Hospital No1
The Surgery Unit No1,
tel.mob. +996 550 65 00 08,
e-mail: musa-aliev-69@mail
Aliev Musabai Z.
Information about the authors:
Aliev Musabai Zh., PhD, Physician, Surgical Unit No1, City Clinical Hospital No1, Bishkek, Kyrgyz Republic.
http://orcid.org/0000-0003-0771-245X
Zubekhina Lyubov M., PhD, Honorary Professor, Associate Professor of the Department of the Faculty Surgery, Kyrgyz State Medical Academy Named after I. K. Akhunbayev, Bishkek, Kyrgyz Republic.
http://orcid.org/0000-0001-8827-1021
Niiazbekov Kubat I., PhD, Associate Professor of the Department of General Practice Surgery with a Course of Combustiology, Kyrgyz State Medical Academy Named after I. K. Akhunbayev, Bishkek, Kyrgyz Republic.
http://orcid.org/0000-0002-4103-3138

V.V. BOYKO 1, A.V. MALOSHTAN 1, R.M. SMACHYLO 1, A.M. TYSHCHENKO 1, A.A. NEKLIUDOV 1, V.A. VOVK 2, M.A. KLOSOVA 1, O.V. VOLCHENKO 1

PHYSICAL AND CHEMICAL PROPERTIES OF BILE DURING THE ONSET AND MANIFESTATION OF CHOLANGITIS. ACUTE CHOLANGITIS: POSSIBLE TRIGGERING MECHANISMS

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

Objective. To determine the possible triggering mechanism for the development and manifestation of acute suppurative cholangitis based on the study of the rheological, physical and chemical properties of bile.
Methods. The bile of choledoch was studied in patients (n=41) with calculous obstruction of the biliary tract, 25 of them had clinical picture of cholangitis. For comparison, 32 patients with asymptomatic choledocholithiasis were examined. Bile sampling was performed in each patient twice: the first bile intake was obtained during duodenoscopy and cannulation of the major papilla of the duodenum and endoscopic papillosphincterotomy and the second portion during a follow-up examination three days after the endoscopic papillotomy. The biliary pH, viscosity, the amount of solids in it, the concentration of primary bile acids, microbial contamination and the intraductal pressure were studied.
Results. For the first time, it has been hypothesized that a reduced concentration of bile acids in the bile causes a subsequent chain of triggering and manifestation of acute cholangitis. In the first bile intake the concentration of bile acids is three fold decreased in patients with acute cholangitis in comparison with the patients of control group, and in the second case it reliable increased but was lower than in the control group. It was a small amount of bile acids caused sedimentation of a colloidal bile solution, increased its viscosity and amount of dry sediment, caused precipitation and sludge. This chain process caused the instantaneous inclusion of concretion in sludge and acute obstruction of the choledoch. As a result of bacterial contamination, the microbial dissemination of bile increases by 103-104 times, the choledoch becomes like an abscess. Endoscopic papillosphincterotomy breaks this chain and surgical management is the definitive mode of treatment for decompression and biliary track sanitation.
Conclusion. A decrease of bile acids in the content of the bile causes a chain process of sedimentation, the formation of sludge and a complete block of the choledoch, which is the primary trigger for cholangitis.

Keywords: choledocholithiasis, acute cholangitis, primary bile acids, pathogenesis, endoscopic papillosphincterotomy
p. 20-27 of the original issue
References
  1. Akhaladze GG. Choledocholithiasis. cholangitis and biliary sepsis: in what lies the difference? Annaly Khirurg Gepatologii. 2013;18(1):54-58. http://vidar.ru/_getfile.asp?fid=ASH_2013_1_54. (In Russ.)
  2. Akhaladze GG. Pathophysyologic aspects of purulent cholangitis,or why does not appear systemic inflammatory response syndrome in obstructive jaundice? Annaly Khirurg Gepatologii. 2009;14(2):9-15. http://vidar.ru/_getfile.asp?fid=ASH_2009_2_9 (In Russ.)
  3. Datsenko BM, Tamm TI, Borysenko VB, Kramarenko A. Hepatic dysfunction correction in patients, suffering obturation jaundice. Klnchna Khrurgia. 2013;(4):9-12. http://nbuv.gov.ua/UJRN/KlKh_2013_4_4 .(In Russ.)
  4. Datsenko BM, Borisenko VB. Mechanical jaundice, acute cholangitis, biliary sepsis: pathogenic relationship and principles of differential diagnostics. Novosti Khirurgii. 2013 Sep-Oct;21(5):31-39. doi: 10.18484/2305-0047.2013.5.31 (In Russ.)
  5. Zimmer V, Lammert F. Acute bacterial cholangitis. Viszeralmedizin. 2015 Jun; 31(3):166-72. Published online 2015 Jun 11. doi: 10.1159/000430965
  6. Tohda G, Ohtani M, Dochin M. Efficacy and safety of emergency endoscopic retrograde cholangiopancreatography for acute cholangitis in the elderly. World J Gastroenterol. 2016 Oct 7;22(37):8382-88. doi: 10.3748/wjg.v22.i37.8382
  7. Ahmed M. Acute cholangitisan update. World J Gastrointest Pathophysiol. 2018 Feb 15;9(1):1-7. doi: 10.4291/wjgp.v9.i1.1
  8. Reuken PA, Torres D, Baier M, Löffler B, Lübbert C, Lippmann N, Stallmach A, Bruns T. Correction: risk factors of multi-drug resistant pathogens and failure of empiric first-line therapy in acute cholangitis. PLoS One. 2017 Feb 13;12(2):e0172373. doi: 10.1371/journal.pone.0172373. eCollection 2017.
  9. Ray S, Sanyal S, Das K, Ghosh R, Das S, Khamrui S, Sarkar A, Chattopadhyyay G. Outcome of surgery for recurrent pyogenic cholangitis: a single center experience. HPB (Oxford). 2016 Oct;18(10):821-26. doi: 10.1016/j.hpb.2016.06.001
  10. Schwed AC, Boggs MM, Pham XD, Watanabe DM, Bermudez MC, Kaji AH, Kim DY, Plurad DS, Saltzman DJ, de Virgilio C. Association of Admission Laboratory Values and the Timing of Endoscopic Retrograde Cholangiopancreatography With Clinical Outcomes in Acute Cholangitis. JAMA Surg. 2016 Nov 1;151(11):1039-45. doi: 10.1001/jamasurg.2016.2329
  11. Pataia V, Dixon PH, Williamson C. Pregnancy and bile acid disorders. Am J Physiol Gastrointest Liver Physiol. 2017 Jul 1;313(1):G1-G6. doi: 10.1152/ajpgi.00028.2017
  12. Baiocchi L, Zhou T, Liangpunsakul S, Lenci I, Santopaolo F, Meng F, Kennedy L, Glaser S, Francis H, Alpini G. Dual role of bile acids on the biliary epithelium: friend or foe? Int J MolSci. 2019 Apr 16;20(8). pii: E1869. doi: 10.3390/ijms20081869
  13. Kimura Y, Takada T, Strasberg SM, Pitt HA, Gouma DJ, Garden OJ, Büchler MW, Windsor JA, Mayumi T, Yoshida M, Miura F, Higuchi R, Gabata T, Hata J, Gomi H, Dervenis C, Lau WY, Belli G, Kim MH, Hilvano SC, Yamashita Y. TG13 current terminology, etiology, and epidemiology of acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Sci. 2013 Jan;20(1):8-23. doi: 10.1007/s00534-012-0564-0
  14. Sun Z, Zhu Y, Zhu B, Xu G, Zhang N. Controversy and progress for treatment of acute cholangitis after Tokyo Guidelines (TG13). Biosci Trends. 2016 Feb;10(1):22-26. doi: 10.5582/bst.2016.01033
  15. Mohammad Alizadeh AH. Cholangitis: diagnosis, treatment and prognosis. J Clin Transl Hepatol. 2017 Dec 28;5(4):404-13. doi: 10.14218/JCTH.2017.00028
Address for correspondence:
61103, Ukraine, Kharkov,
Balakirev Str., 1
V. T. Zaytsev Institute of General and Urgent Surgery of the National Academy of Medical Sciences
of Ukraine, the Department
of the Liver and Bile Ducts Surgery,
tel. +380 57349-41-20,
e-mail: andrey.aleksandrovich@googlemail.com
Nekliudov Andrey A.
Information about the authors:
Boyko Valeriy V., MD, Professor, Corresponding Member of the National Academy of Medical Sciences of Ukraine, Director of V. T. Zaytsev Institute of General and Urgent Surgery of National Academy of Medical Sciences of Ukraine, Kharkov, Ukraine.
https://orcid.org/0000-0003-4771-9699
Maloshtan Aleksandr V., MD, Chief Researcher, V. T. Zaytsev Institute of General and Urgent Surgery of National Academy of Medical Sciences of Ukraine, Kharkov, Ukraine.
https://orcid.org/0000-0001-5205-8480
Smachylo Rostyslav M., MD, Professor, Head of the Department of the Liver and Bile Ducts Surgery, V. T. Zaytsev Institute of General and Urgent Surgery of National Academy of Medical Sciences of Ukraine, Kharkov, Ukraine.
https://orcid.org/0000-0003-1237-0255
Nekliudov Andrey A., PhD, Researcher, V. T. Zaytsev Institute of General and Urgent Surgery of National Academy of Medical Sciences of Ukraine, Kharkov, Ukraine.
https://orcid.org/0000-0001-5567-2419
Tishchenko Alexand M., MD, Professor, Chief Researcher, V. T. Zaytsev Institute of General and Urgent Surgery of National Academy of Medical Sciences of Ukraine, Kharkov, Ukraine.
https://orcid.org/0000-0002-9151-778X
Vovk Valerii A., MD, Surgeon, Regional Clinical Hospital, Kharkov, Ukraine
https://orcid.org/0000-0003-0888-1837
Klosova Maria A., PhD, Researcher, V. T. Zaytsev Institute of General and Urgent Surgery of National Academy of Medical Sciences of Ukraine, Kharkov, Ukraine.
https://orcid.org/0000-0001-6048-4084
Volchenko Oleg V., Junior Researcher, V. T. Zaytsev Institute of General and Urgent Surgery of National Academy of Medical Sciences of Ukraine, Kharkov, Ukraine.
https://orcid.org/0000-0001-7818-2359

R.E. KALININ, I.A. SUCHKOV, I.N. SHANAEV

CLINICAL ANATOMY OF THE PERFORATING VEINS OF THE PROXIMAL LOWER LIMBS

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

Objective. To clarify the topographic and anatomical feature of the perforating veins (PVs) in the proximal part of the lower extremity.
Methods. 70 amputated lower extremities from the patients with severe ischemia were subjected to sectional anatomical study; 2800 patients with varicose disease underwent lower extremity sonography.
Results. PVs were primarily located on the medial surface of the thigh. In the upper third of the thigh PVs drain into superficial femoral vein. It was detected that one or two PVs occur in the lower third of the hip draining into superficial femoral vein and originating from the great saphenous vein in 73.6% cases. All PVs were accompanied by an arterial branch from the superficial femoral artery. Anatomical sectional study revealed that a nervous branch accompanied PVs in the lower third of the thigh. Two or four PVs were detected on the lateral surface of the thigh. PVs in the popliteal fossa could be referred to as atypical due to their rare occurence (0.4% of cases at sonography) in combination with absent typical sapheno-popliteal junction. PVs in this area were not supported by the intermuscular septa. PVs drained laterally into popliteal vein of the lower limb in 100% cases, while small saphenous vein drained into great saphenous vein in the upper third of the leg or into the intersaphenous vein.
Conclusion. Perforating veins constitute perforating bundles (PV, arterial branch, nervous branch), which are predominantly located along the intermuscular septa, which create a constant and strong orientation along the direction of the great vessels. This ensures stable hemodynamics of great vessels and perforating complexes and does not allow squeezed tham togeter during physical exertion.

Keywords: perforating veins, neurovascular bundle, anatomical features
p. 28-37 of the original issue
References
  1. Fegan Dzh. Varikoznajabolezn. Kompressionnaja skleroterapija. Moscow: Izd-vo NCSSH; 1997. 86 p. (In Russ.)
  2. Ricci S. The venous system of the foot: anatomy, physiology and clinical aspects. Phlebolymphology. 2015;22(2):64-75. https://www.phlebolymphology.org/phlebolymphology-86/
  3. Shvalb PG, Uhov JuI. Patologija venoznogo vozvrata iz nizhnih konechnostej. Rjazan: RjazGMU, 2009. 152 p. (In Russ.)
  4. Cronenwett JL, Johnston KW. Rutherfords vascular surgery. 8-th ed. Elsevier; 2014. 2784 p.
  5. Litvinenko LM. Sosudisto-nervnye kompleksy tela cheloveka. Moscow, RF: Biznes Olimp; 2011. 304 p. (In Russ.)
  6. Vakhitov MSh, Bolshakov OP. Varianty anatomicheskogo stroeniia ven nizhnikh konechnostei, kak vozmozhnaia prichina razvitiia pervichnogo varikoza. Angiologiia i Sosud Khirurgiia. 2011;17(4):64-68http://www.angiolsurgery.org/magazine/2011/4/9.htm. (In Russ.)
  7. Bolshakov OP, Semenov GM. Operativnaja hirurgija i topograficheskaja anatomija. S-Petersburg: Piter; 2018. 960 p. (In Russ.)
  8. Kostromov IA. Communicating veins of the lower extremities and their role in pathogenesis of primary varicosis. Flebologiia. 2010;4(3):74-76. https://www.mediasphera.ru/issues/flebologiya/2010/3/ (In Russ.)
  9. Sherman RS. Varicose veins: a suggested operative procedure. An operation for varicose veins based on anatomical studies of incompetent thigh perforators. Cal West Med. 1942 Sep;57(3):192-96. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1634545/
  10. Baitinger VF, Solovtsova IA, Kochish AYu. Phlebology according to the theory of perforasomes (part 1). Vopr Rekonstrukt i Plast Khirurgii. 2016;19(1):5-12. doi: 10.17223/1814147/56/1 (In Russ.)
  11. Kalinin RE, Suchkov IA, Shanaev IN. Errors in crural perforant veins ligation. Hirurgija Zhurn im NI Pirogova. 2016;(7):45-48. doi: 10.17116/hirurgia2016745-48 (In Russ.)
  12. Kalinin RE, Suchkov IA, Shanaev IN. Rare variants of formation of collateral circulation in patients with obliterating atherosclerosis of lower limb arteries. Nauka Molodyh(Eruditio Juvenium). 2019;7(1):113-21. doi: 10.23888/HMJ201971113-121 (In Russ.)
  13. Kusagawa H. Surgery for varicose veins caused by atypical incompetent perforating veins. Ann Vasc Dis. 2019 Dec 25;12(4):443-48. doi: 10.3400/avd.oa.19-00083
  14. Engelhorn CA, Escorsin JKS, Costa KCO, Miyashiro L, Silvério MM, da Costa RCG. Location and hemodynamic role of perforating veins independent of saphenous veins. J Vasc Bras. 2018 Apr-Jun;17(2):104-108. doi: 10.1590/1677-5449.009117
  15. Gaibov AD, Nematzoda O, Burieva ShM, KalmykovEL. Experience of application of mechanochemical scleroobliteration in treatment for recurrence of lower extremity varicose vein disease. Ros Med-Biol Vestn im Akad IP Pavlova. 2020;28(1):57-66. doi: 10.23888/PAVLOVJ202028157-66 (In Russ.)
  16. Uhl J, Gillot C. Anatomy of the Hunters canal and its role in the venous outlet syndrome of the lower limb. Phlebology. 2015 Oct;30(9):604-11. doi: 10.1177/0268355514551086
Address for correspondence:
390026, Russian Federation,
Ryazan, Vysokovoltnaya Str., 9,
Ryazan State Medical University,
the Depatment of Cardiovascular,
Roentgen-Endovascular,
Operative Surgery and Topographic Anatomy.
tel. +7-4912-97-18-03
e-mail: Suchkov_med@mail.ru
Suchkov Igor A.
Information about the authors:
Kalinin Roman E., MD, PhD, Professor, Head of the Department of Cardiovascular, Roentgen-Endovascular, Operative Surgery and Topographic Anatomy, Ryazan State Medical University Named after Academician I.P.Pavlov, Ryazan, Russian Federation.
http://orcid.org/0000-0002-0817-9573
Suchkov Igor A., MD, PhD, Professor of the Department of Cardiovascular, Roentgen-Endovascular, Operative Surgery and Topographic Anatomy, Ryazan State Medical University named after Academician I.P.Pavlov, Ryazan, Russian Federation.
http://orcid.org/0000-0002-1292-5452
Shanaev Ivan N., PhD, Assistant of the Department of Cardiovascular, Roentgen-Endovascular, Operative Surgery and Topographic Anatomy, Ryazan State Medical University named after Academician I.P.Pavlov, Ryazan, Russian Federation.
http://orcid.org/0000-0002-8967-3978

