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Year 2020 Vol. 28 No 1

SCIENTIFIC PUBLICATIONS
GENERAL & SPECIAL SURGE

U.I. PETUKHOV, S.N. ERMASHKEVICH, M.G. SACHEK, M.V. KUNCEVICZ

INFLUENCE OF TESTOSTERONE DRUGS USE ON SURGICAL TREATMENT OF ACUTE INFECTIOUS PULMONARY DESTRUCTIONS

Vitebsk State Medical University, Vitebsk,
The Republic of Belarus

Objective. To evaluate the clinical effectiveness of testosterone drugs administration in the surgical treatment of male patients with acute infectious pulmonary destruction (AIPD).
Methods. The results of examination and treatment of 74 male patients with AIPD were studied. Using simple randomization 2 groups including 37 people were formed, which did not differ statistically significantly by age, duration of the disease, forms and complications of acute infectious pulmonary destructions, the level of initial total serum testosterone and the frequency of its deficiency. In each group, 35 patients were operated on. According to the frequency of simultaneous and staged operations, patients in the groups did not statistically significantly differ. In patients of group 1, the complex of therapeutic remedies in the postoperative period was supplemented by the introduction of testosterone preparations.
Results. The administration of testosterone preparations was accompanied by a decrease in the frequency of postoperative complications from 83% to 49% (p=0.025), and the total number of postoperative complications from 92 to 43 (p=0.011). Patients of group 1 were 21% less likely to develop pulmonary pleural fistula (p=0.055), pneumonia developed 2 times (p=0.1) less often, the frequency of purulent-resorptive wasting and cachexia decreased by 13% (p=0.11). The number of interventions for postoperative complications in group 1 were 7 in 35 (20%) cases, in group 2 – 12 in 35 (34%) (p=0.18). The overall mortality rate in group 1 was 11% (4 out of 37 patients died), in group 2 – 23% (9 out of 37 patients died), (p=0.22). Postoperative mortality was 11% (4 of 35) and 26% (9 of 35) in groups 1 and 2, respectively (with p=0.22).
Conclusions. The inclusion of testosterone drugs in the complex of the treatment program in patients operated on for acute infectious pulmonary destructions helps to reduce the number of cases of the complicated postoperative period from 83% to 49% (p=0.025) and the frequency of development of the postoperative complications by 2 times (p=0.011).

Keywords: acute infectious pulmonary destruction, lung abscess, lung gangrene, surgical treatment, postoperative complications, testosterone
p. 5-15 of the original issue
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Address for correspondence:
210009, Republic of Belarus,
Vitebsk, Frunze Ave., 27,
Vitebsk State Medical University,
Department of Hospital Surgery with Courses in Urology and Pediatric Surgery.
Tel. mob. +375 29 7191491,
e-mail: kuncevicz@mail.ru,
Maksim U. Kuncevicz
Information about the authors:
Petukhov Uladzimir I., MD, Associate Professor, Head of the Surgery Department of the Faculty of the Advanced Training and Retraining of Specialists, Vitebsk State Medical University, Vitebsk, Republic of Belarus.
https://orcid.org/0000-0002-4042-3978
Ermashkevich Sergey N., PhD, Associate Professor of the Department of Hospital Surgery with Courses in Urology and Pediatric Surgery, Vitebsk State Medical University, Vitebsk, Republic of Belarus.
https://orcid.org/0000-0002-0866-9070
Sachek Mikhail G., MD, Professor, Head of the Department of Hospital Surgery with Courses in Urology and Pediatric Surgery, Vitebsk State Medical University, Vitebsk, Republic of Belarus.
https://orcid.org/0000-0001-9233-7249
Kuncevicz Maksim U., Post-Graduate Student of the Department of Hospital Surgery with Courses in Urology and Pediatric Surgery, Vitebsk State Medical University, Vitebsk, Republic of Belarus.
https://orcid.org/0000-0002-8122-6655

A.V. KASATOV, E.S. GOROVITZ, M.V. KUZNETSOVA

POSSIBLE MECHANISMS OF THE STERNAL WOUND INFECTION IN PURULENT-INFLAMMATORY COMPLICATIONS DEVELOPED AFTER CARDIAC SURGERY

Perm State Medical University named after Academician E. A. Wagner, Perm,
The Russian Federation

Objective. To determine the possibility of the sternal wound infection with S. aureus coprocultures in patients after cardiac surgery.
Methods. The main biological properties, antibiotic sensitivity and genomic variants of 26 S. aureus isolated from the discharge of the sternal wound and colon of 13 patients with sterno-mediastinitis, sternum and ribs osteomyelitis after cardiac surgery were studied. The virulence factors, persistence and antibiotic sensitivity were determined by standard methods, genotyping was performed by RAPD-PCR.
Results. The comparative analysis of phenotypic characteristics revealed in six pairs of S. aureus isolated from the sternal wounds and colon from the specific patients of 13 examined, a definite biological profile: the presence or absence of the same virulence enzymes: hemolysins, DNAasa, lecithinase; persistence factors: anti-lysozyme, anti-complement and anti-lactoferrin activity, as well as ability of biofilm formation. The same pairs of strains were identical in sensitivity to antimicrobial drugs. The analysis of antibiogram of all 12 S. aureus isolates (6 pairs) allowed them to be classified as strains community-acquired origin. Genotyping confirmed the relationship of pairs of S. aureus, isolated from discharge of sternal wounds and feces, in six patients.
Conclusions. Intestinal dysbiosis with the pronounced biotope colonization by S. aureus along with the negative factors of long hours of operations with the artificial blood circulation, cause a decrease in colonization resistance, impaired barrier function of the intestinal mucosa. Against this background, hematogenous translocation of S. aureus from the intestinal mucosa and endogenous infection of the surgical area are possible. In the process of the preoperative preparation of patients, it is advisable to perform bacteriological examination of feces for intestinal dysbiosis and, if necessary, to carry out a correction of biotope microbiome.

Keywords: cardiac surgery, sterno-mediastinitis, S. aureus, endogenous infection
p. 16-23 of the original issue
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Address for correspondence:
614990, Russian Federation,
Perm, Petropavlovskaya Str., 26,
Perm State Medical University
Named after Academician E. A. Wagner,
Department of Microbiology and Virology.
Tel. +7 912 496-30-33,
e-mail: eduard.gorovitz@mail.ru,
Eduard S. Gorovitz
Information about the authors:
Kasatov Anatolii V., PhD, Associate Professor, Head of the Hospital Surgery Department, Perm State Medical University named after Academician E. A. Wagner, Perm, Russian Federation.
http://orcid.org/0000-0001-6835-7063
Gorovitz Eduard S., MD, Professor, Head of the Department of Microbiology and Virology, Perm State Medical University named after Academician E. A. Wagner, Perm, Russian Federation.
http://orcid.org/0000-0003-4320-8672
Kuznetsova Marina V., MD, Professor of the Department of Microbiology and Virology, Perm State Medical University named after Academician E. A. Wagner, Perm, Russian Federation.
http://orcid.org/0000-0003-2448-4823

S.G. ALI-ZADE, SH.K. NAZAROV, P.K. KHOLMATOV

TIM-3 LEVEL IN BLOOD SERUM IN ACUTE PANCREATITIS IN EARLY STAGE

Tajik State Medical University, Dushanbe,
The Republic of Tajikistan

Objective. To study the expression of the serum TIM-3 (sTIM-3) in patients with acute pancreatitis in the early stage.
Methods. 44 patients with acute pancreatitis were examined who were admitted to the surgical departments of the city clinical emergency hospital in Dushanbe in the period from 2017 to 2019. The 1st group included 16 patients with mild acute pancreatitis; the 2nd group included 28 patients with moderate to severe acute pancreatitis. The control group (CG) consisted of 20 healthy volunteers. In the studied patients, the disease severity was assessed according to the APACHE II scale, the level of sTIM-3 in the blood serum and the levels of cytokines IL-6, IL-10 and TNF-α were established with the determination of the correlation between them.
Results. The levels of IL-6 and TNF-α were significantly higher in the 2nd group of patients with severe acute pancreatitis than in the 1st group of patients and the control group. The level of IL-10 in the 2nd group was significantly lower than in the 1st group. The sTIM-3 indices in the 1st and 2nd groups of patients were significantly higher than in the control group. In turn, in patients of the 2nd group, the level of sTIM-3 was significantly higher than in the 1st group. A direct correlation between the level of sTIM-3 and the levels of IL-6 and TNF-α was revealed, whereas between sTIM-3 and the level of IL-10 no significant relationship was found. A direct correlation between the sTIM-3 level and the APACHE II score was determined (r=0.545, p<0.001).
Conclusions. It has been established that the level of sTIM-3 varies depending on the severity of acute pancreatitis, and inhibition of sTIM-3 activation can have a therapeutic effect on the excessive inflammatory response. Measurement of serum sTIM-3 may be an early marker for predicting acute pancreatitis.

