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Khirurgii

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Year 2016 Vol. 24 No 1

SCIENTIFIC PUBLICATIONS
EXPERIMENTAL SURGERY

B.S. SUKOVATYKH, E.A. ELENSKAJA, E.B. ARTJUSHKOVA, A.I. ITINSON, A.A. ITINSON

EFFECTIVENESS OF IMMOBILIZED FORM OF SODIUM HYPOCHLORITE IN TREATMENT OF EXPERIMENTAL INFECTED PANCREATIC NECROSIS

SBEE HPE "Kursk State Medical University" 1,
RBME "Kursk City Clinical Emergency Hospital" 2,
The Russian Federation

Objectives. Experimental substantiation of using immobilized form of sodium hypochlorite in treatment of infected pancreatic necrosis.
Methods. The results of application of immobilized form of sodium hypochlorite in treatment of infected pancreatic necrosis were analyzed based on the experimental model in Wistar rats. Animals were divided into 3 groups, 96 rats per each. Infected pancreatic necrosis was created by moving the pancreas in intermuscular space in the anterior abdominal wall, a short-term cryodestruction of gland by liquid nitrogen followed by suspension of Staphylococcus aureus (1 billion microbial cells). Control group animals got no treatment; the comparison group received Levomecol unguent; the experimental group took the immobilized forms of sodium hypochlorite. Effectiveness of treatment was assessed according the leukocyte formula dynamics, bacterial contamination of purulent cavity, lethality rate, and histology.
Results. Anti-inflammatory activity of immobilized forms of sodium hypochlorite was higher than Levomecol unguent on the 3rd day – in 1,2 fold, on the 5th day – in 1,4, on the 7th day – in 1,3 and on the 10th day – in 1,1 fold. In the experimental group microbial contamination was lower than in control group on the 3rd day – in 1,6, on the 5th day – in 1,8, on the 7th day – in 1,8 and on the 10th day – in 1,6 fold. In the experimental group lethality rate was lower than in the control group on 3rd day – by 10,4%, on 5th day – by 8,4%, on 7th day – by 3,1% and on 10th day – by 1%. On the 5th day of the experiment Levomecol unguent application limited the dissemination of necrosis to pancreas, surrounding cellular tissue and the abdominal wall.
Conclusion. Treating infected pancreatic necrosis with immobilized form of sodium hypochlorite is considered to be an effective and pathogenetically grounded means of early complex therapy.

Keywords: infected pancreatic necrosis, treatment, omental sac sanation, Levomecol unguent, immobilized form of sodium hypochlorite
p. 5-11 of the original issue
References
  1. Ermolov AS. Smoliar AN, Shliakhovskii IA, Khrazhenkov MG. 20 let neotlozhnoi khirurgii organov briushnoi polosti v Moskve [20 years of emergency surgery of the abdominal cavity in Moscow]. Khirurgiia Zhurn im NI Pirogova.2014;(5):7-16.
  2. Litvin AA. Infitsirovannyi pankreonekroz [Infected pancreatic necrosis]. Moscow, RF: Integratsiia; 2011. 240 p.
  3. Beger HG, Buchler H. Acute pancreatitis: research and clinical management. London: Springer Limited; 2011. 412 p.
  4. Besselink MG, van Santvoort HC, Boermeester MA, Nieuwenhuijs VB, van Goor H, Dejong CH, et al. Timing and impact of infections in acute pancreatitis. Br J Surg. 2009 Mar;96(3):267-73. doi: 10.1002/bjs.6447.
  5. Bello B, Matthews JB. Minimally infasive treatment of pancreatic necrosis. World J Gastroenterol. 2012 Dec 14; 18(46): 6829–6835. doi: 10.3748/wjg.v18.i46.6829.
  6. Sleeman D, Levi DM, Cheung MC, Rahnemai-Azar A, Parisek S, Casillas V, et al. Percutaneus lavage as primary treatment for infected pancreatic necrosis. J Am Coll Surg. 2011 Apr;212(4):748-52; discussion 752-54. doi: 10.1016/j.jamcollsurg.2010.12.019.
  7. Martin RF, Hein AR. Operative management of acute pancreatitis. Surg Clin North Am. 2013 Jun;93(3):595-10.
  8. Miller SV, Vinnik IuS, Tepliakova OV. Rezul'tat standartizirovannoi taktiki lecheniia bol'nykh ostrym destruktivnym pankreatitom [The result of a standardized treatment strategy in patients with acute destructive pancreatitis]. Khirurgiia Zhurn im NI Pirogova. 2012;(5):24-30.
  9. Behrman SW, Bahr MH, Dickson PV, Zarzaur BL. The microbiology of secondary and postoperative pancreatic infections: implications for antimicrobial management. Arch Surg. 2011 May;146(5):613-9. doi: 10.1001/archsurg.2011.85.
  10. Freeman ML, Werner J, van Santvoort HC, Baron TH, Besselink MG, Windsor JA, et al. Interventions for necrotizing pancreatitis: summary of a multidisciplinary consensus conference. Pancreas. 2012 Nov;41(8):1176-94. doi: 10.1097/MPA.0b013e318269c660.
  11. Gostishchev VK, red. Infektsii v khirurgii [Infections in surgery]. Moscow, RF: Geotar-Med; 2007. 768 p.
  12. Werner J, Feuerbach S, Uhl W, Büchler M W. Management of acute pancreatitis: from surgery to interventional intensive care. Gut. 2005 Mar; 54(3): 426–436. doi: 10.1136/gut.2003.035907.
  13. Zatevakhin II, Tsitsiashvilli MSh, Budurova MD, Altunin AI. Pankreonekroz (diagnostika, prognozirovanie i lechenie) [Pancreonecrosis (diagnosis, prognosis and treatment)]. Moscow, RF: Meditsina; 2007. 224 p.
  14. Savel'ev VS, Filimonov MN, Burnevich SZ. Pankreonekroz [Pancreonecrosis]. Moscow, RF: MIA; 2008. 264 p.
  15. Sukovatykh BS, Blinkov IuIu, Makienko KG. Vliianie immobilizirovannykh form natriia gipokhlorita na blizhaishie i otdelennye rezul'taty lecheniia bol'nykh s rasprostranennym peritonitom [Influence of immobilized forms of sodium hypochlorite on the immediate and long-term results of treatment of the patients with generalized peritonitis]. Vestn Khirurgii im II Grekova. 2014;173(2):47-51.
  16. Elenskaia EA, Sukovatykh BS, Artiushkova EB, Itinson AI, Itinson AA. Sposob modelirovanie ostrogo destruktivnogo infitsirovannogo pankreonekroza [Method of modeling of acute destructive infected pancreatic necrosis]. Patent RF ¹2547697 G09B 23/28. 10.04.2015.
Address for correspondence:
305041, Russian Federation,
Kursk, ul. K. Marksa, d. 3,
GBOU VPO «Kurskiy gosudarstvennyiy meditsinskiy universitet»,
kafedra obschey khirurgii,
tel. office 8(4712) 52-98-62,
e-mail: SukovatykhBS@kursksmu.net,
Sukovatykh Boris Semenovich
Information about the authors:
Sukovatykh B.S. MD, professor, a head of the general surgery chair of SBEE HPE "Kursk State Medical University".
Elenskaja E.A. A clinical intern of the surgery department of RBME "Kursk City Clinical Emergency Hospital", applicant for degree of the general surgery chair of SBEE HPE "Kursk State Medical University".
Artjushkova E.B. MD, a director of the Research Institute of the ecological medicine of SBEE HPE "Kursk State Medical University".
Itinson A.I. PhD, a clinical intern of the surgery department of RBME "Kursk City Clinical Emergency Hospital".
Itinson A.A. A clinical intern of the general surgery chair of SBEE HPE "Kursk State Medical University".

GENERAL & SPECIAL SURGERY

S.V. SHALASHOV 1, L.K. KULIKOV 2, Y.A. PRIVALOV 2, A.L. MIKHAYLOV1

IC-PLASTY OF POSTOPERATIVE VENTRAL HERNIAS

NME "Railway Clinical Hospital in Irkutsk-Passenger Station" of JSC "Russian Railways"1,
SBEE APE "Irkutsk State Medical Academy of Postgraduate Education" 2,
The Russian Federation

Methods. The study enrolled patients with postoperative ventral hernias (n=157). Standard IC-plasty was performed in 81 patients, comprising the group of clinical comparison (CCG). The advanced version of the mentioned afore surgery was performed in 76 patients. These patients formed the main group (MG).
Results. It was established that in early terms the postoperative complications occurred after the operation in 7 (8,6%) patients in the CCG. Seromas formed in 2 (2,6%) patients from MG which were accessible for puncture. A single case of suppuration was registered in CCG. Thus, the using of less traumatic version of IC-plasty is claimed to be associated with less recurrence and complication rate. In early terms more extensive and long pain manifestations had been registered after the surgery in CCG in comparing with MG. In 5 cases the specific pain was registered in the sites of strips conducting formed at the edges of a polypropylene mesh through the muscle-aponeurotic tissues in CCG. There were no similar cases and fatal outcomes in MG. In terms from 1-3,5 years period surgery outcomes were studied in 73 (MG) and in 75 (CCG) patients. One recurrence in CCG without any delayed complications was observed. In later periods after the intervention no recurrences and complications were registered.
Conclusion. IC-plasty being an effective treatment method in case of postoperative ventral hernia has been evolved over the period of years. Technological advances of IC-plasty have been demonstrated to be favorably affected on the outcomes of the operation and the incisional period. To reduce the number of foreign material inserted into the human body in comparision with standard IC-plasty is also important.

