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Year 2015 Vol. 23 No 1

EXPERIMENTAL SURGERY

E. MATEVOSSIAN 1, I. SNOPOK 2, P. HEILER 1, F. MELCHIOR 1, J. NäHRIG 1,3, G.S. LUPPA 4, E.A. ANASTASIEVA 4, D. DOLL 5

MICROSURGICAL TECHNIQUE OF COMBINED PANCREAS AND KIDNEY TRANSPLANTATION IN EXPERIMENTAL MODEL

University Clinic "rechts der Isar", Munich Technical University1, Munich,
St Lukas Hospital 2, Solingen,
Institute of General Pathology and Pathologic Anatomy 3, Munich,
Germany,
SBEE HPE "Novosibirsk State Medical University" 4,
The Russian Federation
Catholic hospital Oldenburger Munsterland, St. Mary’s Hospital 5, Vechta,
Germany

Objectives. The experimental model testing of a combined pancreas/kidney transplantation more suitable to the technique used in present-day clinical practice that can be used for fundamental transplantation studies.
Methods. Donor rats (8) underwent en bloc pancreatectomy and nephrectomy. The revascularization of the transplanted pancreatic islet was performed via aorta abdominalis-tube with the donor superior mesenteric artery artery mesenterica superior to the recipient abdominal aorta and the recipient's inferior vena cava anatomosis with the donor portal vein segment. Exocrine outflow of secret of pancreas transplant implemented via en bloc explanted duodenal segment of the donor, anastomosed side-to-side to the recipient’s jejunum (terminales Ileum/Jejunum).
The renal vessels anastomosed side-to-side to the abdominal aorta and subhepatic segment of the inferior vena cava. The urethra was implanted by patch technique. Postoperatively, serum parameters were monitored daily. Biopsy samples were taken for histopathology examination via a minilaparotomy approach on the 5th, 8th and 12th day.
Results. In the early postoperative period 7 out of 8 recipients underwent the combined PKTx without serious surgical complications. One thrombosis of the portal vein led to the organ failure. Blood glucose levels were normal by the 2nd postoperative day. On the 5th day the transplanted duodenal segment showed slight villous atrophy, and the kidneys were well perfused without signs of vascular complications. The anastomosis between urethra and bladder was leak-proof in all 8 cases.
Conclusion. Surgical technique optimization and time reduction of the surgical intervention permitted to achieve a regular function of both transplants at relatively low recipients’ morbidity. The proposed PKTx experimental model can be used for fundamental studies.

Keywords: transplantation, pancreas, kidney, allograft, surgical technique, experimental model
p. 5-11 of the original issue
References
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  14. Yoon JH, Jung SI, Cho C, Gil MC, Kim CG.Effects of simultaneous kidney-pancreaticoduodenal transplantation on diabetes-induced renal insufficiency in rats. Microsurgery. 2001;21(4):173-78.
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, professor of surgery, University Clinic "rechts der Isar", Munich Technical University, Munich.
Snopok I. A surgeon’s assistant , St Lukas Hospital, Solingen.
Heiler P. A 5-year student of the medical faculty, University Clinic "rechts der Isar", Munich Technical University, Munich.
Melchior F. A 5-year student of the medical faculty, University Clinic "rechts der Isar", Munich Technical University, Munich.
Nährig J. MD, a pathologist, University Clinic "rechts der Isar", Munich Technical University, Institute of general pathology and pathologic anatomy , Munich.
Luppa G.S. A 5-year student of the pediatric faculty of SBEE HPE "Novosibirsk State Medical University".
Anastasieva E.A. A 5-year student of the pediatric faculty of SBEE HPE "Novosibirsk State Medical University".
Doll D. MD, professor of surgery, Catholic hospital Oldenburger Munsterland, St. Mary’s Hospital, Vechta, Germany.

A.S. ZHIDKOV, V.E. KORIK, A.P.TRUKHAN, S.A. ZHIDKOV, S.N. PIVOVARCHIK, D.G. TERESHKO

DIRECT OXIMETRY IN DIAGNOSIS OF EXPERIMENTAL CRUSH SYNDROME

EE "Belarusian State Medical University"
The Republic of Belarus

Objectives. To study the changes in parameters of the direct oximetry of injured limb muscles, to determine their significance in diagnosis of crush syndrome (CD) and its severity in early postcompression period.
Methods. Guinea pigs (60 animals) were research models. Modeling of crush syndrome was carried out by application of the developed device of adjustable compression. The parameters of direct oximetry of the injured limbs muscles have been analyzed: oxygen partial pressure in muscles, oxygen mass transfer rates and oxygenation rate.
Results. Significant differences in comparing of oxygen mass transfer rate in the range of 150-155 mm Hg (V1) have been revealed between animals of the control group separately with each one of the comparison groups, which indicates some tissue respiration changes at any degree of crush syndrome. Within the first 48 hours in the group of animals with mild crush syndrome the increase of the indicator V1 was observed and with a moderate decline – on the third day. Analysis of data obtained in the group of animals with a moderate degree of pathological changes found no significant changes of the V1 indicator dynamics, while the analysis of the data obtained in the group of animals with severe pathology, showed a statistically significant permanent increase of oxygen mass transfer rate in the range of 150-155 mm Hg. In analyzing the oxygenation indicator the statistically significant differences have been revealed while comparing groups with mild, moderate and severe degrees of compression damage clearly differentiated a mild degree of pathological changes.
Conclusion. The method of direct oximetry permits to detect tissue hypoxia with compression injuries of the limbs, to differentiate mild and severe damages, as well as to predict the severe pathology in the early postcompression period.

Keywords: ñompression, crush syndrome, trauma, oximetry, rhabdomyolysis
p. 12-16 of the original issue
References
  1. Nechaev EA, Revskoi AK, Savitskii GG. Sindrom dlitel'nogo sdavleniia: rukovodstvo dlia vrachei [Crush syndrome: a guide for physicians]. Moscow, USSR: Meditsina, 1993. 208 p.
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  3. Musselius SG, Putinsev MD, Enileev RH. Adviser Expert System in the Myorenal Syndrome: EDTA; Proceedings of the 20-th Congress; Glasgow, 1993: p.78.
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  5. Titovets EP, Griboedova TV, Parkhach LP, Vlasiuk PA. Ekspress -sposob kolichestvennoi otsenki deistviia farmakologicheskikh sredstv na kislorodnyi obmen tkanei [Express method to quantify the action of pharmacological agents on tissue oxygen exchange]. Dostizheniia Med Nauki Belarusi. 2003;(8):22-23.
  6. Berezovskii VA, Boiko KA, Klimenko KS. Gipoksiia i individual'nye osobennosti reaktivnosti [Hypoxia and individual characteristics of reactivity]. Kiev, SSSR: Naukova Dumka, 1978. 215 p.
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  8. Parkhach LP. Pronitsaemost' obolochek golovnogo mozga k kislorodu i ee farmakologicheskaia korrektsiia [Brain membrane permeability to oxygen and its pharmacological correction]. Aktual Problemy Nevrologii i Neirokhirurgii. 2004;(6):111-13.
  9. Titovets EP, Parkhach LP. Sposob issledovaniia massoperenosa kisloroda v biologicheskikh tkaniakh i ustroistvo dlia ego osushchestvleniia [A method of investigating the mass transfer of oxygen into biological tissue and the device for its realization]: pat 7602 Resp. Belarus', SU 1803872 A1, MPK G 01 N27 / 48, 33 / 483, 2005 /– ¹ a20020470; zaiavl. 30.05.02; opubl. 12.03.05.
  10. Kozlovskii VI. Mikulich MN. Ustroistvo dlia opredeleniia napriazheniia kisloroda v kozhe i arterial'noi krovi [A device for determining oxygen tension in the skin and arterial blood]. Zdravookhranenie Belorussii. 1984;(6):67-69.
  11. Tsai AG, Cabales P, Hangai-Hoger N, Intaglietta M. Oxygen distribution and respiration by the microcirculation. Antioxid Redox Signal. 2004 Dec;6(6):1011-18.
  12. Trukhan AP, Zhidkov SA, Korik VE, Kiselev MG, Es'man GA, Zhidkov AS, Tereshko DG. Eksperimental'noe modelirovanie sindroma dlitel'nogo sdavleniia [Experimental modeling of crush syndrome]. Khirurgiia. Vostochnaia Evropa 2013;(1):70-75.
  13. Trukhan AP, Zhidkov SA, Korik VE, Letkovskaia TA, Zhidkov AS, Tereshko VE. Vliianie sily kompressii konechnosti na vyrazhennost' morfologicheskikh izmenenii pri sindrome dlitel'nogo sdavleniia [Influence of compression of the limb on the severity of morphological changes in crush syndrome]. Novosti Khirurgii. 2013;21(5):18-23.
  14. Budnikov GK. Biosensory kak novyi tip analiticheskikh ustroistv [Biosensors as a new type of analytical devices]. Sorosovs Obrazovat Zhurn. 1996;(12):26-32.
  15. Shmidt R, Tevs G/ red. Fiziologiia cheloveka [Human physiology]: v 3 t. Moscow, USSR: Mir, 1996;(2):313 p.
Address for correspondence:
Respublika Belarus, g. Minsk,
ul. Engelsa d. 27,
UO "Belorusskiy gosudarstvennyiy
meditsinskiy universitet",
kafedra voenno-polevoy khirurgii;
tel.:+ 375 17 392-29-16;
E-mail: orcinus84@gmail.com;
Zhidkov Aleksey Sergeevich
Information about the authors:
Zhidkov A.S. An adjunct of military-field surgery chair of the military medical faculty of EE "Belarusian State Medical University".
Korik V.E. An adjunct of military-field surgery chair of the military medical faculty of EE "Belarusian State Medical University".
Zhidkov S.A. MD, professor of military-field surgery chair of the military medical faculty of EE "Belarusian State Medical University".
Trukhan A.P. PhD, associate professor of military-field surgery chair of the military medical faculty of EE "Belarusian State Medical University".
Pivovarchik S.N. A six-year student of the military medical faculty of EE "Belarusian State Medical University".
Tereshko D.G. A surgeon of the emergency and polyclinic department of the medical company.

GENERAL AND SPECIAL SURGERY

A.V. CHERNYH, E.I. ZAKURDAEV, E.N. LYUBYH, V.G. VITCHINKIN

WAVELIKE RELAXING INCISION OF THE ANTERIOR RECTUS SHEATH MEDIATED PLASTIC REPAIR OF THE INGUINAL CANAL

SBEE HPE " Voronezh State Medical Academy named after N.N. Burdenko",
The Russian Federation

Objectives. To develop and to evaluate wavelike relaxing incision of the anterior rectus sheath in experiment and clinical practice.
Methods. Muscle tension was measured with spring dynamometer prior and after the relaxing incision performance in experiment on 24 cadavers. A randomized clinical trial has been carried out on 60 patients with the unilateral uncomplicated inguinal hernias. The patients were divided into three groups depending on the performed inguinal hernia repair. The mediated plasty with a wavelike relaxing incision has been applied in the main group. The mediated plasty according to the classical method was performed to the patients in the first control group. The Lichtenstein tension-free hernioplasty was carried out in the second control group.
Results. The tension of the ligature in the medial corner of the inguinal gap needed for conjunction of lower layers of abdominal lateral muscles with inguinal ligament mediated plasty prior relaxing incision was 27,2±0,4 T, and after relaxing incision performance – 15,8±0,3 T. There were no any recurrence of the inguinal hernias in each studied group within 2-years period. Early postoperative complications developed in 15% of patients of the 1st control group (5% – the scrotal swelling, 10% – paresis of the bladder) and 5% of patients of the second control group – serous inflammation. Chronic pain syndrome was observed in 20% of the second control group patients.
Conclusion. The results of experimental and clinical studies have shown the performance of the wavelike relaxing incision of anterior wall of the rectus sheath mediated plastic repair of the inguinal canal substantially reduces the risk of postoperative complications and recurrence.

