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Khirurgii

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Year 2013 Vol. 21 No 1

HISTORY SURGERY

S.A. SUSHKOU, YU.S. NEBYLITSIN, E.N. REUTSKAYA, A.N. RAK

DIFFICULT PATIENT. WOUND OF PYOTR IVANOVICH BAGRATION. PART II

EE “Vitebsk State Medical University”
The Republic of Belarus

The data about such doctors as Ya.V. Wylie, I.I. Gangart, F.A. Giltebrandt, Ya.I. Govorov, who took part in treatment of P.I. Bagration, are presented in the second part of the article. Studying of their professional activity has shown that they all were qualified physicians with a great personal experience of medical aid rendering in case of combat wounds.
The matters of medical aid organization to the wounded during the war period are also highlighted. The structure and functions of the drainage evacuation system introduced by the Russian army at that period are described. The main principles of this system were considered to be the following statements: rendering the definite prior established volume of medical aid at each stage; differentiation the wounded according to wound severity and determining the place of their treatment; identifying ways of evacuation of the wounded. Many approaches approved firstly during the War of 1812 appeared to be rather progressive and applied in the military field surgery for a long time.
The article concerns the problem of the gunshot wounds treatment in the French and Russian armies. Massive use of artillery by the warring parties resulted in a large number of the wounded with extensive wounds accompanied by the lesions of large vessels, nerves, bones, massive crush of tissues. The wound character predetermined a surgical tactics and an amputation was considered to be primarily a main operation for the French physicians. There wasn’t a single doctrine in the Russian military medicine during the War of 1812. At the same time many Russian surgeons tended to follow a saving treatment technique and try to avoid amputation and performed extremity-saving operations even with a restricted function. The experience of the War of 1812 proved the justification of extremity-saving approach and further the military field medicine continued its development in this direction.

Keywords: history of military field surgery, gunshot wound, Pyotr Ivanovich Bagration, medical aid rendering
p. 3 – 14 of the original issue
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Address for correspondence:
210023, Respublika Belarus, g. Vitebsk, pr. Frunze, d. 27, UO «Vitebskiy gosudarstvennyiy meditsinskiy universitet», kafedra obschey khirurgii,
e-mail: nebylicin.uravgm@mail.ru,
Nebylitsin Yuriy Stanislavovich
Information about the authors:
Sushkou S.A. PhD, associate professor, vice-rector on scientific research work of EE “Vitebsk State Medical University.
Nebylitsin Yu.S. PhD, associate professor of the chair of general surgery of EE “Vitebsk State Medical University”
Reutskaya E.N. A 6-year student of the medical faculty of EE “Vitebsk State Medical University”.
Rak A.N. A 6-year student of the medical faculty of EE “Vitebsk State Medical University”.

EXPERIMENTAL SURGERY

A.A. GLUKHOV, N.T. ALEKSEEVA, A.P. OSTROUSHKO

MORPHOFUNCTIONAL CHANGES IN TISSUES AT WOUNDS HEALING ON THE BACKGROUND OF THE PLATELET CONCENTRATE USE

SBEE HPE “Voronezh State Medical Academy named after N.N. Burdenko”
The Russian Federation

Objectives. To assess the tissue morphofunctional changes during the healing of wounds on the background of the selective and the combined platelet concentrate (PC) and hydroimpulsive sanation (HIS) usage depending on the type of a wound and a phase of a wound process.
Methods. The studies were conducted on 196 adult male rats weighing 250-280 g, who were applied a standard linear wound (1,0×0,5 cm) on the anterior side of the thigh under anesthesia. The first unit consisted of one control and two experimental groups in which reparative processes in aseptic wounds on the background of HIS and ÐC were evaluated.
In the first experimental group the PC with a concentration of at least 1 million/ml was used for treatment. In the second group HIS of a wound was applied. The second unit consisted of one control and 3 experimental groups and was devoted to studies of impact of PC and HIS on the reparative processes in the purulent wounds.
After purulent wounds modeling in the 1st experimental group the PC was applied to the wound; in the 2nd group HIS of a wound was applied. In the 3rd group firstly HIS was conducted and then PC was applied. In the control groups no treatment was carried out. Planimetric, histological, immunohistochemical methods of investigation were used.
Results. The conducted morphological study permitted to determine that the aseptic wounds treatment on the background PC accelerates regeneration, increasing the metabolic processes in the sprout layer of the epidermis, stimulates angiogenesis within the dermis. Healing of purulent wounds appears to be faster in case of the combined HIS and PC usage. These morphological studies data correlate with the results of the dynamics of change in the area of wounds from that of marker protein-synthetic processes.
Conclusions. Selective PC usage potentiates regenerative processes in aseptic wounds, the combined use of HIS and PC is considered to be more effective in septic wounds.

Keywords: healing of wounds, hydroimpulsive sanation, platelet concentrate
p. 15 – 22 of the original issue
References
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Address for correspondence:
394000, Rossiiskaia Federatsiia, g.Voronezh, ul. Studencheskaia, d.10, GBOU VPO «Voronezhskaia gosudarstvennaia meditsinskaia akademiia», kafedra obshchei khirurgii,
e-mail: alexeevant@list.ru
Glukhov Alexandr Anatol'evich
Information about the authors:
Glukhov A.A. MD, professor, a head of the general surgery chair of SBEE HPE “Voronezh State Medical academy named after N.N. Burdenko
Alekseeva N.T. PhD, associate professor of the normal human anatomy chair of SBEE HPE “Voronezh State Medical academy named after N.N. Burdenko
Ostroushko A.P. PhD, assistant of the general surgery chair of SBEE HPE “Voronezh State Medical Academy named after N.N. Burdenko

R.A. MAMMADOV12

MORPHOLOGICAL ESTIMATION OF THE LOCAL REACTION OF AN ORGANISM AT APPLICATION OF MESH MATERIALS FOR PROSTHETICS OF ANTERIOR ABDOMINAL WALL

Azerbaijan Medical University, Baku1,
The Republic Azerbaijan
SBEE HPE “Kursk State Medical University” 2,
The Russian Federation

Objectives. To study the morphological changes in the anterior abdominal wall tissues in the fixation zone of the lavsan and polypropylene prosthesis.
Methods. Experimental investigations were made on 40 mice (20 animals in each series). The animals were subdivided into 2 groups: the 1st group – with the lavsan prosthesis use; in the 2nd group – with the polypropylene prosthesis. Histological examination of the muscular-aponeurotic fragments combined with the synthetic materials with staining of the preparations by hematoxylin and eosin and according to Van-Gizon method was conducted on the 10th, 30th and 60th day.
Results. While performing the comparative analysis of the macrophage reaction in the connective tissue, significantly more number of macrophages in the surrounding connective tissue were registered at the lavsan prosthesis implantation between two groups of animals that testified to more «foreignness» of the given material.
In comparison of the segmented leukocytes dynamics in the 2nd group we found out a reliable decrease of the leukocytes number at the percentage ratio stabilization of fibroblasts and macrophages versus the earlier terms that proved the reduction of the inflammatory process intensity as well as intensification of the repair processes.
In both series of the experiment the lymphocytic reaction analysis indicated the growth of the immune response in terms up to 1 month with its subsequent reduction in the 1st group and the stable manifestation in the 2nd group.
The particular significance is considered to be a comparative characteristics of a fibroblastic reaction as a mechanism of formation of protective fence off capsule of the “foreign” body which is in fact any endoprosthesis.
The research showed a stable formation of the connective tissue in the 2nd group. In the case when the lavsan endoprosthesis is used the formation of the connective-tissue capsule has delayed caused by the inflammatory processes.
Conclusions. On the basis of the conducted experiment the low biocompatibility of the lavsan prosthesis was established in comparison with the polypropylene prosthesis. Therefore the use of polypropylene implant is considered to be preferable in clinical practice.

Keywords: polypropylene prosthesis, lavsan prosthesis, endoprosthetics of anterior abdominal wall
p. 23 – 28 of the original issue
References
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Address for correspondence:
AZ1065, Respublika Azerbaidzhan, g. Baku, ul. Bakikhanova, d. 23, Azerbaidzhanskii meditsinskii universitet, kafedra khirurgicheskikh boleznei ¹ 3,
e-mail: rmamedov2001@yahoo.com,
Mamedov Ruslan Aidyn ogly
Information about the authors:
Mammadov R.A. PhD, assistant of the surgical diseases chair ¹ 3 of Azerbaijan Medical University, post-graduate student of the surgical diseases chair ¹ 1 (2007 – 2009 years) of SBEE HPE “Kursk State Medical University”.