PEDIATRIC SURGERY

A.N. VORONETSKY 1, A.E. DANOVICH 2

NEODYMIUM LASER IN LARINGOTRACHEOSTENOSIS TREATMENT AFTER TRACHEOSTOMY IN CHILDREN


Belarusian State Medical University 1,
The 6th City Clinical Hospital 2, Minsk,
The Republic of Belarus

Objective. To evaluate the effect of neodymium laser application for successful decannulation in infants with a congenital and acquired tracheal stenosis and tracheostomy.
Methods. 6 children were being treated in the 1st City Clinical Hospital of Minsk in 2011-2014. All children underwent tracheostomy with a prolonged tracheal intubation and subsequent development of tracheostenosis. The children were examined using X-ray, esophagogastroscopy (PentaxEG-16K10), and bronchoscopy (Olympus MAF TYPE GM). Tracheal stenosis was treated using a medical multifunctional laser complex Multiline (Linline Medical systems Ltd, Belarus) equipped with a high-energy neodymium laser emitter. Children with excessive growth of granulations in the lumen of the trachea underwent vaporization of granulations by means of a bulbous probe with a neodymium laser emitter (wavelength of 1340 nm, power: 15 W, 2 sec. exposure). In cicatricial tracheal stenosis, incisions were made with a laser scalpel (the wavelength of 1064 nm, power of 20 W).
Results. Effective decannulation was observed in 5 children, including 4 children who underwent 3-5 treatment sessions. In 1 child with the congenital subglottic larynx stenosis, to perform the decannulation became possible after 2 years and 24 sessions of laser recanalization of stenosis and ablation of granulations. One child, after 9 treatment sessions, dropped out of observation, the result has not been defined.
Conclusion. Tracheostomy in children promotes the formation of granulations in the tracheal lumen with the formation of stenosis, which subsequently hinders a successful decannulation. The neodymium laser application with the endoscopic access provides the visual direct approach to the focus of impact with the aim of laser-induced vaporization of soft tissues and recanalization of the tracheal mass in children with short tracheal stenosis leads to successful decannulation.

Keywords: Tracheostomy, tracheal stenosis, neodymium laser, endoscopy, infants
p. 38-45 of the original issue
References
  1. Ozturk K, Erdur O, Sofiyev F, Onal IO, Annagur A. Noninvasive treatment of acquired subglottic stenosis. J Craniofac Surg. 2016 Jul;27(5):e492-e493. DOI: 10.1097/SCS.0000000000002809
  2. Wai KC, Keller RL, Lusk LA, Ballard RA, Chan DK. Characteristics of extremely low gestational age newborns undergoing tracheotomy: a secondary analysis of the trial of late surfactant randomized clinical trial. JAMA Otolaryngol Head Neck Surg. 2017 Jan 1;143(1):13-19. doi: 10.1001/jamaoto.2016.2428
  3. Watters KF. Tracheostomy in infants and children. Respir Care. 2017;62(6):799-25. doi: 10.4187/respcare.05366
  4. Jefferson ND, Cohen AP, Rutter MJ. Subglottic stenosis. Semin Pediatr Surg. 2016 Jun;25(3):138-43. doi: 10.1053/j.sempedsurg.2016.02.006
  5. Voronetsky AN, Danovich . Neodymium laser in treatment of congenital tracheoesophageal fistula in children. Novosli Khinirgii. 2018 Jan-Feb; Vol 26 (1): 60-65. Novosti Khirurgii. 2018;26(1):60-65. doi: 10.18484/2305-0047.2018.1.60 (In Russ.)
  6. Mahida JB, Asti L, Boss EF, Shah RK, Deans KJ, Minneci PC, Jatana KR. Tracheostomy Placement in Children Younger Than 2 Years: 30-Day Outcomes Using the National Surgical Quality Improvement Program Pediatric. JAMA Otolaryngol Head Neck Surg. 2016 Mar;142(3):241-46. doi: 10.1001/jamaoto.2015.3302
  7. Sittel C. Pathologies of the larynx and trachea in childhood. Laryngorhinootologie. 2014 Mar;93(Suppl 1):S70-83. doi: 10.1055/s-0033-1363212 [Article in German]
  8. Pullens B, Hoeve LJ, Timmerman MK, van der Schroeff MP, Joosten KFM. Characteristics and surgical outcome of 98 infants and children surgically treated for a laryngotracheal stenosis after endotracheal intubation: excellent outcome for higher grades of stenosis after SS-LTR. Int J Pediatr Otorhinolaryngol. 2014 Sep;78(9):1444-48. doi: 10.1016/j.ijporl.2014.05.034
  9. Bowen AJ, Nowacki AS, Benninger MS, Lamarre ED, Bryson PC. Is tracheotomy on the decline in otolaryngology? A single institutional analysis. Am J Otolaryngol. 2018 Mar-Apr;39(2):97-100. doi: 10.1016/j.amjoto.2017.12.017
  10. Resen MS, Grønhøj C, Hjuler T. National changes in pediatric tracheotomy epidemiology during 36 years. Eur Arch Otorhinolaryngol. 2018 Mar;275(3):803-808. doi: 10.1007/s00405-018-4872-0
  11. DSouza JN, Levi JR, Park D, Shah UK. Complications Following Pediatric Tracheotomy. JAMA Otolaryngol Head Neck Surg. 2016 May 1;142(5):484-88. doi: 10.1001/jamaoto.2016.0173
  12. Ha TA, Goyal M, Ongkasuwan J. Duration of tracheostomy dependence and development of tracheocutaneous fistula in children. Laryngoscope. 2017 Dec;127(12):2709-12. doi: 10.1002/lary.26718
  13. Fastenberg JH, Roy S, Smith LP. Coblation-assisted management of pediatric airway stenosis. Int J Pediatr Otorhinolaryngol. 2016 Aug;87:213-18. doi: 10.1016/j.ijporl.2016.06.035
  14. Cevizci R, Dilci A, Can IH, Kersin B, Bayazit Y. Flexible CO2 laser treatment for subglottic stenosis. J Craniofac Surg. 2017 Jun;28(4):983-84. doi: 10.1097/SCS.0000000000003549
  15. Tóbiás Z, Pálinkó D, Sztanó B, Csanády M, Gál P, Rovó L. Endoscopic ultra dream pulse laser surgery of laryngomalacia. Our experiences gained during the introduction of the method in Hungary. Orv Hetil. 2017 Aug;158(33):1288-92. doi: 10.1556/650.2017.30722 [Article in Hungarian]
  16. Szabó L, Szakács L, Rovó L. Minimally invasive treatment of postintubation stenosis by use of Ultra Dream Pulse Laser and steroid-mitomycin in a 4-year-old girl. Orv Hetil. 2019 May;160(20):792-96. doi: 10.1556/650.2019.31361 [Article in Hungarian]
Address for correspondence:
220116, Republic of Belarus,
Minsk, Dzerzhinsky Av., 83,
Belarusian State Medical University,
the Pediatric Surgery Department,
tel. mob.: +375 029 32-902-32,
e-mail: anvoron@mail.ru,
Voronetsky Alexandr N.
Information about the authors:
Voronetsky Alexandr N., PhD, Associate Professor of the Pediatric Surgery Department, Belarusian State Medical University, Minsk, Republic of Belarus.
https://orcid.org/0000-0001-7091-376X
Danovich Alexandr E., Head of the Endoscopy Unit, the 6th City Clinical Hospital, Minsk, Republic of Belarus.
https://orcid.org/0000-0002-8149-2363

TRAUMATOLOGY AND ORTHOPEDICS

N.L. ANKIN 1, 2, T.M. PETRYK 1, 2, V.V. ROIENKO 1, V.O. LADYKA 1, 2

FEATURES OF HIP JOINT ARTHROPLASTY IN PATIENTS AFTER OSTEOSYNTHESIS OF THE ACETABULAR FRACTURES

Kiev Regional Clinical Hospital 1,
P.L. Shupyk National Medical Academy of Postgraduate Education 2, Kiev,
Ukraine

Objective. To analyze the late complications after osteosynthesis of the acetabular fractures that led to reoperations; to determine the features of surgical intervention and the choice of the acetabular component during endoprosthetics in these patients.
Methods. From 2009 to 2015, the results of endoprosthetics in patients (n=35) who underwent primary osteosynthesis of the acetabulum and subsequently hip arthroplasty were evaluated at the Orthopedic and Trauma Center of Kiev Regional Clinical Hospital. To assess damage volume, the Letournel-Judet classification was used. 5 years after the endoprosthetics to evaluate functional outcomes the the Harris Hip Scale (HHS) and radiographic method have been used.
Results. The initial preoperative assessment in 35 patients using Harris Hip Scale showed results: 64 (58-71) (LQ; UQ) points. A year after endoprosthetics when examining 33 (94.3%) patients the Harris scale improved the results to 81 (74-88) points (p0-1<0.001). 5 years after arthroplasty the Harris scale was 85 (77-92) points (p0-5<0.001). After 5 years in 31 (88.6%) patients a radiographic evaluation showed stable integration of the acetabular component without any signs of attenuation in 1-3 zones according to the De Lee and Charnley classification.
Conclusion. The most effective way to treat the recent acetabular fractures with fragment displacement is considered to be the early osteosynthesis with anatomical reposition of fragments, which with the development of degenerative changes in the operated joint, makes it possible to perform endoprosthetics using a full-fledged bone mass for immersion of the acetabular component. Careful planning of the operation, preliminary removal of metal fixators, which can affect the placement of the acetabular component, as well as increase the risk of postoperative complications, allows achieving good results.

Keywords: hip joint, cetabular fractures, primary total hip replacement, osteosynthesis of the cetabular fractures, classification of Letournel-Judet, De Lee and Charnley classification
p. 46-52 of the original issue
References
  1. Letournel E, Judet R (eds). Fractures of the acetabulum. Springer Science & Business Media; 2012. 524 .
  2. Matta JM. Fractures of the acetabulum: accuracy of reduction and clinical results in patients managed operatively within three weeks after the injury. J Bone Joint Surg Am. 1996 Nov;78(11):1632-45. https://insights.ovid.com/jbjs/199611000/00004623-199611000-00002
  3. Matta JM. The anterior approach for total hip replacement: background and operative technique. In: MIS Techniques in Orthopedics. Springer, New York, NY; 2006. p. 121-40. doi: 10.1007/978-0-387-29300-4_8
  4. Carroll EA, Huber FG, Goldman AT, Virkus WW, Pagenkopf E, Lorich DG, Helfet DL. Treatment of acetabular fractures in an older population. J Orthop Trauma. 2010 Oct;24(10):637-44. doi: 10.1097/BOT.0b013e3181ceb685
  5. Tile M, Helfet DL, Kellam JF, Vrahas M. Fractures of the pelvis and acetabulum: principles and methods of management. Thieme; 2015. doi: 10.1055/b-003-121618
  6. Judet R, Judet J, Letournel E. Fractures of the acetabulum: classification and surgical approaches for open reduction. Preliminary report. J Bone Joint Surg Am. 1964 Dec;46:1615-46.
  7. Rogers JC, Irrgang JJ. Measures of adult lower extremity function: The American Academy of Orthopedic Surgeons Lower Limb Questionnaire, The Activities of Daily Living Scale of the Knee Outcome Survey (ADLS), Foot Function Index (FFI), Functional Assessment System (FAS), Harris Hip Score (HHS), Index of Severity for Hip Osteoarthritis (ISH), Index of Severity for Knee Osteoarthritis (ISK), Knee Injury and Osteoarthritis Outcome Score (KOOS), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Arthritis & Rheumatism (Arthritis Care & Research). 2003 Oct 15;49(5S):S67-S84. doi: 10.1002/art.11401
  8. DeLee JG, Charnley J. Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res. 1976 Nov-Dec;(121):20-32.
  9. Berger RA, Jacobs JJ, Quigley LR, Rosenberg AG, Galante JO. Primary cementless acetabular reconstruction in patients younger than 50 years old. 7- to 11-year results. Clin Orthop Relat Res. 1997 Nov;(344):216-26.
  10. Berry DJ, Halasy M. Uncemented acetabular components for arthritis after acetabular fracture. Clin Orthop Relat Res. 2002 Dec;(405):164-67. doi: 10.1097/00003086-200212000-00020
  11. Sierra RJ, Mabry TM, Sems SA, Berry DJ. Acetabular fractures: the role of total hip replacement. Bone Joint J. 2013 Nov;95-B(11 Suppl A):11-16. doi: 10.1302/0301-620X.95B11.32897
  12. Stibolt RD Jr, Patel HA, Huntley SR, Lehtonen EJ, Shah AB, Naranje SM. Total hip arthroplasty for posttraumatic osteoarthritis following acetabular fracture: A systematic review of characteristics, outcomes, and complications. Chin J Traumatol. 2018 Jun;21(3):176-81. doi: 10.1016/j.cjtee.2018.02.004
  13. Bellabarba C, Berger RA, Bentley CD, Quigley LR, Jacobs JJ, Rosenberg AG, Sheinkop MB, Galante JO. Cementless acetabular reconstruction after acetabular fracture. J Bone Joint Surg Am. 2001 Jun;83(6):868-76. doi: 10.2106/00004623-200106000-00008
  14. Ranawat A, Zelken J, Helfet D, Buly R. Total hip arthroplasty for posttraumatic arthritis after acetabular fracture. J Arthroplasty. 2009 Aug;24(5):759-67. doi: 10.1016/j.arth.2008.04.004
  15. Tile M, Helfet D, Kellam J (eds). Fractures of the pelvis and acetabulum. 3rd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2003. 850 p.
  16. Danilyak VV. Comment to the article Classifications of acetabular defects: do they provide an objective evidence for complexity of revision hip joint arthroplasty? (Critical literature review and own cases). Traumatology and Orthopedics of Russia. 2019;25(2):166-69. doi: 10.21823/2311-2905-2019-25-2-166-169 (In Russ.)
Address for correspondence:
04107, Ukraine, Kiev,
Baggoutovskaya Str., 1,
Kiev Clinical Hospital,
the Department of Orthopedics and Traumatology No2 of P.L. Shupyk of the National Medical Academy of Postgraduate Education
tel. +3 8096 258 37 05,
e-mail: ladika084@gmail.com,
Ladyka Victoria A.
Information about the authors:
Ankin Mykola L., MD, PhD, Professor, Acting General Director, Kiev Clinical Hospital, Head of the Department of Orthopedics and Traumatology No2, P.L. Shupyk of the National Medical Academy of Postgraduate Education, Kiev Ukraine.
https://orcid.org/0000-0001-9795-0931
Petryk Taras M., PhD, Head of the Orthopedics And Traumatology Center, Kiev Clinical Hospital, Associate Professor of the Department of Orthopedics and Traumatology No2, P.L. Shupyk of the National Medical Academy of Postgraduate Education, Kiev Ukraine.
https://orcid.org/0000-0002-5319-3921
Roienko Vadym V., Traumatic Surgeon of the Orthopedics and Traumatology Center, Kiev Clinical Hospital, Kiev, Ukraine.
https://orcid.org/0000-0002-1220-4049
Ladyka Victoria A., Assistant of the Department of Orthopedics and Traumatology No2, P.L. Shupyk of the National Medical Academy of Postgraduate Education, Traumatic Surgeon of the Orthopedics and Traumatology Center, Kiev Clinical Hospital, Kiev Ukraine.
https://orcid.org/0000-0002-3796-428X