Keywords: postoperative ventral hernia, hernia repair, surgical mesh, the muscle-aponeurotic tissues, standard IC-plasty, complications, incisional period
p. 12-18 of the original issue
References
  1. Bringman S, Conze J, Cuccurullo D, Deprest J, Junge K, Klosterhalfen B, et al. Hernia repair: the search for ideal meshes. Hernia. 2010 Feb; 14(1): 81-87. doi: 10.1007/s10029-009-0587-x.
  2. Parshikov VV, Petrov VV, Khodak VA, Samsonov AA, Romanov RV, Gradusov VP, i dr. Sovremennye tekhnologii v khirurgii gryzh perednei briushnoi stenki [Current technologies in surgery of hernias of anterior abdominal wall]. Sovrem Tekhnologii v Meditsine. 2009;(1):32-38.
  3. Parshikov VV, Petrov VV, Romanov RV, i dr. Kachestvo zhizni patsientov posle gernioplastiki [The quality of life of patients after hernioplasty]. Med Al'm. 2009;(1):100-103.
  4. Klinge U, Binnebösel M, Rosch R, Mertens P. Hernia recurrence as a problem of biology and collagen. J Minim Access Surg. 2006 Sep;2(3):151-54.
  5. Vichová B, Oravský M, Schnorrer M. Scar hernia repairs using a mesh–the sublay technique. Rozhl Chir. 2008 Mar;87(3):138-40. [Article in Slovak].
  6. Schumpelick V, Junge K, Rosch R, Klinge U, Stumpf M. Retromuscular mesh repair for ventral incision hernia in Germany. Chirurg. 2002 Sep;73(9):888-94. [Article in German].
  7. Schumpelick V, Klinge U, Rosch R, Junge K. Light weight meshes in incisional hernia repair. J Minim Access Surg. 2006 Sep;2(3):117-23.
  8. Schumpelick V, Klinge U, Junge K, Stumpf M. Incisional abdominal hernia: the open mesh repair. Langenbecks Arch Surg. 2004 Feb;389(1):1-5.
  9. Kurzer M, Kark A, Selouk S, Belsham P. Open mesh repair of incisional hernia using a sublay technique: long-term follow-up. World J Surg. 2008 Jan;32(1):31-6; discussion 37.
  10. Shalashov SV, Mikhailov AL, Usol'tsev IuK, Egorov IA. Sposob plastiki pri posleoperatsionnykh vantral'nykh gryzhakh [Method of plastics in postoperative ventral hernias]. Patent Ros. Federatsii ¹2366367. 10.09.2009.
  11. Kulikov LK, Buslaev OA, Mikhalevich MI, Shalashov SV, Privalov IuA,, Sobotovich VF, i dr. Kachestvo zhizni u patsientov, operirovannykh po povodu posleoperatsionnykh ventral'nykh gryzh [Quality of life in patients operated on for postoperative ventral hernias]. Novosti Khirurgii. 2014;22(3):286-95.
  12. Kulikov LK, Buslaev OA, Shalashov SV, Smirnov AA, Mikhailov AL, Egorov IA, i dr. Khirurgicheskoe lechenie obshirnykh i gigantskikh posleoperatsionnykh ventral'nykh gryzh [Surgical treatment of large and giant postoperative ventral hernias]. Novosti Khirurgii. 2013;21(2):37-44.
  13. Petri A, Sebin K, red. Nagliadnaia statistika v meditsine [Transparent statistics in medicine]. Leonov VP, per. s angl. Moscow, RF: GEOTAR-MED; 2003. 144 p.
  14. Korenkov M, Paul A, Sauerland S, Neugebauer E, Arndt M, Chevrel JP, et al. Classification and surgical treatment of incisional hernia. Results of an experts' meeting. Langenbecks Arch Surg. 2001 Feb;386(1):65-73.
Address for correspondence:
664013, Russian Federation,
Irkutsk, ul. Obraztsova, d. 27,
NUZ ''Dorozhnaya klinicheskaya bolnitsa na st. Irkutsk-Passazhirskiy''
OAO'' RZhD'', khirurgicheskoe otdelenie.
tel. mob.: 7(950) 069-35-67,
e-mail: Sersha62@gmail.com,
Shalashov Sergey Vladimirovich
Information about the authors:
Shalashov S.V. PhD, a surgeon of the surgery unit of NME ''Railway Clinical Hospital in Irkutsk-Passenger Station'' of JSC '' Russian Railways''.
Kulikov L.K. MD, professor of the surgery chair of SBEE APE ''Irkutsk State Medical Academy of Postgraduate Education''.
Privalov Y.A. MD, an associate professor, a head of the surgery chair of SBEE APE ''Irkutsk State Medical Academy of Postgraduate Education''.
Mikhaylov A.L. A surgeon of the surgery unit of NME ''Railway Clinical Hospital in Irkutsk-Passenger Station'' of JSC ''Russian Railways''.

V.I. NIKOLSKY, E.V. TITOVA, A.A. SAMORODOVA, J.E. FEOKTISTOV

THE QUALITY OF LIFE IN PATIENTS AFTER PROSTHETIC HERNIOPLASTY

Medical Institute of FSEE HPE ''Penza State University '',
The Russian Federation

Objectives. To compare the life quality of patients who have undergone prosthetic hernioplasty using of polypropylene mesh and modified xenopericardial patch.
Methods. Patients were divided into two groups depending on the chosen method of hernioplasty. In the main group xenopericardium plasty was performed by the developed technique. In the second group a polypropylene mesh was used as prosthesis. The life quality of patients was studied using the modified questionnaire EQ-5D-5L one and six years after the surgery.
Results. It was found out that one year after surgery the patients (n=37,5%) of the main group did not report about the pain in the area of operation. Among patients operated on using polypropylene mesh, this figure was only 19,0%. At the same time, 21,5% of patients with implanted polypropylene mesh noted intense pain in the area of operation. Two patients (3,0%) described their condition as "a sensation of extremely intense pain, a feeling of foreign body at the operation site."
46,9% patients operated on with the use of xenopericardium did not observed any discomfort and foreign body sensation at the operation site 6 years after the surgery. In the group of patients operated on with the use of polypropylene mesh the figure is only 26,0%. The visual analog rating scale of health-related quality of life showed that a year after xenopericardium implantation the quality of life was 9,5% higher than in patients operated on with use of polypropylene mesh, and six years after the operation this difference increased up to 11,4 %.
Conclusion. The study has confirmed that the application of the developed method of prosthetic plasty of median ventral hernias with use of xenopericardial plate significantly reduces the incidence of patients with a feeling of a foreign body and sensation of pain at the operation site, thereby improving their physical and mental health.

