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Year 2014 Vol. 22 No 1

HISTORY SURGERY

S.A. SUSHKOU, Y.S. NEBYLITSIN

SURGERY ON THE BELARUSIAN LANDS DURING THE FEUDAL PERIOD

EE “Vitebsk State Medical University”
The Republic of Belarus

The article deals with the historical review of the surgical aid state în the Belarusian lands during the feudal period (IX-XVIII centuries).
Surgery was considered as an important part of medicine in Kievan Rus incorporated Polotsk and Turov principalities. It was forming on the background of praslavic medicine, an original old Russian culture and under the influence of scientific achievements of neighboring countries. By the ÕI century in the period of the greatest prosperity of the Old Russian State two main types of medicine had coexisted – church-monastic and secular medicine. In the monastic hospitals the surgical aid was given free of charge by monks and for payment - by secular physicians. Secular physicians were considered as craftsmen. Substantially the surgical pathology was treated by general practitioners but simultaneously with it a narrow specialization of physicians has already begin to from manifesting the appearance of physician-surgeons. In the Old Russian state the surgical aid was successfully rendered in case of various diseases and physicians mastered by rational treatment techniques.
During the first two centuries after of the Belarusian lands incorporating into Grand Duchy of Lithuania the Old Russian traditions of medical aid rendering In the XV and XVI centuries medicine began transforming similarly to European countries with a manifestation of clear distinction between physicians and barber-surgeons. Barber guild played a major role in the development of surgery on the Belarusian lands; the population had the opportunity to get a qualified surgical care corresponding to the level of European countries. In the ÕVIII century to conduct objectively the medical reforms initiated in Europe has been failed. Despite on the creation of the first higher medical educational institution, before the collapse of the Rzeczpospolita, the surgeons remained in barbers’ status.
In the feudal period analysis of surgery development on the Belarusian lands has shown that depending on the national affiliation of these territories it was acquiring the original features. However, regardless of the organization form, the specialists rendered the surgical aid based on rational approaches and the applied treatment methods quite corresponded to their time.

Keywords: history of surgery, feudal period, Kievan Rus, Polotsk principality, Turov principality, Grand Duchy of Lithuania, Rzeczpospolita, Belarus
p. 5 – 17 of the original issue
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Address for correspondence:
210023, Respublika Belarus', g. Vitebsk, pr. Frunze, d. 27, UO «Vitebskii gosudarstvennyi meditsinskii universitet», kafedra obshchei khirurgii,
e-mail: sergery@nm.ru,
Sushkov Sergei Albertovich
Information about the authors:
Sushkou S.A. PhD, an associate professor, Vice-rector for the scientific research work of EE “Vitebsk State Medical University”.
Nebylitsin Y.S. PhD, an associate professor of the general surgery chair of EE “Vitebsk State Medical University”.

EXPERIMENTAL SURGERY

E. MATEVOSSIAN, I. SNOPOK, ANNE-K VON THADE, G. BABARYKA, D. DOLL

LIVER TRANSPLANTATION IN A RAT: A DESCRIPTION OF EXPERIMENTAL TRIALS, SURGICAL TECHNIQUE AND FUNCTION OF TRANSPLANT

The hospital “Rechts der Isar”, Munich Technical University1, Munich, Germany
Transplantation Center Munich, the hospital “Rechts der Isar”, Munich Technical University 2, Munich, Germany
St. Lukas Hospital 3, Solingen, Germany
Center for Preclinical Research, the hospital “Rechts der Isar”, Munich Technical University 4, Munich, Germany
Institute of General Pathology and Pathological Anatomy, the hospital “Rechts der Isar” of Munich Technical University, Munich 5, Germany
Catholic hospital Oldenburger Munsterland, St. Mary's Hospital 6, Vechta, Germany

Objectives. To develop the model of acute and chronic rejection of the liver graft in rats and studying of occurring histological and functional changes as well as the investigation of the technical modifications of the microvascular anastomoses.
Methods. DA-(RT1av1) rats served as donors, LEWIS-(RT1) rats served as recipients. The arterialized orthotopic liver transplantation (OLT) was performed using a combined suture, cuff and splint-method. The recipients were divided into 4 groups: control groups of syngeneic (I) and allogeneic animals (II), allogeneic rats with high-dose FK506 (Tacrolimus, Prograf®) immunosuppression (III), and allogeneic with high-dose immunosuppression and graft retrograde reperfusion (IV). After OLT blood serum parameters were determined and liver biopsy specimens studied. The histopathological peculiarities of acute rejection reaction with or without immunosuppressive treatment were studied.
Results. On the 10th day after OLT the syngeneic (I) and allogeneic rats with high-dose immunosuppression (group III and IV) showed the normal blood serum parameters and histopathological architectonics. Three-months survival-rate made up 98%. The simplified technique of OLT with one suture and two cuff anastomoses allowed obtaining the best short- and long-term survival rates in all groups of animals. Retrograde reperfusion of the graft via subhepatic part of nferior vena cava demonstrated the lowest values of postoperative liver enzyme in the blood serum.
Conclusions. The experimental model is considered to be easily reproducible and can be used for comprehensive basic research of liver transplantation. In this paper we present the practical recommendations for the quick mastering of this operation.

Keywords: liver transplantation, rat model, surgical technique, rejection, immunosuppression
p. 18 – 25 of the original issue
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Address for correspondence:
Priv.-Doz. Dr. med. habil. Edouard Matevossian, MD, Department of Surgery,
Klinikum rechts der Isar, Technische Universität München, Ismaninger Strasse 22, 81675 Munich, Germany.
e-mail: edouard.matevossian@tum.de
Information about the authors:
Matevossian E. MD, an associate professor of surgery, the hospital “Rechts der Isar” of Munich Technical University, Munich, Germany.
Snopok I. An assistant surgeon, St. Lukas hospital, Solingen, Germany.
Anne-K von Thaden, MD, Center for preclinical research, the hospital “Rechts der Isar” of Munich Technical University, Munich, Germany
Babaryka G. MD, Institute of General Pathology and Pathological Anatomy, the hospital “Rechts der Isar” of Munich Technical University, Munich, Germany
Doll D. MD, an associate professor of surgery, Catholic hospital Oldenburger Munsterland, St. Mary's Hospital, Vechta, Germany.

I.V. MAIBORODIN, I.V. KUZNETSOVA, E.A. BEREGOVOY, A.I. SHEVELA, V.I. MAIBORODINA, A.A. MANAEV, M.I. BARANNICK

ABSENCE OF COMPLETE RESORPTION OF POLYLACTIDE MATERIAL IN THE ORGANISM

Center of New Medical Technologies of the Institute of Chemical Biology and Fundamental Medicine of SB RAS, Novosibirsk,
The Russian Federation

Objectives. To estimate the reaction of rats’ tissues to the lactic acid polymers (PLA) implant and peculiarities of the processes of its resorption morphologically.
Methods. The experiments were carried out on 24 male rats inbred line of WAG weighing 180-200 g at the age of 6 months. Using the inhalation ester anesthesia the PLA fragment was implanted into the subcutaneous adipose tissue over the right shoulder blade. The animals were discharged from the experiment on the 1st, 2nd, 6th and 12th months after the operation. 6 rats were used for every point of the research. The implanted PLA together with the surrounding tissues were taken for the investigation, which were studied microscopically.
Results. It was revealed that after the PLA implantation it is encapsulated by the connective tissue. If the PLA fragment has the keen edges, a thick capsule is formed with the expressed inflammatory infiltration and the sclerosis of surrounding tissues. If the implant was without keen edges a thin capsule is formed and the inflammatory level is minimal. In all cases the giant cells of foreign bodies are in the capsule and surround it. Formation of the adhered multinuclear macrophages in the tissues surrounding the capsule is definitely due to the presence of small polymer fragments there. Gradually within 6 months the activity of inflammatory process reduced so as the thickness of the delimited capsule and strength of its attaching to the surrounding tissues. Expressiveness of the inflammation sharply increased up to 12 months after implantation, when as the result of the phagocytes enzymes action and deformation by the capsule PLA is either fragmented or diluted. Probably, a sharp increase of the inflammation reaction level by the time of the observation period termination correlated with the polymer degradation level.
Conclusions. Complete PLA destruction and absorption in an organism has not occurred, such polymers aren't fully biodegraded and destructed for a long time and generally via macrophage lysis. PLA use has to be critically reconsidered.

