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Year 2006 Vol. 14 No 2

S.S. OSOCHUK, N.YU. KONEVALOVA

LIPID COMPOSITION OF RATS’ LIVER MICROSOMAS AT EXPERIMENTAL PERITONITIS

Endoplasmatic liver reticulum in rats provides the formation and export to the blood of lipid-protein complexes participating thus in the lipid transport system. There is no information in the literature concerning lipid spectrum changing of the liver endoplasmatic reticulum in case of generalized inflammatory processes. Changes of the phospholipid spectrum and fatty acids composition of lysophosphatides, phosphatidylcholines and phosphatidylethanolamines of the liver microsomas in white outbred rats at experimental peritonitis were investigated in the given article. The signs of increase of phospholipids supply to the liver mitochondria were revealed possibly to provide their functional activity. Increase of saturated fatty acids inclusion in phospholipids was marked which could activate D6-desaturase and endogenic polyunsaturated fatty acids production as well as cytochrome P450 activation and ksenobiotics detoxication increase. The signs of increase of digomo-g-linolenic acid export and decrease of arachidic acid supply were found out that could be one of the control factors of the inflammatory process by means of prostanoids production formed from digomo-g-linolenic acid and possessing less activity than prostanoids formed from arachidic acid.

Keywords: peritonitis, endoplasmatic reticulum of the liver, lipid spectrum, phospholipid spectrum
p. 2 - 6 of the original issue
References
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  2. Косинец, А.Н. Профилактика и лечение гнойно-воспалительных осложнений при экстренных операциях на органах брюшной полости (клинико.-экспериментальное исследование): дисс. д-ра мед. наук: 14.00.27 / А.Н. Косинец. – Витебск, 1994. -510 л.
  3. Осочук, С.С.Изменения липидтранспортной системы при экспериментальном перитоните у крыс / С.С. Осочук // Бюллетень экспериментальной биологии и медицины. – 2002. - № 8.- С. 169-172.
  4. Титов, В.Н. Атеросклероз как патология полиеновых жирных кислот / В.Н. Титов. – Москва: “АЛТУС”, 2002. – 495 с.
  5. A universal reagent for fosfolipids analisis / V.E. Vaskowsky [et al.] // J. Chromatogr. - 1975. - Vol. 114. - P. 129-141.
  6. Baker, S. Low speed preparation of microso-mes: a comparative study / S. Baker, L. Coons, E. Hodgson //Chem. Biol. Interact. - 1973. - Vol. 6. - P. 307-316.
  7. Chul-Ho, Yun Conformational Change of Cytochrome P450 1A2 Induced by Phospholipids and Detergents / Yun Chul-Ho, Song Maengseok, Kim Hyoungman // JBC. – 1997. – Vol. 272, № 32. - P. 19725-19730.
  8. Li, Zhou. Sources of eicosanoid precursor fatty acid pools in tissues / Zhou Li Nilsson Еke // Journal of Lipid Research. – 2001. - Vol. 42. -P.1521-1542.
  9. Sathyanarayana, N. Gummadi Transbilayer Movement of Dipalmitoylphosphatidylcholine in Proteoliposomes Reconstituted from Detergent Extracts of Endoplasmic Reticulum / N. Gummadi Sathyanarayana, Menon Anant K. // J. Biol. Chem. – 2002. - Vol. 277, № 28. –P. 25337-25343.

V.V. VOLODKIN, O.D. MYADELETS, N.G. KHARKEVICH

MACROMICROSCOPIC PECULIARITIES OF THE INGUINAL REGION AND POSSIBLE CAUSES OF THE INGUINAL HERNIAS RECURRENCE

Anatomical peculiarities of the inguinal region and linked with them possibilities of inguinal hernia development are described in the article. Predisposing and causing factors of inguinal hernia development are described.
Based on the large clinical material (503 patients) the hernias incidence, their localization and diversity, the average age of patients are analyzed.
Microscopic differences in the collagen fibers composition in the structures forming inguinal region were revealed: in the transversal fascia, in the aponeurosis of the external oblique muscle of the stomach, in the hernial sac, in the transversal muscle in those who have inguinal hernia and in the control group. The most marked changes of collagen fibers in the mentioned structures were observed in patients who had recurrent hernias.
Collagen fibers destruction results in the weakening of the peritoneum framework function as well as of the transverse fascia, the muscle, aponeurosis and as the result in hernia development.