Keywords: quality of life, incisional hernia, hernioplasty, biomaterial, polypropylene mesh, visual analog rating scale, physical and mental health
p. 19-25 of the original issue
References
  1. Adamian AA. Put' alloplastiki v gerniologii i sovremennye ee vozmozhnosti [The way of alloplasty in herniology and current its capabilities]. Materialy I Mezhdunar konf "Sovremennye metody gernioplastiki s primeneniem polimernykh implantatov." Moscow, RF; 2003. p. 15–16.
  2. Egiev VN. Sovremennoe sostoianie i perspektivy gerniologii [Current state and prospects herniology]. Gerniologiia. 2006;(2):5–10.
  3. Belokonev VI, Ponomareva IuV, Pushkin SIu, Melent'eva ON, Guliaev MG. Vozmozhnye prediktory i morfologicheskie aspekty razvitiia seromy posle plastiki gryzhi perednei briushnoi stenki [Available predictors and morphological aspects of seroma after plasty of anterior abdominal wall hernias]. Novosti Khirurgii. 2014;22(6):665–70. doi: 10.18484/2305-0047.2014.6.665.
  4. Eriksson A, Rosenberg J, Bisgaard T. Surgical treatment for giant incisional hernia: a qualitative systematic review. Hernia. 2014 Feb;18(1):31-8. doi: 10.1007/s10029-013-1066-y.
  5. Nikol'skii VI, Kalmin OV, Titova EV, Venediktov AA, Fedorova MG. Kliniko-morfologicheskoe obosnovanie ksenoplastiki ventral'nykh gryzh [Clinico-morphological substantiation of xenon plasty of ventral hernias]. Izv Vysshikh Uchebnykh Zavedenii Povolzh region Med nauki. 2012;(1):11–17.
  6. Burger JW, Halm JA, Wijsmuller AR, ten Raa S, Jeekel J. Evaluation of new prosthetic meshes for ventral hernia repair. Surg Endosc. 2006 Aug;20(8):1320-25.
  7. Cobb WS, Burns JM, Peindl RD, Carbonell AM, Matthews BD, Kercher KW, et al. Textile analysis of heavy weight, mid-weight, and light weight polypropylene mesh in a porcine ventral hernia model. J Surg Res. 2006 Nov;136(1):1-7.
  8. Bachman SL, Ramaswamy A, Ramshaw BJ. Early results of midline hernia repair using a minimally invasive component separation technique. Am Surg. 2009 Jul;75(7):572-7; discussion 577-78.
  9. Novik AA, Ionova TI. Shevchenko IuL, red. Rukovodstvo po issledovaniiu kachestva zhizni v meditsine [Guidance on Quality of Life Research in medicine]. 2 izd. S-Peterburg: Neva; Moscow: OLMA-PRESS Zvezdnyi mir; 2002. 320 p.
  10. Pecherov AA. Egiev VN, Kuchin IuV, Lechiev IU. Ball'naia otsenka v vybore sposoba plastiki briushnoi stenki u bol'nykh s posleoperatsionnymi ventral'nymi gryzhami [Numerical score in the choice of method of plasty of abdominal wall in patients with postoperative ventral hernias]. Khirurgiia im NI Pirogova. 2009;(3):23–25.
  11. Kulikov LK, Buslaev OA, Mikhalevich IM, Shalashov SV, Privalov IuA, Sobotovich VF, i dr. Kachestvo zhizni u patsientov, operirovannykh po povodu posleoperatsionnykh ventral'nykh gryzh [Quality of life in patients operated on for postoperative ventral hernias]. Novosti Khirurgii. 2014;22(3):286–295. doi: 10.18484/2305-0047.2014.3.286.
  12. Timerbulatov MV, Timerbulatov ShV, Gataullina EZ, Valitova ER. Posleoperatsionnye ventral'nye gryzhi: sovremennoe sostoianie problemy [Postoperative ventral hernia: current state of the issue]. Med Vestn Bashkortostana. 2013;(5):101-107.
  13. Sedov VM, Gostevskoi AA, Tarbaev SD. Posleoperatsionnye ventral'nye gryzhi [Postoperative ventral hernia]. Moscow, RF; 2008. 129 p.
  14. Nikol'skii VI, Titova EV, Baulin AV. Sposob proteziruiushchei gernioplastiki sredinnykh ventral'nykh gryzh [Method of prosthetic hernioplasty of median ventral hernias]. Patent RF ¹2400160 A61B17/00. 27.09.2010.
  15. Burtsev PIu, Burtseva EV. Sposob podgotovki biotkani dlia ksenoprotezirovaniia [A method for the preparation of biological tissue for xenoprosthesis]. Patent RF ¹ 2197818 A01N1/00. 10.02.2003.
Address for correspondence:
440026, Russian Federation,
Penza, ul. Lermontova, d. 3,
Kafedra khirurgii
Meditsinskogo instituta
FGBOU VPO ''Penzenskiy gosudarstvennyiy universitet '',
tel.: 7 987 514-09-03,
e-mail: kineta@ya.ru,
Titova Ekaterina Valerevna
Information about the authors:
Nikolsky V.I. MD, professor of the surgery chair of Medical Institute of FSBEE HPE "Penza State University".
Titova E.V. PhD, an assistant of the surgery chair of Medical Institute of FSBEE HPE ''Penza State University ''.
Samorodova A.A. A day-time postgraduate student of the surgery chair of Medical Institute of FSBEE HPE ''Penza State University ''.
Feokttistov J.E. A clinical intern of the surgery chair of Medical Institute of FSBEE HPE ''Penza State University ''.

A.V. CHERNYKH, Y.V. MALEEV, E.F. CHEREDNIKOV, A.N. SHEVTSOV, D.N. GOLOVANOV

NEW DATA ON SURGICAL ANATOMY OF PARATHYROID GLANDS

SBEE HPE "N.N. Burdenko Voronezh State Medical University"
The Russian Federation

Objectives. To develop new approaches to the assessment of surgical anatomy of the parathyroid glands and to obtain new data permitted to improve the quality of planning and performance of operations on the organs of the neck, to reduce the risk of diagnostic errors and development of intraoperative and postoperative complications.
Methods. The study was performed on cadavers (152 men; average age – 47,0±1,0 years) and (68 women; 51,3±1,9 years). Before an autopsy of each cadaver the anthropometric measurements of the neck were done. The width, length of the axis, thickness and height of the parathyroid glands had been measured on the neck organocomplexes extracted from the corpses. The parameters characterized the position of the parathyroid glands towards to the thyroid gland in different planes were proposed.
Results. Totally 1033 parathyroid glands were visualized. More than half of the cases (54,0%) the number of glands exceeded 4. The length of the axis of the parathyroid glands was greater than 1,0 cm in 10,5% of cases. The analysis of age-related changes of linear dimensions and volume of glands allowed identifying three main periods in the postnatal ontogenesis of the glands. It was revealed that 95,4% of glands had typical location in relation to the height of thyroid lobes. The glands located above the upper pole of thyroid lobe were the most distant from the midline, the gland located below the lower pole of the thyroid gland - the most approximate. The angle of axis inclination of parathyroid glands to the median line in the frontal plane and the distance from the glands to the back surface of the thyroid lobe depends on the level of the parathyroid glands localization in relation to the height of thyroid lobe.
Conclusion. Practical implementation of the proposed criteria permits to perform preoperative prediction of topography of the parathyroid glands and their accurate intraoperative visualization, improving the quality of operations performed on the thyroid and parathyroid glands.

Keywords: parathyroid glands, thyroid gland, surgical anatomy, topography, linear dimensions, intraoperative visualization, incisional complication
p. 26-31 of the original issue
References
  1. Kalinin AP, Maistrenko NA, Vetshev PS. Khirurgicheskaia endokrinologiia [Surgical Endocrinology]: ruk. Saint-Petersburg, RF: Piter; 2004. 960 p.
  2. Cheren'ko SM. Pervichnyi giperparatireoz: osnovy patogeneza, diagnostiki i khirurgicheskogo lecheniia: monografiia [Primary hyperparathyroidism: pathogenesis, diagnosis and surgical treatment]. Kiev, Ukraina: Ekspress-Poligraf; 2011. 148 p.
  3. Savenok VU, Savenok EV, Ognerubov NA. Ekstrafastsial'nye operatsii pri rake i uzlovykh obrazovaniiakh shchitovidnoi zhelezy [Extra fascial surgery for cancer and thyroid nodules]. Voronezh, RF; 2006. 168 p.
  4. Kalinina AP. Metody vizualizatsii okoloshchitovidnykh zhelez i paratireoidnaia khirurgiia [Visualization techniques of parathyroid glands and parathyroid surgery]: ruk dlia vrachei. Moscow, RF: Vidar-M; 2010. 311 p.
  5. Chernykh AV, Maleev IuV, Guseva TV, Shevtsov AN. Topografo-anatomicheskie osobennosti stroeniia shchitovidnoi zhelezy u zhitelei Tsentral'no-Chernozemnogo regiona [Topographic and anatomical features of the structure of the thyroid gland in inhabitants of Central Black Earth region]. Morfologiia. 2010;137(4):211.
  6. Schwartz AE, Pertsemlidis D, Gagner M. Endocrine surgery. New York, US: Marcel Dekker; 2004.
  7. Malmaeus J, Bergstrom R. Surgical anatomy of human paratyroid glands. Surgery. 1984:95:14-21.
  8. Petten BM. Embriologiia cheloveka [Human embryology]. Moscow, RF: Medgiz; 1959. 768 p.
  9. Henry JF. Applied embryology of the thyroid and parathyroid glands. In: Randolph GW, editors. Surgery of the thyroid and parathyroid glands / Philadelphia: Elsevier Science, USA; 2003. p. 12-23.
  10. Henry J-F. Surgical anatomy and embryology of the thyroid and parathyroid glands and recurrent and external laryngeal nerves. In: Clark OH, Duh Q-Y, Kebebew E, editors. Textbook of Endocrine Surgery. 2nd ed. Philadelphia, PA: Elsevier; 2005. p. 9-15.
  11. Alveryd A. Parathyroid glands in thyroid surgery. I Anatomy of parathyroid glands II Postoperative hypoparathyroidism, identification and allotransplantation of parathyroid glands. Acta Chir Scand. 1968; 389: 1-120.
Address for correspondence:
394036, Russian Federation,
Voronezh, ul. Studencheskaya, d.10,
GBOU VPO ''Voronezhskiy gosudarstvennyiy
meditsinskiy universitet im. N.N. Burdenko'',
kafedra operativnoy khirurgii s topograficheskoy anatomiey,
tel. office: 7 (473) 253-10-70,
e-mail: shan-87@yandex.ru,
Shevtsov Artem Nikolaevich
Information about the authors:
Chernykh A.V. MD, professor, a head of the operative surgery chair with topographic anatomy of SBEE HPE "N.N.Burdenko Voronezh State Medical University", the first Vice-rector of SBEE HPE "N.N.Burdenko Voronezh State Medical University".
Maleev Y.V. MD, an associate professor of the operative surgery chair with topographic anatomy of SBEE HPE "N.N.Burdenko Voronezh State Medical University".
Cherednikov E.F. MD, professor, a head of the faculty surgery chair of SBEE HPE " N.N.Burdenko Voronezh State Medical University".
Shevtsov A.N. PhD, an assistant of the operative surgery chair with topographic anatomy of SBEE HPE "N.N.Burdenko Voronezh State Medical University".
Golovanov D.N. An extramural post-graduate student of the operative surgery chair with topographic anatomy of SBEE HPE "N.N.Burdenko Voronezh State Medical University".