Keywords: polylactide, degradation, encapsulation, implantation, granulomatous inflammation
p. 26 – 32 of the original issue
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Address for correspondence:
630090, Rossiiskaia Federatsiia, g. Novosibirsk, pr. akad. Lavrent'eva, d. 8, Institut khimicheskoi biologii i fundamental'noi meditsiny SO RAN, Tsentr novykh meditsinskikh tekhnologii,
e-mail: imai@mail.ru,
Mayborodin Igor Valentinovich
Information about the authors:
Maiborodin I.V. MD, professor, a leading researcher of the stem cell laboratory of ICBFM SB RAS.
Kuznetsova I.V. PhD, a researcher of the stem cell laboratory of ICBFM SB RAS.
Beregovoy E.A. PhD, an applicant for Doctor’s degree of the regenerative surgery laboratory of ICBFM SB RAS.
Shevela A.I. MD, professor, Honored Physician of RF, Deputy Director of ICBFM SB RAS (Science).
Maiborodina V.I. MD, a senior researcher of the stem cell laboratory of ICBFM SB RAS.
Manaev A.A. A post-graduate student of the stem cell laboratory of ICBFM SB RAS.
Barannick M.I. PhD, an applicant for Doctor’s degree of the stem cell laboratory of ICBFM SB RAS.

GENERAL AND SPECIAL SURGERY

A.A. ZIANKOU, U.P. OSTROVSKIJ, K.S. VUHRISTENKO, N.G. LOJKO

COMPARATIVE ANALYSIS OF THE RESULTS OF MINIMALLY INVASIVE MYOCARDIAL REVASCULARIZATION AND CORONARY ARTERY BYPASS GRAFTING ON THE BEATING HEART AND WITH ARTIFICIAL BLOOD CIRCULATION

EE “Vitebsk Regional Clinical Hospital” 1,
EE “Vitebsk State Medical University” 2,
SE RSPC “Cardiology” 3,
SEE “Belarusian Medical Academy of Post-Graduate Education”4,
Minsk
The Republic of Belarus

Objectives. To carry out the comparative analysis of the immediate results of the minimally invasive myocardial revascularization (MIMR) and conventional coronary artery bypass surgery (CABS) on the beating heart and with artificial circulation (AC) for optimization of the surgical treatment of the patients with coronary artery disease (CAD).
Methods. During the period from 2008-2013 yrs. 183 patients with the CAD underwent MIMR (1st group), 156 patients – CABS via sternotomy (2nd group) and 99 patients – CABS with AC via sternotomy (3d group) in the cardiac surgery department of ME “Vitebsk regional clinical hospital”. In the 1st group the MIMR strategy was directed to avoid the artificial circulation with cardioplegia and manipulations on the ascending aorta, application of the left minithoracotomic access and tendency to perform complete or functionally adequate composite-sequential arterial myocardial revascularization.
Results. MIMR with aortic no-touch technique was accompanied by the lower index of revascularization (2,33) in comparison with traditional AC on the beating heart (2,79) and with AC (3,17), more frequent application of arterial bypass (80,9%, 54,5% è 43,4%), reducing the frequency of complete (62,8%, 87,8% è 89,9%) and increasing the incidence of functionally adequate revascularization (37,2%, 12,2% è 10,1%) of myocardial revascularization (ð<0,05). Immediate results were found to be satisfactory (absence of the major cardiovascular complications) in 98,9% of patients (MIMR group), in 96,8% of patients (CABS group on BH) and 95,0% of patients (CABS group with AC) and they were quite comparable (ð>0,05).
Conclusions. Application of the MIMR leads to the reduction of the perioperative complications rate (intra- and postoperative blood loss, wound infection) and also to the decrease the length of postoperative hospital stay saving the effectiveness of the coronary procedures. Further comparative randomized trials of minimally invasive coronary surgery results are considered to be necessary with respect to survival, quality of life, the frequency of adverse events, patency of the shunts.

Keywords: minimally invasive myocardial revascularization, minimally invasive coronary surgery, complete revascularization, functionally adequate revascularization
p. 33 – 43 of the original issue
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  6. Jansen EW, Borst C, Lahpor JR, Grundeman PF, Eefting FD, Nierich A, Robles de Medina EO, Bredee JJ. Coronary artery bypass grafting without cardiopulmonary bypass using the octopus method: results in the first one hundred patients. J Thorac Cardiovasc Surg. 1998 Jul;116(1):60–67.
  7. Puskas JD, Williams WH, Duke PG, Staples JR, Glas KE, Marshall JJ, Leimbach M, Huber P, Garas S, Sammons BH, McCall SA, Petersen RJ, Bailey DE, Chu H, Mahoney EM, Weintraub WS, Guyton RA. Off-pump coronary artery bypass grafting provides complete revascularization with reduced myocardial injury, transfusion requirements, and length of stay: a prospective randomized comparison of two hundred unselected patients undergoing off-pump versus conventional coronary artery bypass grafting. J Thorac Cardiovasc Surg. 2003 Apr;125(4):797–808.
  8. Cheng DC, Bainbridge D, Martin JE, Novick RJ; Does off-pump coronary artery bypass reduce mortality, morbidity, and resource utilization when compared with conventional coronary artery bypass? A meta-analysis of randomized trials. Anesthesiology. 2005 Jan;102(1):188–203.
  9. Chu D, Bakaeen FG, Dao TK, LeMaire SA, Coselli JS, Huh J. On-pump versus off-pump coronary artery bypass grafting in a cohort of 63,000 patients. Ann Thorac Surg. 2009 Jun;87(6):1820–26.
  10. Harahsheh B. Transit Time Flowmetry in Coronary Artery Bypass Grafting-experience at Queen Alia Heart Institute, Jordan. Oman Med J. 2012 Nov;27(6):475–77.
  11. Di Giammarco G, Rabozzi R. Can transit-time flow measurement improve graft patency and clinical outcome in patients undergoing coronary artery bypass grafting? Interact Cardiovasc Thorac Surg. 2010 Nov;11(5):635–40.
  12. Hannan EL, Wu C, Walford G, Holmes DR, Jones RH, Sharma S, King SB 3rd. Incomplete revascularization in the era of drug-eluting stents: impact on adverse outcomes. JACC Cardiovasc Interv. 2009 Jan;2(1):17–25.
  13. van den Brand MJ, Rensing BJ, Morel MA, Foley DP, de Valk V, Breeman A, Suryapranata H, Haalebos MM, Wijns W, Wellens F, Balcon R, Magee P, Ribeiro E, Buffolo E, Unger F, Serruys PW. The effect of completeness of revascularization on event-free survival at one year in the ARTS trial. J Am Coll Cardiol. 2002 Feb 20;39(4):559–64.
  14. Serruys PW, Morice MC, Kappetein AP, Colombo A, Holmes DR, Mack MJ, Stahle E, Feldman TE, van den Brand M, Bass EJ, Van Dyck N, Leadley K, Dawkins KD, Mohr FW; Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease. N Engl J Med. 2009 Mar 5;360(10):961-72.
  15. Moher D, Hopewell S, Schulz KF, Montori V, Gotzsche PC, Devereaux PJ, Elbourne D, Egger M, Altman DG. CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials. BMJ. 2010 Mar 23;340:c869.
Address for correspondence:
210037, Respublika Belarus', g. Vitebsk, ul. Voinov-internatsionalistov, d. 37, UZ «Vitebskaia oblastnaia klinicheskaia bol'nitsa», otdelenie kardiokhirurgii,
e-mail: Zenkov_Al@rambler.ru,
Ziankou Alexander Alexandrovich
Information about the authors:
Ziankou A.A. PhD, a head of the cardiac surgery department of ME “Vitebsk Regional Clinical Hospital”, an associate professor of the surgery chair of Faculty of Advanced Training and Staff Retraining of EE “Vitebsk State Medical University”.
Ostrovskij U.P. Corresponding member of National Academy of Sciences, MD, professor, a head of laboratory of cardiac surgery of SE RSPC “Cardiology”, a head of cardiac surgery chair of SEE “Belarusian Medical Academy of Postgraduate Education”.
Vuhristenko K.S. An assistant of the hospital surgery chair of EE “Vitebsk State Medical University”.
Lojko N.G. A cardiologist of the cardiac surgery chair of EE “Vitebsk State Medical University”.

