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Year 2018 Vol. 26 No 2

SCIENTIFIC PUBLICATIONS
EXPERIMENTAL SURGERY

M.G. RYABKOV 2, E.B. KISELEVA 1, N.D. GLADKOVA 1, M.S. BALEEV 2, E.L. BEDERINA 2, E.E. LUKOYANYCHEV 2, A.A. MIRONOV 1, I.L. DEZORTSEV 2, V.V. BESCHASTNOV 2

THE ROLE OF INTRAMURAL BLOODSTREAM DYSFUNCTION IN THE DEVELOPMENT OF SMALL INTESTINE ISCHEMIC NECROSIS

Nizhny Novgorod State Medical Academy 1,
City Clinical Hospital ¹ 30, Nizhny Novgorod 2,
The Russian Federation

Objective. To study experimentally the mechanisms of intramural bloodstream dysfunction and small bowel necrosis development in case of the acute mesenteric ischemia.
Methods. Acute complete mesenteric ischemia was modelled in laboratory animals by ligating a. mesenterica cranialis. The OCT-based microangiography technique was used to monitor bowel microcirculation till the visual signs of its non-viability appeared. Then the bowel was resected, the degree of ischemic lesion was histologically evaluated.
Results. In occlusion of mesenteric arteries by the moment when macroscopic nonviability signs appear, the ischemic damage without necrosis spreads out to 22.2% of the bowel length and mucous tunic necrosis and transmural necrosis spread out to 38.1% and 39.7% of the bowel length correspondingly. While comparing the histological preparations and OCT images, the features of OCT-microangiograms were described in different degrees of ischemic lesion and bowel necrosis. According to OCT-microangiography, in 60.3% of the wall of the ischemic intestine the number of functioning vessels remained normal. The decrease in the length of functioning vessels (by 5.6%, p=0.029), the total area of the vascular bed (by 4.5%, p=0.032) and the average vascular density (by 5.1%, p=0.001) occurred only in the intestinal wall with transmural necrosis. The mechanism of the superficial bowel necrosis development was a decrease in the proportion of small diameter vessels (p=0.029) against the background of the preserved microcirculation.
Conclusions. The attempt to recommence hemocirculation in the bowel arteries which are traditionally considered empty is the basis of modern surgical treatment of the mesenteric ischemia. However, the authors came to the conclusion that for 38% of ischemic bowel the blood supply remains at a normal level till necrosis development. This fact seems important for improving results of surgical treatment of acute mesenteric ischemia because it gives the opportunity to save a part of the bowel without thrombectomy. In these cases the OCT-based microangiography method can be an effective noninvasive tool for functioning blood vessels visualization and control of treatment results.

Keywords: acute mesenteric ischemia, intestinal infarction, mesenteric arterial occlusion, microcirculation, optical coherence tomography, OCT-based microangiography, mesenteric revascularization
p. 135-145 of the original issue
References
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Address for correspondence:
605157, The Russian Federation,
Nizhny Novgorod, Berezovskaya Str., 85À,
City Clinical Hospital ¹ 30
of Moscow District,
Surgical Unit ¹ 2,
Tel.: +7 905 012-21-50,
e-mail: maxim-ryabkov@yandex.ru,
Ryabkov Maxim G.
Information about the authors:
Ryabkov Maxim G., MD, Associate Professor, Consultant of the Surgical Unit ¹ 2, City Clinical Hospital ¹ 30 of Moscow District, Nizhny Novgorod, Russian Federation.
http://orcid.org/0000-0002-9555-190X
Kiseleva Elena B., PhD, Researcher of the Laboratory of Studying the Optical Properties of Tissues of SRI of Biomedical Technologies, Nizhny Novgorod State Medical Academy, Nizhny Novgorod, Russian Federation.
http://orcid.org/0000-0003-4769-417X
Gladkova Natalia D., MD, Professor, Deputy Director of SRI of Biomedical Technologies, Nizhny Novgorod State Medical Academy, Russian Federation.
http://orcid.org/0000-0002-8386-7157
Baleev Mixail S., Surgeon, the Surgical Unit ¹ 2, City Clinical Hospital ¹ 30 of Moscow District, Nizhny Novgorod, Russian Federation.
http://orcid.org/0000-0001-6943-9757
Bedrina Evgenia L., Pathologist, City Clinical Hospital ¹ 30 of Moscow District, Nizhny Novgorod, the Chief Out-Of-Staff Specialist (Pathologist) of the Department of Health, Nizhny Novgorod, Russian Federation.
http://orcid.org/0000-0001-5368-8396
Lukoyanychev Egor E., PhD, Surgeon, City Clinical Hospital ¹ 30 of Moscow District, Nizhny Novgorod, Russian Federation.
http://orcid.org/0000-0001-6392-2692
Mironov Andrey A., PhD, Senior Researcher of the Central Research Laboratory, Nizhny Novgorod State Medical Academy, Nizhny Novgorod, Russian Federation.
http://orcid.org/0000-0001-7387-2860
Dezortsev Ilya L., Surgeon, City Clinical Hospital ¹ 30 of Moscow District, Nizhny Novgorod, Russian Federation.
http://orcid.org/0000-0003-2715-8599
Beschastnov Vladimir V., MD, Associate Professor, Surgical Unit N2, Consultant of the Surgical Unit ¹ 2, City Clinical Hospital ¹ 30 of Moscow District, Nizhny Novgorod, Russian Federation.
http://orcid.org/0000-0002-9332-3858

GENERAL & SPECIAL SURGERY

A. A. ZIANKOU 1, 2, K.S. VYKHRYSTSENKA 2, N.G. LOJKO1, W.A. CHUESHOW 1, YU.P. OSTROVSKY 3, 4

MIDTERM DISTANT RESULTS OF A PROSPECTIVE RANDOMIZED TRIAL MICSREVS

Vitebsk Regional Clinical Hospital 1,
Vitebsk State Medical University 2, Vitebsk,
Republic Scientific and Practical Center «Cardiology» 3,
Belarusian Medical Academy of Postgraduate Education 4, Minsk,
The Republic of Belarus

Objective. To evaluate midterm distant results of the prospective randomized controlled trial “Minimally Invasive Cardiac Surgery Revascularization Strategy”, aimed to compare the effectiveness of minimally invasive cardiac surgery coronary artery bypass grafting versus off-pump coronary artery bypass grafting and on-pump coronary artery bypass grafting.
Methods. The randomized controlled trial was started in January 2014 (http://www.clinicaltrials.gov/show/NCT02047266). In accordance with the trial plan, 150 patients were included, divided into 3 groups, 50 subjects in each. In the first (main) group, the minimally invasive bypass strategy was directed to perform multivessel full arterial revascularisation on the beating heart without manipulations on the ascending aorta through the left-sided minothoracotomy. Conventional myocardial revascularization was performed on the beating heart (2 group) or with cardio-pulmonary bypass (3 group) via the median sternotomy. Inclusion criteria were multivessel coronary artery disease; II-IV functional class of angina pectoris and terms longer than 1 month after acute myocardial infarction. Exclusion criteria were previous coronary artery bypass grafting, single-vessel disease and need for emergency revascularization. The main endpoints of the study were the main adverse cardiac and brain events, as well as death from the cardiovascular cause and from any cause.
Results. The follow-up period in the groups constituted 975.5 (691.8; 1151.0) days, 792.5 (638.3; 936.3) days and 691.0 (506.0; 803.0) days, respectively. Cumulative survival (taking into account all causes of deaths and cardiovascular death) and freedom from major adverse cardiac and cerebral-vascular events did not differ significantly within the specified terms between the treatment groups of patients (p>0.05).
Conclusions. Minimally invasive myocardial revascularization can be successfully applied potentially in every patient with coronary heart disease who needs the multivessel coronary artery bypass grafting in the scheduled manner, saving the coronary interventions effectiveness during the midterm distant follow-up.

