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Year 2017 Vol. 25 No 2

SCIENTIFIC PUBLICATIONS
EXPERIMENTAL SURGERY

Y.M. IRYANOV, D.Y. BORZUNOV, O.V. DYURYAGINA

COMPENSATION OF CAVITARY BONE DEFECTS UNDER IMPLANTATION OF TITANIUM NICKELIDE MESH CONSTRUCTIONS

FSBE Russian Scientific Center “Restorative Traumatology and Orthopedics”, named after Academician G.A. Ilizarov,
Kurgan,
The Russian Federation

Objectives. To study the morphological features of reparative bone formation in metaphysis cavitary defect filling by implanting mesh constructs of titanium nickelide.
Methods. In adult male rats of Wistar lines in the experimental (n=25) and control (n=25) groups, the metaphysis cavity defects of the femur were modeled. The frame made of titanium-nickelide mesh was implanted into the bone defect in the animals of the experimental group; in the control group no additional manipulations were performed. The total experiment term made up 90 days. The methods of radiography, histology, scanning electron microscopy and X-ray electron probe microanalysis were used; the bone image in the characteristic X-ray of calcium atoms was obtained.
Results. It was found out that on the periosteal surface of the implant, a layer of dense connective tissue was formed to serve as a biological protective barrier preventing the paraosseal connective tissue germination. The microporous surface of the implant provides cell adhesion and tissue integration. Fine-meshed structure of the implant and its nanostructuring surface provide capillary properties, resulting in the adsorption of endogenous bone morphogenetic proteins and growth factors. The functional activity of the latter provides osteoconductivity, osteoinductivity of the implant. Reparative bone formation using the implant is carried out by the direct intramembranous type. Compensation of defect is performed by osseous tissue, the bulk density of which is more than one and a half times higher the control values. Chemical composition of the regenerate, which formed after implantations into the tibial bone defect, approaches to the indices of the trabecular bone of the intact metaphysis. A composite biomaterial is formed in the defect – a dense fibrous connective tissue reinforced by the threads of titanium nickelide, a trabecular bone and compact bone.
Conclusion. The mesh constructions of titanium nickelide implant has biocompatibility and marked osteoplastic properties and relieves the inflammatory process. It can be successfully used in orthopedic surgery for the treatment of cavitary defects of bones, especially in patients with impaired reparative potential.

Keywords: bone defect, reparative osteogenesis, implant, mesh constructions, titanium nickelide, biocompatibility, inflammatory process
p. 115-123 of the original issue
References
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Address for correspondence:
640014, Russian Federation,
Kurgan, M. Ulyanova st., 6, FGBI "Russian Scientific Center "Restorative Traumatology and Orthopaedics named after Acad. GA Ilizarov"
Morphology Lab.
Tel.: +7 (3522) 43-08-83
E-mail: irianov@mail.ru
Yuri M. Iryanov
Information about the authors:
Iryanov Y.M. MD, Professor, Chief Researcher of morphology laboratory, FSBE "Russian Scientific Center "Restorative Traumatology and Orthopedics named after G.A.Ilizarov".
Borzunov D.Y. MD, Deputy Director (Science), FSBE "Russian Scientific Center "Restorative Traumatology and Orthopedics named after G.A.Ilizarov".
Dyuryagina O.V. PhD, Senior Researcher of laboratory of purulent osteology and replacement of limb defects, FSBE "Russian Scientific Center "Restorative Traumatology and Orthopedics named after G.A.Ilizarov".

GENERAL & SPECIAL SURGERY

B.M. BELIK1, G.M. CHIRKINYAN1, A.I. MASLOV1, D.V. MAREEV2

CLINICAL SIGNIFICANCE OF INTRA-ABDOMINAL PRESSURE ELEVATION IN PATIENTS WITH SEVERE ACUTE PANCREATITIS

FSBEE HE "Rostov State Medical University"1,
MBEHC "Municipal Hospital N1 named after N.A. Semashko"2
Rostov,
The Russian Federation

Objective. To determine the clinical significance of intra-abdominal pressure (IAP) in forecasting of the severe acute pancreatitis (AP), in evaluating the effectiveness of the perfomance of intensive therapy and in substantiating of the conduction of early sanitational and decompression surgery.
Methods. The analysis of treatment results of patients (n=76) with severe AP has been performed. Depending on the AP severity, all patients were divided into four groups. In 26 (34,2%) patients the organ dysfunctions were transitory (group 1), in 18 (23,7%) – functional failure of one organ was registered (group 2), in 15 (19,7%) – of two organs (group 3) and in 17 (22,4%) – of three or more organs (group 4). Within the 1-7th days from the disease onset, patients’ intra-abdominal pressure (IAP) was monitored with the calculation of abdominal perfusion pressure and filtration gradient as well as evaluating the severity of the patients’ condition by APACHE II scores. Prevalence of retroperitoneal necrosis was estimated according to US data, a bolus contrast-enhanced computed tomography and the information obtained during the operation and autopsy.
Results. It has been found out that IAP level of patients (1-2 groups) corresponded to the 1st degree of the intra-abdominal hypertension (IAH) with a reduction of this value by the 5-7th days. In patients of the 3-4th groups remained the 2-3rd degree of IAH by the 5-7th days. A direct correlation between the values of IAP and APACHE II scores was noted. The values of IAP and APACHE II scores in patients with the generalized retroperitoneal necrosis were significantly higher than in patients with limited forms of retroperitoneal necrosis. Lethal outcome occurred in 17 (22,4%) out of 76 patients with severe AP. In the 1st group of patients there were no lethal outcomes. In the 2nd group mortality was 11,1%, in the 3rd group – 33,3%, in the 4th group – 58,8%.
Conclusion. The level of IAP objectively represents the severity of AP, allows predicting the course and outcome of the disease and evaluating the effectiveness of intensive therapy and substantiating the performance of early sanitational and decompression surgery.

Keywords: severe acute pancreatitis, intra-abdominal pressure, intra-abdominal hypertension, multiorgan failure, retroperitoneal necrosis, mortality, sanitational and decompression surgery
p. 124-130 of the original issue
References
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  10. Dibirov MD, Isaev AI, Dzhadzhiev AB, Ashimova AI, Ataev T. Rol' korrektsii sindromov kishechnoi nedostatochnosti i vnutribriushnoi gipertenzii v profilaktike infitsirovaniia pankreonekroza [The role of the correction syndromes of intestinal failure and abdominal hypertension, in the prevention of infection of pancreatic necrosis]. Khirurgiia Zhurn im NI Pirogova. 2016;(8):67-72. doi: 10.17116/hirurgia2016867-72.
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Address for correspondence:
344000, Russian Federation,
Rostov-on-Don, Voroshilov pr., 105,
MBUZ "City Hospital N1 named after N.A. Semashko",
Department of general surgery.
tel.: 8-904-500-64-42
e-mail: bbelik@yandex.ru
Boris M. Belik
Information about the authors:
Belik B.M. MD, Head of department of general surgery, FSBEE HE "Rostov State Medical University".
Chirkinyan G.M. Post-graduate student of department of general surgery, FSBEE HE "Rostov State Medical University".
Maslov A.I. PhD, Ass. Professor of department of general surgery, FSBEE HE "Rostov State Medical University". D.V.
Mareev D.V. PhD, physician- surgeon of surgical department , MBEHC “Municipal Hospital N1 named after N.A. Semashko” Rostov-on-Don

V.I. RUSIN, V.V. KORSAK, P.A. BOLDIZHAR, V.V. RUSIN, M.I. PEKAR, F.V. GORLENKO, V.V. MASHURA, O.V. LANGAZO

LONG-TERM SURGICAL TREATMENT RESULTS OF CRITICAL LOWER LIMBS ISCHEMIA FOLLOWING SIMULTANEOUS DIRECT AND INDIRECT REVASCULARIZATION

