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Year 2018 Vol. 26 No 1

SCIENTIFIC PUBLICATIONS
EXPERIMENTAL SURGERY

N.N. YAROTSKAYA 1, V.K. GOSTISHEV 2, V.A. KOSINETS 1, I.V. SAMSONOVA 1

ULTRASTRUCTURAL AND MORPHOFUNCTIONAL CHANGES IN THE MITOCHONDRIAL APPARATUS OF HEPATOCYTES IN EXPERIMENTAL DIFFUSE PURULENT PERITONITIS

Vitebsk State Medical University 1, Vitebsk,
The Republic of Belarus
I.M. Sechenov First Moscow State Medical University (Sechenov University) 2, Moscow,
The Russian Federation

Objective. To study the ultrastructural changes in the liver mitochondria in experimental diffuse purulent peritonitis against the background of the metabolic support.
Methods. The morphometric evaluation of the rabbit liver mitochondria electron microscopic images (n=55) was performed in experimental diffuse purulent peritonitis. The obtained electron diffraction patterns were estimated using the ImageJ 1.45s program, in which the number of mitochondria sections, the number of intermithochondrial contacts and the number of damaged and intact mitochondria were counted. The average area, perimeter, and specific volume (measured in %) were calculated for the undamaged mitochondrial profiles. Metabolic agents with energotropic properties, phosphocreatine preparations containing creatine phosphate and preparations containing the succinic acid, niacinamide, inosine diphosphate and riboflavin were used.
Results. Electron microscopic analysis of mitochondria of hepatocytes made it possible to reveal significant changes in their structure, caused by the development of purulent peritonitis. Morphometric evaluation of electron diffraction patterns showed changes in the quantitative and qualitative characteristics of mitochondria: the ratio of the damaged and intact mitochondria, their size, perimeter and specific volume of all groups. The use of metabolic support permitted to reduce the negative effect of purulent peritonitis in the postoperative period, which is exerted on the liver mitochondria, in comparison with the control group of animals that did not receive any metabolic support. Conducting a comparative analysis revealed a higher efficacy of the metabolic agent containing the succinic acid, niacinamide, inosine diphosphate and riboflavin, which resulted in more intensive restoration of the mitochondrial membrane structure.
Conclusions. The development of purulent peritonitis is accompanied by a violation of the ultrastructural organization of the liver mitochondria in all studied groups. Metabolic correction allows restoring the membrane structure of mitochondria, and as the result improving the energy supply of cells to combat the negative consequences of endotoxicosis in peritonitis.

Keywords: peritonitis, liver, mitochondria, endotoxin, inflammation, active forms of oxygen
p. 5-15 of the original issue
References
  1. Vlasov AP, Tarasova TV, Kozlov IG, Loginova OV, Leshankina NY, Visaitov DA. The ways rising of detoxication natural mechanisms during peritonitis. Kuban Nauch Med Vestn. 2010;(2):17-22. (in Russ.)
  2. Chernov VN. Foci of introduction of infection and hepatic failure-accuracy in common abdominal infections. Kuban Nauch Med Vestn. 2013;(3):135-38. (in Russ.)
  3. Mittal M, Siddiqui MR, Tran K, Reddy SP, Malik AB. Reactive oxygen species in inflammation and tissue injury. Antioxid Redox Signal. 2014 Mar 1; 20(7):1126-67. doi: 10.1089/ars.2012.5149.
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  5. Camara AK, Lesnefsky EJ, Stowe DF. Potential therapeutic benefits of strategies directed to mitochondria. Antioxid Redox Signal. 2010 Aug 1;13(3):279-47. doi: 10.1089/ars.2009.2788.
  6. Jain MV, Paczulla AM, Klonisch T, Dimgba FN, Rao SB, Roberg K, Schweizer F, Lengerke C, Davoodpour P, Palicharla VR, Maddika S, łos M. Interconnections between apoptotic, autophagic and necrotic pathways: implications for cancer therapy development. J Cell Mol Med. 2013 Jan;17(1):12-29. doi: 10.1111/jcmm.12001.
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  8. Bagnenko SF, Gorbachev NB, Amagyrov VP, Batotsyrenov BV, Miroshnichenko VN. Farmakologicheskaia korrektsiia metabolicheskikh narushenii pri razlitom peritonite: posobie dlia vrachei. S-Petersburg; 2007. 20 p. (in Russ.)
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  12. Okovityi SV, Shulenin SN, Smirnov AV. Klinicheskaia farmakologiia antigipoksantov i antioksidantov. S-Petersburg, RF: FARMindeks; 2005. 72 p. (in Russ.)
  13. Perepech NB. Neoton (mekhanizmy deistviia i klinicheskoe primenenie. 2-e izd. S-Petersburg: Progress-Pogoda; 1997. 88 p. (in Russ.)
Address for correspondence:
210022, The Republic of Belarus,
Vitebsk, Frunze Avenue, 27, b. 3
Vitebsk State Medical University,
Research Laboratory,
Tel. mobile: +375 29 714-18-76,
e-mail: yardip@yandex.ru,
Yarotskaya Natalia N.
Information about the authors:
Yarotskaya Natalia N., Researcher of the Research Laboratory, Vitebsk State Medical University, Vitebsk, Republic of Belarus.
http://orcid.org/0000-0002-2493-7653
Gostishev Victor K., MD, Professor, Academician of RAMS, Head of the General Surgery Department of the Medical Faculty, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation.
http://orcid.org/0000-0002-2900-0069
Kosinets Vladimir A., MD, Professor of the Hospital Surgery Department with the Courses of Urology and Pediatric Surgery of Vitebsk State Medical University, Vitebsk, Republic of Belarus.
http://orcid.org/0000-0001-7127-1877
Samsonova Inna V., PhD, Associate Professor, Head of the Pathologic Anatomy Department, Vitebsk State Medical University, Vitebsk, Republic of Belarus.
http://orcid.org/0000-0003-0847-9856

A.A. NAZARCHUK, S.V. VERNYGORODSKYI, V.G. PALII, G.G. NAZARCHUK

EXPERIMENTAL RESEACH OF EFFECTIVENESS OF ANTIMICROBIAL SURGICAL MATHERIALS CONTAINING DECAMETHOXINUM

National Pirogov Memorial Medical University, Vinnytsya, Ukraine

Objective. To study the properties of antimicrobial surgical materials containing decamethoxinum.
Methods. In the experimental model of the wound primary infected by Staphylococcus (60 white mongrel male rats), the antimicrobial effectiveness of dressings (medical coarse calico) and suture (silk) materials, impregnated with antiseptic decamethoxinum (with 1,10-Decamethylene-bis-(N,N-dimethylmethoxycarbonylmethyl) ammonium dichloride), in comparison with topical wound management with chlorhexidine was researched. The effectiveness of wound healing was studied experimentally by standard microbiological and morphological methods (3rd, 7th, 14th days).
Results. The decrease of S. aureus colonization in wounds (6.47±0.11 CFU/ml) was registered on the 3rd day after administration of antimicrobial silk and medical coarse calico with decamethoxinum. The use of materials, impregnated with decamethoxinum was proved to have advantages in reduction of S. aureus colonization (in 1.3-1.4 times) after 7 days. Complete reduction of S. aureus from wounds was registered on the 14th day. But at the same time, in the comparison group microbial colonization was higher than 106 CFU/ml (p<0.01).
In comparison group the pathomorphological changes of skin were noted such as a significant inflammation response, purulent inflammation extension in the derma (3rd day). While using antimicrobial silk and dressings with decamethoxinum, the depression of inflammatory reaction more than in 1.5 times was registered (p<0.05); exudation and purulent character of the inflammatory process was specified in the form of the expressed activation of leucocytes and macrophages in the first 7 days. In comparison group a long-lasting purulent inflammation was observed as well as progression of necrotic and dystrophic disorders (7th day). After using of surgical material, impregnated with decamethoxinum, the acceleration of reparation, more active wound healing were registered (7th, 14th day), than in comparison group (ð<0.05).
Conclusions. The use of antimicrobial surgical materials, impregnated with decamethoxinum provides effective antimicrobial, anti-inflammatory and anti-edematous action; synchronizes cell interaction in healing of purulent wounds; creates the balance between maturation and resorption of granulations and scar tissue.