Keywords: arterial myocardial revascularization, off-pump surgery, coronary heart disease, minimally invasive coronary artery bypass grafting, minimally invasive myocardial revascularization, left minithoracotomy
p. 146-154 of the original issue
References
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  3. Ruel M, Une D, Bonatti J, McGinn JT. Minimally invasive coronary artery bypass grafting: is it time for the robot? Curr Opin Cardiol. 2013 Nov;28(6):639-45. doi: 10.1097/HCO.0b013e3283653fd1.
  4. Poston RS, Tran R, Collins M, Reynolds M, Connerney I, Reicher B, Zimrin D, Griffith BP, Bartlett ST. Comparison of economic and patient outcomes with minimally invasive versus traditional off-pump coronary artery bypass grafting techniques. Ann Surg. 2008 Oct;248(4):638-46. doi: 10.1097/SLA.0b013e31818a15b5.
  5. Puskas JD, Williams WH, Mahoney EM, Huber PR, Block PC, Duke PG, Staples JR, Glas KE, Marshall JJ, Leimbach ME, McCall SA, Petersen RJ, Bailey DE, Weintraub WS, Guyton RA. Off-pump vs conventional coronary artery bypass grafting: early and 1-year graft patency, cost, and quality-of-life outcomes: a randomized trial. JAMA. 2004 Apr 21;291(15):1841-49. doi: 10.1001/jama.291.15.1841.
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  13. Ruel M, Shariff MA, Lapierre H, Goyal N, Dennie C, Sadel SM, Sohmer B, McGinn JT Jr. Results of the Minimally Invasive Coronary Artery Bypass Grafting Angiographic Patency Study. J Thorac Cardiovasc Surg. 2014 Jan;147(1):203-8. doi: 10.1016/j.jtcvs.2013.09.016.
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Address for correspondence:
210037, The Republic of Belarus,
Vitebsk, W.-internationalists Str., 37,
Vitebsk Regional Clinical Hospital,
Cardiac Surgery Unit,
Tel. office: +375 212 61-63-15,
e-mail: Zenkov_Al@rambler.ru,
Ziankou Aliaksandr A.
Information about the authors:
Ziankou Aliaksandr A., PhD, Head of the Cardiac Surgery Unit, Vitebsk Regional Clinical Hospital, Associate Professor of the Surgery Department of the Faculty of Advanced Training and Retraining of Specialists, Vitebsk State Medical University, Vitebsk, Republic of Belarus.
http://orcid.org/0000-0002-7119-2340
Vykhrystsenka Kiryl S., PhD, Assistant of the Hospital Surgery Department, Vitebsk State Medical University, Vitebsk, Republic of Belarus.
http://orcid.org/0000-0003-0407-9265
Lojko Nikolaj G., Cardiac Surgeon of the Cardiac Surgery Unit, Vitebsk Regional Clinical Hospital, Vitebsk, Republic of Belarus.
http://orcid.org/0000-0003-1630-946Õ
Chueshow Wjacheslaw A., Angiosurgeon of the Cardiac Surgery Unit, Vitebsk Regional Clinical Hospital, Vitebsk, Republic of Belarus.
http://orcid.org/0000-0001-8603-9448
Ostrovsky Youry P., MD, Professor, Academician of NAS of Belarus, Head of the Heart Surgery Laboratory of the Republic Scientific and Practical Center «Cardiology», Head of the Department of Cardiac Surgery with the Course of Transplantology, Belarusian Medical Academy of Postgraduate Education, Minsk, Republic of Belarus.
http://orcid.org/0000-0003-0683-0147

I.A. SANETS ¹, A.E. SILIN ¹, YU.I. YARETS ¹, V.V. ANICHKIN ²

GENETIC MARKERS OF VENOUS THROMBOEMBOLISM IN SURGICAL PATIENTS

The Republican Research Centre for Radiation Medicine and Human Ecology 1,
Gomel State Medical University2, Gomel
The Republic of Belarus

Objective. Òo study the occurrence of genetic markers of the venous thromboembolism (FV:G1691A, FII:G20210A, MTHFR:C677T and PAI-1:5G/4G) in patients who have previously had deep vein thrombosis and/or the pulmonary embolism as well as in surgical patients without phlebothrombosis episodes in the anamnesis.
Methods. The subjects of the study were patients (n=54) suffering from cholelithiasis. All individuals were divided into two groups: group 1 consisted of patients with deep vein thrombosis and/or pulmonary embolism in the past (n=29, 12 males and 17 females, the mean age of patients was 59.4±12.4 years). The second group was presented by patients without venous thromboembolism in the case history (n=25, 9 males and 16 females, the mean age – 54.7±8.4 years). The molecular genetic testing of four main factors associated with a predisposition to thrombotic complications (FV:G1691A, FII:G20210A, MTHFR:C677T and PAI-1:5G/4G) was performed in patients of both groups. The study was carried out using the PCR method with three different oligonucleotide primers to identify each genetic polymorphism (mutation).
Results. The incidence of Leiden mutation (FV:G1691A) in the surgical patients with the venous thromboembolism was significantly higher than in patients without phlebothrombosis episodes in the past (25% and 4%, respectively, ð=0.038).
There were no significant differences between the groups of patients with the venous thrombotic complications and in the control group patients in terms of others genetic polymorphism: FII: G20210A (ð=0.349), PAI-1: 5G/4G (ð=0.751) and MTHFR: C677T (ð=0.416).
Conclusions. The presence of the Leiden mutation of the V coagulation factor in surgical patients significantly increases the risk of thrombotic complications in the postoperative period. The presence of FII:G20210A, PAI-1:5G/4G, MTHFR:C677T genetic defects in surgical patients are not associated with the likelihood of the postoperative thrombosis development.

Keywords: venous thromboembolism, Leiden mutation, prothrombin, methylene tetrahydrofolate reductase, inhibitor of plasminogen activation
p. 155-162 of the original issue
References
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  10. Miranda-Vilela AL. Role of polymorphisms in factor V (FV Leiden), prothrombin, plasminogen activator inhibitor type-1 (PAI-1), methylenetetrahydrofolate reductase (MTHFR) and cystathionineβ-synthase (CBS) genes as risk factors for thrombophilias. Mini Rev Med Chem. 2012 Sep 1;12(10):997-1006. doi: 10.2174/138955712802762338.
  11. Glueck CJ, Phillips H, Cameron D, Wang P, Fontaine RN, Moore SK, Sieve-Smith L, Tracy T. The 4G/4G polymorphism of the hypofibrinolytic plasminogen activator inhibitor type 1 gene: an independent risk factor for serious pregnancy complications. Metabolism. 2000 Jul;49(7):845-52. doi: 10.1053/meta.2000.6749.
  12. Gipergomotsisteinemiia kak etiologicheskii faktor reproduktivnoi nedostatochnosti pri trombofilii [Elektronnyi resurs]. 2017 [Data dostupa: 25.02.2017]. Available from: http://newlab-med.ru/vracham/poleznaya-informacziya/gipergomoczisteinemiya-kak-etiologicheskij-faktor-reproduktivnoj-nedostatochnosti-pri-trombofilii.html (in Russ.)
  13. Lee YH, Song GG. Plasminogen activator inhibitor-1 4G/5G and the MTHFR 677C/T polymorphisms and susceptibility to polycystic ovary syndrome: a meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2014 Apr;175:8-14. doi: 10.1016/j.ejogrb.2013.12.030.
  14. Strandberg K, Stenflo J, Nilsson C, Svensson PJ. APC-PCI complex concentration is higher in patients with previous venous thromboembolism with Factor V Leiden. J Thromb Haemost. 2005 Nov;3(11):2578-80. doi: 10.1111/j.1538-7836.2005.01617.x.
  15. Isordia-Salas I, Leaños-Miranda A, Sainz IM, Reyes-Maldonado E, Borrayo-Sánchez G. Association of the plasminogen activator inhibitor-1 gene 4G/5G polymorphism with ST elevation acute myocardial infarction in young patients. Rev Esp Cardiol. 2009 Apr;62(4):365-72. doi: 10.1016/S1885-5857(09)71663-9. [Article in English, Spanish]
Address for correspondence:
246040, The Republic of Belarus,
Gomel, Ilyich Str., 290,
Republican Scientific Center
for Radiation Medicine and Human Ecology,
Surgical Unit of the Consultative Polyclinic,
Tel. office: +375-232-38 96 36,
e-mail: igor-sanets@yandex.ru,
Sanets Igor A.
Information about the authors:
Sanets Igor A., Surgeon, Surgical Unit of the Consultative Polyclinic, the Republican Scientific Center for Radiation Medicine and Human Ecology, Gomel, Republic of Belarus.
http://orcid.org/0000-0001-5777-3416
Yarets Yuliya I., PhD, Associate Professor, Head of the Clinical and Diagnostic Laboratory, the Republican Scientific Center for Radiation Medicine and Human Ecology, Gomel, Republic of Belarus.
http://orcid.org/0000-0001-8879-5079
Silin Arkadij E., PhD, Head of the Laboratory of Molecular Genetics, the Republican Scientific Center for Radiation Medicine and Human Ecology, Gomel, Republic of Belarus.
http://orcid.org/0000-0003-2387-554x
Anichkin Vladimir V., MD, Professor, Professor of the Department of Surgical Diseases ¹3 with the Course of Urology, Gomel State Medical University, Gomel, Republic of Belarus.
http://orcid.org/0000-0002-9022-5320

