|

Ru | En

Android Applicaion

Year 2014 Vol. 22 No 2

HISTORY SURGERY

DOI: http://dx.doi.org/10.18484/2305-0047.2014.2.137   |  

E. MATEVOSSIAN ¹, I. SNOPOK ², J. NäHRIG ³, I. SINICINA ⁴, D. DOLL ⁵

HISTORICAL FACTS ABOUT FIRST IN THE WORLD CLINICAL POSTMORTEM EXPLANTATION AND CONSEQUENT ALLOGENIC HETEROTOPIC TRANSPLANTATION OF DONOR KIDNEY: LEGENDARY LIFE PAGES OF PROMINENT SURGEON Y. VORONOY

“Rechts der Isar” Hospital of Technical University of Munich ¹, Munich,
St. Lukas Hospital, Solingen ²,
Institute of General Pathology and Pathologic Anatomy,
“Rechts der Isar” Hospital of Technical University of Munich ³, Munich,
Ludwig-Maximilian Institute of Forensic Medicine, Innenstadt Hospital and Technical University of Munich ⁴, Munich ,
St. Mary's Hospital, Academic Teaching Hospital Hannover University, Vechta ⁵,
Federal Republic of Germany

Kidney transplants are one of the most common transplant operations in the modern transplantology saving annually tens of thousands of lives worldwide. This technique has come a long way of development before reaching the current state. Such world famous scientists and surgeons as Carrel, Landsteiner, Hufnagel and Murray were pioneers of the kidney transplantation. The honorable place among them belongs also to the Ukrainian surgeon Yury Voronoy who performed the first human-to-human renal transplant using cadaver organ. Astonishing is that until recently this fact hasn’t been known to the world medical community.
In the present paper we aim to review the archival literature about Yury Voronoy and present a new independent view at the biography of this prominent surgeon and scientist. We have also tried to describe and analyze the first in the world clinical kidney explantation and allotransplatation to human carried out in 1933 by Voronoy. In addition we had the goal to perform a retrospective analysis of the results of all the kidney transplantations that he performed and evaluate them in respect on their importance for the development of the transplantology. We have also tried to review the researches of this scientist in the other branches of surgery.
Yury Voronoy was not an ordinary person, surgeon and scientist who, despite all the unfavorable political and social circumstances of his time by fate and thanks to the force of his own character, became a pioneer of the world kidney transplantation. The results of the clinical transplantations performed by Yury Voronoy were an important source of the primary knowledge that allowed developing this method for the surgeons of the western countries. Every patient with the transplanted kidney, as a matter of fact, to a certain extent is obliged by his life to Yury Voronoy.

Keywords: history of medicine, history of transplantology, kidney transplantation, Y.Y. Voronoy

p. 137 – 149 of the original issue

References

1. Starzl TE. History of clinical transplantation. World J Surg. 2000 Jul;24(7):759-82.
2. Matevossian E, Kern H, Huser N, Doll D, Snopok Y, Nahrig J, Altomonte J, Sinicina I, Friess H, Thorban S. Surgeon Yurii Voronoy (1895-1961) - a pioneer in the history of clinical transplantation: in memoriam at the 75th anniversary of the first human kidney transplantation. Transpl Int. 2009 Dec;22(12):1132-9.
3. Mirskii MB. Pervaia peresadka pochki v klinike (k 50 -letiiu operatsii sovetskogo khirurga Iu.Iu. Voronogo) [The 1st clinical kidney transplant (to the 50th anniversary of the operation by the Soviet surgeon Iu. Iu. Voronoy)]. Klin Med. 1983; 61:147-149.
4. Hume DM, Merrill JP, Miller BF, Thorn GW. Expiriences with renal homotransplantation in the human. J Clin Invest. 1955 Feb;34(2):327–82.
5. Korol' IE, Poliukh II, Volchenko SIu. Stranitsy zhizni Voronogo [Pages of Voronoy life]. 2007, Kherson, Ukraine:1-12.
6. Ullmann E (1902) Experimentelle Nierentransplantation. Vorlaufige Mittheilung. Wien Klin Wochenschr 15:281–82
7. Shumakov VI, Onishchenko NA, Shtengol'd ESh. Konservatsiia organov [Conservation of organs]. Moscow, SSSR: Meditsina; 1981. 250 p.
8. Voronoi IuIu. K voprosu o blokade retikuloendotelial'nogo apparata u cheloveka pri nekotorykh formakh otravleniia sulemoi i o svobodnoi peresadki tseloi pochki, vziatoi u trupa, kak metoda lecheniia anurii pri etom otravlenii [The blockade of the reticuloendothelial apparatus in humans with some forms of poisoning with mercuric chloride and free transplantation of the whole kidney taken from the corpse, as a method of anuria treatment]. V kn. Trudy Vseukrainskogo instituta neotlozhnoi khirurgii i perelivaniia krovi. Dnepropetrovsk; 1934. p. 221–33.
9. Carrel A, Guthrie CC. Successful transplantation of both kidneys from a dog into a bitch with removal of both normal kidneys from the latter. Science. 1906 Mar 9;23(584):394–95.
10. Carrel D. Operative technic of vascular anastomoses and visceral transplantation. Lyon Med. 1964 Dec 20;212:1561–68.
11. Petrovskii BV, Solov'ev GM, Govallo VI, Iarmolinskii IS, Krylov VS. Peresadka pochki: (Biologicheskie i klinicheskie aspekty) [Kidney transplantation: (Biological and clinical aspects)]. AMN SSSR. Moscow, SSSR: Meditsina; Warsaw: Gos Pol'sk med izd-vo; 1969. 250 p.
12. Voronoy YY. До питання про специфічні комплемент-в’язальні антитіла за вільного пересаджування нирки із застосуванням швасудин [Some aspects of the specific compliment-binding antibodies with free kidney transplantation using vascular suture]. Україн Мед Арх. 1930;6:33-46.
13. Voronoi Iu.Iu. Do pitannia pro roliu ta znachіnnia spetsifіchnikh komplement-v’iazal'nikh antitіl za vіl'nogo peresadzhuvannia testis [The role and significance of specific compliment-binding antibodies in free testis transplantation]. Ukraїn Med Arkh. 1929;(4): 69.
14. Mirskii MB. Pioner klinicheskoi transplantologii (k 110-letiiu so dnia rozhdeniia professora Iu.Iu. Voronogo) [The pioneer of clinical transplantology (to the 110th anniversary professor Yu. Yu. Voronoi)]. Klіn Khіr. 2005; (6): 60-64.
15. Stefoni S, Campieri C, Donati G, Orlandi V. The history of clinical renal transplant. J Nephrol. 2004 May-Jun;17(3):475-8.
16. Mirskii MB. Istoriia eksperimental'noi i klinicheskoi transplantatsii pochki [History of experimental and clinical kidney transplantation]. Vestn Khir im II Grekova 1979;122(5):143-145.
17. Nechai A I. K voprosu o pervoi v mire allotransplantatsii pochki ot trupa cheloveku [The question of the 1st in the world cadaveric kidney allotransplantation to man]. Vestn Khir im II Grekova 1999;158(4):101-102 Trudy 4-go Vseukrainskogo s"ezda khirurgov [Proceedings of the 4th All-Ukrainian congress of surgeons]; 1930 Sent 6–10; Khar'kov. Dnepropetrovsk, Ukraina; 1931. 368 p.
18. Woronoy U. Die Immunitat bei Organtransplantation- II Mitteilung. Uber spezifische komplementbindende Antikorper bei freier Nierentransplantation mittelst Gefassnaht. Arch f Klin Chir 1929;171: 386
19. Kirpatovskii ID, Bykova NA. Peresadka pochki [Kidney transplantation]. Moscow, AMN SSSR. 1969. 232 p.
20. Mirskii MB. Sovetskii khirurg Iu.Iu. Voronoi – pioner klinicheskoi allotransplantatsii trupnoi pochki [Soviet surgeon Iu. Iu. Voronoi - a pioneer in clinical allotransplantation of cadaveric kidney]. Klin Khir. 1973;(5):76-81.
21. Voronoi Iu Iu. Peresadka konservirovannoi trupnoi pochki, kak metod biostimuliatsii pri tiazhelykh nefritakh [Transplantation of a conserved cadaveric kidney as a method of biostimulation in severe nephritides]. Vrach Delo. 1950;(9): 813–816.
22. Voronoy YY. Sobre el bloqueo del aparato reticuloendotelial del hombre en - de intoxicacion por el sublimado y sobre la transplantacion del rinon cadaverico - consecutiva a aquella intoxication. El Siglo Med 1936; 97:296-298 (March) )
23. Mozhdrakov G. Popov N. Bolezni pochek [Kidney disease]. Meditsina i Fizkul'tura. Sofiia, 1980. p. 786.
24. Aimanbekov MA. Kak prodlit' zhizn' cheloveka ? (peresadka organov i tkanei) [How to extend the human life? (transplantation of organs and tissues)]. Frunze, SSSR: Kyrgyzstan; 1983. p. 20, 33.

Address for correspondence:
Priv.-Doz. Dr. med. habil. Edouard Matevossian, Department of Surgery, Transplantationszentrum München Klinikum rechts der Isar, Technische Universität München, Ismaningerstrasse 22, 81675 Munich, Germany,
e-mail: edouard.matevossian@tum.deс

Information about the authors:
Matevossian E. MD, PhD, a head of the department of transplantation surgery and transplantation, an assistant professor, “Rechts der Isar” hospital of Technical University of Munich, Munich, Germany.
Snopok I. An assistant physician of the surgical unit, St. Lukas hospital, Solingen, Germany.
Nährig J. MD, PhD, Chief physician of the Pathological-anatomical Institute, pathologist, an associate professor, “Rechts der Isar” hospital of Technical University of Munich, Munich, Germany.
Sinicina I. MD, PhD, a head physician of the Institute of Forensic Medicine, an associate professor, Innenstadt Hospital, University of Ludwig-Maximillians and “Rechts der Isar” hospital of Technical University of Munich, Munich, Germany.
Doll D. MD, PhD, Chief physician of the surgery unit, surgeon, an associate professor, Catholic hospital of Oldenburg, St. Mary's Hospital, Vechta, Germany.

Article in the .pdf format

EXPERIMENTAL SURGERY

DOI: http://dx.doi.org/10.18484/2305-0047.2014.2.150   |  

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

MODELING AND CORRECTION OF EXPERIMENTAL VENOUS ENDOTHELIAL DYSFUNCTION

HBEE HPE “Ryazan State Medical University named after academician I.P. Pavlov”,
The Russian Federation

Objectives. To estimate the different ways of the venous endothelial dysfunction modeling in experiment and study its further correction using the micronized purified flavonoid fraction (MPFF).
Methods. The experiment was carried out on 105 Wistar rats divided into 3 groups: the 1^st one – the model of deep venous thrombosis, the 2^nd – the model of the postthrombotic syndrome and the 3^rd group – the model of L-NAME-induced endothelial dysfunction. The micronized purified flavonoid fraction was administrated within 6 months in the dosage 100 mg/kg/day. At the scheduled time the blood sampling was performed in 7 animals with their further euthanasia. The following metabolites have been determined: super oxide dismutase (SOD), malone dialdehyde (MDA) and nitric oxide (II) (NO).
Results. In all groups a reliable reduction of metabolites of nitric oxide (II), increasing of MDA level and, as a consequence, compensatory activation of antioxidant system, manifested in the increase of SOD level have been revealed. The authentic decreasing of NO and SOD levels, and increasing of MDA level and as the result a compensatory activity of antioxidant system, manifesting in the increase in the SOD level have been found out in all groups. The administration of the micronized purified fraction of flavonoids has led to the reliable (р<0,05) increasing of NO synthesis and decreasing of MDA and SOD levels in all groups during the experiment. All studied readings had reached their initial levels by the 1^st month of the research and remained on these levels within whole period of the experiment. It is likely, that SOD activity on the background of the micronized purified fraction of flavonoids administration decreased due to lipid peroxidation products reduction being a prerequisite for positive effects of NO realization.
Conclusions. The performed research has proved that the reproduced models allow making all requisite conditions for studying different diseases of the venous system in experiment. The administration of the micronized purified fraction of flavonoids makes a positive influence on the endothelium functional state characterizing by the increase of nitric oxide (II) level and reduction of free-radical oxidation.

Keywords: endothelial dysfunction, micronized purified fraction of flavonoids, thrombosis, postthrombotic syndrome

p. 150 – 154 of the original issue

References

1. Lilienfeld DE. Decreasing mortality from pulmonary embolism in the United States, 1979-1996. Int J Epidemiol. 2000 Jun;29(3):465–69.
2. Heit JA. Venous thromboembolism: disease burden, outcomes and risk factors. J Thromb Haemost. 2005 Aug;3(8):1611–17.
3. Pokrovskii AV, Sapelkin SV. Khronicheskaia venoznaia nedostatochnost' nizhnikh konechnostei, sovremennye problemy diagnostiki, klassifikatsii, lecheniia [Chronic venous insufficiency of the lower limbs, the current problems of diagnosis, classification, treatment]. Angiologiia i Sosud Khirurgiia. 2003;9(1):53–60.
4. Kalinin RE. Problema perekisnogo okisleniia lipidov v sosudistoi khirurgii: (obzor literatury) [The problem of lipid peroxidation in vascular surgery (review)]. Ros Med-Biol Vestn im Akad IP Pavlova. 2006;(3):84–89.
5. Kirichuk VF, Glybochko VF. Disfunktsiia endoteliia [Endothelial dysfunction]. Saratov, RF: Izd-vo SGMU; 2008. 110 p.
6. Granik VG, Grigor'ev NB. Oksid azota (NO) [Nitric oxide (NO)]. Novyi put' k poisku lekarstv. Moscow, RF: Vuzovskaia kniga; 2004. 360 p.
7. Kuznetsova IV, Shevela AI, Morozov VV, Novikova VV, Marchukov SV, Sevost'ianova KS, Maiborodin IV. Eksperimental'nye modeli venoznogo tromboza i vozmozhnost' primeneniia kletochnykh tekhnologii dlia korrektsii tromboticheskikh sostoianii [Experimental model of venous thrombosis and the possibility of cell technologies application for correction of thrombotic conditions]. Flebologiia. 2012;6(1):43–47.
8. Bogachev VIu, Golovanova OV, Kuznetsov AN, Shekoian AO. Bioflavonoidy i ikh znachenie v angiologii. Fokus na diosmin [Bioflavonoids and their role in angiology. Focus on diosmin]. Angiologiia i Sosud Khirurgiia. 2013;19(1):73–81.
9. Silambarasan T, Raja B. Diosmin, a bioflavonoid reverses alterations in blood pressure, nitric oxide, lipid peroxides and antioxidant status in DOCA-salt induced hypertensive rats. Eur J Pharmacol. 2012 Mar 15;679(1-3):81–89.
10. Kostiuk VA, Potapovich AM, Kovaleva ZhV. Prostoi i chuvstvitel'nyi metod opredeleniia aktivnosti superoksiddismutazy, osnovannyi na reaktsii okisleniia kvertsetina [Simple and sensitive method for the determination of superoxide dismutase activity based on quercetin oxidation]. Vopr Med Khimii. 1990;(2):88–91.
11. Korobeinikova EN. Modifikatsiia opredeleniia produktov perekisnogo okisleniia lipidov v reaktsii s tiobarbiturovoi kislotoi [Modification of the determination of lipid peroxidation products in the reaction with thiobarbituric acid]. Lab Delo. 1989;(7):8–9.
12. Metel'skaia V.P., Chumanova N.G. Skrining-metod opredeleniia urovnia metabolitov oksida azota v syvorotke krovi [The screening method for determining the level of nitric oxide in serum]. Klin Lab Diagn. 2005:6:15–18.
13. Jerjes-Sanchez C. Venous and arterial thrombosis: a continuous spectrum of the same disease? Eur Heart J. 2005 Jan;26(1):3–4.
14. Prandoni P, Bilora F, Marchiori A, Bernardi E, Petrobelli F, Lensing AW, Prins MH, Girolami A. An association between atherosclerosis and venous thrombosis. N Engl J Med. 2003 Apr 10;348(15):1435–41.