GENERAL AND SPECIAL SURGERY

V.A. KLOPOVA, I.V. SAMSONOVA

INFLAMMATION INFLUENCE ON THE CHARACTER OF NEUROFILAMENT EXPRESSION IN THE PANCREAS AT CHRONIC PANCREATITIS

EE ‘Vitebsk State Medical University”
The Republic of Belarus

Objectives. To study dependence of NF (neurofilament) expression degree on the inflammation process severity in pancreas at chronic pancreatitis.
Methods. Using morphological, immunohistochemical, morphometric and statistical methods, we investigated the pancreas tissue specimens of 43 patients with chronic pancreatitis who underwent duodenum saving resection of the head of the pancreas. Control group included 5 pancreas head specimens of people died due to by accidents and without any pathology of pancreas. After staining with hematoxylin and eosin according to Van-Gizon method as well as immunohistochemical method (NF) at ×100, ×200, ×400 magnification, we estimated changes in the pancreas, lymphocytic (including perineural) inflammatory infiltration and the character of neurofilament expression.
Results. Involvement of the nervous tissue in the inflammatory process and its changes was demonstrated morphologically combined with the lymphocytic inflammatory infiltration, diffuse degenerative and expressed fibrous changes in the pancreas at chronic pancreatitis.
Severity of perineural inflammation varied in limits from 0,2 up to 1,714, median was equal to 0,914 (0,658-1,198). At the same time with the severity increasing of the inflammatory perineural lymphocytic infiltration the tendency to reduction of the NF expression degree, a marker of expressed mature and viable nervous tissue, as well as of the percentage of positively expressed nervous elements was observed.
The revealed link between the severity of the inflammatory changes and reduction of the size of mature and viable nervous tissue, testifying to the change of neurofilament expression degree, proves the dominance of the alteration processes of the nervous elements over the reparation in the pancreas in chronic pancreatitis.
Conclusions. The revealed changes testify to the straight role of the inflammation and the nervous component affection in chronic pancreatitis and are considered to be one of the pathogenetic mechanisms of the pain syndrome development in patients with chronic pancreatitis and progressive degenerative changes in the pancreas.

Keywords: chronic pancreatitis, nerve tissue, neurofilament, inflammation
p. 29 – 35 of the original issue
References
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Address for correspondence:
210023, Respublika Belarus', g. Vitebsk, pr. Frunze, 27, UO «Vitebskii gosudarstvennyi meditsinskii universitet», kafedra patologicheskoi anatomii,
e-mail: victoriya_06@tut.by,
Klopova Viktoriia Aleksandrovna
Information about the authors:
Klopova V.A. A post-graduate student of the pathologic anatomy chair of EE “Vitebsk State Medical University”.
Samsonova I.V. PhD, associate professor, head of the pathologic anatomy chair of EE “Vitebsk State Medical University”.

V.I. RUSIN1, Ê.Å. RUMJANTSEV1, I.I. KOPOLOVEC1, I.B. KRAVCHUK 2

IMMEDIATE TREATMENT RESULTS OF BLEEDING FROM ESOPHAGEAL VARICES IN PATIENTS WITH B-CLASS LIVER CIRRHOSIS

SHEE “Uzhgorod National Universitó”1,
Transcarpatian Regional Clinical Hospital named after Andrey Novak2,
The Ukraine

Objectives. To evaluate the effectiveness of the treatment strategy of bleeding from the esophageal varices in patients with B-class liver cirrhosis according to Child-Pugh criteria.
Methods. 67 patients with B-class cirrhosis and bleeding from esophageal varices were included in the study. The endoscopic sclerotherapy was used to stop bleeding and in case of its ineffectiveness – the Blakemore tube was applied. Vasoactive therapy with octreotide or terlipressin, volumic resuscitation, antibiotics, solutions of aminoacids, proton pump inhibitors intravenously, menadione intramuscularly, lactulose appeared to be the components of the conservative treatment. Hepatic encephalopathy (I-II degree) was treated conservatively and albumin peritoneal dialysis was performed at III-IV degree.
Results. Endoscopic sclerotherapy stopped bleeding immediately in 53 (79%) of 67 patients. Blakemore tube was applied in the remaining 14 patients (21%). In 13 (26%) patients out of 53 endoscopic sclerotherapy was primary effective, recurrence of bleeding occurred within the first 5 days. In 9 of them it was stopped with the repeated session of endoscopic sclerotherapy, in 4 – with Blakemore tube. 5 (9,4%) patients died due to progression of the liver failure. Mortality calculated on the number of recurrences made up 38,5%. Recurrence took place in 8 (57,1%) out of 14 patients with Blakemore tube used initially. In 6 of them bleeding was stopped by the repeated endoscopic sclerotherapy. 8 (57,1%) patients died. Mortality calculated in patients with recurrences composed 100%. Mortality in the subgroup of the conservative treatment of encephalopathy made up 18%, in the case of the application of albumin peritoneal dialysis – 23,5%.
Conclusions. Endoscopic sclerotherapy is considered to be an effective method of bleeding treatment (an efficiency of 79% in primary haemorrhage stopping and 71% – at recurrence) with a moderate number of recurrences – 26% and a low mortality – 9,4%. Albumin peritoneal dialysis is considered to be a safe and effective treatment for hepatic encephalopathy of III-IV degree (23,5% mortality), which was not significantly different from that of patients with I-II degree.

Keywords: liver cirrhosis, esophageal varicose veins, bleeding, hepatic encephalopathy, endoscopic sclerotherapy, albumin peritoneal dialysis
p. 36 – 45 of the original issue
References
  1. Zviagintseva TD, Glushchenko SV. Khronicheskie diffuznye zabolevaniia pecheni: patogeneticheskie podkhody k lecheniiu [Chronic diffuse liver disease: pathogenetic approaches to treatment]. Zdorov’ia Ukra¿ni. 2010;(1):46–47.
  2. Dekompensovanii tsiroz pech³nki [Decompensated cirrhosis of liver]. Rusin V. ²., Siplivii V. O., Rusin AV, Beresnºv OV, Rumiantsev Kª. Uzhgorod, Ukraine: VETA-Zakarpattia; 2006. 232 p.
  3. Portal'naia gipertenziia i ee oslozhneniia [Portal hypertension and its complications]. Boiko VV, Nikishaev VI, Rusin VI, Boiko VV (red). Khar'kov, Ukraina: Martiniak, 2008. 335 p.
  4. De Franchis R. Revising consensus in portal hypertension: Report of the Baveno V consensus workshop on methodology of diagnosis and therapy in portal hypertension. J Hepatol. 2010;6:1010–16.
  5. Sass DA, Chopra KB. Portal hypertension and variceal hemorrhage. Med Clin North Am. 2009 Jul;93(4):837–53, vii-viii. Review.
  6. Samonakis DN, Triantos CK, Thalheimer U, Patch DW, Burroughs AK. Management of portal hypertension. Postgrad Med J. 2004 Nov;80(949):634–41.
  7. Yan BM, Lee SS. Emergency management of bleeding esophageal varices: drugs, bands or sleep? Can J Gastroenterol. 2006 Mar;20(3):165–70.
  8. Garcia-Tsao G, Sanyal AJ, Grace ND, Carey W Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. Hepatology. 2007 Sep;46(3):922–38.
  9. Sanyal AJ, Bosch J, Blei A, Arroyo V. Portal hypertension and its complications. Gastroenterology. 2008 May;134(6):1715–28.
  10. Sovremennye dèagnostècheskèe è lechebnye podhody k pechenochnoj nedostatochnostè [Current diagnostic and therapeutic approaches to liver failure]. Rusèn VÈ, Avdeev VV, Rumjancev KE, Sirchak JeS, Maljar MN. Uzhgorod, Ukraèna: Karpaty; 2011. 360 p.
Address for correspondence:
88018, Ukraina, g. Uzhgorod, ul. Pobedy, d. 22, Zakarpatskaia oblastnaia klinicheskaia bol'nitsa im. A. Novaka, kafedra khirurgicheskikh boleznei meditsinskogo fakul'teta GVUZ «Uzhgorodskii natsional'nyi universitet»,
e-mail: rusinkafedra@gmail.com,
Rusin Vasilii Ivanovich
Information about the authors:
Rusin V.I. MD, professor, head of the surgical diseases chair of the medical faculty of SHEE “Uzhgorod National University”.
Rumjantsev K.E. PhD, associate professor of the surgical diseases chair of the medical faculty of SHEE “Uzhgorod National University”.
Kopolovec I.I. A post-graduate student of the surgical diseases chair of the medical faculty of SHEE “Uzhgorod National University”.
Kravchuk I.B. Endoscopist of Transcarpatian regional clinical hospital named after Andrey Novak.