Keywords: inguinal hernia, recurrence, inguinal region, destruction of the collagen fibers
p. 7 - 12 of the original issue
References
  1. Иоффе, И.Л. Оперативное лечение паховых грыж / И.Л. Иоффе. – М.: Медицина, 1968. - 171 с.
  2. Матяшин, И.М. Некоторые тактические вопросы лечения грыж брюшной стенки / И.М. Матяшин, А.А Войтенко, Н.П. Морозова // Клиническая хирургия. - 1972.-№7.- С.7-71.
  3. Лаврова, Т.Ф. Клиническая анатомия и грыжи передней брюшной стенки / Т.Ф. Лаврова. - М.: Медицина, 1979.-104 с.
  4. Тоскин, К.Д. Грыжи брюшной стенки / К.Д. Тоскин, В.В. Жебровский. - М.: Медицина, 1990. – 269 с.
  5. Володькин, В.В. Клинические и морфологические аспекты патогенеза паховых грыж / В.В. Володькин, Н.Г Харкевич, О.Д. Мяделец // Актуальные вопросы современной медицины: материалы 57-ой итоговой науч.конференции студентов и молодых ученых ВГМУ, Витебск, 21-22 апр. 2005. – С.12-13.

I.P. SHTURICH, V.N. SHILENOK, L.N. KIRPICHENOK

ACTIVITY OF PROTEOLYTIC PROCESSES IN THE BLOOD SERUM AND PERITONEAL LIQUID AT DIFFERENT STAGES OF PERITONITIS

The research results of proteolytic processes activity in the blood serum and peritoneal liquid in 42 patients at different stages of peritonitis are presented in the article. It has been found out that in case of peritonitis, changes in activity and/or in components content of the proteolysis system in the blood serum and peritoneal liquid occur depending on the stage of peritonitis. In the blood serum general proteolytic activity is subjected to the most significant changes; at the stage of polyorganic insufficiency it 13, 4 times increases in comparison with the toxic stage. In the peritoneal liquid a1- proteinase inhibitor is the most labile which decreases sharply at the toxic stage – in 3, 2 times in comparison with the reactive stage and then it rises again. Increase of general proteolytic activity in the blood serum of more than 100 nmole/lHs is the criteria of transferring from the toxic stage of peritonitis to the stage of the polyorganic insufficiency. Decrease of a1- proteinase inhibitor content in the peritoneal liquid less than 0, 4 g/l is the criteria of transferring of the reactive peritonitis stage to the toxic one. Not only the liver but also the blood cells – monocytes, lymphocytes and segmental- nucleus neutrophils are the source of proteinase and its endogenic inhibitors. Different cells participate at different stages of peritonitis according to the revealed correlations.

Keywords: peritonitis, stages of peritonitis, proteolytic activity, polyorganic insufficiency
p. 13 - 21 of the original issue
References
  1. Веремеенко, К.Н. Протеолиз в норме и при патологии / К.Н. Веремеенко, О.П. Голобородько, А.И. Кизим. – Киев: Здоров’я, 1988. – 199 с.
  2. Косинец, А.Н Протеиназы и их ингибиторы в гнойной хирургии и онкологии / А.Н. Косинец, Л.Н. Кирпиченок. – Витебск, 2003. – 410 с.
  3. Хватов, В.Б. Ускоренный метод определения основных ин-гибиторов протеиназ в плазме крови человека: метод. рекомендации / В.Б. Хватов, Т.А. Белова; МЗ РСФСР.– Москва, 1981. – 16 с.
  4. Erlanger, D.F. The preparation and properties of two new chromogenic substates of trypsin / N. Kokowsky, W. Cohen // Arch. Biochem. Biophys. – 1961. – Vol. 95, N 2. – P. 271-278.