Address for correspondence:
390026, Rossiiskaia Federatsiia, g. Riazan', ul. Vysokovol'tnaia, d. 9, kafedra angiologii, sosudistoi, operativnoi khirurgii i topograficheskoi anatomii GBOU VPO «Riazanskii gosudarstvennyi meditsinskii universitet im. akad. I.P. Pavlova»,
e-mail: anovikovn@rambler.ru,
Novikov Aleksei Nikolaevich

Information about the authors:
Kalinin R.E. MD, professor, a head of the angiology, vascular, operative surgery and topographic anatomy chair of SBEE HPE “Ryazan State Medical University named after academician I.P. Pavlov”.
Suchkov I.A. PhD, an associate professor of the angiology, vascular, operative surgery and topographic anatomy chair of SBEE HPE “Ryazan State Medical University named after academician I.P. Pavlov”.
Novikov A.N. An intramural post-graduate student of the angiology, vascular, operative surgery and topographic anatomy chair of SBEE HPE “Ryazan State Medical University named after academician I.P. Pavlov”.
Pshennikov A.S. PhD, an assistant of the angiology, vascular, operative surgery and topographic anatomy chair of SBEE HPE “Ryazan State Medical University named after academician I.P. Pavlov”.

Article in the .pdf format

GENERAL AND SPECIAL SURGERY

DOI: http://dx.doi.org/10.18484/2305-0047.2014.2.155   |  

S.L. ZYBLEV, Z.A. DUNDAROV

APPLICATION OF ANTIOXIDANTS IN ACUTE GASTRODUODENAL ULCER BLEEDING

EE "Gomel State Medical University”
The Republic of Belarus

Objectives. To examine the effectiveness of using the drug "Citoflavin” in patients with the acute gastroduodenal ulcer bleeding.
Methods. The research enrolled 76 patients divided into two groups. In the first group the drug "Citoflavin" was included into the complex of intensive therapy. In the second group the traditional therapy of acute blood loss was carried out. The number of erythrocytes, hemoglobin concentration, blood biochemical values, acid-base balance, gases and blood electrolytes of patients were evaluated. The level of antioxidant activity (АОА) of the blood serum was analyzed.
Results. On admission the significant depletion of the antioxidant properties of blood serum and a significant increase substances with prooxidant activity have been observed. Within 48 hours the blood serum of patients of the second group had prooxidant activity testifying to the development of oxidative stress. After 24 hours blood serum of the first group had antioxidant activity. After 48 hours AOA rate did not differ from the rate of healthy people. Hyperglycemia, hyperuremiya, hyperasotemia and hyperuricemia were observed in the blood biochemical analysis of all patients on admission. During the first day the blood biochemical parameters reached the normal values in the first group. High efficiency of the antioxidant complex "Citoflavin" for the correction of metabolic posthemorrhagic changes has been found out. Introduction of the antioxidant complex eliminates the prevalence of peroxidation processes and prevent the oxidative stress which has developed as a result of acute severe blood loss. In the first group the reduction of hospital stay length and mortality in comparison with the second group have been registered.
Conclusions. As a result of severe blood loss the oxidative stress with the depletion of the antioxidant defense system of the organism has developed that exponentiates the occurrence of the organ dysfunction. Standard treatment regimen does not allow to fill the antioxidant capacity of the body and reduce the peroxidation processes. The use of antioxidants at acute blood loss is known as the effective measure of oxidative stress cupping improves the treatment results of patients.

Keywords: gastroduodenal bleeding, severe blood loss, oxidative stress, antioxidantss

p. 155 – 163 of the original issue

References

1. Klimov AE, Lebedev NV, Barkhudarov TV, Malkarov MA. Taktika lecheniia bol'nykh s iazvennymi gastroduodenal'nymi krovotecheniiami [Tactics of treatment of patients with ulcerative gastroduodenal bleedings]. Vestn Khirurgii im II Grekova. 2007;(4):76-79.
2. Simonenkov AP. O edinstve tkanevoi gipoksii i shoka [Some aspects of unification of tissue hypoxia and shock]. Anesteziol i Reanimatol. 2000; (6):73-76.
3. Murphy MP. How mitochondria produce reactive oxygen species. Biochem J. 2009 Jan 1;417(1):1-13.
4. Pasechnik IN. Okislitel'nyi stress i kriticheskie sostoianiia u khirurgicheskikh bol'nykh [Oxidative stress and the critical conditions in the surgical patients]. Vestn Intensiv Terapii. 2004;( 3):27 – 31.
5. Sazontova TG, Arkhipenko IuV. Znachenie balansa prooksidantov i antioksidantov - ravnoznachnykh uchastnikov metabolizma [The role of the balance of pro-oxidants and antioxidants – the equivalent participants of metabolism]. Patolog Fiziologiia i Eksperiment Terapiia. 2007;(3):2-18.
6. Afanas'ev VV. Klinicheskaia farmakologiia reamberina [Clinical pharmacology of reamberin]: posobie dlia vrachei. Saint-Petersburg, RF: OOO Taktik-Studio; 2005. 44 p.
7. Ivnitskii IuIu, Golovko AI, Sofronov GA. Iantarnaia kislota v sisteme sredstv metabolicheskoi korrektsii funktsional'nogo sostoianiia rezistentnosti organizma [Succinic acid in the metabolic correction of functional state of organism resistance]. Saint-Petersburg, RF: Lan'; 1998. 82 p.
8. Luk'ianova LD. Rol' bioenergeticheskikh narushenii v patogeneze gipoksii. [The role of bioenergy disorders in the pathogenesis of hypoxia]. Patolog Fiziol i Eksperiment Terapiia. Moscow, RF: Meditsina; 2004;(2):2-11.
9. Morgunov SS. Korrektsiia tkanevoi gipoksii i protsessov svobodnoradikal'nogo okisleniia pri gastroduodenal'nykh krovotecheniiakh [Correction of tissue hypoxia and free radical oxidation processes at gastroduodenal bleeding]. Khirurgiia. Zhurnal im NI Pirogova. 2011;(9):71-75.
10. Stupin VA, Siluianov SV, Afanas'ev VV, Baglaenko MV, Sabirov MA, Smirnova GO. Osobennosti konservativnoi terapii patsientov s krovotochashchimi iazvami zheludka i dvenadtsatiperstnoi kishki [Features of conservative treatment of patients with bleeding ulcers of the stomach and duodenum]. Farmateka. 2011;(2):58-63.
11. Silina EV, Stupin VA, Sabirov MA, Bolevich SB, Smirnova GO, Siluianov SV, Martirosov AV, Men'shova NI. Svobodnoradikal'nye protsessy u bol'nykh s zheludochno-kishechnymi krovotecheniiami [Free-radical processes in patients with gastrointestinal bleeding]. Khirurgiia. Zhurn im NI Pirogova. 2011;(12):64-70.
12. Gritsuk AI, Cupoma TB, Dravitsa LV, Kreddok EA. Otsenka sostoianiia antioksidantnoi aktivnosti sleznoi zhidkosti [Assessment of antioxidant activity of tear fluid]. Biomed Khimiia. 2006;52(6):601–07.
13. So A, Thorens B. Uric acid transport and disease. J Clin Invest. 2010 Jun;120(6):1791-99.
14. Pochepen' ON. Nutritivnaia podderzhka u tiazhelo obozhzhennykh [Nutritional support in severely burnt patients]. Minsk, RB: BelMAPO; 2009. 25 p.
15. Mesejo A, Vaquerizo Alonso C, Acosta Escribano J, Ortiz Leyba C, Montejo Gonzalez JC; Guidelines for specialized nutritional and metabolic support in the critically-ill patient. Nutr Hosp. 2011 Nov;26 Suppl 2:1-6.

Address for correspondence:
246000, Respublika Belarus', g. Gomel', ul. Lange, d. 5, UO «Gomel'skii gosudarstvennyi meditsinskii universitet», kafedra khirurgicheskikh boleznei №2 s kursami detskoi khirurgii, anesteziologii i reanimatologii,
e-mail: S.zyblev@yandex.ru,
Zyblev Sergei Leonidovich

Information about the authors:
Zyblev S.L. An assistant of the surgical diseases chair №2 with the course of pediatric surgery, anesthesiology and reanimatology of EE “Gomel State Medical University”.
Dundarov Z.A. MD, professor, a head of the surgical diseases chair №2 with the course of pediatric surgery, anesthesiology and reanimatology of EE “Gomel State Medical University”.

Article in the .pdf format

DOI: http://dx.doi.org/10.18484/2305-0047.2014.2.164   |  

O.A. BAULINA, A.S. IVACHEV, V.A. BAULIN, А.А. BAULIN

LAPAROSCOPIC FIXATION OF HIS ANGLE USING XENOPERICARDIAL BAND IN PATIENTS WITH GASTROESOPHAGEAL REFLUX DISEASE

SBEE APE “Penza Institute of Physicians’ Advanced Training”,
The Russian Federation

Objectives. To carry out a comparative evaluation of the results of laparoscopic His angle fixation with the polypropylene mesh and xenopericardial band in patients with gastroesophageal reflux disease.
Methods. Depending on the fixation material type used for the laparoscopic His angle fixation the patients were divided into two groups. In the main group (32 patients) antireflux surgery was performed using biological implant – the calf pericardium. In the comparison group (162 patients) – surgery was performed using polypropylene mesh as a fixation material.
Results. Indications for antireflux surgery were: reflux esophagitis, extraesophageal manifestations of gastroesophageal reflux disease, failure of the cardia, hiatal hernia, ineffective conservative treatment, expressed clinic of gastroesophageal reflux disease, reduction quality of life, the impossibility of an adequate medical treatment due to economic factors, combined abdominal pathology, patient preference even with an effective treatment in the case of the reduced quality of life, lifelong need for conservative treatment and its high cost. In both groups, attention was paid primarily to the prosthesis-associated complications. In the main group there were no such complications and early postoperative complications were: dysphagia during 3 days (3,1%); hyperthermia during 2 days (34,4%). In the distant postoperative period, 95% of clinic, endoscopic and radiographic results may be regarded as good and excellent. In the comparison group prosthesis-related the following complications were observed: suppuration in the mesh area (1,9%); mesh eruption through the posterior wall into the lumen of the esophagus (5,6%); foreign body sensation (2,5%). In the distant period good and excellent results make up 89,5%.
Conclusions. The first positive short- and long-term results manifested good prospects of the new method, using the xenopericardial plate as a fixation material, and possibilities of its introduction in the antireflux surgery.

Keywords: gastroesophageal reflux disease, surgical treatment, laparoscopic fixation of His angle, xenopericard, polypropylene mesh

p. 164 – 170 of the original issue

References

1. Furnee EJ, Draaisma WA, Broeders IA, Gooszen HG. Surgical reintervention after failed antireflux surgery: a systematic review of the literature. 2009 Aug;13(8):1539–49.
2. Karpitskii AS, Pan"ko SV, Zhurbenko GA, Boufalik RI, Shestiuk AM, Vakumich DS, Ignatiuk AN. Sposob khirurgicheskogo lecheniia nedostatochnosti nizhnego pishchevodnogo sfinktera [The method of surgical treatment of insufficiency of the lower esophageal sphincter]. V kn. materialy XVI S"ezda Ros o-va endoskop khirurgov; 2013 Fevr 26–28. Moscow RF. p. 58–59.
3. Gutschow CA, Holscher AH. Surgical treatment of gastroesophageal reflux disease. Langenbecks Arch Surg. 2013 Jun;398(5):661–67.
4. Zalevskii AA. Innovatsionnaia kontseptsiia patogeneza i khirurgicheskogo lecheniia gastroezofageal'noi refliuksnoi bolezni v sochetanii s kardial'noi gryzhei pishchevodnogo otverstiia diafragmy [The innovative concept of the pathogenesis and surgical treatment of gastroesophageal reflux disease in combination with cardiac hiatal hernia]. Krasnoiarsk gos med un-t im VF Voino-Iasenetskogo. Krasnoiarsk, RF: KrasGMU, 2009. 115 p.
5. Alishikhov ShA, Meshkov MV, Bogdanov DIu. Obosnovannost' primeneniia laparoskopicheskikh tekhnologii pri khirurgicheskom lechenii gastroezofageal'noi refliuksnoi bolezni [Validity of the use of laparoscopic techniques in the surgical treatment of gastroesophageal reflux disease]. Al'manakh in-ta khirurgii im AV Vishnevskogo. 20124;7(1). c. 128.
6. Antoniou SA, Koch OO, Antoniou GA, Pointner R, Granderath FA. Mesh-reinforced hiatal hernia repair: a review on the effect on postoperative dysphagia and recurrence. Langenbecks Arch. Surg. 2012 Jan;397(1):19-27.
7. Catarci M, Gentileschi P, Papi C, Carrara A, Marrese R, Gaspari AL, Grassi GB. Evidence-based appraisal of antireflux fundoplication. Ann Surg. 2004 Mar;239(3):325-37.
8. Baulin AA, Baulin VA, Baulina EA, Starov AA. Pat. 2431448 Ros. Federatsiia, MKI6 A 61 V 17/00 Sposob khirurgicheskogo lecheniia gryzh pishchevodnogo otverstiia diafragmy [The method of surgical treatment of hiatal hernia]; zaiavitel' i patentoobladatel' Baulin A.A. 2009111933/14; zaiavl. 31.03.2009; opubl. 20.10.2011 Biul. № 29. Data publikatsii: 20 Oktiabria, 2011
9. Granderath F., Kamolz Т., Pointner R. Gastroesophageal reflux disease. Wien: Springer-Verlag, 2006. p. 320.
10. Kotiv BN, Priadko AS, Vasilevskii DI, Silant'ev DS. Lechenie gryzh pishchevodnogo otverstiia diafragmy s primeneniem setchatykh implantov [Treatment of hiatal hernias with mesh implants using]. Khirurgiia. Zhurn im NI Pirogova. 2012;(4):59–62.
11. Stadlhuber RJ, Sherif AE, Mittal SK, Fitzgibbons RJ Jr, Michael Brunt L, Hunter JG, Demeester TR, Swanstrom LL, Daniel Smith C, Filipi CJ. Mesh complications after prosthetic reinforcement of hiatal closure: a 28-case series. Surg Endosc. 2009 Jun;23(6):1219-26
12. Starodubtsev VA, Kupriianov MP, Belousova IB, Baulin AA, Baulin VA. Blizhaishie i otdalennye endoskopicheskie rezul'taty khirurgicheskogo lecheniia gastroezofageal'noi refliuksnoi bolezni [The short- and long-term results of surgical endoscopic treatment of gastroesophageal reflux disease]. Eksperiment i Klin Gastroenterologiia. 2012;(4):39–42.
13. Tytgat GN, McColl K, Tack J, Holtmann G, Hunt RH, Malfertheiner P, Hungin AP, Batchelor HK. New algorithm for the treatment of gastro-oesophageal reflux disease. Aliment Pharmacol Ther. 2008 Feb 1;27(3):249-56.
14. Burikov MA, Shul'gin OV. Modifitsirovannyi metod laparoskopicheskoi khirurgicheskoi korrektsii gryzhi pishchevodnogo otverstiia diafragmy [The modified method of laparoscopic surgical correction of hiatal hernia]. Al'manakh In-ta khirurgii im AV Vishnevskogo. 2012:7(10):111–12.
15. Mitroshin AN, Sivakon' SV, Mozerov SA, Abdullaev AK, Mitroshin IA. Issledovanie biointegratsii ksenoperikarda pri plastike defektov sukhozhil'no-sviazochnykh struktur. Izvestiia vyssh ucheb zavedenii [Study biointegration xenopericardial in plastic tendon-ligamentous structures defects]. Povolzhsk region. Med nauki. Klin Med. 2010;3(15):35–43.