Keywords: inguinal hernia, inguinal hernia repair, results, complications, chronic pain, recurrence, randomized clinical trial
p. 17-22 of the original issue
References
  1. Vizgalov SA, Smotrin SM. Kombinirovannaia atenzionnaia gernioplastika pri naruzhnykh pakhovykh gryzhakh [Combined attentional hernioplasty with external inguinal hernias]. Novosti Khirurgii. 2012;20(3):9-15.
  2. Koshelev PI. Innovatsionnye puti sovershenstvovaniia metoda nenatiazhnoi gernioplastiki [Innovative ways of improving the method of non-tension hernioplastics]. Sistem Analiz i Upravlenie v Biomed Sistemakh. 2007;6(2):528-32.
  3. Ostrovskii VK. Sposob dvukhsloinoi plastiki zadnei stenki pakhovogo kanala pri pakhovykh gryzhakh Khirurgiia [A method of two-layer plastic of the back wall of the inguinal canal with inguinal hernias]. Khirurgia. Zhurn im NI Pirogova. 2009;(3):67-68.
  4. Chernykh AV, Liubykh EN, Vitchinkin VG, Zakurdaev EI. Anatomicheskoe obosnovanie modifikatsii oposredovannoi plastiki pakhovogo kanala [Anatomic substantiation of mediated plasticity modification of the inguinal canal]. Novosti Khirurgii. 2014;22 (4):403-407.
  5. Desarda MP.New method of inguinal hernia repair: a new solution. ANZ J Surg. 2001 Apr;71(4):241-44
  6. Figueiredo CM, Lima SO, Xavier Júnior SD, da Silva CB.Morphometric analysis of inguinal canals and rings of human fetus and adult corpses and its relation with inguinal hernias. [Article in Portuguese] Rev Col Bras Cir. 2009 Aug;36(4):347-49.
  7. Read RC. Herniology: past, present, and future. Hernia. 2009 Dec;13(6):577-80.
  8. Ioffe IL. Operativnoe lechenie pvkhovykh gryzh [Surgical treatment of inguinal hernias]. Moscow, USSR: Meditsina. 1968. 172 p.
Address for correspondence:
394036, Rossiyskaya Federatsiya,
g. Voronezh, ul. Studencheskaya, d. 10,
GBOU VPO "Voronezhskaya gosudarstvennaya
meditsinskaya akademiya
imeni N.N. Burdenko", kafedra operativnoy khirurgii
s topograficheskoy anatomiey,
tel.: 7(951)566-43-61,
e-mail: ezakurdaev@rambler.ru,
Zakurdaev Evgeniy Ivanovich
Information about the authors:
Chernyh A.V. MD, professor, First Vice-rector, a head of the operative surgery chair with topographic anatomy of SBEE HPE "Voronezh State Medical Academy named after N.N. Burdenko".
Zakurdaev E.I. A post-graduate student of the operative surgery chair with topographic anatomy of SBEE HPE "Voronezh State Medical Academy named after N.N. Burdenko".
Lyubyh E.N. MD, professor, director of the Research Institute of gerontology, professor of the faculty surgery chair of SBEE HPE "Voronezh State Medical Academy named after N.N. Burdenko".
Vitchinkin V.G. PhD, associate professor of the operative surgery chair with topographic anatomy of SBEE HPE "Voronezh State Medical Academy named after N.N. Burdenko".

G.A. JURBENKO, A.S. KARPITSKI

LAPAROSCOPIC VALVE FUNDOPLICATION AS A METHOD OF SURGICAL TREATMENT OF HIATAL HERNIA

ME "Brest Regional Hospital",
The Republic of Belarus

Objectives. To improve surgical treatment outcomes of hiatal hernia by developing antireflux surgery includes a valve esophagofundoplication and an advanced method of Gis acute angle forming.
Methods. Efficiency assessment of 128 laparoscopic fundoplications has been conducted. Toupet fundoplication was applied in 54 (42,2%) patients (group 1); 61 (47,6%) patients underwent laparoscopic valve fundoplication according to their own technique (group 2) and 13 patients (10,2%) were operated by different operation methods application. The antireflux effect of the surgery in the patients (group 2) was achieved by creating a valve and Gis acute angle. The results of the surgery were evaluated in a survey using GERD-Q and GERD-HRQL questionnaires in the early and 1-1,5 years postoperative period.
Results. In the early postoperative period a comparable efficacy of both evaluated techniques was observed. 51 (94,5%) patients (group 1) and 56 (92%) patients (group 2) were satisfied with the surgery outcome.
The surgical treatment was evaluated in the late postoperative period in 26 (group 1) and 35 (group 2) patients. In the 1st group 5 out of 8 patients unsatisfied with the results the recurrence has occured, and 3 – suffered from gas-bloating symptom. 7 patients rated their overall health as neutral to abdominal pain, gas-bloating after meals and the necessity of regular conservative treatment. In the 2nd group there were two patients dissatisfied with the surgery outcomes due to the disease recurrence and gas-bloating syndrome. 8 patients rated their quality of life as neutral. Three of them suffered from recurrent heartburn, less often, though, than prior the surgery. Five patients suffered from moderate abdominal pain and bloating against the background of periodic administration of drugs improving the intestinal motility.
Conclusion. The Gis angle restoration is considered to be anatomically reasonable. It eliminates the risk of postoperative dysphagia and improves the quality of life in the late postoperative period.

Keywords: hiatal hernia, gastroesophageal reflux disease, laparoscopic fundoplication
p. 23-29 of the original issue
References
  1. Allison PR. Reflux esophagitis, sliding hiatal hernia, and the anatomy of repair. Surg Gynecol Obstet. 1951 Apr; 92(4):419-31.
  2. Belilov FI. Gastroezofageal'naia refliuksnaia bolezn' [Gastroesophageal reflux disease]. Irkutsk, RF: RIO IGIUVa. 2010. 23 p.
  3. Murray JA, Camilleri M. The fall and rise of the hiatal hernia. Gastroenterology. 2000 Dec;119(6):1779-81.
  4. Beaumont H, Bennink RJ, de Jong J, Boeckxstaens GE. The position of the acid pocket as a major risk factor for acidic reflux in healthy subjects and patients with GORD. Gut. 2010 Apr;59(4):441-51.
  5. Sgouros SN, Mpakos D, Rodias M, Vassiliades K, Karakoidas C, Andrikopoulos E, Stefanidis G, Mantides A. Prevalence and axial length of hiatus hernia in patients, with nonerosive reflux disease: a prospective study. J Clin Gastroenterol. 2007 Oct;41(9):814-18.
  6. Scheffer RC, Bredenoord AJ, Hebbard GS, Smout AJ, Samsom M.Effect of proximal gastric volume on hiatal hernia. Neurogastroenterol Motil. 2010 May;22(5):552-56, e120.
  7. Guidelines for Surgical Treatment of Gastroesophageal Reflux Disease (GERD) Society of American Gastrointestinal and Endoscopic Surgeons http://www.sages.org/publications/guidelines/guidelines-for-surgical-treatment-of-gastroesophageal-reflux-disease-gerd/
  8. David Kim, Vic Velanovich. Surgical Treatment of GERD. Where Have We Been and Where Are We Going? Gastroenterol Clin North Am. 2014;43(1)3:135-45.
  9. Dallemagne B, Weerts J, Markiewicz S, Dewandre JM, Wahlen C, Monami B, et al. Clinical results of laparoscopic fundoplication at ten years after surgery. Surg Endosc. 2006;20(1):159-65.
  10. Wang YR, Dempsey DT, Richter JE.Trends and perioperative outcomes of inpatient antireflux surgery in the United States, 1993-2006. Dis Esophagus. 2011 May;24(4):215-23.
  11. Baulina OA, Ivachev AS, Baulin VA, Baulin AA. Laparoskopicheskaia fiksatsiia ugla Gisa ksenoperikardial'noi lentoi v khirurgii gastroezofageal'nnoi refliuksnoi bolezni [Laparoscopic fixing of Gis angle by xenopericardial tape in surgery of gastroesophageal reflux disease]. Novosti Khirurgii. 2014;22(2):164-70.
  12. Nikitenko AI, Rodin AG, Ovchinnikov VA. Analiz rezul'tatov endovideokhirurgicheskogo lecheniia gryzh pishchevodnogo otverstiia diafragmy [Analysis of the results of treatment endovideosurgical hiatal hernia]. Endoskop Khirurgiia. 2012;(5):3 -7.
  13. Rodin AG, Nikitenko AI, Bazaev AV, Domnin MA. Opyt operativnogo lecheniia gryzh pishchevodnogo otverstiia diafragmy [Experience of surgical treatment of hiatal hernias]. Klin Meditsina. 2012;(4):89-93.
  14. Zhurbenko GA, Karpitskii AS, Pan'ko SV, Boufalik RI. Sposob khirurgicheskogo lecheniia nedostatochnosti nizhnego pishchevodnogo sfinktera [The method of surgical treatment of the lower esophageal sphincter insufficiency]: pat. ¹ 17738 Resp. Belarus'; zaiavitel': zaiavitel' Brestskaia oblastnaia bol'nitsa. ¹ a20110453. Of fict biul. Gos patentnogo vedomstva Resp Belarus'. 2013;6(95):70.
  15. Puchkov KV, Filimonov VV. Gryzhi pishchevodnogo otverstiia diafragmy [Hiatal hernia]: monografiia. Moscow, RF: Medpraktika, 2003. 172 p.
  16. Kaibysheva VO, Kucheriavyi IuA, Trukhmanov AS, Storonova OA, Kon'kov MIu, Maev IV, Ivashkin VT. Rezul'taty mnogotsentrovogo nabliudatel'nogo issledovaniia po primeneniiu mezhdunarodnogo oprosnika GerdQ dlia diagnostiki gastroezofageal'noi refliuksnoi bolezni [Results of a multicenter observational study on the application of international GerdQ questionnaire for the diagnosis of gastroesophageal reflux disease]. RZhGGK. 2013;23(5):15-23.
  17. Nicolau AE, Crăciun M, Zota R, Kitkani A.Quality of life after laparoscopic fundoplication for gastroesophageal reflux disease. Preliminary study. Khirurgia (Bucur). 2013 Nov-Dec;108(6):788-93.
Address for correspondence:
224027, Respublika Belarus,
g. Brest, ul. Meditsinskaya, d. 7,
UZ "Brestskaya oblastnaya bolnitsa",
otdelenie torakalnoy khirurgii,
tel. office: +375 016 27-21-80,
e-mail: jurbik1@yandex.by,
Jurbenko Gennadiy Anatolvich
Information about the authors:
Jurbenko G.A. A surgeon of the thoracic surgery unit of ME "Brest Regional Hospital".
Karpitski A.S. MD, professor, a Chief physician of ME "Brest Regional Hospital".