E.P. BURLEVA 1, S.A. TYRIN 2, R.R. FASKHIEV 2

CLINICAL AND ULTRASOUND COMPARISON IN THE GREAT SAPHENOUS VEIN SYSTEM AT VENOUS DISEASE

SBEE HPE “Ural State Medical Academy”1,
MAE “City Clinical Hospital ¹ 40” 2, Yekaterinburg,
The Russian Federation

Objectives. To perform the comparison of clinical and ultrasonic examination in the assessment of varicose veins of the lower limbs in the great saphenous vein system.
Methods. 102 patients (102 limbs) with varicose veins of lower limbs (VVLL) of C 2-6 classes of chronic venous disease (CVD) were examined. The patients were subdivided into 4 groups: the 1st group (Ñ 2, 3) – 30 patients, the 2nd (Ñ 4) – 34, the 3rd (C5) – 22, the 4th (C6) – 16.
At the ultrasound investigation the trunk diameters (D) of the large saphenous vein (LSV) on the thigh were registered as well as the extent of the vertical pathological refluxes, the number of the incompetent perforating veins (PV) and their summarized diameter (∑ D).
Results. The average diameter of GSV in the 1st group was 7,2 ± 0,2 mm, in the 2nd and 3rd groups – 9,07 ± 0,12 mm and 10,6 ± 1,2 mm, in the 4th group –12,5 ± 1,22 mm. In the 1st group the extended reflux prevailed - 76,7% , in the 2nd – the subtotal one – 58,8%, in the 3rd and 4th groups – the total one – 54,6% and 87,5%. The average number of the incompetent PV of the thigh and shin increased from 2,1 ± 0,22 in the 1st group up to 4,8 ± 0,13 in the 4th group (ð<0,05). The summarized diameter of PV between the 1st group – 6,1 ± 1,8 mm; the 2nd group – 6,1 ± 1,8 mm and the 3rd group – 11,0 ± 3,4 mm reliably differs (ð<0,05); there were no reliable differences between the 3rd and 4th groups – 16,4 ± 5,8 mm (ð>0,05).
Conclusions. At VVLL in the GSV system with the CVD class increase, D of the GSV trunk, the extent of the vertical pathological reflux, the number of PV and ∑ D of PV also increase.

Keywords: varicose veins, great saphenous vein, perforating veins, ultrasound angioscannings
p. 46 – 51 of the original issue
References
  1. Stoiko IuM, Lytkin MN, Shaidakov EV. Venoznaia gipertenziia v sisteme polykh ven [Venous hypertension in the system of hollow veins]. Saint-Petersburg: Rubin, RF; 2002. 276 p.
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  5. Zolotukhin IA, Bogachev VIu, Kuznetsov AN, Kirienko AI. Nedostatochnost' perforantnykh ven goleni: kriterii i chastota vyiavleniia [Limb perforating veins failure: criteria and the detection rate]. Flebologiia. 2008;2(1):21–26.
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  10. Shval'b PG. Sistemnyi podkhod k patogenezu khronicheskoi venoznoi nedostatochnosti nizhnikh konechnostei [A systematic approach to the pathogenesis of chronic venous insufficiency of the lower limbs]. Angiologiia i Sosud Khirurgiia. 2002 8(3):30–36.
  11. Coleridge-Smith P, Labropoulos N, Partsch H, Myers K, Nicolaides A, Cavezzi A. Duplex ultrasound investigation of the veins in chronic venous disease of the lower limbs–UIP consensus document. Part I. Basic principles. Eur J Vasc Endovasc Surg. 2006 Jan;31(1):83–92. Review.
  12. Mdez-Herrero A, Gutierrez J, Camblor L, Carreno J, Llaneza J, Rguez-Olay J, Suarez E. The relation among the diameter of the great saphenous vein, clinical state and haemodynamic pattern of the saphenofemoral junction in chronic superficial venous insufficiency. Phlebology. 2007;22(5):207–13.
  13. Zolotukhin IA, Bogachev VIu, Kirienko AI. Bol'shaia podkozhnaia vena: osobennosti ul'trazvukovoi anatomii i patologicheskogo refliuksa [Large subcutaneous vein: ultrasound features of anatomy and pathological reflux]. Grud i Serdech-Sosud Khirurgiia. 2006;(5):39–42.
  14. Korovin AIa, Shumskaia VV, Andreev AV. Topicheskaia sonograficheskaia diagnostika varikoznoi bolezni [Topical sonographic diagnosis of varicose veins]. Ekhografiia. 2003;(2):192–93.
  15. Shval'b PG, Ukhov IuI. Patologiia venoznogo vozvrata iz nizhnikh konechnostei [The pathology of venous return from the lower extremities]. Ryazan, RF: RiazGMU; 2009. 152 p.
  16. 16.Dumpe EP, Ukhov IuI, Shval'b PG. Fiziologiia i patologiia venoznogo krovoobrashcheniia nizhnikh konechnostei [Physiology and pathology of the venous circulation of the lower limbs]. Moscow, RF: Meditsina; 1982. 168 p.
  17. Sukovatykh BS, Sukovatykh MB, Belikov LN, Akatov AL. Sostoianie perforantnykh ven goleni posle sklerokhirurgicheskikh vmeshatel'stv po povodu bolezni nizhnikh konechnostei [Perforating veins state after sclerosurgical interventions for diseases of the lower extremities]. Angiologiia i Sosud Khirurgiia. 2012;(2): 84–88.
Address for correspondence:
620102, Rossiiskaia Federatsiia, g. Ekaterinburg, ul. Volgogradskaia, d. 189, MAU «Gorodskaia klinicheskaia bol'nitsa ¹ 40», kafedry obshchei khirurgii,
e-mail: burleva@gkb40.ur.ru,
Burleva Elena Pavlovna
Information about the authors:
Burleva E.P. MD, professor of the general surgery chair of SBEE HPE “Ural State Medical Academy”.
Tyrin S.A. Surgeon of the vascular surgery department of MAE “City clinical hospital ¹ 40”.
Fashiev R.R. Physician of the functional and ultrasound diagnostics of the functional diagnostics unit of MAE “City clinical hospital ¹ 40”.

S.V. SHAKHRAI

COMBINED SURGICAL TREATMENT TECHNIQUE OF CHRONIC HEMORRHOIDS

SEE “Belarusian Medical Academy
of Postgraduate Education”,
The Republic of Belarus

Objectives. To study the results and carry out a clinical analysis of the complex surgical treatment technique of patients with chronic hemorrhoids including laser radiation using (1,56 microns) and transanal suture ligation and mucopexy.
Methods. 52 patients with chronic hemorrhoid were included in the research. The patients were divided into two groups. The control group was made up of 30 patients with the 3rd stage of the disease. All patients of this group were subjected to a standard technique (open). The second (main) group was made up of 22 patients with the 3rd stage of chronic hemorrhoid who had undergone a submucous laser destruction of the hemorrhoidial nodes by means of infrared radiation which coagulates tissue (wavelength of 1560 nm) and transanal suture ligation and mucopexy of hemorrhoids. Procedures were carried out under local anesthesia by instrument for laser volumetric destruction of hemorrhoid worked out by the authors.
During the first postoperative week the patients’ state was daily assessed; then weekly – during a six-month period after the operation. Wound healing rate, the presence of local purulent inflammatory changes, hemorrhage as well as dysuric disorders development in the postoperative period have been assessed.
Results. Comparison of the average objective and subjective indicators at the monitoring of the operation and the postoperative period shows the advantages of the suggested combined technique with use of laser destruction of the hemorrhoid and mucopexy versus a standard hemorrhoidectomy. Statistically significant differences were observed between the groups of comparison; at the same time both the pains induced by defecation and the pain reaction during the postoperative period at rest were considerably lower the 2nd group. The period of the postoperative rehabilitation was shorter as well.
Conclusions. The designed combined surgical method for the treatment of chronic hemorrhoids can be a mini-invasive alternative to hemorrhoidectomy and be recommended to be applied in the ambulant operating room or outpatient department of the hospital with short-staying of patients.