Keywords: local anti-infective agents, sutures, bandages, decamethoxinum, wound healing, inflammation, Staphylococcus
p. 16-23 of the original issue
References
  1. Sood A, Granick MS, Tomaselli NL. Wound dressings and comparative effectiveness data. Adv Wound Care (New Rochelle). 2014 Aug 1;3(8):511-29. doi: 10.1089/wound.2012.0401.
  2. Kong M, Chen XG, Xing K, Park HJ. Antimicrobial properties of chitosan and mode of action: a state of the art review. Int J Food Microbiol. 2010 Nov 15;144(1):51-63. doi: 10.1016/j.ijfoodmicro.2010.09.012.
  3. Maksimenia GG. The kliniko-farmakologichesky characteristic of preparations for processing of wounds. Voen Meditsina. 2014;(2):105-14. (in Russ.)
  4. Percival SL, Finnegan S, Donelli G, Vuotto C, Rimmer S, Lipsky BA. Antiseptics for treating infected wounds: Efficacy on biofilms and effect of pH. Crit Rev Microbiol. 2016;42(2):293-309. doi: 10.3109/1040841X.2014.940495.
  5. Afinogenov GE, Lebedeva IK, Darovskaya EN, Afinogenova AG, Zaitseva MIu, Moldaver BL, Balaev TA, Bogdanova TIa. A new natural antiseptic «Galenophyllipt» for the treatment of staphylococcal skinmuscle wound infection in white mice. Klin Mikrobiologiia Antimikrob Khimioterapiia. 2010;12(2):170-76. (in Russ.)
  6. Avtandilov GG. Osnovy patologoanatomicheskoi praktiki: ruk. 3 izd, dop. Moscow, RF: RosMAPO; 2007. 480 p. (in Russ.)
  7. Obermeier A, Schneider J, Wehner S, Matl FD, Schieker M, von Eisenhart-Rothe R, Stemberger A, Burgkart R. Novel high efficient coatings for anti-microbial surgical sutures using chlorhexidine in fatty acid slow-release carrier systems. PLoS One. 2014 Jul 1;9(7):e101426. doi: 10.1371/journal.pone.0101426. eCollection 2014.
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  9. Menke NB, Ward KR, Witten TM, Bonchev DG, Diegelmann RF. Impaired wound healing. Clin Dermatol. 2007 Jan-Feb;25(1):19-25. doi: 10.1016/j.clindermatol.2006.12.005.
Address for correspondence:
21018, Ukraine,
Vinnytsya, Pirogov str., 56,
Vinnytsya National Pirogov
Memorial Medical University,
Department of Microbiology
e-mail: nazarchukoa@gmail.com,
Nazarchuk Alexander A.
Information about the authors:
Nazarchuk Aleksandr A., PhD, Senior Lecturer of the Department of Microbiology, Vinnytsya National Pirogov Memorial Medical University, Vinnytsya, Ukraine.
http://orcid.org/0000-0001-7581-0938
Vernygorodskyi Sergii V., MD, Professor, Professor of the Department of Pathological Anatomy, Forensic Medicine and Law, Vinnytsya National Pirogov Memorial Medical University, Vinnytsya, Ukraine.
http://orcid.org/0000-0002-9314-8527
Palii Viktor G., MD, Professor, Professor of the General Surgery Department, Vinnytsya National Pirogov Memorial Medical University, Vinnytsya, Ukraine.
http://orcid.org/0000-0002-2289-1786
Nazarchuk Galina G., PhD, Assistant of the Eye Diseases Department, Vinnytsya National Pirogov Memorial Medical University, Vinnytsya, Ukraine.
http://orcid.org/0000-0003-3902-1741

GENERAL & SPECIAL SURGERY

V.A. SHVARTZ 1, A.R. KISELEV 1,2, A.S. KARAVAEV 3, K.A. VULF 1, E.I. BOROVKOVA 4, A.D. PETROSYAN 1, O.L. BOCKERIA 1

MUTUAL DYNAMICS OF SYNCHRONIZATION OF LOW-FREQUENCY OSCILLATIONS IN CIRCULATION VEGETATIVE REGULATION AND INDICATORS OF VARIABILITY OF THE HEART RHYTHM IN PATIENTS AFTER OPERATIONS WITH ARTIFICIAL CIRCULATION IN THE EARLY POSTOPERATIVE PERIOD

A.N. Bakulev Scientific and Practical Center for Cardiovascular Surgery 1,
Saratov State Medical University named after V.I. Razumovsky 2,
Saratov Branch of the Institute of Radio Engineering and Electronics named after V.A. Kotelnikov of RAS 3,
Saratov National Research State University named after N.G. Chernyshevsky 4 , Saratov,
The Russian Federation

Objective. To investigate peculiarity of co-operative dynamics of autonomic circulatory control indices, including synchronization of low frequency oscillations in heart rate variability (HRV) and photoplethysmogram (PPG), in patients after surgery with cardiopulmonary bypass (CPB) in the early postoperative period.
Methods. 62 patients, who had survived surgery with CPB, were included in the study (40 men, 22 women, aged 57,9±7,6 years). The synchronous registration of cardiointervalogram and PPG during 15 minutes was performed in all patients before surgery and 5-7 days after surgery in the morning. We calculated the total percentage of phase synchronization of low frequency rhythms in HRV and PPG (index S), heart rate (HR) and some assessments of HRV (SDNN, TP, HF% è LF%). We calculated the dynamics of these indices after surgery: ΔS, ΔHR, ΔSDNN, ΔHF%, ΔLF%.
Results. After surgery, index S decreased (ΔS<-5%) in 26 patients, has not changed (ΔS -5% to +5%) in 18 patients and increased (ΔS>+5%) in 18 patients. Patients with ΔS<-5% had the highest value of the index S and the lowest of TR, relatively to other patients (ð<0.05). In all study phases, the strong correlation was shown for SDNN and TP (R=0.86 and 0.90, ð<0.05), and the medium correlation was shown for index S è TP (R=-0.41 and -0.53, ð<0.05). The multiple regression correlation was identified between ΔS and following indices: S, HF%, blood glucose, cardioplegia, ΔTP, ΔHF%.
Conclusions. We revealed the heterogeneity of patients with coronary artery disease, requiring surgery with CPB, using source autonomic status and its dynamics in the early postoperative period. We showed multiple dependent postoperative dynamics of the index S with some indices, which characterize the initial status of the patient, peculiarities of the operation and dynamics of autonomic status in the early postoperative period.

Keywords: coronary artery bypass grafting, valvular pathology of heart, cardiopulmonary bypass, autonomic control, heart rate variability, low frequency oscillations, synchronization
p. 24-33 of the original issue
References
  1. Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Circulation. 1996 Mar 1;93(5):1043-65. [No authors listed]
  2. Buccelletti F, Bocci MG, Gilardi E, Fiore V, Calcinaro S, Fragnoli C, Maviglia R, Franceschi F. Linear and nonlinear heart rate variability indexes in clinical practice. Comp Math Methods Med. 2012;2012:Article ID 219080. 5 p. doi: 10.1155/2012/219080.
  3. Zhang Q, Patwardhan AR, Knapp CF, Evans JM. Cardiovascular and cardiorespiratory phase synchronization in normovolemic and hypovolemic humans. Eur J Appl Physiol. 2015 Feb;115(2):417-27. doi: 10.1007/s00421-014-3017-4.
  4. Kiselev AR, Karavaev AS, Gridnev VI, Prokhorov MD, Ponomarenko VI, Borovkova EI, Shvartz VA, Ishbulatov YuM, Posnenkova OM, Bezruchko BP. Method of estimation of synchronization strength between low-frequency oscillations in heart rate variability and photoplethysmographic waveform variability. RusOMJ. 2016;5(1):e0101. doi: 10.15275/rusomj.2016.0101.(in Russ.)
  5. Soares PP, Moreno AM, Cravo SL, Nóbrega AC. Coronary artery bypass surgery and longitudinal evaluation of the autonomic cardiovascular function. Crit Care. 2005;9(2):R124-R131. doi: 10.1186/cc3042.
  6. Bakari S, Koca B, Oztunç F, Abuhandan M. Heart rate variability in patients with atrial septal defect and healthy children. J Cardiol. 2013 Jun;61(6):436-39. doi: 10.1016/j.jjcc.2013.01.014.
  7. Pantoni CB, Mendes RG, Di Thommazo-Luporini L, Simoes RP, Amaral-Neto O, Arena R, Guizilini S, Gomes WJ, Catai AM, Borghi-Silva A. Recovery of linear and nonlinear heart rate dynamics after coronary artery bypass grafting surgery. Clin Physiol Funct Imaging. 2014 Nov;34(6):449-56. doi: 10.1111/cpf.12115.
  8. Taylor R. Interpretation of the correlation coefficient: a basic review. J Diagn Med Sonogr. 1990;6(Is):35-39. doi: 10.1177/875647939000600106.
  9. Chello M, Mastroroberto P, De Amicis V, Pantaleo D, Ascione R, Spampinato N. Intermittent warm blood cardioplegia preserves myocardial beta-adrenergic receptor function. Ann Thorac Surg. 1997 Mar;63(3):683-88. doi: 10.1016/S0003-4975(96)01367-7.
  10. Lakusic N, Mahovic D, Sonicki Z, Slivnjak V, Baborski F. Outcome of patients with normal and decreased heart rate variability after coronary artery bypass grafting surgery. Int J Cardiol. 2013 Jun 20;166(2):516-18. doi: 10.1016/j.ijcard.2012.04.040.
  11. Jelinek HF, Huang ZQ, Khandoker AH, Chang D, Kiat H. Cardiac rehabilitation outcomes following a 6-week program of PCI and CABG patients. Front Physiol. 2013;4:302. Front Physiol. 2013;4:302. doi: 10.3389/fphys.2013.00302.
  12. Badra LJ, Cooke WH, Hoag JB, Crossman AA, Kuusela TA, Tahvanainen KU, Eckberg DL. Respiratory modulation of human autonomic rhythms. Am J Physiol Heart Circ Physiol. 2001 Jun;280(6):H2674-88.
  13. Nolan J, Batin PD, Andrews R, Lindsay SJ, Brooksby P, Mullen M, Baig W, Flapan AD, Cowley A, Prescott RJ, Neilson JM, Fox KA. Prospective study of heart rate variability and mortality in chronic heart failure: results of the United Kingdom heart failure evaluation and assessment of risk trial (UK-heart). Circulation. 1998 Oct 13;98(15):1510-16. doi: 10.1161/01.CIR.98.15.1510.
  14. Kleiger RE, Miller JP, Bigger JT Jr, Moss AJ. Decreased heart rate variability and its association with increased mortality after acute myocardial infarction. Am J Cardiol. 1987 Feb 1;59(4):256-62. doi: 10.1016/0002-9149(87)90795-8.
  15. Arslan ü, Memetoğlu ME, Kutlu R, Erbasan O, Tort M, çal?k ES, Y?ld?z Z, Kayg?n MAli, Erdem O, Tekin AI. Preoperative Hba1c level in prediction of short-term morbidity and mortality outcomes following coronary artery bypass grafting surgery. RusOMJ. 2015;4(Is 2):e0204. doi: 10.15275/rusomj.2015.0204.
Address for correspondence:
121552, The Russian Federation,
Moscow, Rublevskoe Highway, 135,
A.N. Bakulev Scientific and Practical
Center for Cardiovascular Surgery,
Department of Surgical Treatment
of Interactive Pathology,
Tel. mobile: +79032619292,
e-mail: shvartz.va@ya.ru,
Shvartz Vladimir A.
Information about the authors:
Shvartz Vladimir A., PhD, Researcher, Department of Surgical Treatment of Interactive Pathology, A.N. Bakulev Scientific and Practical Center for Cardiovascular Surgery, Moscow, Russian Federation.
http://orcid.org/0000-0002-8931-0376
Kiselev Anton R., MD, Researcher, Department of Surgical Treatment of Interactive Pathology, A.N. Bakulev Scientific and Practical Center for Cardiovascular Surgery, Moscow, Leading Researcher, Institute of Cardiology, Department of Promotion of New Cardiological Information Technologies, Saratov State Medical University named after V.I. Razumovsky, Saratov, Russian Federation.
http://orcid.org/0000-0003-3967-3950
Karavaev Anatoly S., PhD, Senior Researcher, Saratov Branch of the Institute of Radio Engineering and Electronics named after V.A. Kotelnikov of RAS, Saratov, Russian Federation.
http://orcid.org/0000-0003-4678-3648
Vulf Kristina A., Post-Graduate Student, Department of Surgical Treatment of Interactive Pathology, A.N. Bakulev Scientific and Practical Center for Cardiovascular Surgery, Moscow, Russian Federation.
http://orcid.org/0000-0001-8732-6721
Borovkova Ekaterina I., Post-Graduate Student, Assistant of the Department of Dynamic Modeling and Biomedical Engineering, Saratov National Research State University named after N.G. Chernyshevsky , Saratov, Russian Federation.
http://orcid.org/0000-0002-9621-039X
Petrosyan Andrey D., Cardiovascular Surgeon, Department of Surgical Treatment of Interactive Pathology, A.N. Bakulev Scientific and Practical Center for Cardiovascular Surgery, Moscow, Russian Federation.
http://orcid.org/0000-0002-0001-0693
Bockeria Olga L., Corresponding Member of the Russian Academy of Sciences, Chief Researcher, Department of Surgical Treatment of Interactive Pathology, A.N. Bakulev Scientific and Practical Center for Cardiovascular Surgery, Moscow, Russian Federation.
http://orcid.org/0000-0002-7711-8520