Keywords: acute pancreatitis, pancreonecrosis, diagnosis, treatment, immunoglobulins
p. 24-29 of the original issue
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  1. Johnson CD, Besselink MG, Carter R. Acute pancreatitis. BMJ. 2014 Aug 12;349:g4859. doi: 10.1136/bmj.g4859
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Address for correspondence:
734003, Republic of Tajikistan,
Dushanbe, Rudaki Ave.,139,
Tajik State Medical University,
Surgical Diseases Department ¹1.
Tel. +992 928 21-77-55,
e-mail: suhrob_a@mail.ru,
Sukhrob G. Ali-Zade
Information about the authors:
Ali-Zade Sukhrob G., PhD, Assistant of the Surgical Diseases Department No1, Tajik State Medical University, Dushanbe, Republic of Tajikistan.
https://orcid.org/0000-0002-2456-7509
Nazarov Shohin K., MD, Professor, Head of the Surgical Diseases Department No1, Tajik State Medical University, Dushanbe, Republic of Tajikistan.
https://orcid.org/0000-0003-2099-2353
Kholmatov Pulat K., PhD, Associate Professor of the Surgical Diseases Department No1, Tajik State Medical University, Dushanbe, Republic of Tajikistan.
https://orcid.org/0000-0001-8025-0832

H.I. HERYCH, V.V. VASHCHUK, D.V. ANDRIUSHCHENKO, O.B. MATVIYCHUK, R.L. BOKHONKO, N.R. FEDCHYSHYN

GILMORE’S GROIN TREATMENT METHOD

Danylo Halytsky Lviv National Medical University,
Lviv, Ukraine

Objective. To develop a surgical procedure for the treatment of Gilmore’s groin.
Methods. In 2008-2017, 52 patients with Gilmore’s groin were treated. All patients were males, the age ranged from 18 to 35. Fifty-one patients were athletes (professional football for more than 5 years), in 1 case – professional activity was associated with weight lifting. The reason for seeking medical help in 38 (73%) patients was the presence of chronic pain in the inguinal region, in 14 (27%) complaints were combined with the pain in the pubic region and along the medial surface of the thigh. All patients were operated on according to the developed technique. The idea of the technique is to restore the structures of the inguinal canal with the obligatory withdrawal of n. ilioinguinalis outside the inguinal canal. Immediate and long-term (6 and 12 months) results were evaluated.
Results. The postoperative period was without any complications: from the 1st day after the operation, all patients confirmed the disappearance of pain in the inguinal and pubic region, along the medial surface of the thigh. At follow-up after 6 and 12 months, 48 out of 52 patients (92.3%) felt healthy, had no complaints and continued to play football actively. Three patients (5.8%) after 6 months did not restore professional activity (left sports). One of the patients (1.9%) did not want to resume professional activity, since the onset of Gilmore’s groin was associated with weight lifting. The effectiveness of the treatment was 92.3%.
Conclusions. The developed method of surgical treatment of the Gilmore’s groin, caused by the rupture of the aponeurosis of m. obliquus externus abdominis and scapular displacement of the nerves of the inguinal canal, is simple to implement and provides a thorough restoration of the anatomical structure of the inguinal canal.

Keywords: Gilmore’s groin, inguinal canal, inguinal region, surgical treatment
p. 30-37 of the original issue
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  12. Meyers WC, Lanfranco A, Castellanos A. Surgical management of chronic lower abdominal and groin pain in high-performance athletes. Curr Sports Med Rep. 2002 Oct;1(5):301-5. doi: 10.1249/00149619-200210000-00008
  13. Gilmore J. Groin pain in the soccer athlete: fact, fiction, and treatment. Clin Sports Med. 1998 Oct;17(4):787-93, vii. doi: 10.1016/s0278-5919(05)70119-8
  14. Paksoy M, Sekmen Ü. Sportsman hernia; the review of current diagnosis and treatment modalities. Ulus Cerrahi Derg. 2015;32(2):122-29. Published 2015 Aug 18. doi: 10.5152/UCD.2015.3132
  15. Sheen AJ, Stephenson BM, Lloyd DM, Robinson P, Fevre D, Paajanen H, de Beaux A, Kingsnorth A, Gilmore OJ, Bennett D, Maclennan I, O’Dwyer P, Sanders D, Kurzer M. Treatment of the sportsman’s groin’: British Hernia Society’s 2014 position statement based on the Manchester Consensus Conference. Br J Sports Med. 2014 Jul;48(14):1079-87. doi: 10.1136/bjsports-2013-092872
Address for correspondence:
79010, Ukraine,
Lviv, Pekarskaya Str., 69,
Danylo Halytsky Lviv National
Medical University,
Department of Surgery and Endoscopy
Of Post-Graduate Education.
Tel. +38 067 767 45 37,
e-mail: romanbokhonko@gmail.com,
Roman L. Bokhonko
Information about the authors:
Herych Hnat I., Assistant of the General Surgery Department of Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.
http://orcid.org/0000-0002-9907-1874
Vashchuk Vsevolod V., PhD, Associate Professor of the General Surgery Department of Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.
http://orcid.org/0000-0002-0152-0820
Andriushchenko Dmytro V., MD, Professor of the Department of Surgery and Endoscopy of Post-Graduate Education, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.
http://orcid.org/0000-0003-1046-7889
Matviychuk Oleh B., MD, Associate Professor of the General Surgery Department of Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.
http://orcid.org/0000-0002-5864-1535
Bokhonko Roman L., PhD, Assistant of the Department of Surgery and Endoscopy of Post-Graduate Education, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.
http://orcid.org/0000-0003-3859-0635
Fedchyshyn Nazar R., PhD, Assistant of the Department of Surgery and Endoscopy of Post-Graduate Education, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.
http://orcid.org/0000-0003-4695-7599

A.YU. KRYLOV, À.Ì. SHULUTKO, S.E. KHMYROVA, E.G. OSMANOV, À.À. PETROVSKAYA

OPPORTUNITIES OF EVLA IN COMPLEX TREATMENT OF VENOUS TROPHIC ULCERS IN AGED AND SENILE PATIENTS

I.M. Sechenov First Moscow State Medical Universit, Moscow,
The Russian Federation

Objective. To optimize the results of complex treatment of decompensated forms of varicose disease of the lower limbs in aged and senile patients.
Methods. The complex treatment results of 15 aged and senile patients with venous trophic ulcers of the lower limbs (clinical class C6 according to CEAP) using stem endovenous laser ablation are analyzed. The mean age of the patients was 74.1±4.76 years (M±σ). All patients had an open trophic leg ulcer, which existed from 10 to 18 years. Endovenous laser ablation was performed using “Lakhta-Milon” laser apparatus with a wavelength of 1470 nm. In the postoperative period, prophylactic doses of low molecular weight heparins were prescribed as prophylaxis of the venous thromboembolic complications for 5 days. The results were evaluated the next day, one week and one month after the operation. The state of the operated limb and the quality of venous trunk obliteration and the local status of the venous trophic ulcer were evaluated.
Results. All patients were operated on without complications; at the same day they were discharged for outpatient monitoring. A week after the surgery, 8 patients (53.3%) noted a decrease in heaviness and feeling of swelling in the legs, and a month later, 10 patients (66.7%). Positive dynamics of the local status of trophic ulcers was noted in all patients one week after surgery. Complete healing of the trophic ulcer was revealed in 2 patients a week later, in 14 patients (93.3%) – by the end of the first month after surgery, in one patient complete healing of the trophic ulcer was detected by the end of the second month of treatment. In the long-term period, after 6–9 months, recurrence of a trophic ulcer was not registered in any case.
Conclusions. The undertaken tactics of treatment of aged and senile patients with venous trophic ulcers is clinically justified and confirmed by the achieved positive results in 100% of patients, which allows recommending it for a wide practical application.