UROLOGY

V.I. DUBROV 1, 2, A.V. STROTSKY 2

THE RESULTS OF LAPAROSCOPIC HEMINEPHRURETERECTOMY AND URETEROPYELOANASTOMOSIS (URETEROURETEROANASTOMOSIS) FOR DUPLEX KIDNEY IN CHILDREN

The 2nd City Children's Clinical Hospital 1,
Belarusian State Medical University2, Minsk
The Republic of Belarus

Objective. To study the results of laparoscopic heminephrureterectomy (LHNE), ureteropyelostomy (LUPS) and ureteroureterostomy (LUUS) in the laparoscopic treatments of megaurete of a duplex system in children.
Methods. The records of patients (n=102) who underwent LHNE and LUPS (LUUS) were retrospectively analyzed (26 (25,5%) boys and 76(74,5%) girls). The age of patients was from 3 months to 17 years (median 17.9 months). Megaureter of the upper pole was observed in 82 (80.4%) patients, of the lower pole in 20 (19.6%). LHNE was performed in 68 patients (66.7%), LUPA (LUUA) in 34 (33.3%).
Results. Intraoperative complications occurred in 2 patients (2.0%), conversion was required in both cases. Median operative LHNE time was 146,046,2 minutes (median 120 minutes); in LUPS(LUUS) 160,144,7 minutes (median 150 minutes). One patient after LUUA developed the urinary leakage due to stent obstruction and required nephrostomy (IIIb, ClavienDindo classification). The remote results were traced for a period from 10 months to 6 years.The patients after LHNE (n=15) (22.1%) had a significant decrease of kidney function (>5%), including one patient (1.5%) with a complete loss of the function. An inflammatory process after partial ureteral resection was observed in the stump , which required relaparoscopy in 3 children (6.5%). The ipsilateral ureter injury during the total ureterectomy in the lateral position occurred in 2 children (6.9%).
Conclusion. LHNE and LUPA (LUUA) are considered to be the effective surgical methods of duplex system megaureter in children. The disadvantage of LHNE is the high risk of significant decrease of kidney function; LUPA (LUUA) are the safer methods. Total ureterectomy in the supine position of a patient can prevent the complications associated with the healthy ureter injury and leaving the ureteral stump.

Keywords: laparoscopy, duplex kidney, heminephrectomy, ureteropyelostomy, ureteroureterostomy
p. 53-61 of the original issue
References
  1. Nation EF. Duplication of the kidney and ureter: a statistical study of 230 new cases. J Urol. 1944 May 1;51(5):456-65. doi: 10.1016/s0022-5347(17)70379-5
  2. Taghavi K, Mushtaq I. Retroperitoneoscopic Hemi Nephrectomy. J Pediatr Urol. 2018 Apr;14(2):196-97. doi: 10.1016/j.jpurol.2018.02.010
  3. Villanueva CA. Open vs robotic infant ureterou-reterostomy. J Pediatr Urol. 2019 Aug;15(4):390.e1-390.e4. doi: 10.1016/j.jpurol.2019.05.003
  4. Smith FL, Ritchie EL, Maizels M, Zaontz MR, Hsueh W, Kaplan WE, Firlit CF. Surgery for duplex kidneys with ectopic ureters: ipsilateralureteroureterostomy versus polar nephrectomy. J Urol. 1989 Aug;142(2 Pt 2):532-34. doi: 10.1016/s0022-5347(17)38806-7
  5. Bolduc S, Upadhyay J, Sherman C, Farhat W, Bagli DJ, McLorie GA, Khoury AE, El-Ghoneimi A. Histology of upper pole is unaffected by prenatal diagnosis in duplex system ureteroceles. J Urol. 2002 Sep;168(3):1123-26. doi: 10.1097/01.ju.0000025866.15856.0f
  6. Cabezali D, Maruszewski P, López F, Aransay A, Gomez A. Complications and late outcome in transperitoneal laparoscopic heminephrectomy for duplex kidney in children. J Endourol. 2013 Feb;27(2):133-38. doi: 10.1089/end.2012.0379
  7. Jayram G, Roberts J, Hernandez A, Heloury Y, Manoharan S, Godbole P, LeClair M, Mushtaq I, Gundeti MS. Outcomes and fate of the remnant moiety following laparoscopic heminephrectomy for duplex kidney: a multicenter review. J Pediatr Urol. 2011 Jun;7(3):272-75. doi: 10.1016/j.jpurol.2011.02.029
  8. Michaud JE, Akhavan A. Upper pole heminephrectomy versus lower pole ureteroureterostomy for ectopic upper pole ureters. CurrUrol Rep. 2017 Mar;18(3):21. doi: 10.1007/s11934-017-0664-0
  9. Malashenko AS, Poddubnyi IV, Faizulin AK, Fedorova EV, Tolstov KN, Petrova MG. Laparoscopic and open heminephrectomy in children: results comparison. KhirurgiiaZhurnim NI Pirogova.2014;(10):68-72.https://www.mediasphera.ru/issues/khirurgiya-zhurnal-im-n-i-pirogova/2014/10 (In Russ.)
  10. Mushtaq I, Haleblian G. Laparoscopic hemine-phrectomy in infants and children: first 54 cases. J Pediatr Urol. 2007 Apr;3(2):100-03. doi: 10.1016/j.jpurol.2006.05.011
  11. Husmann DA. Renal dysplasia: the risks and consequences of leaving dysplastic tissue in situ. Urology. 1998 Oct;52(4):533-36. doi: 10.1016/s0090-4295(98)00289-1
  12. Casale P, Lambert S. Robotic ureteroureterostomy in children with a duplex collecting system. J Robot Surg. 2009 Oct;3(3):161-14. doi: 10.1007/s11701-009-0153-7
  13. Grimsby GM, Merchant Z, Jacobs MA, Gargollo PC. Laparoscopic-assisted ureteroureterostomy for duplication anomalies in children. J Endourol. 2014 Oct;28(10):1173-77. doi: 10.1089/end.2014.0113
  14. Casale P, Grady RW, Lee RS, Joyner BD, Mitchell ME. Symptomatic refluxing distal ureteral stumps after nephroureterectomy and heminephroureterectomy. What should we do? J Urol. 2005 Jan;173(1):204-06. doi: 10.1097/01.ju.0000147849.80627.41
  15. Ade-AjayiN, WilcoxDT, DuffyPG, RansleyPG. Upper pole heminephrectomy: is complete ureterectomy necessary? BJU Int. 2001 Jul; 88(1):77-79. doi: 10.1046/j.1464-410x.2001.02249.x
  16. Chandrasekharam V, Jayaram H. Laparoscopic ipsilateralureteroureterostomy for the management of children with duplication anomalies. J Indian Assoc Pediatr Surg. 2015 Jan;20(1):27-31. doi: 10.4103/0971-9261.145442
  17. Husmann D, Strand B, Ewalt D, Clement M, Kramer S, Allen T. Management of ectopic ureterocele associated with renal duplication: a comparison of partial nephrectomy and endoscopic decompression. J Urol. 1999 Oct;162(4):1406-09. doi: 10.1016/s0022-5347(05)68322-x
Address for correspondence:
220020, Republic of Belarus,
Minsk, Narochanskaya Str. 17,
the 2nd City Childrens Clinical Hospital,
the Urology Department,
Tel. +375 29 674-42-49,
e-mail: dubroff2000@mail.ru,
Dubrov Vitaly I.
Information about the authors:
Dubrov Vitaly I., PhD, Head of the Urology Department, the 2nd City Childrens Clinical Hospital, Minsk, Republic of Belarus.
https://orcid.org/0000-0002-3705-1288
Strotsky Alexander V., MD, Professor, Head of the Urology Department, Belarusian State Medical University, Minsk, Republic of Belarus.
https://orcid.org/0000-0003-1640-5857

ANESTHESIOLOGY-REANIMATOLOGY

D.S. TRATSIAK, K.A. ABDIN, A.A. MAKAROV, A.P. TRUKHAN, A.I. DOBRYANETS

AUTOMATIC PLASMAPHERESIS IN PATIENTS WITH COVID-19-ASSOCIATED PNEUMONIA. THE FIRST EXPERIENCE OF APPLICATION

432nd Main Military Clinical Medical Center of the Armed Forces of the Republic of Belarus, Minsk,
The Republic of Belarus

Objective. To determine the possibility of using automatic plasmapheresis in patients with COVID-19- associated bilateral polysegmental pneumonia.
Methods. The treatment of three patients with COVID-19-associated pneumonia with application of the Autopheresis-C automatic plasmapheresis machine (the USA) has been analyzed. The patients age was 47. 49 and 55 years. The patients case histories included factors aggravating the course of pneumonia (diabetes mellitus, chronic cardiovascular pathology with heart failure, obesity). The condition of all patients was severe. The effectiveness estimation of the given technique was carried out 6 hours after the manipulation and included a general clinical blood test, a biochemical blood test, hemodynamic parameters, and objective data.
Results. After the first application of automatic plasmapheresis, all patients occurred a decrease in temperature and the level of respiratory failure, which was accompanied by an increase in hemoglobin saturation; a decrease in the severity of dyspnea was also reported, which was the reason for the changing patient position from prone to supine. All patients had a blood pressure reduction. Positive changes in the hemodynamic situation were the basis for reducing the dosage of antihypertensive drugs. Along with this, in the course of manipulation, a gradual decrease in the severity of tachycardia was noted in all patients: a reduction of heart rate was recorded. On the second day after the manipulation, the main blood parameters (leukocytosis, c-reactive protein) decreased. The observed positive effects contributed to the early transfer (by 10-15 days) of patients from the intensive care unit to the general somatic departments.
Conclusion. The early inclusion of automatic plasmapheresis in the complex therapy of patients with COVID-19- associated bilateral polysegmental pneumonia leads to the stabilization of hemodynamic parameters, decline of the severity of respiratory failure, which made it possible to avoid the mechanical ventilation.

Keywords: COVID-19, bilateral polysegmental pneumonia, automatic plasmapheresis, functional and metabolic disorders, SARS-CoV-2
p. 62-66 of the original issue
References
  1. Kirkovskii VV. Fiziko-khimicheskie metody korrektsii gomeostaza. Moscow, RF: Russkii vrach; 2012. 216 p. (In Russ.)
  2. Moskvin SV, Fedorova TA, Foteeva TS. Plazmaferez i lazernoe osvechivanie krovi. Moscow-Tver, RF; 2018. 416 p. (In Russ.)
  3. Kumar P, Ahmad MI, Sangam S. Plasmapheresis: A new strategy in the treatment of COVID- 19. Pharm Sci. 2020;26(Suppl 1):S82-S83. doi: 10.34172/PS.2020.55
  4. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, Zhang L, Fan G, Xu J, Gu X, Cheng Z, Yu T, Xia J, Wei Y, Wu W, Xie X, Yin W, Li H, Liu M, Xiao Y, Gao H, Guo L, Xie J, Wang G, Jiang R, Gao Z, Jin Q, Wang J, Cao B. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020 Feb 15;395(10223):497-506. doi: 10.1016/S0140-6736(20)30183-5
  5. Sun X, Wang T, Cai D, Hu Z, Chen J, Liao H, Zhi L, Wei H, Zhang Z, Qiu Y, Wang J, Wang A. Cytokine storm intervention in the early stages of COVID-19 pneumonia. Cytokine Growth Factor Rev. 2020 Jun;53:38-42. doi: 10.1016/j.cytogfr.2020.04.002
  6. Jose RJ, Manuel A. COVID-19 cytokine storm: the interplay between inflammation and coagulation. Lancet Respir Med. 2020 Jun;8(6):e46-e47. doi: 10.1016/S2213-2600(20)30216-2
  7. Busund R, Koukline V, Utrobin U, Nedashkovsky E. Plasmapheresis in severe sepsis and septic shock: a prospective, randomised, controlled trial. Intensive Care Med. 2002 Oct;28(10):1434-39. doi: 10.1007/s00134-002-1410-7
Address for correspondence:
220123, Republic of Belarus,
Minsk, Masherov Avenue, 26,
432 Main Military Clinical Medical
Center of the Armed Forces
of the Republic of Belarus,
tel. mob.: +375 (29) 755-77-62,
e-mail: tds2006@yandex.ru,
Tratsiak Dmitry S.
Information about the authors:
Tratsiak Dmitry S., PhD, Head of the Blood Transfusion Center, 432 Main Military Clinical Medical Center of the Armed Forces of the Republic of Belarus, Minsk, Republic of Belarus.
http://orcid.org/0000-0002-2731-4777.
Abdin Konstantin A., Head of the Intensive Care Unit, 432 Main Military Clinical Medical Center of the Armed Forces of the Republic of Belarus, Minsk, Republic of Belarus.
http://orcid.org/0000-0001-60-76-6495
Makarov Alexandr A., Deputy Head, Head of the Medical Unit, 432 Main Military Clinical Medical Center of the Armed Forces of the Republic of Belarus, Minsk, Republic of Belarus.
http://orcid.org/0000-0003-0804-4422.
Trukhan Alexey P., PhD, Associate Professor, Leading Surgeon of the 432 Main Military Clinical Medical Center of the Armed Forces of the Republic of Belarus, Minsk, Republic of Belarus.
http://orcid.org/0000-0001-7422-8014
Dobryanets Alexandr I., Head of the Gravitational Blood Surgery Unit, 432 Main Military Clinical Medical Center of the Armed Forces of the Republic of Belarus, Minsk, Republic of Belarus.
http://orcid.org/0000-0002-0291-9593

INFORMATION TECHNOLOGIES IN SURGERY

I.Y. ZHERKA 1, E.P. ZHILIAYEVA 1, L.V. NAUMENKA 1, ZH.V. KALIADZICH 1, D.L. ENA 1, I.D. ZAMOTIN 2, P.A. ARLOU 2

THE APPLICATION OF NAVIGATION SYSTEM BASED ON THE AUGMENTED REALITY TECHNOLOGY FOR THE SURGICAL TREATMENT OF ORBITAL TUMORS

N.N. Alexandrov National Cancer Center of Belarus 1,
International Software Development Company Innowise 2, Minsk,
The Republic of Belarus

Objective. To assess the effectiveness and feasibility of using an intraoperative navigation system based on augmented reality technology in the surgical treatment of intra-orbital tumors.
Methods. Two patients with intra-orbital tumors were operated on with the application of the intraoperative navigation system. The virtual volumetric model was designed on the basis of files in the Digital Imaging and Communications in Medicine (DICOM) format, taking into account the fact that the quality of reconstruction depends on the quality of the input data and the accuracy of the reconstruction system. The required structures and parameters of color rendering for inclusion in the model were selected taking into consideration a specific clinical situation. Then the model was subjected to processing and modification to facilitate visualization. The prepared and optimized model was loaded into Microsoft HoloLens2 augmented reality glasses. In the preoperative period, using the possibilities of full screen image zoom and rotation of 3D model, the planning of the surgical intervention was carried out with the participation of all members of the surgical team. Intraoperatively, a 3D skull model was superimposed on the patient along bony landmarks (lower orbital edge and nasal bones). Surgical access and surgery were performed in the projection of the visualized tumor.
Results. In the first case, the surgical planning as the preoperative method of pre-visualising a surgical intervention was used by means of the possibilities of model zooming and rotating; a detailed preoperative tumor assessment was made. In the second case, the navigation system was used in the process of diagnostic orbitotomy to facilitate the access to the tumor.
Conclusion. Augmented reality allows highly detail visualization of individual anatomical models. Models are interactive, adaptive to real time and manipulating does not require the special skills. The technologies are flexible and can be programmed to perform a number of tasks (diagnostics, preoperative planning and intraoperative navigation). Models might be used for surgical training of surgeons to possess the skills.