V.N. BELORUSETS 1, A.S. KARPITSKIJ 1, N.N. GOLUBEVA 2

MORPHOLOGICAL CHANGES IN THE RETROPERITONEAL FAT TISSUE IN THE EARLY PHASE OF ACUTE NECROTIZING PANCREATITIS

Brest Regional Hospital 1,
Brest Region Directorate of the State Forensic Examination Committee of the Republic of Belarus 2, Brest,
The Republic of Belarus

Objective. To study the nature of pathomorphological changes in the retroperitoneal tissue in the early phase of acute necrotizing pancreatitis.
Methods. The article presents the results of the histological examination of biopsy specimens of the retroperitoneal tissue of 22 patients with acute necrotizing pancreatitis, who were treated with early laparoscopic drainage of the retroperitoneal tissue performed in the first 5 days after the disease onset. The use of biopsy material allowed studying the morphological changes in the retroperitoneal tissue at the earliest stages of the disease.
Results. The analysis of the obtained results revealed a number of features of the inflammatory reaction in the retroperitoneal tissue in acute pancreatitis. First of all, it is a delayed exudative inflammatory reaction when an immediate increase of the vascular wall permeability for the blood cells did not occur. Microvascular reactions were delayed confirmed by the late (after 48 hours) occurrence of small-focal hemorrhages and fibrin deposits. There were practically no thromboses at the microcirculatory level. The peculiarity of cellular reactions in the first 2 days was the dominance of lymphocytes. The leukocyte round cell infiltration was detected, which indicates a serous nature of the inflammatory reaction. Starting with the second day, there were single polynucleous leukocyte infiltrates, being a morphological sign of a suppurative inflammation. Their amount progressively increased with the prolongation of the disease terms. Fat necrosis was detected 48 hours after the disease onset.
Conclusions. The lesion of the retroperitoneal tissue occurred much later than the manifestation of acute necrotizing pancreatitis. Pathomorphological changes in the retroperitoneal tissue in the early phase of acute pancreatitis are subject to evolution and have staging, determined by the duration of the impact of disturbing factors. The nature of the inflammatory reaction reflects a consistent transition from serous inflammation to purulent one. The obtained data show a pathogenetic foundation to apply early draining operations using minimally invasive technologies in the first 48 hours in the stage of serous inflammation, when pathological changes in the retroperitoneal tissue are potentially reversible.

Keywords: acute necrotizing pancreatitis, retroperitoneal tissue, biopsy, fat necrosis, laparoscopic drainage, inflammation
p. 34-41 of the original issue
References
  1. Kondratenko PG, Konkova MV, Vasiliev AA, Yepifantsev AA, Djansiz IN, Shirshov IV, Yudin AA. Surgical Tactics in Acute Necrotizing Pancreatitis. Ukr Zhurn Khirurgii. 2013;(3):150-55.(in Russ.)
  2. Shoroh GP, Shoroh SG. Ostryj destruktivnyj pankreatit. Minsk, RB: Paradoks; 2013. 208 p. (in Russ.)
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  4. Mayorov VM, Dundarov ZA, Avizhets ÍuN. Some morphological regularities of damage and spreading of the destructive process in the retroperitoneal area in severe acute necrotizing pancreatitis according to autopsy data. Novosti Khirurgii. 2015;23(4):385-90. doi: 10.18484/2305-0047.2015.4.385.(in Russ.)
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  6. IAP/APA evidence-based guidelines for the management of acute pancreatitis. Working Group IAP/APA Acute Pancreatitis Guidelines. Pancreatology. 2013 Jul-Aug;13(4 Suppl 2):e1-15. doi: 10.1016/j.pan.2013.07.063.
  7. Wada K, Takada T, Hirata K, Mayumi T, Yoshida M, Yokoe M, Kiriyama S, Hirota M, Kimura Y, Takeda K, Arata S, Hirota M, Sekimoto M, Isaji S, Takeyama Y, Gabata T, Kitamura N, Amano H. Treatment strategy for acute pancreatitis. J Hepatobiliary Pancreat Sci. 2010 Jan;17(1):79-86. doi: 10.1007/s00534-009-0218-z.
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  12. Wan MH, Huang W, Latawiec D, Jiang K, Booth D M, Elliott V, Mukherjee R, Xia Q. Review of experimental animal models of biliary acute pancreatitis and recent advances in basic research. HPB (Oxford). 2012 Feb; 14(2):73-81. doi: 10.1111/j.1477-2574.2011.00408.x.
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Address for correspondence:
224027, The Republic of Belarus,
Brest, Meditsinskaya Str.,7,
Brest Regional Hospital,
Purulent Surgery Unit,
Tel. office: +375 162 27-21-91,
e-mail: victorbelorusets@yandex.ru,
Belorusets Victor N.
Information about the authors:
Belorusets Victor N., Applicant of the General Surgery Department, Grodno State Medical University, Surgeon of the Purulent Surgery Unit, Brest Regional Hospital, Brest, Republic of Belarus.
http://orcid.org/0000-0001-8150-0207
Karpitskij Aliaksandr S., MD, Professor, Head Physician, Brest Regional Hospital, Brest, Republic of Belarus.
http://orcid.org/0000-0001-8900-8890
Golubeva Natalja N., State Medical Forensic Expert of the Department îf Forensic Histological Examinations of the Laboratory Examination of Physical Evidence of a Biological Nature of the Brest Region Directorate of the State Forensic Examination Committee of the Republic of Belarus, Brest, Republic of Belarus.
http://orcid.org/0000-0002-6207-3411

Y.S. VINNIK1, R.A. PAKHOMOVA1, L.V. KOCHETOVA1, V.V. KOZLOV2

CHEMILUMINESCENT ACTIVITY AND CYTOARCHITECTONICS OF NEUTROPHILIC GRANULOCYTES IN PATIENTS WITH MECHANICAL JAUNDICE

Krasnoyarsk State Medical University named after Professor V. F. Voino-Yasenetsky1 ,Krasnoyarsk
I.M. Sechenov First Moscow State Medical University (Sechenov University) 2, Moscow,
The Russian Federation