Address for correspondence:
440060, Rossiiskaia Federatsiia, g. Penza, ul. Stasova, d. 8 A, GBOU DPO «Penzenskii institut usovershenstvovaniia vrachei», kafedra khirurgii i endoskopii,
e-mail: olga.kosenko@mail.ru,
Baulina Ol'ga Aleksandrovna

Information about the authors:
Baulina O.A. A post-graduate student of the surgery and endoscopy chair of SBEE APE “Penza Institute for Advanced Training of Physicians”.
Ivachev A.S. MD, professor, a head of the surgery and endoscopy chair of SBEE APE “Penza Institute for Advanced Training of Physicians”.
Baulin V.A. PhD, an assistant of the surgery and endoscopy chair of SBEE APE “Penza Institute for Advanced Training of Physicians”.
Baulin A.A. MD, professor of the surgery and endoscopy chair of SBEE APE “Penza Institute for Advanced Training of Physicians”.

Article in the .pdf format

DOI: http://dx.doi.org/10.18484/2305-0047.2014.2.171   |  

V.N. OCHKOLYAS ¹, G.YU. SOKURENKO ²

THE EVALUATION OF EXPRESSION OF CEREBRAL ISCHEMIA AFTER SURGICAL TREATMENT OF THE INTERNAL CAROTID ARTERY PATHOLOGY BY DETERMINING THE AUTOANTIBODY LEVEL TO NR2A SUBUNIT OF NMDA GLUTAMATE RECEPTORS

FSEE HPE “First Saint-Petersburg I.P. Pavlov State Medical University” ¹
FSBE “All-Russian Center of Emergency and Radiation Medicine named after A.M. Nikiforov” RMES ² ,
Saint-Petersburg
The Russian Federation

Objectives. Study of the NMDA glutamate receptors reaction on the change of the cerebral blood flow in the internal carotid artery basin in patients with cerebral ischemic disease.
Methods. 92 patients with hemodynamically significant stenosis of the internal carotid artery have been examined. The patients were divided into 2 groups: patients with a sufficient structural and functional potential of the cerebral blood flow compensation and patients with a low structural and functional potential of the cerebral blood flow compensation. The determination of antibody level to NR2A was carried out before the operation (the 1^st period of control), 30 minutes after ICA clamping (the 2^nd period of control), 3 hours after the operation (the 3^rd period of control), 3 days (the 4^th period of control) and 14 days (the 5^th period of control) and 4 weeks after the operation (the 6^th period of control). The immunoassay method for the semiquantitative determination of the antibodies level to NR2A subunit of NMDA receptors of glutamate was applied.
Results. It has been established that the alteration of NMDA glutamate receptors prevailed in the group of patients with a low potential of structural and functional compensation of the cerebral blood flow. Deterioration of the cerebral blood flow during the period of carotid artery clamping is considered as a factor objectively aggravating the degree of hypoxia in the affected vascular pool and amplifying the degree of alteration of NMDA glutamate receptors. Wherein the longer the clamping of the ICA, the greater destructive effect on the NMDA glutamate receptors occurs via the implementation of excitotoxicity mechanisms.
Conclusions. Objective estimation of the cerebral ischemia degree as well as the evaluation of the adjuvant therapy efficacy is known as one of the primary conditions for the treatment of patients with ischemic brain. In this regard the level of AAT to NR2A subunit of NMDA glutamate receptors is considered as an objective criterion for the effectiveness of the cerebral blood flow and allows evaluating both the cerebral ischemic disease course and the effectiveness of the therapeutic measures.

Keywords: ischemic stroke, carotid endarterectomy, NMDA glutamate receptors

p. 171 – 178 of the original issue

References

1. Gusev EI, Skvortsova VI. Ishemiia golovnogo mozga [Cerebral ischemia]. Moscow, RF: Meditsina; 2001. 328 p.
2. Warlow C, van Gijn J, Dennis M, Wardlaw J, Bamford J, Hankey G, Peter AG,, Rinkel G, Langhorne P, Sudlow C, Rothwell P. Stroke – Practical Management, 3^rd ed. Oxford, Blackwell, 2008, 1008 p.
3. Dambinova SA, Skoromets AA, Skoromets AP. Biomarkery tserebral'noi ishemii (razrabotka, issledovanie i praktika) [Biomarkers of cerebral ischemia (development, research and practice)]. Saint-Petersburg, RF: Kosta, RF; 2013. 336 p.
4. Hazell AS. Excitotoxic mechanisms in stroke: an update of concepts and treatment strategies. 2007 Jun;50(7-8):941-53.
5. Roach ES, Bettermann K, Biler J. Toole’s Cerebrovascular Disorders 6th Edition. Cambridge University Press, Cambridge, UK: 2010.- 408 p.
6. Hassel B, Dingledine R. Glutamate and glutamate receptors Basic Neurochemistry: Principles of molecular, cellular and medical neurobiology. Editors ST Brady, GJ Siegel, RW Albers & DL Price. Eighth edition, 2012, Academic Press, Academic Press; 2012. 1096 p.
7. Bayir H, Kagan VE. Bench-to-bedside review: Mitochondrial injury, oxidative stress and apoptosis--there is nothing more practical than a good theory. Crit Care. 2008;12(1):206.
8. Dambinova SA. Biomarkers for transient ischemic attack (TIA) and ischemic stroke. Clin Lab Int. 2008;32: 7–10.
9. Dambinova SA, Bettermann K, Glynn T, Tews M, Olson D, Weissman JD, Sowell RL.Diagnostic potential of the NMDA receptor peptide assay for acute ischemic stroke. PLoS One. 2012;7(7):e42362.
10. Weissman JD, Khunteev GA, Heath R, Dambinova SA. NR2 antibodies: risk assessment of transient ischemic attack (TIA)/stroke in patients with history of isolated and multiple cerebrovascular events. J Neurol Sci. 2011 Jan 15;300(1-2):97-102.
11. Dambinova SA, Izykenova GA. Diagnosticheskii nabor reagentov "cis-test" dlia vyiavleniia ishemicheskoi bolezni golovnogo mozga mlekopitaiushchikh [Diagnostic reagent "cis-test" kit to detect the coronary artery disease of the mammalian brain]: pat. 2146826 Rossiiskaia Federatsiia, MPK 7 G01N33/68C07K2/00, C07K14/705, C07K16/28, C07K17/00, G01N33/535, G01N33/53, A61K39/00; zaiavitel' i patentoobladatel' Dambinova S.A. - № 98107477/13; zaiavl. 24.04.1998; opubl. 20.03.2000, Biul. № 16.
12. Bamford J, Sandercock P, Dennis M, Burn J, Warlow C. Classification and natural history of clinically identifiable subtypes of cerebral infarction. Lancet. 1991 Jun 22;337(8756):1521-6.
13. Mead GE, Lewis SC, Wardlaw JM, Dennis MS, Warlow CP.How well does the Oxfordshire community stroke project classification predict the site and size of the infarct on brain imaging? J Neurol Neurosurg Psychiatry. 2000 May;68(5):558-62.
14. Gaidar BV, Dudanov IP, Parfenov VE, Svistov DV. Ul'trazvukovye metody issledovaniia v diagnostike porazhenii vetvei dugi aorty [Ultrasonic methods in the diagnosis of lesions of the aortic arch branches]. Petrozavodsk, RF; 1994. 71 p.
15. Chevalier JM, Gayral M, Duchemin JF, Beck F, Streichenberger T, Reignier B, Enon B. Reverse endarterectomy of the internal carotid. J Mal Vasc. 1994;19 Suppl A:18–23.

Address for correspondence:
197022, Rossiiskaia Federatsiia, g. Sankt-Peterburg, ul. L. Tolstogo, d. 6-8, FGOU VPO «Pervyi Sankt-Peterburgskii meditsinskii universitet imeni akademika I.P.Pavlova», kafedra nevrologii i neirokhirurgii,
e-mail: ovn@ihb.spb.ru; dumpo@rambler.ru
Ochkolias Vladislav Nikolaevich

Information about the authors:
Ochkolyas V.N. PhD, an associate professor of the neurology and neurosurgery chair with the clinic, FSEE HPE “The First I.P. Pavlov State Medical University of St. Peterburg”.
Sokurenko G.Yu. MD, professor, Chief physician of the clinic № 2 of FSBE “All-Russian Center of Emergency and Radiation Medicine named after A.M. Nikiforov”, MES of Russia, St. Petersburg

Article in the .pdf format

DOI: http://dx.doi.org/10.18484/2305-0047.2014.2.179   |  

A.N. POPOV ¹, B.A.VESELOV ¹, R.R. FASKHIEV¹, E.P. BURLEVA², A.V. NAZAROV¹

BRACHIAL-SUBCLAVIAN FISTULA AS VASCULAR ACCESS CHOICE IN PROBLEMATIC PATIENTS ON CHRONIC HEMODIALYSIS

Municipal Autonomic Establishment “City Clinical Hospital №40” ¹,
SBEE HPE “Ural State Medical University” ²,
Yekaterinburg,
The Russian Federation

Objectives. To determine the structure of complications and functioning time of the brachial - subclavian fistula (BSF).
Methods. During the period from September 2002 to June 2012 23 patients with the end-stage renal disease (ESRD) underwent 25 BSF with polytetrafluoroethylene (two patients twice). The age of patients ranged from 30 to 74 years (M=52 years), there were 15 women, 10 men. The stay duration on chronic hemodialysis before the formation of the fistula ranged from 1 to 132 months (M=44 months). Over the ten-year follow-up period, the complications were analyzed, and the calculation of the cumulative five-year BSF patency using the Kaplan-Meier method was performed.
Results. Totally, 37 complications were registered. The most frequent complication during the use of arteriovenous fistula (AVF) was thought to be thrombosis – in 28 cases. 27 patients underwent thrombectomy and 1 patient – systemic thrombolysis (with thrombolytic drug Actilyse). The maximal number of thrombosis was registered during the first two years – 21 cases (75%), at present 17 (81%) of AVF have been restored. Four aneurysmal resections were performed (n=4). 2 surgeries were performed in patients with infected prosthesis and 2 more operations – the excision of cutaneous fistulas in the projection of BSF without local infection. The BSF cumulative patency through 62 months of follow-up was 48.02% with a standard error – 14,13%.
Conclusions. Formation of the brachial-subclavian fistula from PTFE clarifies acceptable medical options for problematic patients on chronic hemodialysis.

Keywords: сhronic hemodialysis, аrteriovenous fistula, brachial - subclavian fistula, complications, arteriovenous explant, polytetrafluoroethylene

p. 179 – 183 of the original issue

References

1. Bikbov BT, Tomilina NA. Sostoianie zamestitel'noi terapii bol'nykh s khronicheskoi pochechnoi nedostatochnost'iu v Rossiiskoi Federatsii v 1998–2009 gg. (Otchet po dannym Rossiiskogo registra zamestitel'noi pochechnoi terapii)[ State of replacement therapy in patients with chronic renal failure in the Russian Federation in 1998-2009. (Report on the Russian Register data of replacement renal therapy]. Nefrologiia i Dializ. 2011;(13)3:150–64.
2. Gibbons CP. Vascular access in the lower limb. Eur J Vasc Endovasc Surg. 2009 Sep;38(3):373–74.
3. Moisiuk IaG, Beliaev AIu, Inozemtsev AS, Shilo VIu, Denisov AIu, Sharshatkin AV, Kudriavtseva ES, Slesarenko DA. Postoiannyi sosudistyi dostup dlia gemodializa: sovremennye tendentsii [Permanent vascular access for hemodialysis: current trends ]. Nefrologiia i Dializ. 2002;4(1):14–24.
4. NKF-K/DOQI Clinical Practice Guidelines for Vascular Access: update 2000. Am J Kidney Dis. 2001 Jan;37(1 Suppl 1):S137-81.
5. Tordoir1 J, Canaud B, Haage P, Konner K, Basci A, Fouque D, Kooman J, Martin-Malo A, Pedrini L, Pizzarelli F, Tattersall J, Vennegoor V, Wanner C, Wee P, Vanholder R. EBPG on Vascular Access. Nephrol Dial Transplant (2007) 22 (Suppl 2): ii88-iil17.
6. Ganeeva AT, Ganeev TS. Vliianie ob"emnoi skorosti krovotoka po arterio-venoznoi fistule na Ekho-kardiograficheskie razmery pravogo zheludochka serdtsau bol'nykh na programmnom gemodialize [Effect of blood flow velocity on the arteriovenous fistula at the Echo-cardiographic sizes of the right heart ventricle in patients on hemodialysis]. Nefrologiia i Dializ. 2007;9(3):283.
7. Korten E, Toonder IM, Schrama YC, Hop WC, van der Ham AC, Wittens CH. Dialysis fistulae patency and preoperative diameter ultrasound measurements. Eur J Vasc Endovasc Surg. 2007 Apr; 33(4):467–71.
8. Tonnessen BH, Money SR. Embracing the fistula first national vascular access improvement initiative. J Vasc Surg. 2005 Sep; 42(3):585–86.
9. Warnock DG, Tolwani AJ, Gallichio M, Allon M, Ronco C, Levin NW (eds). Vascular grafts for hemodialysis: types, sites and techniques. Hemodialysis vascular access and peritoneal dialysis access. Contrib Nephrol. Basel, Karger, 2004;(142):73–93.
10. NKF KDOQI Guidelines - National Kidney Foundation. Clinical Practice Guidelines and Clinical Practice Recommendations, 2006. www.kidney.org/.../kdoqi/guideline_uphd_pd_.
11. Ljungstrom KG, Troeng T, Bjorck M. Time-trends in vascular access surgery in Sweden 1987-2006. Eur J Vasc Endovasc Surg. 2008 Nov;36(5):592–96.
12. Haimov M. (ed) Vascular access. A practical guide. Futura Publishing Company, Inc. Mount Kisko New York, USA; 1987. 184 p.
13. Polo JR, Tejedor A, Polo J, Sanabia J, Calleja J, Gomez F. Long-term follow-up of 6-8 mm brachioaxillary polytetrafluorethylene grafts for hemodialysis. Artif Organs. 1995 Nov;19(11):1181–84.
14. Savader SJ, Lund GB, Scheel PJ. Forearm loop, upper arm straight, and brachial-internal jugular vein dialysis grafts: a comparison study of graft survival utilizing a combined percutaneous endovascular and surgical maintenance approach. J Vasc Interv Radiol. 1999 May;10(5):537–45.
15. Munda R, First MR, Alexander JW, Linnemann CC Jr, Fidler JP, Kittur D. Polytetrafluoroethylene graft survival in hemodialysis. JAMA. 1983 Jan 14;249(2):219–22.