V.M. CHUMAKOV, O.L. SYTNIK, V.I. BUGAIOV

POLYMORPHISM OF IL-8 CYTOKINE GENE IN PATIENTS WITH PANCREATOGENIC PERITONITIS

Sumy State University, Medical Institute,
Ukraine

Objective. This preliminary study was conducted to assess the possible association of IL-8 (-251À/Ò) polymorphism with clinical course and outcome of acute pancreatitis aggravated by pancreatogenic peritonitis.
Methods. Data for the study were DNA samples, received from the leucocytes of 143 humans: 83 patients with acute pancreatitis aggravated by pancreatogenic peritonitis, 60 healthy blood donors without acute pancreatitis in the anamnesis served as controls. IL-8 (-251À/Ò) polymorphism detection was made with polymerase chain reaction with further length analysis of the restriction fragments.
Results. The analysis of frequency of allelic variants of the cytokine gene IL-8 (-251À/Ò) revealed that genotype A/T was the dominant variant (45%) among healthy blood donors. Distribution of IL-8 (-251À/Ò) polymorphism among the patients with pancreatogenic peritonitis without and after surgical treatment is characterized by dominance of genotype T/T in group after surgical treatment (ð<0.05). This may indicate association of genotype T/T and unfavorable clinical course of pancreatogenic peritonitis (OR>1). Among patients after surgical treatment genotype A/T was less often met in comparison with the group without it (p<0.05). This may indicate the association of genotype A/T and favorable clinical course of pancreatogenic peritonitis (OR<1). Genotype A/A was rarely registered, which may be due to regional peculiarities of the patient’s genotype.
Conclusions. This preliminary study suggests that the identification of genetic polymorphism of IL-8 (-251A/T)
may be informative and serve as an additional criterion to predict both the clinical course and outcome of pancreatogenic peritonitis; it may also specify indications for surgical treatment. However, the possible role of IL-8 (-251A/T) cytokine polymorphism in the outcome of pancreatogenic peritonitis requires further carefully planned cohort investigations.

Keywords: acute pancreatitis, pancreatogenic peritonitis, interleukin-8, gene polymorphism, immune response, cytokines
p. 163-168 of the original issue
References
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  2. S tepanov IuM, Gravirovskaia NG, Skirda IIu, Petishko OP. Bolezni podzheludochnoi zhelezy kak odna iz vedushchikh problem gastroenterologii i abdominal’noi khirurgii (sovremennaia epidemiologiia). Gastroeterolog³ia. 2014;53(3):7-14. (in Russ.)
  3. Chernov VN, Belik BM, Alibekov AZ. Treatment of the infected forms of acute destructive pancreatitis using minimally invasive technologies. Novosti Khirurgii.2014;22(1):63-67. doi: 10.18484/2305-0047.2014.1.63. (in Russ.)
  4. van Brunschot S, Schut AJ, Bouwense SA, Besselink MG, Bakker OJ, van Goor H, Hofker S, Gooszen HG, Boermeester MA, van Santvoort HC. Abdominal compartment syndrome in acute pancreatitis: a systematic review. Pancreas. 2014 Jul;43(5):665-74. doi: 10.1097/MPA.0000000000000108.
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  6. Zubritskiy V, Zemlyanoi A, Matveyev D, Ayrapetyan A, Golubev I, Rozberg Ye, Korenev D. Intra-abdominal hypertension and pancreatogenic peritonitis. Med Vestn MVD. 2015;76(4):27-31. (in Russ.)
  7. Kylänpää ML, Repo H, Puolakkainen PA. Inflammation and immunosuppression in severe acute pancreatitis. World J Gastroenterol. 2010 Jun 21;16(23):2867-72. doi: 10.3748/wjg.v16.i23.2867.
  8. Fisic E, Poropat G, Bilic-Zulle L, Licul V, Milic S, Stimac D. The role of IL-6, 8, and 10, sTNFr, CRP, and pancreatic elastase in the prediction of systemic complications in patients with acute pancreatitis. Gastroenterol Res Pract [Electronic resource]. 2013;2013:282645:[about 6 p.]. Available from: https://www.hindawi.com/journals/grp/2013/282645/abs.
  9. Firsova VG, Parshikov VV, Gradusov VP. Ostryi pankreatit: sovremennye aspekty patogeneza i klassifikatsii. Sovrem Tekhnologii v Meditsine. 2011;(2):127-34. (in Russ.)
  10. Ismailov EL, Eralina SN, Bekesbaev BB, Abdrasulov RB. Extracorporeal detoxification methods in the treatment of destructive pancreatitis. Obshch Reanimatologiia. 2015;11(3):65-74. doi: 10.15360/1813-9779-2015-3-65-74. (in Russ.)
  11. Cruz-Santamaría DM, Taxonera C, Giner M. Update on pathogenesis and clinical management of acute pancreatitis. World J Gastrointest Pathophysiol. 2012 Jun 15;3(3):60-70. doi: 10.4291/wjgp.v3.i3.60.
  12. Kylänpää L, Rakonczay ZJr, O’Reilly DA. The clinical course of acute pancreatitis and the inflammatory mediators that drive it. Int J Inflam. 2012; 2012:360685. doi: 10.1155/2012/360685.
  13. Yin YW, Sun QQ, Feng JQ, Hu AM, Liu HL, Wang Q. Influence of interleukin gene polymorphisms on development of acute pancreatitis: a systematic review and meta-analysis. Mol Biol Rep. 2013 Oct;40(10):5931-41. doi: 10.1007/s11033-013-2700-6.
  14. Li D, Li J, Wang L, Zhang Q. Association between IL-1β, IL-8, and IL-10 polymorphisms and risk of acute pancreatitis. Genet Mol Res. 2015 Jun 18;14(2):6635-41. doi: 10.4238/2015.June.18.6.
  15. Chen WC, Nie JS. Genetic polymorphism of MCP-1-2518, IL-8-251 and susceptibility to acute pancreatitis: a pilot study in population of Suzhou, China. World J Gastroenterol. 2008 Oct 7;14(37):5744-48. doi: 10.3748/wjg.14.5744.
Address for correspondence:
40007, Ukraine,
Sumy, Rimsky-Korsakov Str., 2,
Sumy State University,
Department of Surgery and Oncology,
Tel. office: +380 542 64-03-18,
e-mail: triftonte@gmail.com,
Chumakov Volodymyr M.
Information about the authors:
Chumakov Volodymyr N., Assistant of the Department of Surgery and Oncology, Sumy State University, Sumy, Ukraine.
https://orcid.org/0000-0002-3022-7148
Sytnik Oleksandr L., PhD, Associate Professor of the Department of Surgery and Oncology, Sumy State University, Sumy, Ukraine.
https://orcid.org/0000-0001-6855-2467
Bugaiov Volodymyr I., PhD, Associate Professor of the Department of Surgery and Oncology, Sumy State University, Sumy, Ukraine.
https://orcid.org/0000-0002-5681-3153