Objective. To study the functional activity and cytoarchitectonics of neutrophilic granulocytes by the atomic force microscopy technique in the patients with mechanical jaundice of benign genesis of varying severity.
Methods. The subject of the study were 92 patients aged from 47 to 69 years undergoing the in-patient treatment in the surgical departments of medical institutions in Krasnoyarsk with the diagnosis of mechanical jaundice of benign genesis. The control group consisted of 60 donors, comparable in sex and age with the main group. Depending on the severity of mechanical jaundice, luminol-dependent chemiluminescence of neutrophils was investigated and atomic-force microscopy of neurophilic granulocytes was performed to determine the shape, membrane state, geometric dimensions and adhesion forces of the blood neutrophils.
Results. In patients with mechanical jaundice, the intensity of spontaneous chemiluminescence depends on the severity of mechanical jaundice. The kinetics of the chemiluminescent response of the peripheral blood neutrophils indicates an increase in the compensatory functional capacity of this cell population in case of mild degree of mechanical jaundice severity with their depletion in parallel with the increase in the severity of mechanical jaundice.
Atomic force microscopy revealed violations of the structural organization of the neutrophil granulocyte. With increasing severity of mechanical jaundice, neutrophil became convex in shape, the number of segments of the nucleus increased, the cell membrane became irregular, the neutrophil volume reached 62.20 + 5.94 μm3. The magnitude of the adhesion forces of neutrophils decreased by 25% in patients with class B severity of mechanical jaundice and by 31% with class C severity of mechanical jaundice.
Conclusions. Based on the analysis of the chemiluminescent activity of neutrophilic granulocytes and their cytoarchitectonics, we concluded that the functional capabilities of neutrophilic granulocytes in mechanical jaundice are depleted in parallel with the increase in the severity of mechanical jaundice. Dysfunctions of neutrophils in mechanical jaundice are caused by the change in its cytoarchitectonics and by the decrease in adhesion forces.

Keywords: mechanical jaundice, chemiluminescent response, atomic force microscopy, cytoskeleton, neutrophil
p. 42-50 of the original issue
References
  1. Gal’perin EI. Klassifikatsiia tiazhesti mekhanicheskoi zheltukhi. Annaly Khirurg Gepatologii. 2012;17(2):26-33. (in Russ.)
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  4. Smirnova ÎV, Titova NM, Manchuk VT, Elmanova NG, Kochetova LV, Pakhomova RÀ. Cellular immunity features in patients with benign origin obstructive jaundice depending on bilirubin. Fundam Issledovaniia. 2015;(2-10):2174-79. (in Russ.)
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  7. Stupin VA, Laptev VV, Tskaev AYu, Givirovskaya NE. Immune System in Benign Obstructive Jaundice Patients. Annaly Khirurg Gepatologii. 2008;13(2):69-75. (in Russ.)
  8. Kurtasova LM, Semenov EV, Zukov RA, Shkapova EA. Changes in parameters of luminol-dependent and lucigenin-dependent chemiluminescence of peripheral blood neutrophils in patients with bladder cancer in the disease dynamics. Med Immunologiia. 2015;17(2):173-78. (in Russ.)
  9. Savchenko AA, Dresvjankina LV, Grinshtejn YuI, Aristov AI. Features of chemiluminescent activity of blood neutrophils and sputum of patients with community-acquired pneumonia during the treatment. Sib Med Obozrenie. 2014;(5):52-56. (in Russ.)
Address for correspondence:
660022, The Russian Federation,
Krasnoyarsk, P.Zheleznyak Str., 1,
Krasnoyarsk State Medical University
named after Professor
V. F. Voino-Yasenetsky,
General Surgery Department,
Tel. mobile +79029423912,
e-mail: PRA5555@mail.ru,
Pakhomova Regina A.
Information about the authors:
Vinnik Yurij S., MD, Professor, Head of the General Surgery Department named after Professor M.I. Gulman, Krasnoyarsk State Medical University named after Professor V. F. Voino-Yasenetsky, Krasnoyarsk, Russian Federation.
http://orcid.org/0000-0002-8135-0445
Pakhomova Regina A., PhD, Assistant of the General Surgery Department named after Professor M.I. Gulman, Krasnoyarsk State Medical University named after Professor V. F. Voino-Yasenetsky, Krasnoyarsk, Russian Federation.
http://orcid.org/0000-0002-3681-4685
Kochetova Lyudmila V., PhD, Associate Professor of the General Surgery Department named after Professor M.I. Gulman, Krasnoyarsk State Medical University named after Professor V. F. Voino-Yasenetsky, Krasnoyarsk, Russian Federation.
http://orcid.org/0000-0001-5784-7067
Kozlov Vasiliy V., PhD, Associate Professor of the Department of Public Health and Health Care, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation.
http://orcid.org/0000-0002-2389-3820

R.E. KALININ, I.A. SUCHKOV, A.S. PSHENNIKOV, A.A. KAMAEV, S.A. ISAKOV, A.N. RYABKOV

APPLICATION OF MAGNESIUM DRUGS AND THEIR INFLUENCE ON THE INDICATORS OF CONNECTIVE TISSUE DYSPLASIA IN PATIENTS WITH VARICOSE VEINS

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

Objective. To study the effect of magnesium drugs on the concentration of matrix metalloproteinases and magnesium ions in patients with varicose veins of the lower extremities.
Methods. The study included 124 patients with varicose veins of the lower extremities, C2-C6, which were divided into 4 groups. In the 1st group, surgical treatment followed with the administering the standard conservative treatment (32 patient); in the 2nd group after the operation in addition to conservative treatment, magnesium drugs (32 patient) were prescribed; in the 3rd group, conservative treatment without surgery (30 patient) was performed; in the 4th group patients received standard conservative treatment and magnesium drugs (30 patient). The 5th control group consisted of 20 healthy volunteers who did not suffer from varicose veins disease. Patients of groups 2 and 4 were given magnesium orotate 500 mg 2 tablets 3 times a day for 3 months. The content of serum matrix metalloproteinase-1 (MMP-1), matrix metalloproteinase-9 (MMP-9), tissue inhibitor of matrix metalloproteinase-1 (TIMP-1) was determined by quantitative solid-phase enzyme immunoassay. The magnesium ion concentration was determined by colorimetric method.
Results. In patients with varicose veins of lower extremities a significantly lower level of magnesium was registered compared to healthy volunteers not suffering from varicose veins: 35.5% of those with varicose veins had a magnesium deficiency, while only 15% had a decrease in this indicator among healthy volunteers. Against the background of additional therapy with magnesium drugs, there was a decrease in the number of patients with magnesium deficiency in groups with varicose veins of lower extremities, a decrease in MMP-9 concentration and an increase in TIMP-1 activity was also established.
Conclusions. This study has confirmed the efficacy of magnesium drugs which have a pronounced effect on collagen degradation processes and extracellular matrix, reduce the activity of MMP-9, increase the concentration of TIMP-1, thereby affecting the MMP/TIMP balance in patients with varicose veins of lower extremities.

Keywords: primary varicose veins, pharmacotherapy, magnesium, matrix metalloproteinase, connective tissue dysplasia
p. 51-89 of the original issue
References
  1. Pokrovskii AV, Gradusov EG, Bredikhin RA. Diagnostika i lechenie varikoznoi bolezni. Moscow, RF: RMAPO; 2013. 125 p. (in Russ.)
  2. Staffa R. Chronic venous insufficiency–epidemiology. Bratisl Lek Listy. 2002;103(4-5):166-68.
  3. Nebylitsyn IuS, Kondrat’eva VI. Experience of managing patients with primary varicosity. Nauka molodykh – Eruditio Juvenium. 2016;(3):52-66. (in Russ.)
  4. Kirienko AI, Bogachev VIu, Gavrilov SG, Zolotukhin IA, Golovanova OV, Zhuravleva OV, Briushkov AIu. Chronic diseases of lower extremity veins in industrial workers of Moscow (Results of the epidemiological survey). Angiologiia i Sosud Khirurgiia. 2004;10(1):77-85. (in Russ.)
  5. Seliverstov EI, Avak’iants IP, Nikishkov AS, Zolotukhin IA. Epidemiology of chronic venous disease. Flebologiia. 2016;10(1):35-43. doi: 10.17116/flebo201610135-42. (in Russ.)
  6. Fomina NV, Fomina MA. Assessment of communication activity of lysosomal cystein proteases in plasma and indicators of endothelial dysfunction in patients with diseases of lower limbs veins. Nauka molodykh –Eruditio Juvenium. 2014;(1):60-67. (in Russ.)
  7. Amălinei C, Căruntu ID, Giuşcă SE, Bălan RA. Matrix metalloproteinases involvement in pathologic conditions. Rom J Morphol Embryol. 2010;51(2):215-28.
  8. Gromova OA. Magnii i piridoksin: osnovy znanii. Moscow, RF: ProtoTip; 2006. 234 p. (in Russ.)
  9. Gromova OA, Kalacheva AG, Torshin IIu, Rudakov KV, Grustlivaia UE, Iudina NV, Egorova EIu, Limanova OA, Fedotova LE, Gracheva ON, Nikiforova NV, Satarina TE, Gogoleva IV, Grishina TR, Kuramshina DB, Novikova LB, Lisitsyna EIu, Kerimkulova NV, Vladimirova IS, Chekmareva MN, Lialiakina EV, Shalaeva LA, Taleporovskaia SIu, Siling TB, Prozorova NV, Semenov VA, Semenova OV, Nazarova NA, Galustian AN, Sardarian IS. Nedostatochnost’ magniia – dostovernyi faktor riska komorbidnykh sostoianii: rezul’taty krupnomasshtabnogo skrininga magnievogo statusa v regionakh Rossii. Farmateka. 2013;(6):115-29. (in Russ.)
  10. Pagès N, Gogly B, Godeau G, Igondjo-Tchen S, Maurois P, Durlach J, Bac P. Structural alterations of the vascular wall in magnesium-deficient mice. A possible role of gelatinases A (MMP-2) and B (MMP-9). Magnes Res. 2003 Mar;16(1):43-48.
Address for correspondence:
390026, The Russian Federation,
Ryazan, Vyisokovoltnaya str., 9,
Ryazan State Medical University
named after Academician I.P. Pavlov,
Department of Cardiovascular,
X-Ray Endovascular,
Operative Surgery and Topographic Anatomy,
Tel. 7 951 101-21-23,
e-mail: kamaev.rgmu@gmail.com,
Kamaev Aleksey Andreevich
Information about the authors:
Kalinin Roman E., MD, Professor, Head of the Department of Cardiovascular, X-Ray Endovascular, Operative Surgery and Topographic Anatomy of Ryazan State Medical University named after Academician I.P. Pavlov, Ryazan, Russian Federation.
http://orcid.org/0000-0002-0817-9573
Suchkov Igor A., MD, Associate Professor, Professor of the Department of Cardiovascular, X-Ray Endovascular, Operative Surgery and Topographic Anatomy of Ryazan State Medical University named after Academician I.P. Pavlov, Ryazan, Russian Federation.
http://orcid.org/0000-0002-1292-5452
Pshennikov Alexander S., PhD, Associate Professor of the Department of Cardiovascular, X-Ray Endovascular, Operative Surgery and Topographic Anatomy of Ryazan State Medical University named after Academician I.P. Pavlov, Ryazan, Russian Federation.
http://orcid.org/0000-0002-1687-332X
Kamaev Aleksey À., Post-Graduate Student of the Department of Cardiovascular, X-Ray Endovascular, Operative Surgery and Topographic Anatomy of Ryazan State Medical University named after Academician I.P. Pavlov, Ryazan, Russian Federation.
http://orcid.org/0000-0002-3979-1271
Isakov Sergey À., MD, Professor of the Dermatovenereology Department of Ryazan State Medical University named after Academician I.P. Pavlov, Ryazan, Russian Federation.
http://orcid.org/0000-0002-0694-1309
Ryabkov Alexander N., MD, Associate Professor of the Department of Pharmacology with the Course of Pharmacy of the Faculty of Additional Professional Education of Ryazan State Medical University named after Academician I.P. Pavlov, Ryazan, Russian Federation.
http://orcid.org/0000-0003-4705-747X