Address for correspondence:
620102, g. Ekaterinburg, ul. Volgogradskaia, 189, MAU «Gorodskaia klinicheskaia bol'nitsa №40», otdelenie sosudistoi khirurgii,
e-mail: burleva@gkb40.ur.ru,
Burleva Elena Pavlovna

Information about the authors:
Popov A.N. A cardiovascular surgeon of the cardiovascular surgery unit of MAE “City Clinical Hospital №40”, Yekaterinburg.
Veselov B.A. A cardiovascular surgeon of the cardiovascular surgery unit of MAE “City Clinical Hospital №40”, Yekaterinburg.
Faskhiev R.R. A physician of functional and ultrasound diagnostics of the functional diagnostics unit of MAE “City Clinical Hospital №40”, Yekaterinburg.
Burleva E.P. MD, professor of the general surgery chair of SBEE HPE “Ural State Medical University”.
Nazarov A.V. MD, a head of the chronic dialysis and detoxification unit of MAE “City Clinical Hospital №40”, Yekaterinburg.

Article in the .pdf format

DOI: http://dx.doi.org/10.18484/2305-0047.2014.2.184   |  

R.V. SABADOSH

THE ROLE OF SMALL SAPHENOUS VEIN IN THE DEEP VENOUS THROMBOSIS DEVELOPMENT AT ACUTE VARICOSE THROMBOPHLEBITIS OF THE LOWER LIMBS

SHEE “Ivano-Frankovsk National Medical University”,
The Ukraine

Objectives. To improve the treatment results of patients with acute varicose thrombophlebitis (AVTP) of the lower limbs by studying the role of a small saphenous vein (SSV) in the extension of a thrombotic process in the deep venous system.
Methods. 236 patients with AVTP were examined. After the color duplex scanning the limbs were referred to one of 3 groups: the 1^st group with thrombosis of the superficial veins; the 2^nd – the limbs with thrombotic process in the superficial and perforating veins; and the 3^rd – the limbs with thrombotic process in the superficial and deep veins. The thrombosis frequency of SSV and great saphenous vein (GSV) were compared in each of 3 indicated groups as well as inside of the third one.
Results. Among all patients with AVTP, complicated with deep venous thrombosis (DVT), the frequency of GSV thrombosis made up 70.2% (95% CI 55,1-82,7%) and SSV – 34,0% (20,9-49,3%) (p=0,004). Among the same patients but with a pathological reflux in SSV and GSV simultaneously, the frequency of SSV thrombosis composed 88,9% (51,8-99,7%) and GSV – 44,4% (13,7-78,8%) (p=0,007). The frequency of SSV thrombosis in the 2^nd group in contrast to the frequency of thrombosis of GSV was higher than in the 1^st group, and the difference of thrombosis frequency in groups 3 and 1 was statistically higher than for GSV.
Conclusions. From the obtained results it can be concluded that thrombosis of SSV in case of AVTP plays more important role in the development of accompanying DVT than thrombosis of GSV. However, due to the considerably more frequent detection of pathological reflux in the GSV and its thrombosis among all patients with AVTP complicated DVT is more common.

Keywords: superficial vein thrombosis, varicose veins, small saphenous vein, deep venous thrombosis

p. 184 – 190 of the original issue

References

1. Wichers IM, Di Nisio M, Buller HR, Middeldorp S.Treatment of superficial vein thrombosis to prevent deep vein thrombosis and pulmonary embolism: a systematic review. Haematologica. 2005 May;90(5):672–7.
2. Quenet S, Laporte S, Decousus H, Leizorovicz A, Epinat M, Mismetti P; Factors predictive of venous thrombotic complications in patients with isolated superficial vein thrombosis. STENOX Group. J Vasc Surg. 2003 Nov;38(5):944–9.
3. Decousus H, Prandoni P, Mismetti P, Bauersachs RM, Boda Z, Brenner B, Laporte S, Matyas L, Middeldorp S, Sokurenko G, Leizorovicz A. Fondaparinux for the treatment of superficial-vein thrombosis in the legs. CALISTO Study Group. N Engl J Med. 2010 Sep 23;363(13):1222–32.
4. Ascher E, Hanson JN, Salles-Cunha S, Hingorani A. Lesser saphenous vein thrombophlebitis: its natural history and implications for management. Vasc Endovascular Surg. 2003 Nov-Dec;37(6):421–7.
5. Rusin VІ. Anatomotopografіchnі osoblivostі maloї pіdshkіrnoї veni ta vibіr metodu khіrurgіchnogo lіkuvannia gostrogo varikotromboflebіtu [Anatomotopographic features of small saphenous vein and the choice of surgical treatment of acute varicose thrombophlebitis ]. Praktichna Meditsina. 2011;(4):10–19.
6. Chengelis DL, Bendick PJ, Glover JL, Brown OW, Ranval TJ.Progression of superficial venous thrombosis to deep vein thrombosis. J Vasc Surg. 1996 Nov;24(5):745–9.
7. Verlato F, Zucchetta P, Prandoni P, Camporese G, Marzola MC, Salmistraro G, Bui F, Martini R, Rosso F, Andreozzi GM.An unexpectedly high rate of pulmonary embolism in patients with superficial thrombophlebitis of the thigh. J Vasc Surg. 1999 Dec;30(6):1113–5.
8. Kirienko AI, Matiushenko AA, Andriiashkin VV, Son DA. Radikal'noe khirurgicheskoe lechenie ostrogo varikotromboflebita [Radical surgical treatment of acute varicose thrombophlebitis]. Grudn i Serd-Sosud Khirurg. 2003;(2):43–46.
9. Savel'ev VS, Pokrovskii AV, Zatevakhin II, Kirienko AI. Rossiiskie klinicheskie rekomendatsii po diagnostike i lecheniiu khronicheskikh zabolevanii ven [Russian clinical guidelines for the diagnosis and treatment of chronic venous disease]. Flebologiia. 2013;7(2, vyp. 2):2-47.
10. Decousus H, Quere I, Presles E, Becker F, Barrellier MT, Chanut M, Gillet JL, Guenneguez H, Leandri C, Mismetti P, Pichot O, Leizorovicz A. Superficial venous thrombosis and venous thromboembolism: a large, prospective epidemiologic study. Ann Intern Med. 2010 Feb 16;152(4):218-24.
11. Chernukha LM, Shchukіn SP. Trombotichnі uskladnennia vazhkikh form varikoznoї khvorobi: dіagnostika, khіrurgіchne lіkuvannia ta profіlaktika trombembolії legenevoї arterії [Thrombotic complications of severe varicose disease: diagnosis, surgical treatment and prevention of pulmonary embolism in patients with thromboembolism]. Nauk Vіsn Uzhgor Un-t Cer Meditsina. 2012;3(45):128–32.
12. Guch AA, Chernukha LN. Varikoznaia bolezn'. Klassifikatsiia, ul'trazvukovaia dіagnostika [Varicose veins. Classification, ultrasound diagnostics]. Klіn Khіrurgіia. 2004;(3):46–51.

Address for correspondence:
76000, Ukraina, g. Ivano-Frankovsk, ul. Galitskaia, d. 2, GVUZ «Ivano-Frankovskii natsional'nyi meditsinskii universitet», kafedra khirurgii stomatologicheskogo fakul'te-ta.
e-mail: r.sabadosh@gmail.com
Sabadosh Rostislav Vasil'evich

Information about the authors:
Sabadosh R.V. PhD, an associate professor of the surgery chair of the dental faculty of SHEE “Ivano-Frankovsk National Medical University”.

Article in the .pdf format

DOI: http://dx.doi.org/10.18484/2305-0047.2014.2.191   |  

L.M. CHERNUKHA¹, E.V. KASHYROVA¹, E.V. LUGOVSKOY², S.V. KOMISARENKO², I.N. KOLESNIKOVA², E.M. MAKOHONENKO², T.N. PLATONOVA², L.V. PIROGOVA², O.V. GORNICKAYA²

CHARACTERISTICS OF HEMOSTATIC SYSTEM STATE AT ARTERIOVENOUS FORMS OF CONGENITAL VASCULAR MALFORMATIONS

SE “National Institute of Surgery and Transplantology named after O.O. Shalymov under NAMS of the Ukraine”,¹
A.V. Palladin Institute of Biochemistry of the National Academy of Sciences of the Ukraine²
The Ukraine

Objectives. To study the hemostatic system state in patients with diffuse arteriovenous forms of congenital vascular malformations (AVF CVM) based on the assessment of immunodiagnostic tests informativeness for determination of plasma coagulation and fibrinolysis systems activation degree aimed to forecast hemostasiological disturbances in the perioperative period.
Methods. The study results of plasma hemostasis system (D-dimer, soluble fibrin, fibrinogen) and fibrinolysis system (protein C) using immunodiagnostic tests in the preoperative and in the early postoperative periods (up to 3 days) in the main group patients with AVF CVM (n=23) and in the control group patients with varicose vein disease (n=16, clinical class С3-С5, by CEAP) are presented in the article.
Results. In the preoperative period in 9 (43%) patients with AVF CVM, the imbalance manifested in a significant activation of coagulation capacity with normal activity of protein C was revealed. In 10 (62,5%) patients of the control group, a moderate activity of the coagulation capacity activation of hemostasis system at the normal activity of the fibrinolysis system (protein C) was established. The correlation between characteristics of coagulative and fibrinolytic potentials was observed in postoperative period in the main group, hypocoagulation – in 4 (57%) patients; imbalance between characteristics of coagulation and fibrinolytic system (hypercoagulability) – in 5 (45,5%) patients of the control group.
Conclusions. Diagnostic tests defining the state of coagulative and fibrinolytic systems are considered necessary to be done for timely correction of hemostasiological disturbances and for the prevention of fatal hemorrhagic complications in the perioperative period in patients with diffuse AVF CVM.

Keywords: congenital vascular malformations, arteriovenous forms, immunodiagnostic test-system, D-dimer, soluble fibrin, fibrinogen, protein C, balance, imbalance

p. 191 – 198 of the original issue

References

1. Dan VN, Sapelkin CB. Angiodisplazii (vrozhdennye poroki razvitiia sosudov) [Angiodysplasia (vascular malformations)]. Moscow, Verdana, 2008. Moscow, RF: Izdatel'stvo RGMU; 2008. 44 p.
2. Lee BB, Do YS, Yakes W, Kim DI, Mattassi R, Hyon WS. Management of arteriovenous malformations: a multidisciplinary approach. J Vasc Surg. 2004 Mar;39(3):590–600.
3. Khrushcheva EA, Titova MI. Sistema gemostaza pri khirurgicheskikh zabolevaniiakh serdtsa, sosudov, legkikh [Hemostatic system in surgical diseases of the heart, blood vessels, lungs]. Moscow, RF; 1974. 155 p.
4. Yamamoto H, Muneta T, Asahina S, Furuya K, Suzuki K. Lower leg fracture with Parkes-Weber syndrome complicated by disseminated intravascular coagulation. J Orthop Trauma. 1995;9(5):449–52.
5. Mazoyer E, Enjolras O, Laurian C, Houdart E, Drouet L. Coagulation abnormalities associated with extensive venous malformations of the limbs: differentiation from Kasabach-Merritt syndrome. Clin Lab Haematol. 2002 Aug;24(4):243–51.
6. Sturov VG, Chuprova AV, Antonov AR. Gemorragicheskie disfibrinogenemii i drugie narusheniia effektivnosti konechnogo etapa svertyvaniia krovi u detei s sindromom sistemnoi mezenkhimal'noi displazii [Hemorrhagic disfibrinogenemia and other changes of the effectiveness of the final stage of the blood coagulation in children with systemic mesenchymal dysplasia syndrome]. Pediatriia. 2005;84(3):11–16.
7. Lugovskoi EV, Kolesnikova IN, Lugovskaia NE, Gritsenko PG, Litvinova LM, Gogolinskaia GK, Liashko ED, Kostiuchenko EP, Golota VIa, Kurochka VV, Komisarenko SV. Rastvorimyi fibrin i D-dimer pri normal'no protekaiushchei beremennosti i pri ugroze ee preryvaniia [Soluble fibrin and D-dimer in normal pregnancy and the threat of abortion]. Ukr bіokhіm zhurn. 2006;78(4):120–29.
8. Platonova TN, Gornitskaia OV. Vydelenie i svoistva aktivatora proteina C iz iada shchitomordnika obyknovennogo (Agkistrodon halys halis) [Isolation and properties of protein C activator from the venom of the copperhead snake (Agkistrodon halys halis)]. Biomed Khimiia: Nauchno-Prakt Zhurn. 2003;49(5):470–78.
9. Rublenko AM, Urvant LP, Makogonenko ЄM, Platonova TM, Tsap PIu, Chernishenko TM, Kolesnikova ІM, Fishchenko VO, Lugovskoi EV. Vliianie aktivatora proteina s na obshchii gemostaticheskii potentsial plazmy krovi pri endoprotezirovanii tazobedrennogo sustava [Effect of activator protein with the overall hemostatic potential of blood plasma in hip replacement]. Ukr Bіokhіm Zhurn. 2011;83(5):32–39.
10. Papaian LP, Kniazeva ES. Petrishchev NN, red. D-Dimer v klinicheskoi praktike: Posobie dlia vrachei [D-dimer in clinical practice: a guide for physicians]. Moscow, RF: 000 Insait poligrafik; 2002. 20 p.
11. Zhu T, Martinez I, Emmerich J. Venous thromboembolism: risk factors for recurrence. Arterioscler Thromb Vasc Biol. 2009 Mar;29(3):298–10.
12. Lugovskoi EV, Efimov DA, Gritsenko PG, Kolesnikova IN, Lugovskaia NE, Litvinova LM, Kostiuchenko EP, Efimov AS, Komisarenko SV. Rastvorimyi fibrin i D-dimer kak molekuliarnye markery sosudistykh oslozhnenii u bol'nykh sakharnym diabetom [Soluble fibrin and D-dimer as molecular markers of vascular complications in diabetic patients]. Dopovidi Natsional'noї akademiї nauk Ukraїni. 2009;(12):190–93.
13. Vachev AN, Trukhanova IG, Gureev AD. Korrektsiia koagulopatii potrebleniia u patsientov pri otkrytykh operatsiiakh na briushnom otdele aorty [Correction of coagulopathy in patients with open operations on the abdominal aorta]. Angiologiia i Sosud Khirurgiia. 2013;19(3):117–21.
14. Dolgov VV, Svirin PV. Laboratornaia diagnostika narushenii gemostaza [Laboratory diagnosis of hemostatic disorders]. Moscow -Tver': OOO Izdatel'stvo Triada; 2005. 227 p.
15. Carr ME, Jr, Hermans J. Size and density of fibrin fibers from turbidity. Macromolecules. 1978 Jan–Feb;11(1):46–50.