A.V. BOGDANOVICH, V.N. SHILENOK, L.N. KIRPICHENOK

PROTEOLYTIC ACTIVITY IN THE BLOOD SERUM AND SMALL INTESTINE IN PATIENTS WITH ACUTE COMISSURAL ILEUS

The analysis of the treatment results of 37 patients with acute commissural ileus is presented in the article. The operation on the commissural dissection was performed in 30 patients; the commissural dissection and resection of the small intestine region was carried out in 7 patients. The nasogastrointestinal intubation with prolonged decompression of the small intestine was included in the treatment complex in all the patients. The intestinal content evacuation and the small intestine irrigation with the physiological solution of sodium chloride were done during the operation and in the postoperative period. The proteolytic activity was studied in the blood serum and the aspirated intestinal content in dynamics. The highest level of proteolytic activity was registered in the 1st and 2nd days of the postoperative period, thus there wasn’t a significant increase of inhibitor activity. It was found out that decrease of proteolytic activity permitted to speak about positive dynamics in the disease course. The investigation results let evaluate the degree of endotoxicosis and therapeutic actions efficacy.

Keywords: acute ileus, endotoxicosis, proteolytic activity, nasogastrointestinal intubation
p. 22 - 25 of the original issue
References
  1. Веремеенко, К.Н. Протеолиз в норме и при патологии / К.Н. Веремеенко, О.П. Голобородько, А.И. Кизим. – Киев: Здоров’я, 1988. – 199 с.
  2. Косинец, А.Н Протеиназы и их ингибиторы в гнойной хирургии и онкологии / А.Н. Косинец, Л.Н. Кирпиченок. – Витебск, 2003. – 410 с.
  3. Хватов, В.Б. Ускоренный метод определения основных ин-гибиторов протеиназ в плазме крови человека: метод. рекомендации / В.Б. Хватов, Т.А. Белова; МЗ РСФСР.– Москва, 1981. – 16 с.
  4. Erlanger, D.F. The preparation and properties of two new chromogenic substates of trypsin / N. Kokowsky, W. Cohen // Arch. Biochem. Biophys. – 1961. – Vol. 95, N 2. – P. 271-278.

A.N. KOSINETS, A.V. FROLOVA, V.P. BULAVKIN, V.I. DENISENKO

“PHYTOMP” IN THE COMPLEX TREATMENT OF TROPHIC ULCERS

The medicinal plant origin preparation “PhytoMP” made from the macleya and plantain to improve the treatment results of trophic ulcers is suggested. Local treatment efficacy was evaluated by means of clinical, cytological and bacteriological methods of investigation. It was found out that due to the antimicrobial effect of the medicinal preparation “PhytoMP” more rapid cleaning of the ulcerous surface from pathogenic microflora occurred. Application of the given plant origin preparation permits to decrease the dosage of antibiotics and to exclude painkillers prescribing. There is more rapid repairing of the ulcerous surface with the smooth scar forming at the 2nd and 3rd phases of the wound process under the action of the medicinal preparation “PhytoMP”.

Keywords: trophic ulcer, chronic venous insufficiency, diabetic angiopathy, phytotherapy
p. 26 - 31 of the original issue
References
  1. Васютков, В.Я. Трофические язвы стопы и голени / В.Я. Васютков, Проценко Н.В. – Москва: «Медицина». – 160с.
  2. Результаты открытого сравнительного исследования эффективности и безопасности перевязочного материала «Воскопран» для местного лечения венозных трофических язв во II–III стадиях раневого процесса / А.И. Кириенко [и др.] // Хирургия. – 2003. – № 9. – С. 38–40.
  3. Липницкий, Е.М. Лечение трофических язв нижних конечностей / Е.М. Липницкий. – М., 2001. – 160 с.
  4. Лымарь, А.Г. Применение «Воскопрана» в терапии трофических язв венозного генеза / А.Г. Лымарь, С.В. Прокудин, М.Г. Фабрикант // Хирургия. – 2004. – № 4. – С. 39–41.
  5. Сажин, В.П. Лечение варикозной болезни нижних конечностей, осложнённой тромбофлебитом поверхностных вен и трофическими язвами / В.П. Сажин, А.Л. Авдовенко, В.М. Емкужев // Матер. Х Всерос. съезда хирургов. – Волгоград, – 2000. – С. 295.