P.M. KOSENKO 1, S.A. VAVRINCHUK1, L.K. KULIKOV2

EVALUATION OF ELECTROPHYSIOLOGICAL INDICATORS OF COMPENSATION MOTILITY OF STOMACH IN PATIENTS WITH ULCER PYLORODUODENAL STENOSIS

SBEE HPE "Far East State Medical University" 1, Khabarovsk
SBEE APE "Irkutsk State Medical Academy of Post-graduate Education" 2

Objectives. To determine electrophysiological criteria of compensation motility of stomach in patients with ulcer pyloroduodenal stenosis according to the peripheral electrogastroenterography.
Methods. 57 patients with ulcer pyloroduodenal stenosis (PDS) have been examined and subdivided into 3 groups on the basis of compensation degree. Compensated PDS was diagnosed in 25 (43,8%) patients, subcompensated PDS – in 24 (42,1%) and decompensated one – in 8 (14,1%) patients. Control group consisted of 28 healthy persons; 28 patients with subcompensated PDS were enrolled in the main group. Evaluation of the gastrointestinal motor activity was performed using the peripheral electrogastroenterography method.
Results. It is found that the group of patients with subcompensated stenosis combines patients with both compensated (hypermotor type) and decompensated (hypomotor type) gastric motility. In patients with hypermotor type of subcompensated stenosis, maximal degree of compensation of gastric motility was observed; on the contrary, in the pre- and postoperative periods in patients with hypomotor type of subcompensated stenosis the signs of decompensation of gastric motility were revealed.
The most significant manifestation of decompensation of stomach motorics in patients with the ulcer pyloroduodenal stenosis was the reduction of the electric (Pi) and peristaltic activity of the stomach more than twice after food stimulation relatively to the basal values.
Conclusion. Based on the obtained results two new electrophysiological ices were proposed – «index of compensation of electric gastric motility» which is the ratio of the stimulated electric stomach activity values to its basal value, and “index of compensation of stomach peristaltic motility” which is the ratio of the stimulated coefficient of gastric rhythm values to its basal value and which characterizes the stomach peristaltic activity. Informativeness of the proposed indicators has proved by mathematical modeling based on discriminant analysis (prediction accuracy – 81,1%), as well as the identified correlation between the proposed values and the degree of stenosis compensation.

Keywords: ulcer, duodenal stenosis, electrogastroenterogram, gastric motility, mathematical modeling, discriminant analysis
p. 30-36 of the original issue
References
  1. Rukhliada NV, Nazarov VE, Ermolaev IA. Diagnostika i lechenie iazvennoi bolezni, oslozhnennoi stenozom [Diagnosis and treatment of peptic ulcer complicated by stenosis]. Saint-Petersburg, RF: DEAN; 2006. 240 p.
  2. Pantsyrev IuM, Cherniakevich SA, Mikhalev AI. Khirurgicheskoe lechenie iazvennogo piloroduodenal'nogo stenoza [Surgical treatment of ulcerative pyloroduodenal stenosis]. Khirurgiia. Zhurn im NI Pirogova. 2003;(2):18-21.
  3. Chernousov AF. Selektivnaia proksimal'naia vagotomiia [Selective proximal vagotomy]. Moscow, RF: IzdAT, 2001. 160 p.
  4. Durleshter VM, Didigov MT. Khirurgicheskoe lechenie dekompensirovannogo rubtsovo-iazvennogo stenoza (obzor literatury) [Surgical treatment of decompensated scar-ulcerative stenosis (review)]. Vestn Khirurg Gastroenterologii. 2009;(2):59-66.
  5. Stupin VA, Smirnova GO, Baglaenko MV, Siluianov SV. Perifericheskaia elektrogastroenterografiia v diagnostike narushenii motorno-evakuatornoi funktsii zheludochno-kishechnogo trakta [Peripheral electrogastrogram in the diagnosis of motor-evacuation function of the gastrointestinal tract]. Lech Vrach. 2005;(2):60-62.
  6. Tropskaia NS, Vasil'ev VA, Popova TS, Ishmukhametov AI, Azarov IaB, Li LG. Teoreticheskie predposylki i eksperimental'noe obosnovanie ispol'zovaniia elektrogastro-enterografii [Theoretical background and experimental study of electrogastrogram application]. Ross Zhurn Gastroenterologii Gepatologii i Koloproktologii. 2005;(5):82-88.
  7. Matsuura Y, Yamamoto T, Takada M, Shiozawa T, Takada H. Application of electrogastrography to public health. Nihon Eiseigaku Zasshi (Japanese Journal of Hygiene). 2011 Jan;66(1):54-63.
  8. Yin J, Chen JD.Electrogastrography: methodology, validation and applications. J Neurogastroenterol Motil. 2013 Jan;19(1):5-17.
  9. Angeli TR, Du P, Paskaranandavadivel N, Janssen PW, Beyder A, Lentle RG, Bissett IP, Cheng LK, O'Grady G.The bioelectrical basis and validity of gastrointestinal extracellular slow wave recordings. J Physiol. 2013 Sep 15;591(Pt 18):4567-79.
  10. Banerzhi A. Leonov VP/ red. Meditsinskaia statistika poniatnym iazykom [Medical statistics by understandable language]: vvodnyi kurs. Moscow, RF: Prakt Meditsina, 2014. 287 p.
  11. Smirnova GO. Siluianov SV. Stupin VA / red. Perifericheskaia elektrogastroenterografiia v kliniche¬skoi praktike [Peripheral electrogastroenterography in clinical practice]. Posobie dlia vrachei, Moscow, RF: ID Medpraktika-M; 2009. 20 p.
Address for correspondence:
680000, Rossiyskaya Federatsiya,
g. Habarovsk, ul. Muraveva-Amurskogo, d. 35,
GBOU VPO "Dalnevostochnyiy gosudarstvennyiy
meditsinskiy universitet",
kafedra obschey i fakultetskoy khirurgii,
tel. office: 7 (4212) -30-53-11,
e-mail: kosenko@inbox.ru,
Kosenko Pavel Mihaylovich
Information about the authors:
Kosenko P.M. PhD, an associate professor of the general and faculty chair of SBEE HPE "Far East State Medical University", Khabarovsk.
Vavrinchuk S.A. MD, professor of the surgery chair with the course of endoscopic and plastic surgery of the advanced training and retraining faculty of SBEE HPE "Far East State Medical University", Khabarovsk.
Kulikov L.K. MD, professor, a head of the surgery chair of SBEE APE "Irkutsk State Medical Academy of Post-graduate Education".

I.V. KORPUSENKO

APPLICATION OF MINIMALLY INVASIVE EXTAPLEURAL THORACOPLASTY IN PATIENTS WITH BILATERAL TUBERCULOSIS OF THE LUNGS

SE "Dnepropetrovsk Medical Academy of the Ministry of Health of Ukraine"

Objectives. Increasing of surgical treatment effectiveness in patients with bilateral destructive forms of the pulmonary tuberculosis on the basis of new minimally invasive methods of surgical treatment using video-assisted thoracoscopic support.
Methods. 66 patients with bilateral pulmonary tuberculosis have been operated on (2008-2013 yrs.) in the thoracic unit of Dnepropetrovsk regional municipal clinical therapeutic and preventive association «Phthisiatry”. Patients were divided into 2 groups: the main group (34), who underwent video-assisted extrapleural medical thoracoplasty with collagen sealing and control group (32), who underwent classical extrapleural thoracoplasty by Zauerbruch – Bohush technique.
Results. Application of video-assisted extrapleural medical thoracoplasty with collagen sealing lets to reduce the volume of blood loss by 1,6 folds, amount of exudate in the first day of the postoperative period by 2,3 folds, and to decrease quantity of postoperative complications by 2,5 folds. On the basis of spirography, carried out 60 days after, dynamics of the external respiratory function parameters, performed after minimally invasive extrapleural thoracoplasty, showed the best results caused to a significantly lower respiratory biomechanics changes proportional to the volume of thoracoplasty.
Conclusion. The application of video-assisted extrapleural thoracoplasty with collagen sealing permits to abandon the traumatic access in connection with the visualization of the operating field videothoracoscopically. Fixation of the apex of the lung and tight sealing of the subscapular space with collagen provides the selective collapse of caverns within the resected ribs and prevents reexpansion of the lung apex. In applying video-assisted extrapleural thoracoplasty, biomechanics of respiratory system is disturbed to a much lesser extent.

Keywords: bilateral pulmonary tuberculosis, operative treatment, thoracoplasty, mini-access
p. 37-43 of the original issue
References
  1. Ots ON, Agkatsev TV, Perel'man MI. Khirurgicheskoe lechenie tuberkuleza legkikh pri ustoichivosti mikobakterii k khimiopreparatam [Surgical treatment of pulmonary tuberculosis with mycobacterial resistance to chemotherapeutic drugs]. Problemy Tuberkuleza i Boleznei Legkikh . 2009;(2):42-49.
  2. Petrenko VM, Cheren'ko SO, Litvinenko NA, Ivankova OV, Tarasenko OR. Tuberkul'oz 13 rozshirenoiu rezistentnostiu do protituberkul'oznikh preparatov: situatsiia v Ukraine [13 tuberculosis enhanced resistance to antituberculosis drugs: situation in Ukraine]. Ukr Pul'monol Zhurn. 2007; (3):35-39.
  3. Kim HJ, Kang CH, Kim YT, Sung SW, Kim JH, Lee SM, Yoo CG, Lee CT, Kim YW, Han SK, Shim YS, Yim JJ. Prognostic factors for surgical resection in patients with multidrug-resistant tuberculosis. Eur Respir J. 2006 Sep;28(3):576-80.
  4. Shiraishi Y, Katsuragi N, Kita H, Tominaga Y, Kariatsumari K, Onda T. Aggressive surgical treatment of multidrug-resistant tuberculosis. J Thorac Cardiovasc Surg. 2009 Nov;138(5):1180-84.
  5. Takeda S, Maeda H, Hayakawa M, Sawabata N, Maekura R. Current surgical intervention for pulmonary tuberculosis. Ann Thorac Surg. 2005 Mar;79(3):959-63.
  6. Feshchenko Iu². Stan nadannia ftiz³atrichno¿ dopomogi naselenniu Ukra¿ni [The situation with TB care in Ukraine]. Ukr Pul'monol Zhurn. 2008;(3):5-8.
  7. Duzhii ²D, Gres'ko ²Ia, Madiar VV. Ekstraplevral'na torakoplastika – al'ternativne operativne vtruchannia pri poshirenomu tuberkul'oz³ legen' [Extrapleural thoracoplasty - an alternative to surgery in advanced pulmonary tuberculosis]. Khark³vs'ka Kh³rurg Shkola. 2010;6.1(45):S.97-100.
  8. Duzhii ².D. Ekstraplevral'na torakoplastika ta ¿¿ m³stse v umovakh ep³dem³¿ tuberkul'ozu [Extrapleural thoracoplasty and its role in epidemic conditions of tuberculosis]. Kl³n³ch Kh³rurg³ia. 2003;(8):38-40.
  9. Porkhanov VO, Marchenko LG. Khirurgicheskoe lechenie dvustoronnikh form tuberkuleza legkikh [Surgical treatment of bilateral pulmonary tuberculosis]. Problemy Tuberkuleza.2002;(4):22-25.
  10. Repin IuM. Lekarstvenno – ustoichivyi tuberkulez legkikh: khirurgicheskoe lechenie [Drug - resistant pulmonary tuberculosis: surgical treatment]. Saint-Petersburg, RF: Gippokrat; 2007.168 p.
  11. Asanov BM, Giller DB, Iangolenko DV, Slobodin DG. Ekstraplevral'nyi selektivnyi ballonnyi kollaps legkogo – novyi metod khirurgicheskogo lecheniia rasprostranennogo destruktivnogo tuberkuleza legkikh [Extrapleural selective balloon collapsed of lungs - a new method of surgical treatment of advanced destructive pulmonary tuberculosis]. Tuberkulez i Bolezni Legkikh. 2011;(4):40-41.
  12. Giller DB. Miniinvazivnye dostupy s ispol'zovaniem endoskopicheskoi tekhniki v torakal'noi khirurgii [Minimally invasive access using endoscopic techniques in thoracic surgery]. Khirurgiia. 2009;(8):21-28.
  13. Porkhanov VO, Grebennikov SV, Marchenko LG, Poliakov IS, Mova VS. Khirurgicheskoe lechenie dvukhstoronnikh form tuberkuleza legkikh [Surgical treatment of bilateral pulmonary tuberculosis]. Problemy Tuberkuleza. 1998;(1):36-39.
  14. Bakul³n Pª, Savenkov IuF. Pat. 31430. Ukra¿na, MPK A61V17/22. Spos³b torakoplastiki [A method of thoracoplasty]/ ¹ u200713193; zaiavl. 27.11.07; opubl. 10.04.08, Biul. ¹17.
Address for correspondence:
49044, Ukraina,
g. Dnepropetrovsk, ul. Dzerzhinskogo, d. 9,
GU "Dnepropetrovskaya meditsinskaya akademiya MZ Ukrainyi," kafedra khirurgii ¹ 2,
Tel.: 38(056)31-22-72,
e-mail: korpus_i@hotmail.com,
Korpusenko Igor Vasilevich
Information about the authors:
Korpusenko I.V. PhD, an associate professor of the surgical chair ¹ 2 of SE "Dnepropetrovsk Medical Academy of the Ministry of Health of Ukraine".