Keywords: varicose veins, venous trophic ulcers, aged and senile patients, minimally invasive technologies, endovenous laser ablation, complex treatment
p. 38-45 of the original issue
References
  1. Rabe E, Guex JJ, Puskas A, Scuderi A, Fernandez Quesada F; VCP Coordinators. Epidemiology of chronic venous disorders in geographically diverse populations: results from the Vein Consult Program. Int Angiol. 2012 Apr;31(2):105-15. https://www.minervamedica.it/en/journals/international-angiology/article.php?cod=R34Y2012N02A0105
  2. Beebe-Dimmer JL, Pfeifer JR, Engle JS, Schottenfeld D. The epidemiology of chronic venous insufficiency and varicose veins. Ann Epidemiol. 2005 Mar;15(3):175-84. doi: 10.1016/j.annepidem.2004.05.015
  3. Mazaishvili KV, Chen VI. Chronic venous diseases of lower limbs in Petropavlovsk-Kamchatksky. Flebologiia. 2008;2(4):52-54. (In Russ.)
  4. Saveliev VS, Kirienko AI, Zolotukhin IA, Seliverstov EI. Prospective observational study SPECTRUM: the registry of patients with chronic venous diseases. Flebologiia. 2012;6(1):4-9. https://www.mediasphera.ru/issues/flebologiya/2012/1/031997-6976201211 (In Russ.)
  5. Kirienko AI, Vasiutkov VIa, Bogachev VIu, Bogdanets LI, Zolotukhin IA, Gavrilov SG, Savel’ev VS (red). Lechenie troficheskikh iazv venoznoi etiologii: posobie dlia vrachei. Moscow, RF; 2000. 22 p. (In Russ.)
  6. Dibirov MD, Stoiko IuM, red. Khronicheskie rany i troficheskie iazvy: metodicheskoe posobie dlia praktikuiushchikh vrachei. Moscow, RF; 2018. 58 p. (In Russ.)
  7. Shimanko AI, Dibirov MD, Zubritsky VF, Zemlyanoy AB, Matveev DA, Tsuranov SV, Volkov AS, Shvydko VS, Maiorov AV, Tyurin DS, Magdiev AKh, Gagai SP. The combined treatment of trophic ulcers of venous etiology. Flebologiia. 2017;11(2):91-95. doi: 10.17116/flebo201711291-95 (In Russ.)
  8. Nelson EA, Prescott RJ, Harper DR, Gibson B, Brown D, Ruckley CV. A factorial, randomized trial of pentoxifylline or placebo, four-layer or single-layer compression, and knitted viscose or hydrocolloid dressings for venous ulcers. J Vasc Surg. 2007 Jan;45(1):134-41. doi: 10.1016/j.jvs.2006.09.043
  9. Coleridge-Smith P, Lok C, Ramelet AA. Venous leg ulcer: a meta-analysis of adjunctive therapy with micronized purified flavonoid fraction. Eur J Vasc Endovasc Surg. 2005 Aug;30(2):198-208. doi: 10.1016/j.ejvs.2005.04.017
  10. Nicolaides AN, Allegra C, Bergan J, Bradbury A, Cairols M, Carpentier P, Comerota A, Delis C, Eklof B, Fassiadis N, Georgiou N, Geroulakos G, Hoffmann U, Jantet G, Jawien A, Kakkos S, Kalodiki E, Labropoulos N, Neglen P, Pappas P, Partsch H, Perrin M, Rabe E, Ramelet AA, Vayssaira M, Ioannidou E, Taf A. Management of chronic venous disorders of the lower limbs: guidelines according to scientific evidence. Int Angiol. 2008 Feb;27(1):1-59. https://www.minervamedica.it/en/journals/international-angiology/issue.php?cod=R34Y2008N01
Address for correspondence:
119048, Russian Federation,
Moscow, Dovator Str., 15-1,
I.M. Sechenov First Moscow
State Medical University,
Faculty Surgery Department ¹2.
Tel.: 89104450671,
e-mail: doctorwing@mail.ru,
Alexey Yu. Krylov
Information about the authors:
Krylov Alexey Yu., MD, Professor of the Faculty Surgery Department No2, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
https://orcid.org/0000-0003-0328-0223
Shulutko Alexander M., MD, Professor of the Faculty Surgery Department No2, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
https://orcid.org/0000-0002-8001-1601
Khmyrova Svetlana E., PhD, Associate Professor of the Faculty Surgery Department No2, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
https://orcid.org/0000-0003-4455-6716
Osmanov Elkhan G., MD, Professor of the Faculty Surgery Department No2, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
https://orcid.org/0000-0003-1451-1015
Petrovskaya Alexandra A., PhD, Assistant of the Faculty Surgery Department No2, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
http://orcid.org/0000-0003-3839-3287

PEDIATRIC SURGERY

B.N. BISSALIYEV 1, N.A. TSAP 2, A.B. TUSSUPKALIEV 1, S.P. DOSMAGAMBETOV 1, K.K. ZHALMUKHANBETOV 1, A.M. GRJIBOVSKI 3, 4

MAGNETIC COMPRESSION INTER-INTESTINAL ANASTOMOSIS IN THE TREATMENT OF CHILDREN WITH ENTEROSTOMES

West Kazakhstan Marat Ospanov State Medical University 1, Aktobe, The Republic of Kazakhstan
Ural State Medical University 2, Yekaterinburg,
Northern State Medical University 3, Arkhangelsk,
North-Eastern Federal University 4, Yakutsk,
The Russian Federation

Objective. To compare effectiveness of methods for restoring intestinal continuity in infants with enterostomas.
Methods. A retrospective cohort study was conducted covering 34 children with enterostomas treated from 2015 to 2018 at the hospital of West Kazakhstan Medical University (Aktobe, Kazakhstan) and in the First Regional Pediatric Hospital (Yekaterinburg, Russia). The level of intestinal stoma formation is dominated by ileostomy – 22 (64.7%) children, double ileocolostomy – 7 (20.6%) children, yeunostomy – 5 (14.7%) children. The study group included 16 children with enterostomes with the use of method of magnetic compression inter-intestinal anastomosis (MCIA). The reference group consisted of 18 children with enterostomy without the use of MCIA. The following outcomes were compared: duration of in-hospital stay, number of days in the intensive care unit, duration of full parenteral nutrition, number of complications and deaths. The differences between numeric outcomes were presented as means with 95% confidence intervals (CI) while the differences in dichotomous outcomes were presented with relative risks with 95% CI.
Results. Duration of in-hospital stay and stay at the intensive care unit in the MCIA group was 13.1 days (95% CI: 4.4-21.8, p=0.003) and 13.5 days (95% CI: 7.1-19.9, p<0.001), respectively, shorter than in the reference group. Duration of full parenteral nutrition in the MCIA groups was 12.7 days (95% CI: 5.8–19.6, p<0.001) shorter. Complications (OR=3.6, 95% CI: 0.4-28.6) and mortality 4.1 (95% CI: 0.2–78.8), respectively, were more common in the reference group, although not reaching the level of statistical significance.
Conclusions. The use of MCIA contributes to a more rapid improvement of the child’s condition, reduces the need for parenteral nutrition and leads to a reduction in intensive care- and total hospital stay.