SHEE “Uzhhorod National University”,
Uzhhorod,
Ukraine

Objectives. To optimize the tactics of surgical treatment in patients with chronic lower limb ischemia through the development and implemention into the clinical practice of simultaneous combination of direct and indirect methods of revascularization.
Methods. The results of surgical treatment of patients (n=181) have been studied and analyzed; the patients underwent the combined direct and indirect revascularization of the lower limbs. Depending on the type of surgical treatment the patients were divided into two groups: group I – 54 patients who underwent distal (below the knee) bypass surgery simultaneously with a rotary osteotrepanation of the tibia (ROT); group II – 62 patients who underwent profundoplasty simultaneously with ROT. For comparison group III (control) with 65 patients was formed where distal bypass grafting (below the knee) was performed. The long-term results were studied in 47 patients in group I, in 49 – group II and in 53 patients in group III.
Results. Within the 5-year observation the passability after the distal femoropopliteal bypass was registered in 49,4%, the limbs were saved in – 69,1% of cases. In the control group those figures were 43,7% and 55,2%, respectively. After tibial bypass the passability within 5 year observation in the first group was 16,8%, in the control group – 14,3% of cases. It managed to save the limbs in 36,1% of the operated patients and 24,2%, respectively. In the second group of patients who underwent profundoplasty and a rotary osteotrepanation, the index of the surviving limbs made up 56,3%, which is almost twice more as the index of the surviving limbs after tibial bypasses.
Conclusion. The effectiveness of indirect revascularization after the restoration of arterial inflow is considered to be more predictable than its performing in isolated form under the conditions of critical limb ischemia.The combination of direct and indirect methods of revascularization is thought to provide a higher positive result in the late incisional period and increases the rate of the saved limbs.

Keywords: chronic critical arterial ischemia, femoral-popliteal-tibial segment, direct and indirect revascularization interventions, tibial bypasses, incisional period, effectiveness, mortality
p. 131-139 of the original issue
References
  1. Vinnik IuS, Dunaevskaia SS, Podrezenko ES, Antiufrieva DA, Nikiforova AA. Vozmozhnosti otsenki riska razvitiia progressiruiushchego techeniia obliteriruiushchego ateroskleroza sosudov nizhnikh konechnostei [An assessment of a risk of the progressive course of the lower limbs obliterating atherosclerosis]. Fundam Issledovaniia. 2015;(1-8):1544-47.
  2. Kazakov IuI, Lukin IB, Kazakov AIu, Efimov SIu, Velikov PG. Vybor metoda rekonstruktsii sosudov pri kriticheskoi ishemii nizhnikh konechnostei [The choice of angioplasty method in patients with critical limb ischemia]. Angiologiia i Sosud Khirurgiia. 2015;21(2):152-8.
  3. Katel'nitskii II, Katel'nitskii IgI. Vliianie vida i ob"ema vosstanovleniia krovotoka na otdalennye rezul'taty operativnogo lecheniia patsientov s obliteriruiushchim aterosklerozom pri kriticheskoi ishemii nizhnikh konechnostei [Influence of the type and volume of blood flow recovery in the long-term results of surgical treatment of patients with atherosclerosis obliterans in critical lower limb ischemia] Novosti Khirurgii. 2014;22(1):68-74. doi: 10.18484/2305-0047.2014.1.68.
  4. Colini Baldeschi G, Carlizza A. Spinal cord stimulation: predictive parameters of outcome in patients suffering from critical lower limb ischemia. A preliminary study. Neuromodulation. 2011 Nov-Dec;14(6):530-2; discussion 533. doi: 10.1111/j.1525-1403.2011.00378.x.
  5. Owens CD, Kim JM, Hevelone ND, Casper WJ, Belkin M, Creager MA, et al. An integrated biochemical prediction model of all-cause mortality in patients undergoing lower extremity bypass surgery for advanced peripheral artery disease. J. Vasc. Surg. 2012 Sep;56(3):686-95.doi: 10.1016/j.jvs.2012.02.034.
  6. Dib’iak IuM. Suchasn³ p³dkhodi do gom³lkovikh rekonstrukts³i ³ problemi, shcho vinikaiut' pri ¿kh vikonann³ [Current approaches to reconstruction and problems encountered in their implementation]. Shpital'na Kh³rurg³ia. 2014;(3):76-8.
  7. Cherviakov IuV, Staroverov IN, Vlasenko ON, Nersesian EG, Isaev AA, Deev RV. Otdalennye rezul'taty lecheniia bol'nykh s khronicheskoi ishemiei nizhnikh konechnostei metodami nepriamoi revaskuliarizatsii i genoterapii [Long-term results of patients treatment with chronic lower limb ischemia by the methods of indirect revascularization and gene therapy]. Angiologiia i Sosud Khirurgiia. 2016;22(1):29-37.
  8. L³tv³nova NIu, Cherniak VA, Panchuk OV. Metodi nepriamo¿ revaskuliarizats³¿ pri kritichn³i ³shem³¿ nizhn³kh k³nts³vok [The indirect revascularization in critical limb ischemia]. Sertse ³ Sudini. 2015;(1):110-15.
  9. Eroshkin SN, Sachek MG, Krishtopov LE, Fedianin SD, Eroshkina ES. Vozmozhnosti povtornoi revaskuliariziruiushchei osteotrepanatsii bol'shebertsovoi kosti v lechenii patsientov s gnoino-nekroticheskimi oslozhneniiami sindroma diabeticheskoi stopy [The repeated revascularization osteotrephination tibia in the treatment of patients with purulent-necrotic complications of diabetic foot syndrome]. Novosti Khirurgii. 2016;24(3):249-53. doi: 10.18484/2305-0047.2016.3.249.
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Address for correspondence:
88000, Ukraine, Zakarpatskaya region,
Uzhgorod, Narodnaya sq., 1,
SHEE «Uzhhorod National University»,
Medical Faculty
department of surgical diseases.
Tel.: + 38095-553-20-32
e-mail: m_pekar@mail.ru
Mikhail I. Pekar
Information about the authors:
Rusin V.I. MD, Professor of department of the surgical diseases, medical faculty, SHEE “Uzhhorod National University”.
Korsak V.V. MD, Professor of department of the surgical diseases, medical faculty, SHEE “Uzhhorod National University”.
Boldizhar P.A. MD, Professor, Head of department of the surgical diseases, medical faculty, SHEE “Uzhhorod National University”.
Rusin V.V. MD, Ass. Professor of department of the surgical diseases, medical faculty, SHEE “Uzhhorod National University”.
Pekar M.I. Post-graduate student of department of the surgical diseases, medical faculty, SHEE “Uzhhorod National University”.
Gorlenko F.V. PhD, Ass. Professor of department of the surgical diseases, medical faculty, SHEE “Uzhhorod National University”.
Mashura V.V. Post-graduate student of department of the surgical diseases, medical faculty, SHEE “Uzhhorod National University”.
Langazo O.V. Post-graduate student of department of the surgical diseases, medical faculty, SHEE “Uzhhorod National University”.

S.G. BELOV 1, O.V. DANILOVA 2, I.A. TARABAN 3, D.I. GALATA 3, N.I. GORGOL 3, S.N. POTAPOV 3

MORPHOFUNCTIONAL FEATURES OF SOFT TISSUES IN NEUROISCHEMIC FORM OF DIABETIC FOOT SYNDROME

Kharkov Medical Academy of Post-Graduate Education1,
Kharkov Municipal Center "Diabetic Foot" 2,
Kharkov National Medical University 3,
Kharkov
Ukraine

Objectives. To determine the morphological features of the foot skin wounds in patients with neuroischemic form of diabetic foot syndrome (DFS) to optimize the surgical tactics and surgical treatment methods.
Methods. Morphological study of the foot soft tissues in patients (n=12) with purulent-necrotic complications of the neuroischemic form of DFS was performed using histological, histochemical and morphometric methods. The patients were divided into 2 clinical groups. The first group consisted of patients (n=6) with prevalence of the ischemic changes according to clinical, anamnestic and instrumental methods of investigation. The second group included patients (n=6) with prevalence of neuropathic changes in tissues.
Results. Heterogeneity of clinical, instrumental and morphological data was revealed in patients with purulent-necrotic complications of the neuroischemic form of DFS. In the observations of the first group the trophic disorders of the foot were clinically represented by dry gangrene. Severe circulatory disorders, thickening of the arterioles and capillaries with narrowing of lumen were morphologically markerd. Changes in peripheral nerves were characterized by a mild demyelination or absence of signs of myelin destruction. In the second group the trophic disorders of the foot were clinically represented by infected wounds, osteomyelitis and the soft tissue phlegmon. An extensive necrosis with overlay of fibrin and purulent exudate was histologically established. Also the reduction of the number of vessels, thickening of walls and narrowing of lumen were revealed. Changes in the peripheral nerves were characterized by the destruction of myelin even up to the total demyelination and complete degeneration of axons, and in some fields the studies have shown a complete loss of nerve fibers.
Conclusion. While the similarity of vascular disorders (macro- and microangiopathy) in both clinical groups, the performed research has convincingly showed morphological differences in the prevalence of neuropathic or ischemic component of the neuroischemic form of DFS. The revealed clinical-morphological features of neuroischemic form of DFS demonstrate the necessity of an individual approach to patients’ treatment, taking into account the prevalence of specific morphological changes.