PEDIATRIC SURGERY

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

NEODYMIUM LASER IN TREATMENT OF CONGENITAL TRACHEOESOPHAGEAL FISTULA IN CHILDREN

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

Objective. To evaluate the efficiency of neodymium laser with an endoscopic support in the treatment of tracheoesophageal fistula in children.
Methods. Laser technology has been used in the treatment of 8 children with tracheoesophageal fistula (TEF) at the age of 1 month and 26 days to 7 years. One has used the medical multifunctional laser complex Multiline (Belarus), gastroscope «Olympus GIF-XP190N», bronchoscope «Olympus MAF TYPE GM». When performing esophagoscopy and bronchoscopy, the distal segment of the light guide was introduced in the fistula and at the contact impact of the neodymium laser with a wavelength of 1340 nm to the mucous membrane of the fistula with the exposure of 2-3 seconds at a radiation power of 15 watts, the tissues with obliteration of the fistulous duct were coagulated and evaporated.
Results. 8 children had the congenital TÅF; one child had the isolated TÅF, in 7 children it combined with the esophageal atresia. In all children with esophageal atresia, esophageo-esophageal anastomosis was applied with TEF uncoupling in the first or second day after birth. The cause for the TEF laser ablation was fistula recurrence in all of these 8 children. The therapeutic effect with closing the fistula entrance was achieved in 6 children with fistula entrance diameter no more than 3 mm. One child after laser TÅF ablation with fistula entrance diameter of 5 mm had recurrence and re-ablation was required. TÅF was not closed after five sessions of laser therapy in a child with a 4 mm fistula entrance.
Conclusions. Laser ablation of tracheoesophageal fistula can be applied in children when fistula entrance diameter is no more than 3.0 mm. The method is not traumatic and allows providing the physiological function of respiration without surgical intervention.

Keywords: tracheoesophageal fistula, neodymium laser, endoscopy, laser ablation, esophageal atresia, child
p. 60-65 of the original issue
References
  1. Chepurnoy GI, Katsupeev VB, Chepurnoy MG, Leiga AV, Nosachev EA, Rozin BG, Vinnikov VV. Peculiarities of surgical treatment of tracheoesophageal fistula. Det Khirurgiia. 2014;18(4):54-55. (in Russ.)
  2. Prityko D. K voprosu o vnedrenii lazernoi terapii v pediatricheskuiu praktiku. Vrach. 2013;(8):83-84. (in Russ.)
  3. Tatur AA. Nonmalignant tracheoesophageal fistula:diagnosis, classification, treatment and prophylacxis. Med Novosti. 2016;(11) :16-20. (in Russ.)
  4. Roberts K, Karpelowsky J, Fitzgerald DA, Soundappan SS. Outcomes of oesophageal atresia and tracheo-oesophageal fistula repair. J Paediatr Child Health. 2016 Jul;52(7):694-98. doi: 10.1111/jpc.13211.
  5. Ashkraft KU, Kholder TM. Det Khirurgiia. S-Petersburg, RF: Pit-Tal; 1996. 384 p. (in Russ.)
  6. Zani A, Jamal L, Cobellis G, Wolinska JM, Fung S, Propst EJ, Chiu PP, Pierro A. Long-term outcomes following H-type tracheoesophageal fistula repair in infants. Pediatr Surg Int. 2017 Feb;33(2):187-90. doi: 10.1007/s00383-016-4012-0.
  7. Kavalchuk VI. Surgical treatment of esophageal atresia, prevention of postoperative complications. Khirurgiia Vostoch Evropa. 2015;(1):50-57. (in Russ.)
  8. Tröbs RB, Finke W, Bahr M, Roll C, Nissen M, Vahdad MR, Cernaianu G. Isolated tracheoesophageal fistula versus esophageal atresia – Early morbidity and short-term outcome. A single institution series. Int J Pediatr Otorhinolaryngol. 2017 Mar;94:104-11. doi: 10.1016/j.ijporl.2017.01.022. (in Russ.)
  9. Shah PS, Gera P, Gollow IJ, Rao SC. Does continuous positive airway pressure for extubation in congenital tracheoesophageal fistula increase the risk of anastomotic leak? A retrospective cohort study. J Paediatr Child Health. 2016 Jul;52(7):710-14. doi: 10.1111/jpc.13206.
Address for correspondence:
220116, The Republic of Belarus,
Minsk, Dzerzhinsky Ave., 83,
Belarusian State Medical University,
Pediatric Surgery Department,
Tel. mobile: +375 029 32-902-32,
e-mail: anvoron@mail.ru,
Voronetsky Alexandr N.
Information about the authors:
Voronetsky Alexandr N., PhD, Associate Professor of the Pediatric Surgery Department, Belarusian State Medical University, Minsk, Republic of Belarus.
http://orcid.org/0000-0001-7091-376X
Danovich Aleksandr E., Head of the Endoscopy Unit, 6th Municipal Clinical Hospital, Minsk, Republic of Belarus.
https://orcid.org/0000-0002-2116-4675

ANESTEGIOLOGY-REANIMATOLOGY

D.A. SHKURUPII, M.Î. HARKAVENKO, D.A. KHOLOD

OPHTHALMOLOGICAL COMPLICATIONS OF GENERAL ANESTHESIA

Ukrainian Medical Stomatological Academy, Poltava,
Ukraine

Objective. To determine the frequency and nature of ophthalmic disorders, depending on the use of general anesthesia means.
Methods. A prospective cohort non-interventional study was organized, in which 100 patients were included. A comparison was made of the nature of the disturbances of the visual organ, depending on the type of general anesthesia performed. Clinical examinations included standard perioperative monitoring, determination of the type and nature of pharmacological support for anesthesia, perioperative assessment of saturation, noninvasive blood pressure with determination of its systolic, diastolic and perfusion components, ophthalmologic examination, ocular tonometry, quality assessment of tear film, volume of basal secretion of tear, visual acuity, color sensation, peripheral and binocular vision.
Results. The incidence of disturbances of the visual organ and the visual analyzer after general anesthesia was 19% (n=19). Of them, 84.2% (n=16) of patients had several ophthalmic disorders. The relationship between changes in the arterial pressure figures and the frequency of ophthalmic disorders was established. At the same time, the development of ophthalmic disorders was mainly associated with a change in perfusion blood pressure (p = 0.02). The character of these changes depended on the use of a certain anesthetic. Thus, the drugs of the hypnotic group (thiopental sodium, propofol) reduced the ophthalmotonus, tear secretion, tear film resistance, visual acuity. These effects were more pronounced in thiopental sodium. Also, the ability of ketamine to increase the ophthalmotonus, to cause lacrimation and to disturb visual perception due to disorder of peripheral and binocular vision was proved. Ophthalmic disorders resulted from the use of sedatives (diazepam) and narcotic analgesics (fentanyl) were not proven.
Conclusions. Disturbances of the visual organ and visual analyzer after general anesthesia are transient and account for 19%, of which 84.2% of cases are combined ophthalmic disorders. Their occurrence depends on the arterial pressure figures and the pharmacological effect of the anesthetics used.