Keywords: orbit tumors, augmented reality, mixed reality, computer-guided surgery, head and neck tumors, intraoperative navigation system
p. 67-74 of the original issue
References
  1. Bernardini FP, Kersten RC, Devoto MH, Morton AD, Johnson TE. Outcomes after surgical excision of large and massive orbital tumors. Ophthalmic Plast Reconstr Surg. 2008 Jul-Aug;24(4):280-83. doi: 10.1097/IOP.0b013e318177f12c
  2. Ayoub A, Pulijala Y. The application of virtual reality and augmented reality in Oral & Maxillofacial Surgery. BMC Oral Health. 2019;Article 238. doi: 10.1186/s12903-019-0937-8
  3. Vávra P, Roman J, Zonča P, Ihnát P, Nemec M, Kumar J, Habib N, El-Gendi A. Recent development of augmented reality in surgery: a review. J Healthc Eng. 2017;2017:4574172. doi: 10.1155/2017/4574172
  4. Okamoto T, Onda S, Yanaga K, Suzuki N, Hattori A. Clinical application of navigation surgery using augmented reality in the abdominal field. Surg Today. 2015 Apr;45(4):397-406. doi: 10.1007/s00595-014-0946-9
  5. Abi-Aad KR, AlmekkawiAK, Turcotte E, Welz ME, Rahme RJ, Patra DP, Lyons MK, Bendok BR. Utility of augmented reality imaging (glow800) in resection of hemangioblastoma. World Neurosurg. 2020 Apr;136:294. doi: 10.1016/j.wneu.2019.12.090
  6. Lopez-Rodriguez MM, Fernández-Millan A, Ruiz-Fernández MD, Dobarrio-Sanz I, Fernández-Medina IM. New technologies to improve pain, anxiety and depression in children and adolescents with cancer: a systematic review. Int J Environ Res Public Health. 2020 May; 17(10):3563. Published online 2020 May 19. doi: 10.3390/ijerph17103563
  7. Cornelis FH, Najdawi M, Ammar MB, Nouri-Neuville M, Lombart B, Lotz JP, Cadranel J, Barral M. Integrative medicine in interventional oncology: a virtuous alliance. Medicina (Kaunas). 2020 Jan 17;56(1):35. doi: 10.3390/medicina56010035
  8. Patel P, Ivanov D, Bhatt S, Mastorakos G, Birckhead B, Khera N, Vittone J. Low-cost virtual reality headsets reduce perceived pain in healthy adults: a multicenter randomized crossover trial. Games Health J. 2020 Apr;9(2):129-36. doi: 10.1089/g4h.2019.0052
  9. Li C, Cai Y, Wang W, Sun Y, Li G, Dimachkieh AL, Tian W, Sun R. Combined application of virtual surgery and 3D printing technology in postoperative reconstruction of head and neck cancers. BMC Surg. 2019 Nov 28;19(1):182. doi: 10.1186/s12893-019-0616-3
  10. Pritchett MA, Bhadra K, Calcutt M, Folch E. Virtual or reality: divergence between preprocedural computed tomography scans and lung anatomy during guided bronchoscopy. J Thorac Dis. 2020 Apr;12(4):1595-611. doi: 10.21037/jtd.2020.01.35
  11. Rath T, Morgenstern N, Vitali F, Atreya R, Neurath MF. Advanced Endoscopic Imaging in Colonic Neoplasia. Visc Med. 2020;36(1):48?59. doi: 10.1159/000505411
  12. Penza V, Soriero D, Barresi G, Pertile D, Scabini S, Mattos LS. The GPS for surgery: A user-centered evaluation of a navigation system for laparoscopic surgery. Int J Med Robot. 2020 Oct;16(5):1-13. doi: 10.1002/rcs.2119
  13. Chen L, Zhang F, Zhan W, Gan M, Sun L. Optimization of virtual and real registration technology based on augmented reality in a surgical navigation system. Biomed Eng Online. 2020 Jan 8;19(1):1. doi: 10.1186/s12938-019-0745-z
  14. Chen PC, Gadepalli K, MacDonald R, Liu Y, Kadowaki S, Nagpal K, Kohlberger T, Dean J, Corrado GS, Hipp JD, Mermel CH, Stumpe MC. An augmented reality microscope with real-time artificial intelligence integration for cancer diagnosis. Nat Med. 2019 Aug12;25(9):1453?57. doi: 10.1038/s41591-019-0539-7
  15. Besharati Tabrizi L, Mahvash M. Augmented reality-guided neurosurgery: accuracy and intraoperative application of an image projection technique. J Neurosurg. 2015 Jul;123(1):206-11. doi: 10.3171/2014.9.JNS141001
  16. Inoue D, Cho B, Mori M, Kikkawa Y, Amano T, Nakamizo A, Yoshimoto K, Mizoguchi M, Tomikawa M, Hong J, Hashizume M, Sasaki T. Preliminary study on the clinical application of augmented reality neuronavigation. J Neurol Surg A Cent EurNeurosurg. 2013 Mar;74(2):71-76. doi: 10.1055/s-0032-1333415
  17. Wang Y, Zhai G, Chen S, Min X, Gao Z, Song X. Assessment of eye fatigue caused by head-mounted displays using eye-tracking. Bio Med Eng On Line. 2019;18(11):111. doi: 10.1186/s12938-019-0731-5
Address for correspondence:
223040 Belarus, Minsk region, ag Lesnoy,
N.N. Alexandrov National Cancer Center
of Belarus, the Laboratory of the Head and Neck Oncopathology with the Group of the Central Nervous System Oncopathology,
tel. +37533699-05-33,
e-mail: zherko.irina@mail.ru,
Zherka Irina Yu.
Information about the authors:
Zherka IrinaY., Ophthalmologist, N.N. Alexandrov National Cancer Center of Belarus, Minsk, Republic of Belarus.
https://orcid.org/0000-0002-5134-3666
Zhyliayeva Ekaterina P., Ophthalmologist, N.N. Alexandrov National Cancer Center of Belarus, Minsk, Republic of Belarus.
http://orcid.org/0000-0003-2964-6895
Naumenko Larisa V., PhD, Leading Researcher of the Laboratory of the Head and Neck Oncopathology with the Group of the Central Nervous System Oncopathology, N.N. Alexandrov National Cancer Center of Belarus, Minsk, Republic of Belarus.
http://orcid.org/0000-0002-1875-9176
Kaliadzich ZhannaV., MD, Head of the Laboratory of the Head and Neck Oncopathology with the Group of the Central Nervous System Oncopathology, N.N. Alexandrov National Cancer Center of Belarus, Minsk, Republic of Belarus.
http://orcid.org/0000-0002-3759-141
Ena Dmitry L., Oncologist-surgeon, N.N. Alexandrov National Cancer Center of Belarus, Minsk, Republic of Belarus.
http://orcid.org/0000-0003-0601-983
Zamotin Ilya D., Medical Consultant, International Software Development Company Innowise, Minsk, Republic of Belarus.
https://orcid.org/0000-0003-2719-4100
Arlou Pavel A., Vice-Director, International Software Development Company Innowise, Minsk, Republic of Belarus.
https://orcid.org/0000-0001-9550-9966

REVIEWS

S.E. KATORKIN 1, S.A. SUSHKOU 2, M.Y. KUSHNARCHUK 1

CURRENT STANDARDS OF SURGICAL TREATMENT FOR VENOUS TROPHIC ULCERS OF THE LOWER EXTREMITIES

Samara State Medical University 1, Samara,
The Russian Federation
Vitebsk State Medical University 2, Vitebsk,
The Republic of Belarus

Today, a wide spectrum of surgical techniques for the treatment of patients with refractory persistent venous trophic ulcers of the lower extremities based on the generally accepted standards are proposed. The main aim of surgical therapy is the elimination of the lower extremity venous reflux so that the solution of this problem significantly reduces the incidence rate of recurrent ulceration in comparison with the conservative therapy alone. In addition to classical varicose vein surgery, the current options of the endovenous interventions are available: endovenous laser ablation (EVLA), radiofrequency ablation (RFA), mechanochemical ablation (MOCA), foam sclerotherapy or cyanoacrylate embolization. The most preferable method of a local surgical correction of the refractory venous trophic ulcers is layer-by-layer dermatolypectomy (shave therapy) in combination with simultaneous autodermoplasty with free split perforated cutaneous flap. The remote results with a healing rate of over 80% cannot be achieved with any other method. Subfascial endoscopic perforator surgery (SEPS) in the presence of an epithelialized or open trophic ulcer is used for correction of pathological venous reflux in the case when endovasal and minimally invasive techniques of obliteration cannot be applied. The shin fasciotomy is used to relieve pressure in the diagnosed muscle compartment. Lower extremity fasciotomy for acute compartment syndrome is currently performed in case of special indications for the treatment of deep transfascial necrosis, recurrence of trophic ulcers after shave therapy, severe calcification of the shin tissues and correction of chronic venous compartment syndrome. Apart from the optimal choice of surgical treatment the remote healing rates of venous trophic ulcers depend on standardized in-patient treatment and care for wound in the postoperative period, followed by outpatient medical rehabilitation.