Keywords: diabetic foot, diabetic complications, ischemic ulcer, diabetic peripheral neuropathy, arterial ischemia, neuroischemic form, morphological changes
p. 140-147 of the original issue
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  2. Ahmad N, Thomas GN, Gill P, Torella F. The prevalence of major lower limb amputation in the diabetic and non-diabetic population of England 2003-2013. Diab Vasc Dis Res. 2016 Sep;13(5):348-53. doi: 10.1177/1479164116651390.
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  4. Gök ü, Selek ö, Selek A, Güdük A, Güner Mç. Survival evaluation of the patients with diabetic major lower-extremity amputations. Musculoskelet Surg. 2016 Aug;100(2):145-8. doi: 10.1007/s12306-016-0399-y.
  5. Wilbek TE, Jansen RB, Jørgensen B, Svendsen OL. The Diabetic Foot in a Multidisciplinary Team Setting. Number of Amputations below Ankle Level and Mortality. Exp Clin Endocrinol Diabetes. 2016 Jul 20. [Epub ahead of print]
  6. Udovichenko OV, Grekova NM. Diabeticheskaia stopa [Diabetic foot]: ruk dlia vrachei. Moscow, RF: Prakt Meditsina; 2010. 271 p.
  7. Vorobikhina NV, Zelenina TA, Petrova TM. Vliianie metoda operativnogo lecheniia bol'nykh s gnoino-nekroticheskimi formami sindroma diabeticheskoi stopy na chastotu retsidivirovaniia, risk povtornykh amputatsii i vyzhivaemost' [The impact of the method of surgical treatment of patients with purulent-necrotic forms of diabetic foot syndrome on the recurrence rate; the risk of repeated amputation and survival]. Infektsii v Khirurgii. 2009;7(4):41-46.
  8. International Best Practice Guidelines: Wound Management in Diabetic Foot Ulcers. Wounds International publication; 2013. 23 p. Available from: http://www. woundsinternational.com.
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  11. Belkin VS, Dorofeev AA, Mashkov VS, Usmanov MU. Morfometricheskii analiz sostoianiia vnutriorgannykh krovenosnykh sosudov [The morphometric analysis of the intraorganic blood vessels]. Arkh Anatomii Gistologii Embriologii. 1980;(7):88-93.
  12. Sergienko VI, Bondareva IB. Matematicheskaia statistika v klinicheskikh issledovaniiakh [Mathematical statistics in clinical trials]. Moscow, RF: Geotar Meditsina; 2000. 256 p.
Address for correspondence:
61022, Ukraine, Kharkov, Science pr.,
4, Kharkiv National Medical University,
Department of pathological anatomy.
Tel.:+ 38 095 219-53-53
E-mail: daryagalata@gmail.com
Daria I. Galata
Information about the authors:
Belov S.G. MD, Professor, department of surgery and proctology, Kharkov Medical Academy of Post-graduate Education.
Danilova O.V. Surgeon of Kharkov Municipal Center "Diabetic Foot".
Taraban I.A. MD, Professor, department of surgery N1, Kharkov National Medical University.
Galata D.I. PhD, Assistant, department of pathologic anatomy, Kharkov National Medical University.
Gorgol N.I. PhD, Ass. Professor, department of pathologic anatomy, Kharkov National Medical University.
Potapov S.N. PhD, Ass. Professor, deparment of pathologic anatomy, Kharkov National Medical University.

O.S. OLIFIROVA, A.A. KOZKA

VALUE OF ANTIOXIDANTS AND HYPERBARIC OXYGENATION IN TREATMENT OF BURN WOUNDS

FSBEE HE "Amur State Medical Academy" of Ministry of Health of the Russian Federation,
Blagoveshchensk,
The Russian Federation

Objectives. To assess the value of antioxidants and hyperbaric oxygenation in the complex treatment of burn wounds.
Methods. The treatment analysis of 54 patients with I-II-III degree burns (ICD-10) of different localization has been carried out. In the complex treatment of the main group (n=28), the oral administration of antioxidants (the mixture of dihydroquercetin and arabinogalactan, 1:3) 1 capsule twice a day for 21 days was indicated as well as local application of the powder of dihydroquercetin. At the same time in case of I-II degree burns – 8-10 sessions of hyperbaric oxygenation of 1,5 to 1,8 atmospheres in the chamber "OKA-M", 40 minutes daily were carried out. In case of III degree burns – hyperbaric oxygen was carried out up to delayed autodermoplasty with a free split skin graft and starting from the first postoperative day with in 7 days. The clinical comparison group was comprised of patients (n=26) who received the traditional treatment.
Results. In patients of the main group who received antioxidant therapy and hyperbaric oxygenation the course of wound healing is characterized by even process, manifested in reduction of pain syndrome and the temperature reaction, in the early appearance of granulation, marginal and complete epithelialization of wounds of I-II degree burns was noted, as well as the reduction of preoperative preparation terms of III degree burns. Due to the stimulation of reparative processes, complete engraftment of the split free autodermotransplant was achieved in 100% of cases in the main group and only in 72,4% – in the clinical group. Hyperproduction of pro-inflammatory interleukins (IL-1β, IL-6, IL-8, TNF-α) was observed in all patients, however, to the 21st day of treatment, its significant reduction was registered in the main group. Antioxidants and hyperbaric oxygen application permitted to reduce the intensity of lipid peroxidation and to increase the activity of antioxidant protection system.
Conclusion. The conducted study showed the efficacy of application of antioxidants and hyperbaric oxygen therapy in complex treatment of patients with burn wounds.

Keywords: burn wounds, dihydroquercetin, arabinogalactan, hyperbaric oxygenation, engraftment, lipid peroxidation, pro-inflammatory cytokines
p. 148-154 of the original issue
References
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  4. Ryssel H, Germann G, Kloeters O, Gazyakan E, Radu CA. Dermal substitution with Matriderm(®) in burns on the dorsum of the hand. Burns. 2010 Dec;36(8):1248-53. doi: 10.1016/j.burns.2010.05.003.
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  8. Kozka AA, Olifirova OS. Antioksidanty i giperbaricheskaia oksigenatsiia v kompleksnom lechenii bol'nykh s glubokimi ozhogami [Antioxidants and hyperbaric oxygen therapy in the complex treatment of patients with deep burns]. Prakt Meditsina. 2015;(6):112-15.
  9. Bagaev VG, Sergeeva VV, Bobrova AA, Medinskii PV, Nalbandian RT, Davydov MIu, i dr. Giperbaricheskaia oksigenatsiia v kompleksnoi terapii ran u detei [Hyperbaric oxygen therapy in the treatment of wounds in children]. Rany i Ranevye Infektsii. 2014;(2): 31-37.
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  12. Olifirova OS, Tseluiko SS, Bregadze AA, Lebed' AA, Alekseevnina VV, Shtarberg MI. Sposob stimuliatsii zazhivleniia ran razlichnogo geneza prirodnym antioksidantom digidrokvertsetinom [A method of stimulating of wound healing of various genesis by natural antioxidant dihydroquercetin]. Patent Ros Federatsii N 2522214. 15.05.2014.
  13. Baidin SA, Gramenitskii AB, Rubinchik BA, red. Rukovodstvo po giperbaricheskoi meditsine [Guidelines for hyperbaric medicine]. Moscow, RF: Meditsina; 2008. 560 p.
  14. Olifirova OS, Bregadze AA, Kozka AA, Kiridon OI. Sposob stimuliatsii zazhivleniia dermal'nykh ozhogov [A method of stimulating the healing of dermal burns]. Patent Ros Federatsii N2577950. 20.03.2016.
Address for correspondence:
675000, Russian Federation,
Blagoveshchensk, Gorky str., 95,
FGBOU «Amur State Medical Academy»
Faculty of Postgraduate Education,
Department of surgical diseases.
Tel.: 7 914 554-46-52
e-mail: olif.oc@mail.ru
Olga S.Olifirova
Information about the authors:
Olifirova O.S. MD, Ass. Professor, Head, department of surgical diseases, FSBEE HE "Amur State Medical Academy" of Ministry of Health, the Russian Federation, Blagoveshchensk.
Kozka A.A. Post-graduate student of department of surgical diseases, FSBEE HE "Amur State Medical Academy" of Ministry of Health, the Russian Federation, Blagoveshchensk.