Address for correspondence:
03680, Ukraina, g. Kiev, ul. Geroev Sevastopolia, d. 30, GU «Natsional'nyi institut khirurgii i transplantologii im. A.A. Shalimova NAMNU», otdel khirurgii magistral'nykh sosudov,
e-mail: aristosha@list.ru,
Kashirova Elena Vladimirovna

Information about the authors:
Chernukha L.M. MD, a leading researcher of the main vessels department of SE “National Institute of Surgery and Transplantology named after O.O. Shalymov under NAMS of the Ukraine”, Kiev, the Ukraine.
Kashyrova O.V. A junior researcher of the main vessels department of SE “National Institute of Surgery and Transplantology named after O.O. Shalymov under NAMS of the Ukraine”, Kiev, the Ukraine.
Lugovskoy E.V. A corresponding member of NAS of the Ukraine, Dr.Sci.(Biol), professor, a head of the structure and function of protein department of A.V. Palladin Institute of Biochemistry of NAS of the Ukraine.
Komisarenko S.V. An academician of NAS and NAMS of the Ukraine, Dr.Sci.(Biol), professor, Director of A.V. Palladin Institute of Biochemistry of NAS of the Ukraine.
Makohonenko E.M. Dr.Sci.(Biol), a chief researcher of the structure and function of protein department of A.V. Palladin Institute of Biochemistry of NAS of the Ukraine.
Platonova T.M. Dr.Sci.(Biol), a leading researcher of the protein structure and function of protein department of A.V. Palladin Institute of Biochemistry of NAS of the Ukraine.
Pirogova L.V. A junior researcher of A.V. Palladin Institute of Biochemistry of NAS of the Ukraine.
Gornickaya O.V. PhD, a senior researcher of A.V. Palladin Institute of Biochemistry of NAS of the Ukraine.

Article in the .pdf format

DOI: http://dx.doi.org/10.18484/2305-0047.2014.2.199   |  

V.A. SAMARTSEV¹, Y.A. ENCHEVA^{1, 2}, M.V. KUZNETSOVA^{1, 3}, T.I. KARPUNINA¹

THE PECULIARITIES OF BURN WOUND CONTAMINATION

SBEE HPE “Perm State Medical Academy named after academician E.A. Vagner” ¹,
SAME PR “City Clinical Hospital №21”, Perm²,
Institute of Ecology and Genetics of Microorganisms of Ural Branch or RAS³,²

Objectives. To reveal the peculiarities of burn wound contamination taking into account antibiotic sensitivity and genotypic characteristics of dominant pathogens.
Methods. The medical records from the burn unit of Perm multi-type hospital have been analyzed for the period 2011-2012 yrs. Microbiological monitoring included the detection of genetic determinants of antibiotic resistance and strain typing with rep-PCR and RAPD-PCR.
Results. It was shown that 270 bacterial cultures that were referred to 19 taxons were isolated from 190 patients within the period analyzed. Total proportion of Staphylococcus aureus and Pseudomonas aeruginosa comprised 40% of the bacteria isolated. Frequency of S. aureus and P. aeruginosa in mono- or mixed cultures did not significantly differ, whereas A. baumannii was more often detected in associations. Prevailing majority of associations including S. aureus was found with Enterococcus spp., while P. aeruginosa associations were observed with A. baumannii. Following the repeated inoculations from the wound S. aureus and P. aeruginosa strains were detected in 37,5% and 52,2%, respectively. The proportion of S. aureus strains being oxacillin-resistant comprised 32,6%, specific weight of ceftazidime-resistant P. aeruginosa strains – 33,3% and imipenem – 21,7%. Molecular typing confirmed the suggestion based on phenotypic characteristics of cultures about circulation of the closely related isolates in burn unit. Genome of non-fermenting bacterial strains of P. aeruginosa and A. baumannii contain neither intI-, nor blaVIM- sequences.
Conclusions. Characteristic features of infectious complications of burn wounds could be considered as follows: predominance of S. aureus and P. aeruginosa among etiopathogens; growing role of multi-resistant A. baumannii strains; delayed pathogen elimination from wounds and development of mixed and super infections.

Keywords: microbiota, burn wound, antibiotic resistance, genotyping

p. 199 – 206 of the original issue

References

1. Vindenes H, Bjerknes R. Microbial colonization of large wounds. Burns. 1995 Dec;21(8):575–79.
2. Pruitt BA Jr, McManus AT, Kim SH, Goodwin CW. Burn wound infections: current status. World J Surg. 1998 Feb;22(2):135–45.
3. Alekseev AA, Bobrovnikov AE, Krutikov MG, Tusinova SA, Kashin IuD, Lagvilava MG. Opyt primeneniia poligeksanida dlia mestnogo lecheniia infitsirovannykh ozhogovykh ran [Experience of using polihexanide for the local treatment of infected burn wounds]. Consilium Medicum. Khirurgiia. 2006;(1):55-58.
4. Vorob'eva ON, Denisenko LI, Zhilina NM. Etiologiia gnoino-septicheskikh protsessov u ozhogovykh bol'nykh [Etiology of septic processes in burn patients]. Biul. SO RAMN. 2010;30(6):57–63.
5. Gordinskaia NA, Sabirova EV, Abramova NV, Dudareva EV, Skleenova EIu, Nekaeva ES. Fenotipicheskie i molekuliarno-geneticheskie osobennosti vozbuditelei ranevoi ozhogovoi infektsii [Phenotypic, molecular and genetic features of microbial infection of burn wound]. Klin Mikrobiol i Antimikrob Khimioterapiia. 2012;(4):342–46.
6. Oncul O, Ulkur E, Acar A, Turhan V, Yeniz E, Karacaer Z, Yildiz F. Prospective analysis of nosocomial infections in a burn care unit, Turkey. Indian J Med Res. 2009 Dec;130(6):758–64.
7. Krutikov MG. Kontrol' infektsii v ozhogovom statsionare Kombustiol [Infection control in the burn hospital Kombustiol]. 2003. 14; [Available from] http://combustiolog.ru/journal/kontrol-infektsii-v-ozhogovom-statsionare.
8. Stone GG, Oberst RD, Hays MP, McVey S, Chengappa MM. Detection of Salmonella serovars from clinical samples by enrichment broth cultivation-PCR procedure. J Clin Microbiol. 1994 Jul;32(7):1742-9.
9. Poirel L, Naas T, Nicolas D, Collet L, Bellais S, Cavallo JD, Nordmann P. Characterization of VIM-2, a carbapenem-hydrolyzing metallo-beta-lactamase and its plasmid- and integron-borne gene from a Pseudomonas aeruginosa clinical isolate in France. Antimicrob Agents Chemother. 2000 Apr;44(4):891-7.
10. Molecular epidemiology and mechanisms of carbapenem resistance in pseudomonas aeruginosa isolates from spanish hospitals. Antimicrob Agents Chemother. 2007 Dec;51(12):4329-35.
11. Queenan AM, Bush K. Carbapenemases: the versatile beta-lactamases. Clin Microbiol Rev. 2007 Jul;20(3):440-58,
12. Huey B, Hall J. Hypervariable DNA fingerprinting in Escherichia coli: minisatellite probe from bacteriophage M13. J Bacteriol. 1989 May;171(5):2528–32.
13. Wolska K, Kot B, Jakubczak A, Rymuza K. BOX-PCR is an adequate tool for typing of clinical Pseudomonas aeruginosa isolates. Folia Histochem Cytobiol. 2011;49(4):734–38.
14. Mayhall CG. The epidemiology of burn wound infections: then and now. Clin Infect Dis. 2003 Aug 15;37(4):543–50.
15. Iarets IuI, Shevchenko NI, Rubanov LN. Monitoring shtammov i lekarstvennoi chuvstvitel'nosti mikroorganizmov Gomel'skogo oblastnogo tsentra termicheskoi travmy, ran, ranevoi infektsii i rekonstruktivnoi khirurgii [Monitoring of strains and antibiotic resistance of microorganisms in Gomel regional center of thermal injury, wound, wound infections and reconstructive surgery]. Infektsii v Khirurgii. 201;9(3):8–11.
16. Shatalova EV, Bel'skii VV. Vzaimnoe vliianie vozbuditelei pri smeshannoi infektsii ozhogovoi travmy [Mutual influence of pathogens in a mixed infection of burn injury]. Zhurn Mikrobiol Epidemiol i Immunobiol. 1999;(4):3–7.
17. Eidel'shtein MV, Skleenova EIu, Shevchenko OV, Tapal'skii DV, Azizov IS, Dsouza DV, Timokhova AV, Sukhorukova MV, Kozyreva VK, Safronova EV, Astakhova MV, Karpov IA, Shamaeva SKh, Abramova NV, Gordinskaia NA, Kozlov RS. Rasprostranennost' i molekuliarnaia epidemiologiia gramotritsatel'nykh bakterii, produtsiruiushchikh metall-beta-laktamazy, v Rossii, Belarusi i Kazakhstane [Prevalence and molecular epidemiology of Gram-negative bacteria producing metall-beta-lactamase in Russia, Belarus and Kazakhstan]. Klin Mikrobiol i Antimikrob Khimioterapiia. 2012;(2):132–52.
18. Solomennyi AP, Zubareva NA, Goncharov AE, Satosova NV, Krylov KM. Mul'tipleksnaia PTsR-diagnostika integronov rezistentnosti vozbuditelei nozokomial'noi infektsii [Multiplex PCR-diagnostics of integrons resistance of nosocomial infection pathogens]. Infektsii v Khirurgii. 2011;9(3):26–27.

Address for correspondence:
614107, Rossiiskaia Federatsiia, g. Perm', ul. Kim, d. 2, GBOU VPO «Permskaia gosudarstvennaia meditsinskaia akademiia im. ak. E.A. Vagnera», kafedra obshchei khirurgii №1,
e-mail: samarcev-v@mail.ru,
Samartsev Vladimir Arkad'evich

Information about the authors:
Samartsev V.A. MD, professor, a head of the general surgery chair №1 of SBEE HPE “Perm State Medical Academy named after E.A.Vagner”.
Encheva Y.A. An extramural post-graduate student of the general surgery chair №1 of SBEE HPE “Perm State Medical Academy named after E.A.Vagner”, surgeon of the burn unit of SAME PR “City Clinical Hospital №21”.
Kuznettsova M.V. PhD, a senior researcher of the molecular microbiology and biotechnology laboratory of Institute of ecology and genetics of microorganisms of Ural branch of RAS, an associate professor of the microbiology and virology chair of SBEE HPE “Perm State Medical Academy named after E.A.Vagner”.
Karpunina T.I. MD, professor of the microbiology and virology chair of SBEE HPE “Perm State Medical Academy named after E.A.Vagner”.

Article in the .pdf format

TRAUMATOLOGY AND ORTHOPEDICS

DOI: http://dx.doi.org/10.18484/2305-0047.2014.2.207   |  

V.P. DEYKALO ¹, G.V. DIVOVICH ²

EPIDEMIOLOGY OF CONGENITAL CLUBFOOT AMONG CHILDREN’S POPULATION OF GOMEL REGION

EE “Vitebsk State Medical University” ¹,
EE “Gomel State Medical University” ²,
The Republic of Belarus

Objectives. To study the prevalence and the structure of a congenital clubfoot among children of Gomel region of the Republic of Belarus.
Methods. We have analyzed medical records in the orthopedic and trauma consultative offices of Gomel regional policlinic, Gomel central city children's policlinic and in its branches No. 1 and No. 4 as well as the card files of clubfoot patients in Gomel branch of the Belarusian orthopedic regenerative center, documents of Gomel regional specialized orthopedic medico-rehabilitation commission of experts during the period from 2000 to 2012 yrs. The data on cases reports of a congenital clubfoot, a child’s sex, side of deformity localization have been included in the research base.
Results. The data statistical analysis concerning cases of a congenital clubfoot has shown the following: the number of children with a congenital clubfoot regarding to the relation of the total number of newborns in Gomel region on the average makes 0,06% (varying on years from 0,02% to 0,09%); 0,63 cases of a congenital clubfoot are the share of one thousand newborns; on every 1585 childbirth there is one case of a clubfoot. This defect does seem to have an increased incidence in boys than in girls (2,8:1). There is one case of a congenital clubfoot out of 1089 boys and there is one case of a congenital clubfoot out of 3054 girls. Club foot (unilateral and bilateral) is a condition which affects children, more often males than females, and generally at birth, bilateral forms of disease dominate among girls.
Conclusion. In Gomel region (the Republic of Belarus) the incidence of clubfoot children birth, the correlation of this pathology occurrence according to sex and the side of lesion are correlated with the information on the prevalence and structure presented in literature. The results of this study are considered to be representative and can be used for studying of the problem of a clubfoot in the other regions of Belarus.

Keywords: congenital clubfoot, equino-varus deformity of foot, congenital deformity of foot, prevalence of a congenital clubfoots

p. 207 – 212 of the original issue

References

1. Lechenie kosolaposti po metodu Ponseti [Treatment of clubfoot with the Ponseti method]. Rezhim dostupa: ponseti.ru/methods/treatment/
2. Ponseti IV. Congenital clubfoot: fundamentals of treatment. New York: Oxford University Press; 1996. p. 140
3. Fridland MO. Ortopediia [Orthopedy]. Moscow, RF: Medgiz; 1954.508 p.
4. Gafarov X3. Lechenie deformatsii stop u detei [Treatment of foot deformities in children]. Kazan', RF: Tatarskoe kn. izd-vo; 1990. 176 p.
5. Novachenko NP, Bogdanov FR red. Boichev B, Volkov MV, Volkov MV, Dedova VD, Trubnikov VF. Mnogotomnoe rukovodstvo po ortopedii i travmatologii [Multivolume guide. Orthopedics and traumatology]: [v 3 t.] T.2: Ortopediia. Moscow, RF: Meditsina; 1968. 770 p.
6. Vreden R R. Prakticheskoe rukovodstvo po ortopedii [Practical guide to orthopedics]. Leningrad, RF; 1936. 604 p.
7. Zatsepin TS. Ortopediia detskogo i podrostkovogo vozrasta [Orthopedics in childhood and adolescence]. Moscow, RF: Medgiz; 1956. 320 p.
8. Bogoraz NA. Vosstanovitel'naia khirurgiia [Reconstructive surgery]: v 2 t. Moscow, RF: Medgiz; 1949;(20):680 p.
9. Mirzoeva II, Koniukhov MP. Ortopediia detei pervogo goda zhizni [Orthopedics of infants]. Leningrad, RF: Meditsina; 1983. 128 p.
10. Usoskina RIa, Krumin' KA, Seglin' TIa. Ambulatornoe lechenie detei s ortopedicheskimi zabolevaniiami [Outpatient treatment of children with orthopedic diseases]. Leningrad, RF: Meditsina; 1979. 256 p.
11. Chaklin VD. Ortopediia [Orthopedy] (v 2-kh knigakh).-Moscow, RF: Medgiz; 1957. 798 p.
12. Klychkova IIu, Koniukhov MP. Mironov SP, Kotel'nikova GP, red. Vrozhdennaia kosolapost'. Ortopediia [Congenital clubfoot. Orthopedy]: nats ruk. Moscow, RF: GEOTAR-Media; 2011;(gl 6):192–04 p.
13. Blandinskii VF i dr. Lechenie atipichnoi vrozhdennoi kosolaposti metodom Ponseti [Treatment of atypical clubfoot by the Ponseti method]. Travmatol i Ortoped Rossii. 2010;(1):75–79.
14. Natsional'nyi statisticheskii komitet Respubliki Belarus' [National statistical committee of the Republic of Belarus]. (Elektronnyi resurs). belstat.gov.by/
15. Vasil'kov NA. i dr Analiz mediko-demograficheskikh pokazatelei naseleniia Gomel'skoi oblasti [Analysis of medical and demographic values of the population of Gomel region]. Vopr Organizatsii i Informatizatsii Zdravookhraneniia. 2011;(3):4–11.

Address for correspondence:
246050, Respublika Belarus', g. Gomel', ul. Lange, d. 5, UO «Gomel'skii gosudarstvennyi meditsinskii universitet», kafedra travmatologii, ortopedii i VPKh,
e-mail: divovich_gol@mail.ru,
Divovich Gennadii Vladimirovich

Information about the authors:
Deykalo V.P. MD, professor, Rector of EE “Vitebsk State Medical University”.
Divovich G.V. An assistant of the traumatology, orthopedics and military field surgery chair of EE “Gomel State Medical University”.