Keywords: chronic venous diseases, venous trophic ulcers of the lower limbs, chronic venous compartment syndrome, vein surgery, endovenous therapy, shave therapy, endoscopic dissection of perforating veins, fasciotomy
p. 75-89 of the original issue
References
  1. Mumme A. Operative phlebologie: vielfalt in der phlebologie. Phlebologie. 2019;48(03):141-42. doi: 10.1055/a-0890-5584
  2. Baber JT Jr, Mao J, Sedrakyan A, Connolly PH, Meltzer AJ. Impact of provider characteristics on use of endovenous ablation procedures in Medicare beneficiaries. J Vasc Surg Venous Lymphat Disord. 2019 Mar;7(2):203-209.e1. doi: 10.1016/j.jvsv.2018.09.012
  3. Bosanquet DC, Twine CP. The endovenous literature: a perfect storm of limited effectiveness data, rapid technological evolution and potential conflict of interest. Eur J Vasc Endovasc Surg. 2017 Dec;54(6):771. doi: 10.1016/j.ejvs.2017.09.009
  4. Rabe E, Guex JJ, Puskas A, Scuderi A, Fernandez Quesada F; VCP Coordinators. Epidemiology of chronic venous disorders in geographically diverse populations: results from the Vein Consult Program. Int Angiol. 2012 Apr;31(2):105-15.
  5. Kotelnikov GP, Losev II, Sizonenko YV. Katorkin S.E. Peculiarities of diagnostics and treatment tactics of patients with combined lesion of the musculoskeletal and the venous systems of the lower limbs. Novosti Khirurgii. 2013;21(3):42-53. doi: 10.18484/2305-0047.2013.3.42 (In Russ.)
  6. Stoffels I, Dissemond J, Klode J. Modern wound surgery-surgical treatment options. Phlebologie-Stuttgart. 2013Jan;42(4):199-204. doi: 10.12687/phleb2149-4-2013
  7. Engelhardt M, Elias K, Augustin M, Debus ES. Erfassung der Lebensqualität bei chronischen Wunden und Gefäßkrankheiten. Gefässchirurgie. 2015;20:10-17. doi: 10.1007 / s00772-014-1405-z
  8. Hermanns HJ. Chirurgie des Ulcus cruris Eine aktuelle Übersicht. Vasomed. 2016;28(04):158-65. https://www.der-niedergelassene-arzt.de/fileadmin/user_upload/zeitschriften/vasomed/Artikel_PDF/2016/04-2016/04-16_Uebersicht_Hermanns_m_Literatur.pdf
  9. Gohel MS, Barwell JR, Taylor M, Chant T, Foy C, Earnshaw JJ, Heather BP, Mitchell DC, Whyman MR, Poskitt KR. Long term results of compression therapy alone versus compression plus surgery in chronic venous ulceration (ESCHAR): randomised controlled trial. BMJ. 2007 Jul 14;335(7610):83. doi: 10.1136/bmj.39216.542442.BE
  10. Katorkin SE, Zhukov AA, Kushnarchuk MJ. Combined treatment of vasotrophic ulcers in lower limbs chronic venous insufficiency. Novosti Khirurgii. 2014;22(6):701-709. doi: 10.18484/2305-0047.2014.6.701 (In Russ.)
  11. Diagnostics and Treatment of Chronic Venous Disease: Guidelines of Russian Phlebological Association. Flebologiia. 2018;12(3):146-40. doi: 10.17116/flebo20187031146 (In Russ.)
  12. Shevchenko IuL, Stoiko IuM, Gudymovich VG, Ivanov AK. Complex approach in the treatment of extensive trophic leg ulcers in a multidisciplinary hospital. Journal of Experimental and Clinical Surgery. 2014;7(3):221-227 doi: 10.18499/2070-478X-2014-7-3-221-227 (In Russ.)
  13. Finlayson KJ, Courtney MD, Gibb MA, OBrien JA, Parker CN, Edwards HE. The effectiveness of a four-layer compression bandage system in comparison with Class 3 compression hosiery on healing and quality of life in patients with venous leg ulcers: a randomised controlled trial. Int Wound J. 2014 Feb;11(1):21-27. doi: 10.1111/j.1742-481X.2012.01033.x
  14. Cohen JM, Akl EA, Kahn SR. Pharmacologic and compression therapies for postthrombotic syndrome: a systematic review of randomized controlled trials. Chest. 2012 Feb;141(2):308-20. doi: 10.1378/chest.11-1175
  15. Coleridge-Smith P, Lok C, Ramelet AA. Venous leg ulcer: a meta-analysis of adjunctive therapy with micronized purified flavonoid fraction. Eur J Vasc Endovasc Surg. 2005 Aug;30(2):198-208. doi: 10.1016/j.ejvs.2005.04.017
  16. Andreozzi GM. Sulodexide in the treatment of chronic venous disease. Am J Cardiovasc Drugs. 2012 Apr 1;12(2):73-81. doi: 10.2165/11599360-000000000-00000
  17. Opletalová K, Blaizot X, Mourgeon B, Chene Y, Creveuil C, Combemale P, Laplaud AL, Sohyer-Lebreuilly I, Dompmartin A. Maggottherapyforwounddebridement: arandomized multicenter trial. Arch Dermatol. 2012 Apr;148(4):432-38. doi: 10.1001/archdermatol.2011.1895
  18. Hermanns HJ. Chirurgie des Ulcus cruris. Gefässchirurgie. 2010 Jul;15(4):273-87. doi: 10.1007/s00772-010-0826-6
  19. Schwahn-Schreiber C. Surgery of ulcus cruris venosum. Phlebologie-Stuttgart. 2010 Jun;39(3):156-62. doi: 10.1055/s-0037-1622306
  20. Hermanns HJ, Hermanns A, Waldhausen P. Therapy-resistant Ulcera cruris et pedis in ludicrous foot deformity. Phlebologie. 2011;40(06):334-36. doi: 10.1055/s-0037-1621788
  21. van Gent WB, Catarinella FS, Lam YL, Nieman FH, Toonder IM, van der Ham AC, Wittens CH. Conservative versus surgical treatment of venous leg ulcers: 10-year follow up of a randomized, multicenter trial. Phlebology. 2015 Mar;30(1 Suppl):35-41. doi: 10.1177/0268355514568848
  22. Padberg FT. Surgical intervention in venous ulceration. Cardiovasc Surg. 1999 Jan;7(1):83-90. doi: 10.1016/s0967-2109(98)00034-9
  23. Gallenkemper G. Diagnostik und Therapie des Ulcus cruris venosum. Aktuelle Dermatologie. 2009;35(06):221-24. doi: 10.1055/s-0028-1119687
  24. Sushkov SA, Kukhtenkov PA, Khmelnikov VIa. Pervyi opyt primeneniia posloinoi dermatolipektomii (shave-therapy) pri lechenii khronicheskoi venoznoi nedostatochnosti. Novosti Khirurgii. 2007;15(1):53-57. http://www.surgery.by/pdf/full_text/2007_1_8_ft.pdf (In Russ.)
  25. Hermanns HJ. Standards bei der operativen Behandlung des Ulcus cruris. Phlebologie. 2019;48(03):161-69. doi: 10.1055/a-0887-4656
  26. Kröger K, Assenheimer B, Bültemann A, Gerber V, Hoppe HD, Schwarzkopf A. Wundversorgung auf dem Niveau einer S3-Leitlinie Und was nun? Wund Management. 2012;(06):252-54. https://www.werner-sellmer.de/files/Kommentar-S3-Leitlinie-durch-ICW.pdf
  27. Hach W, Mumme A, Hach-Wunderle V (Hrsg). Venen Chirurgie. Operative, interventionelle und konservative Aspekte. 3. Auflage. Stuttgart: Schattauer; 2012.
  28. Hach W, Schwahn-Schreiber C, Kirschner P, Nestle HW. Die krurale Fasziektomie zur Behandlung des inkurablen Gamaschenulkus (Chronisches Faszienkompressionssydrom). Gefäßchirurgie. 1997;2:101-7.https://link.springer.com/article/10.1007/PL00010481
  29. Schmidt AH. Acute Compartment Syndrome. Orthop Clin North Am. 2016 Jul;47(3):517-25. doi: 10.1016/j.ocl.2016.02.001
  30. Wang SM, Kim M. Compartment syndrome after varicose vein surgery evidenced by CT images. Int J Low Extrem Wounds. 2016 Mar;15(1):71-73. doi: 10.1177/1534734614555003
  31. Edigin E, Shaka H. Idiopathic acute compartment syndrome of the leg with incidental deep venous thrombosis: a case report. Cureus. 2019 Jul 12;11(7):e5130. doi: 10.7759/cureus.5130
  32. Hach W, Gerngroß H, Präve F, Sterk J, Willy Ch, Hach-Wunderle V. Kompartmentsyndrome in der Phlebologie. Phlebologie. 2000;29(01):1-11. doi: 10.1055/s-0037-1617337
  33. Schmeller W, Roszinski S. Shave therapy for surgical treatment of persistent venous ulcer with large superficial dermatoliposclerosis. Hautarzt. 1996 Sep;47(9):676-81. doi: 10.1007/s001050050488
  34. Schmeller W, Gaber Y, Gehl HB. Shave therapy is a simple, effective treatment of persistent venous leg ulcers. J Am Acad Dermatol. 1998 Aug;39(2 Pt 1):232-38. doi: 10.1016/s0190-9622(98)70081-7
  35. Quaba AA, McDowall RA, Hackett MEJ. Layered shaving of venous ulcers. Br J Plast Surg. 1987;40(1):68-72. doi: 10.1016/0007-1226(87)90014-2
  36. Schmeller W, Gaber Y. Persistierendes Ulcus cruris und chronisches venöses Kompartmentsyndrom. Phlebologie. 2001;30(03):75-80. doi: 10.1055/s-0037-1617272
  37. Hermanns HJ, Gallenkämper G, Kanya S, Waldhausen P. Die Shave-Therapie im Konzept der operativen Behandlung des therapieresistenten Ulcus cruris venosum. Phlebologie. 2005;34(04):209-215. doi: 10.1055/s-0037-1621564
  38. Obermayer A, Göstl K, Walli G, Benesch T. Chronic venous leg ulcers benefit from surgery: long-term results from 173 legs. J Vasc Surg. 2006 Sep;44(3):572-79. doi: 10.1016 / j.jvs.2006.05.039
  39. van Gent WB, Catarinella FS, Lam YL, Nieman FH, Toonder IM, van der Ham AC, Wittens CH. Conservative versus surgical treatment of venous leg ulcers: 10-year follow up of a randomized, multicenter trial. Phlebology. 2015 Mar;30(1 Suppl):35-41. doi: 10.1177/0268355514568848
  40. Kahle B. Stellenwert der Schaumsklerosierung in der Behandlung des Ulcus cruris venosum. Phlebologie. 2010;39(03):152-55. doi: 10.1055/s-0037-1622308
  41. Seager MJ, Busuttil A, Dharmarajah B, Davies AH. Editors Choice A Systematic Review of Endovenous Stenting in Chronic Venous Disease Secondary to Iliac Vein Obstruction. Eur J Vasc Endovasc Surg. 2016 Jan;51(1):100-20. doi: 10.1016/j.ejvs.2015.09.002
  42. Schmedt CG, Sroka R, Sadeghi M, Steckmeier BM, Hupp T. Neue entwicklungen der endovenösen lasertherapie. Gefäßchirurgie. 2010;15:125-32. doi: 10.1007/s00772-009-0759-0
  43. Pannier F, Rabe E. Endovenöse Lasertherapie mit dem 980-nm-Diodenlaser bei Ulcus cruris veno-sum. Phlebologie. 2007;36(04):179-85. doi: 10.1055/s-0037-1622181
  44. Hauer G. Endoscopic subfascial discussion of perforating veins--preliminary report. Vasa. 1985;14(1):59-61. [Article in German]
  45. Vashist MG, Malik V, Singhal N. Role of subfascial endoscopic perforator surgery (SEPS) in management of perforator incompetence in varicose veins: A prospective randomized study. Indian J Surg. 2014 Apr;76(2):117-23. Published online 2012 Jul 5. doi: 10.1007/s12262-012-0675-5
  46. Sahoo MR, Misra L, Deshpande S, Mohanty SK, Mohanty SK. Subfascial endoscopic perforator surgery: a safe and novel minimal invasive procedure in treating varicose veins in 2nd trimester of pregnancy for below knee perforator incompetence. J Minim Access Surg. 2018 Jul-Sep;14(3):208-12. doi: 10.4103/jmas.JMAS_107_17
  47. Obermayer A, Göstl K, Partsch H, Benesch T. Venous reflux surgery promotes venous leg ulcer healing despite reduced ankle brachial pressure index. Int Angiol. 2008 Jun;27(3):239-46.
  48. Hach W, Hach-Wunderle V. Neue Aspekte zum chronisch venösen Kompartment syndrom. Gefäss Chirurgie. 2001;6:164-69. doi: 10.1007/s007720100147
  49. Hach W. Wie es zur paratibialen Fasziotomie kam. Phlebologie. 2004; 33(03):110-14. doi: 10.1055/s-0037-1617282
  50. Schwahn-Schreiber C, Schmeller W, Gaber Y. Langzeitergebnisse nach Shave-Therapie bzw. kruraler Fasziektomie bei persistierenden venösen Ulzera. Phlebologie. 2006;35(02):89-91. doi: 10.1055/s-0037-1622134
  51. Obermayer A, Maier A, Zacherl J, Hitzl W, Steinbacher F. Lateral fasciectomy sparing the superficial peroneal nerve with simultaneous graft in non-healing lateral leg ulcers of diverse vascular origins: surgical technique, short- and long-term results from 44 legs. Eur J Vasc Endovasc Surg. 2016 Aug 01;52(2):225-32. doi: 10.1016/j.ejvs.2016.02.023
  52. Hermanns HJ, Waldhausen P. Shave therapy for venous ulcers-a review and current results. Phlebolymphology. 2009;16(2):253-58. https://www.phlebolymphology.org/shave-therapy-for-venous-ulcersa-review-and-current-results/
  53. Webster J, Scuffham P, Sherriff KL, Stankiewicz M, Chaboyer WP. Negative pressure wound therapy for skin grafts and surgical wounds healing by primary intention. Cochrane Database Syst Rev. 2012 Apr 18;(4):CD009261. doi: 10.1002/14651858.CD009261.pub2
  54. Leclercq A, Labeille B, Perrot JL, Vercherin P, Cambazard F. Skin graft secured by VAC (vacuum-assisted closure) therapy in chronic leg ulcers: a controlled randomized study. Ann Dermatol Venereol. 2016 Jan;143(1):3-8. doi: 10.1016/j.annder.2015.06.022
  55. Lokaltherapie chronischer Wunden bei Patienten mit den Risiken periphere arterielle Verschlusskrankheit, Diabetes mellitus, chronisch venöse Insuffizienz. AWMF LL-Register 091/001, 2012. S3. AWMF online Das Portal der wissenschaftlichen Medizin. https://www.dga-gefaessmedizin.de/uploads/media/S3_LL_Lokaltherapie_chronischer_Wunden_2012-06.pdf
Address for correspondence:
443013, Russian Federation,
Samara, Karl Marks pr., 165b,
Samara State Medical University,
the Department and Clinic of Hospital Surgery
Tel. +7 927 206-71-02,
e-mail:katorkinse@mail.ru
Katorkin Sergei E.
Information about the authors:
Katorkin Sergei E., MD, Associate Professor, Head of the Department and Clinic of Hospital Surgery, Samara State Medical University of the Ministry of Health of Russia, Samara, Russian Federation.
https://orcid.org/0000-0001-7473-6692
Sushkou Siarhei A., PhD, Associate Professor, Vice-Rector of Scientific and Research Affairs, Vitebsk State Medical University, Vitebsk, Republic of Belarus.
http://orcid.org/0000-0002-7524-6182
Kushnarchuk Mikhail Y., Cardiovascular Surgeon, the Department of Vascular Surgery of the Department and Clinic of Hospital Surgery, Samara State Medical University of the Ministry of Health of Russia, Samara, Russian Federation. https://orcid.org/0000-0001-8764-2054

YU.P. ORLOV, O.V. KORPACHEVA, N.V. GOVOROVA, V.N. LUKACH, E.N. KAKULYA, G.A. BAJTUGAEVA

EVOLUTION OF POINTS OF VIEW ON HEMOTRANSFUSION FROM THE POSITION OF A PATHOPHYSIOLOGIST

Omsk State Medical University, Omsk,
The Russian Federation

A careful assessment of the risks and benefits should precede each decision to transfusion allogeneic erythrocytes. Currently, a number of important problem in transfusion medicine is very controversial, most importantly the influence of different transfusion thresholds on clinical outcome. The purpose of this article is to highlight some features regarding to effectiveness, outcomes and risks, as well as to present a new trend in the recommendations for blood transfusion. In our days there is a general consensus about the decision to transfuse blood to a specific patient should be based primarily on his/her need for global and regional oxygen delivery and consumption, i.e. on clinical assessment of signs of insufficient global and regional tissue oxygenation, which can vary significantly depending on the individual characteristics of the patient (reactivity features). Evaluation of these signs physiological triggers of transfusion requires a deep knowledge of the physiology and pathophysiology of blood transfusions and clinical experience. Actualization of theoretical knowledge and the formation of clinical experience on this problem will permit a physician to make decisions about blood transfusion with the lowest risk for the patient. However, quantitative criteria for individual blood indicators numerical triggers of transfusion can be useful in some situations, for example, when monitoring is insufficient or due to the lack of adequate sufficient experience of medical personnel.