O.S. OLIFIROVA, N.N. TRYNOV, S.V. KNALYAN, L.K. RESHETNICOVA, M.A. SHTARBERG, N.I. PROCLOVA

POSTOPERATIVE HYPOTHYROIDISM: SOME CLINICAL AND HUMORAL ASPECTS

SBEE HPE “Amur State Medical Academy”,
Blagoveshchensk,
The Russian Federation

Objectives. To specify reasons, features of humoral changes and principles of correction of the early postoperative hypothyroidism (POH).
Methods. The patients were divided into two groups depending on the conducted treatment. The first group was made up of the patients with early postoperative hypothyroidism (24), the second group – the patients (19) without clinical or laboratory signs of postoperative hypothyroidism. The content of peroxidation products and antioxidant protection, the thyroid and immune status were studied before the surgery on the thyroid gland, and on the 10th day after the surgery.
Results. It has been established that in 75% of cases the postoperative hypothyroidism appeared on the 10th day of the postoperative period after thyroidectomy and maximum subtotal resection of the thyroid gland in patients with the initial euthyroid and hypothyroid (any volume of the operation). The patients from the first group had significant decrease of indicators of cytokines (IL-4, IL-6, IL-10, TNF- α), humoral (IgA, IgG) and cellular immunity (lymphocytes, ÑD3+, CD4+, CD8+, ÑÄ16+, ÑÄ25+) in comparison with the initial level and the similar figures of the patients from the second group. In the first group patients with POH the activation of lipid peroxidation (LPO) and the reduction of antioxidant protection (AOP) due to the increasing of the level of diene conjugates and hydroperoxides lipids are registered as well as the reduction of vitamin E content.
Conclusions. The factors enabling to predict the occurrence of early POH during the recent 10 days of the postoperative period are considered to be the surgery of thyroidectomy and maximal subtotal resection of the thyroid gland on the euthyroid background as well as the initial hypothyroidism at any volume of the surgery. Early postoperative hypothyroidism is accompanied by the secondary immunodeficiency, the activation of lipid peroxidation and the decrease of hydroperoxides lipids. The rehabilitation of the postoperative hypothyroidism patients should include the correction of hormonal and immune disorders.

Keywords: hypothyroidism, thyroid gland, surgery, immune status, lipid, peroxidation
p. 44 -50 of the original issue
References
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Address for correspondence:
675000, Rossiiskaia Federatsiia, g. Blagoveshchensk, ul. Gor'kogo, d. 95, GBOU VPO «Amurskaia gosudarstvennaia meditsinskaia akademiia», fakul'tet poslediplomnogo obrazovaniia, kafedra khirurgicheskikh boleznei,
e-mail: olif.oc @ mail.ru,
Olifirova Olga Stepanivna
Information about the authors:
Olifirova O.S. MD, an associate professor, a head of the surgical diseases chair of PGEF SBEE HPE “Amur State Medical Academy”.
Trynov N.N. A post-graduate student of the surgical diseases chair of PGEF SBEE HPE “Amur State Medical Academy”.
Knalyan S.V. A post-graduate student of the surgical diseases chair of PGEF SBEE HPE “Amur State Medical Academy”.
Reshetnicova L.K. PhD, an assistant of the faculty therapy chair of SBEE HPE “Amur State Medical Academy”.
Shtarberg M.A. PhD, a senior researcher of CSRL of SBEE HPE “Amur State Medical Academy”.
Proclova N.I. A clinical resident of the surgical diseases chair of PGEF SBEE HPE “Amur State Medical Academy”.

V.I. BELOKONEV, S.Y. PUSHKIN, À.S. BENYAN, I.R. KAMåEV, M.P. AYRAPETOVA

THE PECULIARITIES OF DIAGNOSTICS AND TREATMENT OF PATIENTS WITH ESOPHAGEAL TRAUMA CAUSED BY METALLIC DEVICES FOR CERVICAL SPINE FIXATION

SBEE HPE “Samara State Medical University”1,
SBME SO “Samara Regional Clinical Hospital named after M.I. Kalinin” 2,
The Russian Federation

Objectives. To determine the peculiarities of the esophageal trauma caused by metallic devices for cervical spine fixation and work out intraoperative treatment tactics.
Methods. The treatment analysis of 14 patients with the esophageal trauma caused by the cervical spine fixation caused by metallic devices has been carried out. The complications have been confirmed by the esophageal roentgenography and computed tomography (CT). All patients have been operated on. The operation characteristics depended on the alterations in the esophageal wall, perforation size, kind of injury and mediastinitis prevalence.
Results. Three mechanisms of the esophageal trauma are distinguished: 1) when metallic devices placement; 2) as the result of the device pressure on the esophageal wall or migration of the fixed screws into the organ lumen; 3) when devices removal. The first kind of the injury was registered in 5 patients, the second in 5, and the third – in 4. The partial suturing of the esophagus was done in 6 patients, the partial suture incompetence occurred in 2 cases and it resulted in the repeated operations. The partial suturing of the defect and through luminal transesophageal drainage of the fistula and mediastinum in the manner of V.I. Belokonev (2005) has been performed in 8 patients. The drainage of the esophageal perforation through its lumen contributed to forming of the tubular fistula which closed on its own. One out of 14 patients died from multiorganic failure and sepsis.
Conclusions. Esophageal injury by the metallic device used for the vertebral fixation has the peculiarities of clinical course. The suturing of the esophageal defect in combination with the suture line strengthening by the local tissues is indicated in the cases of minor changes of the esophageal wall and absence of pyogenic inflammations. In pyogenic necrotic lesions and fistula recurrence the esophageal defect suturing in the combination with a through luminal transesophageal drainage of the trauma and mediastinum area is required. The suturing of the esophageal defect and the suture strengthening m. sternocleidomastoideus on the pedicle complemented by a through luminal transesophageal drainage have advantage in comparison with the esophageal wall suturing without drainage.

Keywords: vertebral instability, spondylodesis, metallic devices, injury of esophagus, treatment
p. 51 -57 of the original issue
References
  1. Polishchuk NE, Korzh NA, Fishchenko VIa. Povrezhdeniia pozvonochnika i spinnogo mozga (mekhanizmy, klinika, diagnostika, lechenie) [Trauma of the spine and spinal cord (mechanisms, clinical manifestations, diagnosis, treatment)]. Kiev, Ukraina: Kniga plius; 2001. 388 p.
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  15. Wierzbicka M, Bartochowska A, Banaszewski J, Szyfter W. Cervical oesophageal and hypopharyngeal perforations after anterior cervical spine surgery salvaged with regional and free flaps. Neurol Neurochir Pol. 2013 Jan-Feb;47(1):43–8.
Address for correspondence:
443095, Rossiiskaia Federatsiia, g. Samara, ul. Tashkentskaia, d. 159, GBUZ SO «Samarskaia oblastnaia klinicheskaia bol'nitsa im. M.I. Kalinina»,
e-mail: serpuschkin@mail.ru,
Pushkin Sergey Yur’evich
Information about the authors:
Belokonev V.I. MD, professor, a head of the surgical diseases chair ¹2 of SBEE HPE “Samara State Medical University”.
Pushkin S.Yu. MD, a deputy chief physician of surgery of SBME ND “Samara Regional Clinical Hospital named after M.I. Kalinin”, a head specialist of Ministry of Health of Samara region (thoracic surgery).
Benyan A.S. PhD, a head of the surgical thoracic department of SBME ND “Samara Regional Clinical Hospital named after M.I. Kalinin”.
Kameev I.R. A thoracic surgeon of the surgical thoracic department of SBME ND “Samara Regional Clinical Hospital named after M.I. Kalinin”.
Ayrapetova M.P. A thoracic surgeon of the surgical thoracic department of SBME ND “Samara Regional Clinical Hospital named after M.I. Kalinin”.

Y.S. VINNIK, S.S. DUNAEVSKAYA, D.A. ANTUFRIEVA

POSSIBILITY OF THE CURRENT METHODS OF VISUALIZATION AT SEVERE ACUTE PANCREATITIS

SBEE HPE “Krasnoyarsk State Medical
University named after prof. V.F.
Voyno-Yasenetsky”
The Russian Federation

Objectives. To determine effectiveness of application of ultrasonography (US), CT-angiography and magnetic resonance imaging (MRI) in diagnosis of severe acute pancreatitis in the enzymatic stage of the disease.
Methods. 30 patients with diagnosis of a severe acute pancreatitis in the enzymatic stage of the disease have been studied. The age of patients varied between 23 and 76 years. The patients were carried out US of the abdominal cavity organs, CT-angiography with contrast bolus and MRI with contrast in the period between 24 and 48 hour after hospitalization. All patients (abdominal organs) were scanned by B-mode Ultrasonography with Aloka product (model SSD-3500) Ultrasound diagnostic system equipped with 3,5 MHz transducer. As the peculiarity of the conduction of CT-angiography is the performance of a 3-phase scan: native (contrast free), arterial and venous. The delay of scanning start for obtaining the arterial phase was determined automatically according to the program Bolus tracking.
A series of images in the coronal and axial planes in T1VI and T2VI has been performed in MRI and MR cholangiography. The recommended dosage of MAGNEVIST injection is 0,2 ml/kg.
To assess diagnostic methods of efficacy the following parameters have been calculated: sensitivity, specificity, accuracy, prognostic value of a positive result (PVPR), prognostic value of a negative result (PVNR).
Results. While determining efficacy of the visualization methods at severe acute pancreatitis US sensitivity was made – 50%, specificity – 20,0%, accuracy – 37,1%, PVPR – 45,5%, PVNR – 23,1%. While establishing MRI effectiveness sensitivity made up 86,9%, specificity – 100%%, accuracy – 90%, PVPR – 100%, PVNR – 70%.
Conclusions. CT-angiography and MRI revealed no reliable diagnostic distinctions. The more clearly visualization of infiltration sites and collection of fluid in the peritoneal cavity are considered to be the advantages of MRI with contrast. Ultrasonography appears to be not able to provide the clearly visualization of lesion volume, however, is considered to be relevant as a screening method.