Article in the .pdf format

ANESTHESIOLOGY-REANIMATOLOGY

DOI: http://dx.doi.org/10.18484/2305-0047.2014.2.213   |  

K.V. NIKITINA, I.M. SAMSONOVA

CORRELATION OF INTRAABDOMINAL PRESSURE WITH INDICATORS OF BLOOD GASES, ACID-BASE BALANCE AND FREQUENCY OF MECHANICAL LUNG VENTILATION IN PATIENTS WITH ACUTE DESTRUCTIVE PANCREATITIS

EE “Vitebsk State Medical University”
The Republic of Belarus

Objectives. To study the correlation of different levels of intraabdominal pressure with indicators of the respiratory index (PaO₂/FiO₂), PaCO₂, the acid-base balance and necessity for carrying out a mechanical ventilation of the lungs (MVL) in patients with the acute destructive pancreatitis at hospitalization to the intensive care unit.
Methods. 70 patients with the acute destructive pancreatitis after transferring to the intensive care unit of a hospital have been examined. The indicators of intraabdominal pressure, the acid-base balance, PaCO₂, a respiratory index and number of the patients demanded the mechanical lung ventilation сonduction have been determined. Depending on the intraabdominal pressure level the patients were distributed into 3 groups. The received results were compared between the groups and their correlation was analyzed.
Results. At intraabdominal pressure up to 12 mm Hg the respiratory index and PaCO₂ didn’t change, thus 24% of patients demanded mechanical lung vantilation. Intraabdominal pressure over 12 mm Hg promoted the reduction of the respiratory index up to 236 mm Hg, thus 68 % of patients required MLV. Intraabdominal pressure over 20 mm Hg led to the reduction of the respiratory index up to 201 mm Hg and the increase РаСО₂, thus 100 % of patients required MLV. Indicators of the acid-base balance at different level of intraabdominal pressure (5-25 mm Hg) didn’t change.
Conclusions. Intraabdominal pressure increase over 20 mm Hg in patients with the acute destructive pancreatitis leads to the respiratory insufficiency development and increase the number of the patients with MLV up to 100 %.

Keywords: acute destructive pancreatitis, respiratory insufficiency, intraabdominal pressure, respiratory index, acid-base balances

p. 213 – 217 of the original issue

References

1. Malbrain ML, Chiumello D, Pelosi P, Bihari D, Innes R, Ranieri VM, Del Turco M, Wilmer A, Brienza N, Malcangi V, Cohen J, Japiassu A, De Keulenaer BL, Daelemans R, Jacquet L, Laterre PF, Frank G, de Souza P, Cesana B, Gattinoni L. Incidence and prognosis of intraabdominal hypertension in a mixed population of critically ill patients: a multiple-center epidemiological study. Crit Care Med. 2005 Feb;33(2):315–22.
2. Gel'fand BR, Protsenko DN, Podachin PV, Chubchenko SV, Lapina IIu. Sindrom intraabdominal'noi gipertenzii: sostoianie problemy [Intra-abdominal hypertension syndrome: state of the problem]. Meditsinskii Alfavit. Neotlozhnaia Meditsina. 2010;(3):36–43.
3. Balogh Z, Jones F, D'Amours S, Parr M, Sugrue M. Continuous intra-abdominal pressure measurement technique. Am J Surg. 2004 Dec;188(6):679–84.
4. Malbrain ML, De laet IE. Intra-abdominal hypertension: evolving concepts. Clin Chest Med. 2009 Mar;30(1):45–70, viii.
5. Kirkpatrick AW, Brenneman FD, McLean RF, Rapanos T, Boulanger BR. Is clinical examination an accurate indicator of raised intra-abdominal pressure in critically injured patients? Can J Surg. 2000 Jun;43(3):207–11.
6. Kondratenko PG, Vasil'ev AA, Kon'kova MV. Ostryi pankreatit [Acute pancreatitis]. Donetsk, RF; 2008. 352 p.
7. Malbrain ML. Abdominal pressure in the critically ill. Curr Opin Crit Care. 2000;(6):17–29.
8. Obeid F, Saba A, Fath J, Guslits B, Chung R, Sorensen V, Buck J, Horst M.Increases in intra-abdominal pressure affect pulmonary compliance. Arch Surg. 1995 May;130(5):544–47.
9. Sugrue M. Abdominal compartment syndrome. Curr Opin Crit Care. 2005 Aug;11(4):333–38.
10. Malbrain ML. Different techniques to measure intra-abdominal pressure (IAP): time for a critical re-appraisal. Intensive Care Med. 2004 Mar;30(3):357–71.

Address for correspondence:
210023, Respublika Belarus', g. Vitebsk, pr. Frunze, d. 27, UO «Vitebskii gosudarstvennyi meditsinskii universitet», kafedra anesteziologii i reanimatologii s kursom FPK i PK,
e-mail: katarinaanaest@gmail.com,
Nikitina Ekaterina Vladimirovna

Information about the authors:
Nikitina E.V. PhD, an assistant of the anesthesiology and reanimatology chair with the course of advanced training and retraining of EE “Vitebsk State Medical University”.
Samsonova I.M. An assistant of the anesthesiology and reanimatology chair with the course of advanced training and retraining of EE “Vitebsk State Medical University”.

Article in the .pdf format

NEW METHODS

DOI: http://dx.doi.org/10.18484/2305-0047.2014.2.218   |  

A.V. BRUKHNOU, V.G. PIACHERSKI, A.V. MAROCHKOV, Z.V. KOKHAN, A.N. BARDZILOUSKI

ANTERIOR TRANSSCALENE ACCESS TO BRACHIAL PLEXUS WHILE PERFORMING REGIONAL BLOCK

ME “Mogilev Regional Hospital”,
The Republic of Belarus

Objectives. This report focuses on an area of practice increases safety of a regional brachial plexus blockage performed according to anatomical landmarks with electrical stimulation of the peripheral nerves but without ultrasonograpy by means of development of a new anterior transscalene approach for brachial plexus block.
Methods. The advantages and disadvantages of different generally recognized accesses for transscalene brachial plexus block: the brachial plexus in the interscalene space: access according to Winnie, Meier and posterior access according to Pippa have been analyzed. Mutual arrangement of the brachial plexus trunks and other anatomical abnormalities in the neck area has been evaluated.
The access to the brachial plexus according to the anatomical landmarks (the sternal head of a sternocleidomastoid muscle, the clavicular head of the sternocleidomastoid muscle, the cricoid, the jugular notch, the interscalene groove) when the risk of large vessels damage as well as the dome of the pleura and the development of total spinal anesthesia will consider to be minimal.
Results. The main difference of proposed access to the brachial plexus from the widely known techniques of Winnie and Meier is the direction of the injection needle into the opposite side of the main vessels, the dome of the pleura, the spinal canal, which undoubtedly increases the block safety performance. The designed access was used to perform brachial plexus block with 1% lidocaine by the anatomical landmarks, using a peripheral nerve stimulator without the ultrasound visualization. Blocks were done for anesthesia maintenance of surgical interventions for the shoulder joint injuries, fractures of the clavicle and proximal shoulder sections in 20 patients. Regional anesthesia with the developed access use in all 20 cases was accompanied by a complete motor and sensory block. No complications were observed.
Conclusions. When using ultrasound imaging during regional block is impossible, the proposed access can be an alternative to the classical variants of the brachial plexus access. In the case of impossibility of performance of ultrasound visualization in regional block the proposed approach can be considered as the alternative classic variant of access to the brachial plexus.

Keywords: anterior transscalene access, brachial plexus block, electrical stimulation of peripheral nerves, anatomical landmarks

p. 218 – 223 of the original issue

References

1. Marhofer P, Harrop-Griffiths W, Willschke H, Kirchmair L.Fifteen years of ultrasound guidance in regional anaesthesia: Part 2-recent developments in block techniques. Br J Anaesth. 2010 Jun;104(6):673-83.
2. Marhofer P, Harrop-Griffiths W, Kettner SC, Kirchmair L.. Fifteen years of ultrasound guidance in regional anaesthesia: part 1. Br J Anaesth. 2010 May;104(5):538-46
3. Neuburger M, Buttner J. Anaesthesist. 2011 Nov;60(11):1014-26. [Complications of peripheral regional anesthesia].[Article in German]
4. Rafmell Dzh.R, Nil DzhM, Viskoumi KM. Regionarnaia anesteziia: samoe neobkhodimoe v anesteziologii [Regional anesthesia: the most necessary in anesthesiology]. Per. s angl; Moscow, RF: MEDpress-inform; 2007. 272 p.
5. Auroy Y, Benhamou D, Bargues L, Ecoffey C, Falissard B, Mercier FJ, Bouaziz H, Samii K.Major complications of regional anesthesia in France: The SOS Regional Anesthesia Hotline Service. Anesthesiology. 2002 Nov;97(5):1274–80.
6. Piacherski V, Marochkov A, Brukhnou A, Kokhan Z. Comparison of three methods of regional anesthesia of peripheral nerves and plexuses. OJ Anes. 2012;2(5):237–43.
7. Pecherskii VG, Marochkov AV. Osobennosti rasprostraneniia mestnogo anestetika pri blokade sedalishchnogo nerva [The peculiarities of local anesthetic distribution in blockade of the sciatic nerve]. Novosti Khirurgii. 2011;19(3): 91–95.
8. Maier G, Biuttner I. Perifericheskaia regionarnaia anesteziia: atlas [Peripheral regional anesthesia: an atlas]. per s angl.; red. Kamchatnov PR. Moscow, RF: BINOM. Laboratoriia Znanii; 2010. 260 p.
9. Chelly JE. Peripherial nerve blocks: a color atlas. 3rd ed. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins; 2009. p. 1–474.
10. Kovanov VV. Operativnaia khirurgiia i topograficheskaia anatomiia [Operative surgery and topographic anatomy]. Moscow, RF: Meditsina; 1977. 415 p.
11. Sinel'nikov RD. Atlas anatomii cheloveka. Uchenie o nervnoi sisteme, organakh chuvstv i organakh vnutrennei sekretsii [Atlas of human anatomy. Doctrine of the nervous system, sensory organs and organs of internal secretion]. Moscow, RF: Meditsina; 1974;(3):399 p.
12. Geert-Jan van Geffen. The value of ultrasonography for performing peripheral nerve blocks. In: Theory, practice and clinical experience in adults and children. Optima Grafische Communicatie, Rotterdam, NL; 2008. p. 234–79.
13. Moayeri N, Bigeleisen PE, Groen GJ. Quantitative Architecture of the Brachial Plexus and Surrounding Compartments, and Their Possible Significance for Plexus Blocks. Anesthesiology. 2008;108(2):299–04.
14. Verma AK, Sah MK, Agarwal A, Singh C. Total spinal anaesthesia with Interscalene brachial plexus block by Winnie approach. Indian J Anaesth. 2013 Mar;57(2):199-201.
15. Bouaziz H, Iohom G, Estebe JP, Campana WM, Myers RR. Effects of levobupivacaine and ropivacaine on rat sciatic nerve blood flow. Br J Anaesth. 2005 Nov;95(5):696-700.

Address for correspondence:
212026, Respublika Belarus', g. Mogilev, ul. B.-Biruli, d. 12. UZ «Mogilevskaia oblastnaia bol'nitsa», otdelenie anesteziologii i reanimatsii,
e-mail: andreibruhnov@gmail.com,
Brukhnou Andrei Viktorovich

Information about the authors:
Brukhnou A.V. An anesthesiologist-reanimatologist, of the anesthesia and resuscitation department of ME “Mogilev regional hospital”.
Piacherski V.G. An anesthesiologist-reanimatologist, anesthesia and resuscitation department of ME “Mogilev regional hospital”.
Marochkov A.V. MD, professor, a head of anesthesia and resuscitation department of ME “Mogilev regional hospital”.
Kokhan Z.V. An anesthesiologist-reanimatologist, anesthesia and resuscitation department of ME “Mogilev regional hospital”.
Bardzilouski A.N. An anesthesiologist-reanimatologist, anesthesia and resuscitation department of ME “Mogilev regional hospital”.

Article in the .pdf format

INFORMATION TECHNOLOGIES IN SURGERY

DOI: http://dx.doi.org/10.18484/2305-0047.2014.2.224   |  

P.M. KOSENKO¹, S.A. VAVRINCHUK¹, L.K. KULIKOV², E.S. PODVALNYJ³, A.V. PLOTNIKOV⁴

MATHEMATICAL MODELING OF THE MOTOR-EVACUATION DISORDERS OF THE GASTROINTESTINAL TRACT IN PATIENTS WITH ULCEROUS PYLORIC DUODENAL STENOSIS

HBEE HPE “Far Eastern State Medical University”, Khabarovsk ¹,
SBEE APE “Irkutsk State Medical Academy of Post-Graduate Education”²,
FSBEE HPE “Russian Academy of National Economy and Public Administration under the President of the Russian Federation” Voronezh Branch³,
FSBEE HPE “Voronezh State Technical University”⁴,
The Russian Federation

Objectives. To improve the diagnosis of ulcerative pyloric duodenal stenosis by creating a mathematical model of the motor-evacuation disorders and the automated computer system diagnosis.
Methods. 57 patients with ulcerative pyloric duodenal stenosis, divided according to the degree of stenosis severity into three groups have been examined. Control group consisted of 28 healthy persons. Evaluation of the gastrointestinal tract motor activity was performed using the peripheral electrogastroenterography method. Mathematical modeling of the motor-evacuation disorders was done on the basis of the discriminant analysis of the peripheral electrogastroenterography parameters.
Results. The group of patients with a subcompensated pyloric duodenal ulcerous stenosis is found out to be heterogeneous concerning the character of the disorders of gastrointestinal motility with the presence of transitional types from the motility compensation (hyperkinetic type) to decompensation (hypomotor type). The mathematical model of motor-evacuation disorders in patients with ulcerous pyloric duodenal stenosis was designed on the basis of the discriminant analysis parameters. To improve the prediction of patients’ distribution into the corresponding groups according to the stenosis degree severity, our earlier data concerning the age peculiarities of the peripheral electrogastroenterography readings have been used. 23 electrophysiological parameters were included in the designed mathematical model, 17 of them were considered to be statistically important for the differential diagnostics. It provided a high (96,2%) prediction accuracy of patients’ distribution in the corresponding groups permitted firstly to create a computer system diagnosis and definition of the compensation degree of the pyloric duodenal stenosis.
Conclusion. On the basis of the mathematical model of motor-evacuation disorders prediction, a computer decision support system for determining of compensation degree of pyloric duodenal stenosis was designed, allowing performing of the automated analysis of the peripheral electrogastroenterography data.