A.V. VELICHKO1, Y.I. YARETS 1, S.L. ZYBLEV2, Z.A. DUNDAROV2,
V.V. POKHOZHAY 2

EFFECT OF PARATHYROIDECTOMY ON THE BONE METABOLISM INDICATORS IN PATIENTS WITH SECONDARY HYPERPARATHYROIDISM AGAINST THE BACKGROUND OF CHRONIC RENAL DISEASE

SE ''Republican Research Center for Radiation Medicine and Human Ecology''1,
EE ''Gomel State Medical University bone'' 2
The Republic of Belarus

Objectives. To examine the effect of parathyroidectomy on the bone metabolism and remodeling bone in patients with the secondary parathyroidectomy against the background of chronic renal desease (CRD).
Methods. The diagnostic and treatment results of patients (n=19) with the secondary hyperparathyroidism had been examined; the patients received medical treatment at the surgery department (a department of transplantation, reconstructive and endocrine surgery) of SE "The Republican Research Center for Radiation Medicine and Human Ecology". The patients’ age ranged from 23 to 66 years. There were 12 males (63%) and 7 females (37%). All the patients were subjected to parathyroidectomy (PTE) accompanied by the determination of parathyroid hormone concentration in venous blood 30 minutes prior to operation and 20 minutes after it. The study examined level indicators of β2-microglobulin (B2MG), cystatin C, osteocalcin and β-Cross laps prior surgery and 3 months after it.
Results. Efficacy of parathyroidectomy was confirmed by the considerable reduction of parathyroid hormone concentration in 20 minutes after the operation. The total and ionized calcium level reduced after the surgical operation. The study showed that the level of bone resorption markers was decreasing during the incisional period. The considerable reduction of osteocalcin and β-Cross laps concentration had been registered in comparision with that was done prior to operation. The considerable decrease of β2-microglobulin and cystatin C level was indicated the efficiency of parathyroidectomy performance in improving indicators of the nephrone functional activity.
Conclusion. The surgical correction of hyperparathyroidism is an efficient treatment method of metabolic bone disease at chronic renal disease. The parathyroidectomy is considered to be a surgical operation of choice in patients with chronic renal disease for arrest disease progression and hypercalcemia consequences. With a view to cupping the metabolic disorders in secondary hyperparathyroidism due to chronic kidney disease the surgical correction of hyperparathyroidism is quite justified.

Keywords: secondary hyperparathyroidism, chronic renal failure, parathyroidectomy, parathyroid hormone concentration, bone metabolism, remodeling bone, hypercalcemia consequences
p. 32-39 of the original issue
References
  1. Golokhvastov NN., red. Giperkal'tsiemiia. Pervichnyi giperparatireoz: ucheb [Hypercalcemia. Primary hyperparathyroidism]. posobie dlia vrachei. SPb, RF: Gippokrat; 2003. 136 p.
  2. Shchegolev AA, Filiptsev PIa, Larin AA, Piashin VV, Sokol'skii AS. Kogan MA, i dr. Vtorichnyi giperparatireoz pri khronicheskoi pochechnoi nedostatochnosti [Secondary hyperparathyroidism in chronic kidney failure]. Lechebnoe Delo. 2009;(3):75-79.
  3. Samokhvalova NA, Maistrenko NA, Romashchenko PN. Programmnyi podkhod k lecheniiu vtorichnogo giperparatireoza pri khronicheskoi bolezni pochek [The program approach to the treatment of secondary hyperparathyroidism in chronic kidney disease]. Vestn khirurgii im II Grekova. 2013;172(2):43-46.
  4. Voronenko IV, Mokrysheva NG, Rozhinskaia LIa, Syrkin AL. Narusheniia uglevodnogo i zhirovogo obmena pripervichnom giperparatireoze [Disturbances of carbohydrate and fat metabolism in primary hyperparathyroidism]. Ozhirenie i Metabolizm. 2008;(4):18-24.
  5. Dedov II, Rozhinskaia LIa, Mokrysheva NG, Vasil'eva TO. Etiologiia, patogenez, klinicheskaia kartina, diagnostika i lechenie pervichnogo giperparatireoza [Etiology, pathogenesis, clinical presentation, diagnosis and treatment of primary hyperparathyroidism]. Osteoporoz i Osteopatii. 2010;(1):13-18.
  6. Kaji1 H, Nomural N, Yamauchi M, Chihara1 K, Sugimoto T. The usefulness of bone metabolic Indices for the prediction of changes in Bone mineral density after parathyroidectomy in patients with primary hyperparathyroidism. Horm Metab Res. 2006 Jun;38(6):411-16.
  7. Bart LC, editor. Primary Hyperparathyroidism and Hypoparathyroidism. Endocrinology. 2000;2(Pt 1):2-12.
  8. McCormick R. Osteoporosis: Integrating biomarkers and other diagnostic correlates into the management of bone flagility. Altern Med Rev. 2007 Jun;12(2):113-27.
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  10. Rozhinskaia LIa. Vtorichnyi giperparatireoz i pochechnye ostaopatii pri khronicheskoi pochechnoi nedostatochnosti [Secondary hyperparathyroidism and renal osteopathy with chronic renal failure]. Nefrologiia i Dializ. 2000;2(4):241–47.
  11. Egshatian LV, Rozhinskaia LIa, Kuznetsov NS, Kim IV, Artemova AM, Mordik AI, i dr. Lechenie vtorichnogo giperparatireoza, refrakternogo k al'fakal'tsidolu, u patsientov, poluchaiushchikh zamestitel'nuiu pochechnuiu terapiiu programmnym gemodializom [Treatment of secondary hyperparathyroidism refractory to alfacalcidol in patients receiving renal replacement therapy by program hemodialysis]. Endokrin Khirurgiia. 2012;(2):27-41.
  12. Samokhvalova NA, Romanchishen AF, Gerasimchuk RP, Grinev KM, Zemchenkov AIu. Vtorichnyi giperparatireoz: chastota, klinicheskie proiavleniia, lechenie [Secondary hyperparathyroidism: incidence, clinical manifestations, treatment]. Vestn Khirurgii im II Grekova. 2007;166(5):78-81.
  13. Vetchinnikova ON. Giperparatireoz pri khronicheskoi bolezni pochek. Effektivnaia farmakoterapiia [Hyperparathyroidism in chronic kidney disease. Effective pharmacotherapy]. Urologiia i Nefrologiia. 2013;44:26-39.
  14. Okabe R, Nakatsuka K, Inaba M, Miki T, Naka H, Masaki H, et al. Clinical evaluation of the elecsys β-CrossLaps Serum assay, new assay for degradation products I type collagen C-telopeptides. Clin Chem. 2004 Aug;47(8):1410-14.
  15. Samokhvalova HA. Vtorichnyi giperparatireoz. Paratireoidektomiia kak metod profilaktiki destruktsii kostei u bol'nykh vtorichnym giperparatireozom [Secondary hyperparathyroidism. Parathyroidectomy as a method of preventing bone destruction in patients with secondary hyperparathyroidism]. V: Romanchishen AF, red. Khirurgiia shchitovidnoi i okoloshchitovidnoi zhelez. SPb, RF: Vesti; 2009. p. 434-60.
Address for correspondence:
246040, Republic of Belarus,
Gomel, ul. Ilicha, d. 290,
GU ''Respublikanskiy nauchno-prakticheskiy
tsentr radiatsionnoy meditsinyi i ekologii cheloveka'',
khirurgicheskoe otdelenie
(transplantatsii, rekonstruktivnoy i endokrinnoy khirurgii),
tel. mob.: 375 29 656-57-11, e-mail: velichkoav@rambler.ru,
Velichko Alexander Vladimirovich
Information about the authors:
Velichko A.V. PhD, an associate professor, a head of the surgery department (transplantation, reconstructive and endocrine surgery) of SE ''The Republican Research Center for Radiation Medicine and Human Ecology''.
Yarets Y.I. PhD, an associate professor, a head of the clinical and diagnostics laboratory of SE ''The Republican Research Center for Radiation Medicine and Human Ecology''.
Zyblev S.I. PhD, an assistant of the chair of surgical diseases ¹2 with the course of pediatric surgery, anesthesiology and reanimatology of EE ''Gomel State Medical University''.
Dundarov Z.A. MD, professor, a head of the chair of surgical diseases ¹2 with the course of pediatric surgery, anesthesiology and reanimatology of EE
''Gomel State Medical University''.
Pokhozhay V.V. An assistant of the oncology chair with the course of radiation diagnosis and radiotherapy of EE ''Gomel State Medical University''.