V.V. PODPALOV

THE LONG-TERM RESULTS OF SURGICAL REPAIR OF AORTIC STENOSIS

SE "Republican Scientific and Practical Centre "Cardiology", Minsk
The Republic of Belarus

Objectives. To analyze the survival rate after surgery in patients with severe aortic stenosis (AS) complicated by atrioventricular valves insufficiency and to evaluate importance of echocardiographic parameters for estimating the prognosis of 5-year mortality in the ginen patient’s category.
Methods. A prospective study has been conducted. Out of all patients treated at the Center in 2005-2007 yrs., 198 patients with severe stenosis of the aortic valve and relative insufficiency of the mitral and tricuspid valves have been included in the study. The patients were divided into 2 groups: the 1st group – 46 patients not operated for different reasons; the 2nd group – 152 patients who had undergone aortic valve replacement (AVR) combined with the atrioventricular valves plasty. Follow-up period made up 5 years.
Results. The average age of 198 patients was 59,16 years, proportion of men – 67%. Hospital mortality of operated patients was 0,7%. Within 5 years 35 patients (76,1%) died in the 1st group and 28 persons (18.4%) – in the 2nd group, that was significantly lower after adjusting for age and sex (p=0,0001). Considering age, sex and effect of surgery the statistically significant correlation was detected between the increasing of 5-year mortality and the following echocardiographic parameters changes by: the increasing of maximal (p=0,0008) and average (p=0,0011) gradients; left atrium diameter (p=0,0023); end-diastolic (p=0,0355), end-systolic (p=0,0021) of left ventricular (LV) diameters; end-diastolic (p=0,0001), end-systolic (p=0,0001) LV volumes; LV myocardial mass (p=0,0001); pulmonary artery systolic pressure (p=0,0001); right ventricle diameter (p=0,0001); reduction of LV ejection fraction (p=0,0076).
Conclusion. Aortic valve replacement (AVR) in combination with the atrioventricular valves plasty reliably improves the survival rate in the late postoperative period in patients with severe AS complicated by atrioventricular valves insufficiency. Presented echocardiographic parameters statistically significantly affect the risk of 5-year mortality in these patients.

Keywords: aortic stenosis, aortic valve replacement, mitral regurgitation, mitral valve plasty, long-term results
p. 44-50 of the original issue
References
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  7. Stewart BF, Siscovick D, Lind BK, Gardin JM, Gottdiener JS, Smith VE, Kitzman DW, Otto CM.Clinical factors associated with calcific aortic valve disease. Cardiovascular Health Study. J Am Coll Cardiol. 1997 Mar 1;29(3):630-34.
  8. Bech-Hanssen O, Caidahl K, Wall B, Mykén P, Larsson S, Wallentin I. Influence of aortic valve replacement, prosthesis type, and size on functional outcome and ventricular mass in patients with aortic stenosis. J Thorac Cardiovasc Surg. 1999 Jul;118(1):57-65.
  9. Vahanian A, Alfieri O, Andreotti F, Antunes MJ, Barón-Esquivias G, et al. Guidelines on the management of valvular heart disease (version 2012): the Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur J Cardiothorac Surg. 2012;(4):S1-S44.
  10. Bonow RO, Carabello BA, Chatterjee K, de Leon AC Jr, Faxon DP, et al. 2008 focused update incorporated into the ACC/AHA 2006 guidelines for themanagement of patients with valvular heart disease: a repor of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2008;(13):e1-e142.
  11. Tribouilloy C, Lévy F, Rusinaru D, Guéret P, Petit-Eisenmann H, et al. Outcome after aortic valve replacement for low-flow/low-gradient aortic stenosis without contractile reserve on dobutamine stress echocardiography. J Am Coll Cardiol. 2009 May 19;53(20):1865-73.
  12. Quere JP, Monin JL, Levy F, Petit H, Baleynaud S. Influence of preoperative left ventricular contractile reserve on postoperative ejection fraction in low-gradient aortic stenosis. Circulation. 2006 Apr 11;113(14):1738-44.
Address for correspondence:
220036, Respublika Belarus, g. Minsk,
ul. R. Lyuksemburg, d. 110,
GU "Respublikanskiy nauchno-prakticheskiy
tsentr "Kardiologiya",
3-e kardiohirurgicheskoe otdelenie,
tel. office: +375 17 208-67-35,
e-mail: v.podpalov@gmail.com,
Podpalov Vladislav Vladislavovich
Information about the authors:
Podpalov V.V. An junior researcher of SE "Republican Scientific and Practical Centre "Cardiology", Minsk.

R.E. KALININ, A.S. PSHENNIKOV, I.A. SUCHKOV

REALIZATION OF ISCHEMIA AND REPERFUSION IN SURGERY OF MAJOR ARTERIES OF THE LOWER LIMBS

SBEE HPE "Ryazan State Medical University named after academician I.P. Pavlov",
The Russian Federation

Objectives. To study the molecular mechanisms of endogenic angioprotectors of stress-limiting system NO-heat shock proteins HSP70 and vascular endothelial growth factor system (VEGF) as a long-term adaptation variant to ischemia in lower limb reconstructive surgery.
Methods. According to the design the study is considered to be an open, prospective, in parallel groups, includes 40 patients with the obliterating lower limb atherosclerosis. The patients were divided into 4 groups according to the degree of the lower limb ischemia and the methods of operation: the 1st group – 10 patients according to Fontaine classification system (IIb-III stages) and the 2nd group – 10 patients (IV stage) who had undergone reconstructive surgery with polytetrafluroethylene graft (PTFE); the 3rd group – 10 patients with cardiogenic nonvalvular embolism of lower extremity arteries undergone urgent embolectomy; group 4 – 10 patients (IIb stage) without arterial reconstruction due to poor distal runoff or patient’s refusal to be operated on.
Results. In ischemia/reperfusion realization HSP70 dynamics was comparable in all patients undergone arterial reconstruction, i.e. stress reaction to damage was similar regardless of the extent of ischemia. Increased secretion of the studied metabolites may be regarded as a protective mechanism to ischemic/reperfusion injury. Increased secretion of the studied metabolites is considered as a kind of defense mechanism in the implementation of ischemia/repersusion and their reduction in the postoperative period is largely due to the degree of circulatory compensation. Intraoperative endothelial injury deteriorated the course of the endothelial dysfunction by activating NO synthesis.
Conclusion. Stress-inducible NO and HSP70 systems combined with endothelial growth factor form a kind of “shield” which timely limits the impact of the damaging ischemic/reperfusion factors.

Keywords: ischemia, reperfusion, heat shock protein, nitric oxide, vascular endothelial growth factor, endothelial dysfunction
p. 51-56 of the original issue
References
  1. Klinicheskaia angiologiia [Clinical angiology]: rukovodstvo: v 2-kh t. / pod red AV. Pokrovskogo. Moscow, RF: Meditsina; 2004. 888 p.
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  6. Alcocer F, Whitley D, Salazar J, Jordan W, Bland KI.Mutual exclusion of apoptosis and hsp70 in human vein intimal hyperplasia in vitro. J Surg Res. 2001 Mar; 96(1):75-80.
  7. Fraisl P, Mazzone M, Schmidt T, Carmeliet P. Regulation of angiogenesis by oxygen and metabolism. Dev Cell. 2009 Feb;16(2):167-79.
  8. Zhang Y, Yang H, Barnie PA, Yang P, Su Z, Chen J, Jiao Z, Lu L, Wang S, Xu H.The expression of Toll-like receptor 8 and its relationship with VEGF and Bcl-2 in cervical cancer. Int J Med Sci. 2014 Apr 16;11(6):608-13.
  9. Kirichuk VF, Glybochko PV, Ponomareva AI. Disfunktsiia endoteliia [Endothelial dysfunction]. Saratov, RF: Izd-vo Saratov med un-ta. 2008. 129 p.
  10. Kalinin RE, Zviagina VI, Pshennikov AS, Suchkov IA, Matveeva IV. Fotokolorimetricheskii metod opredeleniia urovnia metabolitov oksida azota v syvorotke krovi [Photocolorimetric method of determining the level of nitric oxide in serum]. Astrakh Med Zhurn. 2010;5(1):88-89.
  11. Pal'tsev MA, Ivanov AA, Severin SE. Mezhkletochnye vzaimodeistviia [Intercellular interactions]. Moscow, RF: Meditsina. 2003. 288 p.
Address for correspondence:
390048, Rossiyskaya Federatsiya,
g. Ryazan, ul. Stroykova, d. 96,
GBOU VPO "Ryazanskiy gosudarstvennyiy
meditsinskiy universitet imeni akademika I.P. Pavlova",
kafedra angiologii, sosudistoy,
operativnoy khirurgii i topograficheskoy anatomii,
tel. mob: 7 910 900-95-23,
e-mail: Pshennikov1610@rambler.ru,
Pshennikov Aleksandr Sergeevich
Information about the authors:
Kalinin R.E. MD, professor, a head of the angiology, operative surgery and topographic anatomy chair of SBEE HPE "Ryazan State Medical University named after Academician I.P.Pavlov".
Pshennikov A.S. PhD, an assistant of the angiology, operative surgery and topographic anatomy chair of SBEE HPE "Ryazan State Medical University named after Academician I.P.Pavlov".
Suchkov I.A. MD, an associate professor of the angiology, operative surgery and topographic anatomy chair of SBEE HPE "Ryazan State Medical University named after Academician I.P. Pavlov".