TRAUMATOLOGY AND ORTHOPEDICS

A.I. RADCHENKO, A.G. ZHUKOVEC, Y.M. BOGDAEV

OSTEOSYNTHESIS IN SURGICAL TREATMENT OF METASTATIC LESIONS OF THE LONG TUBULAR BONES

SE "N.N. Alexandrov National Cancer Centre of Belarus for Oncology and Medical Radiology",
Minsk,
The Republic of Belarus

Objectives. This study was designed to investigate the causes and risk factors of complications requiring revision surgeries after intramedullary and plate osteosynthesis of the long tubular bones affected by metastases.
Methods. Surgical treatment outcomes of patients with long tubular bones metastases (n=44) were analyzed retrospectively. Twelve patients had solitary skeletal metastasis, eleven – multiple, twenty one – bone metastases combined with visceral metastases. The pathological fracture was diagnosed in 35 patients and the threat of the pathological fracture – in 9. Intramedullary osteosynthesis was carried out in 34 cases, plate osteosynthesis – in 3 cases, intramedullary osteosynthesis with alloplasty – in 12 cases.
Results. Application of OS in the metastatic treatment of malignant tumors in long tubular bones have allowed saving the extremity function in 75% cases; the revision organ-saving surgery was carried out in 14,6% observations; restoration of the extremity function was failed in 10,4% cases. Thirteen complications caused by bone metastases required the revision surgery. Median time was 6 months (range of 1-12 months). The causes of complications included local tumor progression, the absence of osseous consolidation and violation of the structural integrity. Risk factors of complications development which require the revision surgeries were the following: pathologic fracture (p=0,046), progressive renal cell carcinoma (p=0,013) and radiation therapy before surgery (p=0,029). In patients with the best life prognosis the complications related with violation of the metal construction integrity or bone fixation failure have developed in longer and active load on the extremity.
Conclusion. Osteosynthesis appears to be an efficient method in the treatment of metastatic bone disease in the specific clinical cases. Radical surgical removal of the metastases with the elimination of the bone defect by allograft or endoprosthesis is more reasonable in case of solitary metastases of radio-resistant tumors and controlled tumor process.

Keywords: metastases, long tubular bones, osteosynthesis, radical surgical removal, bone fixation failure, complications, mortality
p. 155-162 of the original issue
References
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  14. Mirels H. Metastatic disease in long bones. A proposed scoring system for diagnosing impending pathologic fractures. Clin Orthop Relat Res. 1989 Dec;(249):256-64.
  15. Brumback RJ, Toal TR Jr, Murphy-Zane MS, Novak VP, Belkoff SM. Immediate weight-bearing after treatment of a comminuted fracture of the femoral shaft with a statically locked intramedullary nail. J Bone Joint Surg Am. 1999 Nov;81(11):1538-44.
  16. Qu Huayi, Guo Wei, Yang Rongli, Li Dasen, Tang Shun, Yang Yi, et al. Reconstruction of segmental bone defect of long bones after tumor resection by devitalized tumor-bearing bone. World J Surg Oncol. 2015;13:282. doi: 10.1186/s12957-015-0694-3.
  17. Ahlmann ER, Menendez LR. Intercalary endoprosthetic reconstruction for diaphyseal bone tumours. J Bone Joint Surg [Br]. 2006 Nov;88-B(11):1487-91. doi: 10.1302/0301-620X.88B11.
Address for correspondence:
223040, Republic of Belarus, Minsk
region, Lesnoy settl.,
EE «N.N. Alexandrov National Cancer Centre
of Belarus for Oncology and Medical Radiology».
Laboratory of oncological pathology
of the central nervous system with a group
of oncological pathology of the head and neck,
Tel.: 375447724255
e-mail: Aradchenko@mail.ru
Artem I. Radchenko
Information about the authors:
Radchenko A.I. Researcher of laboratory of oncopathology of the central nervous system with the group of oncopathology of head and neck, SE "N.N. Alexandrov National Cancer Centre of Belarus for Oncology and Medical Radiology".
Zhukovec A.G. PhD, Head of laboratory of oncopathology of central nervous system with the group of oncopathology of head and neck, SE "N.N. Alexandrov National Cancer Centre of Belarus for Oncology and Medical Radiology" .
Bogdaev Y.M. PhD, Head of department of reconstructive-restorative surgery, SE "N.N. Alexandrov National Cancer Centre of Belarus for Oncology and Medical Radiology".

ONCOLOGY

K.V. PUCHKOV1, D.A. KHUBEZOV1,2, D.K. PUCHKOV1,2, R.V. LUKANIN2

ARE THERE ANY FACTORS AFFECTING THE SPECIMEN QUALITY OF TOTAL MESORECTUMECTOMY?

SBEE HPE "Ryazan State Medical University Named after Academician I.P. Pavlov"1
SBE RR "Regional Clinical Hospital", 2
Ryazan,
The Russian Federation

Objectives. To analyze the results of performing the total mesorectumectomy (TME) via the an open and laparoscopic access and identification of the factors affecting the quality of TME specimen.
Methods. Open prospective randomized trials have been conducted, including patients (n=193) who underwent the total mesorectumectomy with the deriving the loop stoma due to middle- and lower-ampullar rectal cancer. The potential factors affecting TME quality were analyzed: age, sex, pelvic dimensions, previous operations on the abdominal and pelvic organs, neoadjuvant radiation therapy, the size and location of the tumor, a surgical access, TNM stage of the tumor process.
Results. Out of 193 resections, 117 (60,6%) have been carried out via laparoscopic access, and 76 (39,4%) – via an open access. Within the operation conversion from laparoscopic to open surgery was made in 4 cases (2,07%). Quality of TME specimen in 132 (68,4%) cases was evaluated as "completed", in 56 (29%) – as "almost completed"», and in 5 (2,6%) – as "uncompleted." "Uncompleted" samples of preparations were obtained in case of tumor location on the anterior wall – 3 (60%) cases and on the posterior side – 2 (40%) cases. Circular resection margin (CRM) was positive in 6 (3,1%) specimens, 5 (2,6%) of which were "completed" and 1 (0,51%) was "uncompleted". In one case (0,51%) "uncompleted" specimen in presence of N1c stage as well as in 1 (0,51%) case in the patient with the degree of tumor invasion – T4b was obtained.
Conclusion. Male gender, "difficult" pelvis anatomy, the location of the tumor on the anterior surface of the rectum and circularly, may potentially affect the quality of the specimen in patients who had undergone TME for the rectal cancer.