Keywords: acute pancreatitis, diagnostics, visualization, severe course
p. 58 – 62 of the original issue
References
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Address for correspondence:
660022, Rossiiskaia Federatsiia, g. Krasnoiarsk, ul. Partizana Zhelezniaka, d. 1, GBOU VPO «Krasnoiarskii gosudarstvennyi meditsinskii universitet im. prof. V.F. Voino-Iasenetskogo», kafedra obshchei khirurgii,
e-mail: Vikto-potapenk@yandex.ru,
Dunaevskaya Svetlana Sergeevna
Information about the authors:
Vinnick Y.U. MD, a head of the chair of general surgery of SEI HPE "Krasnoyarsk State Medical University named after prof. V.F. Voyno-Yasenetsky".
Dunaevskaya S.S. PhD, an associate professor of the chair of general surgery of SEI HPE "Krasnoyarsk State Medical University named after prof. V.F. Voyno-Yasenetsky."
Antyufrieva D.A. A clinical resident of a chair of general surgery of SEI HPE "Krasnoyarsk State Medical University named after prof. V.F. Voyno-Yasenetsky."

V.N. CHERNOV, B.M. BELIK, A.Z. ALIBEKOV

TREATMENT OF THE INFECTED FORMS OF ACUTE DESTRUCTIVE PANCREATITIS USING MINIMALLY INVASIVE TECHNOLOGIES

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

Objectives. To determine the role and estimate clinical efficiency of minimally invasive interventions in treatment of patients with the infected forms of the acute destructive pancreatitis (ADP).
Methods. The study included 167 patients with infected forms of ADP, 48 (28,7%) patients underwent minimally invasive interventions. In 32 patients by ultrasonically guided percutaneous puncture and drainage interventions (PPDI) have been performed, in 3 patients – under video laparoscopic control, 6 patients underwent necrosectomy by video laparoscopy and/or retroperitoneosopy and 7 patients underwent necrosectomy from mini approaches with application of set “mini-Assistant”. The choice of a minimally invasive method was defined strictly individually taking into account the character, volume and localization of a purulent cavity, the sizes of sequesters, the ratio of fluidic and tissue components, and also initial severity of a patient condition according to SAPS scale.
Results. From 48 patients with the infected forms of ADP who were subjected to minimally invasive interventions, a positive clinical effect was obtained in 41 (85,4%) patients. In these patients minimally invasive interventions appeared to be the final surgical manipulation. In 7 (14,6%) cases after the minimally invasive interventions application the further traditional surgical treatment was considered to be necessary. The postoperative lethality in the group of patients with the infected forms of ADP, who were subjected to the minimally invasive interventions, made up 12,5%.
Conclusions. Minimally invasive intervention is considered to be the effective methods of surgical treatment of patients with the infected forms of ADP with obligatory careful selection of patients and a strict individual approach to the choice of operation.

Keywords: pancreatonecrosis, minimally invasive surgery, transcutaneous drainage, necrosectomy
p. 63 – 67 of the original issue
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  12. Balnykov SI. Chreskozhnye vmeshatel'stva pod kontrolem UZI u bol'nykh pankreaonekrozom [Percutaneous ultrasound-guided intervention in patients with necrotizing pancreatitis]. Med Vizualizatsiia. 2010;(2):104–08.
  13. Carter R. Percutaneous management of necrotizing pancreatitis. HPB (Oxford). 2007(3) 9:235–39.
  14. Gel'fand BR, Burnevich SZ, Brazhnik TB, Sergeeva NA. Novoe v diagnostike infektsionnykh oslozhnenii i sepsisa v khirurgii: rol' opredeleniia prokal'tsitonina [New in the diagnosis of infectious complications and sepsis in surgery: the role of determining procalcitonin]. Infektsii v Khirurgii. 2003;(1):8–13.
  15. Istomin NP, Belov IN, Egorov MS, Agapov KV, Dzugkoeva FA. Primenenie lechebno-diagnosticheskogo algoritma dlia opredeleniia khirurgicheskoi taktiki u bol'nykh s pankreonekrozom [Application of diagnostic and treatment algorithm for determining the surgical approach in patients with necrotizing pancreatitis]. Khirurg. 2010;7:6–13.
Address for correspondence:
344000, Rossiiskaia Federatsiia, g. Rostov-na-Donu, per. Nakhichevanskii, d. 29, GBOU VPO «Rostovskii gosudarstvennyi meditsinskii universitet», kafedra obshchei khirurgii,
e-mail: xupypr@doctor.com,
Alibekov Albert Zaurbekovich
Information about the authors:
Chernov V.N. MD, an Honored Scientist of RF, professor, a head of the general surgery chair of SBEE HPE “Rostov State Medical University”.
Belik B.M. MD, professor the general surgery chair of SBEE HPE “Rostov State Medical University”.
Alibekov A.Z. A post-graduate student of the general surgery chair of SBEE HPE “Rostov State Medical University”.

I.I. KATELNITSKIY, IG.I. KATELNITSKIY

THE IMPACT OF TYPE AND VOLUME OF BLOOD FLOW RESTORATION ON LONG-TERM SURGICAL TREATMENT RESULTS IN PATIENTS WITH OBLITERATING ATHEROSCLEROSIS IN STAGE OF CHRONIC CRITICAL ISCHEMIA OF THE LOWER EXTREMITIES

SBEE HPE "Rostov State Medical University"
The Russian Federation

Objectives. To assess the long-term revascularization results depending on the volume, type of reconstructive interventions as well as the achieved degree of the blood flow compensation as a result.
Methods. Operative treatment results of 157 patients with atherosclerotic occlusions of the lower extremities arteries have been analyzed. Patients were subdivided into 2 groups. Open interventions on the iliac-femoral-popliteal region without blood flow correction along the shin vessels were done in the 1st group (66 patients). Shin revascularization using the combined or hybrid techniques was carried out in the 2nd group (91 patients). The long-term results were followed in terms up to 5 years.
Morphological and functional changes of the blood cells flowing from the ischemic extremities as well as their regress depending on the volume of the blood flow restoration were studied in 57 patients.
Results. A positive result immediately after the operation was obtained in 56,1% of patients of the 1st group and in 62,9% of patients of the 2nd group. The same percentage of positive outcomes was registered immediately after the surgery in the 1st group in (63,1%) and in (63,1%) in the 2nd group, thus a significant prevalence of positive results (29,5%) in the 2nd group of patients compared with the 1st group (16,7%) has been detected. Negative results in the patients of the 2nd group made up 13,1%, it was lower than in the patients of the 1st group (20,2%). Within the whole period 73,23% cases of thrombosis were registered in the 1st group and in the 2nd group they occurred reliably seldom – 58,76%.
At electronic microscopy the rough changes of the structure and function of blood cells were revealed that testify to thrombus formation tendency correcting by the blood flow disturbance degree.
Conclusions. While using the combination of open and X-ray-endovascular methods of revascularization the better results were obtained in short- and long-term terms. Severe disturbances of the blood cell composition were registered in patients with obliterating atherosclerosis. Disturbance regress was more evident in the blood flow restoration on all affected portion of the extremity arterial system.