Y.T. TSUKANOV, A.I. NIKOLAYCHUK

EVALUATION OF FACTORS AFFECTING THROMBUS REGRESSION OF SUBCUTANEOUS VEINS OF THE LOWER LIMBS IN ANTICOAGULATION THERAPY

SEE HPE "Omsk State Medical Academy",
The Russian Federation

Objectives. To assess the factors affecting the thrombus regression using anticoagulants in patients with subcutaneous venous thrombosis.
Methods. 65 patients receiving anticoagulants in the adjuvant therapy within 1-14 days, (on the average 5,05 days) after thrombosis development have been examined. An evaluation of thrombus changes, venous wall and paravasal cellulose was perfomed by duplex ultrasonography.
Results. Mass and density of thrombus, distal displacement of its borders, reduction of inflamed venous wall and paravasal cellular tissue have been reduced in all patients. Regression began in 1-10 days (on the average 5,37 day). Depending on the rate of regression, the observations are divided into two subgroups: 1) relatively quick - within a week (16), and 2) relatively slow – within a month (49 people). It has been found out that treatment with anticoagulants started up to 3 days, low echodensity of the proximal part of thrombus, cellular character, unexpression of paravasal inflammation throughout the thrombus and its proximal part make the significant probability of rapid thrombus regression (p=0,000001).
Conclusion. Thrombosis regression of the subcutaneous veins in the treatment process, including anticoagulants, in the nearest terms passes the way of thrombolysis with a minimal damage of the venous wall by reducing its mass and density, increasing its cellular structure. Rapid regression of the proximal part of the subcutaneous vein thrombus occurs in treatment beginning up to 3 days from the moment of a blood clot formation, its low echodensity, thickness of the inflamed paravasal tissue in the proximal part of the blood clot not more than 5 mm and for thrombus not more than 7 mm. In case of ligation of large subcutaneous veins to prevent the pulmonary embolism a clot lysis slows down.

Keywords: subcutaneous vein thrombosis, anticoagulants, regression of thrombosis, thrombolysis
p. 57-62 of the original issue
References
  1. Wichers IM, Di Nisio M, Büller HR, Middeldorp S. Treatment of superficial vein thrombosis to prevent deep vein thrombosis and pulmonary embolism: a systematic review. Haematologica. 2005 May;90(5):672-77.
  2. Decousus H, Quéré I, Presles E, Becker F, Barrellier MT, Chanut M, Gillet JL, Guenneguez H, Leandri C, Mismetti P, Pichot O, Leizorovicz A. Superficial venous thrombosis and venous thromboembolism: a large, prospective epidemiologic study. Ann Intern Med. 2010 Feb 16;152(4):218-24.
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  6. Shabunin AV, Gavrilov SG, Pustovoit AA, Bychkova TV, Karalkin AV, Zolotukhin IA. Sravnenie effektivnosti khirurgicheskoi i konservativnoi taktiki pri ostrom voskhodiashchem varikotromboflebite bol'shoi podkozhnoi veny [Comparison of the effectiveness of surgical and conservative management for acute ascending varikotromboflebite of great saphenous vein]. Flebologiia. 2013;(2):10-14.
  7. Kalodiki E, Stvrtinova V, Allegra C, Andreozzi G, Antignani PL, Avram R, Brkljacic B, et al. Superficial vein thrombosis: a consensus statement. Int Angiol. 2012 Jun;31(3):203-16.
  8. Decousus H, Prandoni P, Mismetti P, Bauersachs RM, Boda Z, Brenner B, Laporte S, Matyas L, Middeldorp S, Sokurenko G, Leizorovicz A; CALISTO Study Group. Fondaparinux for the treatment of superficial-vein thrombosis in the legs. N Engl J Med. 2010 Sep 23;363(13):1222-32.
  9. Zwiebel William J, Pellerito John S. Introduction to Vascular Ultrasonography, 5th Edition. Saunders (W.B.) CoLtd; 2004. 752 p.
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    Deep venous thrombosis: rate of spontaneous lysis and thrombus extension. Int Angiol. 2003 Dec;22(4):376-82.
  13. Piovella F, Crippa L, Barone M, Viganò D'Angelo S, Serafini S, Galli L, Beltrametti C, D'Angelo A. Normalization rates of compression ultrasonography in patients with a first episode of deep vein thrombosis of the lower limbs: association with recurrence and new thrombosis. Haematologica. 2002 May;87(5):515-22.
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Address for correspondence:
644043, Rossiyskaya Federatsiya,
g. Omsk, ul. Lenina, d. 12,
GOU VPO "Omskaya gosudarstvennaya
meditsinskaya akademiya",
kafedra khirurgicheskih bolezney i urologii PDO,
tel. office 7 3812 36-07-62,
e-mail: alex79nik@mail.ru,
Nikolaychuk Aleksandr Ivanovich
Information about the authors:
Tsukanov Y.T. MD, professor, a head of the surgical diseases and urology chair of SBEE HPE "Omsk State Medical Academy".
Nikolaychuk A.I. An assistant of the surgical diseases and urology chair of SBEE HPE "Omsk State Medical Academy".

M.G. OREL

THE INCIDENCE OF DETECTION OF LOWER LIMB DEEP VEIN THROMBOSIS IN THROMBOTIC LESIONS OF SUBCUTANEOUS VEINS

Lviv National Medical University named after Danylo Halytsky
Ukraine

Objectives. To detail data of the nature of the vein thrombotic lesions, localization of dilated perforants and their involvement in this pathologic process by ultrasound duplex scanning in patients with the main lower extremity veins thrombosis.
Methods. In the main group the examination of 149 lower limbs in 119 patients (17-82 yrs) with the main vein thrombosis, in the control group – 191 limbs in 121 patients (17-87 yrs) without thrombotic lesions and varicose changes of the lower limb veins have been performed. The ultrasonic device Toshiba Powervision with transducer of exchangeable frequency (5,0-12,0 MHz and 2,5-4,0 MHz) was applied. The different patient’s position, compression and respiratory probes were used.
Results. The main group: the acute and subacute thrombotic lesions of deep and subcutaneous veins were revealed in 121 (81,2%) limbs. The subcutaneous veins thrombosis was found out in 86 limbs (57,7%). Thrombus apex flotation was revealed in 23 (15,4%) limbs. Varicose of the subcutaneous veins was observed in 59,7%. In the main group the dilated perforating veins were found in 61,8%, most often – muscular perforants (32,9%) and Boyd perforants (28,2%). In the control group the dilated perforants were found in 18,9%, the most frequently – Cockett III perforants (7,9%) and Sherman perforants (5,2%). Spreading of thrombotic lesions between the large and small subcutaneous veins pools through the communicating branches has occurred in 2,7% cases. The propagation of thrombosis through dilated perforants to the deep veins was detected in 22,1% cases.
Conclusion. Ultrasonic duplex scanning of the lower limb veins permitted to detail the parameters of thrombotic lesion and the probable ways of its propagation. The authors suggest for the predictive purpose to indicate the status of communicating and perforating branches of the lower limbs veins in the protocol.

Keywords: venous thrombosis, perforating veins, communicating veins, duplex scanning
p. 63-69 of the original issue
References
  1. Guillermo Escobar A, Thomas W Wakefield, FACS and Peter K Henke, John T Owings. Venous thromboembolism [Scientific american surgery / Vascular System]. 2011/01 [cited 2014 Nov 04]. Available from: www.sciamsurgery.com/sciamsurgery/institutional/regGetFile.action? fileName=part06_ch06.pdf
  2. Mishalov VG, Amosova EN, Litvinova IuN, Beichuk SV, Rogovskii V M. Klinicheskie proiavleniia i faktory riska ostrogo tromboza glubokikh ven nizhnikh konechnostei. Effektivnost' i bezopasnost' razlichnykh vidov antikoaguliantnoi terapii (retrospektivnoe issledovanie) [Clinical manifestations and risk factors of acute deep vein thrombosis of the lower extremities. The efficacy and safety of different types of anticoagulation therapy (retrospective study)]. Sertse ³ Sudini. 2008;(1):33-40.
  3. Gubka AV, Pertsov VI, Gubka VA. Ostryi tromboz ven nizhnikh konechnostei. Faktory riska, metody profilaktiki i lecheniia [Acute venous thrombosis of the lower extremities. Risk factors, treatment and prevention methods]. Kl³n Kh³rurg³ia. 2003;(3):44-48.
  4. Baeshko AA. Risk i profilaktika tromboembolicheskikh oslozhnenii v khirurgii [Risk and prevention of thromboembolic complications in surgery]. Khirurgiia 2001;(4):61-69.
  5. Otraslevoi standart. Protokol vedeniia bol'nykh. Profilaktika tromboembolii legochnoi arterii pri khirurgicheskikh i inykh invazivnykh vmeshatel'stvakh [Industry standard. Treatment protocol. Prevention of pulmonary embolism in surgical and other invasive procedures]. Moscow, RF: N'iudiamed; 2004. 64 p.
  6. Stoiko IuM, Zamiatin MN. Sovremennye vozmozhnosti profilaktiki tromboembolicheskikh oslozhnenii u patsientov s vysokim i ochen' vysokim riskom [Modern possibilities of prevention of thromboembolic complications in patients with high and very high risk]. Consilium Medicum. Khirurgiia. 2007;(2):40-43.
  7. Qaseem A, Snow V, Barry P. Management of venous thromboembolism: A clinical practice guideline from the American college of physicians and American academy of family physicians. Ann Intern Med. 2007 Feb 6;146(3):204-10.
  8. Kharchenko VP, Zubarev AR, Kotliarov PM. Ul'trazvukovaia flebologiia [Ultrasonic phlebology]. Moscow, RF: ZAO Eniki, 2005. 176 p.
  9. Churikov DA, Kirienko AM. Ul'trazvukovaia diagnostika boleznei ven [Ultrasound diagnosis of vein diseases]. Moscow, RF: Littera; 2006. 96 p.
  10. Mostovii IuM. Tromboembol³ia legenevo¿ arter³¿: suchasn³ standarti d³agnostiki ta l³kuvannia (metodichn³ rekomendats³¿) [Pulmonary artery: current standards for diagnosis and treatment]. V³nnitsia, Ukraine; 2003. 55 p.
  11. Rusin V², Levchak IuA, Bold³zhar PO. Suchasna d³agnostika gostrikh venoznikh tromboz³v. Aktual'n³ problemi suchasno¿ meditsini [Current diagnosis of acute venous thrombosis. Actual problems of modern medicine]. Ukr Med Stomat Akad. 2007; 7(2):277-81.
  12. Prevention and treatment of venous thromboembolism. International Consensus Statement // Int Angiol [Electronic Resource]. 2013;32(2):111–60. available from:
    http://www.europeanvenousforum.org/files/publications/guid_vte/IUA_Guidelines_2013.
  13. Savel'ev VS, Gologorskii VA, Kirienko AI./ red Savel'ev VS. Flebologiia: Rukovodstvo dlia vrachei [Phlebology: a guide for physicians]. Moscow, RF: Meditsina; 2001. 664 p.
  14. Chernukha LM, Nikul'nikov PI, Guch AA, Artemenko MO. Venoznyi tromboz nizhnikh konechnostei. Vozmozhno li reshenie problemy segodnia? [Venous thrombosis of the lower extremities. Is it possible to solve the problem today?] Kl³n Kh³rurg³ia. 2007;(10):48-54.
  15. Rusin V², Korsak VV, Bold³zhar PO, Mad³ Iu Iu. Poºdnannia gostrogo var³kotrombofleb³tu malo¿ p³dshk³rno¿ veni z trombozom litkovikh ven [The combination of acute varicothrombophlebitis of small saphenous vein thrombosis of the calf veins]. Nauk V³sn Uzhgorod un-tu, Ser Meditsina, 2012;2(44):97-100.
  16. Nabil Aly. Superficial thrombophlebitis or deep vein thrombosis? GM: Midlife & Beyond. 2010;(40)12:699-704.
Address for correspondence:
79010 Ukraina,
g. Lvov, ul. Pekarskaya, d. 69,
Lvovskiy natsionalnyiy meditsinskiy universitet im. Danila Galitskogo,
kafedra operativnoy hirurgii s topograficheskoy anatomiey,
tel. office: 38 (032) 275-59-31,
e-mail: orelmasha@ukr.net,
Orel Mariya Glebovna
Information about the authors:
Orel M.G. An assistant of the operative surgery with topographic anatomy chair of Lviv National Medical University named after Danylo Halytsky.