Keywords: anemia, hemoglobin, blood transfusion, red blood cell transfusion, adverse effects, complications
p. 90-100 of the original issue
References
  1. Castaigne A. Reassessment of drugs. Rev Prat. 2002 Mar 1;52(5):507-9. [Article in French]. https://www.researchgate.net/publication/11416454_Reassessment_of_drugs
  2. Dameshek W. Editorial. Blood. 1946;1(1):83-84. doi: 10.1182/Blood.V1.1.83.83
  3. Coller BS. Blood at 70: its roots in the history of hematology and its birth. Blood. 2015 Dec 10;126(24):2548-60. doi: 10.1182/blood-2015-09-659581
  4. Goodnough LT. Blood management: transfusion medicine comes of age. Lancet. 2013 May 25;381(9880):1791-92. doi: 10.1016/S0140-6736(13)60673-X
  5. Goodnough LT, Levy JH, Murphy MF. Concepts of blood transfusion in adults. Lancet. 2013 May 25;381(9880):1845-54. doi: 10.1016/S0140-6736(13)60650-9
  6. Isbister JP. Perioperative transfusion management. Transfus Apher Sci. 2002 Aug;27(1):17. doi: 10.1016/s1473-0502(02)00022-8
  7. Schmidt PJ, Ness PM. Hemotherapy: from bloodletting magic to transfusion medicine. Transfusion. 2006 Feb;46(2):166-68. doi: 10.1111/j.1537-2995.2006.00697.x
  8. Madjdpour C, Spahn DR. Allogeneic red blood cell transfusions: efficacy, risks, alternatives and indications. Br J Anaesth. 2005 Jul;95(1):33-42. doi: 10.1093/bja/aeh290
  9. Gell DA. Structure and function of haemoglobins. Blood Cells Mol Dis. 2018 May;70:13-42. doi: 10.1016/j.bcmd.2017.10.006
  10. Spahn DR, Bouillon B, Cerny V, Duranteau J, Filipescu D, Hunt BJ, Komadina R, Maegele M, Nardi G, Riddez L, Samama CM, Vincent JL, Rossaint R. The European guideline on management of major bleeding and coagulopathy following trauma: fifth edition. Crit Care. 2019 Mar 27;23(1):98. doi: 10.1186/s13054-019-2347-3
  11. Jaramillo S, Montane-Muntane M, Gambus PL, Capitan D, Navarro-Ripoll R, Blasi A. Perioperative blood loss: estimation of blood volume loss or haemoglobin mass loss? Blood Transfus. 2019 Nov 27:1-11. doi: 10.2450/2019.0204-19.
  12. Miserocchi G, Bartesaghi M. Pathophysiological alterations in oxygen delivery to the tissues. Transfus Apher Sci. 2011 Dec;45(3):291-97. doi: 10.1016/j.transci.2011.10.011
  13. Demaret P, Emeriaud G, Hassan NE, Kneyber MCJ, Valentine SL, Bateman ST, Tucci M. Recommendations on RBC Transfusions in Critically Ill Children With Acute Respiratory Failure From the Pediatric Critical Care Transfusion and Anemia Expertise Initiative. Pediatr Crit Care Med. 2018 Sep;19(9S Suppl 1):S114-S120. doi: 10.1097/PCC.0000000000001619
  14. Goodnough LT, Shah N. Is there a magic hemoglobin number? Clinical decision support promoting restrictive blood transfusion practices. Am J Hematol. 2015 Oct;90(10):927-33. doi: 10.1002/ajh.24101
  15. Ghiani A, Sainis A, Sainis G, Neurohr C. Anemia and red blood cell transfusion practice in prolonged mechanically ventilated patients admitted to a specialized weaning center: an observational study. BMC Pulm Med. 2019 Dec 18;19(1):250. doi: 10.1186/s12890-019-1009-1
  16. Kumar A. Perioperative management of anemia: limits of blood transfusion and alternatives to it. Cleve Clin J Med. 2009 Nov;76(Suppl 4):S112-18. doi: 10.3949/ccjm.76.s4.18
  17. Hare GM, Tsui AK, Ozawa S, Shander A. Anaemia: can we define haemoglobin thresholds for impaired oxygen homeostasis and suggest new strategies for treatment? Best Pract Res Clin Anaesthesiol. 2013 Mar;27(1):85-98. doi: 10.1016/j.bpa.2012.12.002
  18. Garcia-Casal MN, Pasricha SR, Sharma AJ, Peña-Rosas JP. Use and interpretation of hemoglobin concentrations for assessing anemia status in individuals and populations: results from a WHO technical meeting. Ann N Y Acad Sci. 2019 Aug;1450(1):5-14. doi: 10.1111/nyas.14090
  19. Carson JL, Grossman BJ, Kleinman S, Tinmouth AT, Marques MB, Fung MK, Holcomb JB, Illoh O, Kaplan LJ, Katz LM, Rao SV, Roback JD, Shander A, Tobian AA, Weinstein R, Swinton McLaughlin LG, Djulbegovic B. Red blood cell transfusion: a clinical practice guideline from the AABB. Ann Intern Med. 2012 Jul 3;157(1):49-58. doi: 10.7326/0003-4819-157-1-201206190-00429
  20. Carson JL, Guyatt G, Heddle NM, Grossman BJ, Cohn CS, Fung MK, Gernsheimer T, Holcomb JB, Kaplan LJ, Katz LM, Peterson N, Ramsey G, Rao SV, Roback JD, Shander A, Tobian AA. Clinical Practice Guidelines From the AABB: Red Blood Cell Transfusion Thresholds and Storage. JAMA. 2016 Nov 15;316(19):2025-35. doi: 10.1001/JAMA.2016.9185
  21. Centor RM, Carson JL. Web Exclusive. Annals On Call - Outcomes of Patients Discharged With Anemia. Ann Intern Med. 2019 Mar 19;170(6):OC1. doi: 10.7326/A19-0001
  22. Franchini M, Marano G, Veropalumbo E, Masiello F, Pati I, Candura F, Profili S, Catalano L, Piccinini V, Pupella S, Vaglio S, Liumbruno GM. Patient Blood Management: a revolutionary approach to transfusion medicine. Blood Transfus. 2019 May;17(3):191-95. doi: 10.2450/2019.0109-19
  23. Graffeo C, Dishong W. Severe blood loss anemia in a Jehovahs Witness treated with adjunctive hyperbaric oxygen therapy. Am J Emerg Med. 2013 Apr;31(4):756.e3-4. doi: 10.1016/j.ajem.2012.11.013
  24. de Araújo Azi LM, Lopes FM, Garcia LV. Postoperative management of severe acute anemia in a Jehovahs Witness. Transfusion. 2014 Apr;54(4):1153-57. doi: 10.1111/trf.12424
  25. Dai J, Tu W, Yang Z, Lin R. Case report: intraoperative management of extreme hemodilution in a patient with a severed axillary artery. Anesth Analg. 2010 Nov;111(5):1204-6. doi: 10.1213/ANE.0b013e3181e668b8
  26. Carson JL, Noveck H, Berlin JA, Gould SA. Mortality and morbidity in patients with very low postoperative Hb levels who decline blood Transfusion. Transfusion. 2002 Jul;42(7):812-18. doi: 10.1046/j.1537-2995.2002.00123.x
  27. Tobian AA, Ness PM, Noveck H, Carson JL. Time course and etiology of death in patients with severe anemia. Transfusion. 2009 Jul;49(7):1395-99. doi: 10.1111/j.1537-2995.2009.02134.x
  28. Roberson RS, Bennett-Guerrero E. Impact of red blood cell transfusion on global and regional measures of oxygenation. Mt Sinai J Med. 2012 Jan-Feb;79(1):66-74. doi: 10.1002/msj.21284
  29. Hajjar LA, Vincent JL, Galas FR, Nakamura RE, Silva CM, Santos MH, Fukushima J, Kalil Filho R, Sierra DB, Lopes NH, Mauad T, Roquim AC, Sundin MR, Leão WC, Almeida JP, Pomerantzeff PM, Dallan LO, Jatene FB, Stolf NA, Auler JO Jr. Transfusion requirements after cardiac surgery: the TRACS randomized controlled trial. JAMA. 2010 Oct 13;304(14):1559-67. doi: 10.1001/JAMA.2010.1446
  30. Lacroix J, Hébert PC, Hutchison JS, Hume HA, Tucci M, Ducruet T, Gauvin F, Collet JP, Toledano BJ, Robillard P, Joffe A, Biarent D, Meert K, Peters MJ. Transfusion strategies for patients in pediatric intensive care units. N Engl J Med. 2007 Apr 19;356(16):1609-19. doi: 10.1056/NEJMoa066240
  31. Salpeter SR, Buckley JS, Chatterjee S. Impact of more restrictive blood transfusion strategies on clinical outcomes: a meta-analysis and systematic review. Am J Med. 2014 Feb;127(2):124-31.e3. doi: 10.1016/j.amjmed.2013.09.017
  32. Klein HG, Spahn DR, Carson JL. Red blood cell transfusion in clinical practice. Lancet. 2007 Aug 4;370(9585):415-26. doi: 10.1016/S0140-6736(07)61197-0
  33. Lukach VN Orlov YuP, Dolgih VT, Govorova NV, Gluschenko AV, Ivanov AV. Problem of intraoperative hemoTransfusion. Anesteziologiia i Reanimatologiia. 2014;(3):20-25. https://www.elibrary.ru/item.asp?id=21669590 (In Russ.)
  34. Casutt M, Seifert B, Pasch T, Schmid ER, Turina MI, Spahn DR. Factors influencing the individual effects of blood transfusions on oxygen delivery and oxygen consumption. Crit Care Med. 1999 Oct;27(10):2194-200. doi: 10.1097/00003246-199910000-00021
  35. Zimmerman R, Tsai AG, Salazar Vázquez BY, Cabrales P, Hofmann A, Meier J, Shander A, Spahn DR, Friedman JM, Tartakovsky DM, Intaglietta M. Posttransfusion Increase of Hematocrit per se Does Not Improve Circulatory Oxygen Delivery due to Increased Blood Viscosity. Anesth Analg. 2017 May;124(5):1547-54. doi: 10.1213/ANE.0000000000002008
  36. Nielsen ND, Martin-Loeches I, Wentowski C. The Effects of red Blood Cell Transfusion on Tissue Oxygenation and the Microcirculation in the Intensive Care Unit: A Systematic Review. Transfus Med Rev. 2017 Oct;31(4):205-22. doi: 10.1016/j.tmrv.2017.07.003
  37. Hariri G, Bourcier S, Marjanovic Z, Joffre J, Lemarié J, Lavillegrand JR, Charue D, Duflot T, Bigé N, Baudel JL, Maury E, Mohty M, Guidet B, Bellien J, Blanc-Brude O, Ait-Oufella H. Exploring the microvascular impact of red blood cell transfusion in intensive care unit patients. Crit Care. 2019 Aug 30;23(1):292. doi: 10.1186/s13054-019-2572-9
  38. Carson JL, Stanworth SJ, Roubinian N, Fergusson DA, Triulzi D, Doree C, Hebert PC. Transfusion thresholds and other strategies for guiding allogeneic red blood cell Transfusion. Cochrane Database Syst Rev. 2016 Oct 12;10:CD002042. doi: 10.1002/14651858.CD002042.pub4
  39. Shander A, Van Aken H, Colomina MJ, Gombotz H, Hofmann A, Krauspe R, Lasocki S, Richards T, Slappendel R, Spahn DR. Patient blood management in Europe. Br J Anaesth. 2012 Jul;109(1):55-68. doi: 10.1093/bja/aes139
  40. Spahn DR. Anemia and patient blood management in hip and knee surgery: a systematic review of the literature. Anesthesiology. 2010 Aug;113(2):482-95. doi: 10.1097/ALN.0b013e3181e08e97
  41. Shander A, Popovsky MA. Understanding the consequences of transfusion-related acute lung injury. Chest. 2005 Nov;128(5 Suppl 2):598S-604S. doi: 10.1378/chest.128.5_suppl_2.598S
  42. Barrett NA, Kam PC. Transfusion-related acute lung injury: a literature review. Anaesthesia. 2006 Aug;61(8):777-85. doi: 10.1111/j.1365-2044.2006.04742.x
  43. Shander A, Fink A, Javidroozi M, Erhard J, Farmer SL, Corwin H, Goodnough LT, Hofmann A, Isbister J, Ozawa S, Spahn DR. Appropriateness of allogeneic red blood cell transfusion: the international consensus conference on transfusion outcomes. Transfus Med Rev. 2011 Jul;25(3):232-46.e53. doi: 10.1016/j.tmrv.2011.02.001
  44. Holst LB, Petersen MW, Haase N, Perner A, Wetterslev J. Restrictive versus liberal transfusion strategy for red blood cell transfusion: systematic review of randomised trials with meta-analysis and trial sequential analysis. BMJ. 2015;350:h1354. doi: 10.1136 / bmj.h1354
  45. Zilber AP. Krovopoteria i gemotransfuziia. Printsipy i metody beskrovnoi khirurgii. Petrozavodsk, RF: Izd. PetrGU; 1999. 120 s. https://www.booksmed.com/hirurgiya/1131-krovopoterya-i-gemotransfuziya-zilber.html (In Russ.)
Address for correspondence:
644119, Russian Federation,
Omsk, Perelet Str., 9,
City Emergency Clinical Hospital No1,
the Department of Anesthesiology
and Reanimatology,
Omsk State Medical University
tel.: +381-2-75-32-64,
-mail: orlov-up@mail.ru,
Orlov Yurij P.
Information about the authors:
Orlov Yurij P., MD, Professor of the Department of Anesthesiology and Reanimatology, Omsk State Medical University, Omsk, Russian Federation.
http://orcid.org/0000-0002-6747-998X
Govorova Natalya V., MD, Professor, Head of the Department of Anesthesiology and Reanimatology, Omsk State Medical University, Omsk, Russian Federation.
http://orcid.org/0000-0002-0495-902X
Korpacheva Olga V., MD, Associate Professor, Head of the Department of Pathological Physiology, Clinical Physiology, Omsk State Medical University, Omsk, Russian Federation.
http://orcid.org/0000-0001-6110-3933
Lukach Valerij N., MD, Professor of the Department of Anesthesiology and Reanimatology, Omsk State Medical University, Omsk, Russian Federation.
https://orcid.org/0000-0002-9440-3235
Kakulya Evgenij N., PhD, Assistant of the Department of Anesthesiology and Reanimatology, Omsk State Medical University, Omsk, Russian Federation.
http://orcid.org/0000-0002-2811-6051
Bajtugaeva Galina A., PhD, Associate Professor of the Department of Anesthesiology and Reanimatology, Omsk State Medical University, Omsk, Russian Federation.
https://orcid.org/0000-0002-6479-7915

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

SPINAL ANESTHESIA AND HYPOTENSION: MECHANISMS, RISK FACTORS, PROPHYLAXIS AND CORRECTION

Sechenov First Moscow State Medical University (Sechenov University), Moscow,
The Russian Federation

Hypotension is the most common adverse effect of spinal anesthesia (SA). The insidence of SA-induced hypotension in the total population is 15-33%, in patients of older age groups it reaches 80%. At young and middle ages, the main determinant of SA-induced hypotension is considered to be a reduction of postload and venous reflux, due to blood deposition in capacitance vessels of the lower extremities. The aortocaval compression syndrome plays a significant role in obstetric practice, cardiac output does not change. In elderly patients, the main prerequisite for the development of hypotension is an enhanced basal sympathetic tone on the background of SA. In patients of this category, in addition to reducing the total peripheral vascular resistance (TPVR), a decline in cardiac output also plays a role. Risk factors for anesthesia-induced hypotension are the followings: (chronic alcohol consumption, history of hypertension, sensory block upper than Th6, and urgency of surgery). To prevent SA-induced hypotension it is advisable to reduce the doses of local anesthetics. Data from the most studies do not confirm the effectiveness of extended infusion therapy in the prevention and correction of hypotension. Vasopressors - phenylephrine in obstetric practice, ephedrine or dopamine in elderly patients are effective for preventing hypotension.