Keywords: chronic hemorrhoid, hemorrhoidectomy, mini-invasive treatment, laser destruction, mucopexy
p. 52 – 57 of the original issue
References
  1. Vorob'ev GI. Osnovy koloproktologii [Fundamentals of coloproctology]. Rostov-on-Don, RF: Feniks; 2001. 416 p.
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  4. Geinits AV, Elisova TG. Lazery v khirurgicheskom lechenii gemorroia. [Lasers in the surgical treatment of hemorrhoids]. Lazer Meditsina. 2009;(1):31–35.
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  6. Sokolov AL, Liadov KV, Stoiko IuM. Endovenoznaia lazernaia koaguliatsiia v lechenii varikoznoi bolezni [Endovenous laser coagulation in the treatment of varicose veins]. Moscow, RF: Meditsina, 2007. 220 p.
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  8. Mackay E. Saphenous vein ablation: Do different laser wavelengths translate into different patient experiences? Endovascular Today. 2006;(2s.r.):45–48.
Address for correspondence:
220107, Respublika Belarus' g. Minsk, ul. Korzhenevskogo, d. 4, GUO «Belorusskaia meditsinskaia akademiia poslediplomnogo obrazovaniia», kafedra neotlozhnoi khirurgii s kursom ambulatornoi khirurgii,
e-mail: s.shakhrai@mail.ru,
Shakhrai Sergei Vladimirovich
Information about the authors:
Shakhrai S.V. PhD, associate professor of the emergency surgery chair with the course of ambulant surgery of SEE “Belarusian Medical Academy of Postgraduate Education”.

B.N. ZHUKOV, V.R. ISAEV, A.V. ZHURAVLEV, A.A. CHERNOV, S.E. KATORKIN

EXPERIENCE OF CIRCULAR RESECTION OF THE MUCO- SUBMUCOSAL LAYER OF THE RECTAL LOWER AMPULLAR SECTION IN TREATMENT OF PATIENTS WITH RECTOCELE IN COMBINATION WITH CHRONIC INTERNAL HEMORRHOIDS OF 3-4 STAGE

SBEE HPE “Samara State Medical University”,
The Russian Federation

Objectives. To evaluate the treatment results of patients suffering from rectocele in combination with the chronic internal hemorrhoids after the circular endorectal resection of the muco-submucosal layer of the distal colon section.
Methods. The analysis of the surgical treatment results of 358 patients suffering from the chronic rectocele and chronic internal hemorrhoids who underwent the circular endorectal resection of the muco-submucosal layer of the distal colon section by A. Longo method was conducted. 3 subgroups of patients were formed: I – patients with rectocele in combination with the chronic internal hemorrhoids; II – females with rectocele without the chronic hemorrhoids; III – patients of both sexes suffering from the chronic internal hemorrhoids.
Rectoromanoscopy, sphincterometry, profilometry, irrigoscopy with defecography, transrectal and transvaginal ultrasound examination were applied. Standard surgical sets were used while carrying out the operations.
During early postoperative period dynamics and intensity of the pain syndrome were evaluated, complications were analyzed. Long-term treatment results were studied in 252 patients (70,4%). The number of recurrences was analyzed and defecography was performed.
Results. Postoperative complications (hemorrhage, urinary retention, external hemorrhoids nodules edema) developed in 37 patients (7,5%). Long-term analysis revealed the A. Longo method of operation in case of combination of rectocele and the chronic internal hemorrhoids permitted to achieve good and satisfactory results in 98,8% of patients.
Conclusions. The advantages of the circular resection method of the colonic submucosal layer in case of combination of rectocele and the chronic internal hemorrhoids are the followings: low incidence of trauma, the lack of significant pain syndrome in the postoperative period, shortening of hospitalization period as well as of medical and social rehabilitation terms. The method permits to eliminate the redundant mucosal prolapse, to remove rectocele and at the same time to make a strong connective muscular frame along the colon anterior wall.

Keywords: hemorrhoids, rectocele, Longo method of operation, hemorrhoidectomy
p. 58 – 63 of the original issue
References
  1. Vorob'ev GI. Osnovy koloproktologii: ucheb. posobie [Fundamentals of ñoloproctology: a textbook]. Rostov na Don, RF: Feniks; 2001. 412 p.
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  9. of the rectum during treatment of hemorrhoids]. Koloproktologiia. 2008;(1):4–8.
  10. Zhukov BN, Isaev VR, Chernov AA, Shamin AB, Zhuravlev AB. Maloinvazivnye tekhnologii v khirurgicheskom lechenii bol'nykh pri sochetanii rektotsele i gemorroia [Minimally invasive technology in the surgical treatment of patients with a combination of rectocele and hemorrhoids]. Samar Med Zhurn. 2008;43(3):21–23.
  11. Zhukov BN, Isaev VR, Chernov AA, Zhuravlev AB. Sochetannoe khirurgicheskoe lechenie bol'nykh pri rektotsele i gemorroe [Combined surgical treatment of patients with rectocele and hemorrhoids]. Koloproktologiia. 2009;(1):18–20.
  12. Aminev AM. Rukovodstvo po proktologii: v 4 t. [A guideline on proctology: 4 vol]. Kuibyshev, RF: Kn izd-vo; 1979;4. 560 p.
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  14. Doshchinin KV, Karamyshev A.S. Neposredstvennye i otdalennye rezul'taty operatsii Longo [The immediate and late results of the Longo's operation]. Koloproktologiia. 2010;(1):13–18.
  15. Longo A. Treatment of haemorrhoids disease by reduction of mucosa and haemorrhoidal prolapse with a circular suturing device: a new procedure. Proceedings of the 6th World Congress of Endoscopic Surgery. Rome, IT: Monduzzi Editore, Bologna; 1998:777–84.
  16. Vorob"ev GI. Osnovy koloproktologii [Fundamentals of coloproctology]. Moscow, RF: Med inform agentstvo; 2006. 432 p.
Address for correspondence:
443079, Rossiiskaia Federatsiia, g. Samara, pr. Karla Marksa, d. 165 «b», Kliniki Samarskogo gosudarstvennogo meditsinskogo universiteta, kafedra i klinika gospital'noi khirurgii,
e-mail: katorkinse@mail.ru,
Katorkin Sergei Evgen'evich
Information about the authors:
Zhukov B.N. Honored Worker of science of RF, MD, professor, head of the chair and clinic of the hospital surgery of SBEE HPE “Samara State Medical University”.
Isaev V.R. MD, professor of the chair and clinic of the hospital surgery of SBEE HPE “Samara State Medical University”, chief freelance coloproctologist of MHC of Samara region.
Zhuravlev A.V. PhD, assistant of the chair and clinic of the hospital surgery of SBEE HPE “Samara State Medical University”.
Chernov A.A. PhD, head of the coloproctology department of the hospital surgery clinic of SBEE HPE “Samara State Medical University”.
Katorkin S.E. PhD, associate professor of the chair and clinic of the hospital surgery of SBEE HPE “Samara State Medical University”.

ENDOSKOPY

V.A. KASHCHENKO 1, D.V. RASPEREZA 1, V.P. AKIMOV 2

VIDEO CAPSULE ENDOSCOPY IN DIAGNOSTICS OF GASTROINTESTINAL BLEEDINGS

FSB ME “Clinical hospital ¹ 122 named after L.G. Sokolov of FMBA of Russian Federation ”1,
SBEE HPE “North-Western State Medical University named after I.I.Mechnikov” 2, Saint-Petersburg. The Russian Federation

Objectives. To present the potential of the video capsule endoscopy in the diagnostics of the gastrointestinal bleedings.
Methods. The results of the video capsule endoscopy in the clinical hospital ¹ 122 of FMBA of Russia from April, 2010 till December, 2011 have been analyzed. 32 patients (17 males and 15 females) have been surveyed during this period. The video capsule EU type 1 (“Olympus” corporation) was used in the research.
Results. Out of total 32 patients, the pathological changes in the mucous membrane of the small intestine were revealed in 17 (53,1%): small bowel neoplasia – in 2; adenocarcinoma (bleeding) – in 1; leiomyosarcoma (bleeding) – in 1); Cron’s disease – in 6; angiodysplasia – in 2; celiac disease – in 1; portal hypertensive enteropathy – in 1; an intestinal lymphangiectasia – in 2; lymphfollicular hyperplasia – in 1; polyp of the small intestine – in 1; cicatricial changes of the intestinal anastomosis – in 1. In the abdominal surgery the leading indication for the capsule endoscopy conduction is considered to be a small intestine bleeding. An active bleeding in the small intestine lumen in 2 out of 4 patients with the signs of the "hidden" gastrointestinal bleeding has been registered. The cause one of them was established on the basis of images assessment obtained by means of the capsule (adenocarcinoma); in the other case the character of the bleeding origin was determined only intraoperatively (leiomyosarcoma).
Conclusions. The video capsule endoscopy permits to obtain the unavailable earlier information concerning the state of the small intestine and to improve significant the diagnostic yieldel in the cases of gastrointestinal bleedings. In patients with a clinical picture of anemia and gastrointestinal bleeding the video capsule endoscopy is recommended as the third diagnostic method at negative results of gastroduodenoscopy and colonoscopy.