S.D. SHAPOVAL, I.L. SAVON, A.N. YAKUNICH, O.O. MAKSIMOVA

RESISTANT AND MULTIRESISTANT AGENTS OF PYONECROTIC COMPLICATIONS OF DIABETIC FOOT SYNDROME

SE "Zaporozhye Medical Academy of Postgraduate Education of the Ministry of Health of Ukraine",
Ukraine

Objectives. To study the microbiological profile and antimicrobial resistance in patients with complicated diabetic foot syndrome (DFS).
Methods. The study involved 174 patients with DFS within 2013-2014 yrs. All patients with diabetes mellitus (DM) II type (average duration 12,8±2,9 years). The average age of the patients was 59,3±5,3 years. The pyo-necrotic injuries of foot – abscess, phlegmon, pyogenic abscess, pyogenic tendovaginitis, pyogenic arthritis, gangrene have been diagnosed in the patients. According to the PEDIS classification the process had P1-2E1-2D2-3I2-3S1-2 characteristics. Determination of the qualitative composition of flora and sensitivity to antibiotics of isolated cultures was performed with the automatic bacteriological analyzer (Vitek 2 Compact – France).
Results. The cause of pyo-necrotic complications of DFS were gram-positive flora in 56,9% of cases, in 33,3% – gram-negative, in 2,9% – anaerobes, in 2,3% – fungi. The phenomenon of resistance to the major antimicrobial drugs was revealed in 65 (37,4%) bacteria. Pseudomonas aeruginosa, Staphylococcus aureus, Staphylococcus epidermidis, Esherihia coli, Acinetobacter baumannii, Enterococcus faecalis had the greatest resistance. Among the groups with the identified Pseudomonas aeruginosa, 66,0% of the bacteria were characterized by a phenotype of resistance to carbapenems, 33,0% of which were panresistant ones. In patients with Staphylococcus aureus in 60,5% of cases the gene of MRSA with three genetic variations differed by resistance to certain groups of antibiotics was revealed. The most important was panresistant one (4,3%).
Conclusion. The antibiotic therapy ineffectiveness in patients with DFS is caused by a large number of resistant and panresistant forms. Active drugs against MRSA are daptomycin, vancomycin, teicoplanin, tigecycline. In case of infections caused by ESBL-producing bacteria the use of carbapenems (imipenem / cilastatin and meropenem) remains topical. Reserve tigecycline for use in situations when alternative treatments not suitable.

Keywords: diabetic foot, resistant bacteria, antibiotic therapy, MRSA, ESBL
p. 70-76 of the original issue
References
  1. Gilbert DN, Mellering RK, Eliopulos DM. / red. Spasokukotskii A.L. Spravochnik Senforda po protivomikrobnoi terapii [The Sanford Guide to Antimicrobial Therapy]. Kiev, Ukraina: Ukr Med Vestn; 2012. 272 p.
  2. Crouzet J, Lavigne JP, Richard JL, Sotto A. Diabetic foot infection: a critical review of recent randomized clinical trials on antibiotic therapy. Int J Infect Dis. 2011 Sep;15(9):e601-10.
  3. Lipsky BA, Hoey C. Topical antimicrobial therapy for treating chronic wounds. 2009 Nov 15;49(10):1541-49.
  4. Liu C, Bayer A, Cosgrove SE, Daum RS, Fridkin SK, et. Infectious Diseases Society of America. Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children. Clin Infect Dis. 2011 Feb 1;52(3):e18-55.
  5. Iakovlev SV, Iakovlev VP. Sovremennaia antimikrobnaia terapiia v tablitsakh [Modern antimicrobial therapy in the tables]. Consilium Medicum. 2009;4(11):2-82.
  6. Salmanov AG, Marievskii VF. Antibiotikorezistentnost' nozokomial'nykh shtammov Staphylococcus aureus v Ukraine: rezul'taty mnogotsentrovogo issledovaniia [Antibiotic resistance of nosocomial Staphylococcus aureus strains in Ukraine: results of a multicenter study]. Novosti Khirurgii. 2013;21(4):78-83.
  7. Gardner SE, Hillis SL, Frantz RA. Clinical signs of infection in diabetic foot ulcers with high microbial load. Biol Res Nurs. 2009 Oct;11(2):119-28.
  8. Richard JL, Lavigne JP, Got I, Hartemann A, Malgrange D, Tsirtsikolou D, Baleydier A, Senneville E. Management of patients hospitalized for diabetic foot infection: results of the French OPIDIA study. 2011 Jun;37(3):208-15.
  9. Aragón-Sánchez J.Seminar review: A review of the basis of surgical treatment of diabetic foot infections. Int J Low Extrem Wounds. 2011 Mar;10(1):33-65.
  10. Fincke BG, Miller DR, Christiansen CL, Turpin RS. Variation in antibiotic treatment for diabetic patients with serious foot infections: a retrospective observational study. BMC Health Serv Res. 2010 Jul 6;10:193.
  11. International Working Group on the Diabetic Foot. International consensus on the diabetic foot [CD-ROM]. Brussels: International Diabetes Foundation, May, 2003.
Address for correspondence:
69096, Ukraina, g. Zaporozhe,
bul. Vintera, d. 20,
GZ "Zaporozhskaya meditsinskaya akademiya
poslediplomnogo obrazovaniya MZ Ukrainyi" ,
kafedra ambulatornoy,
gnoyno-septicheskoy khirurgii i ultrazvukovoy diagnostiki,
tel.office: 38 (061) 213-15-42,
t.mob.: 38-050-577-16-47,
e-mail: konsilium@ukr.net,
Shapoval Sergey Dmitrievich
Information about the authors:
Shapoval S.D. MD, professor, first Vice-rector, a head of the ambulant, purulent-septic surgery and ultrasound diagnostics chair of SE "Zaporozhye Medical Academy of Postgraduate Education of the Ministry of Health of Ukraine".
Savon I.L. MD, an associate professor of the ambulant, pyo-septic surgery and ultrasound diagnostics chair of SE "Zaporozhye Medical Academy of Postgraduate Education of the Ministry of Health of Ukraine".
Yakunich A.N. PhD, an assistant of the ambulant, pyo-septic surgery and ultrasound diagnostics chair of SE "Zaporozhye Medical Academy of Postgraduate Education of the Ministry of Health of Ukraine".
Maksimova O.O. PhD, assistant of the ambulant, purulent-septic surgery and ultrasound diagnostics chair of SE "Zaporozhye Medical Academy of Postgraduate Education of the Ministry of Health of Ukraine".

E.A. MATUSEVICH

METABOLIC CORRECTION OF T CELL-MEDIATED IMMUNITY AND ENDOGENOUS INTOXICATION IN GENERALIZED PURULENT PERITONITIS

HI "Braslav Central Regional Hospital",
EE "Vitebsk State Medical University",
The Republic of Belarus

Objectives. To assess changes of the immunogram indicators, integral hematologic indices of endogenous intoxication, mortality rate, the number of postoperative complications in patients with generalized purulent peritonitis and possibilities of their correction by Cytoflavin, a drug which contains succinic acid.
Methods. The treatment analysis of 158 patients with generalized purulent peritonitis has been carried out; the patients were classified into 2 groups: the control group (106 patients treated with traditional and complex therapy) and the main group (52 patients receiving additionally Cytoflavin). The effect of Cytoflavin on the main parameters of T cell-mediated immunity, dynamics of integral hematologic indices of endogenous intoxication, mortality rate and the number of postoperative complications in case of the given pathology has been studied.
Results. In the postoperative period in patients with generalized purulent peritonitis the significant changes in immunogram parameters characterized by the increase of the number of active T-lymphocytes, the reduction of general T- lymphocytes, T-helper lymphocytes, the immunoregulatory index, indices of stimulated NBT test of leukocytes with simultaneous increase of NBT-spontaneous test and the reduced phagocytic index test have been registered. The elevated main hematologic indices of the endogenous intoxication and the increase in the number of absolute leukocytes count have been noticed. On the 7-10th days the changes were persisted in the case of the traditional treatment. In the group of patients where Cytoflavin was applied, the studied indices were considered to be similar to normal or were not statistically differed from those. The mortality was reduced from 19,81% up to 11,54%, and the number of postoperative complications – from 16,98% up to 13,46% (in 1,72 and 1,26, respectively) in the main group compared with the control one.
Conclusion. The inclusion of Cytoflavin, a drug which contains succinic acid, in the complex treatment of patients with generalized purulent peritonitis contributes to the normalization of cellular immune parameters, as well as the reduction of the leukocytosis and endotoxicosis severity within the early postoperative period, the decrerase of the mortality rate and quantity of postoperative complications indicates for the possibility of Cytoflavin application as a metabolic immunocorrector.