Keywords: gastrointestinal motility, peptic ulcer, duodenal stenosis, electrogastroenterography, mathematical modeling, discriminant analysis

p. 224 – 230 of the original issue

References

1. Vavrinchuk SA, Kosenko PM. Sistemnyi analiz pokazatelei perifericheskoi elektrogastroenterograffii u bol'nykh s oslozhnennoi iazvennoi bolezn'iu [System analysis of peripheral electrogastroenterography in patients with ulcer complications. Khabarovsk, RF: Tsentr IPKSZ; 2012. 189 p.
2. Rukhliada NV, Nazarov VE, Ermolaev IA. Diagnostika i lechenie iazvennoi bolezni, oslozhnennoi stenozom [Diagnosis and treatment of peptic ulcer disease complicated by stenosis]. Saint-Petersburg, RF: DEAN; 2006. 240 p.
3. Yin J, Chen JD. Electrogastrography: methodology, validation and applications. J Neurogastroenterol Motil. 2013. Jan;19(1):5–17.
4. Matsuura Y, Yamamoto T, Takada M, Shiozawa T, Takada H. Application of electrogastrography to public health. Nihon Eiseigaku Zasshi (Japanese Journal of Hygiene). 2011 Jan;66(1):54-63. PMID: 21358135. [Article in Japanese]
5. Stupin VA, Smirnova GO, Baglaenko MV, Siluianov SV, Zakirov DB. Perifericheskaia elektrogastroenterografiia v diagnostike narushenii motorno-evakuatornoi funktsii zheludochno-kishechnogo trakta [Peripheral electrogastroenterography in diagnosing of motor-evacuation function disorder of the gastrointestinal tract]. Lechashchii Vrach. 2005;(2):60–62.
6. Tropskaia NS, Vasil'ev VA, Popova TS, Ishmukhametov AI, Azarov IaB, Li LG. Teoreticheskie predposylki i eksperimental'noe obosnovanie ispol'zovaniia elektrogastroenterografii [Theoretical background and experimental study on electrogastroenterography application]. Ros Zhurn Gastroenterol Gepatol i Koloproktol. 2005;15(5):82–88.
7. Dronova OB, Tret'iakov AA, Kagan II, Shchetinin AF. Perifericheskaia elektrogastroenterografiia v diagnostike GERB. Posobie dlia vrachei [Peripheral electrogastroenterography in the diagnosis of GERD. Manual for physicians]. Moscow, RF: MEDPRAKTIKA-M; 2011. 32 p.
8. Tkachenko EI, Avalueva EB, Sitkin SI, Zhigalova TN, Skazyvaeva EV, Mirgorodskaia EV, Petrenko VV. Intestinal'naia dvigatel'naia aktivnost' u patsientov s sindromom razdrazhennogo kishechnika [Intestinal motor activity in patients with irritable bowel syndrome]. Gastroenterologiia Saint-Petersburg. 2008;(4):7–10.
9. Semeriakova EG, Berestneva OG, Makarova LS. Matematicheskie metody v zadachakh meditsinskoi diagnostiki [Mathematical methods in the medical diagnostics]. Sovr Probl Nauki i Obraz. 2012;(6):29.
10. Vil'deman AV, Tashkinov AA, Bronnikov VA. Mnogomernyi metod individual'nogo prognozirovaniia indeksa motoriki [Multivariate method to predict individual motility index]. Informats Tekhnol i Vychisl Sistemy. 2010;(3):79–85.
11. Rebrova OY. Statisticheskii analiz meditsinskikh dannykh. Primenenie paketa prikladnykh programm Statistica [Statistical analysis of medical data. Application of software package Statistica]. Moscow, RF: MediaSfera 2002; 312 p.

Address for correspondence:
680000, Rossiiskaia Federatsiia, g. Khabarovsk, ul. Murav'eva-Amurskogo, d. 35, GBOU VPO «Dal'nevostochnyi gosudarstvennyi meditsinskii universitet», kafedra obshchei i fakul'tetskoi khirurgii,
e-mail: rec@mail.fesmu.ru,
Kosenko Pavel Mikhailovich

Information about the authors:
Kosenko P.M. PhD, an associate professor of the general and faculty surgery of SBEE HPE “Far Eastern State Medical University”, Khabarovsk.
Vavrinchuk S.A. MD, an associate professor of the surgery chair with the course of endoscopic and plastic surgery of the advanced training and retraining faculty of SBEE HPE “Far Eastern State Medical University”, Khabarovsk.
Kulikov L.K. MD, professor, a Head of the surgery chair of SBEE APE “Irkutsk State Medical Academy of Post-graduate Education”.
Podvalnyj E.S. Dr.Sci.(Tech) , professor, Director of FSBEE HPE “Russian Academy of National Economy and Public Administration under the President of the Russian Federation” Voronezh branch.
Plotnikov A.V. A post-graduate student of the computer-aided and computing systems chair of SBEE HPE “Voronezh State Technical University”.

Article in the .pdf format

REVIEWS

DOI: http://dx.doi.org/10.18484/2305-0047.2014.2.231   |  

A.A. PECHENKIN, A.A. LYZIKOV

CAROTID ENDARTERECTOMY: OUTCOMES AND PROSPECTS

EE “Gomel State Medical University”
The Republic of Belarus

Today the atherosclerotic lesions of the brachiocephalic arteries occupy one of the leading places among vascular disease, second only to coronary vessels and lower extremities vessels. Despite the development of high technologies and minimally invasive treatment techniques, carotid endarterectomy remains a leading treatment method of the given pathology. By the present moment the methods of examination and indication for the surgery have been strictly determined; many kinds of surgeries have been worked out. However, the problem of further disease progression remains valid regardless of the method of intervention and the plastic material used in the operation. On the average restenosis is detected in 10-15% of earlier operated patients. Different operative techniques and their distant results have been analyzed in the review. Comparative analysis of plastic materials used for carotid endarterectomy has been carried out.
Literature analysis has permitted to determine the most significant and successful ways to reduce restenosis incidence in distant postoperative period. At the same time it has been established that there are no distinct data concerning restenosis development after various operative interventions. Significant variety of opinions concerning plastic materials has been found out, indicating the absence of a single point of view of their choice.
The carried out literature analysis proves the necessity for further studies of restenosis pathogenesis after surgical interventions as well as for search of the operative correction techniques and alternative tissue for the internal carotid artery reconstruction. To study the application of the femoral vein for reconstruction of the aortic arch branches seems to be perspective.

Keywords: atherosclerosis, brachiocephalic arteries, internal carotid artery, operative treatment, carotid endarterectomy

p. 231 – 238 of the original issue

References

1. World Health Statistics 2012 [Available from] http://www.who.int/gho/publications/world_health_statistics/2012/en/
2. Pokrovskii AV, Beloiartsev DF, Kolosov RV. Chto vliiaet na standarty «kachestva» vypolneniia karotidnoi endarterektomii [What does affect the "quality" standards of performing carotid endarterectomy]? Angiologiia i Sosud Khirurgiia. 2003;9(3):80–89.
3. Lloyd-Jones D, Adams R, Carnethon M, De Simone G, Ferguson TB, Flegal K, Ford E, Furie K, Go A, Greenlund K, Haase N, Hailpern S, Ho M, Howard V, Kissela B, Kittner S, Lackland D, Lisabeth L, Marelli A, McDermott M, Meigs J, Mozaffarian D, Nichol G, O'Donnell C, Roger V, Rosamond W, Sacco R, Sorlie P, Stafford R, Steinberger J, Thom T, Wasserthiel-Smoller S, Wong N, Wylie-Rosett J, Hong Y. Heart disease and stroke statistics-2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2009 Jan 27;119(3):480–86.
4. Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJ. Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data. Lancet. 2006 May 27;367(9524):1747–57.
5. Linfante I, Andreone V, Akkawi N, Wakhloo AK. Internal carotid artery stenting in patients over 80 years of age: single-center experience and review of the literature. J Neuroimaging. 2009 Apr;19(2):158–63.
6. Goldstein LB, Adams R, Alberts MJ, Appel LJ, Brass LM, Bushnell CD, Culebras A, Degraba TJ, Gorelick PB, Guyton JR, Hart RG, Howard G, Kelly-Hayes M, Nixon JV, Sacco RL. Primary prevention of ischemic stroke: a guideline. Stroke. 2006 Jun;37(6):1583–33.
7. Eastcott HH, Pickering GW, Rob CG. Reconstruction of internal carotid artery in a patient with intermittent attacks of hemiplegia. Lancet. 1954 Nov 13;267 (6846):994–96.
8. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators. N Engl J Med. 1991 Aug 15;325(7):445–53.
9. Endarterectomy for moderate symptomatic carotid stenosis: interim results from the MRC European Carotid Surgery Trial. Lancet. 1996 Jun 8;347(9015):1591–93.
10. Rothwell PM, Eliasziw M, Gutnikov SA, Fox AJ, Taylor DW, Mayberg MR, Warlow CP, Barnett HJ. Analysis of pooled data from the randomised controlled trials of endarterectomy for symptomatic carotid stenosis. Carotid Endarterectomy Trialists' Collaboration. Lancet. 2003 Jan 11;361(9352):107–16.
11. Sacco RL, Adams R, Albers G, Alberts MJ, Benavente O, Furie K, Goldstein LB, Gorelick P, Halperin J, Harbaugh R, Johnston SC, Katzan I, Kelly-Hayes M, Kenton EJ, Marks M, Schwamm LH, Tomsick T. Guidelines for prevention of stroke in patients with ischemic stroke or transient ischemic attack. Circulation. 2006 Mar 14;113(10):e409-49.
12. Rothwell PM, Eliasziw M, Gutnikov SA, Warlow CP, Barnett HJ. Endarterectomy for symptomatic carotid stenosis in relation to clinical subgroups and timing of surgery. Carotid Endarterectomy Trialists Collaboration. Lancet. 2004 Mar 20;363(9413):915–24.
13. Endarterectomy for asymptomatic carotid artery stenosis. Executive Committee for the Asymptomatic Carotid Atherosclerosis Study. JAMA. 1995 May 10;273(18):1421–28.
14. Abbott AL. Medical (nonsurgical) intervention alone is now best for prevention of stroke associated with asymptomatic severe carotid stenosis: results of a systematic review and analysis. Stroke. 2009 Oct;40(10):e573–83.
15. Mas JL, Chatellier G, Beyssen B; EVA-3S Investigators. Carotid angioplasty and stenting with and without cerebral protection: clinical alert from the Endarterectomy Versus Angioplasty in Patients With Symptomatic Severe Carotid Stenosis (EVA-3S) trial. Stroke. 2004 Jan;35(1):e18–20.
16. Brott TG, Hobson RW 2nd, Howard G, Roubin GS, Clark WM, Brooks W, Mackey A, Hill MD, Leimgruber PP, Sheffet AJ, Howard VJ, Moore WS, Voeks JH, Hopkins LN, Cutlip DE, Cohen DJ, Popma JJ, Ferguson RD, Cohen SN, Blackshear JL, Silver FL, Mohr JP, Lal BK, Meschia JF; CREST Investigators. Stenting versus endarterectomy for treatment of carotid-artery stenosis. N Engl J Med. 2010 Jul 1;363(1):11-23.
17. Maldonado TS. What are current preprocedure imaging requirements for carotid artery stenting and carotid endarterectomy: have magnetic resonance angiography and computed tomographic angiography made a difference? Semin Vasc Surg. 2007 Dec;20(4):205–15.
18. Alberts M. Results of a multicenter prospective randomized trial of carotid artery stenting vs. carotid endarterectomy. Abstracts of the International Stroke Conference. Stroke 2001;32:325.
19. Ouriel K, Hertzer NR, Beven EG, O'hara PJ, Krajewski LP, Clair DG, Greenberg RK, Sarac TP, Olin JW, Yadav JS. Preprocedural risk stratification: identifying an appropriate population for carotid stenting. J Vasc Surg. 2001 Apr;33(4):728-32.
20. Fluri F, Hatz F, Voss B, Lyrer PA, Engelter ST. Restenosis after carotid endarterectomy: significance of newly acquired risk factors. Eur J Neurol. 2010 Mar;17(3):493–98.
21. Schanzer A, Hoel A, Owens CD, Wake N, Nguyen LL, Conte MS, Belkin M. Restenosis after carotid endarterectomy performed with routine intraoperative duplex ultrasonography and arterial patch closure: a contemporary series. Vasc Endovascular Surg. 2007 Jun-Jul; 41(3):200–5.
22. Hudorovic N, Lovricevic I, Hajnic H, Ahel Z. Postoperative internal carotid artery restenosis after local anesthesia: presence of risk factors versus intraoperative shunt. Interact Cardiovasc Thorac Surg. 2010 Aug;11(2):182–84.
23. Dudanov IP, Belinskaia VG, Laptev KV, Vasil'chenko NO, Kablov E S, Sterlin OV. Rekonstruktivnye operatsii na sonnykh arteriiakh v kompleksnom lechenii ostrogo ishemicheskogo insul'ta [Reconstructive surgery on the carotid arteries in the complex treatment of acute ischemic stroke]. Med Akadem Zhurn. 2011;(2):109–16.
24. Bokeriia LA, Gudkova RG. Serdechno-sosudistaia khirurgiia. Bolezni i vrozhdennye anomalii sistemy krovoobrashcheniia [Cardiovascular Surgery. Disease and congenital malformations of the circulatory system]. Moscow, RF: NTsSSKh im AN Bakuleva RAMN; 2012.196 p.
25. Clagett GP, Robinowitz M, Youkey JR, Fisher DF Jr, Fry RE, Myers SI, Lee EL, Collins GJ, Irmani R. Morphogenesis and clinicopathologic characteristics of recurrent carotid disease. J Vasc Surg. 1986 Jan;3(1):10–23.
26. Burrig KF, Schrix T. Arterial wall texture after uncomplicated endarterectomy. Pathologe. 1995 Sep;16(5):336-41. [Article in German].
27. Laguta PS, Panchenko EP. Rol' aspirina v lechenii i profilaktike serdechno-sosudistykh zabolevanii [The role of aspirin in the treatment and prevention of cardiovascular diseases]. Angiologiia i Sosud Khirurgiia. 2002;8(3):6–12.
28. Pokrovskii AV, Kuntsevich GI, Beloiartsev DF, Timina IE, Kolosov RV. Sravnitel'nyi analiz otdalennykh rezul'tatov karotidnoi endarterektomii v zavisimosti ot metodiki operatsii [Comparative analysis of long-term results of carotid endarterectomy depending on the method of operations]. Angiologiia i Sosud Khirurgiia. 2005;11(1):93–03.
29. Ignat'ev IM. Operatsii na sonnykh arteriiakh v ostrom periode ishemicheskogo insul'ta [Operation on the carotid arteries in acute ischemic stroke]. Angiol i Sosud Khirurgiia. 2011;17(2):113–18.
30. Makihara N, Toyoda K, Uda K, Inoue T, Gotoh S, Fujimoto S, Yasumori K, Ibayashi S, Iida M, Okada Y. Characteristic sonographic findings of early restenosis after carotid endarterectomy. J Ultrasound Med. 2008 Sep;27(9):1345–52.
31. Aleksandrov IuV, Grigor'ev VM, Dragunov AG, i dr. Zavisimost' sostoianiia operirovannoi arterii ot vida i dliny zaplaty [The dependence of the operated artery state on the type and length of the patch]. Angiologiia i Sosud Khirurgiia. 2003;(3 pril):8.
32. Ferrero E, Ferri M, Viazzo A, Gaggiano A, Ferrero M, Maggio D, Berardi G, Pecchio A, Piazza S, Cumbo P, Nessi F. Early carotid surgery in patients after acute ischemic stroke: is it safe? A retrospective analysis in a single center between early and delayed/deferred carotid surgery on 285 patients. Ann Vasc Surg. 2010 Oct;24(7):890–9.
33. Setacci C, de Donato G. Is early carotid stenting indicated in patients with recent neurological events? Eur J Vasc Endovasc Surg. 2008 Sep;36(3):251–52.
34. Muto A, Nishibe T, Dardik H, Dardik A. Patches for carotid artery endarterectomy: current materials and prospects. J Vasc Surg. 2009 Jul;50(1):206–13.
35. Pirtskhalaishvili ZK, Lavrent'ev AV, Darvish NA, Churakova AV, Seleznev AI, Spiridonov AA. Sravnitel'naia otsenka rezul'tatov karotidnoi endarterektomii v zavisimosti ot metodov plastiki [Comparative evaluation of carotid endarterectomy results in the depending on plastics methods]. Annaly Khirurgii. 2002;(5):66–70.
36. Cao P, Giordano G, De Rango P, Zannetti S, Chiesa R, Coppi G, Palombo D, Peinetti F, Spartera C, Stancanelli V, Vecchiati E. Eversion versus conventional carotid endarterectomy: late results of a prospective multicenter randomized trial. J Vasc Surg. 2000 Jan;31(1 Pt 1):19-30.
37. Biasi GM, Sternjakob S, Mingazzini PM, Ferrari SA. Nine-year experience of bovine pericardium patch angioplasty during carotid endarterectomy. J Vasc Surg. 2002 Aug;36(2):271–77.
38. Trisal V, Paulson T, Hans SS, Mittal V. Carotid artery restenosis: an ongoing disease process. Am Surg. 2002 Mar;68(3):275-9; discussion 279-80.
39. AbuRahma AF, Robinson PA, Saiedy S, Richmond BK, Khan J. Prospective randomized trial of bilateral carotid endarterectomies: primary closure versus patching. Stroke. 1999 Jun;30(6):1185–89.
40. Clagett GP, Patterson CB, Fisher DF Jr, Fry RE, Eidt JF, Humble TH, Fry WJ. Vein patch versus primary closure for carotid endarterectomy. A randomized prospective study in a selected group of patients. J Vasc Surg. 1989 Feb;9(2):213-23.
41. Hertzer NR. The hidden statistics of carotid patch angioplasty. J Vasc Surg. 1994 Mar;19(3):555–56.
42. Sedov VM, Batalin IV, Kondrat'ev VM. Zavisimost' rezul'tatov lecheniia bol'nykh s aterosklerozom arterii golovnogo mozga ot tekhnologii karotidnoi endarterektomii [Dependence on the treatment results of patients with atherosclerosis of cerebral arteries from the technology of carotid endarterectomy]. Angiologiia i Sosud Khirurgiia. 2004;10(1):111–15.
43. Naylor AR, Mackey WC. Carotid artery surgery. London, UK: WB Saunders; 2000. 408 p.
44. Reikhert V, Shmitts-Riksen T, Antonov A, Efremov A. Izmeneniia rigidnosti biologicheskikh sosudistykh protezov v zavisimosti ot sposoba konservatsii [Changes of the rigidity of biological vascular prostheses according to the method of preservation]. Angiologiia i Sosud Khirurgiia. 1999;(4):58–69.
45. Rosenthal D, Archie JP Jr, Garcia-Rinaldi R, Seagraves MA, Baird DR, McKinsey JF, Lamis PA, Clark MD, Erdoes LS, Whitehead T, et al. Carotid patch angioplasty: immediate and long-term results. J Vasc Surg. 1990 Sep;12(3):326–33.
46. Archie JP Jr. A fifteen-year experience with carotid endarterectomy after a formal operative protocol requiring highly frequent patch angioplasty. J Vasc Surg. 2000 Apr;31(4):724–35.
47. Fokin AA, Babkin EV. Infektsionnye oslozhneniia rekonstruktivnykh operatsii na sonnykh arteriiakh pri ateroskleroticheskikh stenozakh [Infectious complications of reconstructive surgery on the carotid artery at atherosclerotic stenosis]. Angiologiia i Sosud Khirurgiia. 2010;16(2):87–90.
48. Cherniavskii AM, Starodubtsev VB, Stoliarov MS, Al'sov SA, Semenova II, Vinogradova TE, Bakharev AV. Rezul'taty ispol'zovaniia razlichnykh vidov zaplat v khirurgii sonnykh arterii [The results of different kinds of patches using in carotid surgery]. Angiologiia i Sosud Khirurgiia. 2009;15(1):103–05.
49. AbuRahma AF, Robinson PA, Saiedy S, Kahn JH, Boland JP. Prospective randomized trial of carotid endarterectomy with primary closure and patch angioplasty with saphenous vein, jugular vein, and polytetrafluoroethylene: long-term follow-up. J Vasc Surg. 1998 Feb;27(2):222–32.
50. Archie JP Jr. Prospective randomized trials of carotid endarterectomy with primary closure and patch reconstruction: the problem is power. J Vasc Surg. 1997 Jun;25(6):1118–20.