Keywords: general anesthesia, complications of anesthesia, ophthalmic disorders, vision, visual acuity
p. 66-72 of the original issue
References
  1. Berg KT, Harrison AR, Lee MS. Perioperative visual loss in ocular and nonocular surgery. Clin Ophthalmol. 2010 Jun 24;4:531-46.
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  12. Nair G, Kim M, Nagaoka T, Olson DE, Thulé PM, Pardue MT, Duong TQ. Effects of common anesthetics on eye movement and electroretinogram. Doc Ophthalmol. 2011 Jun;122(3):163-76. doi: 10.1007/s10633-011-9271-4.
  13. Schmechtig A, Lees J, Perkins A, Altavilla A, Craig KJ, Dawson GR, William Deakin JF, Dourish CT, Evans LH, Koychev I, Weaver K, Smallman R, Walters J, Wilkinson LS, Morris R, Williams SC, Ettinger U. The effects of ketamine and risperidone on eye movement control in healthy volunteers. Transl Psychiatry. 2013 Dec 10;3:e334. doi: 10.1038/tp.2013.109.
  14. Bunch TJ, Tian B, Seeman JL, Gabelt BT, Lin TL, Kaufman PL. Effect of daily prolonged ketamine anesthesia on intraocular pressure in monkeys. Curr Eye Res. 2008 Nov;33(11):946-53. doi: 10.1080/02713680802447121.
Address for correspondence:
36011, Ukraine,
Poltava, Shevchenko Str., 23,
Ukrainian Medical Stomatological Academy,
Department of Anesthesiology
with Intensive Therapy
Tel: +380 532 60-95-81,
e-mail: d.a.shkurupiy@gmail.com,
Shkurupii Dmytro A.
Information about the authors:
Shkurupii Dmytro A., MD, Associate Professor of the Department of Anesthesiology with Intensive Therapy, Ukrainian Medical Stomatological Academy, Poltava, Ukraine.
http://orcid.org/0000-0003-3803-4444
Harkavenko Maxim A., Applicant for Master’s Degree of the Department of Anesthesiology with Intensive Therapy, Ukrainian Medical Stomatological Academy, Poltava, Ukraine.
http://orcid.org/0000-0002-1091-0855
Kholod Dmytro A., Post-Graduate Student of the Department of Anesthesiology with Intensive Therapy, Ukrainian Medical Stomatological Academy, Poltava, Ukraine.
http:// orcid.org/0000-0001-6381-216X

REVIEWS

M.Y. GAIN, S.V. SHAKHRAI, Y.M. GAIN, D.V. KUDRYTSKI

LASER LIPOLYSIS: MECHANISMS, MODERN POSSIBILITIES AND USE PROSPECTS IN SURGERY

Belarusian Medical Academy of Post-Graduate Education, Minsk,
The Republic of Belarus

Objective. To estimate the prospects of surgical technologies of adipose tissue laser destruction by the analysis of literary data about the mechanisms, technical potential and areas of practical application.
Methods. Using the literature data, the comparative analysis of the main fields of application, mechanisms and efficiency of the modern laser lipolysis technologies was performed. The database of medical and biological publications PubMed (section «biotechnology» of National medical library of the USA) through NCBI-Entrez access was used. The analysis of more than 300 sources of medical literature was carried out.
Results. Laser lipolysis is the complex of surgical technologies aimed at thermal destruction of adipose tissue by laser radiation. Along the thermal destruction of adipocytes, use of the laser radiation of certain parameters effects collagen, promoting adipose cells destruction and skin lifting.
Diode laser lipolysis by the wavelength of 980 nanometers is characterized by less destructive action on the tissues and shorter rehabilitation period than traditional methods of liposuction. At present there are researches based on using the laser radiation of several sources of different power with various combinations of wavelength.
According to literature, the most widespread laser technologies of adipose tissue destruction are used for adipose tissue elimination by plastic and esthetic surgery, minimally-invasive excision of adipose tissue tumors (lipomas), and also for treatment of gynecomastia, hyperhidrosis, osmidrosis, cellulitis and some other conditions.
Conclusions. The literature analysis shows that numerous descriptions of laser lipolysis methods contain various, sometimes contradictory data on technology, efficiency, safety for a patient. Interest in this field is due to relevance of minimally-invasive technologies for correction of the most widespread surgical diseases in out-patient and short-term stays conditions.

Keywords: laser lipolysis, liposuction, lipoma, adipose tissue, minimally-invasive surgery
p. 72-81 of the original issue
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Address for correspondence:
220013, The Republic of Belarus,
Minsk, P.Brovka Str., 3,
Belarusian Medical Academy
of Post-Graduate Education,
Emergent Surgery Department,
Tel. office: +375 17-225-88-10,
e-mail: mishahain@tut.by,
Gain Mikhail Y.
Information about the authors:
Gain Mikhail Y., PhD, Senior Lecturer of the Emergent Surgery Department, Belarusian Medical Academy of Post-Graduate Education, Minsk, Republic of Belarus.
http://orcid.org/0000-0001-9012-5277
Shakhrai Siarhei V., MD, Associate Professor, Professor of the Emergent Surgery Department, Belarusian Medical Academy of Post-Graduate Education, Minsk, Republic of Belarus.
http://orcid.org/0000-0002-9423-9535
Gain Yuri M., MD, Professor, Vice-Rector for Scientific Work, Belarusian Medical Academy of Post-Graduate Education, Minsk, Republic of Belarus.
http://orcid.org/0000-0001-7622-5642
Kudrytski Dzmitry V., Post-Graduate Student of the Emergent Surgery Department, Belarusian Medical Academy of Post-Graduate Education, Minsk, Republic of Belarus.
https://orcid.org/0000-0001-8581-2494

V.A. LIPATOV 1, S.V. LAZARENKO 1, K.A. SOTNIKOV 2, D.A. SEVERINOV1, M.P. ERSHOV1

TO THE ISSUE OF METHODOLOGY OF COMPARATIVE STUDY OF THE DEGREE OF HEMOSTATIC ACTIVITY OF TOPICAL HEMOSTATIC AGENTS

Kursk State Medical University 1, Kursk,
City Clinical Hospital ¹1 2, Belgorod,
The Russian Federation

At present new drugs affecting the hemostasis system and locally affecting hemostatic agents are being intensively developed. New types of the developed substances require highly objective and precise comparative methods for efficiency measuring. However, despite the current situation, the choice of methods for assessing the hemostatic activity of drugs and hemostatic implants (both in clinical practice and in experiment) remains open. In this regard, the authors have analyzed most common modern methods, combinations of the evaluated hemostasis indicators and methods for studying hemostatic activity of drugs and implants (in vitro and in vivo); the advantages and disadvantages of these methods are described and their most effective combinations are proposed. The authors propose the algorithm for the selection of hemostatic agents developed for the purpose of their application in surgical interventions primarily on the parenchymal organs of the abdominal cavity. The algorithm is based on the phasing of using various techniques (I step - a screening study of physic-mechanical and hemostatic properties in vitro implant procedures, II step – the method of «acute» experience in vivo for determining bleeding time and blood loss volume, III step – the method of «chronic» experiment in vivo (investigation of expression of the animal tissue response to the implant after subcutaneous implantation and a simulated parenchymal injury of organs and so forth.), permitting to study comprehensively the hemostatic ability of the topical hemostatic implants and to avoid possible negative effects when they are used.

Keywords: hemostasis, hemostatic agents, parenchymatous organs, hemostatic sponge, application implants, bleeding, blood loss, blood clots
p. 81-95 of the original issue
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Address for correspondence:
305004, The Russian Federation,
Kursk, Karl Marks Str., 3,
Kursk State Medical University,
Department of Operative Surgery
and Topographic Anatomy
Tel. mobile: +7 903 870-89-83,
e-mail: drli@yandex.ru,
Lipatov Viacheslav A.
Information about the authors:
Lipatov Viacheslav A., MD, Ass. Professor, Professor of the Department of Operative Surgery and Topographic Anatomy, Kursk State Medical University, Kursk, Russian Federation.
http://orcid.org/0000-0001-6121-7412
Lazarenko Sergej V., PhD, Assistant of the Oncology Department, Kursk State Medical University, Kursk, Russian Federation.
http://orcid.org/0000-0002-7200-4508
Sotnikov Konstantin A., Head of the Cabinet of Accounting and Medical Statistics, Radiologist, City Clinical Hospital ¹1, Kursk, Russian Federation.
http://orcid.org/0000-0001-8162-5448
Severinov Dmitriy A., Student, Kursk State Medical University, Kursk, Russian Federation.
http://orcid.org/0000-0003-4460-1353
Ershov Mixail P., Student, Kursk State Medical University, Kursk, Russian Federation.
http://orcid.org/0000-0002-1747-4689

E.N. DEGOVTSOV 1, P.V. KOLYADKO 2

SEROMAS AS A COMPLICATION OF SURGICAL TREATMENT OF INCISIONAL HERNIAS OF ANTERIOR ABDOMINAL WALL USING MESH IMPLANTS: CURRENT STATE OF THE PROBLEM

Omsk State Medical University of the Ministry of Health of Russia 1,
Nizhnevartovsk District Clinical Hospital, Nizhnevartovsk 2
The Russian Federation

The purpose of this review was to analyze the current literature about seromas after large incisional hernia repair with mesh implants. This complication may develop after different plasty methods of the anterior abdominal wall, but its incidence grows with the increase of volume of surgical intervention, which is typical for large and complex incisional hernias of the anterior abdominal wall. Their plasty is accompanied by the release of subcutaneous fat of the flap over a large area and installation of a mesh implant. The residual cavity resulting from the wide separation is formed, which is gradually filled with serous fluid, becoming seromas. The formation of seroma of postoperative wounds leads to the increased incidence of infectious complications, which in turn leads to the increase in the length of stay in hospital, and increases the economic burden of a hospital. This review considers terminological definitions, the main causes leading to the development of seromas, the specific pathogenetic and classification aspects of this complications and various current practical pre-, intra -, and postoperative methods of this complication prophylaxis.