S.A. SUSHKOV, P.A. KUKHTENKOV, YU.S. NEBYLITSIN, O.S. SUSHKOVA

PHENOTYPICAL SYMPTOM-COMPLEX OF THE CONNECTIVE TISSUE DYSPLASIA AT DEEP VENOUS INSUFFICIENCY IN VARICOSITY PATIENTS

Phenotypical signs of the connective tissue dysplasia were studied in 106 varicosity patients. They were found out to be present in 97% of patients. The most prevalent phenotypical markers of dysplasia are the following: scoliosis, kyphosis, arachnodactyly, cubital joints hypermobility, varus or vagal lower limbs deformity, longitudinal or transverse flat foot, “fine” skin. According to the frequency of the connective tissue dysplasia sighs it was determined that they reliably occurred more frequently at the lower limbs valve insufficiency. Minimal number of revealed markers in this category of patients composed 3, but in the majority it varied from 4 to 10. Symptoms complex evaluation of the connective tissue dysplasia at the stage of clinical investigation permits to suspect deep vein valve insufficiency. In case 3 and more markers are revealed it is necessary to carry out profound instrumental investigation. The connective tissue dysplasia is the basis for deep vein valve insufficiency development.

Keywords: varicosity, valve insufficiency, connective tissue dysplasia, phenotype symptom-complex
p. 32 - 37 of the original issue
References
  1. Богачев, В.Ю. Новые данные о хронической венозной недостаточности: от эпидемиологии к лечению: обзор материалов симпозиума на 14 Всемирном Конгрессе международного общества флебологов, Рим, 9-14 сентября 2001 г. / В.Ю. Богачев // Ангиология и сосудистая хирургия. – 2002. – Т. 8. – №2. – С. 119-126.
  2. Домницкая, Т.Д. Исследование глубоких вен нижних конечностей с помощью ультразвуковой допплерографии у больных с аномально расположенными хордами сердца / Т.Д. Домницкая // Терапевтический архив. –1997. – №4. – С. 22-23.
  3. Кадурина, Т.И. Наследственные коллагенопатии (клиника, диагностика, лечение и диспансеризация) / Т.И. Кадурина. – СПб.: Невский диалект, 2000. – 271 с.
  4. Клеменов, А.В. Внекардиальные проявления недифференцированной дисплазии соединительной ткани / А.В. Клеменов // Клиническая медицина. – 2003. – №10. – С.4-7.
  5. Мартынов, А.И. Маркеры дисплазии соединительной ткани у больных с идиопатическим пролабированием атриовентрикулярных клапанов и с аномально расположенными хордами / А.И. Мартынов, О.В. Степура, О.Д. Остроумова // Терапевтический архив. – 1996. – №2. – С. 40-43.
  6. Михайлова, А. В. Особенности клинической картины и показателей физической работоспособности у спортсменов с синдромом дисплазии соединительной ткани / А.В. Михайлова, А.В. Смоленский // Клиническая медицина. – 2004. – №8. – С. 44-47.
  7. Материалы VI конференции ассоциации флебологов России, Москва, 23-25 мая 2006 г. – Москва, 2006. – 160 с.
  8. Фенотипический симптомокомплекс дисплазии соединительной ткани у женщин / Т.Ю. Смольнова [и др.] // Клиническая медицина. – 2003. – №8. – С. 42-48.
  9. Цуканов, Ю.Т. Варикозная болезнь вен нижних конечностей как следствие дисплазии соединительной ткани / Ю.Т.Цуканов, А.Ю. Цуканов // Ангиология и сосудистая хирургия. – 2004. – Т.10., №2. – С. 84-89.
  10. Яковлев, В.М. Иммунопатологические синдромы при наследственной дисплазии соединительной ткани / В.М. Яковлев, А.В. Глотов, А.В. Ягода.– Ставрополь, 2005. – 234 с.

S.A. SUSHKOV, P.A. KUKHTENKOV, A.G. PAVLOV

COMPARISON OF DIFFERENT WAYS OF THE SHIN PERFORANT VEINS TREATMENT AT CHRONIC VENOUS INSUFFICIENCY

Treatment analysis of 76 patients operated on because of chronic venous insufficiency with marked trophic disturbances is performed. The patients were divided into 3 groups. In the 1st one in order to liquidate the horizontal blood reflux subfascial ligation of the perforant veins from access according to D. Felder was carried out; in the 2nd – endoscopic dissection of the perforant veins; in the 3rd – supfascial ligation of the perforant veins in combination with distant occlusion of the posterior tibial veins.
The performed analysis shows that in the patients with chronic venous insufficiency at the marked trophic disturbances subfascial ligation of perforant veins from access according to D. Felder is the worst variant of the operative treatment. endoscopic dissection of perforant veins should be regarded an optimal choice. Perforant veins subfascial ligation is only in the u/3 and the m/3 in combination with distant posterior tibial veins occlusion can be carried out at any surgical department and its results are significantly better than at subfascial ligation of perforant veins from access according to D. Felder and are comparable in case of endoscopic dissection application.