YU.V. AVDOSYEV 1, 2, I.V. BELOZEROV 2, O.N. KUDREVICH 2

ENDOVASCULAR METHODS OF DIAGNOSIS AND TREATMENT OF ACUTE HEMORRHAGES IN THE GASTROINTESTINAL TRACT LUMEN

Institute of General and Emergency Surgery named after V. T. Zaitsev of National Academy of Medical Sciences of Ukraine 1,
Kharkiv National University named after V.N. Karazin 2,
Kharkiv, Ukraine

Objective. To assess the effectiveness of endovascular diagnosis and treatment methods of acute gastrointestinal hemorrhage.
Methods. The paper summarizes the experience of angiographic diagnosis and endovascular treatment of 342 patients who were admitted to the Institute of General and Emergency Surgery named after V. T. Zaitsev with a clinical picture of bleeding in the lumen of the gastrointestinal tract for the period from 1998 to 2016. There were 145 (42.4%) women and 197 (57.6%) men aged 16 to 77 years (mean age 59.3±11.1 years) among the patients.
Results. As the study has established the most informative method was superselective arteriography, which permitted to reveal both direct and indirect angiographic signs of gastrointestinal hemorrhage. Thus, in 63 (18.4%) patients the direct signs of continuing bleeding were diagnosed. In 272 (79.5%) examined patients, the indirect angiographic signs of stopped bleeding were revealed. A higher percentage of indirect signs of bleeding is associated with both the chronic course of the underlying disease and the characteristic angiographic pattern for a particular gastrointestinal disease complicated by bleeding and with stopping of active bleeding by the time of angiography.
Based on the clinical examination and angiographic data, a direct source of gastrointestinal hemorrhage was diagnosed in 215 (62.8%) patients.
Conclusions. The conducted study has confirmed that selective angiography of the branches of the abdominal aorta and iliac arteries is a highly informative diagnostic method and in 62.8% of observations it was possible to establish the source and localization of bleeding. In patients with ongoing gastrointestinal hemorrhage and questionably tolerance of surgical intervention, the endovascular hemostasis is often a choice of treatment of these patients. Differentiated using of both primary and repeated (in case of recurrent bleeding), the endovascular methods of hemostasis in patients with acute gastrointestinal hemorrhage allowed achieving final hemostasis in 90.4% of cases.

Keywords: gastrointestinal hemorrhage, diagnosis of bleeding, angiography, surgical treatment, X-ray endovascular hemostasis
p. 169-178 of the original issue
References
  1. Vertkin AL, Sveshnikov KA. Natsional’noe rukovodstvo po skoroi pomoshchi. Moscow, RF: EKSMO; 2012. 816 p. (in Russ.)
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  6. Avdos’ev IuV, Boiko VV. Angiografiia i rentgenendovaskuliarnaia khirurgiia abdominal’nykh krovotechenii: monogr. Khar’kov, Ukraina: Izdatel’ Savchuk OO; 2011. 648 p. (in Russ.)
  7. Nanavati SM. What if endoscopic hemostasis fails? Alternative treatment strategies: interventional radiology. Gastroenterol Clin North Am. 2014 Dec;43(4):739-52. doi: 10.1016/j.gtc.2014.08.013.
  8. Dallal HJ, Palmer KR. ABC of the upper gastrointestinal tract: Upper gastrointestinal haemorrhage. BMJ. 2001 Nov 10;323(7321):1115-17.
  9. Annamalai G, Masson N, Robertson I. Acute gastrointestinal haemorrhage: investigation and treatment. Imaging. 2009;21(Is 2):142-51.
  10. Walker TG, Salazar GM, Waltman AC. Angiographic evaluation and management of acute gastrointestinal hemorrhage. World J Gastroenterol. 2012 Mar 21;18(11):1191-201. doi: 10.3748/wjg.v18.i11.1191.
  11. Teng HC, Liang HL, Lin YH, Huang JS, Chen CY, Lee SC, Pan HB. The Efficacy and long-term outcome of microcoil embolotherapy for acute lower gastrointestinal bleeding. Korean J Radiol. 2013 Mar-Apr; 14(2): 259-68. Published online 2013 Feb 22. doi: 10.3348/kjr.2013.14.2.259.
Address for correspondence:
61000, Ukraine,
Kharkiv, Svoboda Square, 6,
Kharkiv National University
named after V.N. Karazin,
Department of Surgical Diseases,
Operative Surgery and Topographic Anatomy,
Tel. +380 50 902-72-72,
e-mail: b0risfen@ukr.net,
Kudrevich Olexandr N.
Information about the authors:
Avdosyev Yuriy V., MD, Head of the X-ray Surgery Unit, Institute of General and Emergency Surgery named after V. T. Zaitsev of National Academy of Medical Sciences of Ukraine, Professor of the Department of Surgical Diseases, Operative Surgery and Topographic Anatomy of the Medical Faculty, Kharkiv National University named after V.N. Karazin, Kharkiv, Ukraine.
http://orcid.org/0000-0002-2677-4464.
Belozerov Igor V., MD, Dean of the Medical Faculty, Kharkiv National University named after V.N. Karazin, Kharkiv, Ukraine.
http://orcid.org/0000-0002-7567-6449.
Kudrevich Olexandr N., PhD, Head of the Department of Surgical Diseases, Operative Surgery and Topographic Anatomy of the Medical Faculty, Kharkiv National University named after V.N. Karazin, Kharkiv, Ukraine.
http://orcid.org/0000-0002-2086-8822.

A.YA. KOROVIN, M.B. ANDREEVA, D.V. TURKIN, N.A. TRIFANOV

COMPLEX TREATMENT OF PATIENTS WITH ACUTE MESENTERIC ISCHEMIA AND PERITONITIS

Kuban State Medical University,
Krasnodar,
The Russian Federation

Objective. To develop surgical tactics in acute mesenteric ischemia and purulent peritonitis and to find ways to improve the results of treatment of this complicated pathology.
Methods. 118 cases of acute mesenteric ischemia complicated by diffuse peritonitis were analyzed. For urgent diagnosis of the pathology, computed tomography was used. In the first group (n=72), one-step procedures were applied – the intestinal resection and embolthrombectomy with application of the primary anastomosis. Reoperations were performed «on demand». In the second group (n=46), operations were of a separate nature, along with thrombembolectomy and intestinal resection at the stages of the programmed relaparotomy, delayed interintestinal anastomoses were used. The maximum number of relaparotomies in both groups was 3. The gradual treatment outcomes were assessed during the first day hospital mortality and integrated rates of severity of the sepsis APACHE II and SOFA, the peritonitis index of Mannheim (IPM) and the abdominal cavity index (IAC) in the intervals between relaparotomies. At the final stage, hospital mortality was compared in the groups of patients.
Results. The mortality rate after the first operation in the groups was 43.6% and 41.3%, respectively. Reduction in the severity of abdominal sepsis was registered at the time of the third relaparotomy, in the second SOFA group <8, the IPM decreased by 16%, and the IAC by 27%. Significant differences in IPM and IAC indicators were registered only with the third relaparotomy, and the tendency of the positive dynamics of peritonitis course was traced in the second group of observations. Hospital lethality exceeded the staged predicted values and constituted 87.5% in the first, and 84.8% in the second group.
Conclusions. Surgical tactics, including the use of obstructive bowel resections with the delayed anastomosis after restoration of mesenteric hemocirculation and relief of the reperfusion syndrome at the stages of the programmed relaparotomy, contributes to improving the treatment results of acute mesenteric ischemia and diffuse peritonitis.