Keywords: video capsule endoscopy, small intestine, gastrointestinal bleeding
p. 64 – 69 of the original issue
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  9. Schulmann K, Hollerbach S, Kraus K, Willert J, Vogel T, Moslein G, Pox C, Reiser M, Reinacher-Schick A, Schmiegel W. Feasibility and diagnostic utility of video capsule endoscopy for the detection of small bowel polyps in patients with hereditary polyposis syndromes. Am J Gastroenterol. 2005 Jan;100(1):27–37.
  10. Selby W. Complete small-bowel transit in patients undergoing capsule endoscopy: determining factors and improvement with metoclopramide. Gastrointest Endosc. 2005 Jan;61(1):80–5.
  11. Caddy GR, Moran L, Chong AK, Miller AM, Taylor AC, Desmond PV.The effect of erythromycin on video capsule endoscopy intestinal-transit time. Gastrointest Endosc. 2006 Feb;63(2):262–66.
  12. Delvaux M, Gerard Gay. Capsule endoscopy in 2005: facts and perspectives. Best Pract Res Clin Gastroenterol. 2006 Feb;20(1):23–39.
  13. Fireman Z. The light from the beginning to the end of the tunnel. Gastroenterology. 2004 Mar;126(3):914–6.
  14. DiSario JA, Burt RW, Vargas H, McWhorter WP. Small bowel cancer: epidemiological and clinical characteristics from a population-based registry. Am J Gastroenterol. 1994 May;89(5):699–701.
  15. Gay GJ, Delmotte JS. Enteroscopy in small intestinal inflammatory diseases. Gastrointest Endosc Clin N Am. 1999 Jan;9(1):115–23.
  16. Iddan G, Meron G, Glukhovsky A, Swain P. Wireless capsule endoscopy. Nature. 2000 May 25;405(6785):417.
  17. Liangpunsakul S, Maglinte DD, Rex DK. Comparison of wireless capsule endoscopy and conventional radiologic methods in the diagnosis of small bowel disease. Gastrointest Endosc Clin N Am. 2004 Jan;14(1):43–50.
  18. Perez-Cuadrado E, Macenlle R, Iglesias J, Fabra R, Lamas D. Usefulness of oral video push enteroscopy in Crohn's disease. Endoscopy. 1997 Oct;29(8):745–47.
  19. Schulmann K, Hollerbach S, Kraus K, Willert J, Vogel T, Moslein G, Pox C, Reiser M, Reinacher-Schick A, Schmiegel W. Feasibility and diagnostic utility of video capsule endoscopy for the detection of small bowel polyps in patients with hereditary polyposis syndromes. Am J Gastroenterol. 2005 Jan;100(1):27–37.
Address for correspondence:
191015, Rossiiskaia Federatsiia, g. Sankt-Peterburg, ul. Kirochnaia, d. 41, GBOU VPO «Severo-Zapadnyi gosudarstvennyi meditsinskii universitet im. I.I.Mechnikova», kafedra khirurgii im. N.D. Monastyrskogo,
e-mail: akimov.spbmapo@ mail.ru,
Akimov Vladimir Pavlovich
Information about the authors:
Kashchenko V.A. MD, the chief surgeon of FSB ME “Clinical hospital ¹ 122 named after L.G. Sokolov of FMBA of Russian Federation ”.
Raspereza D.V. Endoscopist of FSB ME “Clinical hospital ¹ 122 named after L.G. Sokolov of FMBA of Russian Federation”.
Akimov V.P. MD, professor of surgery chair named after N.D. Monastyrsky of SBEE HPE “North-western State Medical University named after I.I. Mechnikov”.

V.I. RUSYN 1, P.A. BOLDIZHAR 1, A.V. SOCHKA 2

CHROMOCOLONOSCOPY AS A METHOD OF ENDOSCOPICAL IMAGE IMPROVEMENT

SHEE “Uzhgorod National University”1,
Transcarpatian Regional Clinical oncological hospitaL 2, Uzhgorod. The Ukraine

Objectives. To study the diagnostic significance of chromocolonoscopy with methylene blue for the differential diagnostics between non-neoplastic, neoplastic growth of the colon and the early colorectal cancer.
Methods. The results of chromoendoscopical and histological examination of 211 colorectal polyps are presented in the paper. The videocolonoscopy and chromoscopy (0,2-0,5% solution of methylene blue) were used to improve visualization of the abnormal tissue.
Endoscopic conclusions were made on the basis of Pit Pattern classification which includes 5 types of structures of the pit epithelium: I and II types reflect a norm, inflammation and hyperplasia; III-V types reflect neoplasia. The results of the visual endoscopic interpretation were compared with the histological analysis data.
Results. Out of total number of the colorectal lesions, 171 (81,0%) were adenomas, 39 (18,5%) – non-neoplastic polyps, 1(0,5%) – a polypoid form of early colon cancer (type Ip).
151 adenomas (88,3%) out of 171 were benign ones: 103 (68,2%) – tubular, 29 (19,2%) – tubular-villous, 19 (12,6%) – villous ones. Malignant degenerations were diagnosed in 20 (11,7%) adenomas.
After chromocolonoscopy the number of false-negative results of the visual differential diagnostics between non-neoplastic, neoplastic growths of the colon and the early colorectal cancer decreased up to 10,3-28,6% in comparison with 30-50% after a standard colonoscopy. The largest number of false-negative results was observed in the group of malignant adenomas (28,6%), significantly less in the groups of benign adenomas (13,2%) and non-neoplastic polyps (10,3%).
Sensitivity and specificity of chromocolonoscopy to diagnose non-neoplastic growths made up 89,7% and 95,9%, correspondently, to diagnose neoplastic growths – 86,8% and 93,3%, to diagnose cancer – 71,4% and 96,8%.
Conclusions. A high sensitivity and specificity of chromocolonoscopy for differential diagnosis between non–neoplastic, neoplastic lesions and early colorectal cancer have been established.

Keywords: colonoscopy, chromoscopy, methylene blue, polyps
p. 70 – 77 of the original issue
References
  1. Banks MR, Haidry R, Butt MA, Whitley L, Stein J, Langmead L, Bloom SL, O'Bichere A, McCartney S, Basherdas K, Rodriguez-Justo M, Lovat LB. High resolution colonoscopy in a bowel cancer screening program improves polyp detection. World J Gastroenterol. 2011 Oct 14;17(38):4308–13.
  2. Rabeneck L, Paszat LF. Circumstances in which colonoscopy misses cancer. Frontline Gastroenterology. 2010;1:52–58.
  3. Fomèn P.D., Nèkèshaev V.È. Termènologèja è klassèfèkacèja metodov poluchenèja jendoskopècheskogo èzobrazhenèja [Terminology and classification of methods for endoscopic image]. Ukra¿n Zhurn Maloinvazèv ta Endoskopich Hirurgi¿. 2011;15(3):13–18
  4. Nèkèshaev VÈ, Patèj AR, Tumak ÈN, Koljada ÈA. Jendoskopècheskaja dèagnostèka rannego kolorektal"nogo raka [Endoscopic diagnosis of early colorectal cancer]. Ukra¿n Zhurn Maloinvazèv ta Endoskopich Hirurgi¿. 2012;16(1):35–55.
  5. Hafner M, Liedlgruber M, Uhl A, Vecsei A, Wrba F. Delaunay triangulation-based pit density estimation for the classification of polyps in high-magnification chromo-colonoscopy. Comput Methods Programs Biomed. 2012 Sep;107(3):565–81.
  6. Kanao H, Tanaka S, Oka S, Kaneko I, Yoshida S, Arihiro K, Yoshihara M, Chayama K. Clinical significance of type V(I) pit pattern subclassification in determining the depth of invasion of colorectal neoplasms. World J Gastroenterol. 2008 Jan 14;14(2):211–17.
  7. Tominaga K, Fujinuma S, Endo T, Saida Y, Takahashi K, Maetani I. Efficacy of the revised Vienna Classification for diagnosing colorectal epithelial neoplasias. World J Gastroenterol. 2009 May 21;15(19):2351–56.
Address for correspondence:
88014, Ukraina, g. Uzhgorod, ul. Brodlakovicha, d. 2, Zakarpatskii oblastnoi klinicheskii onkologicheskii dispanser, poliklinicheskoe otdelenie, endoskopicheskii kabinet,
e-mail:sochka_anna@inbox.ru,
Sochka Anna Vladimirovna
Information about the authors:
Rusin V.I. MD, professor, head of the surgical diseases chair of the medical faculty of SHEE “Uzhgorod National University”.
Boldizhar P.A. MD, professor of the surgical diseases chair of the medical faculty of SHEE “Uzhgorod National University”.
Sochka A.V. Post graduate student of the surgical diseases chair of the medical faculty of SHEE “Uzhgorod National University”, endoscopist of the out-patient department of Transcarpatian regional clinical oncological hospital.