Keywords: seroma, incisional hernia, hernia repair, prevention of seromas, punctures, separation technique
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  15. Macias LH, Kwon E, Gould DJ, Spring MA, Stevens WG. Decrease in Seroma Rate After Adopting Progressive Tension Sutures Without Drains: A Single Surgery Center Experience of 451 Abdominoplasties Over 7 Years. Aesthet Surg J. 2016 Oct;36(9):1029-35. doi: 10.1093/asj/sjw040.
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  17. Belokonev VI, Ponomareva IuV, Pushkin SIu, Melent’eva ON, Guliaev MG. Potential predictors and morphological aspects of seroma development after plastic surgery of the anterior abdominal wall hernia. Novosti Khirurgii. 2014;22(6):665-70. doi: 10.18484/2305-0047.2014.6.665. (in Russ.)
  18. Postnikov DG, Pavlenko VV, Krasnov OA, Oorzhak OV, Egorova ON, Lesnikov SM. Problems of prophylaxis of wound complications at patients with postoperative ventral hernias. Meditsina i Obrazovanie v Sibiri. 2015;(3):73. (in Russ.)
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  20. Morales-Conde S. A new classification for seroma after laparoscopic ventral hernia repair. Hernia. 2012 Jun;16(3):261-67. doi: 10.1007/s10029-012-0911-8.
  21. Sukovatykh BS, Ivanov AV, Valuiskaia NM, Gerasimchuk EV. The influence of late implantation fabric reaction on the choice of polypropylene endoprosthesis for preventive subaponeurotic plasty of the abdominal wall. Novosti Khirurgii. 2013;21(5):11-17. doi: 10.18484/2305-0047.2013.5.11(in Russ.).
  22. Bondarev RV, Chibisov AL, Orekhov AA, Chibisov LP. Profilaktika rannikh posleoperatsionnykh oslozhnenii pri gernioplastike posleoperatsionnykh ventral’nykh gryzh. Ukr Zhurn Khirurgii. 2012;(3):38-40. (in Russ.)
  23. Nockolds CL, Hodde JP, Rooney PS. Abdominal wall reconstruction with components separation and mesh reinforcement in complex hernia repair. BMC Surg. 2014 Apr 30;14:25. doi: 10.1186/1471-2482-14-25.
  24. Sonis AG, Grachev BD, Stolyarov EA, Ishutov IV. Prevention and treatment of infection wound complications at prosthetic hernia repair. Rany i Ranevaia Infektsiia. 2014;(2):16-22. (in Russ.)
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  26. Patti R, Caruso AM, Aiello P, Angelo GL, Buscemi S, Di Vita G. Acute inflammatory response in the subcutaneous versus periprosthethic space after incisional hernia repair: an original article. BMC Surg. 2014 Nov 15;14:91. doi: 10.1186/1471-2482-14-91.
  27. Kolpakov AA, Kazantsev AA. Sravnitel’nyi analiz rezul’tatov primeneniia protezov «titanovyi shelk» i polipropilena u bol’nykh s posleoperatsionnymi ventral’nymi gryzhami. RMZh. 2015;23(13):774-75. (in Russ.)
  28. Parshikov VV, Fedaev AA. Proteziruiushchaia plastika briushnoi stenki v lechenii ventral’nykh i posleoperatsionnykh gryzh: klassifikatsiia, terminologiia i tekhnicheskie aspekty (obzor). STM. 2015;7(2):138-52. doi: 10.17691/stm2015.7.2.19. (in Russ.)
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Address for correspondence:
644112, The Russian Federation,
Omsk, Perelet Str., 9,
Municipal Clinical Emergency Hospital N 1,
Department of Hospital Surgery,
Tel. office: +8 3812 75-32-72,
mobile.: +7 913 971-32-73;
e-mail: edego2001@mail.ru,
Degovtsov Evgeny N.
Information about the authors:
Degovtsov Evgeny N., MD, Head of the Department of Hospital Surgery, Omsk State Medical University of the Ministry of Health of Russia, Omsk, Russian Federation.
http://orcid.org/0000-0003-0385-8232
Kolyadko Pavel V., Surgeon, Surgical Department N3, Nizhnevartovsk District Clinical Hospital, Nizhnevartovsk, Russian Federation.
http://orcid.org/0000-0002-5635-0929

CASE REPORTS

M.D. ROMANOV 1, E.M. KIREEVA 1,2

PULMONARY ENDOMETRIOSIS: TREATMENT TACTICS

National Research N.P. Ogarev Mordovia State University 1,
Republican Clinical Hospital ¹ 4 2, Saransk
The Russian Federation

The article presents two clinical observations of a rare pathology, pulmonary endometriosis, complicated by hemoptysis. A 34-year-old female patient has had periodic hemoptysis during menses since 1969. At the age of 19 she underwent an emergency operation for pulmonary hemorrhage, which was stopped by the ligation of the intermediate bronchus root with the ligature due to ventricular fibrillation and unstable hemodynamics. Subsequently, periodic hemoptysis continued, but the patient refused to undergo bronchial examination and biopsy. 27.10.1983 a right-sided pneumonectomy was performed, during which the pneumocirrhosis of the lower and middle lobes and foci of the endometrioid tissue in the upper lobe of the right lung were observed. During the follow-up for 10 years, hemoptysis has not been observed, pathology from the side of the trachea bronchial tubes and left lung has not been detected.
The second observation demonstrates the effectiveness of a 6-month continuous course of treatment of pulmonary endometriosis in combination with adenomyosis with the use of dienogest in a 25-year-old patient, which was accompanied not only by the activity suppression of the endometriosis foci, but also by the disappearance of clinical and instrumental manifestations both in the uterus, and in the lung. In this observation, the duration of the disease before treatment was 3 months; both patients had an unfavorable gynecological anamnesis.

Keywords: extragenital endometriosis, pulmonary endometriosis, hemoptysis, adenomyosis, dienogest, diagnostics, treatment tactics
p. 103-108 of the original issue
References
  1. Voskresenskii OV, Smoliar AN, Damirov MM, Galankina IE, Zhelev IG. Thoracic endometriosis and catamenial pneumothorax. Khirurgiia Zhurn im NI Pirogova. 2014;(10):4-9. (in Russ)
  2. Pichurov AA, Orzheshkovskiy OV, Dvorakovskaya IV, Romanova LA, Ivanishchak BE, Karelskaya EA, Petrunkin AM, Petrov AS, Atyukov MA, Yablonskiy PK. Thoracic endometriosis – the rare pathology in thoracic surgery. Vestn Khirurgii im II Grekova. 2014;173(1):26-29. (in Russ.)
  3. Chatra PS. Thoracic endometriosis: a case report. J Radiol Case Rep. 2012 Jan; 6(1):25-30. doi: 10.3941/jrcr.v6i1.614.
  4. Choi SY, Kim CK, Park CB. Successful treatment of catamenial hemoptysis by video-assisted thoracoscopic surgery. Thorac Cardiovasc Surg. 2013 Jan;61(1):94-96. doi: 10.1055/s-0032-1330227.
  5. Dvorakovskaya IV, Pechennikova VA, Ariel’ BM, Platonova IS, Novikova LN, Orzheshkovskiy OV, Pichurov AA,Yablonskiy PK. Pulmonary endometriosis as a form of endometrial disease. Pul’monologiia. 2016;26(4):459-65. doi: 10.18093/0869-0189-2016-26-4-459-465. (in Russ.)
  6. Adamian LV, Andreeva EN, Apolikhina IA, Bezhenar’ VF, Gevorkian MA, Gus AI, Demidov VN, Kalinina EA, Levakov SA, Marchenko LA, Popov AA, Sonova MM, Khashukoeva AZ, Chernukha GE, Iarotskaia EL. Endometrioz: diagnostika, lechenie i reabilitatsiia: federal’nye klinicheskie rekomendatsii po vedeniiu bol’nykh. Moscow, RF; 2013. 65 p. (in Russ.)
  7. Schweppe KW, Rabe T, Langhardt M, Kiesel L. Endometriosis-pathogenesis, diagnosis and therapeutic options for clinical and ambulatory care. J Reproduktionsmed Endokrinol. 2013;10(1):102-19.
  8. Romanov MD, Kuvakin VI, Kosarev IuI. Lechebnaia taktika pri legochnykh krovotecheniiakh. Klin Khirurgiia. 1986;10:29–31. (in Russ.)
  9. Sotnikova LS, Udut EV, Nasyrova RF, Tonkikh OS. Modern methods of endometriosis therapy – the experience of visanne use. Problemy Reproduktsii. 2012;(6):34-39. (in Russ.)
Address for correspondence:
430032, The Russian Federation,
Saransk, Ulyanov Str., 32,
National Research
N.P. Ogarev Mordovia State University,
Department of Hospital Surgery,
Tel. mobile +79279710237,
å-mail: mdromanov@yandex.ru,
Romanov Mikhail D.
Information about the authors:
Romanov Mikhail D., MD, Professor, Professor of the Hospital Surgery Department, National Research N.P. Ogarev Mordovia State University, Saransk, the Russian Federation.
https://orcid.org/0000-0002-9646-4007
Kireeva Ekaterina M., PhD, Associate Professor of the Hospital Surgery Department, Thoracic Surgeon, National Research N.P. Ogarev Mordovia State University, Republican Clinical Hospital ¹ 4, Saransk, the Russian Federation.
https://orcid.org/0000-0003-1034-167X