Keywords: chronic venous insufficiency, operative treatment, Felder’s operation, endoscopic dissection, distant occlusion
p. 38 - 44 of the original issue
References
  1. Веденский, А.Н. Варикозная болезнь / А.Н. Веденский. – Л.: Медицина, 1983. – 208 с.
  2. Веденский, А.Н. Новый способ коррекции патологического кровотока в венах голени / А.Н. Веденский // Вестник хирургии. – 1988. – №4. – С. 143-144.
  3. Гавриленко, А.В. Диагностика и лечение хронической венозной недостаточности нижних конечностей / А.В.Гавриленко. – Москва, 1999. – 152 с.
  4. Гришин, И.Н. Варикоз и варикозная болезнь нижних конечностей / И.Н. Гришин, В.Н. Подгайский, И.С. Старосветская. – Мн.: Выш.шк., 2005. – 253 с.
  5. Киршин, А.А. Патофизиологические аспекты гемодинамики в хирургии хронической венозной недостаточности нижних конечностей / А.А. Киршин, М.Ф. Муравьев // Практическая флебология. – Самара, 1991. – С. 30-38.
  6. Осложненные формы хронической венозной недостаточности нижних конечностей / М.Д. Ханевич [и др.]. – М.: МедЭкспертПресс; Петрозаводск: ИнтелТек, 2003. – 176 с.
  7. Ошибки, опасности и осложнения в хирургии вен: руководство для врачей / под ред. Ю.Л. Шевченко. – СПб: Питер Ком, 1999. – 320 с.
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M.A. KRISHTOPOVA, V.S. KUNITSKY, O.D. MYADELETS

EXPERIMENTAL-MORPHOLOGICAL GROUNDING OF POLYETHER COMPLEX FIBERS IMPLANT USE IN SEPTOPLASTY

To ground the application possibilities of the cloth gauze implant to restore the osteal-cartilage framework of the nasal septum after its correction because of curvature we used cloth gauze implant from polyether fibers for the nasal septum plasty in the experimental research on the laboratory animals (rabbits of the chinchilla breed). The open rhinoseptoplasty technique was used to operate on 18 animals. The animals were excluded from the experiment – 3 rabbits every 3, 7, 15, 30, 60 and 120 days after the operation. Histological cuts were stained with hematoxiline-eozine and azan. The following indexes were evaluated: the state of animals (everyday during 4 months), their behavior (active, passive, depressed); the control over the operation wound took place, the character of nasal discharging was evaluated; visual control over the mucous nasal membrane was performed as well as visual estimation of the dissected septum fragment (in the 1, 7, 15, 30, 60 and 120 days after the operation); morphological changes of implants and surrounding tissues of the nasal septum ((in the 1, 7, 15, 30, 60 and 120 days after the operation) were registered. The research results showed that the polyether complex fibers cloth gauze implant suppresses the development of the inflammatory reaction decreasing its intensity. During the period from the 3 to 15 days after the operation the signs of inflammatory reaction were observed in the mucous membrane, around the implant. The cartilage had’t almost changed. 30 days after the operation the implant sprouted with thin connective tissue fibers. The character of the inflammatory reaction tended to decrease. There were no signs of rejection. The cartilage didn’t reveal any signs of changes. The signs of the regeneration hypertrophy of the cartilage tissue appeared in the 30-60 days. By the 120th day after the operation a complete restoration of the nasal septum structure and germination of the implant with mature collagen fibers had completed. Thus one may conclude that the polyether complex fibers cloth gauze implant in the complex with the quadrangular cartilage can be used as an implant during the correction of the posttraumatic nasal septum deformations when there is deficiency of the autogenic cartilage. Porous implant structure contributes to its germination with connective tissue fibers increasing thus the nasal septum firmness. Besides the signs of the cartilage regeneration were revealed.