ANESTHESIOLOGY-REANIMATOLOGY

D.V. OSIPENKO

GUIDED HYPOCOAGULATION AS A COMPONENT OF ANESTHESIA SUPPORT AT OPERATIVE INTERVENTIONS IN VASCULAR SURGERY

E “Gomel Regional Clinical Cardiology Dispensary”
The Republic of Belarus

Objectives. To evaluate efficacy and safety of the unfractionated heparin (UFH) use in the dosage 50 mg per kg of the patient body weight in the vascular surgery with intraoperative dosage correction depending on the severity of hypocoagulation.
Methods. 60 patients underwent the planned surgeries on the arterial bed were included in the study. In the 1st group of patients (n=30) the unfractionated heparin in the dosage of 50 U/kg of the patient body weight was injected before the clip was applied on the operated vessel. Fixed-dose weight-adjusted unfractionated heparin (5000 units) was injected to the patients of the 2nd group (n=30).
In the 1st group the heparin action was controlled by determining the activated time of blood coagulation (ATBC) at the main stages of the study with the subsequent changes analysis and if necessary by additional administration of the UFH in the dosage 25 U/kg. The number of the thrombotic and hemorrhagic complications, intra- and postoperative lethality was also registered in the groups of patients.
Results. The application of the suggested technique of heparin use permitted to get the reliable and stable increase of ATBC value during the vessel clamping at the statistically lower heparin dosage in the investigated group in comparison of fixed-dose weight-adjusted unfractionated heparin (5000 units).
The 1st group patients were divided into 3 subgroups depending on the marked character of changes of ATBC level in 5 minutes after UFH injection.
Conclusions. The conducted study has demonstrated efficacy and safety of the suggested technique of UFH use in the vascular surgery. It is suggested that incidence of hemorrhagic and thrombotic complications depends on the individual reaction of a patient’s coagulation system to the intravenous UFH injection.

Keywords: vascular surgery, unfractionated heparin, activated time of blood coagulation, individual reaction
p. 78 – 83 of the original issue
References
  1. In: Hobson II RW, Wilson SE, Veith FJ, editors. Vascular Surgery Principles and Practice. 3 rd ed. New York, US: Marcel Dekker Inc; 2004. 1292 p.
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  3. Tremey B, Szekely B, Schlumberger S, Francois D, Liu N, Sievert K, Fischler M. Anticoagulation monitoring during vascular surgery: accuracy of the Hemochron low range activated clotting time (ACT-LR). Br J Anaesth. 2006 Oct;97(4):453–39.
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  10. Intraoperative heparinisation, blood loss and myocardial infarction during aortic aneurysm surgery: a Joint Vascular Research Group study. Eur J Vasc Endovasc Surg. 1996 Jul;12(1):86–90.
  11. Mauney MC, Buchanan SA, Lawrence WA, Bishop A, Sinclair K, Daniel TM, Tribble CG, Kron IL. Stroke rate is markedly reduced after carotid endarterectomy by avoidance of protamine. J Vasc Surg. 1995 Sep;22(3):264–69.
  12. Khensli F.A., Martin D.E., Grevli G.P. Prakticheskaia kardio-anesteziologiia [Practical cardiac anesthesiology]: per. s angl. 3-e izd. Moscow, RF: MIA; 2008. 1104 p.
  13. Wakefield TW, Lindblad B, Stanley TJ, Nichol BJ, Stanley JC, Bergqvist D, Greenfield LJ, Bergentz SE. Heparin and protamine use in peripheral vascular surgery: a comparison between surgeons of the Society for Vascular Surgery and the European Society for Vascular Surgery. Eur J Vasc Surg. 1994 Mar;8(2):193–98.
  14. Baluda VP, Bakagan ZS, Gol'dberg ED, Kuznik BI, Lakin KM. Laboratornye metody issledovaniia sistemy gemostaza [Laboratory methods of hemostasis]. Gol'dberg ED, red. Tomsk; 1980. 311 p.
  15. Poisik A, Heyer EJ, Solomon RA, Quest DO, Adams DC, Baldasserini CM, McMahon DJ, Huang J, Kim LJ, Choudhri TF, Connolly ES. Safety and efficacy of fixed-dose heparin in carotid endarterectomy. Neurosurgery. 1999 Sep;45(3):434–41.
  16. Bull BS, Korpman RA, Huse WM, Briggs BD. Heparin therapy during extracorporeal circulation. I. Problems inherent in existing heparin protocols. J Thorac Cardiovasc Surg. 1975 May;69(5):674–84.
Address for correspondence:
246012, Respublika Belarus', g. Gomel', ul. Meditsinskaia, d. 4, Uchrezhdenie «Gomel'skii oblastnoi klinicheskii kardiologicheskii dispanser», otdelenie anesteziologii i reanimatsii s palatami intensivnoi terapii.
e-mail: Osipenko081081@mail.ru,
Osipenko Dmitrii Vasil'evich
Information about the authors:
Osipenko D.V. A post-graduate student of general and clinical pharmacology chair with the courses of anesthesiology and resuscitation of EE “Gomel State Medical University”, anesthetist-resuscitator of the anesthesiology and resuscitation department with the wards of intensive care E “Gomel Regional Clinical Cardiology Dispensary”.

ORGANIZATION OF THE SURGICAL CARE

YU.P. OSTROVSKY 1, V.V. SELESNEV 1, N.S. MIKUTSKI 2, P.F. CHERNOGLAZ 2, A.L. SMOLJAKOV 2

IS CARDIOVASCULAR SURGERY AT CROSSROADS?

SEE “Belarusian Medical Academy of Postgraduate Education” 1,
SE RSPC “Cardiology” 2, Minsk.
The Republic of Belarus

Objectives. Basing on the analysis of the cardiac surgery state in the republic and tendencies of the cardiac surgery development to identify the ways for further improvement of the given aspect in the national healthcare.
Methods. The results of work of the cardiovascular surgery departments, catheterization laboratories of the Republic of Belarus possessing significant experience in operations on the open heart and major vessels as well as in X-ray-endovascular interventions on different vascular pools have been analyzed.
Results. In 2011, 9131 operations on the heart and thoracic aorta section were carried out in the republic including 2312 with use of artificial blood circulation; 1119 – aorta-coronary shunting combined with other cardiac operations; 260 – aorta-coronary shunting on the working heart; 3008 – X-ray-endovascular operations (vessel angioplasty – 512, direct stenting – 2209). During the recent 5 years the number of the coronary angioplasty has more than 10 times increased in the republic (2006 year – 201 procedures – 21/1 million of the population; 2011 year - 2672 – 282 /1 million of the population; by October, 2012 in Minsk – 750 procedures/1 million of the population). In general during the recent 20 years the tendency typical for modern development of the cardiovascular surgery has been registered in the republic, i.e. annual increase of the endovascular interventions and expansion of the given service.
Conclusions. At present modern tendencies in the cardiovascular surgery are being developed and realized in the Republic of Belarus. The required conditions for further development of the cardiovascular surgery are considered to be a collaboration and interdisciplinary approach; advanced training in cardiovascular and endovascular surgery at all stages; development and consolidation of the clinical bases for wide application of hybrid technologies in practice; introduction of modern treatment standards in the clinical practice; active integration in international scientific-practical communities.