Keywords: acute mesenteric ischemia, superior mesenteric artery occlusion, CT-angiography, diffuse peritonitis, abdominal sepsis
p. 179-187 of the original issue
References
  1. Kosinets VA. Influence of new pathogenetic reasonable scheme of complex treatment of widespread purulent peritonitis on the course of inflammatory process. Khirurgiia Zhurn im NI Pirogova. 2012;(8):69-73. (in Russ.)
  2. Sazhin VP, Avdovenko AL, Iurishchev VA. Current trends in surgical treatment of peritonitis. Khirurgiia Zhurn im NI Pirogova. 2007;(11):36-39. (in Russ.)
  3. Shugaev AI, Vovk AV. Ostrye narusheniia arterial’nogo mezenterial’nogo krovoobrashcheniia. Vestn Khirurgii im II Grekova. 2005;164(4):112-15. (in Russ.)
  4. Düber C, Wüstner M, Diehl SJ, Post S. Emergency diagnostic imaging in mesenteric ischemia. Chirurg. 2003 May;74(5):399-406. [Article in German]
  5. Baeshko AA, Klimuk SA, Iushkevich VA. Prichina i osobennosti porazhenii kishechnika i ego sosudov pri ostrom narushenii bryzheechnogo krovoobrashcheniia. Khirurgiia Zhurn im NI Pirogova. 2005;(4):57-63. (in Russ.)
  6. Maskin SS, Golbraykh VA, Derbenzeva TV, Karsanov AM, Ermolaeva NK, Lopasteysky DS. Programmed and emergency relaparotomy in the treatment of diffuse peritonitis. Vestn VolgGMU. 2012;(4):105-107. (in Russ.)
  7. Gostishchev VK, Sazhin VP, Avdovenko AL. Peritonit. Moscow, RF: Geotar-med; 2002. 240 p. (in Russ.)
  8. Baeshko AA, Klimuk SA, Yushkevich VA. Acute disorders of mesenteric circulations: the etiology, risk factors and incidence of lesions. Angiologiia i Sosud Khirurgiia. 2004;10(4):99-13.
  9. Edwards MS, Cherr GS, Craven TE, Olsen AW, Plonk GW, Geary RL, Ligush JL, Hansen KJ. Acute occlusive mesenteric ischemia: surgical management and outcomes. Ann Vasc Surg. 2003 Jan;17(1):72-79.
  10. Park WM, Gloviczki P, Cherry KJ Jr, Hallett JW Jr, Bower TC, Panneton JM, Schleck C, Ilstrup D, Harmsen WS, Noel AA. Contemporary management of acute mesenteric ischemia: Factors associated with survival. J Vasc Surg. 2002 Mar;35(3):445-52.
  11. Klimovich IN, Maskin SS, Dubrovin IA, Karsanov AM, Derbentseva TV. Endovideokhirurgiia v diagnostike i lechenii posleoperatsionnogo peritonita. Vestn Khirurgii im II Grekova. 2015;174(4):113-16. (in Russ.)
  12. Alhan E, Usta A, çekiç A, Saglam K, Türky?lmaz S, Cinel A. A study on 107 patients with acute mesenteric ischemia over 30 years. Int J Surg. 2012;10(9):510-3. doi: 10.1016/j.ijsu.2012.07.011.
  13. Kirkpatrick ID, Kroeker MA, Greenberg HM. Biphasic CT with mesenteric CT angiography in the evaluation of acute mesenteric ischemia: initial experience. Radiology. 2003 Oct;229(1):91-8. Epub 2003 Aug 27. doi: 10.1148/radiol.2291020991.
  14. Björck M, Acosta S, Lindberg F, Troeng T, Bergqvist D. Revascularization of the superior mesenteric artery after acute thromboembolic occlusion. Br J Surg. 2002 Jul;89(7):923-27.
  15. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, Bellomo R, Bernard GR, Chiche JD, Coopersmith CM, Hotchkiss RS, Levy MM, Marshall JC, Martin GS, Opal SM, Rubenfeld GD, van der Poll T, Vincent JL, Angus DC. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016 Feb 23;315(8):801-10. doi: 10.1001/jama.2016.0287.
Address for correspondence:
350063, The Russian Federation,
Krasnodar, Sedin Str., 4,
Kuban State Medical University,
Department of the Faculty
Surgery with the Course of Anesthesiology
and Intensive Care,
Tel. mobile: + 7 988 244-69-44,
e-mail: kuman52@mail.ru,
Korovin Alexander Ja.
Information about the authors:
Korovin Alexander Ja., MD, Professor, Head of the Department of the Faculty Surgery with the Course of Anesthesiology and Intensive Care, Kuban State Medical University, Krasnodar, Russian Federation.
http://orcid.org/0000-0002-7986-4455
Andreeva Marina B., PhD, Assistant of the Department of the Faculty Surgery with the Course of Anesthesiology and Intensive Care, Kuban State Medical University, Krasnodar, Russian Federation.
http://orcid.org/0000-0002-5705-0063
Turkin Denis V., PhD, Assistant of the Department of the Faculty Surgery with the Course of Anesthesiology and Intensive Care, Kuban State Medical University, Krasnodar, Russian Federation.
http://orcid.org/0000-0002-8454-2346
Trifanov Nikolay A., Post-Graduate Student of Department of the Faculty Surgery with the Course of Anesthesiology and Intensive Care, Kuban State Medical University, Krasnodar, Russian Federation.
http://orcid.org/0000-0001-9006-6860

V.A. LAZARENKO, E.A. BOBROVSKAYA

HYPERHOMOCYSTEINEMIA AND FUNCTIONAL STATE OF ENDOTHELIUM IN PATIENTS WITH PERIPHERAL ARTERY DISEASE WITH ARTERIAL RECONSTRUCTIONS

Kursk State Medical University, Kursk,
The Russian Federation

Objective. To study the relationship between homocysteine and markers of the functional state of the endothelium in patients with obliterating atherosclerosis in operations on the aorta and arteries of the lower limbs.
Methods. The study included 68 patients with peripheral artery disease, the average age was 57.8±7.3 years, with II B – III degree of chronic arterial insufficiency according to R. Fontaine-A.V. Pokrovsky, who were divided into three groups: I group underwent the femoro-popliteal bypass (n=32), II – the aorto-femoral bypass (n=20), III – x-ray endovascular angioplasty and stenting of the iliac arteries (n=16). A correlation analysis was made between the content of homocysteine and the markers of the endothelium functional state of: the oxidized low-density lipoproteins (oxidized LDL), a molecule of adhesion of the vascular endothelium type 1 (sVCAM-1), the tissue type 1 plasminogen activator inhibitor (PAI-1), the tissue plasminogen activator (t-PA), Annexin V in the systemic and local bloodstream prior to surgery and after the arterial reconstructions.
Results. Correlation relationships between homocysteine and oxidized LDL were established both in the systemic blood flow and the affected limb, this association persisted after the reconstructive intervention, the most significant in the local bloodstream after femoro-popliteal bypass surgery. Preoperative positive correlation of the systemic level of homocysteine and sVCAM-1 in group I was marked. The effect of homocysteine on the fibrinolytic function of the endothelium was shown, as indicated by the direct correlation between homocysteine and PAI-1 in the systemic blood flow and in the affected limb, which persist after open reconstructions. Significant links between homocysteine and the level of Annexin V were revealed in the group of patients with the lesion of the femoro-popliteal arterial segment.
Conclusions. Hyperhomocysteinemia contributes significantly to the disturbance of the endothelium functional state, affecting apoptosis, the activation of atherogenic LDL, and the procoagulant potential, which persist even after arterial reconstructions both in the systemic and local bloodstream.