Î.N. SADRIEV 1, À.D. GAIBOV 1,2 S.S. ANVAROVA2

POTENTIAL OF COMPUTED TOMOGRAPHY IN DIFFERENTIAL DIAGNOSIS OF ADRENAL TUMORS

Republican Scientific Center of Cardiovascular Surgery 1,
Avicenna Tajik State Medical University2,
Dushanbe
The Republic of Tajikistan

Objectives. To assess the possibilities of computed tomography at differential diagnostics of adrenal tumors.
Methods. Correlation analysis between the results of computed tomography (CT) and morphologiocal structure of the adrenal tumors in patients (n=54) with pheochromocytoma (PCHC) (n=23; 42,6%), aldosteroma (AS) (n=18; 33,3%) and corticosteroma (CS) (13; 24,1%) has been analyzed. At 3-phase CT such parameters as the tumor size, structure and contours, the presence of the capsule, native and maximum density at contrasting, washout time of contrast medium by more than 60% have been assessed.
Results. While comparing the size of PCHC, CS and AS the reliable difference between them has been registered. Round and oval tumors are more typical for CS and AS; PCHC tumors are of irregular shape. Uneven contours, heterogeneity of the structure and the presence of inclusions in the structure of the tumor turned out to be typical mainly for PCHC, while at CS and AS those signs were practically absent. At comparative assessment of PCHC density (+22 (20-25) UH, CS(+14 (11-16) UH; and AS(+6 (4,25-8,5) UH) in the native regimen and at contrasting, PCHC – +41 (40-45) UH; CS – +20 (16-20,5) UH; AS – +11 (9,25-13) UH), their reliable difference has also been established (ð<0,001). While comparing washout time of contrast PCHC (+14 (11-15) min.) and adrenocortical tumors (+8 (6-12,75) min. and +4,9 (3,5-6,625) min. for CS and AS, statistically reliable diference has been registered.
Conclusion. The analysis of tumor size, structure, density in different phases of contrasting and washout time of contrast medium, revealed at CT permits to differentiate the different nosological forms of adrenal tumors and to be clinically significant in the choice of further treatment tactics.

Keywords: computed tomography, comparative assessment, adrenal tumors, diagnostics, pheochromocytoma, aldosteroma, corticosteroma
p. 40-46 of the original issue
References
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  8. Bel'tsevich DG, Soldatova TV, Kuznetsov NS, Remizov OV, Vorontsov A V, Rogal' EIu, i dr. Differentsial'naia diagnostika intsidentalom nadpochechnikov [Differential diagnosis of adrenal incidentalomas]. Problemy Endokrinologii. 2011;57(6):3-8.
  9. Terzolo M, Stigliano A, Chiodini I, Loli P, Furlani L, Arnaldi G, et al. AME position statement on adrenal incidentaloma. Eur J Endocrinol. 2011 Jun;164(6):851-70. doi: 10.1530/EJE-10-1147.
  10. Blake MA, Krishnamoorthy SK, Boland GW, Sweeney AT, Pitman MB, Harisinghani M, et al. Low-density pheochromocytoma on CT: a mimicker of adrenal adenoma. AJR Am J Roentgenol. 2003 Dec;181(6):1663-8.
  11. Young WF Jr. Clinical practice. The incidentally discovered adrenal mass. N Engl J Med. 2007 Feb 8;356(6):601-10.
  12. Degenhart C. Adrenal tumors: principles of imaging and differential diagnostics. Radiologe. 2014 Oct;54(10):998-1006. doi: 10.1007/s00117-014-2690-y. [Article in German]
  13. Goldman SM, Coelho RD, Freire Filho Ede O, Abdala N, Szejnfeld D, Faria J, et al. Imaging procedures in adrenal pathology. Arq Bras Endocrinol Metabol. 2004 Oct;48(5):592-611.
Address for correspondence:
734003, Republic of Tadzhikistan,
Dushanbe, prospekt Rudaki, d. 139,
Tadzhikskiy gosudarstvennyiy
meditsinskiy universitet imeni Abuali ibni Sino,
kafedra khirurgicheskih bolezney ¹2.
tel.: 992 915 25 00 55;
e-mail: sadriev_o_n@mail.ru,
Sadriev Okildzhon Nemadzhonovich
Information about the authors:
Sadriev O.N. A leading researcher of the Republican Scientific Center of Cardiovascular Surgery.
Gaibov A.D. Corresponding member of the academy of Medical Sciences of the Ministry of Health and Social Protection of the Population of the republic of Tajikistan, MD, professor of the surgical diseases chair ¹2 of Avicenna Tajik State Medical University, professor and tutor of the vascular surgery department of the Republican Scientific Center of Cardiovascular Surgery.
Anvarova S.S. MD, a head of the endocrinology chair of Avicenna Tajik State Medical University.

I.A. KRYVORUCHKO, N.Ì. GONCHAROVA, I.A. TARABAN, I.V. SOROKINA

THE FEATURES OF MORPHOGENESIS OF COMPLICATED PANCREATIC PSEUDOCYSTS

Kharkov National Medical University of the Ministry of Public health Ukraine
Ukraine

Objectives. To study the specific wall structural features of complicated pancreatic pseudocyst and pancreatic pseudocysts located within the pancreatic parenchyma by immunohistochemical techniques.
Methods. The features of pseudocyst morphogenesis using immunohistochemical methods have been studied in biopsies of patients (n=47) with complicated pancreatic pseudocysts.
Results. The predominance of type III collagen and the deficiency of type I collagen in the walls of type I pseudocysts and adjacent pancreatic parenchyma in the connective tissue component have been revealed; in the vascular component – deficiency of type IV collagen and weak capacity of endothelial cells to express receptors for endothelin-1. Predominance CD18 in the inflammatory infiltrates testified to favour of an acute inflammatory reaction with a marked tendency to fester. The ability of cellular pancreatic component to express receptors to HLADR–antigen was low. In the connective tissue component of pseudocysts type II the both types of collagens with a predominance of type III collagen over type I collagen have been identified.The microvessel walls of pseudocysts type II were presented by the basal membranes, containing type IV collagen and endotheliocytes located on the surface were able to express receptors for endothelin–1; lymphocytes CD3 and CD20 were dominated. The degree of receptor expression to HLADR–antigen was low. The predominance of type I collagen over type III collagen was considered to be the feature of pseudocysts type III. Basal membranes of microvessel walls of type III pseudocysts were thickened due to excessive accumulation of type IV collagen, leading to the reduced ability of the endothelial lining to express receptors for endothelin–1.
Conclusion. The appearance of type I collagen in the walls of pseudocysts type II is binded with maturation phase – type I collagen replaces type III, indicating a chronic process, i.e. as maturation continues pseudocyst type II developed in the connective tissue wall of pseudocysts type I. The high degree of expression of HLA DR-antigen indicated to the presence of an autoimmune link in the morphogenesis of type III pseudocysts.

Keywords: pseudocyst, pancreas, connective tissue, collagen, immune cells, chronic process, morphogenesis
p. 47-54 of the original issue
References
  1. Apte M, Pirola R, Wilson J. The fibrosis of chronic pancreatitis: new insights into the role of pancreatic stellate cells. Antioxid Redox Signal. 2011 Nov 15;15(10):2711-22. doi: 10.1089/ars.2011.4079.
  2. Nichitailo ME, Kravchenko DA, Shpon'ka IS, Medvetskii EB, Savitskaia IM, Bulik II, i dr. Ingibirovanie zvezdchatykh kletok podzheludochnoi zhelezy lizinoprilom i lovastatinom dlia preduprezhdeniia fibroza ee kul'ti posle distal'noi rezektsii v modeli khronicheskogo alkogol'nogo pankreatita [Inhibition of stellate cells of the pancreas by lisinopril and lovastatin to prevent fibrosis after it stump after distal resection in a model of chronic alcoholic pancreatitis]. Kl³n Kh³rurg³ia. 2013;(2):65-66.
  3. Zaporozhchenko BS, Shevchenko VG. Immunologicheskaia reaktivnost' u bol'nykh psevdokistami podzheludochnoi zhelezy v razlichnykh usloviiakh khirurgicheskogo lecheniia [Immunological reactivity in patients with pancreatic pseudocysts in different surgical conditions]. Khark³' Kh³rurg Shk. 2012;(2):45-47.
  4. Krivoruchko IA, Teslenko SM, Teslenko MM, Cheverda VM, AndreЄshchev SA. Rol' marker³v poshkodzhennia endotel³iu v prognozuvann³ gostrogo p³sliaoperats³inogo pankreatitu p³slia priamikh vtruchan' na p³dshlunkov³i zaloz³ z perevazhnikh urazhenniam ¿¿ golovki [The role of endothelial damage markers in predicting postoperative acute pancreatitis after direct interventions on the pancreas, mainly affecting her head]. Kl³n Kh³rurg³ia. 2014;(9.2):25-28.
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Address for correspondence:
61022, Ukraine, Harkov, pr. Lenina, d. 4,
Harkovskiy natsionalnyiy meditsinskiy universitet,
kafedra khirurgii ¹ 2,
tel. office. 38 050 301-90-90,
e-mail: ikryvoruchko@mail.ru
Kryvoruchko Igor Andreevich
Information about the authors:
Kryvoruchko I.A. MD, professor, a head of the surgery chair ¹ 2 of Kharkov National Medical University.
Goncharova N.M. PhD, an applicant for Doctor’s degree of the surgery chair ¹ 2 of Kharkov National Medical University.
Taraban I.A. MD, professor of the surgery chair ¹ 2 of Kharkov National Medical University.
Sorokina I.V. MD, professor of the pathologic anatomy chair of Kharkov National Medical University.