Keywords: cardiovascular and endovascular surgery, tendencies of developments
p. 84 – 87 of the original issue
References
  1. Veith FJ. Conference scene: 38th Annual VEITH symposium. Interventional Cardiology. 2012 Apr;4(2):163–64.
  2. Biasi GM. The evolution of vascular surgery. Endovascular Today. 2008 Apr:65–67.
  3. Mrochek AG, Patseev AV, Ermolkevich FF, Bel'skaia MI. Dostizheniia kardiologicheskoi sluzhby Respubliki Belarus [Achievements of cardiological service in the Republic of Belarus]. Kardiologiia v Belarusi. 2012;(4):8–21.
  4. Volodos' SN. Protivorechiia i tendentsii v razvitii sosudistoi khirurgii na sovremennom etape [Contradictions and trends in vascular surgery at the present stage]. Serdtse ³ Sudin³. 2009;(2):11–17.
  5. Allie DE, Hebert ChJ, Walker CM. Establishing a peripheral vascular Center of Excellence. It’s much more than just technology Endovascular Today. 2005 Feb:41–44.
  6. Wijns W, Kolh P, Danchin N, Di Mario C, Falk V, Folliguet T, Garg S, Huber K, James S, Knuuti J, Lopez-Sendon J, Marco J, Menicanti L, Ostojic M, Piepoli MF, Pirlet C, Pomar JL, Reifart N, Ribichini FL, Schalij MJ, Sergeant P, Serruys PW, Silber S, Sousa Uva M, Taggart D. Guidelines on myocardial revascularization. Eur Heart J. 2010 Oct;31(20):2501–55.
  7. Pikovskii D.L. SP Fedorov – khirurg, uchenyi, filosof [ÑÏ Fedorov – a surgeon, scientist, philosopher]. Annaly Khirurg Gepatologii. 2001(1):158–62.
Address for correspondence:
220036, Respublika Belarus', g. Minsk, ul. R. Liuksemburg, d. 110, GU RNPTs «Kardiologiia», kafedra kardiokhirurgii,
e-mail: nickdoc@rambler.ru,
Mikutskii Nikolai Stanislavovich
Information about the authors:
Ostrovsky Yu.P. Corresponding member of NAS of RB, MD, professor, head of the cardiac surgery laboratory of SE RSPC “Cardiology”, head of the cardiac surgery chair of SEE “Belarusian Medical Academy of Post-Graduate Education”.
Selesnev V.V. PhD, associate professor of the cardiac surgery chair of SEE “Belarusian Medical Academy of Post-Graduate Education”.
Mikutski N.S. PhD, cardiac surgeon of the 1st cardiac surgery department of SE RSPC “Cardiology”.
Chernoglaz P.F. Endovascular surgeon of the endovascular surgery department of SE RSPC “Cardiology”.
Smoljakov A.L. Cardiac surgeon of the 1st cardiac surgery department of SE RSPC “Cardiology”.

NEW METHODS

N.V. ALEKSANDRENKOV 1, A.S. MYKHIN 2, V.A. REBCOVSKY 3, À.Å. LEONTEV 3

WOUND CLOSURE METHOD AT SUBAPONEUROTIC PLASTY WITH POLYPROPYLENE MESH OF LARGE POSTOPERATIVE VENTRAL HERNIA

SBME KR “Babyninsky central regional hospital”1, SBEE HPE “Nizhny Novgorod State Medical Academy” 2,
MEHC “City Clinical Hospital ¹39”, Nizhny Novgorod 3,
The Russian Federation

Objectives. To decrease the number of wound complications after subaponeurotic plasty of large postoperative ventral hernia by means of the designed method of the herniotomy wound closure.
Methods. Patients with postoperative ventral hernia were subdivided into 2 groups. In the control group A (31 patients) the vacuum drainages were left in the wound over the mesh and the skin was sewed with the nodal sutures; the drainages were removed 4-5 days afterwards. In the main group B (52 patients) the separated subcutaneous fat was fixed in several layers by thread to the aponeurosis through the mesh endoprosthesis. The wound was not drained. The skin was sewed with the intracutaneous suture. In both groups ultrasound examination of the wound was performed on the 2-5 and 8-12 day. In care of detection seromas exceeding 1 cm in width the puncture method was used.
Results. According to the ultrasound data, large seromas were revealed in 32,5% patients in the group A on 8-12 day. In group B they were detected in 5,7% operated patients. Their number remained unchanged one month afterwards in both groups despite the puncture method of treatment. Total number of the wound complications in groups A and B made up 41,9% and 17,3%, correspondently. Group A patients stayed in hospital within 10-22 days, 13,54±3,40 on the average, in group B they were discharged on 8-17 days. The average time of hospitalization was 10,96±2,01 days.
Conclusions. The wound closure over endoprosthesis at herniotomy according to the designed method 2 time reduces wound complications as well as reducen of patients’ hospitalization up to 2,5 days on the average. It is associated with the ability of small seromas to self-resolve without any treatment. Absence of the cavity drainage and the intracutaneous suture excludes the wound infection.

Keywords: postoperative ventral hernia, endoprosthesis, wound complications, wound closure method
p. 88 – 93 of the original issue
References
  1. Mirzabekian IuR, Dobrovol'skii SR. Prognoz i profilaktika ranevykh oslozhnenii posle plastiki perednei briushnoi stenki po povodu posleoperatsionnoi ventral'noi gryzhi [Prediction and prevention of wound complications after plastic abdominal wall of the postoperative ventral hernia]. Khirurgiia Zhurn im NI Pirogova; 2008(1):66–71.
  2. Toskin KD, Zhebrovskii VV. Gryzhi zhivota. Biblioteka prakticheskogo vracha [Abdominal hernia. Library of practitioners]. Moscow, RF: Meditsina; 1983. 240 p.
  3. Fedorov IV, Chugunov AN. Protezy v khirurgii gryzh: stoletniaia evoliutsiia [Prostheses in hernia surgery: centenary evolution ]. Gerniologiia. 2004;(2):45–52.
  4. Vasil'ev MN, Vaniushin PN, Grigor'ev KIu. Sposob alloplastiki bol'shikh ventral'nykh gryzh [Method of alloplastics of large ventral hernias]. Fundam Issledovaniia. 2010;(11):33–36.
  5. Volkov DE, Dobrokvashin SV, Izmailov AG. Prichiny gnoino-septicheskikh ranevykh oslozhnenii pri khirurgicheskom lechenii ushchemlennykh posleoperatsionnykh ventral'nykh gryzh [Causes of septic wound complications in the surgical treatment of strangulated postoperative ventral hernias]. Kazan Med Zhurn. 2006;87(5):341–45.
  6. De Vries Reilingh TS, van Geldere D, Langenhorst B, de Jong D, van der Wilt GJ, van Goor H, Bleichrodt RP. Repair of large midline incisional hernias with polypropylene mesh: comparison of three operative techniques. Hernia. 2004 Feb;8(1):56–9.
  7. Tsverov IA, Bazaev AV. Otsenka osnovnykh sposobov alloplastiki s tsel'iu optimizatsii lecheniia bol'nykh s posleoperatsionnymi ventral'nymi gryzhami [Assessment of the main methods of alloplastics to optimize the treatment of patients with postoperative ventral hernias]. Sovrem Tekhnologii v Meditsine. 2011;(2):73–76.
  8. Soler M, Verhaeghe PJ, Stoppa R. Polyester (Dacron mesh. In: Bendavid R. et al. (eds). Abdominal wall hernias principles and management. New York, US: Springer-Verlaj; 2001. p. 266–71.
  9. Neliubin PS, Galota EA, Timoshin A.D. Khirurgicheskoe lechenie bol'nykh s posleoperatsionnymi i retsidivnymi ventral'nymi gryzhami [Surgical treatment of patients with postoperative and recurrent ventral hernias]. Khirurgiia. Zhurn im NI Pirogova. 2007;(7):69–74.
  10. Zoltan Ia. Sicatrix optima. Operativnaia tekhnika i usloviia optimal'nogo zazhivleniia ran [Operative technique and the conditions for optimal wound healing]. Budapest, Hungary: AKADEMIAI KIADO; 1974. 173 p.
  11. Semenov GM. Khirurgicheskii shov [Surgical suture]. Saint-Petersburg, RF: Piter, 2001. 256 p.
  12. Obolenskii VN, Gorkush KN, Plotnikov AA. Modifikatsiia vnutrikozhnogo shva pri prolongirovannykh razrezakh [Modification of intracutaneous suture with prolonged cuts]. Rus Med Zhurn. 2010;18(17):1044. Available from: Rezhim dostupa: http://www.rmg.ru.
  13. Zarivchatskii MF, Iagovkin VF. Sravnitel'naia otsenka rezul'tatov operativnogo lecheniia bol'shikh i gigantskikh posleoperatsionnykh ventral'nykh gryzh [Comparative evaluation of surgical treatment results of large and giant postoperative ventral hernias].Vestn Khirurgii im II Grekova. 2005(6):33–37.
Address for correspondence:
249210, Rossiiskaia Federatsiia, Kaluzhskaia oblast', Babyninskii raion, p. Babynino, ul. Molodezhnaia, d. 11, GBUZ KO «TsRB Babyninskogo raiona»,
e-mail: aleksandrenkov@mail.ru,
Aleksandrenkov Nikolai Vladimirovich
Information about the authors:
Aleksandrenkov N.V. Head of the surgical service of SBME KR “Babyninsky central regional hospital”.
Mykhin A.S. MD, professor, head of the chair of surgery FPKV SBEE HPE “Nizhny Novgorod State Medical Academy of Ministry of Healthcare of Russia”.
Rebcovsky V.A. A senior clinical intern of the surgical department of MEHC “City clinical hospital ¹ 39”, Nizhny Novgorod.
Leontev A.E. PhD, a clinical intern of the surgical department of MEHC “City clinical hospital ¹ 39”, Nizhny Novgorod.