Keywords: colorectal cancer, total mesorectumectomy, neoadjuvant radiation therapy, quality of TME specimen, completed TME, laparoscopic TME
p. 163-170 of the original issue
References
  1. Campa-Thompson M, Weir R, Calcetera N, Quirke P, Carmack S. Pathologic processing of the total mesorectal excision. Clin Colon Rectal Surg. 2015 Mar;28(1):43-52. doi: 10.1055/s-0035-1545069.
  2. Kulikov EP, Riazantsev ME, Zubareva TP, Sudakov IB, Kaminskii IuD, Sudakov AI, i dr. Dinamika zabolevaemosti i smertnosti ot zlokachestvennykh novoobrazovanii v Riazanskoi oblasti v 2004-2014 godakh [Dynamics of morbidity and mortality from cancer in the Ryazan region in 2004-2014 years]. Ros Med-Biol Vestn im akad IP Pavlova. 2015;(4):109-14.
  3. Deng H, Chen H, Zhao L, Shen Z, Wang Y, Lan X, et al. Quality of laparoscopic total mesorectal excision: results from a single institution in China. Hepatogastroenterology. 2015 Mar-Apr;62(138):264-67.
  4. Leonard D, Penninckx F, Fieuws S, Jouret-Mourin A, Sempoux C, Jehaes C, et al. PROCARE, a multidisciplinary Belgian Project on Cancer of the Rectum. Factors predicting the quality of total mesorectal excision for rectal cancer. Ann Surg. 2010 Dec;252(6):982-88. doi: 10.1097/SLA.0b013e3181efc142.
  5. Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery–the clue to pelvic recurrence? Br J Surg. 1982 Oct;69(10):613-16.
  6. Quirke P. Training and quality assurance for rectal cancer: 20 years of data is enough. Lancet Oncol. 2003 Nov;4(11):695-702.
  7. Laurent C, Leblanc F, Wütrich P, Scheffler M, Rullier E. Laparoscopic versus open surgery for rectal cancer: long-term oncologic results. Ann Surg. 2009 Jul;250(1):54-61. doi: 10.1097/SLA.0b013e3181ad6511.
  8. Simunovic MR, DeNardi FG, Coates AJ, Szalay DA, Eva KW. Product analysis and initial reliability testing of the total mesorectal excision-quality assessment instrument. Ann Surg Oncol. 2014 Jul;21(7):2274-9. doi: 10.1245/s10434-014-3604-y.
  9. Maslekar S, Sharma A, Macdonald A, Gunn J, Monson JR, Hartley JE. Mesorectal grades predict recurrences after curative resection for rectal cancer. Dis Colon Rectum. 2007 Feb;50(2):168-75.
  10. Phang PT1. Total mesorectal excision: technical aspects. Can J Surg. 2004 Apr;47(2):130-7.
  11. Baik SH, Kim NK, Lee KY, Sohn SK, Cho CH, Kim MJ, et al. Factors influencing pathologic results after total mesorectal excision for rectal cancer: analysis of consecutive 100 cases. Ann Surg Oncol. 2008 Mar;15(3):721-28.
  12. Khat'kov IE, Makhonina EM. Topografoanatomicheskie usloviia povysheniia bezopasnosti vypolneniia endovideokhirurgicheskikh operatsii na priamoi kishke [Topographic-anatomical conditions of improve safety of endovideosurgical operations performance on the rectum.]. Endoskop Khirurgiia. 2006;(2):145-46.
  13. Ballian N, Lubner MG, Munoz A, Harms BA, Heise CP, Foley EF, et al. Visceral obesity is associated with outcomes of total mesorectal excision for rectal adenocarcinoma. J Surg Oncol. 2012 Mar 15;105(4):365-70. doi: 10.1002/jso.22031.
  14. Rickles AS, Iannuzzi JC, Mironov O, Deeb AP, Sharma A, Fleming FJ, Monson JR. Visceral obesity and colorectal cancer: are we missing the boat with BMI? J Gastrointest Surg. 2013 Jan;17(1):133-43; discussion p.143. doi: 10.1007/s11605-012-2045-9.
  15. Vennix S, Pelzers L, Bouvy N, Beets GL, Pierie JP, Wiggers T, et al. Laparoscopic versus open total mesorectal excision for rectal cancer. Cochrane Database Syst Rev. 2014 Apr 15;(4):CD005200. doi: 10.1002/14651858.
  16. Khubezov DA, Rodimov SV, Puchkov DK, Lukanin RV, Iudina EA. Osobennosti primeneniia protokola uskorennoi reabilitatsii v kolorektal'noi khirurgii [Features of the application of accelerated rehabilitation protocol in colorectal surgery]. Ros Med-Biol Vestn im akad IP Pavlova. 2016;(1):134-41.
  17. Mendez MA, Wilcox R, Callas PW, Cataldo P. Tumor Location may Affect Total Mesorectal Excision Quality. Colorec Cancer. 2016,2:1. doi: 10.21767/2471-9943.100012.
Address for correspondence:
390026, Russian Federation,
Ryazan, Vyisokovoltnaya str., 9
Department of Surgery with the
course endosurgery FDPO,
Tel.: 7(952) 122-81-85
E-mail: puchkovdk@mail.ru
Dmitriy K.Puchkov
Information about the authors:
Puchkov K.V. MD, Professor of the surgery department with the course of endosurgery, the faculty of supplementary professional education, SBEE HPE "Ryazan State Medical University named after Academician I.P.Pavlov".
Khubezov D.A. MD, Professor, Head of the surgery department with the course of endosurgery of the faculty of supplementary professional education, SBEE HPE "Ryazan State Medical University named after Academician I.P.Pavlov", Head of the coloproctology department, SBE RR "Regional Clinical Hospital".
Puchkov D.K. PhD, Assistant of the surgery department with the course of endosurgery, the faculty of supplementary professional education, SBEE HPE "Ryazan State Medical University named after Academician I.P.Pavlov", Coloproctologist of the coloproctology department, SBE RR "Regional Clinical Hospital".
Lukanin R.V. Coloproctologist of the coloproctology department, SBE RR "Regional Clinical Hospital".

ANESTESIOLOGY-REANIMATOLOGY

R.E. YAKUBTSEVICH

OPTIMIZATION OF HAEMODYNAMICS AND HYDROBALANCE WITH TRANSPULMONAL THERMODILUTION WHILE APPLYING CONTINUOUS METHODS OF RENAL REPLACEMENT THERAPY IN PATIENTS WITH SEVERE SEPSIS AND MULTIPLE ORGAN DYSFUNCTION

EE "Grodno State Medical University",
Grodno
The Republic of Belarus

Objectives. To evaluate the effectiveness of PiCCO monitoring parameters for making a decision on the regulation of hydrobalance and correction of hemodynamics during the continuous veno-venous haemofiltration (CVVHF) or haemodiafiltration (CVVHDF) in severe sepsis with multiple organ dysfunction.
Methods. 36 sessions of renal replacement therapy (RRT) (14 – CVVHF and 22 – CVVHDF) in 18 patients with sepsis resulting in multiple organ dysfunction syndrome have been analyzed. Hemodynamic parameters and hydrobalance was measured in 15 cases using the invasive PiCCO monitor during the CVVHDF procedure every 4-6 hours. In 21 cases the assessment of hemodynamics and hydrobalance was carried out by the non-invasive measurement of the mean arterial pressure (MAP) and central venous pressure (CVP).
Results. It was found out that the critical period of haemodynamics during the sessions of RRT was every 4-6 hour from the beginning of the procedure. Within this period a significant reduction of MAP was observed. Critical changes of MAP in patients monitored by the PiCCO were not recorded. There were no significant changes in the cardiac index despite the ultrafiltration and the positive dynamics manifested by reduction of global end-diastolic volume index (GEDI) and the extravascular lung water index (ELWI) just 6 hours from the session onset. This stability was due to the early physicians response to the change of PiCCO parameters, without waiting for the systematic blood pressure reduction in an adequate dose correction of inotropic support and regulation of the ultrafiltration rate in its reducing or complete stopping, as well as by the prescription of vasopressor support.
Conclusion. PiCCO monitoring turned out to be effective for making a decision on the regulation and correction of hemodynamics and hydrobalance during CVVHF or CVVHDF in severe sepsis with multiple organ dysfunction syndrome.