Keywords: obliterating atherosclerosis, critical ischemia, operative treatment, revascularization, hybrid intervention, morphology of blood cells
p. 68 - 74 of the original issue
References
  1. Carruthers TN, Farber A. Current state of affairs in the treatment of infrainguinal critical limb ischemia. Angiol Sosud Khir. 2013;19(2):133-7, 129-33.
  2. Nemkov AS, Kobak AE, Lembrikov IA, Batalin IV, Belyi SA, Lukashenko VI, Senchik IIu. Uspeshnaia simul'tannaia operatsiia u bol'nogo s mul'tifokal'nym aterosklerozom [Successful simultaneous operations in a patient with multifocal atherosclerosis]. Vestn Khir im II Grekova. 2011;170(4):105–106.
  3. Gavrilenko AV, Egorov AA, Kotov AE, Molokopoi SN, Mamukhov AS. Metody khirurgicheskogo lecheniia bol'nykh obliteriruiushchimi zabolevaniiami arterii nizhnikh konechnostei s porazheniem distal'nogo rusla (chast' II) [Surgical treatment of patients with obliterating diseases of the arteries of the lower extremities with a lesion of the distal bed (Part II)]. Angiol Sosud Khir. 2011;17(4):115–20.
  4. Gavrilenko AV, Voronov DA, Kochetov SV. Prognozirovanie rezul'tatov arterial'nykh rekonstruktsii i veroiatnosti progressirovaniia ateroskleroza na osnovanii urovnia plazmennykh tsitokinov [Predicting the results of arterial reconstruction and the likelihood of progression of atherosclerosis based on the level of plasma cytokines]. Angiol Sosud Khir. 2010;16(3):146-51.
  5. Uchkin IG, Shugushev ZKh, Talov NA, Bagdasarian AG, Gonsales AK, Khmyrova AV. Opyt primeneniia gibridnykh metodik khirurgicheskogo lecheniia patsientov s kriticheskoi ishemiei nizhnikh konechnostei [The trial of the use of hybrid methods of surgical treatment of patients with critical ischemia of the lower limbs]. Angiol Sosud Khir. 2013;19(2):48–57.
  6. Pityk OI, Prasol VA, Boiko VV. Vybor metoda revaskuliarizatsii u patsientov s kriticheskoi ishemiei nizhnikh konechnostei [Select method revascularization in patients with critical lower limb ischemia]. Klin Khirurgiia. 2013 Apr;(4):48-51.
  7. Shval'b PG, Kalinin RE. Antioksidantnaia zashchita i funktsional'noe sostoianie endoteliia u bol'nykh obliteriruiushchim aterosklerozolm arterii nizhnikh konechnostei do i posle operativnogo lecheniia [Antioxidant protection and endothelial function in patients with obliterating atherosclerosis of the lower limbs before and after surgery]. Khirurgiia. Zhurn im NI Pirogova. 2009;(1):53–55.
  8. Vita JA, Hamburg NM. Does endothelial dysfunction contribute to the clinical status of patients with peripheral arterial disease? Can J Cardiol. 2010 Mar;26 Suppl A:45A-50A.
  9. De Haro Miralles J., Martinez-Aguilar E., Florez A., Varela C., Bleda S., Acin F. Nitric oxide: link between endothelial dysfunction and inflammation in patients with peripheral arterial disease of the lower limbs. Interact Cardiovasc Thorac Surg. 2009 Jul;9(1):107–12.
  10. Davies PF, Civelek M. Endoplasmic reticulum stress, redox, and a proinflammatory environment in athero-susceptible endothelium in vivo at sites of complex hemodynamic shear stress. Antioxid Redox Signal. 2011 Sep 1;15(5):1427-32.
  11. Weis-Muller BT, Rommler V, Lippelt I, Porath M, Godehardt E, Balzer K, Sandmann W. Critical chronic peripheral arterial disease: does outcome justify crural or pedal bypass surgery in patients with advanced age or with comorbidities? Ann Vasc Surg. 2011 Aug;25(6):783-95.
  12. Ohno T, Kaneda H., Nagai Y, Fukushima M. Regenerative medicine in critical limb ischemia. J Atheroscler Thromb. 2012;19(10):883-9.
  13. Pokrovskii AV. Klinicheskaia angiologiia [Clinical angiology]: prakt ruk: v 2 t. Moscow, RF: Meditsina; 2004;2. 878 p.
Address for correspondence:
344000, Rossiiskaia Federatsiia, g. Rostov-na-Donu, per. Nakhichevanskii, d. 29, GBOU VPO «Rostovskii gosudarstvennyi meditsinskii universitet», kafedra khirurgicheskikh boleznei ¹1,
e-mail: katelnizkji@mail.ru,
Katelnitskiy Igor Ivanovich
Information about the authors:
Katelnitskiy I.I. MD, professor, a head of the chair of surgical diseases N1 SBEE HPE
"Rostov State Medical University" Public Health Ministry of Russian Federation
Katelnitskiy Ig.I. PhD, an accosiate profesor of the chair of surgical diseases N1 SBEE HPE
"Rostov State Medical University" Public Health Ministry of Russian Federation

TRANSPLANTOLOGY

A.E. SHCHERBA, S.V. KOROTKOV, O.A. LEBEDZ, M.M. SAUCHUK, À.M. DZYADZKO, À.F. MINOU, E.O. SANTOCKY, Î.O. RUMMO

EXPERIMENTAL HYPOTHERMIC MACHINE PERFUSION OF LIVER GRAFTS BY CUSTODIOL HTK SOLUTION

Republican Scientific and Practical Center “Organs and Tissues Transplantation”,
ME “The 9th City Clinical Hospital”, Minsk 1,
SEE “Belarusian Medical Academy of Postgraduate Education” 2,
ME “City Clinical Pathoanatomical Bureau”, Minsk3,
The Republic of Belarus

Objectives. To define experimentally the efficiency and safety of the hypothermic machine perfusion of the liver grafts with Custodiol HTK preservation solution.
Methods. The study was carried out on five donor organs taken from donors with deceased brain, beating heart and with liver recognized to be non-transplantable according to some factors by the donor team. The apparatus of artificial blood circulation was used as a pump. The circuit of the solution circulation was open with free outflow from the inferior vena cava. Solution perfusion was performed through portal vein only, the intake – from the container with the organ located. The left portal vein was clamped to prevent machine perfusion and continuation of a static cold preservation of the left liver lobe. The intake of effluent from the hepatic veins for a biochemical analysis as well as the biopsy of both liver lobes was performed for efficacy estimation.
Results. It has been established that the machine perfusion leads to more profound liver hypothermia two hours after the beginning of perfusion. The another important aspect is considered as a reliable reduction of cytolytic markers expression maximum for two hours. The machine perfusion contributed to the reliable reduction of AST and LDH from the perfused lobe with respect to the initial value. Wherein the values of AST, LDH and ALT in a static cold preservation lobe have not changed reliably comparing to the initial value. Moreover a double reduction of level of necrosis and apoptosis in the perfused lobe was registered in comparison with a static cold preserved lobe after eleven-hours machine perfusion.
Conclusions. The application of hypothermic machine liver perfusion with Custodiol HTK solution with approximated to physiological flow parameters leads to decrease of AST and ALT levels and lactic acidosis. Moreover it associated with reduction of necrosis and apoptosis of hepatocytes in comparison with a static cold liver preservation.

Keywords: liver graft, machine perfusion, ischemia reperfusion injury, Custodiol, HTK solution
p. 75 – 82 of the original issue
References
  1. Ohkohchi N. Mechanisms of preservation and ischemic/reperfusion injury in liver transplantation. Transplant Proc. 2002 Nov;34(7):2670–3.
  2. Briceno J, Marchal T, Padillo J, Solorzano G, Pera C.Influence of marginal donors on liver preservation injury. Transplantation. 2002 Aug 27;74(4):522–6.
  3. Bussutil RW, Klintmalm GK. Transplantation of the liver. Elsevier; 2005. 186 p.
  4. Monbaliu D, Brassil J, Heedfeld V, et al. Comparison of cold storage versus hypothermic machine perfusion in a preclinical model of liver transplantation. Transplantation. 2006; 82(1)(suppl 3): 90-91.
  5. Olschewski P, Gass P, Ariyakhagorn V, Jasse K, Hunold G, Menzel M, Schoning W, Schmitz V, Neuhaus P, Puhl G. The influence of storage temperature during machine perfusion on preservation quality of marginal donor livers.Cryobiology. 2010 Jun;60(3):337–43.
  6. Vekemans K, Liu Q, Pirenne J, Monbaliu D.Artificial circulation of the liver: machine perfusion as a preservation method in liver transplantation. AnatRec (Hoboken). 2008 Jun;291(6):735-40.
  7. Monbaliu D, Brassil J. Machine perfusion of the liver: past, present and future. Curr Opin Organ Transplant. 2010 Apr;15(2):160–6.
  8. Hart NA, van der Plaats A, Leuvenink HG, van Goor H, Wiersema-Buist J, Verkerke GJ, Rakhorst G, Ploeg RJ. Hypothermic machine perfusion of the liver and the critical balance between perfusion pressures and endothelial injury.Transplant Proc. 2005 Jan-Feb;37(1):332–4.
  9. Guarrera JV, Henry SD, Samstein B, Odeh-Ramadan R, Kinkhabwala M, Goldstein MJ, Ratner LE, Renz JF, Lee HT, Brown RS Jr, Emond JC. Hypothermic machine preservation in human liver transplantation: the first clinical series. Am J Transplant. 2010 Feb;10(2):372-81.
  10. Stegemann J, Hirner A, Rauen U, Minor T. Use of a new modified HTK solution for machine preservation of marginal liver grafts.J Surg Res. 2010 May 1;160(1):155–62.
  11. Matsuoka L, Shah T, Aswad S, Bunnapradist S, Cho Y, Mendez RG, Mendez R, Selby R. Pulsatile perfusion reduces the incidence of delayed graft function in expanded criteria donor kidney transplantation. Am J Transplant. 2006 Jun;6(6):1473–8.
  12. Dutkowski P, Odermatt B, Heinrich T, Schonfeld S, Watzka M, Winkelbach V, Krysiak M, Junginger T. Hypothermic oscillating liver perfusion stimulates ATP synthesis prior to transplantation. J Surg Res. 1998 Dec;80(2):365–72.
  13. Monbaliu D, Liu Q, Libbrecht L, De Vos R, Vekemans K, Debbaut C, Detry O, Roskams T, van Pelt J, Pirenne J. Preserving the morphology and evaluating the quality of liver grafts by hypothermic machine perfusion: a proof-of-concept study using discarded human livers. LiverTranspl. 2012 Dec;18(12):1495-507.
Address for correspondence:
220116, Respublika Belarus', g. Minsk, ul. Semashko, d. 8, RNPTs «Transplantatsii organov i tkanei», UZ «9-ia gorodskaia klinicheskaia bol'nitsa», otdel transplantologii.
e-mail: max.sauchuk @ mail.ru,
Sauchuk Maxim Mikhailovich
Information about the authors:
Shcherba A.E. PhD, an associate professor, a head of the transplantation department of RSPC “Organs and Tissues Transplantation”, ME “The 9th City Clinical Hospital”, Minsk.
Korotkov S.V. PhD, an associate professor, a head of the 1st surgical department of ME “The 9th City Clinical Hospital”, Minsk.
Lebedz O.A. A pathologist of ME “City Clinical Pathoanatomical Bureau”, Minsk. Savchuk M.M. A post-graduate student of the transplantation chair, SEE “Belarusian Medical Academy of Postgraduate Education”.
Dzyadzko A.M. PhD, an associate professor, a head of the anesthesia and reanimation department of RSPC “Organs and Tissues Transplantation”, ME “The 9th City Clinical Hospital”, Minsk.
Minov A.F. A head of the anesthesia department of RSPC “Organs and Tissues Transplantation”, ME “The 9th City Clinical Hospital”, Minsk.
Santocky E.O. A head of the anesthesia and reanimation department ¹2 of ME “The 9th City Clinical Hospital”, Minsk.
Rummo O.O. MD, an associate professor, a head of RSPC “Organs and Tissues Transplantation”, ME “The 9th City Clinical Hospital”, Minsk.