Keywords: peripheral artery disease, aorto-ileal segment, femoro-popliteal segment, reconstructive surgeries, X-ray endovascular interventions, homocysteine, endothelial dysfunction
p. 188-194 of the original issue
References
  1. Petrishchev NN, Vasina LV, Vlasov TD, Gavrisheva NA, Menshutina MA. Tipovye formy disfunktsii endoteliia. Klin-Lab Konsilium. 2007;(18):31-35. (in Russ.)
    2.Tsybikova NM, Tsybikov MN. Rol’ gipergomotsisteinemii v patologii cheloveka. Dal’nevostoch Med Zhurn. 2007;(4):110-112. (in Russ.)
  2. Chia S, Wilson R, Ludlam CA, Webb DJ, Flapan AD, Newby DE. Endothelial dysfunction in patients with recent myocardial infarction and hyperhomocysteinaemia: effects of vitamin supplementation. ClinSci (Lond). 2005 Jan;108(1):65-72. doi: 10.1042/CS20040150.
  3. Steed MM, Tyagi SC. Mechanisms of cardiovascular remodeling in hyperhomocysteinemia. Antioxid Redox Signal. 2011 Oct 1;15(7):1927-43. doi: 10.1089/ars.2010.3721.
  4. Loscalzo J. Homocysteine-mediated thrombosis and angiostasis in vascular pathobiology. J Clin Invest. 2009 Nov;119(11):3203-5. doi: 10.1172/JCI40924.
  5. Lazarenko VA, Bobrovskaya EA, Sorokin A.V. Hyperhomocysteinemia: peripheral atherosclerosis and
    reconstructive surgery. Kursk Nauch-Prakt Vestn «Chelovek i Ego Zdorov’e». 2014;(4):63-66. (in Russ.)
  6. Zobova DA, Kozlov SA. Rol’ gomotsisteina v patogeneze nekotorykh zabolevanii. Izv Vysshikh Ucheb Zavedenii. Povolzh Region. Med Nauki. 2016;3(39):132-44. doi: 10.21685/2072-3032-2016-3-15. (in Russ.)
  7. Loscalzo J. The oxidant stress of hyperhomocyst(e)inemia. J Clin Invest. 1996 Jul 1;98(1):5-7. doi: 10.1172/JCI118776.
  8. Ingenbleek Y. The Oxidative stress of hyperhomocysteinemia results from reduced bioavailability of sulfur-containing reductants. Open Clin Chem J. 2011;4(1):34-44. doi: 10.2174/1874241601104010034.
  9. Karazhanova LK, Zhunuspekova AS. Hyperhomocysteinemia as a risk factor of cardiovascular diseases (literature review). Nauka i Zdravookhranenie. 2016;(4):129-44. orcid.org/0000-0003-1496-3281. (in Russ.)
  10. Leoncini G, Bruzzese D, Signorello MG. Activation of p38 MAPKinase/cPLA2 pathway in homocysteine-treated platelets. J Thromb Haemost. 2006;4(1):209-16. doi: 10.1111/j.1538-7836.2005.01708.x.
  11. Yeh JK, Chen CC, Hsieh MJ, Tsai ML, Yang CH, Chen DY, Chang SH, Wang CY, Lee CH, Hsieh IC. Impact of homocysteine level on long-term cardiovascular outcomes in patients after coronary artery stenting. J Atheroscler Thromb. 2017 Jul 1;24(7):696-705. doi: 10.5551/jat.36434.
  12. Tofler GH, Massaro J, O’Donnell CJ, Wilson PWF, Vasan RS, Sutherland PA, Meigs JB, Levy D, D’Agostino RB Sr. Plasminogen activator inhibitor and the risk of cardiovascular disease: The framingham heart study. Thromb Res. 2016 Apr;140:30-35. doi: 10.1016/j.thromres.2016.02.002.
  13. de Jong SC, Stehouwer CD, van-den Berg M, Vischer UM, Rauwerda JA, Emeis JJ. Endothelial marker proteins in hyperhomocysteinemia. ThrombHaemost. 1997 Nov;78(5):1332-37.
  14. Sipkens JA, Hahn N, van den Brand CS, Meischl C, Cillessen SA, Smith DE, Juffermans LJ, Musters RJ, Roos D, Jakobs C, Blom HJ, Smulders YM, Krijnen PA, Stehouwer CD, Rauwerda JA, van Hinsbergh VW, Niessen HW. Homocysteine-induced apoptosis in endothelial cells coincides with nuclear NOX2 and peri-nuclear NOX4 activity. Cell Biochem Biophys. 2013 Nov;67(2):341-52. doi: 10.1007/s12013-011-9297-y.
Address for correspondence:
305041, The Russian Federation,
Kursk, K.Marx Str., 3,
Kursk State Medical University,
Department of Surgical Diseases
of the Faculty of Post-Graduate Training,
Tel.: +7 (4712) 58-81-32,
e-mail: azaroks@mail.ru,
Lazarenko Viktor A.
Information about the authors:
Lazarenko Viktor A., MD, Professor, Rector, Head of the Department of Surgical Diseases of the Faculty of Post-Graduate Training, Kursk State Medical University, Kursk, Russian Federation.
http://orcid.org/0000-0002-2069-7701
Bobrovskaya Elena A., PhD, Associate Professor of the Department of Surgical Diseases of the Faculty of Post-Graduate Training, Kursk State Medical University, Kursk, Russian Federation.
https://orcid.org/0000-0003-3898-5522

TRAUMATOLOGY & ORTHOPEDICS

YE.N. TOKTAROV, M.A. ZHANASPAYEV, A.S. TLEMISSOV, D.T. BAKHTYBAEV, A.O. MYSSAYEV

INTERLOCKING NAILING OF TIBIA SHAFT FRACTURES BY EXPANDABLE NAIL: NON-RANDOMIZED CONTROLLED TRIAL

Semey State Medical University, Semey
The Republic of Kazakhstan

Objective. To improve the treatment results of the tibia diaphysis fracture by the designed device for intraosseous interlocking osteosynthesis.
Methods. It was a non-randomized controlled trial. There were two groups of patients (n=163): the main group (n=41) who underwent the fracture treatment by the designed device; the control group (n=122) who were treated with the ChM interlocking nail. The groups were comparable in age (p=0.066), sex (p=0.824), fracture level (p=0.659), type of injury (p=0.189) and fracture type (p=0.566). Preoperative and postoperative patients’ management was identical.
Results. The period of disability to work in the main group (M=62.8; Me=63.0; IQR=11 days) was shorter than in the control group (M=87.4; Me=82.0; IQR=28 days) (p<0.001). Also, higher weight bearing ability at the time of discharge (M=45.7 vs. M=33.0); and 1 month after the operation (M=90.9 vs. M=86.5) and earlier time for restoration of ability to walk without crutches (M=29.3 vs. 64.9 days) were registered in the main group vs. the control (p<0.001; p=0.018; p<0.001 respectively). At the same time, the number of inpatient days in the groups did not differ statistically (17.4 days in the control vs. 18.1 days in the main). There was not statistically significant difference in weight bearing ability at terms of 3 months after surgery (in both groups it reached 100%, p=0.059); number of complications (p=0.369); presence of shortening (p=0.149); treatment outcomes (p=0.849).
Conclusions. In this study, the designed expandable nail for interlocking osteosynthesis of the tibia shaft fracture enabled faster recovery of the patients’ ability to work. At the same time, for such parameters as inhospital stay, the presence of shortening and complications, the outcome of the treatment, the designed nail was not worse than the standard ChM nail.

Keywords: fracture, diaphysis, tibia, fracture fixation, interlocking nailing, treatment
p. 195-203 of the original issue
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  11. Sakhvadze Sh. Biological osteosynthesis as the treatment mode for multifragmental extra-articular fractures. Georgian Med News. 2009 Mar;(168):15-20.
Address for correspondence:
071400, The Republic of Kazakhstan,
East Kazakhstan region,
Semey, Abaya Str., 103,
Semey State Medical University,
Department of Public Health,
Tel/fax: +7 (7222) 56 97 55,
e-mail: amyssaev@mail.ru,
Myssayev Ayan O.
Information about the authors:
Toktarov Yernar N., PhD Student of the Department of Traumatology and Orthopedics, Semey State Medical University, Semey, Republic of Kazakhstan.
http://orcid.org//0000-0002-5166-243X
Zhanaspayev Marat A., Doctor of medical Science, Head of the Department of Traumatology and Orthopedics, Semey State Medical University, Semey, Republic of Kazakhstan.
https://orcid.org//0000-0002-0610-0112
Tlemissov Aidos S., PhD, Assistant of the Department of Traumatology and Orthopedics, Semey State Medical University, Semey, Republic of Kazakhstan.
http://orcid.org//0000-0002-4239-6627
Bakhtybaev Daryn T., Assistant of the Department of Traumatology and Orthopedics, Semey State Medical University, Semey, Republic of Kazakhstan.
https://orcid.org/0000-0002-3582-6449
Myssayev Ayan O., PhD, Associate Professor, Head of the Department of Public Health, Semey State Medical University, Semey, Republic of Kazakhstan.
http://orcid.org//0000-0001-7332-4856