Keywords: continuous methods of renal replacement therapy, continuous veno-venous haemofiltration, continuous veno-venous haemodiafiltration, transpulmonary thermodilution, PiCCO, severe sepsis, multiple organ dysfunction syndrome
p. 171-176 of the original issue
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Address for correspondence:
230000, Republic of Belarus,
Grodno, Gorky str., 80, EE "Grodno
State Medical University", Department
of anesthesiology and intensive care.
Tel.: 375 152 43-40-85
E-mail: jackruslan@tut.by
Ruslan E. Yakubtsevich
Information about the authors:
Yakubtsevich R.E. PhD, Ass. Professor of the department of anesthesiology and critical care medicine, EE "Grodno State Medical University".

INFORMATION TECHNOLOGIES IN SURGERY

S.E. KATORKIN, A.V. KOLSANOV, S.A. BYSTROV, S.S. CHAPLYGIN, P.M. ZELTER, R.M. NAZAROV

PREOPERATIVE 3D MODELING SPLENECTOMY IN PATIENTS WITH PRIMARY IMMUNE THROMBOCYTOPENIA

FSBEE HE "Samara State Medical University",
Samara
The Russian Federation

Objectives. To explore the possibilities of preoperative 3D modelling and analysis system based on multislice computed tomography data, to evaluate its effectiveness in performing laparoscopic splenectomy for the primary immune thrombocytopenia.
Methods. A female patient, (55 yrs) with the diagnosis of idiopathic thrombocytopenic purpura, recurrent course. For 10 years she had been observed and underwent the numerous courses of conservative treatment; she also took daily 60 mg of prednisolone. The blood platelet levels reduced below 30×109/l. The splenectomy was indicated due to the failure of conservative treatment. Multislice computed tomography with contrast bolus was performed. For preoperative planning a color 3D model of the surgical site was created on the basis of the obtained data in the “Autoplan” system. Systems giving the ability to plan surgical intervention combines the medical equipment, PACS system (picture archiving and communication system) available onsite advanced image-viewing workstations that can guide physicians; the ability to view images from various workstations via the network including the navigation enabling physicians to create the accurate and realistic models from stereo cameras, and to use computers as well as mobile computing devices directly in the operating room. The patient was underwent laparoscopic hybrid splenectomy.
Results. According to the 3D model a main type of vascularization of the spleen was revealed. The distal part of the pancreatic tail did not reach (1.5 cm) the gate of the spleen. Accessory spleens and periprotsess were absent. The data of 3D model were confirmed intraoperatively and allowed performing a laparoscopic hybrid splenectomy without technical difficulties precisely with a minimal blood loss. The postoperative period was uneventful. The patient was discharged on the 5th day in a satisfactory condition. The parameters of platelet level have reached the reference values (356×109/l).
Conclusion. Preoperative 3D modelling permits the surgeon to make pre-operative planning and provides him with important information on individual topographic and anatomic features in forthcoming operation sites. The information about the individual characteristics of the splenic vascularization and pancreatic topography in its gate lets to allocate and ligate vessels precisely, that improves the quality of hemostasis and also reduces the probability of the pancreatic injury. Preoperative visualization of accessory spleens increases the radicalism of the surgery.

Keywords: splenectomy, thrombocytopenia, computer tomography, 3D modelling, hemostasis, vascularization
p. 177-182 of the original issue
References
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  10. Kolsanov AV, Zel'ter PM, Manukian AA, Chaplygin SS., Kolesnik IV. Primenenie sistemy po predoperatsionnomu modelirovaniiu na osnove dannykh komp'iuternoi tomografii u bol'nogo ekhinokokkozom pecheni [The use of preoperative simulation system based on the data of computer tomography in a patient with liver echinococcosis]. REJR. 2016;6(2):111-14. doi: 10.21569/2222-7415-2016-6-2-111-114.
  11. Fedorov VD, Karmazanovskii GG, Guzeeva EB, Tsvirkun VV. Virtual'noe khirurgicheskoe modelirovanie na osnove dannykh komp'iuternoi tomografii [The virtual surgical simulation on the basis of computer tomography data]. Moscow, RF: Vidar-M; 2003. 184 p.
Address for correspondence:
443079, Russian Federation,
Samara, Karl Marx pr., 165, «b»,
Clinics of Samara State Medical University,
department and clinic of hospital surgery.
Tel.: 8 10 846 276-77-89
å-mail: katorkinse@mail.ru
Sergey E.Katorkin
Information about the authors:
Katorkin S.E. PhD, Ass. Professor, Head of department and clinic of hospital surgery, FSBEE HE «Samara State Medical University».
Kolsanov A.V. MD, Professor, Head of operative surgery and clinical anatomy department with the course of innovative technologies, FSBEE HE «Samara State Medical University», Director of Institute of innovative Development, Head of the Center of breakthrough researches «Information Technologies in Medicine.»
Bystrov S.A., PhD, Ass. Professor, Head of clinic of hospital surgery, FSBEE HE «Samara State Medical University».
Chaplygin S.S. PhD, Ass. Professor of operative surgery and clinical anatomy department with the course of innovative technologies, FSBEE HE «Samara State Medical University».
Zelter P.M. PhD, Assistant of department radiology fnd radiotherapy with the course of medical information, FSBEE HE «Samara State Medical University».
Nazarov P.M. Surgeon of surgical department of the hospital surgery clinic, FSBEE HE «Samara State Medical University».

REVIEWS

A.T. SHCHASTNY, S.A. SUSHKOU, O.D. MYADELETS, E.I. LEBEDEVA

CHALLENGES AND PROSPECTS OF CELLULAR THERAPY IN TREATMENT OF LIVER DISEASES

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

It is reported on the results of an international experience, reflecting the achievements in the field of studying of the possibilities of stem cell use in the treatment of pathological processes in the liver, as well as the challenges and prospects of development of this field in medicine. Clinical application of the stem cells for the treatment of liver disease is on the initial stage. Many problems requiring careful investigation are still occurred. One of the main objectives is a search of the optimal source of cells. The priority is given to the optimization of cryo-storage techniques. An actual problem remains the poor survival rate of the cells and elimination by the immune system within a few months after transplantation. There is no consensus on the number of transplanted cells, the multiplicity of ways of their administration, adjuvant therapy with cytokines and growth factors for receiving optimal results. The mechanism of differentiation in hepatocyte direction remains insufficiently studied and controversial. There is a security problem, in particular, related to the possible development of fibrosis involved the transplanted cells, which can aggrevate the course of disease. Despite the absence of direct evidence, there is wariness about the risks of oncogenic transformation of mesenchymal stem cells, as all stem cells have the capacity to self-renew by dividing similar to that of the tumor cells. No optimal method of visualization of transplanted cells exists yet. These problems requires the further laborious research in vitro and in vivo. Overview of the properties of these different types of stem cells can serve as a starting point for researchers working in the conditions of rapid development of stem cell engineering and cell therapy.

Keywords: liver regeneration, differentiation, transplantation, stem cells of the liver and extrahepatic origin cells, stem cell engineering, cell therapy
p. 183-193 of the original issue
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Address for correspondence:
210023, Republic of Belarus,
Vitebsk, Frunze pr., 27,
EE "Vitebsk State Medical University",
Department of histology, cytology and embryology.
Tel.: 375 33 675 76 99
Tel.: 8 0212 60-29-14
E-mail: lebedeva.ya-elenale2013@yandex.ru
Elena I. Lebedeva
Information about the authors:
Shchastny A.T. MD, Professor, Rector, EE "Vitebsk State Medical University".
Sushkou S.A. PhD, Ass. Professor, Vice-rector (Science), EE "Vitebsk State Medical University".
Myadelets O.D. MD, Professor, Head of department of histology, cytology and embryology, EE "Vitebsk State Medical University".
Lebedeva E.I. PhD, Assistant of the department of histology, cytology and embryology, EE "Vitebsk State Medical University".