Keywords: spinal anesthesia, subarachnoid block, hypotension, phenylephrine, ephedrine, dopamine
p. 101-115 of the original issue
References
  1. Juelsgaard P, Sand NP, Felsby S, Dalsgaard J, Jakobsen KB, Brink O, Carlsson PS, Thygesen K. Perioperative myocardial ischaemia in patients undergoing surgery for fractured hip randomized to incremental spinal, single-dose spinal or general anaesthesia. Eur J Anaesthesiol. 1998 Nov;15(6):656-63. doi: 10.1097/00003643-199811000-00006
  2. Minville V, Asehnoune K, Salau S, Bourdet B, Tissot B, Lubrano V, Fourcade O. The effects of spinal anesthesia on cerebral blood flow in the very elderly. Anesth Analg. 2009 Apr;108(4):1291-94. doi: 10.1213/ane.0b013e31819b073b
  3. Sanborn KV, Castro J, Kuroda M, Thys DM. Detection of intraoperative incidents by electronic scanning of computerized anesthesia records. Comparison with voluntary reporting. Anesthesiology. 1996 Nov;85(5):977-87. doi: 10.1097/00000542-199611000-00004
  4. Pattinson R. Saving Mothers 2011-2013: The Sixth Report of the National Committee for Confidential Enquiries into Maternal Deaths in South Africa [Internet]. Pretoria: Government Printer; 2019. 91 . Available from: http://www.kznhealth.gov.za/mcwh/Maternal/Saving-Mothers-2011-2013-short-report.pdf
  5. Hartmann B, Junger A, Klasen J, Benson M, Jost A, Banzhaf A, Hempelmann G. The incidence and risk factors for hypotension after spinal anesthesia induction: an analysis with automated data collection. Anesth Analg. 2002 Jun;94(6):1521-29, table of contents. doi: 10.1097/00000539-200206000-00027
  6. Shifman Y, Filippovich G, Antipin D, Bukin V, Vainshtein B, Geronimus V, Zhemchugov A, Zarubina I, Kalinin A, Katsman A, Maslak V, Moshensky V, Nomokonov G, Smirnov I, Terentyev N, Katsman O. Impact of Neuroaxial Block on Hemodynamic Changes in Puerperas. GeneralReanimatology. 2006;2(2):20-23. doi: 10.15360/1813-9779-2006-2-20-23 (In Russ.)
  7. Klöhr S, Roth R, Hofmann T, Rossaint R, Heesen M. Definitions of hypotension after spinal anaesthesia for caesarean section: literature search and application to parturients. Acta Anaesthesiol Scand. 2010 Sep;54(8):909-21. doi: 10.1111/j.1399-6576.2010.02239.x
  8. HabibAS. A review of the impact of phenylephrine administration on maternal hemodynamics and maternal and neonatal outcomes in women undergoing cesarean delivery under spinal anesthesia. Anesth Analg. 2012 Feb;114(2):377-90. doi: 10.1213/ANE.0b013e3182373a3e
  9. Critchley LA, Stuart JC, Short TG, Gin T. Haemodynamic effects of subarachnoid block in elderly patients. Br J Anaesth. 1994 Oct;73(4):464-70. doi: 10.1093/bja/73.4.464
  10. WongCA, ed. Spinal and Epidural Anesthesia. New York: McGraw-Hill; 2007. 374 p.
  11. Holmes F. Spinal analgesia and caesarean section; maternal mortality. J ObstetGynaecol Br Emp. 1957 Apr;64(2):229-32. doi: 10.1111/j.1471-0528.1957.tb02626.x
  12. Lee JE, George RB, HabibAS. Spinal-induced hypotension: Incidence, mechanisms, prophylaxis, and management: Summarizing 20 years of research. Best Pract Res Clin Anaesthesiol. 2017 Mar;31(1):57-68. doi: 10.1016/j.bpa.2017.01.001
  13. Langesaeter E, Rosseland LA, Stubhaug A. Continuous invasive blood pressure and cardiac output monitoring during cesarean delivery: a randomized, double-blind comparison of low-dose versus high-dose spinal anesthesia with intravenous phenylephrine or placebo infusion. Anesthesiology. 2008 Nov;109(5):856-63. doi: 10.1097/ALN.0b013e31818a401f
  14. Dyer RA, ReedAR, van Dyk D, Arcache MJ, Hodges O, Lombard CJ, Greenwood J, James MF. Hemodynamic effects of ephedrine, phenylephrine, and the coadministration of phenylephrine with oxytocin during spinal anesthesia for elective cesarean delivery. Anesthesiology. 2009 Oct;111(4):753-65. doi: 10.1097/ALN.0b013e3181b437e0
  15. Sharwood-Smith G, Drummond GB. Hypotension in obstetric spinal anaesthesia: a lesson from pre-eclampsia. Br J Anaesth. 2009 Mar;102(3):291-94. doi: 10.1093/bja/aep003
  16. Bridenbaugh P, Greene N, Brull S. Spinal (subarachnoid) neural blockade. In: Cousins MJ, Bridenbaugh PO (eds). Neural Blockade in Clinical Anesthesia and Management of Pain. 3rd ed. Philadelphia: Lippincott-Raven; 1998. p. 221-26.
  17. Salinas FV, Sueda LA, Liu SS. Physiology of spinal anaesthesia and practical suggestions for successful spinal anaesthesia. Best Pract Res Clin Anaesthesiol. 2003 Sep;17(3):289-303. doi: 10.1016/s1521-6896(02)00114-3
  18. Lairez O, Ferré F, Portet N, Marty P, Delmas C, Cognet T, Kurrek M, Carrié D, Fourcade O, Minville V. Cardiovascular effects of low-dose spinal anaesthesia as a function of age: An observational study using echocardiography. Anaesth Crit Care Pain Med. 2015 Oct;34(5):271-76. doi: 10.1016/j.accpm.2015.02.007
  19. Monge García MI, Guijo González P, Gracia Romero M, Gil Cano A, Oscier C, Rhodes A, Grounds RM, Cecconi M. Effects of fluid administration on arterial load in septic shock patients. Intensive Care Med. 2015 Jul;41(7):1247-55. doi: 10.1007/s00134-015-3898-7
  20. Meyhoff CS, Hesselbjerg L, Koscielniak-Nielsen Z, Rasmussen LS. Biphasic cardiac output changes during onset of spinal anaesthesia in elderly patients. Eur J Anaesthesiol. 2007 Sep;24(9):770-75. doi: 10.1017/S0265021507000427
  21. Ferré F, Delmas C, Carrié D, Cognet T, Lairez O, Minville V. Effects of Spinal Anaesthesia on Left Ventricular Function: An Observational Study using Two-Dimensional Strain Echocardiography. Turk J Anaesthesiol Reanim. 2018 Aug;46(4):268-71. doi: 10.5152/TJAR.2018.48753
  22. Hofhuizen C, Lemson J, Snoeck M, Scheffer GJ. Spinal anesthesia-induced hypotension is caused by a decrease in stroke volume in elderly patients. Local Reg Anesth. 2019 Mar 4;12:19-26. doi: 10.2147/LRA.S193925. eCollection 2019.
  23. Donati A, Mercuri G, Iuorio S, Sinkovetz L, Scarcella M, Trabucchi C, Pelaia P, Pietropaoli P. Haemodynamic modifications after unilateral subarachnoid anaesthesia evaluated with transthoracic echocardiography. Minerva Anestesiol. 2005 Mar;71(3):75-81. https://www.minervamedica.it/en/journals/minerva-anesthesiology/article.php?cod=R02Y2005N03A0075
  24. Kamenik M, Paver-Erzen V. The effects of lactated Ringers solution infusion on cardiac output changes after spinal anesthesia. Anesth Analg. 2001 Mar;92(3):710-14. doi: 10.1097/00000539-200103000-00030
  25. Racle JP, Poy JY, Haberer JP, Benkhadra A. A comparison of cardiovascular responses of normotensive and hypertensive elderly patients following bupivacaine spinal anesthesia. RegAnesth. 1989 Mar-Apr;14(2):66-71.
  26. Johnson RH, Eisenhofer G, Lambie DG. The effects of acute and chronic ingestion of ethanol on the autonomic nervous system. Drug Alcohol Depend. 1986 Dec;18(4):319-28. doi: 10.1016/0376-8716(86)90094-3
  27. Roofthooft E, Van de Velde M. Low-dose spinal anaesthesia for Caesarean section to prevent spinal-induced hypotension. Curr Opin Anaesthesiol. 2008 Jun;21(3):259-62. doi: 10.1097/ACO.0b013e3282ff5e41
  28. McNaught AF, Stocks GM. Epidural volume extension and low-dose sequential combined spinal-epidural blockade: two ways to reduce spinal dose requirement for caesarean section. Int J Obstet Anesth. 2007 Oct;16(4):346-53. doi: 10.1016/j.ijoa.2007.03.013
  29. Cluver C, Novikova N, Hofmeyr GJ, Hall DR. Maternal position during caesarean section for preventing maternal and neonatal complications. Cochrane Database Syst Rev. 2013 Mar 28;(3):CD007623. doi: 10.1002/14651858.CD007623.pub3
  30. Cyna AM, Andrew M, Emmett RS, Middleton P, Simmons SW. Techniques for preventing hypotension during spinal anaesthesia for caesarean section. In: Cochrane Database of SystematicReviews. John Wiley & Sons, Ltd; 2006. doi: 10.1002/14651858.CD002251.pub2
  31. Kuhn JC, Hauge TH, Rosseland LA, Dahl V, Langesæter E. Hemodynamics of phenylephrine infusion versus lower extremity compression during spinal anesthesia for cesarean delivery: a randomized, double-blind, placebo-controlled study. Anesth Analg. 2016 Apr;122(4):1120-29. doi: 10.1213/ANE.0000000000001174
  32. Jackson R, Reid JA, Thorburn J. Volume preloading is not essential to prevent spinal-induced hypotension at caesarean section. Br J Anaesth. 1995 Sep;75(3):262-65. doi: 10.1093/bja/75.3.262
  33. Dyer RA, Farina Z, Joubert IA, Du Toit P, Meyer M, Torr G, Wells K, James MF. Crystalloid preload versus rapid crystalloid administration after induction of spinal anaesthesia (coload) for elective caesarean section. Anaesth Intensive Care. 2004 Jun;32(3):351-57. doi: 10.1177/0310057X0403200308
  34. Banerjee A, Stocche RM, Angle P, Halpern SH. Preload or coload for spinal anesthesia for elective Cesarean delivery: a meta-analysis. Can JAnaesth. 2010 Jan;57(1):24-31. doi: 10.1007/s12630-009-9206-7
  35. Mercier FJ, Diemunsch P, Ducloy-Bouthors AS, Mignon A, Fischler M, Malinovsky JM, Bolandard F, Aya AG, Raucoules-Aimé M, Chassard D, Keita H, Rigouzzo A, Le Gouez A; CAESAR Working Group. 6% Hydroxyethyl starch (130/0.4) vs Ringers lactate preloading before spinal anaesthesia for Caesarean delivery: the randomized, double-blind, multicentre CAESAR trial. Br J Anaesth. 2014 Sep;113(3):459-67. doi: 10.1093/bja/aeu103
  36. Mercier FJ, Augè M, Hoffmann C, Fischer C, Le Gouez A. Maternal hypotension during spinal anesthesia for caesarean delivery. Minerva Anestesiol. 2013 Jan;79(1):62-73. https://www.minervamedica.it/en/journals/minerva-anesthesiology/article.php?cod=R02Y2013N01A0062
  37. Pouta AM, Karinen J, Vuolteenaho OJ, Laatikainen TJ. Effect of intravenous fluid preload on vasoactive peptide secretion during Caesarean section under spinal anaesthesia. Anaesthesia. 1996 Feb;51(2):128-32. doi: 10.1111/j.1365-2044.1996.tb07698.x
  38. Ripollés J, Espinosa Á, Casans R, Tirado A, Abad A, Fernández C, Calvo J. Coloides versus cristaloidesemfluidoterapiaguiadaporobjetivos, revisãosistemática e metanálise. Demasiadamente cedo ou demasiadamente tarde para obter conclusoes. Brazilian J Anesthesiol. 2015 Jul-Aug;65(4):281-91. doi: 10.1016/j.bjan.2014.07.003
  39. Ralston DH, Shnider SM, DeLorimier AA. Effects of equipotent ephedrine, metaraminol, mephentermine, and methoxamine on uterine blood flow in the pregnant ewe. Anesthesiology. 1974 Apr;40(4):354-70. doi: 10.1097/00000542-197404000-00009
  40. Liles JT, Dabisch PA, Hude KE, Pradhan L, Varner KJ, Porter JR, Hicks AR, Corll C, Baber SR, Kadowitz PJ. Pressor responses to ephedrine are mediated by a direct mechanism in the rat. J Pharmacol Exp Ther. 2006 Jan;316(1):95-105. doi: 10.1124/jpet.105.090035
  41. Ngan Kee WD, Khaw KS, Lee BB, Lau TK, Gin T. A dose-response study of prophylactic intravenous ephedrine for the prevention of hypotension during spinal anesthesia for cesarean delivery. Anesth Analg. 2000 Jun;90(6):1390-95. doi: 10.1097/00000539-200006000-00024
  42. Veeser M, Hofmann T, Roth R, Klöhr S, Rossaint R, Heesen M. Vasopressors for the management of hypotension after spinal anesthesia for elective caesarean section. Systematic review and cumulative meta-analysis. Acta Anaesthesiol Scand. 2012 Aug;56(7):810-16. doi: 10.1111/j.1399-6576.2011.02646.x
  43. Ngan Kee WD, Khaw KS, Tan PE, Ng FF, Karmakar MK. Placental transfer and fetal metabolic effects of phenylephrine and ephedrine during spinal anesthesia for cesarean delivery. Anesthesiology. 2009 Sep;111(3):506-12. doi: 10.1097/ALN.0b013e3181b160a3
  44. Ngan Kee WD, Khaw KS, Ng FF, Lee BB. Prophylactic phenylephrine infusion for preventing hypotension during spinal anesthesia for cesarean delivery. Anesth Analg. 2004 Mar;98(3):815-21, doi: 10.1213/01.ane.0000099782.78002.30
  45. das Neves JF, Monteiro GA, de Almeida JR, SantAnna RS, Bonin HB, Macedo CF. Phenylephrine for blood pressure control in elective cesarean section: therapeutic versus prophylactic doses. Rev Bras Anestesiol. 2010 Jul-Aug;60(4):391-98. doi: 10.1016/S0034-7094(10)70048-9
  46. Allen TK, George RB, White WD, Muir HA, HabibAS. A double-blind, placebo-controlled trial of four fixed rate infusion regimens of phenylephrine for hemodynamic support during spinal anesthesia for cesarean delivery. Anesth Analg. 2010 Nov;111(5):1221-29. doi: 10.1213/ANE.0b013e3181e1db21
  47. Siddik-Sayyid SM, Taha SK, Kanazi GE, Aouad MT. A randomized controlled trial of variable rate phenylephrine infusion with rescue phenylephrine boluses versus rescue boluses alone on physician interventions during spinal anesthesia for elective cesarean delivery. Anesth Analg. 2014 Mar;118(3):611-18. doi: 10.1213/01.ane.0000437731.60260.ce
  48. Stewart A, Fernando R, McDonald S, Hignett R, Jones T, Columb M. The dose-dependent effects of phenylephrine for elective cesarean delivery under spinal anesthesia. Anesth Analg. 2010 Nov;111(5):1230-37. doi: 10.1213/ANE.0b013e3181f2eae1
  49. Ngan Kee WD, Lee SW, Ng FF, Tan PE, Khaw KS. Randomized double-blinded comparison of norepinephrine and phenylephrine for maintenance of blood pressure during spinal anesthesia for cesarean delivery. Anesthesiology. 2015 Apr;122(4):736-45. doi: 10.1097/ALN.0000000000000601
  50. Korrektsiya arterialnoi gipertonii pri neiroaksialnoi anestezii vovremia operatsiikesa revosechenie. Klinicheskie rekomendatsii Federatsiia nesteziologov ireanimatologov [Elektronnyiresurs]. 2018. 33 c. Available from: https://www.irgpc.ru/employees/clinicrecomend/klinicheskie-rekomendacii-po-gipotonii_26.06.pdf (In Russ.)
  51. Ueyama H, He YL, Tanigami H, Mashimo T, Yoshiya I. Effects of crystalloid and colloid preload on blood volume in the parturient undergoing spinal anesthesia for elective Cesarean section. Anesthesiology. 1999 Dec;91(6):1571-76. doi: 10.1097/00000542-199912000-00006
  52. Morgan PJ, Halpern SH, Tarshis J. The effects of an increase of central blood volume before spinal anesthesia for cesarean delivery: a qualitative systematic review. Anesth Analg. 2001 Apr;92(4):997-1005. doi: 10.1097/00000539-200104000-00036
  53. Mojica JL, Meléndez HJ, Bautista LE. The timing of intravenous crystalloid administration and incidence of cardiovascular side effects during spinal anesthesia: the results from a randomized controlled trial. Anesth Analg. 2002 Feb;94(2):432-37, doi: 10.1097/00000539-200202000-00039
  54. Stoelting R. Sympathomimetics. In: Stoelting RK, ed. Pharmacology and Physiology in Anesthetic Practice. 3rd ed. Philadelphia, Lippincott Williams & Wilkins; 1999. p. 272-73.
  55. Casati A, Fanelli G. Unilateral spinal anesthesia. State of the art. Minerva Anestesiol. 2001 Dec;67(12):855-62. https://www.minervamedica.it/en/journals/minerva-anesthesiology/article.php?cod=R02Y2001N12A0855
  56. Imbelloni LE. Spinal hemianesthesia: Unilateral and posterior. Anesth Essays Res. 2014 Sep-Dec;8(3):270-76. doi: 10.4103/0259-1162.143108
  57. Ozmen S, Koşar A, Soyupek S, Armağan A, Hoşcan MB, Aydin C. The selection of the regional anaesthesia in the transurethral resection of the prostate (TURP) operation. Int Urol Nephrol. 2003;35(4):507-12. doi: 10.1023/b:urol.0000025616.21293.6c
  58. Wassef MR, Michaels EI, Rangel JM, Tsyrlin AT. Spinal perianal block: a prospective, randomized, double-blind comparison with spinal saddle block. Anesth Analg. 2007 Jun;104(6):1594-96, doi: 10.1213/01.ane.0000261510.37489.00
Address for correspondence:
119991, Russian Federation,
Moscow, Trubetskaya Str., 8-2,
Sechenov First Moscow
State Medical University (Sechenov University),
the Department of Anesthesiology
and Reanimatology,
Sklifosovsky Institute of Clinical Medicine
tel.: +7 (916) 143-96-21,
e-mail: ovechkin_alexei@mail.ru
Ovechkin lexei M.
Information about the authors:
Ovechkin lexei M., MD, Professor of the Department of Anesthesiology and Reanimatology, Sechenov First Moscow State Medical University (Sechenov University) of the Ministry of Health of Russia, Moscow, Russian Federation.
https://orcid.org/0000-0002-3453-8699
Sokologorskiy Sergei V., MD, Professor of the Department of Anesthesiology and Reanimatology, Sechenov First Moscow State Medical University (Sechenov University) of the Ministry of Health of Russia, Moscow, Russian Federation.
https://orcid.org/0000-0001-6805-9744
Politov Mikhail E., PhD, Associate Professor of the Department of Anesthesiology and Reanimatology, Sechenov First Moscow State Medical University (Sechenov University) of the Ministry of Health of Russia, Moscow, Russian Federation.
https://orcid.org/0000-0003-0623-4927