K.V. LIPATOV 1, E.A. KOMAROVA 1,2, A.V. BORODIN 1,2, Y.V. STRUCHKOV 1, V.V. FROLKOV 2, A.V. KIRILLIN 1,2 , M.A. KIRYUPINA 1

NECROTIZING INFECTION OF SOFT TISSUES AS THE COMPLICATION OF PERFORATING TUMOR OF SIGMOID COLON

I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow 1,
City Clinical Hospital named after I.V. Davydovsky, Moscow 2,
The Russian Federation

This clinical case demonstrates the development of severe streptococcal (Streptococcus pyogenes) necrotizing soft tissue infection as a result of perforation of the sigmoid neoplasm. The rapidly progressive necrotic process in the soft tissues of the lumbar and gluteal region as well as necrotic process in the left thigh (with the predominant lesion of the superficial fascia, subcutaneous fat and skin) led to the formation of an extensive postnecrectomic wound defect with an area of more than 1000 square centimeters. In addition to the severity of illness, the patient’s belated treatment and the underestimation of the clinical situation by surgeons who provided emergency care contributed to such an extensive spread of the pathological process. The development of sepsis was accompanied by severe multiple organ failure. Because of the severity of the patient’s condition, the surgical removal of the sigmoid neoplasm extended in the abdomen wall became possible only after its stabilization as a result of surgical focal sanation and complex intensive therapy in the conditions of the ICU. The most important point of the stage-by-stage surgical treatment was the choice of methods for the plastic closure of an extensive postnecrectomic wound that involved the entire left gluteal region, part of the lumbar and antero-inner surface of the left thigh. Taking into account the size and localization of the defect, the plastic reserves of the surrounding skin, the wound was closed in three stages with the help of combined plastic surgery techniques: with local tissues by the method of tissue expansion and a split-thickness skin graft.

Keywords: soft tissue infections, necrotizing fasciitis, streptococcus pyogenes, plastic surgery, skin transplantation
p. 109-114 of the original issue
References
  1. Sadasivan J, Maroju NK, Balasubramaniam A. Necrotizing fasciitis. Indian J PlastSurg. 2013;46(3):472-78. doi: 10.4103/0970-0358.121978.
  2. Briko NI, Gluschkova EV, Dmitrieva NF, Klejmenov DA, Lipatov KV, Eschina AS, Timofeev UM, Mirskaja MA, Vvedenskaja OB. Invasive Streptococcal (Group A) Infection of Soft Tissues in a Moscow Surgical Hospital. Vestn RAMN. 2013;68(6):15-20. doi: 10.15690/vramn.v68i6.668. (in Russ.)
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  4. Privol’nev VV, Pleshkov VG, Kozlov RS, Savkin VA, Golub AV. Diagnostika i lechenie nekroticheskikh infektsii kozhi i miagkikh tkanei na primere gangreny Furn’e. Statsionarozameshchaiushchie Tekhnologii: Ambulator Khirurgiia. 2015;(3-4):50-57. (in Russ.)
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Address for correspondence:
119991,The Russian Federation,
Moscow, Bolshaya Pirogovskaya str., 2-4,
I.M. Sechenov First Moscow State Medical University (Sechenov University),
Department of General Surgery,
Tel. mobile: +7 (916) 635-89-88,
e-mail: k_lipatov@mail.ru,
Lipatov Konstantin V.
Information about the authors:
Lipatov Konstantin V., MD, Professor of the General Surgery Department, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation.
http://orcid.org/0000-0002-9902-2650
Komarova Elena A., PhD, Assistant of the General Surgery Department, I.M. Sechenov First Moscow State Medical University (Sechenov University); Surgeon of the Purulent Surgery Unit, City Clinical Hospital named after I.V. Davydovsky, Moscow, Russian Federation.
http://orcid.org/0000-0003-0900-3577
Borodin Alexey V., PhD, Acting Head of the Purulent Surgery Unit, City Clinical Hospital named after I.V. Davydovsky; Assistant of the General Surgery Department, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation.
http://orcid.org/0000-0002-9583-2023
Struchkov Yuri V., MD, Professor of the General Surgery Department, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation.
http://orcid.org/0000-0002-7340-7878
Frolkov Valery V., PhD, Head of the Anaesthesiology, Reanimation and Intensive Care Unit, City Clinical Hospital named after I.V. Davydovsky, Moscow, Russian Federation.
http://orcid.org/0000-0001-7813-199X
Kirillin Alexey V., PhD, Deputy Chief Physician on Surgery, City Clinical Hospital named after I.V. Davydovsky; Assistant of the General Surgery Department, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation. http://orcid.org/0000-0003-0585-9941
Kiryupina Maria A., Student of the 4th course of General Medicine Faculty, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation.
http://orcid.org/0000-0001-8133-8115

EXCHANGE OF EXPERIENCE

K.M. KURBONOV, U.U. MANSUROV, K.R. NAZIRBOEV

SURGICAL TREATMENT TACTICS OF IATROGENIC LESIONS AND CICATRICIAL STRICTURES OF EXRTAHEPATIC BILE DUCTS

Avicenna Tajik State Medical University, Dushanbe,
The Republic of Tajikistan

Objective. To improve the results of surgical treatment of iatrogenic lesions and cicatricial strictures of extrahepatic bile ducts using timely two-stage treatment tactics.
Methods. The results of surgical treatment of 48 patients with iatrogenic lesions of extrahepatic bile ducts (EBD) in the period from 2004 to 2016 years were analyzed. New damages were observed in 17 (35.4%), scar strictures – in 31 (64.6%).
Results. In most cases the causes of lesions were: laparoscopic cholecystectomy – 39 (81.2%), traditional cholecystectomy – 3 (6.2%) and cholecystectomy from mini-access – 2 (4.2%). Overall, cholecystectomy accounted for 44 (91.6%) of the total number of interventions. In other cases, the causes of iatrogenic injuries of EBD were echinococcectomy from the liver in 2 cases, resection of the stomach – in 1 and pancreatic necroectomy in one patient. Iatrogenic injuries of EBD occurred in the clinic in 17 (35.4%), but the remaining patients were accordingly transferred from other institutions of the republic. When choosing a treatment strategy and the nature of surgical interventions one considered the time of diagnosis, severity of the patient’s state, the kind and nature of the iatrogenic lesion or strictures of EBD, as well as secondary complications. In 5 (10.4%) of 17 patients with new EBD injuries, the lesions were diagnosed intraoperatively. In 31 (64.6%) patients, postoperative cicatricial strictures were revealed. These patients were adhered to strictly two-stage therapeutic tactics. Various reconstructive surgeries were performed, including choledochojunoanastomosis on Roux - 9 patients and bihepaticojunoanastomosis on Roux - 15 cases. Of all 48 operated patients, postoperative complications were observed in 6 (12.5%) patients. Postoperative mortality made up 3 patients.
Conclusions. The main type of reconstructive treatment of iatrogenic lesions and cicatricial strictures of EBD are bi-, tri- and Roux hepaticojunoanastomosis on jejunum loop, depending on the localization level of injury or stricture.

Keywords: iatrogenic disease, postoperative cicatricial stricture, extrahepatic bile ducts, cholecystectomy, reconstructive surgical procedures
p. 115-120 of the original issue
References
  1. Barvanian GM, Glukhikh AA. Khirurgicheskoe lechenie iatrogennykh povrezhdenii vnepechenochnykh zhelchnykh protokov posle kholetsistektomii. Vestn Nats Med-Khirurg Tsentra im NN Pirogova. 2010;5(3):57-60. (in Russ.)
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Address for correspondence:
734003, The Republic of Tajikistan,
Dushanbe, Rudaki Ave., 139,
Avicenna Tajik State Medical University,
Department of Surgical Diseases ¹ 1,
Tel. office: +992 98 555-78-88,
e-mail: surgeon7888@mail.ru,
Mansurov Usmon U.
Information about the authors:
Kurbonov Karimhon M., MD, Professor, Academician of Academy of Medical Sciences of the Republic of Tajikistan, Honored Worker of Science and Technology of the Republic of Tajikistan, Head of the Department of Surgical Diseases ¹ 1, Avicenna Tajik State Medical University, Dushanbe, Republic of Tajikistan.
http://orcid.org/0000-0002-8100-9722
Mansurov Usmon U., Post-Graduate Student of the Department of Surgical Diseases ¹ 1, Avicenna Tajik State Medical University, Dushanbe, Republic of Tajikistan.
http://orcid.org/0000-0002-3097-9630
Nazirboev Kahramon R., PhD, Assistant of the Department of Surgical Diseases ¹ 1, Avicenna Tajik State Medical University, Dushanbe, Republic of Tajikistan.
http://orcid.org/0000-0001-8381-0364
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