Y.V. SIZONENKO, S.E. KATORKIN, I.I. LOSEV

DYSFUNCTION OF VENOUS PUMP MUSCLES IN PATIENTS WITH COMBINED LESION OF MUSCULOSKELETAL AND VENOUS SYSTEMS OF THE LOWER LIMBS

SBEE HPE "Samara State Medical University",
The Russian Federation

Objectives. To reveal the main factors reliably influencing the function of the muscular-venous pump of the lower limbs at the combined lesions of the musculoskeletal and venous systems.
Methods. The study was conducted in the laboratory of clinical biomechanics in the period from 2014 to 2015. The study included patients (n=37) with combined lesions of the musculoskeletal and venous systems of the lower limbs. The average age of patients was 51,4±15,8 years (M±S). Podometrics, functional electromyography, plantography, statistical analysis of the obtained data were carried out.
Results. Functional impairment of venous pump in the tibia is 74%, in the hip – 81%. Significant reduction in the bioelectric activity of m. gastrocnemius medialis (maxav.<120 mkV at an average rate of 312 mkV) and m. vastus medialis (maxav.<110 mkV at an average rate of 162 mkV). Spearman’s correlation showed a strong relationship between the maximum of m. gastrocnemius med. reduction (R=0,88; p<0,001) and m. vastus med. (R=0,94; p<0,001). The moderate correlation was found between indicators of function of tibial and femur pump (R=0,52; p<0,001). There is the effect of lameness on the dysfunction of the tibial venous pump (χ2emp.= 8,1; p<0,05 and χ2kr. = 5,9; OR=6,7±0,8; CI=1,4-31,2). In all cases a transverse flatfoot was revealed. In 77% of cases the pathology of the longitudinal arch of the foot and its impact on the dysfunction of the tibial (χ2emp.=10,7 at p<0,05 and χ2kr.=9,5) and femur venous pump (χ2emp.=7,1 for p<0,01 and χ2kr.=6,6; OR=4,1±0,6; CI=1,4-14,9) had been established. Hallux valgus was diagnosed in 74% of cases. Foot hyperpronation was diagnosed in 69% of cases, which statistically affect the function of the venous pump (χ2emp.=12,9; p<0,01 and χ2kr.=6,6; OR=9,2±0,7 DI=1,9-18,2).
Conclusion. Biomechanical studies have revealed the deficits in muscle function, violations of the act of walking, foot pathology that should be maximally eliminated with the use of orthopedic aids, physical therapy and physiotherapy.

Keywords: chronic venous diseases, muscular-venous pump, flatfoot, podometrics, functional electromyography, plantography, biomechanics
p. 55-61 of the original issue
References
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  6. Uhl JF, Gillot C. Anatomy of the veno-muscular pumps of the lower limb. Phlebology. 2015 Apr;30(3):180-93. doi: 10.1177/0268355513517686.
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  14. Shevchenko IuL, Stoiko IuM, Gudymovich VG, Ivanov AK. Kompleksnyi podkhod v lechenii obshirnykh troficheskikh iazv golenei v mnogoprofil'nom statsionare [A comprehensive approach in the treatment of extensive venous leg ulcers in multidisciplinary hospital]. Vestn Eksperim i Klin Khirurgii. 2014;7(3):221-27.
Address for correspondence:
443079, Russian Federation, Samara,
pr. Karla Marksa, d. 165 "b".
Kliniki Samarskogo gosudarstvennogo meditsinskogo universiteta,
laboratoriya klinicheskoy biomehaniki.
tel. mob. 7 917 116-86-35,
e-mail: iva3633@gmail.com,
Sizonenko Yaroslav Vladimirovich
Information about the authors:
Sizonenko Y.V. PhD, a head of the laboratory of clinical biomechanics of clinics of SBEE HPE "Samara State Medical University".
Katorkin S.E. PhD, an associate professor, a head of the chair and clinic of hospital surgery of SBEE HPE "Samara State Medical University".
Losev I.I. MD, professor of the chair and clinic of traumatology, orthopedics and extreme surgery of SBEE HPE "Samara State Medical University".

N.N. YAROTSKAYA, I.V. SAMSONOVA, V.A. KOSINETS

THE INFLUENCE OF METABOLIC PREPARATIONS ON INTENSITY OF CYTOCHROME C EXPRESSION AT EXPERIMENTAL GENERALIZED PURULENT PERITONITIS

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

Objectives. To study the influence of metabolic preparations "Citoflavin" and "Neoton" on cytochrome c expression of apoptotic markers in the rabbit liver at experimental generalized purulent peritonitis.
Methods. The immunohistochemical analysis of cytochrome c expression intensity in the liver specimens of rabbits (n=55) was carried out at experimental generalized purulent peritonitis. Tissue samples were stained using antibodies to cytochrome c ("Sigma", USA). The analysis of serial microphotos was performed by the digital analytical system (microscope Leica DM 2000, Leica Application Suite 3.6.0 program.). All morphometric parameters were manually measured using ImageJ 1.45S software with histological quantification assessed intensity of staining agents.
Results. Liver sections revealed its presence in cytoplasm of hepatocytes both at purulent peritonitis and in samples of intact group as light to dark brown staining of different intensity. At the same time in the early stages of peritonitis initiation the level of cytochrome c expression as a apoptotic signal significantly decreases due to the damage of membrane structures of hepatocytes, accompanied by the modification activity of many intracellular enzymes, inhibition of antitoxic liver function, violation of synthetic processes, dissociation in respiring tissues and oxidative phosphorylation, reduction in ATP synthesis, development of hypoxia. The preparation "Citoflavin" (containing amber acid) in comparison to the preparation "Neoton" (containing creatinephosphate) on the 5th day of the postoperative period leads to gradual restoration of the cytochrome c level. It may be a result of a positive influence of the preparation on energy processes in a cell, thus increasing resistance to intoxication.
Conclusion. The cytochrome c expression is a marker for the early diagnosis at experimental generalized purulent peritonitis. Reduction of its intensity is correlated with the massive hepatocyte apoptosis due to the severe intoxication.

Keywords: experimental generalized purulent peritonitis, cytochrom c, Citoflavin, Neoton, amber acid, creatinephosphate, resistance to intoxication
p. 62-69 of the original issue
References
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Address for correspondence:
210022, Republic of Belarus
Vitebsk, pr-t Frunze, d. 27, kor. 3,
UO ''Vitebskiy gosudarstvennyiy
meditsinskiy universitet '',
nauchno-issledovatelskaya laboratoriya,
tel. mob: 375 29 714-18-76,
e-mail: yardip@yandex.ru,
Yarotskaya Natalya Nikolaevna
Information about the authors:
Yarotskaya N.N. A researcher of scientific research laboratory of EE ''Vitebsk State Medical University ''.
Samsonova I.V. PhD, an associate professor, a head of the pathologic anatomy chair of EE ''Vitebsk State Medical University ''.
Kosinets V.A. MD, professor of the hospital surgery chair with the courses of urology and pediatric surgery of EE ''Vitebsk State Medical University''.
References

TRAUMATOLOGY & ORTTHOPEDICS

V.P. DEYKALO 1, À.N. TOLSTIK 1, K.B. BOLOBOSHKO 1, À.I. KRYLOV 2, À.N. MASTYKOV 1

MEDICAL REHABILITATION IN HAND INJURIES USING THE METHOD OF FINGERS AND METACARPAL BONES TRANSPOSITION

EE "Vitebsk State Medical University" 1,
ME "Vitebsk Regional Clinical Hospital" 2,
The Republic of Belarus

Objectives. The improved outcomes of patients with various consequences of the open hand injuries were related to the using the method of transposition of fingers and/or metacarpal bones.
Methods. Medical rehabilitation of patients (n=21) had been carried out. All patients were males (15-38 years). Injuries term – 3-12 months ago. The method consisted in transposing the adjacent finger and metacarpal into the defect (n=18) at the pathology of the 3rd and 4th fingers, transposition of the metacarpals of the fingerless hand with simultaneous deepening of spacing between fingers (n=2) was done, in one case with the help of transposition of the 2nd finger the pollicization was performed. The long-term results in different periods (1-25 years) were studied in all patients using the worked out method of determining the degree of functional disorder and disability at hand injuries and diseases.
Results. In all cases in patients with post-traumatic defects of the third or fourth fingers, the function of the hand was significantly improved (25% prior surgery and 90-100% functional restoration – after transposition). The absence of one of the fingers did not cause the patients and the people around them feeling of hand cosmetic defect, and they were satisfied with the the results of operation. Two patients with fingerless hand (100% hand dysfunction) as a result of the transposition performance of the metacarpals with the deepening of interdigital spaces was managed to restore the function of capturing and retaining of large things. After the 2nd finger is transposed to the base of the 1st one (the loss of thumb leads to hand dysfunction to 40%) a hand functional recovery achieved to 75%.
Conclusion. The use of the method of transposition of fingers and/or the metacarpals for the rehabilitation of patients helps significantly to improve the function of the hand and this method is believed to be more efficient for rehabilitation of patients with consequences of severe open hand injuries.