Keywords: infants, enterostomy, magnetic compression inter-intestinal anastomosis, treatment
p. 46-52 of the original issue
References
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  2. Ryou M, Aihara H, Thompson CC. Minimally invasive entero-enteral dual-path bypass using self-assembling magnets. Surg Endosc. 2016 Oct;30(10):4533-38. doi: 10.1007/s00464-016-4789-x
  3. Matsuura R, Ueno T, Tazuke Y, Tanaka N, Yamanaka H, Takama Y, Nakahata K, Yamamichi T, Maeda N, Osuga K, Yamanouchi E, Okuyama H. Magnetic compression anastomosis for postoperative biliary atresia. Pediatr Int. 2017 Jun;59(6):737-39. doi: 10.1111/ped.13295
  4. Kistenova AA, Konovalov AK, Petlakh VI, Sergeev AV, Konstantinova IN, Ivanov VA. Dvukhetapnoe khirurgicheskoe lechenie detei mladshego vozrasta s oslozhnennoi kishechnoi invaginatsiei. Med Vestn Sever Kavkaza. 2009;(1):37-38. https://cyberleninka.ru/article/n/dvuhetapnoe-hirurgicheskoe-lechenie-detey-mladshego-vozrasta-s-oslozhnennoy-kishechnoy-invaginatsiey (In Russ.)
  5. Toselli L, Martinez-Ferro M, Cervio G, Kwiat D, Imamura-Ching J, Graves CE, Gaston B, Harrison M. Magnetic Compression Anastomosis (Magnamosis) for Functional Undiversion of Ileostomy in Pediatric Patients. J Laparoendosc Adv Surg Tech A. 2017 Dec;27(12):1314-17. doi: 10.1089/lap.2017.0300
  6. Graves CE, Co C, Hsi RS, Kwiat D, Imamura-Ching J, Harrison MR, Stoller ML. Magnetic compression anastomosis (magnamosis): first-in-human trial. J Am Coll Surg. 2017 Nov;225(5):676-81.e1. doi: 10.1016/j.jamcollsurg.2017.07.1062
  7. Obolenskii VN, Gatkin EIa, Konovalov AK, Korsunskii AA, Revuk MS, Sein VA. Opyt ispol’zovaniia magnitnogo anastomoza i kvantovoi terapii pri likvidatsii vysokikh kishechnykh svishchei. Mezhdunar Akad Zhurn Ros akad Estestv Nauk. 2014;(4):34-39. (In Russ.)
  8. Grjibovski AM. Confidence intervals for proportions. Ekologiia Cheloveka. 2008;(5):57-60. https://cyberleninka.ru/article/n/doveritelnye-intervaly-dlya-chastot-i-doley (In Russ.)
Address for correspondence:
030020, Republic of Kazakhstan,
Aktobe, Maresyev Str., 68,
West Kazakhstan State Medical University,
Pediatric Surgery Department.
Tel. +7 775 179-35-25,
e-mail: baurjan.79@mail.ru,
Bauyrzhan N. Bissaliyev
Information about the authors:
Bissaliyev Bauyrzhan N., PhD, Associate Professor of the Pediatric Surgery Department, West Kazakhstan Marat Ospanov State Medical University, Aktobe, Republic of Kazakhstan.
http://orcid.org/0000-0002-4875-1140
Tsap Natalya A., MD, Professor, Head of the Pediatric Surgery Department, Ural Statement Medical University, Yekaterinburg, Russian Federation.
https://orcid.org/0000-0001-9050-3629
Tussupkaliev Assylbek B., PhD, Associate Professor, Head of the Pediatric Surgery Department, West Kazakhstan Marat Ospanov State Medical University, Aktobe, Republic of Kazakhstan.
http://orcid.org/0000-0003-2386-2984
Dosmagambetov Sagidulla P., PhD, Professor of the Pediatric Surgery Department, West Kazakhstan Marat Ospanov State Medical University, Aktobe, Republic of Kazakhstan.
http://orcid.org/0000-0002-6525-8438
Zhalmukhanbetov Kairat K., Assistant of the Pediatric Surgery Department, West Kazakhstan Marat State Medical University, Aktobe, Republic of Kazakhstan.
http://orcid.org/0000-0002-6833-1784
Grjibovski Andrej M., MD, Director of the Central Scientific Research Laboratory, Northern State Medical University, Arkhangelsk, Russian Federation, Professor of the Department of Public Health, Health Care, Hygiene and Bioethics, North-Eastern Federal University, Yakutsk, Russian Federation.
https://orcid.org/0000-0002-5464-0498

TRAUMATOLOGY

K.B. BALABOSHKA, YU.K. KHADZKOU, K.M. KUBRAKOV, Z.N. ABDULINA

EFFICACY OF INTEGRATED APPROACH TO TOTAL KNEE REPLACEMENT PERIOPERATIVE MANAGEMENT

Vitebsk State Medical University, Vitebsk,
The Republic of Belarus

Objective. To improve the results of total knee replacement by creating conditions for the early active rehabilitation of a patient on the basis of the integrated approach to reduce perioperative blood loss and pain intensity.
Methods. A prospective, comparative clinical study was conducted involving 100 patients with the knee osteoarthritis of the 3rd stage who had undergone primary total knee replacement. Monolateral spinal anesthesia, preemptive analgesia, combined administration of aminocaproic acid and local infiltration analgesia considering the anatomy of the main neural structures were used in the treatment of patients of the study group (n=50). In the control group (n=50) surgeries were performed using spinal anesthesia, without the use of preemptive analgesia, inhibitors of fibrinolysis and local infiltration analgesia. The volume of perioperative blood loss, hematological parameters (hemoglobin, erythrocytes, hematocrit), frequency of transfusion of donor blood components, pain syndrome, functional result were evaluated.
Results. The total volume of the perioperative blood loss in patients of the control group was 1425 (911; 1762) ml and was significantly higher (p<0.01) than in the study group 943 (758; 1135) ml, which required transfusion of donor blood components to 11 patients of the control group. The average value of erythrocytes, hemoglobin and hematocrit in the postoperative period in patients of the study group was significantly higher than in the control group (p<0,01). The intensity of pain syndrome was significantly lower in patients of the study group both at rest and with movements in the knee joint (p<0,01). We observed statistically significantly better functional result in patients of the study group (p<0,01).
Conclusions. The integrated approach to perioperative management of knee replacement allows reducing the volume of total blood loss, eliminating the need for donor blood transfusion, reducing the intensity of pain syndrome, which creates favorable conditions for patient’s early active rehabilitation, improves the functional result and reduces economic costs.