CASE REPORTS

V.L. TIMOSHOK, A.A. SVIRSKY, E.V. KOROLKOVA, K.V. DROZDOVSKY, A.M. MAKHLIN, V.V. DEDOVICH, A.L. SHALKEVICH, V.V. DROZDOVSKAYA

THE FIRST CASE OF SUCCESSFUL THORACOSCOPIC PERICARDECTOMY IN THE REPUBLIC OF BELARUS IN INFANT AGED 1,5 MONTHS WITH FIBRINOPURULENT PERICARDITIS

SE "Republican Research and Practical Center for Pediatric Surgery"
Minsk,
The Republic of Belarus

The article describes the first successful thoracoscopic pericardectomy performed in the Republic of Belarus in the infant aged 1,5 months due to the acute fibrinopurulent exudative pericarditis. Pericarditis is the inflammation of the serous heart membrane. According to pericarditis clinical signs the acute, subacute and chronic course has been defined. Depending on the inflammatory nature of pericarditis the fibrinous and exudative pericarditis with the presence of purulent, fibrinopurulent, serous, serous-fibrinous and hemorrhagic effusion has been determed. Surgical treatment is indicated in case of a life-threatening condition and development of the cardiac tamponade, in purulent and constrictive pericarditis. Issues related to a method and size of surgical intervention in acute purulent pericarditis in children are discussed in this paper. The infant was performed the subtotal thoracoscopic pericardectomy with good clinical and cosmetic effect. The case is interesting due to the application of minimally invasive technique in an infant of the first months of life.
Pericardectomy is an effective treatment method of purulent and fibrinopurulent pericarditis. Thoracoscopic pericardectomy is an effective and feasible alternative to thoracotomy and sternotomy; since it is a minimally invasive procedure advantageous in reducing tissue response to trauma and for rapid recovery. Thoracoscopic pericardiectomy is an advisable surgical procedure for pyopericardium in children and requires further study of the long-term results.

Keywords: pericarditis, thoracoscopy, pericardectomy, children, pericardium, pericardiocentesis, trauma
p. 194-201 of the original issue
References
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  2. Cakir O, Gurkan F, Balci AE, Eren N, Dikici B. Purulent pericarditis in childhood: ten years of experience. J Pediatr Surg. 2002 Oct;37(10):1404-8.
  3. Augustin P, Desmard M, Mordant P, Lasocki S, Maury JM, Heming N, et al. Clinical review: intrapericardial fibrinolysis in management of purulent pericarditis. Crit Care. 2011 Apr 20;15(2):220. doi: 10.1186/cc10022.
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  5. Ohtsuka T, Takamoto S, Nakajima J, Miyairi T, Kotsuka Y. Minimally invasive limited pericardiectomy: the hybrid approach. Ann Thorac Surg. 2000 Oct;70(4):1429-30.
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  9. Agrawal V, Saxena A, Sethi A, Acharya H, Sharma D. Thoracoscopic pericardiotomy for management of purulent pneumococcal pericarditis in a child. Asian J Endosc Surg. 2012 Aug;5(3):145-48. doi: 10.1111/j.1758-5910.2011.00129.x.
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  11. Razumovskii AIu, Mitupov ZB. Endokhirurgicheskie operatsii v torakal'noi khirurgii u detei [Endosurgical operations in thoracic surgery of children]: ruk. Moscow, RF: GEOTAR-Media; 2010. 304 p.
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Address for correspondence:
220013, Republic of Belarus,
Minsk, Nezavisimosti ave.,
64, SE "Republican Research and Practical Center for Pediatric Surgery"
Tel.: 375 29 306-64-37
E-mail: dr.tsimashok@gmail.com
Valeriy L. Timoshok
Information about the authors:
Timoshok V.L. Cardiosurgeon of department of cardiosurgery N2, SE "Republican Research and Practical Center for Pediatric Surgery", Minsk.
Svirsky A.A. PhD, Ass. Professor, Head of department of pediatric surgery SE "Republican Research and Practical Center for Pediatric Surgery", Minsk.
Korolkova E.V. Head of department of pediatric cardiosurgery, SE "Republican Research and Practical Center for Pediatric Surgery",
Minsk.
Drozdovsky K.V. PhD, Director of SE "Republican Research and Practical Center for Pediatric Surgery", Minsk.
Makhlin A.M. Deputy Director (clinical work), SE "Republican Research and Practical Center for Pediatric Surgery", Minsk.
Dedovich V.V. Head of department of cardiosurgery N2, SE "Republican Research and Practical Center for Pediatric Surgery",
Minsk.
Shalkevich A.L. Head of department of anesthesia and intensive care N3, SE "Republican Research and Practical Center for Pediatric Surgery", Minsk.
Drozdovskaya V.V. Cardiologist (the first category) of department of cardiosurgery N2, SE "Republican Research and Practical Center for Pediatric Surgery", Minsk.

A.I. PANASYUK 1,3, E.G. GRIGORYEV 1,2

PECULIARITIES OF CLINICAL SIGNS AND DIAGNOSTIC DIFFICULTIES OF ACUTE APPENDICITIS IN INTRAMESENTERIC MESOGASTRAL (MESOCELIAC) LOCATION OF THE VERMIFORM APPENDIX

SBEE HE "Irkutsk State Medical University"1
FSBSE "Irkutsk Scientific Center of Surgery and Traumatology"2
SBME "Irkutsk Regional Clinical Hospital"3
Irkutsk
The Russian Federation

Atypical variants of the acute appendicitis course occur in 20-30% of patients. Indistinctive clinical picture is explained by the location variety of the vermiform appendix in the abdomen.
The paper presents the peculiarities of clinical manifestations of acute appendicitis. Particular attention is given to the atypical clinical signs depending on the localization of the vermiform appendix in the abdominal cavity. Posibilities of diagnostic visualization methods (ultrasound, multislice computed tomography) for the differential diagnosis of the “acute abdomen” syndrome are under discussion, as well as the reasons of possible misdiagnosis.
This case report demonstrates one of the multiple “masks” of acute appendicitis – the “chameleon of the abdominal cavity” and the difficulties of clinical diagnosis in case of mesoceliac appendix. Atypical onset of the disease, which the patient associated with a large meal, intolerable pains, frequen vomiting, not typical for acute appendicitis forced position, physical findings served as a basis for working diagnosis – acute intestinal obstruction. This version of small bowel invagination was supported by means of diagnostic visualization. The erroneous conclusion was obviously associated with the location of the vermiform appendix, its size (D=1,2 cm) and severe inflammatory changes. Videolaparoscopy turned out to be a comprehensive method of diagnosis and treatment.

Keywords: acute appendicitis, atypical onset, vermiform appendix location, acute intestinal olstruction, “chameleon of the aldominal cavity”, differential diagnosis, videolaparoscopic appendectomy
p. 202-205 of the original issue
References
  1. Schein Ì, Rogers PN, Leppaniemi A, Rosin D, Efron JE. Schein's Common Sense Emergency Abdominal Surgery. 4th ed. Harley, UK: TFM Publishing Ltd; 2015. 772 p.
  2. Kriger AG, Fedorov AV, Voskresenskii PK, Dronov AF. Ostryi appenditsit [Acute appendicitis]. Moscow, RF: Medpraktika-M; 2002. 244 p.
  3. Toshovskii V. Appenditsit u detei [Appendicitis in children]: monografiia. Moscow, RF: Meditsina, 1988. 208 p.
  4. Pronin VA, Boiko VV. Patologiia cherveobraznogo otrostka i appendektomiia [The pathology of the appendix and appendectomy]. Khar'kov, Ukraina: SIM; 2007. 271 p.
  5. Astaf'ev VI, Grigor'ev EG, Sandakov PI, Agryzkov AL, Veniaminov LK. Kishechnye svishchi posle appendektomii [Intestinal fistula after appendectomy]. Vestn Khirurgii im II Grekova. 1988;119(7):122-25.
  6. Grigor'ev EG, Shumov AV, Sandakov PI, Veniaminov LK. Planovye relaparotomii pri appendikuliarnom peritonite u detei [Planned relaparotomy in appendicular peritonitis in children]. Khirurgiia Zhurn im NI Pirogova. 1989; (11):20-23.
  7. Rotkov IL. Diagnosticheskie i takticheskie oshibki pri ostrom appenditsite [Diagnostic and tactical errors in acute appendicitis]. Moscow, RF: Meditsina; 1980. 208 p.
Address for correspondence:
664049, Russian Federation,
Irkutsk, Yubileyniy, 100, a /b 15,
FGBNU «Irkutsk Scientific Center
of Surgery and Traumatology»,
Tel.: 7 (3952) 40-78-09,
e-mail: egg@iokb.ru,
Evgeniy G. Grigoryev
Information about the authors:
Panasyuk A.I. Surgeon of emergency department, SBME «Irkutsk Regional Clinical Hospital».
Grigoryev E.G. Corresponding member of RAS, MD, Professor, Scientific Supervisor, FSBSE «Irkutsk Scientific Center of Surgery and Traumatology», Head of department of hospital surgery, SBEE HE «Irkutsk State Medical University».