NEW METHODS

A.N. RAZIN, B.N. ZHUKOV, A.A. CHERNOV, S.E. KATORKIN

THE METHOD OF OPERATIVE TREATMENT OF PATIENTS WITH EXTRASPHINCTERIC PARARECTAL FISTULAS

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

Objectives. To improve treatment results of patients with extrasphincteric pararectal fistulas by means of the operative method of plastic correction.
Methods. The results of the examination and operative treatment of 146 patients with extrasphincteric pararectal fistulas have been analyzed. Clinical and instrumental examination (sigmoidoscopy, test with vital dye, probing of the fistulous passage, sphincterometry, transrectal sonoraphy of the pararectal zone tissues and fistulography) has been performed. Ligature method was applied in 50 (34,2%) patients (the 1st group). Rectoplasty with lateral displacement of the mucous-submucosal rectal flap was performed in 50 (34,2%) cases (the 2nd group). The proposed method of plastic correction was done in 46 (31,5%) patients (the 3rd group). Assessment of the operative treatment results was carried out in the early (up to 3 months) and distant (up to 4 years) postoperative periods.
Results. In the early postoperative period hemorrhage was diagnosed in 2 (4,0%) cases in the 1st group, in 3 (6,0%) – in the 2nd group, in 5 (3,4%) – in the 3rdst group, in 3 (6,0%) – of the 2nd group, in 2 (4,3%) – of the 3rdst group, in 6 (12,0%) – of the 2nd group, in 3 (8,6%) – of the 3rdst group, in 1 (2,0%) – of the 2nd group and there wasn’t any – in the 3rd group.
Conclusions. Minor trauma, the lack of the anal sphincter functional insufficiency, a small number of relapses, reduction of the medical and social rehabilitation terms of patients are considered to be the advantages of the designed method of the operative correction of the extrasphincteric pararectal fistulas.

Keywords: extrasphincteric fistula, mucosa displacement, operative treatment
p. 83 – 88 of the original issue
References
  1. Il'in VA, Vorobei AV, Khulup GIa, Shved IA. Rezul'taty khirurgicheskogo lecheniia vysokikh svishchei priamoi kishki [Results of surgical treatment of rectal fistulas in a high position]. Koloproktologiia. 2005;(2):8-15.
  2. Van Onkelen RS, Gosselink MP, Schouten WR. Treatment of anal fistulas with high intersphincteric extension. Dis Colon Rectum. 2013 Aug;56(8):987–91.
  3. Osnovy koloproktologii [Fundamentals of coloproctology]: ucheb. Posobie. red. Vorob'ev GI. 2-e izd. Moscow, RF; 2006. 432 p.
  4. Ratto C, Litta F, Parello A, Zaccone G, Donisi L, De Simone V. Fistulotomy with end-to-end primary sphincteroplasty for anal fistula: results from a prospective study. Dis Colon Rectum. 2013 Feb;56(2):226–33.
  5. Schwandner T, Roblick MH, Kierer W, Brom A, Padberg W, Hirschburger M. Surgical treatment of complex anal fistulas with the anal fistula plug: a prospective, multicenter study. Dis Colon Rectum. 2009 Sep;52(9):1578–83.
  6. Mitalas LE, van Onkelen RS, Monkhorst K, Zimmerman DD, Gosselink MP, Schouten WR. Identification of epithelialization in high transsphincteric fistulas. Tech Coloproctol. 2012 Apr;16(2):113–17.
  7. Wallin UG, Mellgren AF, Madoff RD, Goldberg SM. Does ligation of the intersphincteric fistula tract raise the bar in fistula surgery? Dis Colon Rectum. 2012 Nov;55(11):1173–78.
  8. Tan KK, Tan IJ, Lim FS, Koh DC, Tsang CB. The anatomy of failures following the ligation of intersphincteric tract technique for anal fistula: a review of 93 patients over 4 years. Dis Colon Rectum. 2011 Nov;54(11):1368–72.
  9. Tsunoda A, Sada H, Sugimoto T, Nagata H, Kano N. Anal function after ligation of the intersphincteric fistula tract. Dis Colon Rectum. 2013 Jul;56(7):898–902.
  10. Murav'ev AV, Maliugin VS, Zhuravel' RV, Lysenko OV. Sposob plasticheskoi operatsii pri ekstrasfinkternykh svishchakh priamoi kishki [The method of plastic surgery for extra-sphincter fistulas of the rectum]. Koloproktologiia. 2012;(3):11–14.
  11. Zhukov BN, Razin AN, Katorkin SE, Chernov AA. Optimizatsiia khirurgicheskogo lecheniia patsientov so slozhnymi formami khronicheskogo paraproktita [Optimization of surgical treatment of patients with complicated forms of chronic paraproctitis]. Vrach-aspirant. 2012; 52(3.4):517–20.
  12. Zhukov BN, Razin AN, Chernov AA, Razin NN, Katorkin SE. Sposob operativnogo lecheniia patsientov s ekstrasfinkternymi pararektal'nymi svishchami [The method of surgical treatment of patients with extra sphincter pararectal fistulas]: patent na izobretenie ¹ 2491024 RF / ¹ 2012107057/14; zaiav. 27.02.2012; opubl. 27.08.2013, Biull ¹ 24.
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 Sergey Evgenievich
Information about the authors:
Razin A.Ò. A surgeon of coloproctology department, a post-graduate student of the chair of hospital surgery of SBEE HPE "Samara State Medical University."
Zhukov B.N. Honored Worker of Science, MD, professor, a head of the chair of hospital surgery of SBEE HPE "Samara State Medical University."
Chernov A.A. PhD, a head of coloproctology department of hospital surgery of SBEE HPE "Samara State Medical University."
Katorkin S.E. PhD, an assistant professor of the chair of hospital surgery SBEE HPE
"Samara State Medical University".