Keywords: consequences of open hand injuries, transposition of fingers and metacarpal bones, the long-term results, disability, posttraumatic defects, significant improvement, medical rehabilitation
p. 70-76 of the original issue
References
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  15. Deikalo VP, Tolstik AN. Sposob opredeleniia stepeni narusheniia funktsii i poteri trudosposobnosti pri povrezhdeniiakh i zabolevaniiakh kisti [A method of determining the degree of dysfunction and disability in injuries and diseases of the hand]: instruktsiia. Vitebsk, RB; 2006. 20 p.
Address for correspondence:
210023, Republic of Belarus,
Vitebsk, pr-t. Frunze, d. 27,
UO "Vitebskiy gosudarstvennyiy
meditsinskiy universitet",
kafedra travmatologii,
ortopedii i voenno-polevoy khirurgii,
tel. mob. 80296414929.
e-mail: barrett@tut.by,
Deykalo Valeriy Petrovich
Information about the authors:
Deykalo V.P. MD, professor of traumatology, orthopedics and military surgery of EE "Vitebsk State Medical University".
Tolstik A.N. PhD, an associate professor, a head of traumatology, orthopedics and military surgery of EE "Vitebsk State Medical University".
Boloboshko K.B. PhD, an associate professor of traumatology, orthopedics and military surgery of EE "Vitebsk State Medical University".
Krylov A.I. A head of the orthopedics and trauma department of ME "Vitebsk Regional Clinical Hospital".
Mastykov A.N. PhD, an associate professor of traumatology, orthopedics and military surgery of EE "Vitebsk State Medical University".

REVIEWS

S.A. PLAKSIN, N.I. KHRAMTSOVA

COMPARATIVE ASPECTS OF USAGE AND SIDE-EFFECTS OF DIFFERENT METHODS OF LIPOASPIRATION

SBEE HPE "Perm State University of Medicine named after Academician E.A.Wagner"
The Russian Federation

Liposuction is one of the most commonly performed aesthetic procedures. Indications for liposuction are divided into aesthetic and functional. Aesthetic indications include the improvement of body contour and weight reduction by the removal of adipose tissue surplus. Functional indications are: lipedema, Madenung’s disease (multiple symmetric lipomatosis), Dercum’s disease, lipomas, lymphedema, extraction of permanent intracorporal fillers, axillary hyperidrosis, gynecomastia, macromastia, gigantomastia. Liposuction is a low-traumatic procedure with some complications and side-effects. The advancement in liposuction techniques is aimed at improvement of the safety, efficiency and aesthetic results. Suction-assisted liposuction is safe, simple accessible and effective, but it is known as the most traumatic technique. Ultrasound-assisted liposuction is preferred in areas rich by blood vessels and connective tissues; however, it is characterized by an increased risk of infiltrate forming. Vibration technique reduces the physical load of the surgeon but it is characterized by a low percentage of viable adipocytes. Advantages of the laser and radiofrequency-assisted techniques are good contractility of skin, less edema and pain syndrome, but the high temperature can cause skin necrosis. Water-assisted lipoaspiration is less traumatic, it is preferable for mild volume of fat in patients with the moderate elasticity of the skin, and for lipofilling.
The long-term results of different methods of liposuction are practically the similar. The usage of stem cells, contained in lipoaspirate in high quantities, lipofilling, non-invasive methods of body contouring, such as cryolipolysis and non-invasive focused ultrasound should be noted as some of perspective directions.

Keywords: liposuction, lipoaspiration, lipectomy, fat removal, body contouring, plastic surgery, cryolipolysis, non-invasive focused ultrasound
p. 77-83 of the original issue
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Address for correspondence:
614000, Russian Federation, Perm,
ul. Kuybyisheva, d. 43,
GBOU VPO "Permskiy gosudarstvennyiy meditsinskiy universitet
im. akademika E.A. Vagnera", kafedra gospitalnoy khirurgii.
tel. office: 7 342 239-29-72,
e-mail: splaksin@mail.ru,
Plaksin Sergey Aleksandrovich
Information about the authors:
Plaksin S.A. MD, professor of the surgery chair of the advanced professional education faculty of SBEE HPE "Perm State Medical University named after Academician E.A.Vagner".
Khramtsova S.A. PhD, an assistant of the hospital surgery chair of SBEE HPE "Perm State Medical University named after Academician E.A.Vagner".

NEW METHODS

S.D. FEDYANIN, A.A. KOVALENKO, L.E. KRISHTOPOV, V.P. BULAVKIN, D.G. SOSINOVICH

METHOD OF PHASE-ADAPTING PROVISIONAL SUTURE

EE ''Vitebsk State Medical University''
The Republic of Belarus

Objectives. To analyze the clinical efficacy of the developed method of phase-adapting provisional suture in the treatment of patients with purulent wounds.
Methods. The randomized study was conducted in patients (n=30) with purulent wounds of various localizations. Patients were divided into the main and control groups. In the main group along with traditional treatment the designed method of phase-adapting provisional suture was used firstly. The needle is charged with a thick nylon thread (40 cm length) forming 2 identical filaments (20 cm each). Stepping back (1,5cm) from the edge of the wound, the skin and subcutaneous tissue are sewed with the stitches (1.5cm) which should be placed opposite each other, perpendicular to the wound line, the needle is injected at the edge of the wound. The threads (15cm) stretch through the punctures and fix them with four surgical knots. When treating a wound a surgeon pulls the edges of the wound toward one another temporarily and tied by surgical knots. The clinical efficacy was assessed by duration of complete wound healing.
Results. Duration of the cleansing phase was 10 (9; 11) days in the control group and 9 (8; 10) days - in the main group. In the control group healthy granulation tissue appeared only on the the 6th (6;7) day, and in the main group – by the 5th (5; 6) day. In the control group visible epithelialization was observed on the 9th (7; 10) day, and in the main – on the 7th (6, 8) day. The wound was clinically ready for skin graft on the 13th (12; 14) day, and in the main group – on the 12th (10; 12) day.
Conclusion. The developed method of a phase-adapting provisional suture imposing is characterized by technical simplicity, convenience and can be recommended for complex treatment of wounds.

Keywords: purulent wound, phase-adapting provisional suture, epithelialization, granulation, randomized study, technical simplicity, complex treatment
p. 84-87 of the original issue
References
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  6. Beschastnov VV, Maramokhin VN. Novyi sposob aktivnogo lecheniia gnoinykh ran miagkikh tkanei [A new way of active treatment of purulent wounds of soft tissues]. Izv Vysshikh Uchebnykh Zavedenii Povolzh Region Med Nauki. 2010;15(3):59-67.
  7. Piatakov SN, Zavrazhnov AA, Lebedev IO, Zimin VA, Morozov VV, Ralko SN. Sovremennye predstavleniia o vozmozhnostiakh primeneniia dermotenzii v lechenii obshirnykh defektov miagkikh tkanei [Current concepts about the possibilities of dermotension application of extensive soft tissue defects]. Infektsii v Khirurgii. 2014;12(2):7-12.
  8. Misteli H, Kalbermatten D, Settelen C. Simple and complicated surgical wounds. Ther Umsch. 2012 Jan;69(1):23-7. doi: 10.1024/0040-5930/a000246. [Article in German].
Address for correspondence:
210023, Republic Belarus,
Vitebsk, pr. Frunze, d. 27,
UO "Vitebskiy gosudarstvennyiy meditsinskiy universitet'',
kafedra gospitalnoy khirurgii
s kursami urologii i detskoy khirurgii,
tel. office: 375 212 34-08-21,
e-mail: fedyanin-1977@mail.ru,
Fedyanin Sergey Dmitrievich
Information about the authors:
Fedyanin S.D. PhD, an associate professor of the hospital surgery chair with the courses of urology and pediatric surgery of EE ''Vitebsk State Medical University''.
Kovalenko A.A. PhD, an associate professor of the hospital surgery chair with the courses of urology and pediatric surgery of EE ''Vitebsk State Medical University''.
Krishtopov L.E. PhD, an associate professor of the hospital surgery chair with the courses of urology and pediatric surgery of EE ''Vitebsk State Medical University''.
Bulavkin V.P. PhD, an associate professor of the faculty of the advanced training and staff retraining faculty of EE ''Vitebsk State Medical University''.
Sosinovich D.G. An assistant of the operative surgery and topographic anatomy chair of EE ''Vitebsk State Medical University''.

CASE REPORTS

A.V. MIKHEEV1, S.N. TRUSHIN1, E.K.SUROV2, S.V. SNEGUR2

FIBROVASCULAR POLYP OF THE ESOPHAGUS

SBEE HPE "Ryazan State Medical University named after I.P.Pavlov"1,
SBE of Ryazan region "Regional Clinical Hospital"2,
The Russian Federation

Fibrovascular polyps are rare, benign, and intraluminal tumors submucosal tumor-like lesions of the proximal esophagus. Fibrovascular polyps account for only 0,5–1% of all benign esophageal tumors. Polyps of a large size are thought to be extremely dangerous due to known risk of obstruction of the respiratory tract and asphyxiation. The removal of these lesions is usually recommended because of the progressive complications of oesophagus. As for correct surgical approach, the accurate assesment of the origin, size, and vascularity of the pedicle and the size of the tumor mass is essial for the proper treatment. Surgical, rather than endoscopic removal, is the treatment of choice. In the article a case of giant fibrovascular polyp of the cervical part of esophagus is presented in 72-yr-old-men, accompanied by specific clinical manifestations: intermitting dysphagia and efforts to regurgitate. Visual examination and fibroesophagoscopy demonstrated the giant fibrovascular polyp (more than 10 cm long) in the proximal esophagus. X-ray investigation of the esophagus with barium sulfate studies failed to demonstrate a proximal pedicle. The fibrovascular polyp due to the presence of thick pedicle could not be removed via endoscopy. A cervical vertical oesophagostomy with the fibrovascular polyp resection appears to be the approach of choice. No any cases of recurrence after radical surgery according to the available literature has been reported.
It is important to make algorhymth of differential diagnostics taking into account the esophageal fibrovascular polyp in patients with dysphagia, vomiting, regurgitation and weight loss inspite of its rarity.