Keywords: knee replacement, blood loss, analgesia, perioperative management, rehabilitation
p. 53-61 of the original issue
References
  1. Neogi T. The epidemiology and impact of pain in osteoarthritis. Osteoarthritis Cartilage. 2013 Sep;21(9):1145-53. doi: 10.1016/j.joca.2013.03.018
  2. Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007 Apr;89(4):780-85. doi: 10.2106/JBJS.F.00222
  3. Liu D, Dan M, Martinez Martos S, Beller E. Blood management strategies in total knee arthroplasty. Knee Surg Relat Res. 2016 Sep;28(3):179-87. doi: 10.5792/ksrr.2016.28.3.179
  4. Chan EY, Blyth FM, Nairn L, Fransen M. Acute postoperative pain following hospital discharge after total knee arthroplasty. Osteoarthritis Cartilage. 2013 Sep;21(9):1257-63. doi: 10.1016/j.joca.2013.06.011
  5. Feng JE, Novikov D, Anoushiravani AA, Schwarzkopf R. Total knee arthroplasty: improving outcomes with a multidisciplinary approach. J Multidiscip Healthc. 2018 Jan 25;11:63-73. doi: 10.2147/JMDH.S140550
  6. Gross JB. Estimating allowable blood loss: corrected for dilution. Anesthesiology. 1983 Mar;58(3):277-80. doi: 10.1097/00000542-198303000-00016
  7. Bogomolov AN, Kanus II. Anesthesia provision and postoperative analgesia at total endoprosthesis of the knee joint. Novosti Khirurgii. 2012;20(6):102-10. http://www.surgery.by/pdf/full_text/2012_6_15_ft.pdf (In Russ.)
  8. Song K, Pan P, Yao Y, Jiang T, Jiang Q. The incidence and risk factors for allogenic blood transfusion in total knee and hip arthroplasty. J Orthop Surg Res. 2019 Aug 28;14(1):273. doi: 10.1186/s13018-019-1329-0
  9. Tille E, Mysliwietz J, Beyer F, Postler A, Lützner J. Intraarticular use of tranexamic acid reduces blood loss and transfusion rate after primary total knee arthroplasty. BMC Musculoskelet Disord. 2019 Jul 27;20(1):341. doi: 10.1186/s12891-019-2715-9
  10. Zhang S, Wang C, Shi L, Xue Q. Multi-route applications of tranexamic acid to reduce blood loss after total knee arthroplasty: a randomized controlled trial. Medicine (Baltimore). 2019 Jul;98(30):e16570. doi: 10.1097/MD.0000000000016570
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  12. Engel JM, Hohaus T, Ruwoldt R, Menges T, Jürgensen I, Hempelmann G. Regional hemostatic status and blood requirements after total knee arthroplasty with and without tranexamic acid or aprotinin. Anesth Analg. 2001 Mar;92(3):775-80. doi: 10.1097/00000539-200103000-00041
  13. Dalury DF. A state-of-the-art pain protocol for total knee replacement. Arthroplast Today. 2016 Feb 12;2(1):23-25. doi: 10.1016/j.artd.2016.01.004
  14. Halawi MJ, Grant SA, Bolognesi MP. Multimodal analgesia for total joint arthroplasty. Orthopedics. 2015 Jul 1;38(7):e616-25. doi: 10.3928/01477447-20150701-61
  15. Gerasimenko MA, Zhuk YV, Vrublevsky VA, Lenkovets AS, Kozlova VI. Perioperative anesthesia in total knee arthroplasty. Med Zhurn. 2018(2):39-42. https://medmag.bsmu.by/category65/ (In Russ.)
  16. Berninger MT, Friederichs J, Leidinger W, Augat P, Bühren V, Fulghum C, Reng W. Effect of local infiltration analgesia, peripheral nerve blocks, general and spinal anesthesia on early functional recovery and pain control in total knee arthroplasty. BMC Musculoskelet Disord. 2018 Jul 18;19(1):232. doi: 10.1186/s12891-018-2154-z
  17. Zhang Z, Shen B. Effectiveness and weakness of local infiltration analgesia in total knee arthroplasty: a systematic review. J Int Med Res. 2018 Dec;46(12):4874-84. doi: 10.1177/0300060518799616
Address for correspondence:
210009, Republic of Belarus,
Vitebsk, Frunze Ave., 27,
Vitebsk State Medical University,
Department of Traumatology, Orthopedics
And Military Field Surgery.
Tel. office: +375(212)574084,
e-mail: bkb@tut.by,
Kanstantsin B. Balaboshka
Information about the authors:
Balaboshka Kanstantsin B., PhD, Associate Professor, Head of the Department of Traumatology, Orthopedics and Military Field Surgery, Vitebsk State Medical University, Vitebsk, Republic of Belarus.
https://orcid.org/0000-0002-5599-3439
Khadzkou Yauheni K., Assistant of the Department of Traumatology, Orthopedics and Military Field Surgery, Vitebsk State Medical University, Vitebsk, Republic of Belarus.
https://orcid.org/0000-0002-9216-7929
Kubrakov Konstantsin M., PhD, Associate Professor of the Neurology and Neurosurgery Department, Vitebsk State Medical University, Vitebsk, Republic of Belarus.
https://orcid.org/0000-0001-6723-0589
Abdulina Ziamfira N., Assistant of the Department of Anesthesiology and Intensive Care with the Course of the Faculty of Advanced Training and Retraining, Vitebsk State Medical University, Vitebsk, Republic of Belarus.
https://orcid.org/0000-0002-5593-5714

NEUROSURGERY

A.I. TRETIAKOVA 1, I.V. KOVALENKO 2, R.A. TRETIAKOV 3, YU.V. TSYMBALIUK 1, L.L. CHEBOTARIOVA 1, A.A. GATSKIY 1, IA.V. TSYMBALIUK 1, I.B. TRETYAK 1

DIAGNOSTICS AND TREATMENT OF PROXIMAL TUNNEL NEUROPATHIES OF THE UPPER LIMBS

A.P. Romodanov Neurosurgery Institute 1, Kiev, Ukraine,
Zhytomyr Regional Hospital named after A.F. Gerbachevsky 2, Zhytomyr,
Institute of Traumatology and Orthopedics 3,
Kiev, Ukraine

Objective. To determine diagnostic criteria for objectifying the localization, nature and severity of pathological changes, improving treatment tactics for tunnel neuropathies of the upper limb at the proximal level.
Methods. The treatment results of 77 patients with the tunnel neuropathies of the upper limb at the proximal level from 2009 to 2018 were analyzed. The average age is 39.1±2.1 years (M±σ), among them 46 patients (59.7%) were women, 31 patients (40.3%) were men. Among the additional methods of examination, the ultrasound of the vessels of the upper limb and peripheral nerve trunks was used as well as magnetic resonance imaging (MRI) of the brachial plexus, cervical spine, multidetector computed tomography (MDCT). Neurophysiological parameters were evaluated according to needle and stimulation electromyography (EMG). Of the methods of surgical treatment, we used both decompression of nerves/plexuses and resection of a problem area of a nerve with its subsequent nerve grafting, or distal neurotization was used. The combination of nerve decompression with the implantation of the system for long-term epineural electrical stimulation was used in 25 cases (32.5%). Evaluation of the early results of surgical treatment was carried out in the first days after surgery, distant – in the period from four months to six years.
Results. In determining the area and nature of the compression, the MRI data were essential. EMG allowed us to determine the functional state of nerves and muscles, to exclude other pathological processes and the level of damage. Positive results of surgical treatment in patients with thoracic outlet syndrome (TOS) were observed in 42 (76.4%) cases, with tunnel mononeuropathies – in 20 (90.9%) patients.
Conclusions. Using the capabilities of modern diagnostic methods for compression neuropathies of the upper limb at the proximal level allows significantly correcting treatment tactics. An individual approach to the choice of treatment methods allows achieving a favorable restoration of the function of structures that have undergone compression.

Keywords: compression neuropathy, thoracic outlet syndrome, electroneuromyography, diagnostics, electrostimulation
p. 62-73 of the original issue
References
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  2. Zhulev NM. Nevropatii: ruk dlia vrachei. S-Petersburg: Izdat dom SPbMAPO; 2005. 320 p. (In Russ.)
  3. Orlando MS, Likes KC, Mirza S, Cao Y, Cohen A, Lum YW, Reifsnyder T, Freischlag JA. A decade of excellent outcomes after surgical intervention in 538 patients with thoracic outlet syndrome. J Am Coll Surg. 2015 May;220(5):934-99. doi: 10.1016/j.jamcollsurg.2014.12.046
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  14. Dvali L, Mackinnon S. The role of microsurgery in nerve repair and nerve grafting. Hand Clin. 2007 Feb;23(1):73-81. doi: 10.1016/j.hcl.2007.02.003
Address for correspondence:
04050, Ukraine,
Kiev, Platon Mayboroda Str., 32,
A.P. Romodanov Neurosurgery Institute,
Department of Reconstructive Neurosurgery.
Tel.: +38(044) 483-12-53,
e-mail: ihor.tretyak@gmail.com,
Ihor B. Tretyak
Information about the authors:
Tretiakova Albina I., MD, Head of the Department of Functional Diagnostics, A.P. Romodanov Neurosurgery Institute, Kiev, Ukraine.
https://orcid.org/0000-0002-3638-4339
Kovalenko Ihor V., Neurosurgeon, Zhytomyr Regional Hospital named after A.F. Gerbachevsky, Zhytomyr, Ukraine.
https://orcid.org/0000-0003-2678-466X
Tretiakov Roman A., Radiologist, Institute of Traumatology and Orthopedics, Kiev, Ukraine.
https://orcid.org/0000-0003-0419-6373
Tsymbaliuk Yuliya V., MD, Neurosurgeon, Department of Reconstructive Neurosurgery, A.P. Romodanov Neurosurgery Institute, Kiev, Ukraine.
https://orcid.org/0000-0002-0025-3505
Chebotariova Lidia L., MD, Professor, Honored Worker of Science and Technology of Ukraine, Head of the Department of Neurophysiology, A.P. Romodanov Neurosurgery Institute, Kiev, Ukraine.
https://orcid.org/0000-0001-7881-8564
Gatskiy Alexander A., PhD, Neurosurgeon, Department of Reconstructive Neurosurgery, A.P. Romodanov Neurosurgery Institute, Kiev, Ukraine.
https://orcid.org/0000-0002-2212-2143
Tsymbaliuk Iaroslav V., Neurosurgeon, Department of Reconstructive Neurosurgery, A.P. Romodanov Neurosurgery Institute, Kiev, Ukraine.
https://orcid.org/0000-0002-8746-0944
Tretyak Ihor B., MD, Head of the Department of Reconstructive Neurosurgery, A.P. Romodanov Neurosurgery Institute, Kiev, Ukraine.
https://orcid.org/0000-0003-0977-7062