INFORMATION TECHNOLOGIES IN SURGERY

R.R. KASIMOV, A.S. MUCHIN, D.A. ELFIMOV, L.V. SOKOLOV

MEDICAL AND DIAGNOSTIC ALGORITHM IN MILITARY PERSONNEL WITH ACUTE APPENDICITIS

Bureau ¹ 5 of FSOI “1586 Military Clinical Hospital” of the Ministry of Defense of Russia Nizhny Novgorod Garrison Military Hospital1,
SBEE HPE “Nizhny Novgorod State Medical Academy” 2,
The Russian Federation

Objectives. To develop the available and effective model for diagnosis of an acute appendicitis.
Methods. On the first stage the retrospective analysis of case histories of the military personnel on an appeal, admitted to the garrison military hospital suspected of an acute appendicitis (n=202) during 10 years has been carried out. On the second prospective stage a new criterion, the determination of concentration of C reactive protein, has been included in the examination 40 patients (the main group). 39 patients of the main group were subjected to the targeted ultrasound scan of appendix. The first and the second stages were targeted to work out a diagnostic model and develop the diagnostic scales. Information analysis has been performed by means of the MS Excel tables, software for the discriminate analysis and design of diagnostic scales. The approbation of working out model has been conducted in the control group (n=30) in municipal medical institution.
Results. The original medical diagnostic algorithm of the acute appendicitis has been worked out. The definition of an acute appendicitis index according to original “ShPOA” and “ShOA” diagnostic scales is considered to be the algorithm basis. The algorithm discriminates the patients, allocates the patient group in which ultrasonic scan of an appendix is absolutely indicated. In case of impossibility of this study performance the algorithm focuses on dynamics of change of an acute appendicitis index. Characteristics of the summarized diagnostic scale of an acute appendicitis are: sensitivity – 94,1%, specificity – 100%, general accuracy – 96,7%, false negative answer – 5,9%, false positive answer – 0%, positive predicted value – 100%.
Conclusions. Universal systems of objective diagnostics of an acute appendicitis increase its accuracy with a error rate 13% for “ShPOA” and 1% for “ShOA”. Integration of determining the concentration of C reactive protein in the diagnostics system permitted to increase the general diagnostic accuracy of an acute appendicitis by 9,7%. The developed medical diagnostic algorithm of an acute appendicitis allows formulating the differentiated indications to application of additional methods of research as well as reducing the frequency of “unfounded” appendectomy.

Keywords: acute appendicitis, diagnostics of appendicitis, medical diagnostic algorithm, diagnostics scale, appendectomys
p. 89 – 95 of the original issue
References
  1. Efimenko NA, Chursin VV, Stepnov AA. Lechebnaia i diagnosticheskaia laparoskopiia pri appenditsite. Voen-Med Zhurn [Therapeutic and diagnostic laparoscopy in appendicitis]. 2007;328(8):19–24.
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  5. Tashtemirova OG, Manekenova KB, Aref'eva ZhA. Sposob identifikatsii virusnoi infektsii v bioptatakh cherveobraznogo otrostka [A method for identifying the viral infection in biopsy specimens of the appendix]. Nizhegorod Med Zhurn. 2005;(4):120–22.
  6. Brochhausen C, Bittinger F, Schmitt VH, Kommoss F, Lehr HA, Heintz A, Kirkpatrick CJ. Expression of E-selectin and vascular cell adhesion molecule-1 in so-called 'negative' appendices: first results to support the pathological diagnosis in borderline cases. Eur Surg Res. 2010;45(3-4):350–55.
  7. Filiz AI, Aladag H, Akin ML, Sucullu I, Kurt Y, Yucel E, Uluutku AH. The role of d-lactate in differential diagnosis of acute appendicitis. J Invest Surg. 2010 Aug;23(4):218–23.
  8. Koc M, Zulfikaroglu B, Kemal Isman F, Ozalp N, Acar A, Kucur M. Serum YKL-40 levels in acute appendicitis. Bratisl Lek Listy. 2010;111(12):656–58.
  9. Mentes O, Eryilmaz M, Harlak A, Yaman H, Yigit T, Ongoru O, Balkan M, Kozak O, Tufan T. The importance of urine 5-hydroxyindoleacetic acid levels in the early diagnosis of acute appendicitis. Am J Emerg Med. 2009 May;27(4):409–12.
  10. Yokoyama S, Takifuji K, Hotta T, Matsuda K, Nasu T, Nakamori M, Hirabayashi N, Kinoshita H, Yamaue H. C-Reactive protein is an independent surgical indication marker for appendicitis: a retrospective study. World J Emerg Surg. 2009 Oct 31;4:36
  11. Thuijls G, Derikx JP, Prakken FJ, Huisman B, van Bijnen Ing AA, van Heurn EL, Buurman WA, Heineman E. A pilot study on potential new plasma markers for diagnosis of acute appendicitis. Am J Emerg Med. 2011 Mar;29(3):256–60.
  12. Rezak A, Abbas HM, Ajemian MS, Dudrick SJ, Kwasnik EM. Decreased use of computed tomography with a modified clinical scoring system in diagnosis of pediatric acute appendicitis. Arch Surg. 2011 Jan;146(1):64–7.
  13. Natroshvili AG, Shulutko AM, Nasirov FN. Rezul'taty primeneniia modifitsirovannoi diagnosticheskoi shkaly u bol'nykh ostrym appenditsitom [The results of modified diagnostic scale application in patients with acute appendicitis]. Khirurgiia. Zhurn im NI Pirogova. 2010;(8):24–27.
  14. Slesarenko CS, Lisunov AIu. Osobennosti khirurgicheskoi taktiki i lecheniia ostrogo appenditsita na sovremennom etape [Features of surgical tactics and treatment of acute appendicitis at present]. Saratov Nauch-Med Zhurn. 2008; 3(21):111–18.
  15. Chong CF, Thien A, Mackie AJ, Tin AS, Tripathi S, Ahmad MA, Tan LT, Ang SH, Telisinghe PU. Comparison of RIPASA and Alvarado scores for the diagnosis of acute appendicitis. Singapore Med J. 2011 May;52(5):340–45.
Address for correspondence:
603105, Rossiiskaia Federatsiia, g. N. Novgorod, ul. Izhorskaia, d. 25, k. 3, Nizhegorodskii voennyi gospital', khirurgicheskoe otdelenie,
e-mail: rusdoc77@mail.ru,
Kasimov Rustam Rifkatovich
Information about the authors:
Kasimov R.R. PhD, major of the military service, senior intern of the surgical unit of the bureau ¹ 5 of FSOI “1586 MCH” of the Ministry of Defense of Russia, Nizhny Novgorod.
Muchin A.S. MD, professor, a head of the surgery chair of the advanced training faculty of SBEE HPE “Nizhny Novgorod State Medical Academy of the Ministry of Public Health”.
Elfimov D.A. Major of the military service, a head of the surgical department of the bureau ¹ 5 of FSOI “1586 MCH” of the Ministry of Defense of Russia, Nizhny Novgorod.
Sokolov L.V. Lieutenant colonel of the military service, a head of the bureau ¹ 5 of FSOI “1586 MCH” of the Ministry of Defense of Russia, Nizhny Novgorod.

REVIEWS

A.A. LITVIN, V.A. LITVIN

CLINICAL DECISION SUPPORT SYSTEMS FOR SURGERY

E “Gomel Regional Clinical Hospital”1,
EE “Gomel State Medical University”2, Gomel
Belarusian State University3, Minsk, Belarus

This article presents a literature review of decision support systems (DSS) use for surgery. A decision support system (DSS) is a computer-based information system that collects, organizes and analyzes the large amounts of clinical data and medical knowledge that can effectively influence on the decision-making processes to generate case-specific advice. The problem of providing computer support decision-making in medicine is thought to be actual due to the increasing information load on the physician and the development of computer technology. In surgery while making medical decisions the lack of time, high dynamics of disease course, high price of medical errors, etc are considered to be specific.
DSS consists of the following computerized procedures: collection, processing, analysis of medical data, mathematical modeling, elaboration of alternatives and selection of the optimal method of diagnosis or treatment. Currently the assisting DSS in clinical practice, the test and opposing DSS in training and advanced training, analytical DSS in the scientific researches have been singed out.
DSS in surgery can be used as a source of medical knowledge for decision making in a diagnosis or treatment process to assist the physician in the diagnostic decision-making process, evaluate the effectiveness of treatment, analysis of the pathological process dynamics, assess of a patient's condition in real-time regime. Medical computer systems permit surgeons not only to test their own predictive and diagnostic assumptions, but to use artificial intelligence technologies in complex clinical situations.

Keywords: clinical decision support systems, computer-assisted decision-making in surgery, medical informatics, expert systems
p. 96 – 100 of the original issue
References
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Address for correspondence:
246029, Respublika Belarus', g. Gomel', ul. Brat'ev Liziukovykh, d. 5, U «Gomel'skaia oblastnaia klinicheskaia bol'nitsa»,
e-mail: aalitvin@gmail.com, Litvin Andrei Antonovich
Information about the authors:
Litvin A.A. PhD, a deputy chief for surgery of ME “Gomel Regional Clinical Hospital”, an associate professor of the surgical diseases chair ¹1, EE “Gomel State Medical University”.
Litvin V.A. A student of the radiophysics and computer technologies faculty, Belarusian State University.