REVIEWS

S.E. KATORKIN, A.V. ZHURAVLEV, A.A. CHERNOV, V.N. KRASNOVA

MODERN SPHINCTER SAVING METHODS OF TREATMENT OF TRANSPHINCTERIC AND EXTRASPHINCTERIC PERIANAL FISTULAS

Samara State Medical University, Samara,
The Russian Federation

The review presents the world experience, reflecting advances in the treatment of patients with extrasphincteric and high transphincteric perianal fistulas. There is no single approach in the treatment of patients with this form of chronic paraproctitis, there are no clear indications for the application of any method of surgical treatment. The priority tasks facing coloproctologists are to reduce the traumatic nature of the operation, to prevent complications, to preserve the anatomical integrity and functional capacity of the rectum apparatus. Currently, preference is given to low-traumatic methods of surgical treatment, denoted by the term «sphincter saving techniques» and aimed at secure closure of the internal fistula opening, excision of the peripheral part of the fistulous tract, detection and elimination of purulent leakages in the pararectal tissue. These include video-assisted anal fistula treatment (VAAFT), obstruction of the fistula by biological sealant tampons (AFP) and two-component fibrin glue (FGA), intersection of the fistula in submucosal (SLOFT) and intersphincter (LIFT) spaces. There are indications for each of the methods; each of them has both advantages and some disadvantages. At present, the most interesting is LIFT, the operation which attracts with its simplicity, high efficiency and safety of surgical techniques in relation to the rectum blockage apparatus. According to the literature, its effectiveness exceeds 75% with full preservation of the anal holding function. The performed analysis allows comparing different methods of treatment of pararectal fistulas and to determine the further direction of their improvement and scientific studies.

Keywords: chronic paraproctitis, perianal fistula, LIFT technique, function of the rectum sphincter, postoperative complications, recurrence of the disease
p. 204-214 of the original issue
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  51. Krasnova VN, Chernov AA, Katorkin SE, Zhuravlev AV. Comparative results of the experience in the ligation of intersphinteric fistula tract in the treatment of transsphincteric and extrasphincteric anal fistulas. Vrach-Aspirant. 2017;80(1.1):179-89. (in Russ.)
Address for correspondence:
443079, The Russian Federation,
Samara, K. Marx Ave., 165B,
Clinic of Samara State Medical University,
Department and Clinic of Hospital Surgery,
Tel. office: 8 10 846 276 -77-89,
e-mail: katorkinse@mail.ru,
Katorkin Sergey E.
Information about the authors:
Katorkin Sergey E., PhD, Associate Professor, Head of the Department and Clinic of Hospital Surgery, Samara State Medical University, Samara, Russian Federation.
https://orcid.org/0000-0001-7473-6692
Zhuravlev Andrej V., PhD, Head of the Coloproctological Unit of the Hospital Surgery Clinic, Associate Professor of the Hospital Surgery Department, Samara State Medical University, Samara, Russian Federation.
https://orcid.org/0000-0002-0353-840x
Chernov Andrey A., PhD, Surgeon of the Coloproctological Unit of the Hospital Surgery Clinic, Assistant of the Hospital Surgery Department, Samara State Medical University, Samara, Russian Federation.
https://orcid.org/0000-0002-7622-6095
Krasnova Veronika N., Surgeon of the Coloproctological Unit of the Hospital Surgery Clinic, Samara State Medical University, Samara, Russian Federation.
https://orcid.org/0000-0001-7788-0665

A.M. FEDORUK

PERFUSION CONDITIONING OF THE LIVER AND KIDNEY ALLOGRAFTS

The Republican Scientific and Practical Center for Organ and Tissue Transplantation,
9th Municipal Clinical Hospital of Minsk,
The Republic of Belarus

Transplantation is the only radical treatment method of terminal stage liver and kidney diseases. Therefore, there has been an increase in the number of transplantations of these organs all over the world and in our country in recent decades. Transplantation success is due to the quality of the donor organ, the clinical status of the recipient before the operation, the time of warm and cold ischemia, the transplantation operation to the recipient, and immunological aspects, but particular importance is attaching to ischemic-reperfusion injury. Static cold preservation determines the development of the ischemia-reperfusion injury of allografts and its severity determines the outcome of the postoperative period.
The review highlights the current state of various variants of machine perfusion of the liver and kidneys. Renewal of interest to perfusion technologies is related to their ability to prevent the ischemia-reperfusion damage, which can be especially important when using donor organs with extended inclusion criteria, the so-called marginal allografts. Hypothermic machine perfusion, subnormothermic machine perfusion, normothermic machine perfusion, controlled heating are used nowadays. The parameters of the perfusion flow of the liver and kidneys were studied. At present, the clinical and economic effectiveness of only hypothermic renal perfusion has been proven. At the same time, the standards of machine perfusion and the protocols of its application are not fully developed and further studies are required.

Keywords: allografts, reperfusion injury, liver, kidney, conditioning methods, perfusion
p. 215-225 of the original issue
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Address for correspondence:
220045, The Republic of Belarus,
Minsk, Semashko Str., 8,
Republican Scientific and Practical
Center for Organ and Tissue Transplantation,
9th Municipal Clinical Hospital, Department of Hepatology and Minimally Invasive Surgery,
Tel.:+375 29 675 12 57,
e-mail: doctorfam@mail.ru,
Fedaruk Aliaksei M.
Information about the authors:
Fedaruk Aliaksei M., MD, Associate Professor, Head of the Department of Hepatology and Minimally Invasive Surgery of Republican Scientific and Practical Center for Organ and Tissue Transplantation, 9th Municipal Clinical Hospital, Minsk, Republic of Belarus.
https://orcid.org/0000-0001-9211-8396

YU.P. ORLOV 1, V.V. AFANAS’EV 2

HYPOXIA AND HYPEROXIA IN ANESTHESIOLOGIST-REANIMATOLOGIST PRACTICE. THE ROLE OF SUCCINATES IN CRITICAL CONDITIONS

Omsk State Medical University1, Omsk,
North-Western State Medical University named after I.I. Mechnikov 2, St. Petersburg,
The Russian Federation

The aim of the review was to analyze the potentially negative effects of hyperoxia in different groups of critically ill patients, including those after the heart arrest, craniocerebral trauma, stroke, and in cases of sepsis. It was found out that in case of these pathological processes and nosological forms, there is evidence that hyperoxia can have a direct and indirect damaging effect. A severe consequence of hyperoxia is not only activation of free radical oxidation and excessive synthesis of active oxygen forms, but also direct toxic damage to the lungs, which is associated with the development of atelectasis, tracheobronchitis and interstitial fibrosis. Hyperoxia can cause damage to any tissues and organs through peripheral vasoconstriction, which is extremely unfavorable for patients after heart arrest, after a craniocerebral trauma and stroke, as well as in septic patients.
The survey data emphasize that, taking into account individual adaptation to hypoxia, oxygen must be used individually, in accordance with the assessment of the current need for it. When using hyperoxia in patients in critical condition, it is possible to reduce the toxic effect of oxygen with the help of succinates, which support the mechanism of adaptation to hypoxia, and which have an antioxidant and antihypoxic effects. When carrying out oxygen therapy, it is necessary to avoid high concentrations of oxygen as much as possible, and in cases requiring high concentrations, to reduce the toxic effects of oxygen with the help of succinates.