REVIEWS

I.V. MAIBORODIN 1, T.V. MIKHEEVA 1, G.YU. YARIN 2, S.V. KHOMENYUK 1, M.K. AGZAEV 1, V.I. MAIBORODINA 3, A.A. SHEVELA 1, I.A. VILGELMI 2, A.I. SHEVELA 1

SOME MORPHOLOGICAL CHARACTERISTICS OF TISSUE REACTIONS AFTER IMPLANTATION OF METAL PRODUCTS

Institute of Chemical Biology and Fundamental Medicine,
Siberian Branch of the Russian Academy of Sciences 1,
Novosibirsk Research Institute of Traumatology and Orthopedics named after Ya.L. Tsivyan 2,
Institute of Molecular Pathology and Pathomorphology, Federal Research Center of Fundamental and Translational Medicine 3, Novosibirsk,
The Russian Federation

The use of metalworks for introduction into the organism is still relevant, and in some cases, it is the only possible way for corrects some pathological processes. However, all metal products, when implanted into the organism, cause a response of the immune system. Also, all metal implants, regardless of their composition and properties, even made from inert and very hard materials are subject for corrosion and destruction. Typically, small particles do not cause organism reactions, but with a large number or the appearance of large fragments, it is possible to develop a typical foreign body reaction with encapsulation and granuloma formation, and potentiation of weakening of fixation and further destruction of the introduced metal product.
Apparently, the greatest prospects for improving the results of the use of metal implants are cellular technologies that reduce the severity of acute (during implantation surgery) and chronic (accompanying the presence of a foreign body in tissues) inflammation, especially since multipotent stromal cells adhere well to the surface of most artificial materials. At the same time, the literature almost doesn’t contain data about the effects of immune cells on the metal structures, how quickly it will cause foreign body reactions and corrode after selective activation or inhibition of certain cells. The solution of this problem will allow not only to improve the results of the implantation procedure, but also to operate the processes of integration, degradation and rejection of various foreign bodies.

Keywords: implants, metals, implantation complications, corrosion particles, immune cells, multipotent stromal cells
p. 74-83 of the original issue
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Address for correspondence:
630090, Russian Federation,
Novosibirsk, Lavrentiev Ave., 8,
Institute of Chemical Biology
And Fundamental Medicine,
Center of New Medical Technologies.
Tel. office: 8-913-753-0767,
e-mail: imai@mail.ru,
Igor V. Maiborodin
Information about the authors:
Maiborodin Igor V., MD, Professor, Chief Researcher of the Laboratory of Health Management Technologies, Institute of Chemical Biology and Fundamental Medicine, Russian Academy of Sciences, Siberian Branch, Novosibirsk, Russian Federation.
http://orcid.org/0000-0002-8182-5084
Mikheeva Tatiana V., PhD, Doctorate Student of the Laboratory of Health Management Technologies, Institute of Chemical Biology and Fundamental Medicine, Russian Academy of Sciences, Siberian Branch, Novosibirsk, Russian Federation.
http://orcid.org/0000-0003-2249-5174
Yarin Gennadiy Yu., PhD, Leading Researcher of the Neurovertebrology Department of Novosibirsk Research Institute of Traumatology and Orthopedics named after Ya.L. Tsivyan, Novosibirsk, Russian Federation.
https://orcid.org/0000-0003-2011-1253
Khomenyuk Sergey V., Senior Researcher of the Laboratory of Health Management Technologies, Institute of Chemical Biology and Fundamental Medicine, Russian Academy of Sciences, Siberian Branch, Novosibirsk, Russian Federation.
https://orcid.org/0000-0002-7346-926X
Agzaev Magomed K., Post-Graduate Student of the Laboratory of Health Management Technologies, Institute of Chemical Biology and Fundamental Medicine, Russian Academy of Sciences, Siberian Branch, Novosibirsk, Russian Federation.
https://orcid.org/0000-0002-7474-4999
Maiborodina Vitalina I., MD, Leading Researcher of the Laboratory of Ultrastructural Bases of Pathology, Institute of Molecular Pathology and Pathomorphology, Novosibirsk, Russian Federation.
http://orcid.org/0000-0002-5169-6373
Shevela Aleksandr A., PhD, Doctorate Student of the Laboratory of Health Management Technologies, Institute of Chemical Biology and Fundamental Medicine, Russian Academy of Sciences, Siberian Branch, Novosibirsk, Russian Federation.
http://orcid.org/0000-0001-9235-9384
Vilgelmi Inna A., Gynecologist of the Center of Urology and Gynecology, Novosibirsk Research Institute of Traumatology and Orthopedics named after Ya.L. Tsivyan, Novosibirsk, Russian Federation.
https://orcid.org/0000-0001-7769-6147
Shevela Andrey I., MD, Professor, Head of the Department “Center of New Medical Technologies”, Institute of Chemical Biology and Fundamental Medicine, Russian Academy of Sciences, Siberian Branch, Novosibirsk, Russian Federation.
http://orcid.org/0000-0002-3164-9377

D.A. MOROZOV, E.S. PIMENOVA, T.D. MARCHUK

HIRSCHSPRUNG’S DISEASE IN CHILDREN WITH DOWN SYNDROME. FEATURES OF CLINICAL ASPECTS, DIAGNOSTICS AND TREATMENT

I.M. Sechenov First Moscow State Medical University, Moscow,
The Russian Federation

The purpose of this review was to combine information about children with aganglionosis and Down syndrome and about the possible causes of high complication rates in this group of patients. Down syndrome is the most common chromosomal abnormality associated with Hirschsprung’s disease (2-10%). The mortality rate in this group of patients is higher. The cause, in addition to combined congenital heart defects, is a specific complication for aganglionic patients – Hirschsprung-associated enterocolitis. The incidence of enterocolitis before and after surgical treatment is statistically significantly higher in children with Down syndrome (29-48%). This may be due to specific disorders in the leukocytes, interferon protection of the intestinal mucosa, as well as blockade of serotonin production and vasoactive intestinal peptide involved in the protection of the enteral nervous system. The frequency of other poor functional results after pull-through surgery (constipation/incontinence) in children with Down syndrome does not statistically different from other patients. Awareness of a physician and parents about the possible risk of developing severe enterocolitis in a child with aganglionosis and Down syndrome can help to choose the treatment and postoperative observation of such patients and to prevent serious complication.