CASE REPORTS

V.B. BOGDANOVICH, N.G. SHEBUSHEV, V.V. ANICHKIN, V.V. MARTINUCK

HYDATID CYST OF THE LEFT ADRENAL GLAND: DIFFICULTIES OF PREOPERATIVE DIAGNOSTICS AND SURGICAL TREATMENT

EE “Gomel State Medical University”,
The Republic of Belarus

This article deals with the case of a rare surgical pathology – a hydatid cyst of the left adrenal gland. The specific features and results of preoperative clinical and instrumental examination are presented in the article. The patient underwent a planned operation (adrenalectomy) from the left and pericystectomy of the hydatid cyst of the left adrenal gland. The diagnosis was confirmed after a morphological research of the removed macropreparation. The conducted hormonal research showed that parasitic invasion into the left adrenal gland caused to the subclinical hypercorticoidism. It was also proved by the fall of blood pressure during the first hours after the removal of the cyst. The control examination was fulfilled in a year and no recurrence signs of the echinococcosis have been detected.
On the basis of the literature analysis the data on epidemiology, etiology, pathogenesis and diagnostic methods of this pathology are shown. Up to the present no observations on hormonal research in patients with the hydatid cysts of the adrenal glands was found in the literature. The given observation is of high interest due to the rareness of that kind of echinococcosis localization and therefore there are some diagnostic difficulties during the preoperative period. Surgical treatment of patients suffering from the hydatid cysts of the adrenal glands should be conducted in the specialized centers with the available current methods of examination, modern equipment and highly qualified personnel.

Keywords: echinococcosis, adrenal gland, surgical treatment, adrenalectomy
p. 101 – 105 of the original issue
References
  1. Vetshev PS, Musaev GKh. Ekhinokokkoz: sovremennyi vzgliad na sostoianie problemy [Echinococcosis: a current view on the problem]. Annaly Khirurg Gepatol. 2006;(1)11:111–17.
  2. Eckert J, Deplazes P. Biological, epidemiological, and clinical aspects of echinococcosis, a zoonosis of increasing concern. Clin Microbiol Rev. 2004 Jan;17(1):107–35.
  3. El Idrissi Dafali A, Dahami Z, Zerouali NO. Hydatid cyst of the adrenal gland. A case report. Ann Urol (Paris). 2002 Mar;36(2):99–103.
  4. Kharnas SS, red. Endokrinnaia khirurgiia [Endocrine surgery]: ruk. dlia vrachei. Moscow, RF: GEOTAR-Media; 2010. 496 p.
  5. Singh N, George RK, Gupta SK, Gupta A, Agarwal A. Giant adrenal cyst presenting as a diagnostic dilemma: a case report. Int Surg. 2005 Apr-Jun;90(2):78–80.
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Address for correspondence:
246050, Respublika Belarus', g. Gomel', ul. Lange, d. 5, UO «Gomel'skii gosudarstvennyi meditsinskii universitet», kafedra khirurgicheskikh boleznei ¹3 s kursom serdechno-sosudistoi khirurgii,
e-mail: vas.martinuck @ yandex.ru,
Martinuck Vasily Vladimirovich
Information about the authors:
Bogdanovich V.B. PhD, an associate professor of the surgical diseases chair ¹3 with the course of the cardiovascular surgery of EE “Gomel State Medical University”.
Shebushev N.G. PhD, an associate professor, a head of the surgical diseases chair ¹3 with the course of the cardiovascular surgery of EE “Gomel State Medical University”.
Anichkin V.V. MD, professor of the surgical diseases chair ¹3 with the course of the cardiovascular surgery of EE “Gomel State Medical University”.
Martinuck V.V. An assistant of the surgical diseases chair ¹3 with the course of the cardiovascular surgery of EE “Gomel State Medical University”.

EXCHANGE OF EXPERIENCE

S.Y. IVANUSA, A.V. KOCHETKOV, A.V. KHOKHLOV, S.A. POVZUN, M.G. KOBIASHVILI, D.Y. BOYARINOV, O.V. SHUSHAKOVA, I.A. SAMUSENKO, V.L. BELEVICH

DIAGNOSIS AND TREATMENT OF THE COMPLICATED FORMS OF REFLUX-ESOPHAGITIS

FSOEE HPE “Military Medical Academy named after S.M. Kirov” 1, MD RF, St. Petersburg,
FSBE “All-Russian Center of Emergency and Radiation Medicine name after A.M. Nikiforov”, MES of Russia2, St. Petersburg,
SBME “SRI of Emergency Care named after I.I. Dzhanelidze” MH of RF3, St. Petersburg,
SBEE HPE “North-West State Medical University named after I.I. Mechnikov MH RF4, St. Petersburg,
The Russian Federation

Objectives. To improve the diagnostic algorithm and surgical treatment results of the complicated forms of reflux-induced inflammatory diseases of the esophagus.
Methods. The investigation of the results of examination and treatment of 182 patients has been performed on 103 (56,6%) of them with uncomplicated course of the disease, 20 (10,9%) with erosive-ulcerous esophageal bleeding, 18 (9,8%) – peptic strictures of esophagus, 41 (22,7%) – Barrett’s esophagus. The treatment tactics in 113 patients was based on using the examination algorithm including the up-to-date methods of diagnosis: daily pH-metry, reogastrography, endoscopy in narrow band imaging (NBI) regimen, I-scan, zoom-endoscopy, histological and immunohistochemical testing of mucosal bioptats. 67 patients were examined by means of the standard diagnostic test.
Results. Application of the suggested algorithm of diagnosing in the patients suffering from esophagitis with identifying pathogenetic mechanisms of its development provides the differentiated approach to treatment. In case of the complicated forms of peptic esophagitis the two-staged treatment was used with the elimination of complications endoscopically in the first turn and with the following resuscitation of cardia closing function by endovideosurgical method. The indication to restore cardia closing function was considered the signs of absolute cardiac insufficiency. Morphological features of altering of the mucosa depending on the type of reflux and possible causes of the insufficient of esophageal epithelium regeneration at the peptic esophagitis have been determined. The study of the treatment results in various terms revealed the excellent and good results in 92% of cases in the recent period of observation and in 89% of cases – in the distant one.
Conclusions. The conducted research showed that treatment of the complicated forms of reflux-esophagitis based on using the complete examination algorithm of patients with the detection of pathogenetic mechanisms of the disease development allowed improving the short- and long-term results.

Keywords: reflux-esophagitis, Barrett’s esophagus, peptic strictures of the esophagus, esophageal erosive ulcer bleedingss
p. 106 – 113 of the original issue
References
  1. Chernousov FA, Shestakov AL, Egorova LK. Rezul'taty fundoplikatsii pri lechenii refliuks-ezofagita [The results of fundoplication in the treatment of reflux oesophagitis]. Vesn Khirurg Gastroenterol. 2009;(4):64–67.
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Address for correspondence:
19044, Rossiiskaia Federatsiia, g. Sankt-Peterburg, ul. Akademika Lebedeva, d. 6, FGKOU VPO «Voenno-meditsinskaia akademiia im. S.M. Kirova» MO RF, kafedra obshchei khirurgii,
e-mail: boyarinov@yandex.ru,
Boyarinov Dmitry Yur’evich
Information about the authors:
Ivanusa S.J., MD, professor, Honoured Medical Doctor of Russia, a head of the chair of general surgery of FSEE VPO "Military Medical Academy named by S.M. Kirov" Russian Federation Ministry of Defense.
Kochetkov A.V., MD, professor, Honoured Medical Doctor of the Russia, a chief specialist in Surgery of FSI "Nikiforov All-Russian Center of Emergency and Radiation Medicine" of the Russian Ministry of Emergency Situations", professor of the chair of general surgery of FSEE VPO "Military Medical Academy named by S.M. Kirov" Russian Federation Ministry of Defense.
Khokhlov A.V., MD, professor of the chair of general surgery of FSEE VPO "Military Medical Academy named by S.M. Kirov" Russian Federation Ministry of Defense.
Povzun S.A., MD, professor, a head of department of pathomorphology and clinical expertise of SBEPH "Scientific Research Institute of Emergency Care named after I.I. Janelidze".
Kobiashvili M.G., MD, professor, a head of the department of endoscopic research of "FSI "Nikiforov All-Russian Center of Emergency and Radiation Medicine" of the Russian Ministry of Emergency Situations", professor of the chair of endoscopy of SBEE HPE "North-West State Medical University named after I.I. Mechnikov " MPH of Russian Federation.
Boyarinov D., PhD, a lecturer of the chair of general surgery of FSEE VPO" Military Medical Academy named by S.M. Kirov" Russian Federation Ministry of Defense.
Shushakova O.V., an endoscopist of the department of endoscopic research of "FSI "Nikiforov All-Russian Center of Emergency and Radiation Medicine" of the Russian Ministry of Emergency Situations.
Samusenko I.A., PhD, a physician-pathologist of pathology department
of "FSI "Nikiforov All-Russian Center of Emergency and Radiation Medicine" of the Russian Ministry of Emergency Situations, the Russian Federation.
Belevich V.L., PhD, a senior lecturer of the chair of general surgery of FSEE VPO" Military Medical Academy named by S.M. Kirov" Russian Federation Ministry of Defense.
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