Keywords: generalized purulent peritonitis, T cell-mediated immunity, endogenous intoxication, treatment, metabolic correction, Cytoflavin
p. 77-84 of the original issue
References
  1. Sartelli M, Catena F, Ansaloni L, Moore E, Malangoni M, Velmahos G, et al. Complicated intra-abdominal infections in a worldwide context: an observational prospective study (CIAOW Study). World J Emerg Surg. 2013 Jan 3;8(1):1.
  2. Alekseev SA. Abdominal'nyi khirurgicheskii sepsis [Abdominal surgical sepsis]. Minsk, RB: Iunipak; 2005. 256 p.
  3. Kemerov SV, Stepin DA. Sovremennye podkhody i sredstva lecheniia abdominal'nogo sepsisa i gnoinogo peritonita [Current approaches and treatment of abdominal sepsis and peritonitis]. Vopr Rekonstrukt i Plast Khirurgii. 2012;(4):36-40.
  4. Larichev AB, Pokrovskii EZh, Dylenok AA. Rezul'taty lecheniia rasprostranennogo gnoinogo peritonita s dekompensatsiei poliorgannoi disfunktsii [The results of treatment of generalized peritonitis with decompensation of multiple organ dysfunctions]. Novosti Khirurgii. 2013;21(5):50-57.
  5. Gürlich R, Adámková V, Ulrych J, Balík M, Ferko A, Havel E, et al. Basic principles of diagnosis and treatment of secondary peritonitis - recommendations of experts with the support of SIS. [Article in Czech] Rozhl Chir. 2014 Jun;93(6):334-48, 350-52.
  6. Efimenko NA, Rozanov VE, Bolotnikov AI. Immunopatogenez i kontseptsiia sovremennoi immunoterapii peritonita u postradavshikh s tiazheloi sochetannoi travmoi zhivota [Immunopatogenesis and the concept of modern immunotherapy of peritonitis in patients with severe combined trauma of the abdomen]. AVTOGRAF. Moscow, RB; 2008. 302 p.
  7. Bulygin GV, Kamzalakova NV, Solonchuk IuR. Vozmozhnosti povysheniia effektivnosti terapii gnoinoi khirurgicheskoi infektsii [Opportunities to improve the effectiveness of treatment of purulent surgical infection]. Khirurgiia. 2010;(5):65-71.
  8. Gavriliuk VP, Karaulov AV, Konoplia AI. Immunomoduliruiushchaia terapiia v kompleksnom lechenii appendikuliarnogo peritonita u detei [Immunomodulatory therapy in treatment of appendicular peritonitis in children]. Immunologiia. 2011;(4):213-16.
  9. Hernández-Palazón J, Fuentes-García D, Burguillos-López S, Domenech-Asensi P, Sansano-Sánchez TV, Acosta-Villegas F. Analysis of organ failure and mortality in sepsis due to secondary peritonitis. [Article in Spanish]. Med Intensiva. 2013 Oct;37(7):461-67.
  10. Bagnenko SF, Mirzabaev AT, Batotsyrenov BV, Gorbachev NB, Miroshnichenko VN, Batotsyrenova KhV, Velikii KF. Farmakologicheskaia korrektsiia svobodnoradikal'nykh narushenii i endotoksikoza u bol'nykh s rasprostranennym peritonitom v posleoperatsionnom periode [Pharmacological correction of free-radical violations and endotoxemia in patients with generalized peritonitis in the postoperative period]. Vestn Khirurgii im II Grekova. 2011;170(5):14-18.
  11. Novikova IA, Afanas'eva ES, Skreblo EI. Kompleksnaia laboratornaia otsenka immunnogo statusa [Comprehensive laboratory evaluation of the immune status]: ucheb -metod posobie dlia prakt zaniatii s vrachami klinich lab diagnostiki. Vitebsk, RB: VGMU, 2003. 40 p.
  12. Gergel' NI, Kosov AI, Kudinova EV, Karslian LS, Mingacheva AA, Kosiakova IuA. Gematologicheskie pokazateli klinicheski zdorovykh lits [Haematological parameters of clinically healthy individuals]. Med Al'manakh. 2011;(3):175-76.
  13. Diabkin EV, Luchikhina MIu, Khrabraia AA, Dedina MS. Strukturno-prognosticheskii analiz ispol'zovaniia integral'nykh gematologicheskikh pokazatelei pri peritonite [Structural and prognostic analysis of the use of integral hematological parameters in peritonitis]. Biull Med Internet-Konferentsii. 2012;2(1):19-26.
  14. Ostrovskii VK, Mashchenko AV, Iangolenko DV, Makarov SV. Pokazateli krovi i leikotsitarnogo indeksa intoksikatsii v otsenki tiazhesti i opredelenii prognoza pri vospalitel'nykh, gnoinykh, gnoino-destruktivnykh zabolevaniiakh [Blood counts and leukocyte index of intoxication in assessing the severity and determining prognosis in inflammatory, suppurative, purulent-destructive diseases]. Klin Lab Diagnostika. 2006;(6):50-53.
Address for correspondence:
211970, Respublika Belarus',
Vitebskaia oblast', g. Braslav,
ul. Sovetskaia, d. 138,
UZ "Braslavskaia TsRB",
tel. mob: +375 29 714-19-10,
e-mail: Burat@km.ru,
Matusevich Evgenii Anatol'evich
Information about the authors:
Matusevich EA, a deputy chief physician (medicine) of HI "Braslav CRH", a competitor of the department of hospital surgery with courses of urology and pediatric surgery EE "Vitebsk State Medical University."

TRANSPLANTOLOGY

S.Z. SHARIPOV 2, A.E. SHCHERBA 2, I.I. PIKIRENIA 1, À.À. HLINNIK 1
À.M. FEDARUK 2, S.V. KOROTKOV 2, Î.Î. RUMMO 2

POSSIBILITY OF STREPTOKINASE THERAPY FOR PROPHYLAXIS OF BILIARY COMPLICATIONS AFTER LIVER TRANSPLANTATION

SEE "Belarusian Medical Academy of Post-Graduate Education"1,
ME "The 9th City Clinical Hospital", Minsk2,
The Republic of Belarus

Objectives. To identify the risk factors for the development of biliary complications after orthotopic liver transplantation and to establish whether streptokinase therapy influences on the formation of biliary complications related liver transplantation in donor phase.
Methods. The analysis of medical records and the treatment results of 117 patients, subjected to the orthotopic liver transplantation within the period from April 2008 to September 2012 has been carried out.
Results. The retrospective analysis has shown the streptokinase treatment in the donor phase does not promote the development of anastomotic biliary strictures. A trend toward a later occurrence of anastomotic strictures after the liver transplantation is considered as a positive effect. The number of the nonanastomotic strictures occurred significantly less during Streptokinase treatment, than in the group without streptokinase application – 2,2% and 13,6%, retrospectively. In the donor phase univariate regression analysis has shown that streptokinase treatment contributed to the risk reduction of nonanastomotic strictures formation almost by 4 folds. The failure of biliary anastomosis occurred in 6 patients out of 117 patients who had undergone the liver transplantation. All of them received a transplant from donors with brain death to whom streptokinase hadn’t been administrated. The average time of failure development – 3 (1; 10) days. Anastomotic strictures related with liver transplantation occurred in 17 patients. Incidence of anastomotic strictures occurrence in the main group was comparable to that in the second group. Thus, in the donor phase streptokinase therapy had no effect on the development of anastomotic strictures. In this case, there was a trend to a later occurrence of anastomotic strictures after transplantation.
Conclusion. The results of the study have shown the effectiveness of the prevention of biliary complications after the liver transplantation by intravenous injections of streptokinase with heparin (dose of 1,5 million IU and 25,000 IU, respectively) 15-20 min before flushing in the donor phase.

Keywords: orthotopic liver transplantation, postoperative complication, biliary stricture, streptokinase
p. 85-90 of the original issue
References
  1. Pascher A, Neuhaus P. Biliary complications after deceased-donor orthotopic liver transplantation. J Hepatobiliary Pancreat Surg. 2006;13(6):487-96.
  2. Wojcicki M, Milkiewicz P, Silva M.Biliary tract complications after liver transplantation: a review. Dig Surg. 2008;25(4):245-57.
  3. Inomata Y, Tanaka K. Pathogenesis and treatment of bile duct loss after liver transplantation. J Hepatobiliary Pancreat Surg. 2001;8(4):316-22.
  4. Moench C, Uhrig A, Lohse AW, Otto G.CC chemokine receptor 5delta32 polymorphism-a risk factor for ischemic-type biliary lesions following orthotopic liver transplantation. Liver Transpl. 2004 Mar;10(3):434-39.
  5. Pomposelli JJ, Jenkins RL. Early and late complication of liver transplantation. In: L.H. Blumgart, ed. Surgery of the liver, biliary tract and pancreas. 4th ed. Philadelpia, US: Saunders Elseiver, 2007;(2):1801-802.
  6. Sharma S, Gurakar A, Jabbour N.Biliary strictures following liver transplantation: past, present and preventive strategies. Liver Transpl. 2008 Jun;14(6):759-69.
  7. Neuhaus P, Blumhardt G, Bechstein WO, Steffen R, Platz KP, Keck H.Technique and results of biliary reconstruction using side-to-side choledochocholedochostomy in 300 orthotopic liver transplants. Ann Surg. 1994 Apr;219(4):426-34
  8. Moser MA, Wall WJ.Management of biliary problems after liver transplantation. Liver Transpl. 2001 Nov;7(11 Suppl 1):S46-52.
  9. Campbell WL, Sheng R, Zajko AB, Abu-Elmagd K, Demetris AJ.Intrahepatic biliary strictures after liver transplantation. Radiology. 1994 Jun;191(3):735-40.
  10. Verdonk RC, Buis CI, van der Jagt EJ, Gouw AS, Limburg AJ, Slooff MJ, Kleibeuker JH, Porte RJ, Haagsma EB. Nonanastomotic biliary strictures after liver transplantation, part 2: Management, outcome, and risk factors for disease progression. Liver Transpl. 2007 May;13(5):725-32.
  11. Abt P, Crawford M, Desai N, Markmann J, Olthoff K, Shaked A.Liver transplantation from controlled non-heart-beating donors: an increased incidence of biliary complications. Transplantation. 2003 May 27;75(10):1659-63.
  12. Cameron AM, Busuttil RW. Ischemic cholangiopathy after liver transplantation. Hepatobiliary Pancreat Dis Int. 2005 Nov;4(4):495-501.
  13. Foley DP, Fernandez LA, Leverson G, Chin LT, Krieger N, Cooper JT, Shames BD, Becker YT, Odorico JS, Knechtle SJ, Sollinger HW, Kalayoglu M, D'Alessandro AM. Donation after cardiac death: the University of Wisconsin experience with liver transplantation. Ann Surg. 2005 Nov;242(5):724-31.
  14. Lang R, He Q, Jin ZK, Han DD, Chen DZ.Urokinase perfusion prevents intrahepatic ischemic-type biliary lesion in donor livers. World J Gastroenterol. 2009 Jul 28;15(28):3538-41.
  15. Shcherba AE, Korotkov SV, Lebed' OA, Savchuk MM, Dziadz'ko AM, Minov AF, Santotskii EO, Rummo OO. Eksperimental'naia gipotermicheskaia mashinnaia perfuziia transplantatov pecheni rastvorom Kustodiol (HTK) [Experimental hypothermic machine perfusion of the liver transplant by Custodiol solution]. Novosti Khirurgii. 2014;22(1):75-82.
  16. Karimian N, Westerkamp AC, Porte RJ.Biliary complications after orthotopic liver transplantation. Curr Opin Organ Transplant. 2014 Jun;19(3):209-16.
  17. Sankary HN, McChesney L, Frye E, Cohn S, Foster P, Williams J. A simple modification in operative technique can reduce the incidence of nonanastomotic biliary strictures after orthotopic liver transplantation. Hepatology. 1995 Jan;21(1):63-69.
Address for correspondence:
2100, Respublika Belarus,
g. Minsk, ul. Semashko, d. 8,
UZ "9-ya gorodskaya klinicheskaya bolnitsa",
otdelenie khirurgii
tel. mob.: +375 25 612 71 11,
e-mail: shohrat07@mail.ru,
Sharipov Shohrat
Information about the authors:
Sharipov S.Z. A surgeon of the surgical unit of ME "The 9th Clinical Hospital", Minsk.
Shcherba A.E., PhD, a head of the hepatobiliary surgery and liver transplantation unit of ME "The 9th Clinical Hospital", Minsk.
Pikirenia I.I. PhD, an associate professor, a head of the transplantation chair of SEE "Belarusian Medical Academy of Post-graduate Education".
Hlinnik A.A. PhD, an associate professor of the transplantation chair of SEE "Belarusian Medical Academy of Post-graduate Education".
Fedaruk A.M. MD, a head of hepatology and low-invasive surgery unit of ME "The 9th Clinical Hospital", Minsk.
Korotkov S.V. PhD, a head of the transplantation unit of ME "The 9th Clinical Hospital", Minsk.
Rummo O.O. MD, a Deputy Chief on surgery, head of the RSPC of organ and tissue transplantation of ME "The 9th Clinical Hospital", Minsk.