Keywords: congenital malformations, Hirschsprung disease, Down syndrome, hirschsprung-associated enterocolitis, children
p. 84-91 of the original issue
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Address for correspondence:
119991, Russian Federation,
Moscow, Trubetskaya Str., 8-2,
I.M. Sechenov First Moscow
State Medical University,
Department of Pediatric Surgery
And Urology-Andrology,
Tel. +7-985-265-33-02,
e-mail: evgeniyapimenova@list.ru,
Evgeniya S. Pimenova
Information about the authors:
Morozov Dmitry A., MD, Professor, Head of the Department of Pediatric Surgery and Urology-Andrology, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
https://orcid.org/0000-0002-1940-1395
Pimenova Evgeniya S., PhD, Associate Professor of the Department of Pediatric Surgery and Urology-Andrology, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
https://orcid.org/0000-0001-7206-5987
Marchuk Tatyana D., 4-Year Student of the Pediatric Faculty, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
https://orcid.org/0000-0002-0608-479X

E.V. NELIPOVICH 1, V.A. YANUSHKO 2, I.P. KLIMCHUK 1

HYBRID REVASCULARIZATION METHOD IN THE TREATMENT OF CRITICAL LOWER LIMB ISCHEMIA

4th City Clinical Hospital named after N.E. Savchenko 1, Minsk,
The Republic of Belarus

The cause of 50-70% of cases of the circulatory disorders decompensated forms with the development of critical lower limb ischemia (CLLI) is multilevel obliterating lesions of the peripheral arteries. During the first year from the diagnosis of CLLI, 25% of patients require primary high amputation. The use of small diameter arteries for the formation of a distal anastomosis, an increase in the length of the shunt with ultra-distal bypass surgery, diffuse damage to the artery wall, causes unfavorable hemodynamics in the shunt.
The frequency of early shunt thrombosis after open reconstructions is 25-35%; infectious complications make up 4-21%. A significant drawback of interventional procedures is the extreme difficulty or inability to carry out the intervention with multiple and extended occlusive lesions. A promising direction in solving this problem is the use of hybrid technologies. Despite the apparent simplicity of solving the problem, there is a high probability of developing restenosis after performing endovascular balloon dilatation (EBD). However, the widespread use of balloon catheters and drug-eluting stents has reduced the number of restenoses by 16%. The use of hybrid technologies for multilevel lesions ensures arterial patency of 76% of patients, preservation of the limb in more than 80% of patients, within 3 years after revascularization, which in turn led to a decrease in mortality to 11%

Keywords: critical ischemia, atherosclerosis, revascularization, hybridmethod, thrombosis, bypass
p. 92-99 of the original issue
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Address for correspondence:
220036, Republic of Belarus,
Minsk, Rosa Luxemburg Str., 110,
4th City Clinical Hospital
Named after N.E. Savchenko,
Vascular Surgery Department.
Tel. mobile: +375 29 1421893,
e-mail: nelipovich@mail.ru,
Evgenij V. Nelipovich
Information about the authors:
Nelipovich Evgenij V., Angiosurgeon, Vascular Surgery Department, 4th City Clinical Hospital named after N.E. Savchenko, Minsk, Republic of Belarus.
https://orcid.org/0000-0002-2921-6601
Yanushko Vyacheslav A., MD, Professor, Chief Researcher of the Laboratory of Vascular Surgery, Republican Scientific and Practical Center «Cardiology», Minsk, Republic of Belarus.
https://orcid.org/0000-0002-2143-7485
Klimchuk Ivan P., PhD, Head of the Vascular Surgery Department, 4th City Clinical Hospital named after N.E. Savchenko, Minsk, Republic of Belarus.
https://orcid.org/0000-0001-9793-0084

CASE REPORTS

N.A. TRIFANOV, A.JA. KOROVIN

GASTROINTESTINAL STROMAL TUMOR IN SMALL INTESTINE INVAGINATES

Kuban State Medical University 1, Krasnodar,
The Russian Federation

Gastrointestinal stromal tumors (GISTs) make up 0.1-3% of all cancers of the gastrointestinal tract and belong to the most common mesenchymal tumors of the small intestine. The diagnosis is more often established during an emergency operation undertaken for intestinal obstruction, bleeding or peritonitis. The clinical case of a patient with GIST of the small intestine complicated by intussusception is described. Difficulties of diagnostics and choice of treatment tactics of this pathology in the patient with severe accompanying neurological pathology with application of mini-invasive interventions are shown. The diagnosis of acute intestinal obstruction and the decision on surgical treatment were complicated by the remitting nature of obstruction with the passage of contrast to the colon, the version about the dynamic nature of intestinal obstruction against the background of tetraparesis. Negative clinical dynamics was an indication for laparoscopy, which made it possible to establish a diagnosis of intussusception of small bowel obstruction. Attempts to perform disinfection laparoscopically failed. Disinvagination and resection of the small intestine, with a tumor found in invaginate, are made of mini-laparotomic access using the mini-assistant apparatus. Immunohistochemical study of the removed specimen: malignant GIST of the jejunum, epithelioid variant. The biological properties of the tumor (absence of lymphogenic metastasis, extremely low incidence of infiltrative growth) allow the use of minimally invasive interventions without deterioration of the overall and relapse-free survival. Minimally invasive surgeries for tumors of the small intestine are rather rare, and cases of their use in complicated course of the disease are not described. This clinical case is of interest due to the atypical course of intestinal obstruction, its causal relationship with GIST and minimally invasive approach to the diagnosis and treatment of the presented pathology.

Keywords: GIST, intestinal obstruction, intussusception, diagnosis, laparoscopy, minimally invasive surgery
p. 100-105 of the original issue
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  15. Demetri GD, Benjamin R, Blanke CD, Choi H, Corless C, DeMatteo RP, Eisenberg BL, Fletcher CD, Maki RG, Rubin BP, Van den Abbeele AD, von Mehren M; NCCN GIST Task Force. NCCN Task Force report: optimal management of patients with gastrointestinal stromal tumor (GIST) – expansion and update of NCCN clinical practice guidelines. J Natl Compr Canc Netw. 2004 May;2(Suppl 1):S-1-26; quiz 27-30. https://www.ncbi.nlm.nih.gov/pubmed/17624289
  16. Berelavichus SV, Kriger AG, Kaldarov AR, Kalinin DV. Minimally invasive surgical treatment of gastrointestinal stromal tumor. Khirurgiia. Zhurn im NI Pirogova. 2015;(3):38-41. doi: 10.17116/hirurgia2015338-41 (In Russ.)
  17. Kashchenko VA, Karachun AM, Orlova RV, Pelipas YuV, Petrova VV, Nopomnyashchaya SL, Gluzman MI, Boskrovny EG. Pecularities of surgical approach in treatment of gastrointestinal stromal tumors. Vestn. Khirurgii im II Grekova. 2017;176(2):22-27. doi: 10.24884/0042-4625-2017-176-2-22-27 (In Russ.)
Address for correspondence:
350063, Russian Federation,
Krasnodar, Mitrophan Sedin Str., 4,
Kuban State Medical University,
Department of Faculty and Hospital Surgery.
Tel. +7 961 581-25-23,
e-mail: nikolaysv26@mail.ru,
Nikolay A. Trifanov
Information about the authors:
Korovin Alexander Ja., MD, Professor, Department of Faculty and Hospital Surgery, Kuban State Medical University, Krasnodar, Russian Federation.
http://orcid.org/0000-0002-7986-4455
Trifanov Nikolay A., Post-Graduate Student, Department of Faculty and Hospital Surgery, Kuban State Medical University, Krasnodar, Russian Federation.
http://orcid.org/0000-0001-9006-6860

S.V. PETROV 1, V.P. ZEMLIANOI 2, B.V. SIGUA 2, A.V. VOVK 1, D.A. CHERNISHEV 1, P.A. KOTKOV 1, V.A. IGNATENKO 1, R.R. FEVZIEV 1

PNEUMATOSIS CYSTOIDES INTESTINALIS - RARE CAUSE OF NON-SURGICAL PNEUMOPERITONEUM

St. Petersburg State Budgetary Healthcare Institution "Elizabethan Hospital"1,
North-Western State Medical University named after I.I. Mechnikov 2, St. Petersburg,
The Russian Federation

For the first time, intestinal air cysts were described by Du Vernoi in 1783. For more than 230-year history of studying this disease, a large number of clinical examples, reviews and hypotheses have been accumulated in the literature, explaining the pathogenesis of the pneumatosis cystoides intestinalis and treatment methods. The clinical symptoms of this disease are extremely nonspecific, the anamnestic features are also often absent, therefore intestinal emphysema is most often detected as a concomitant state or intraoperatively, if we are talking about a complicated case. The article presents a clinical case of pneumatosis cystoides intestinalis, the only manifestation of which was free gas in the abdominal cavity, which served as an indication for emergency surgery. The scanty clinical symptoms and normal laboratory findings usually tend the surgeon to choose less invasive research methods, but diagnostic laparoscopy in the described case was impossible due to repeated surgical interventions on the abdominal organs, as well as the presence of contraindications from the pulmonary system. The described observation indicates the existence non-surgical causes of pneumoperitoneum, despite its high specificity in the diagnosis of hollow organs perforations.