Keywords: nasal septum deformation, septoplasty, gauze implant, polyether fibers, cartilage regeneration
p. 45 - 54 of the original issue
References
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A.V. FROLOVA, A.V. KULIKOV, L.V. SIROZH

CLINICAL APPROBATION OF THE PLANT ORIGIN MEDICINAL PREPARATION “PHYTOMP” AT THE MIDDLE EAR DISEASE

Despite of the significant achievements obtained in the sphere of otorhinolaryngology, chronic purulent medium otitis (CPMO) is still rather prevalent and composes 57% from the total number of middle ear inflammatory diseases. Differential approach to the CPMO treatment includes not only influencing the disease agent but also the mucous membrane of the tympanum cavity as well as in the liquidation of the inflammatory changes without causing irritating action on the ear passage skin. The majority of the proposed preparations have only single-directed action. We have approbated the plant origin medicinal preparation “PhytoMP” made from the macleya and plantain while treating the patients with chronic purulent medium otitis. To evaluate the preparation “PhytoMP” efficacy the whole set of diagnostic methods was used (cytological investigation of the separated from the tympanum cavity, bacteriological investigation of microflora with its sensitivity to the medicinal preparation “PhytoMP” and antibiotics determining, phagocytosis activity determination) as well as the investigation of the ear tube function, X-ray and general clinical examination. It was erstablished that the preparation “PhytoMP” had marked antimicrobial and repairing process stimulating effect, it showed adsorbing activity at profuse exudation.

Keywords: middle ear disease, purulent medium otitis, chronic otitis, phytotherapy
p. 55 - 61 of the original issue
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E.A. ASKERKO

TREATMENT OF THE SHOULDER ROTATOR CUFF TENDINOUS

Inside tendon changes in the form of hydroksiopatite calcium deposits determine the pathology of short shoulder rotators. The reasons of calcification tendinous are unknown. The majority of patients are subjected to the treatment in painful resorptive phase, but in some cases treatment is performed because of the pain development at calcinate wedging under the acromial appendix of the shoulder-blade. In the article dedicated to the treatment of 16 patients with the shoulder rotator cuff tendinous the techniques of complex medical rehabilitation are suggested used in the hospital of traumatology and orthopedy of Vitebsk medical university. Profound analysis of nearest and distant treatment results depending on the phase of symptomatic calcification tendinous was performed. It was noted that the treatment experience of patients with symptomatic calcification tendinous of the shoulder rotator cuff showed significant difficulties in choice of the operative intervention volume because of variety of this pathology clinical manifestations and changes of the cuff tendons. Though the results of treatment of patients applying the used tactics were good at the average clinical index 4,97±0,06 scores and shoulder-scapular angle opening of 99,31±5,29° in terms of 5,33±1,40 months. It was shown that longer terms of restoration of the upper limb function in some patients are determined by the expanded volume of the operation and presence of the external shoulder joint immobilization in the postoperative period.

Keywords: shoulder rotator cuff, calcification tendinous, operative treatment, medical rehabilitation
p. 62 - 68 of the original issue
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E.A. ASKERKO

MISTAKES AND COMPLICATIONS AT COMPLEX REHABILITATION OF THE PATIENTS WITH SHOULDER ROTATOR CUFF PATHOLOGY

It has been pointed out in the article that introduction to the practice of restorative-reconstructive operations on the shoulder rotator cuff in the initial period of formation results in many committed mistakes and complications. The mistakes which are made and errors lead to the worsening of the functional outcomes, to time extension of the operational intervention and to significant prolongation of the rehabilitation period. The mistakes and errors are made at the stages of planning and performing of the operations as well as during the patient’s rehabilitation and repeated operations when metallic constructions are removed. Familiarization with these mistakes can help to prevent their recurrence and to avoid complications.
In the article all mistakes, errors and complications are studied in detail and recommendations concerning their avoidance are given. It is pointed out that treatment of the patients with short shoulder rotator pathologies should be complex and together with atraumatic operative interventions should include correcting impacts aimed to eliminate factors causing movement restriction in the shoulder joint in the preoperative period. It is also necessary to use kinesitherapy together with traditional physioprocedures, various blockages and electrostimulation of the shoulder muscle.

Keywords: shoulder rotator cuff, reconstructive operations, complications, treatment mistakes, rehabilitation
p. 69 - 74 of the original issue
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