CASE REPORTS

K.V. LIPATOV 1, A.G. ASATRYAN 2, G.G. MELKONYAN 2, A.V. KIRILLIN 2, I.V. GORBACHEVA 1, E.I. DEKHISSI 1

THE APPLICATION OF NPWT TECHNIQUE IN TREATMENT OF AN EXTENSIVE INFECTED SUBGALEAL HEMATOMA IN AN ADULT

Sechenov First MoscowState Medical University (Sechenov University), Moscow,
4th Moscow Clinical Hospital, Moscow, Russian Federation2 , Moscow,
The Russian Federation

Negative pressure wound therapy (NPWT) has been proven to be one of the most effective techniques in the treatment of severely infected wounds of various origins and localizations. At the same time, the prospects for its application are constantly expanding. This clinical observation demonstrates the use of NPWT in the treatment of an adult patient hospitalized in severe condition with a picture of extensive post-traumatic infected subgaleal hematoma. The development of a generalized suppurative process was contributed both by the patients late request for medical help (18th day after the injury) and, as a consequence, the lack of primary surgical treatment of the scalp soft tissue injury, as well as the anatomical features of this area. The magnetic resonance tomography as instrumental examination methods played a significant role in the diagnosis of complications in addition to clinical data. Medical tactics was based on the surgical treatment of the infected focus, the application of antibacterial therapy, taking into consideration the isolated microbial flora (Streptococcus pyogenes). To eliminate severe inflammatory changes in the tissues and to reduce the size of the vast subaponeurotic cavity, NPWT technique was applied, which made it possible in short time to prepare a postoperative wound for surgical closure. The early secondary suturing at the final stage of treatment allowed obtaining a good result.

Keywords: infected subgaleal hematoma, surgical treatment, group A streptococcus, VAC-therapy, NPWT negative-pressure wound therapy
p. 116-120 of the original issue
References
  1. Goriunov SV, Abramov IS, Chaparian BA, Egorkin MA, Zhidkikh SIu. Rukovodstvo po lecheniiu ran metodom upravliaemogo otritsatelnogo davleniia. Moscow, RF: Aprel; 2013. 130 p. http://www.nda.ru/images/catalog/LR/Suprasorb%20CNP_book.pdf (In Russ.)
  2. Colditz MJ, Lai MM, Cartwright DW, Colditz PB. Subgaleal haemorrhage in the newborn: A call for early diagnosis and aggressive management. J Paediatr Child Health. 2015 Feb;51(2):140-46. doi: 10.1111/jpc.12698
  3. Sillero R de O. Massive subgaleal hematoma. J Trauma. 2008 Oct;65(4):963. doi: 10.1097/TA.0b013e31809ff3ce
  4. Singh AK, Buch K, Sung E, Abujudeh H, Sakai O, Aaron S, Lev M. Head and neck injuries from the Boston Marathon bombing at four hospitals. Emerg Radiol. 2015 Oct;22(5):527-32. doi: 10.1007/s10140-015-1322-9
  5. Razzouk A, Collins N, Zirkle T. Chronic extensive necrotizing abscess of the scalp. Ann Plast Surg. 1988 Feb;20(2):124-27. doi: 10.1097/00000637-198802000-00006
  6. Barry J, Fridley J, Sayama C, Lam S. Infected subgaleal hematoma following blunt head trauma in a child: case report and review of the literature. Pediatr Neurosurg. 2015;50(4):223-28. doi: 10.1159/000433442
  7. Wiley JF 2nd, Sugarman JM, Bell LM. Subgaleal abscess: an unusual presentation. Ann Emerg Med. 1989 Jul;18(7):785-87. doi: 10.1016/s0196-0644(89)80021-6
  8. NugentNF, Murphy M, Kelly J. Scalp abscess a cautionary tale. J Plast Reconstr Aesthet Surg. 2010 Aug;63(8):e619-21. doi: 10.1016/j.bjps.2010.02.011
  9. Chen CE, Liao ZZ, Lee YH, Liu CC, Tang CK, Chen YR. Subgaleal hematoma at the contralateral side of scalp trauma in an adult. J Emerg Med. 2017 Nov;53(5):e85-e88. doi: 10.1016/j.jemermed.2017.06.007
  10. Sayhan MB, Kavalci C, Sogut O, Sezenler E. Skull base osteomyelitis in the emergensy department: a case report. Emerg Med Int. 2011;2011:947327. Published online 2011 May 29. doi: 10.1155/2011/947327
  11. Duquenne C, Dernis E, Zehrouni A, Bizon A, Duquenne M. Streptococcus milleri: An unusual cause of skull extensive osteomyelitis in an immunocompetent patient. Rev Med Interne. 2017 Sep;38(9):628-32. doi: 10.1016/j.revmed.2017.01.011 [Article in French
Address for correspondence:
119991, Russian Federation,
Moscow, Bolshaya Pirogovskaya Str., 2-4,
I.M. Sechenov First Moscow
State Medical University,
The General Surgery Department.
tel. mobile +7 (916) 635-89-88,
e-mail: k_lipatov@mail.ru,
Lipatov Konstantin V.
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
Asatryan Artur G., PhD, Head of the Purulent Surgery Unit, 4th Moscow Clinical lHospital, 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, 4th 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
Dekhissii Ekaterina I., PhD, Assistant of the General Surgery Department, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
http://orcid.org/0000-0003-4143-3593

M.D. ROMANOV 1, V.I. DAVYDKIN 1, E.M. KIREEVA 1, 2, A.V. PIGACHEV 1

FEATURES OF DIAGNOSIS AND TREATMENT OF PANCREATICOPLEURAL FISTULA

National Research Mordovia State University 1,
State Budgetary Healthcare Institution of the Republik of Mordovia
Republican Clinical Hospital No4" 2, Saransk,
Russian Federation

The analysis of features of diagnosis and treatment of pancreaticopleural fistulas according to the materials of publications and own clinical observation of a 44-year-old patient with fistula between a false pancreas cyst and both pleural cavities is presented. Diagnosis in the debut of this disease was complicated by the prevalence of pleural pulmonary pathology, lack of characteristic clinical signs of pancreatic lesion and lack of references to them in the anamnesis. The sudden color change of pleural exudates from straw yellow to red-brown and comparison of the results of blood serum and pleural fluid analysis for amylase content allowed suspecting pancreatogenic origin of bilateral hydrothorax, which served as a basis for instrumental examination of the pancreas. The nature and prevalence of the process in the pancreas, abdominal cavity and the presence of pancreaticopleural fistula with bilateral hydrothorax were established by ultrasound and multispiral computer tomography of the thoracic and abdominal cavities; specification by magnetic resonance imaging in the modes of T1-BI, T2-BI and magnetic resonance cholangiopancreatography (MRCP). Conservative treatment of acute inflammation of the pancreas in combination with puncture method of sanation of pleural cavities led to the elimination of pancreatic pleural fistula and bilateral hydrothorax. The choice of the method for the rehabilitation of pleural cavities should be justified by the nature, volume, rate of exudates accumulation and its infection. Magnetic resonance cholangiopancreatography (MRCP) is being used routinely to determine the expediency, possibility and the choice of method and volume of surgical treatment of pancreas pathology.

Keywords: pancreaticopleural fistula, hydrothorax, false pancreatic cyst, diagnostic features, therapeutic tactics
p. 121-127 of the original issue
References
  1. Boldin BV, Ponomar SA, Revyakin VI. Pancreaticopleural fistula is a possible cause of acute respiratory failure. Khirurgiia Zhurn im NI Pirogova. 2018;(5):115-16. doi.org/10.17116/hirurgia20185115-116 (In Russ.)
  2. Tay CM, Chang SK. Diagnosis and management of pancreaticopleural fistula. Singapore Med J. 2013 Apr;54(4):190-94. doi: 10.11622/smedj.2013071
  3. Cazzo E, Apodaca-Rueda M, Gestic MA, Chaim FHM, Saito HPA, Utrini MP, Callejas-Neto F, Chaim EA. Management of pancreaticopleural fistulas secondary to chronic pancreatitis. Arq Bras Cir Dig. 2017 Jul-Sep;30(3):225-28. doi: 10.1590/0102-6720201700030014
  4. Mihai C, Floria M, Vulpoi R, Nichita L, CijevschiPrelipcean C, Drug V, Scripcariu V. Pancreatico-pleural fistula from diagnosis to management. A case report. J Gastrointestin Liver Dis. 2018 Dec;27(4):465-69. doi: 10.15403/jgld.2014.1121.274.ple
  5. Shklyaev AE, Korepanov AM, Malakhova IG, Korobeynikova ER, Mullahmetova OA. Redkoe oslozhnenie pankreatita: pankreatoplevralnyi svishch v obe plevralnye polosti. Eksperim i Klin Gastroenterologiia (EiKG). 2015;(9):92-95. https://elibrary.ru/item.asp?id=24323170 https://elibrary.ru/item.asp?id=24323170 (In Russ.)
  6. Tamilarasan V, Tousheed SZ, Gadabanahalli K, Nandish HK, Annapandian VM. Right-sided pancreaticopleural fistula: An unusual presentation of chronic pancreatitis. Indian J Respir Care. 2018;7(2):102-104. doi: 10.4103/ijrc.ijrc_29_17
  7. Kotelnikova LP, Plaksin SA, Farshatova LI. Mediastinal pancreatic cysts: review and own clinical observations. Khirurgiia Zhurn im NI Pirogova. 2019;(7):80-86. doi: 10.17116/hirurgia201907180 (In Russ.)
  8. Grudzińska E, Pilch-Kowalczyk J, Kuśnierz K. Pancreaticopleural and pancreaticomediastinal fistula extending to the cervical region, with dysphagia as initial symptom: A case report. Medicine (Baltimore). 2019 Feb;98(5):e14233. doi: 10.1097/MD.0000000000014233
  9. Chan EE, Shelat VG. Pancreaticopleural fistula causing massive right hydrothorax and respiratory failure. Case Rep Surg. 2016;2016:8294056. doi: 10.1155/2016/8294056
  10. Singh S, Yakubov M, Arya M. The unusual case of dyspnea: a pancreaticopleural fistula. Clin Case Rep. 2018 Apr 10;6(6):1020-22. doi: 10.1002/ccr3.1434. eCollection 2018 Jun.
  11. Aswani Y, Hira P. Pancreaticopleural fistula: a review. JOP. 2015 Jan 31;16(1):90-94. doi: 10.6092/1590-8577/2915
  12. Ramahi A, Aburayyan KM, Said Ahmed TS, Rohit V, Taleb M. Pancreaticopleural fistula: a rare presentation and a rare complication. Cureus. 2019 Jun 24;11(6):e4984. doi: 10.7759/cureus.4984
Address for correspondence:
430032, Russian Federation,
Saransk, Ulyanov Str., 32,
Medical Institute of National Research Mordovia State University Named after N.P.Ogarev,
the Hospital Surgery Department,
tel. +7 927 971-02-37,
-mail:mdromanov@yandex.ru,
Romanov Mikhail D.
Information about the authors:
Romanov Mikhail D., MD, Professor, Professor of the Hospital Surgery Department, National Research Mordovia State University Named after N.P.Ogarev, Saransk, Russian Federation.
https://orcid.org/0000-0002-9646-4007
Davydkin Vasily I., PhD, Head of the Hospital Surgery Department, National Research Mordovia State University Named after N.P.Ogarev, Saransk, Russian Federation.
https://orcid.org/0000-0002-4201-9661;
Kireeva Ekaterina M., PhD, Associate Professor of the Hospital Surgery Department, National Research Mordovia State University Named after N.P.Ogarev; Thoracic Surgeon, Republican Clinical Hospital No4, Saransk, Russian Federation.
https://orcid.org/0000-0003-1034-167X
Pigachev Andrey V., PhD, Associate Professor of the Hospital Surgery Department, National Research Mordovia State University Named after N.P.Ogarev, Saransk, Russian Federation.
https://orcid.org/0000-0001-7557-7910
Contacts | ©Vitebsk State Medical University, 2007-2023