Address for correspondence:
246000, Respublika Belarus', g. Gomel', ul. Lange, d. 5, UO «Gomel'skii gosudarstvennyi meditsinskii universitet», kafedra khirurgicheskikh boleznei № 3,
e-mail: peleka@tut.by,
Pechenkin Aleksei Aleksandrovich

Information about the authors:
Pechenkin A.A. An assistant of the surgical diseases chair№ 3 of EE “Gomel State Medical University”.
Lyzikov A.A. An associate professor of the surgical diseases chair№ 3 of EE “Gomel State Medical University”.

Article in the .pdf format

CASE REPORTS

DOI: http://dx.doi.org/10.18484/2305-0047.2014.2.239   |  

P.N. MYSHENTSEV, S.E. KATORKIN

TACTICS IN THE TREATMENT OF LOWER LIMB SECONDARY LYMPHEDEMA

SBEE HPE “Samara State Medical University”,
The Russian Federation

Objectives. To evaluate the effectiveness of tactics of diagnosis and treatment in patients with the lower-limb secondary lymphedema.
Methods. During 5 years 58 patients with the lower-limb secondary lymphedema (IV stage) were being monitored. Ultrasound scanning, volumetry, computed tomography and clinical analysis of movements were applied during the examination combined with clinical and laboratory studies. The staged operative interventions were carried out in patient on the complex conservative treatment background. Life quality was estimated by means of the questionnaire “SF-36 Health Status Survey” (Russian version).
Results. The presented observation of the patient shows that on the first stage of treatment, the use of lymphotropic and prolonged intramuscular antibiotic therapy, the series of plasmapheresis and ultraviolet blood irradiation resulted in a stable remission in the recurrent erysipelas. Surgical intervention by creating lymphoveinous anastomosis to correct a lymphatic drainage proved to be ineffective. Volumetry and computed tomography performed at the next examination of the patient, permitted to specify a heavy, IV stage of the disease. In this regard, the patient underwent surgery of the modified tibia dermalipofascioectomy by Karavanov II. Five months later a reduction of functional failure of the affected limb and the increase of life quality have been approve. The reduction of the feeling of heaviness in the leg and quickly relieve symptoms have been registered. Volumetric measures of lower limbs made up 20477 cm³. Computed tomography showed a decrease in the soft tissue thickness of the left shin up to 26 mm, and the preservation of their density at the level of -26 HU.
Conclusions. Computer tomography plays a significant role in determining the disease stage and choice of a diagnostic optimal treatment tactics. At all stages of the disease a systematic complex treatment is indicated. A surgical correction such as the lymphoveinous shunting is considered to be possible in patients with the initial stages. Resection is recommended in the case of the 3^rd, especially 4^th stage of lymphedema.

Keywords: lymphedema of the lower limbs, computer tomography, surgical treatment

p. 239 – 243 of the original issue

References

1. Gorshkov SZ, Musalatov KhA. Slonovost' konechnostei i naruzhnykh polovykh organov [Elephantiasis of the limbs and external genitalia]. Moscow, RF: Meditsina; 2002.208 p.
2. Potashov LV, Bubnova RS, Orlov NA i dr. Khirurgicheskaia limfologiia [Surgical lymphology]. Saint-Petersburg, RF: Izd-vo SPbGETU LETI; 2002. 273 p.
3. Foldi M, Foldi E, Kubrik S. Textbook of lymphology for physicians and lymphedema therapists. Hardcover. 2007. – 736 p.
4. Lulay GR. [Lymphedema. Diagnostics and therapy]. Chirurg. 2013 Jul;84(7):607–16. [Article in German]
5. Doller W. Possibilities of surgical therapy of lymphedema. Wien Med Wochenschr. 2013 Apr;163(7-8):177–83. [Article in German].
6. Fionik OV, Bubnova NA, Petrov SV, Erofeev NP, Ladozhskaia-Gapeenko EE, Semenov AIu. Limfedema nizhnikh konechnostei: algoritm diagnostiki i lecheniia [Lymphedema of the lower extremities: diagnostic and treatment]. Novosti Khirurgii. 2009;17(4):49–64.
7. Koshima I, Narushima M, Yamamoto Y, Mihara M, Iida T. Recent advancement on surgical treatments for lymphedema. Ann Vasc Dis. 2012;5(4):409–15.
8. Lee BB, Kim YW, Kim DI, Hwang JH, Laredo J, Neville R. Supplemental surgical treatment to end stage (stage IV-V) of chronic lymphedema. Int Angiol. 2008 Oct;27(5):389–95.
9. Myshentsev PN, Zhukov BN, Katorkin SE, Iarovenko GV. Znachenie komp'iuternoi tomografii v otsenke stadii limfedemy nizhnikh konechnostei [The role of computed tomography in the evaluation of the lower extremities lymphedema stage]. Novosti Khirurgii. 2011;19(5):74–77.
10. Savel'ev VS, red. Sistemnaia enzimoterapiia v profilaktike i lechenii oslozhnenii posleoperatsionnogo perioda: posobie dlia vrachei [Systemic enzyme therapy in the prevention and treatment of postoperative complications: a guide for physicians]. Moscow, RF; 2012. 32 p.

Address for correspondence:
443079, Rossiiskaia Federatsiia, g. Samara, pr. Karla Marksa, d. 165 «b», Kliniki Samarskogo gosudarstvennogo meditsinskogo universiteta, kafedra i klinika gospital'noi khirurgii,
e-mail: katorkinse@mail.ru, Katorkin Sergei Evgen'evich

Information about the authors:
Myshentsev P.N. PhD, an associate professor of the hospital surgery chair and clinic of SBEE HPE “Samara State medical University”.
Katorkin S.E. PhD, an associate professor of the hospital surgery chair and clinic of SBEE HPE “Samara State medical University”.

Article in the .pdf format

EXCHANGE OF EXPERIENCE

DOI: http://dx.doi.org/10.18484/2305-0047.2014.2.244   |  

V.I. RUSYN, Y.M. POPOVYCH, V.V. KORSAK, V.V. RUSYN

THE PLACE OF HYBRID SURGERY IN TREATMENT OF CRITICAL LOWER LIMB ISCHEMIA

SHEE “Uzhgorod National University”,
The Ukraine

Objectives. To optimize accesses to surgical treatment of patients with occlusive-stenotic arterial lesions in case of critical lower limb ischemia by applying hybrid technologies.
Methods. The results of examination and surgery treatment of 35 patients with the occlusive-stenotic arterial lesions of the lower limbs have been analysed in the paper. 21 patients has been a two-stage operative treatment with 3-7 days intervals an open reconstruction or endovascular intervention has been firstly performed depending on the type, extent and character of the occlusive-stenotic lesions. In 14 patients the reconstructive-restorative operations have been combined with the endovascular interventions, i.e. the hybrid operations have been performed. The hybrid interventions were primary performed at the occlusive-stenotic lesions of the talocrural segment with local occlusive stenotic lesion of it, i.e. the open reconstruction was carried out firstly and then the endovascular intervention on the shin arteries was done to improve the outflow ways. The endovascular percutaneous balloon angioplasty was combined with stenting in 12 patients.
Results. A satisfactory result during 1 year follow-up was observed in 28 (80%) patients; the passability of zone of the open and endovascular reconstruction was observed in 25 (71,4%) and 28 (80%) patients, respectively. In two patients due to reocclusion in the place of the balloon angioplasty the stenting was performed to restore the magistral main blood flow. The lack of conditions for performing repeated endovascular interventions which led to a high amputation of the lower limb have been observed in 5 (14,3%) patients after the percutaneous transluminal balloon angioplasty.
Conclusions. Thus, thanks to the application of hybrid technologies during one-year observation period one managed to save the limb in 30 (85,7%) patients.

Keywords: occlusive stenotic lesions, critical ischemia of the lower limbs, angiography, hybrid operations, endovascular interventions, reconstructive restorative surgeries

p. 244 – 251 of the original issue

References

1. Breslow JL. Cardiovascular disease burden increases, NIH funding decreases. Nat Med. 1997 Jun;3(6):600–1.
2. Canaud L, Hireche K, Berthet JP, Branchereau P, Marty-Ane C, Alric P. Endovascular repair of aortic arch lesions in high-risk patients or after previous aortic surgery: midterm results. J Thorac Cardiovasc Surg. 2010 Jul;140(1):52–8.
3. Canaud L, Alric P, Desgranges P, Marzelle J, Marty-Ane C, Becquemin JP. Factors favoring stent-graft collapse after thoracic endovascular aortic repair. J Thorac Cardiovasc Surg. 2010 May;139(5):1153–57.
4. Kobeiter H, Jourdan G, Deux J, Rahmouni A, Lapeyre M, Luciani A, You K, Becquemin J, Desgranges P. Management of anastomotic stenosis after lower extremity bypass surgery with cutting balloon angioplasty. J Radiol. 2010 Jan;91(1 Pt 1):47–51.
5. Coscas R, Becquemin JP, Majewski M, Mayer J, Marzelle J, Allaire E, You K, Desgranges P, Kobeiter H. Management of perioperative endoleaks during endovascular treatment of juxta-renal aneurysms. Ann Vasc Surg. 2012 Feb;26(2):175–84.
6. Cochennec F, Marzelle J, Allaire E, Desgranges P, Becquemin JP. Open vs endovascular repair of abdominal aortic aneurysm involving the iliac bifurcation. J Vasc Surg. 2010 Jun;51(6):1360–66.
7. Desgranges P, Kobeiter H, Castier Y, Senechal M, Majewski M, Krimi A. The Endovasculaire vs Chirurgie dans les Anevrysmes Rompus PROTOCOL trial update. J Vasc Surg. 2010 Jan;51(1):267–70.
8. Lokatskii V. Nadezhda meditsiny: gibridnye tekhnologii [The hope of medicine: hybrid technology]. Effekt Farmakoterapiia. Kardiologiia i Angiologiia. 2011;(2):68–69.
9. Vladimirskii VV. Endovaskuliarnaia khirurgiia v profilaktike i lechenii sosudistykh zabolevanii serdtsa [Endovascular surgery in the prevention and treatment of heart diseases]. Meditsina – Ural. 2012;7(164). [Access available]: http://www.price-med.ru/art.php?id=399&r=25.
10. Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FG. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). J Vasc Surg. 2007 Jan;45 Suppl S:S5–67.

Address for correspondence:
88010, Ukraina, g. Uzhgorod, ul. Kapushanskaia, d. 22, GVUZ «Uzhgorodskii natsional'nyi universitet», Zakarpatskaia oblastnaia klinicheskaia bol'nitsa im. A. Novaka, kafedra khirurgicheskikh boleznei,
e-mail: angiosurgery@i.ua,
Popovich Iaroslav Mikhailovich

Information about the authors:
Rusin V.I. MD, professor, a head of the surgical diseases chair of SHEE “Uzhgorod National University”.
Popovich Y.M. PhD, an associate professor of the surgical diseases chair of SHEE “Uzhgorod National University”.
Korsak V.V. MD, professor of the surgical diseases chair of SHEE “Uzhgorod National University”.
Rusin V.V. PhD, an associate professor of the surgical diseases chair of SHEE “Uzhgorod National University”.

Article in the .pdf format