EXCHANGE OF EXPERIENCE

K.I. SERGATSKY 1, V.I. NIKOLSKY 1, M.L. POLTORAK 2, M.A. MIRONOV 2

TYPES OF PERINEAL SKIN PLASTY IN PATIENTS AFTER AN ACUTE ANAEROBIC PARAPROCTITIS

Medical Institute of FSEE HE "Penza State University"1,
SBME "Penza Regional Clinical Hospital named after N.N. Burdenko" 2,
Penza
The Russian Federation

Acute paraproctitis is the most common disease in practice of emergency proctology and comprises up to 20-40% among patients in the structure of proctologic diseases. Acute paraproctitis of anaerobic etiology refers to life-threatening diseases, the mortality rate makes up 15-40%, and in case of the generalization process it reaches 80%. In case of an extensive anaerobic soft tissue infection the primary aim is to save the patient’s life. After necrectomy, elimination of anaerobic infections and stabilization of patient’s condition it is necessary to eliminate the postoperative skin defects. Two clinical cases of the skin plasty of the perineum area in patients after the acute anaerobic paraproctitis are described. After aggressive interventions in case of the presence of common postoperative perineal skin defects in patients after the acute anaerobic paraproctitis it is advisable to perform plastic surgery. In the presence of the remaining scrotum skin flap at the root of the penis after the acute anaerobic paraproctitis it is expedient to use the flap to form neoscrotum. In the absence of the skin of the scrotum and penis after the acute anaerobic abscess it is appropriate to perform the modified operation in the manner of B.A. Vitsin with installing the subcutaneous expander for the following plasty of the penile skin.

Keywords: acute paraproctitis, anaerobic paraproctitis, anaerobic infection, scrotal defects, skin plasty of the perineum area, reconstruction of scrotum and penis, subcutaneous expander
p. 206-210 of the original issue
References
  1. Abdullaev MSh, Mansurova AB. Ostryi paraproktit u bol'nykh sakharnym diabetom (obzor literatury) [Acute abscess in patients with diabetes mellitus (literature review)]. Koloproktologiia. 2012;(1):46-51.
  2. Bolkvadze EE. Osobennosti diagnostiki i khirurgicheskogo lecheniia ostrogo anaerobnogo paraproktita [Features of diagnostics and surgical treatment of acute anaerobic abscess]. Ros Zhurn Gastroenteroligii Gepatologii i Koloproktologii. 2009; (3):63-69.
  3. Atik B, Tan O, Ceylan K, Etlik O, Demir C. Reconstruction of wide scrotal defect using superthin groin flap. Urology. 2006 Aug;68(2):419-22.
  4. Ayan F, Sunamak O, Paksoy SM, Polat SS, As A, Sakoglu N, et al. Fournier's gangrene: a retrospective clinical study on forty-one patients. ANZ J Surg. 2005 Dec;75(12):1055-58.
  5. Chukhrienko DP, Liul'ko AV. Atlas operatsii na organakh mochepolovoi sistemy [Atlas of operations on the organs of the urogenital system]. Moscow, RF: Meditsina; 1972. 376 p.
  6. Oufkir AA, Tazi MF, El Alami MN. The superomedial thigh flap in scrotal reconstruction: Technical steps to improve cosmetic results. Indian J Urol. 2013 Oct;29(4):360-62. doi: 10.4103/0970-1591.120132.
  7. Lin CT, Chang SC, Chen SG1, Tzeng YS. Reconstruction of perineoscrotal defects in Fournier's gangrene with pedicle anterolateral thigh perforator flap. ANZ J Surg. 2016 Dec;86(12):1052-1055. doi: 10.1111/ans.12782.
  8. Scaglioni MF, Chen YC, Yang JC. Posteromedial thigh (PMT) propeller flap for perineoscrotal reconstruction: A case report. Microsurgery. 2015 Oct;35(7):569-72. doi: 10.1002/micr.22479.
Address for correspondence:
440026, Russian Federation,
Penza, Krasnaya str., 40,
FGBOU IN «Penza State University»,
Medical Institute, department of surgery,
Tel.: 8 902 354-04-68,
E-mail: sergatsky@bk.ru,
Konstantin I. Sergatsky
Information about the authors:
Sergatsky K.I. PhD, Ass. Professor of department of surgery, Medical Institute of FSBEE HE «Penza State University».
Nikolsky V.I. MD, Professor of department of surgery, Medical Institute of FSBEE HE «Penza State University».
Poltorak M.L. PhD, Head of department of esthetic medicine, SBME «Penza Regional Clinical Hospital named after N.N. Burdenko».
Mironov M.A. Head of department of urology N2, SBME «Penza Regional Clinical Hospital named after N.N. Burdenko».

SCIENTIFIC CONGRESSES & CONFERENCES

E.L. KALMYKOV

AN OVERVIEW OF THE COLOGNE SYMPOSIUM ON ISSUE OF VASCULAR ACCESS FOR HEMODIALYSIS PATIENTS ("KöLNER DIALYSESHUNT SYMPOSIUM", JUNE, 24-25, 2016 YEAR)

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

In Cologne (Germany), on the 24-25th of June, 2016 the Fifth symposium dedicated to the issue of a permanent vascular access in patients with chronic kidney disease (CKD) undergoing hemodialysis was held. Vascular surgeons, interventional radiologists, nephrologists, nurses from different cities of Germany as well as from the United States, the Netherlands and Tajikistan took part in the symposium. Two master classes on the upper limb vascular surgical anatomy and practical surgery of forming different types of A-V shunts in the upper limb were carried out during the symposium. The different types of arteriovenous fistulas and their immediate and long-term results were presented and discussed from the current point of view; new data on the results of using cutting baloons and the drug-coated baloons in the surgery of stenotic changes of A-V shunts were demonstrated at the symposium. At the symposium a special attention was given to the use of new systems in patients in whom almost all ways of using veins have been exhausted. The newest trend in the surgery of access for hemodialysis in “difficult” patients is the application of the device Surfacer. The results of the implanted graft – Hemodialysis Reliable Outflow graft (HeRO) were represented too. The article also provides the overview dedicated to necessity of the blood flow monitoring prior, within and after the endovascular interventions in treating the patients with A-V shunts stenosis; the formation of the A-V shunt by means of endovascular techniques, the application of Nitinol stent-like-devices VasQ to improve the maturation and patency of A-V anastomosis. A number of reports were devoted to the issue of the dilation of arteries after the formation of A-V shunt and aneurysms.

Keywords: symposium, arteriovenous shunts, vascular access, complications of vascular access, device Surfacer, aneurysms, A-V anastomosis
p. 211-214 of the original issue
Address for correspondence:
734003, Republic of Tajikistan,
Dushanbe, Rudaki Ave., 139,
Tajik State Medical University
named after Abu Ali ibn Sina.
Tel.: 992 90 811 00 18,
e-mail: egan0428@mail.ru,
Egan L. Kalmykov
Information about the authors:
Kalmykov E.L. PhD, Director of the Center of Evidence Based Medicine of Avicenna Tajik State Medical University, Dushanbe, The Republic of Tajikistan
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