Keywords: pneumatosis cystoides intestinalis, intestinal emphysema, pneumoperitoneum, pulmonary emphysema, diagnostic laparoscopy
p. 106-111 of the original issue
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  13. Goel A, Tiwari B, Kujur S, Ganguly PK. Pneumatosis cystoides intestinalis. Surgery. 2005 Jun;137(Is 6):659-60. doi: 10.1016/j.surg.2003.12.014
  14. Grieve DA, Unsworth IP. Pneumatosis cystoides intestinalis: an experience with hyperbaric oxygen treatment. Aust N Z J Surg. 1991 Jun;61(6):423-26. doi: 10.1111/j.1445-2197.1991.tb00255.x
Address for correspondence:
191015, Russian Federation,
Saint-Petersburg, Kirochnaya Str., 41,
North-Western State Medical University
named after I.I. Mechnikov,
Faculty Surgery Department named after I.I. Grekov.
Tel. +790626192131,
e-mail: kotkovdr@mail.ru,
Pavel A. Kotkov
Information about the authors:
Petrov Sergey V., MD, Professor, Chief Physician, St. Petersburg State Budgetary Healthcare Institution «Elizabethan Hospital», Saint-Petersburg, Russian Federation.
https://orcid.org/0000-0003-4398-5770
Zemlianoi Viacheslav P., MD, Professor, Head of the Faculty Surgery Department named after I.I. Grekov, North-Western State Medical University named after I.I. Mechnikov, Saint-Petersburg, Russian Federation.
https://orcid.org/0000-0003-2329-0023
Sigua Badri V., MD, Professor of the Faculty Surgery Department named after I.I. Grekov, North-Western State Medical University named after I.I. Mechnikov, Saint-Petersburg, Russian Federation.
https://orcid.org/0000-0002-4556-4913
Vovk Andrei V., PhD, Deputy Chief Physician for Medical Affairs, St. Petersburg State Budgetary Healthcare Institution «Elizabethan Hospital», Saint-Petersburg, Russian Federation.
https://orcid.org/0000-0002-6550-589X
Chernishev Denis A., PhD, Deputy Chief Physician for Surgery, St. Petersburg State Budgetary Healthcare Institution «Elizabethan Hospital», Saint-Petersburg, Russian Federation.
https://orcid.org/0000-0001-9055-7651
Kotkov Pavel A., PhD, Surgeon of the Surgical Unit ¹2, St. Petersburg State Budgetary Healthcare Institution «Elizabethan Hospital», Saint-Petersburg, Russian Federation.
https://orcid.org/0000-0002-9762-9854
Ignatenko Viktor A., Head of the Surgical Unit ¹2, St. Petersburg State Budgetary Healthcare Institution «Elizabethan Hospital», Saint-Petersburg, Russian Federation.
https://orcid.org/0000-0002-6615-3005
Fevziev Rishat R., Surgeon of the Surgical Unit ¹2, St. Petersburg State Budgetary Healthcare Institution «Elizabethan Hospital», Saint-Petersburg, Russian Federation.
https://orcid.org/0000-0003-1722-8485

EXCHANGE OF EXPERIENCE

A.F. CHERNOUSOV, T.V. KHOROBRYH, M.V. ZUBAREVA, V.I. KOROTKIY, N.M. ABDULKHAKIMOV, R.E. SALIKHOV

RESULTS OF THE REPEATED STOMACH RESECTION BY BILLROTH I AND ORGAN-PRESERVING OPERATIONS IN THE TREATMENT OF THE DUODENUM ULCER

I.M. Sechenov First Moscow State Medical University, Moscow
The Russian Federation,
N.N.Burdenko Ñlinic of faculty surgery, Department of faculty surgery ¹1
The Russian Federation

Objective. To study of the results of repeated gastric resection by Billroth I and organ-preserving operations in the treatment of duodenal ulcer complicated by pyloroduodenal stenosis in patients who underwent surgery to create a transverse gastroduodenoanastomosis.
Methods. From 2006 to 2017, 96 patients were examined and treated in the Clinic of the faculty surgery named after N. N. Burdenko. 54 patients underwent the reconstructive surgery with the creation of Billroth I anastomosis, 42 patients underwent the organ-preserving surgery with the imposition of transverse gastroduodenoanastomosis, esophagomyotomy and fundoplication for pyloroduodenal stenosis (19 – the laparoscopic operation).
Results. Early postoperative complications after the reconstructive surgery with the creation of Billroth I anastomosis were the following: 8 patients – dyspepsia, acute pancreatitis aggravation and asthenoneurotic syndrome in 7 patients. After organ-preserving surgeries, 5 patients had weakly expressed gastrostasis in the early postoperative period, 2 patients – reactive pancreatitis. All of them were stopped during hospitalization; the postoperative period was not affected by them.
In the late postoperative period (6 months – 5 years) the signs of the postgastrectomy syndromes and recurrence of ulcers were not revealed. Regression of the main symptoms was noted in the vast majority of patients. According to the SF-36 there are similar indicators with general population.
Conclusions. Patients with Billroth II anastomosis and who developed the postgastrectomy syndromes should have the repeated surgery: reconstruction to Billroth I anastomosis with the restoration of the passage of the duodenum. Routine surgical treatment of a complicated form of gastric ulcer (pyloroduodenal stenosis) includes selective proximal vagotomy with the imposition of transverse gastroduodenoanastomosis and circular esophagomyotomy with the formation of fundoplication cuff.

Keywords: gastric ulcer, resection of the stomach, dumping syndrome, duodenal ulcer, Billroth, afferent loop syndrome
p. 112-119 of the original issue
References
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Address for correspondence:
119435, Russian Federation,
Moscow, B. Pirogovskaya Str., 6-1,
I.M. Sechenov First Moscow
State Medical University,
Clinic of the Faculty Surgery
Named after N. N. Burdenko,
Department of Faculty Surgery ¹1.
Tel. +7 906 068-38-12,
e-mail: dr.korotkiy@mail.ru,
Valentin I. Korotkiy
Information about the authors:
Chernousov Alexander F., MD, Professor, Academician of RAS, Honored Scientist of the Russian Federation, Head of the Department of Faculty Surgery No1, Clinic of the Faculty Surgery named after N. N. Burdenko, I.M.Sechenov First Moscow State Medical University, Moscow, Russian Federation.
https://orcid.org/0000-0001-8792-1459
Khorobryh Tatiana V., MD, Professor of the Department of Faculty Surgery No1, Clinic of the Faculty Surgery named after N. N. Burdenko, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
https://orcid.org/0000-0001-5769-5091
Zubareva Mariya V., Surgeon, Clinic of the Faculty Surgery named after N. N. Burdenko, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
https://orcid.org/0000-0002-7050-9393
Korotkiy Valentin I., Surgeon, Post-Graduate Student of the Department of Faculty Surgery No1, Clinic of the Faculty Surgerynamed after N. N. Burdenko, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
https://orcid.org/0000-0002-1359-5379
Abdulkhakimov Nuriddin M., Surgeon, Assistant of the Department of Faculty Surgery No1, Clinic of the Faculty Surgerynamed after N.N. Burdenko, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
https://orcid.org/0000-0002-8324-2376
Salikhov Rashad E., 6-Year Student, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
https://orcid.org/0000-0003-1090-2123

SCIENTIFIC CONGRESSES AND CONFERENCES

A.G. PAVLOV

MODERN PHLEBOLOGY TRENDS: WHAT WAS BROUGHT BY UIP 2019?

Vitebsk State Medical University, Vitebsk,
The Republic of Belarus

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Keywords: -
p. 120-125 of the original issue
Address for correspondence:
210009, Republic of Belarus,
Vitebsk, Frunze Ave., 27,
Vitebsk State Medical University,
Department of Hospital Surgery with Courses
In Urology and Pediatric Surgery.
Tel. +375 29 7-133-622,
e-mail: pavlovsno@rambler.ru,
Aleksandr G. Pavlov
Information about the authors:
Pavlov Aleksandr G., PhD, Associate Professor of the Department of Hospital Surgery with Courses in Urology and Pediatric Surgery, Vitebsk State Medical University, Vitebsk, Republic of Belarus.
https://orcid.org/0000-0001-7280-4364
Contacts | ©Vitebsk State Medical University, 2007-2023