ANESTHESIOLOGY & REANIMATOLOGY

A.L. LIPNITSKI, A.V. MAROCHKOV

COMPARATIVE EVALUATION OF CISATRACURIUM AND ATRACURIUM ACTION AS COMPONENTS OF ENDOTRACHEAL ANESTHESIA IN LAPAROSCOPIC SURGERIES

ME "Mogilev Regional Hospital",
The Republic of Belarus

Objectives. To carry out the comparative evaluation of cisatracurium and atracurium as a component of a balanced endotracheal anesthesia for the abdominal laparoscopic surgeries.
Methods. 80 patients at the age of 18-70, who had undergone the laparoscopic cholecystectomy, were enrolled in the prospective randomized study. All patients received cisatracurium 0,1 mg / kg (the 1st group) or atracurium 0,3 mg / kg (the 2nd group). Monitoring of neuromuscular transmission is carried out according to Stockholm criteria of the pharmacodynamic studies of myorelaxants action.
Results. Cisatracurium administration (270 (225-330) had faster onset time of neuromuscular block in comparison with the 2nd – 390 (210-540) (p<0,01). In the 1st group intubation conditions were excellent in 28 (66,7%) cases, in the 2nd group – in 13 (34,2%) patients (p<0,05), and poor – in 3 cases (1st group), in 12 cases, (p<0,05) in the 2nd group. Duration of action of atracurium was reliably lower – 31,5 (25-37) min in comparison with cisatracurium – 43 (40-50) min (p<0,05). In atracurium group total number of complications / side effects was higher than in cisatracurium group, in 2nd group – 16 and 5 – in the 1st group (p<0,05). Serious complications related to regional anesthesia have not been observed.
Conclusion. Low doses of cisatracurium (0,1 mg/kg) cause faster onset and create better conditions for tracheal intubation, compared with that of atracurium. Cisatracurium (0,1 mg/kg) proved tî have a longer duration of action than atracurium (0,3 mg/kg).

Keywords: myorelaxants, cisatracurium, atracurium, neuromuscular block, general anesthesia, randomized controlled trial
p. 91-96 of the original issue
References
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  13. Adamus M, Hrabalek L, Wanek T, Gabrhelik T, Zapletalova J. Influence of age and gender on the pharmacodynamic parameters of rocuronium during total intravenous anesthesia. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2011 Dec;155(4):347-53.
  14. Sparr HJ. Choice of the muscle relaxant for rapid-sequence induction. Eur J Anaesthesiol Suppl. 2001;23:71-76.
Address for correspondence:
212002, Respublika Belarus,
g. Mogilev, ul. B. Biruli d. 12,
ME "Mogilev Regional Hospital",
otdelenie anesteziologii i reanimatsii,
tel. office: +375 222 278 733,
e-mail: lipnitski.al@gmail.com,
Lipnitski Artur Leonidovich
Information about the authors:
Lipnitski A.L. A head of the transplant-coordination department of ME "Mogilev Regional Hospital".
Marochkov A.V. MD, professor, a head of the anesthesia and intensive care department of ME "Mogilev Regional Hospital".

REVIEWS

A.I. RUNDO

SOME MODERN ASPECTS OF ETIOLOGY AND PATHOGENESIS OF DIABETIC FOOT SYNDROME

EE "Vitebsk State Medical University",
The Republic of Belarus

The analysis of the literature devoted to studying of etiology and pathogenesis of diabetic foot syndrome is carried out. Relevance of this problem is caused by the steady growth of diabetes mellitus incidence (DM). Nearly 25% of patients with diabetes mellitus suffer from the diabetic foot syndrome (DFS). The dietary disturbances, innervation, neuroendocrine status, development of pyo-necrotic infection are the most favorable for disease development – trophic ulcers which are rather difficult to treat and thereby considerably reduce the quality of life.
Probability of high amputations in case of the deep pyo-necrotic tissue lesions reaches 30-70%, thus, the mortality rate fluctuates from 28 to 40%, and only 25-40% 5-year survival of patients.
Pyo-necrotic process of the the lower limbs in patients with DFS leads to early disability– the risk of the limb amputation is 20-40-fold higher than in a person without diabetes mellitus. The mortality rate due to diabetic foot gangrene is 20-30%, the incidence of latter development comprises 7-11%. Furthermore, diabetic foot results in prolonged hospitalization, rehabilitation, and increased need for home care and social services.
Preservation of a functioning extremity is becoming a relatively common and important problem among diabetic patients. In this regard, studying of etiology and pathogenesis of diabetic foot syndrome is considered to be extremely actual as well as the search of alternative option to treat this severe pathology.

Keywords: diabetes mellitus, diabetic foot syndrome, pyonecrotic process, angiopathy, neuropathy, hyperglycemia, aerobic and anaerobic microflora
p. 97-104 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 operativnoy khirurgii i topograficheskoy anatomii,
tel. office: + 375 033 645 1201,
e-mail: qlex2007@yandex.ru,
Rundo Aleksey Ivanovich
Information about the authors:
Rundo A.I. An assistant of the operative surgery and topographic anatomy chair of EE "Vitebsk State Medical University".

A.V. KOCHETKOV, M.S. GUDILOV

CLINICAL AND LABORATORY DIAGNOSIS AND MONITORING OF SEPTIC COMPLICATIONS AFTER ABDOMINAL OPERATIONS

FSBE "All-Russian Center of Emergency and Radiation Medicine named after A.M.Nikiforov of the Russian Ministry of Emergency Situations",
Saint-Petersburg
The Russian Federation

Diagnosis and treatment of patients with advanced pyo-septic complications after abdominal operations remain an urgent problem due to the high mortality rate, especially in the development of abdominal sepsis. In the article the possibilities of current clinical and laboratory methods, including rapid diagnostic tests (RDTs) of sepsis have analyzed; the significance of determination of inflammation markers (interleukin-6, procalcitonin, presepsin), the experience of clinical scales APACHE-II, SOFA and MEDS application for monitoring of the complication, other laboratory methods, including bacteriological diagnosis have evaluated. Early diagnosis and monitoring of the developed complications with the use of current express-methods, according to the authors, permit not only timely to start etiopathogenetical grounded treatment, but also to evaluate its effectiveness for the necessary correction measures.
The primary objective of the treatment is an effective elimination of primary infections focus. Intensive therapy is considered as the priority treatment method: antibacterial, infusion-transfusion, detoxication therapy, correction of systemic disorders of homeostasis, respiratory disorders, nutritional support, and inotropic support (in shock).
According to the analysis of literature the study and application of current methods of clinical and laboratory diagnosis including express-diagnosis has established that the earlier beginning of etiopathogenetical grounded treatment and effective monitoring of the developed complications is considered to be an important direction of improving the treatment outcomes of pyo-septic complications in the abdominal surgery.

Keywords: sepsis, abdominal sepsis, biomarkers of sepsis, diagnosis of sepsis, prognostic scale
p. 105-111 of the original issue
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Address for correspondence:
194044, Rossiyskaya Federatsiya,
g. Sankt-Peterburg, ul. Akademika Lebedeva,
d. 4/2, lit .A, pom. 1N,
FGBU "Vserossiyskiy tsentr ekstrennoy i radiatsionnoy meditsinyi
imeni A.M.Nikiforova" MChS Rossii
tel. office: 7-911-003-41-34,
e-mail: spbkaw@yandex.ru,
Kochetkov Aleksandr Vladimirovich
Information about the authors:
Kochetkov A.V. MD, a chief specialist on surgery of FSBE "All-Russian Center of Emergency and Radiation Medicine named after A.M.Nikiforov of the Russian Ministry of Emergency Situations", Saint-Petersburg.
Gudilov M.S. A post-graduate student on surgery FSBE "All-Russian Center of Emergency and Radiation Medicine named after A.M.Nikiforov of the Russian Ministry of Emergency Situations", Saint-Petersburg.

CASE REPORTS

Y.V. SLABADZIN, L.I. NIKITINA, I.I. PAKLAK-VOLSKY, S.V. GNIPEL, M.P. RUDENKOV, I.I. PRIBUSHENA

GALLSTONE ILEUS

SE "The Republican Clinical Medical Centre of the Administration of the President of the Republic of Belarus", Minsk,
The Republic of Belarus

A clinical case of gallstone ileus accompanied by cholecystoduodenal fistula and tactics of treatment of this pathology in a certain clinical situation is described in the article.
A 74-year-old woman was hospitalized to the center with the diagnosis of chronic pancreatitis, exacerbation; complaints of moderate pains in the epigastrium and paraumbilical area, nausea and single plentiful vomiting within one day. After instrumental examination including the abdominal ultrasound, fibrogastroduodenoscopy, abdominal CT scan the diagnosis of cholecystoduodenal fistula and gallstone ileus was made. In operative intervention performance of laparoscopy revealed the site of obstruction of the small intestine. Considering the age of the patient and the accompanying pathology as well as the absence of duodenal and gallbladder inflammation, only enterolithotomy was done. Throughout the postoperative period no complications were observed. The patient was discharged from the hospital in a satisfactory condition on the 6th day.
This case report demonstrates an unusual complication of cholelithiasis: cholecystoduodenal fistula with the formation of gallstone ileus. Certain attention at pathology is paid to surgical volume in different groups of patients. One-stage elimination of both ileus and cholecystoduodenal fistula with a cholecystectomy is carried out only in stable patients without severe accompanying pathology. In case of pathology described in this report, it is necessary to perform only enterolithotomy preferably by invasive technique and only in the delayed period depending on the condition of the patient the surgeon should decide on implementation of the second stage – cholecystectomy and elimination of cholecystoduodenal fistula.

Keywords: chronic calculous cholecystitis, cholecystoduodenal fistula, obstructive ileus, gallstone ileus
p. 112-116 of the original issue
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Address for correspondence:
220035, Respublika Belarus,
g. Minsk, ul. Krasnoarmeyskaya, d. 10,
GU "Respublikanskiy klinicheskiy meditsinskiy tsentr".
Upravleniya delami Prezidenta Respubliki Belarus, khirurgicheskoe otdelenie statsionara,
tel. office: +375 017 226-05-36,
e-mail: yurydoc75@gmail.com,
Slobodin Yuriy Valerevich
Information about the authors:
Slabadzin Y.V. PhD, a head of the surgical unit of the in-patient department of SE "The Republican Clinical Medical Centre". The Administration of the President of the Republic of Belarus.
Nikitina L.I. A head of the radiology diagnostics unit of SE "The Republican Clinical Medical Centre". The Administration of the President of the Republic of Belarus.
Paklak-Volsky I.I. A surgeon of the surgical unit of the in-patient department of SE "The Republican Clinical Medical Centre". The Administration of the President of the Republic of Belarus.
Gnipel S.V. A physician of the radiology diagnostics unit of SE "The Republican Clinical Medical Centre". The Administration of the President of the Republic of Belarus.
Rudenkov M.P. A surgeon of the surgical unit of the in-patient department of SE "The Republican Clinical Medical Centre". The Administration of the President of the Republic of Belarus.
Pribushena I.I. A surgeon of the surgical unit of the in-patient department of SE "The Republican Clinical Medical Centre". The Administration of the President of the Republic of Belarus.
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