Keywords: giant fibrovascular polyp, esophagus, esophageal polyp, fibroepithelial polyps, dysphagia, vomiting, regurgitation
p. 88-92 of the original issue
References
  1. Palanivelu C, Rangarajan M, John SJ, Annapoorni S, Senthilkumar S. A rare cause of intermittent dysphagia: giant fibrovascular polyp of the proximal esophagus. J Coll Physicians Surg Pak. 2007 Jan;17(1):51-52.
  2. Karpov DV, Kaminskii IuD, Grigor'ev AV, Karpova LI, Vinogradov II. Faktory prognoza i ikh vliianie na rezul'taty lecheniia raka pishchevoda [Prognostic factors and its influence on the results of treatment of esophageal cancer]. Nauka molodykh – Eruditio Juvenium. 2013;(2):39-52.
  3. Chourmouzi D, Drevelegas A. Giant fibrovascular polyp of the esophagus: a case report and review of the literature. J Med Case Rep. 2008; 2: 337. doi: 10.1186/1752-1947-2-337.
  4. Madeira F, Justo J, Wietzycoski C, Burttet L, Kruel C, Da Rosa A. Giant fibrovascular polyp of the esophagus: a diagnostic challenge. Arq Bras Cir Dig. 2013; 26(1): 71-73.
  5. Drenth JPH, Wobbes T, Bonenkamp JJ, Nagengast FM. Recurrent esophageal fibrovascular polyps case history and review of the literature. Dig Dis Sci. 2002 Nov; 47 (Is 11):2598-604.
  6. Kanaan S, DeMeester TR. Fibrovascular polyp of the esophagus requiring esophagectomy. Dis Esophagus. 2007;20(5):453-54.
Address for correspondence:
390026, Russian Federation,
Ryazan, ul. Vyisokovoltnaya, d. 9,
GBOU VPO "Ryazanskiy gosudarstvennyiy meditsinskiy universitet",
kafedra fakultetskoy khirurgii s kursom anesteziologii i reanimatologii,
tel. office: 7 (4912) 36-72-84,
e-mail: almiheev77@mail.ru,
Mikheev Aleksey Vladimirovich
Information about the authors:
Trushin S.N. MD, professor, a head of the faculty surgery chair with the courses of anesthesiology and reanimatology of SBEE HPE ''Ryazan State Medical University named after I.P.Pavlov''.
Mikheev A.V. PhD, an associate professor of the faculty surgery chair with the courses of anesthesiology and reanimatology of SBEE HPE ''Ryazan State Medical University named after I.P.Pavlov''
Surov E.K., Head of the thoracic surgery department of SBE of Ryazan region'' Regional Clinical Hospital''.
Snegur S.V. A pathologist of SBE of Ryazan region ''Regional Clinical Hospital''.

EXCHANGE OF EXPERIENCE

Ê.À. LINYOV, À.V.TORBA

SURGICAL TREATMENT MANAGEMENT OF ABDOMINAL GUNSHOT INJURIES

SE ''Lugansk Medical University'' ,
Ukraine

Objectives. To develop the surgical treatment algorithm for patients with abdomen gunshot injuries.
Methods. The work is based on case histories analysis of victims (n=100) with abdominal gunshot injuries. The nature of injury has been analyzed (isolated – combined, bullet – shrapnel, penetrating – non-penetrating); the nature of the organ damage, the results of the use of the following diagnostic methods: ultrasonography; plain abdominal radiography; spiral computed tomography; the type of operations performed, so as complications and treatment outcome.
Results. It was established that blast mine injury: (shrapnel wounds) constituted 93% of the victims; bullet wounds were noted only in 7%. Penetrating injuries of the abdomen constituted 79%. 29% had isolated abdomen gunshot injuries, 71% of victims – combined gunshot injuries. The wounding projectile inlet was located in the anterior abdominal wall in 41% only, but in 35% it was located on the back surface of the body. The survey procedures were limited to emergency ultrasound examination, plain abdominal radiography, spiral CT.
Conclusion. The indications for laparotomy in abdomen gunshot injuries are considered to be hemorrhagic shock, peritonitis, the presence of free abdominal fluid on ultrasound and intra-abdominal foreign bodies on X-ray and CT, the penetrating trauma according to the revision of wound channel and rectal hemorrhage. In the study of the incidence of organ injuries the small intestine damage was commonly noted – 27%, colon injury – 23%, liver – 23%, spleen – 19%, diaphragm – 13%, rectum – 10%. The penetrating abdomen gunshot injuries were treated by one-stage final operation in 19%, being guided by the "Damage control" principle – in 81%. The mortality rate was 29% mainly in combined gunshot injury, the number of septic complications – 39%.

Keywords: abdominal gunshot injuries, emergency diagnosis, surgical treatment tactics, indications for laparotomy, "damage control" strategy, septic complications, mortality rate
p. 93-98 of the original issue
References
  1. Masliakov VV, Dadaev AIa, Kerimov AZ, Khasikhanov SS. Neposredstvennye i otdalennye rezul'taty lecheniia bol'nykh s ognestrel'nymi raneniiami zhivota [Immediate and long-term results of treatment of patients with gunshot wounds to the abdomen]. Fundam Issledovaniia. 2013;(7):339-43.
  2. Gromov MS, Kerimov AZ. Khirurgicheskaia taktika pri ognestrel'nykh raneniiakh zhivota v usloviiakh regional'nogo konflikta [Surgical tactics in gunshot wounds of the abdomen in a regional conflict]. Sarat Nauch-Med Zhurn. 2010:6(2):460-62.
  3. Bykova IIu, Efimenko NA, Gumanenko EK, redaktory. Voenno-polevaia khirurgiia [Military surgery]: nats ruk. Moscow, RF: GEOTAR Media: 2009. 816 p.
  4. Ermolov AS, Khubutiia MSh, Abakumov M.M. Abdominal'naia travma [Abdominal injury]. Moscow, RF: Vidar; 2012. 495 p.
  5. Beschastnov VV, Maramokhin VN. Sluchai tiazhelogo ognestrel'nogo pronikaiushchego mnozhestvennogo raneniia zhivota, oslozhnennogo razvitiem mestnogo i generalizovannogo infektsionnogo protsessa [Cases of severe multiple gunshot wounds penetrating the stomach, complicated by the development of local and generalized infection]. Sovrem Tekhnologii v Meditsine. 2011;(1):146-48.
  6. Magomedov MP, Khamidov MA, Magomedov MA, i dr. Sravnitel'naia kharakteristika rezul'tatov lecheniia patsientov s ognestrel'nymi raneniiami obodochnoi kishki pri razlichnoi lechebnoi taktike [Comparative characteristics of the results of treatment of patients with gunshot wounds of the colon at different medical tactics]. Vestn Sovrem Klin Meditsiny. 2014;7(1):65-89.
  7. Sutton E, Bochicchio GV, Bochicchio K, Rodriguez ED, Henry S, Joshi M, Scalea TM. Long term impact of damage control surgery: a preliminary prospective study. J Trauma. 2006 Oct;61(4):831-4; discussion 835-36.
  8. Khriakov AS, Esetov AK, Razumov AN, Shubin IuV. Skvoznoe ognestrel'noe ranenie zhivota s mnozhestvennymi povrezhdeniiami vnutrennikh organov [Perforating gunshot wound to the abdomen with multiple internal injuries]. Khirurgiia Zhurn im NI Pirogova. 2005(10):65-66.
  9. Doklestic KS, Bumbasirevic V, Detanac D, Detanac D, Karamarkovic AR. Damage control surgery in abdominal gunshot injury. BHSURG. 2012;(2):58-64.
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  11. Sagraves SG, Toschlog EA, Rotondo MF. Damage control surgery–the intensivist's role. J Intensive Care Med. 2006 Jan-Feb;21(1):5-16.
Address for correspondence:
91045, Ukraine
Lugansk, kv. 50-letiya Oboronyi Luganska, d. 1,
GU ''Luganskiy gosudarstvennyiy
meditsinskiy universitet'',
kafedra gospitalnoy khirurgii, ortopedii i travmatologii,
tel. office. 380954695178, 38 (0642) 63-02-36, 63-02-16,
e-mail: k_linev@mail.ru
Linyov Konstantin Alekseevich
Information about the authors:
Linyov K.A. PhD, an associate professor of the hospital surgery, orthopedics and traumatology chair of SE ''Lugansk State Medical University''.
Torba A.V. PhD, an associate professor of the hospital surgery, orthopedics and traumatology chair of SE ''Lugansk State Medical University''.
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