REVIEWS

M.YU. GAIN

LASER TECHNOLOGIES IN COMPLEX TREATMENT OF HEMORRHOIDS

SEE “Belarusian Medical Academy
of Postgraduate Education”.
The Republic of Belarus

Objectives. Using modern digital search systems to carry out the analysis of the national and foreign literature, concerning applications of mini-invasive laser technologies in surgical treatment of hemorrhoids, and by means of it to define the perspective directions to increase efficiency in the complex treatment of this disease and its complications.
Methods. With the use of the text database of medical and biological publications PubMed (on the basis of “Biotechnology” section of U.S. National Library of Medicine through the access NCBI-Entrez by principle application of “Medical Subject Headings” (MeSH), and also by means of the information received in funds of the State Establishment “Republican Scientific Medical Library” and library of the State Educational Establishment “Belarusian Medical Academy of Postgraduate Education”, the analysis of more than 700 medical sources of the special literature and full-text articles devoted to the high-intensity laser systems use in treatment of chronic hemorrhoids and its complications has been carried out.
Results. According to literary data, the destruction of hemorrhoidal nodes by means of the W-laser (classification of R.A. Weiss and Í. Valley) is considered to be a mini-invasive method of hemorrhoid treatment, based on the interstitial thermal therapy of nodes with its subsequently wrinkling, sclerosing and disappearance, and also occlusion influence on a vascular component. The performance of this method under local infiltrative anesthesia in ambulatory conditions should be considered as a positive aspect and advantage as well as absence of clinically significant rehabilitation period, fast restoration and returning of a patient to a normal life and work. All listed sets the conditions for improvement of patients’ life quality that provides considerable social and economic effects and allows speaking about prospects of new techniques use in ambulatory and mini-invasive proctology and surgery.
Conclusions. Priority of active surgical tactics, a reliable hemostasis and biological properties of the W-laser radiation, absence of necessity for long-term hospitalization appears to be the factors permitting to receive good results of acute and chronic hemorrhoids treatment.

Keywords: hemorrhoids, complications, mini-invasive technologies, intrahemorrhoidal laser influence
p. 94 – 104 of the original issue
References
  1. Vorob'ev GI, Blagodarnyi LA, Shelygin IuA. Gemorroi: ruk dlia prakt vrachei [Hemorrhoids: a practical guide for physicians]. 2-e izd, pererab, dop. Moscow, RF: Litterra; 2010. 200 p.
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Address for correspondence:
210013, Respublika Belarus', g. Minsk,ul. P. Brovki, d. 3, kor. 3, GUO «Belorusskaia meditsinskaia akademiia poslediplomnogo obrazovaniia», kafedra neotlozhnoi khirurgii,
e-mail: gain@tut.by,
Gain Mikhail Iur'evich
Information about the authors:
Gain M.Yu. A post-graduate student of the emergency surgery chair of SEE “Belarusian Medical Academy of Postgraduate Education”.

I.I. PIKIRENIA 1, SH.Z. SHARIPOV 1, O.S. BOGUSHEVICH 2

BILIARY STRICTURES AFTER ORTHOTOPIC LIVER TRANSPLANTATION

SEE “Belarusian Medical Academy of Postgraduate Education” 1,
Committee on Healthcare of Minsk Municipal Executive Committee, 2, Minsk
The Republic of Belarus

A review of the research dedicated to study the risk factors of biliary complications development after liver transplantation is presented in the article. The literature analysis has shown that despite on the appreciable achievements in the liver transplantation, there is still high incidence of the biliary complications development in the postoperative period while treating patients with the terminal stage of liver lesion caused by cirrhosis and a series of focal diseases.
The most wide spread types of biliary complications developed after orthotopic transplantations are considered the following: biliary and biliary-digestive anastomosis incompetence, their stricture as well as the non-anastomotic strictures of the biliary ducts. Among the variety of factors influencing the biliary complications development in the postoperative period are: prolonged transplant cold ischemia, blood circulation disturbance in the bile ducts, technical problems. Summarizing the literature data, risk factors of the non-anastomotic strictures can be subdivided into three main groups: ischemic, immunological and induced by salts of the bile acids.
Presence of the variety of risk factors for the biliary complications development requires further investigation and working out of methods for prevention of the biliary complications development after orthotopic liver transplantations.

Keywords: orthotopic liver transplantation, biliary complications, non-anastomotic biliary strictures
p. 105 – 110 of the original issue
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?
Address for correspondence:
210013, Respublika Belarus', g. Minsk, ul. P. Brovki, d. 3, kor. 3, GUO «Belorusskaia meditsinskaia akademiia poslediplomnogo obrazovaniia», kafedra transplantologii,
e-mail: pik-med@tut.by,
Pikirenia Ivan Ivanovich
Information about the authors:
Pikirenia I.I. PhD, associate professor, head of the transplantation chair of SEE “Belarusian Medical Academy of Postgraduate Education”.
Sharipov Sh.Z. A post-graduate student of the cardiac surgery chair with the course of transplantation of SEE “Belarusian Medical Academy of Postgraduate Education”.
Bogushevich O.S. PhD, chief surgeon of Committee of Health Care of Minsk municipal executive committee.

PRACTICAL CASES

I.P. SHTURICH, S.N. ERMASHKEVICH

GASTROINTESTINAL STROMAL TUMOR OF THE DUODENUM

EE “Vitebsk State Medical University”
The Republic of Belarus

The article presents a clinical case of the gastrointestinal stromal tumor of the duodenum.
In a 74-year-old woman during the surgery for stenosis of the Vater’s papilla and obstructive jaundice, the tumor in the 3 section of the duodenum, 4 cm in diameter was revealed. Cholecystectomy, wedge resection of the duodenal tumor, transduodenal papillosphincterotomy and papillosphincteroplasty with the duodenal defect suturing and choledochostomy on Halsted were carried out in the patient. At the pathohistological study, the removed formation was presented as a gastrointestinal stromal tumors (GIST) of the duodenum (CD 117+). The patient hadn’t any recurrence during 6 months after the surgery.
The data concerning epidemiology, clinical manifestation, diagnostics and treatment methods of this pathology are presented on the basis of the literature review.
Duodenal GIST is a rare disease, characterized by a predominantly local expansion, rarely involving lymph nodes and no tendency to metastases. Resection within healthy tissue and segmental resection of the duodenum are the method of choice at the treatment of duodenal GIST. Surgical treatment of extensive primary tumors or the metastasis or recurrent GIST of the duodenum should be integrated into a multimodal therapeutic concept that includes pancreatoduodenal resection and the targeted therapy with tyrosine kinase inhibitors.

Keywords: gastrointestinal stromal tumor, duodenum, surgical treatment, local resection of the duodenum
p. 111 – 116 of the original issue
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Address for correspondence:
210023, Respublika Belarus', g. Vitebsk, pr. Frunze, h.27, UO «Vitebskii gosudarstvennyi meditsinskii universitet», kafedra gospital'noi khirurgii s kursami urologii i detskoi khirurgii,
e-mail: ivan.shturich@mail.ru,
Shturich Ivan Pavlovich
Information about the authors:
Shturich I.P. PhD, associate professor, chair of hospital surgery with the course of urology and pediatric surgery. Educational Establishment "Vitebsk State Medical University."
Ermashkevich S.N. Assistant of hospital surgery chair with course of urology and pediatric surgery Educational Establishment "Vitebsk State Medical University."
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