Keywords: hypoxia, hyperoxia, succinates, heart arrest, trauma, stroke, sepsis
p. 226-237 of the original issue
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Address for correspondence:
644119, The Russian Federation,
Omsk, Perelet Str., 9
City Clinical Emergency Hospital ¹ 1,
Department of Anesthesiology
and Reanimatology,
Omsk State Medical University,
Tel. +381-2-75-32-64,
å-mail: orlov-up@mail.ru,
Orlov Yurij P.
Information about the authors:
Orlov Yurij P., MD, Professor of the Department of Anesthesiology and Reanimatology, Omsk State Medical University, Omsk, Russian Federation.
http://orcid.org/0000-0002-6747-998X
Afanas’ev Vasilij V., MD, Professor of the Department of Emergency Medicine, North-Western State Medical University named after I.I. Mechnikov, St. Petersburg, Russian Federation.
http://orcid.org/0000-0001-6504-8169

CASE REPORTS

S.V. IVANOV1, A.V. GOLIKOV1, O.S. GORBACHEVA2, I.S. IVANOV1

GIANT INGUINAL HERNIA IN A WOMAN

Kursk State Medical University1,
Kursk Regional Clinical Hospital2, Kursk
The Russian Federation

The article presents a clinical case of treatment of a 55-year-old patient with an incarcerated inguinal hernia of «giant» size. At hospitalization, the patient complained of having a bulging anterior abdominal wall in the inguinal area of «giant» sizes (25×30 cm), the pain with straining, self-service problems and cosmetic difficulties. The history of the disease is more than 40 years, when the first hernia protrusion in the right inguinal region appeared, freely inserted into the abdominal cavity. The patient has never turned for help to any medical establishment. Hernia protrusion gradually increased in size. Recently, the pain syndrome, which occurred with physical activity, coughing, sneezing and rapid growth of hernia size have joined to the symptoms mentioned above. However, the cause of the treatment in the clinic was not a cosmetic defect, but the fact of the hernia irreducibility. After a comprehensive examination, the patient underwent hernia repair, the plastic of the anterior abdominal wall with a polypropylene surgical mesh according to the «onlay» technique. The postoperative period occurred without any exudative complications and manifestations of the compartment syndrome. The given clinical case is interesting as a possible treatment option for a fairly rare, «giant» size inguinal hernia in women.

Keywords: female inguinal hernia, surgical treatment, onlay plastic, åndoprosthetics, herniorrhaphy, pain syndrome, incarcerated hernia, clinical case
p. 238-242 of the original issue
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  4. Rutenburg GM, Bezhenar’ VF, Strizheletskii VV, Zhemchuzhina TIu, Gordeeva TV. Simul’tannye laparoskopicheskie operatsii u zhenshchin s sochetannymi ginekologicheskimi zabolevaniiami i pakhovymi gryzhami. Zhurn Akusherstva i Zhen Boleznei. 2006;LV(1):63-69. (in Russ.)
  5. Musaev AI, Zhamankulova MK, Samarbekov NS. Sovremennye podkhody k lecheniiu pakhovykh gryzh. Vestn KGMA im IK Akhunbaeva. 2016;(4):63-65.
  6. Desai AY, Shirsat D, Pai VD. Giant inguinal hernia repair leading to the diagnosis of complete androgen insensitivity syndrome in an elderly lady. J Health Med Informat. 2015;6:211. doi: 10.4172/2157-7420.1000211.
  7. Vagholkar K, Iyengar M, Vagholkar S. Inguinal hernia in females: do we know enough? Int Surg J. 2016 Feb;3(1):354-56. doi: 10.18203/2349-2902.isj20160074.
Address for correspondence:
305041, The Russian Federation,
Kursk, Karl Marx Str., 3,
Kursk State Medical University,
Department of Surgical Diseases ¹ 1.
Tel. office:+7 4712 35-36-90
e-mail: ivanov.is@mail.ru,
Ivanov Il’ya S.
Information about the authors:
Ivanov Sergej V., MD, Professor, Head of the Department of Surgical Diseases ¹ 1, Kursk State Medical University, Kursk, Russian Federation.
https://orcid.org/0000-0001-7540-5748
Golikov Al’bert V., PhD, Associate Professor of the Department of Surgical Diseases ¹ 1, Kursk State Medical University, Kursk, Russian Federation.
https://orcid.org/0000-0002-3978-8910
Gorbacheva Ol’ga S., PhD, Head of the General Surgery Unit, Kursk Regional Clinical Hospital, Kursk, Russian Federation.
https://orcid.org/0000-0002-6642-1743
Ivanov Il’ya S., MD, Professor of the Department of Surgical Diseases ¹ 1, Kursk State Medical University, Kursk, Russian Federation.
https://orcid.org/0000-0003-4408-961X

N.N. IASKEVICH

A RARE CASE OF SURGICAL TREATMENT OF THE GIANT LIVER HEMANGIOMA

Grodno State Medical University, Grodno,
The Republic of Belarus

Hemangioma of the liver is its frequent benign tumor. However, giant hemangiomas of the liver are a rare pathology. The purpose of this message is to demonstrate the successful surgical treatment of the liver giant left lobe hemangioma. The patient for a long time has linked the abdomen gradual enlargement in volume with pregnancy. The main reason for her turn for help was the presence of signs of partial intestinal obstruction and anemia. Abdominal ultrasound demonstrated the presence of tumor masses originating from the left lobe of the liver. Red blood cell transfusion in the preoperative period to correct anemia was accompanied by a pronounced enlargement of the hemangioma in 4-6 hours after transfusion, with its subsequent reduction up to the initial state during the next 24-48 hours. During laparotomy it was found out that the left lobe of the liver presented by hemangioma occupying the entire abdominal cavity. Hemangioma was removed by the resection of the left lobe of the liver. The postoperative period was uneventful. During the next 12 months of observation, the patient felt satisfactory, without any complaints. According to the biochemical blood analysis the liver function was not impaired.

Keywords: giant hemangioma of the liver, complications of liver hemangiomas, intestinal obstruction, anemia, liver resection
p. 243-247 of the original issue
References
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Address for correspondence:
210023, The Republic of Belarus,
Grodno, Sozialisticheskaya Str., 14, ap. 7,
Tel.:+375 298 227 188,
e-mail: inngrno@mail.ru,
Iaskevich Nikolai N.
Information about the authors:
Iaskevich Nikolai N., MD, Professor of the 1st Department of Surgical Diseases, Grodno State Medical University, Grodno, Republic of Belarus
https://orcid.org/0000-0002-2954-0452

EXCHANGE OF EXPERIENCE

M.A. AKSELROV1,2, V.A. EMELYANOVA2, S.N. SUPRUNEC 1,2, T.V. SERGIENKO2, I.G. ANOXINA2, N.V. KISELEVA2

FIRST EXPERIENCE OF LAPAROSCOPIC DUODENO-DUODENAL ANASTOMOSIS IN NEONATES WITH HIGH INTESTINAL OBSTRUCTION CAUSED BY ANNULAR PANCREAS

Tyumen State Medical University1,
Regional Clinical Hospital ¹ 22, Tyumen,
The Russian Federation

In the Russian Federation, congenital malformations occupy the second place in the structure of infant mortality. Improving operational tactics, anesthesia and post-operative care is an important goal in reducing mortality from this group of diseases. Reduction of the traumatic nature of a surgical intervention directly correlates with the course of the postoperative period. The introduction of a minimally invasive, laparoscopic method of performing the operation must optimize the postoperative period. But volumetric laparoscopic interventions in newborns are difficult. Therefore, the description of laparoscopic treatment of the duodenal obstruction caused by the annular pancreas is sporadic. In the Children’s Surgery Clinic of Tyumen State Medical University, 5 newborns with the duodenal obstruction, caused by the annular pancreas, were operated with the use of laparoscopic technique. The course of the disease in all children was typical. The congenital malformation of development was corrected by the laparoscopic formation of duodeno-duodenal anastomosis. The postoperative period was more uneventful in these children compared with those operated openly. The operation technique and the postoperative course did not differ significantly. Enteral nutrition was started within a week after the operation in all children. After laparotomy, the passage through the gastrointestinal tract is restored not earlier than 10, often 14 days. It is associated with quicker stopping of the inflammation in the anastomosis zone. The article describes in details one clinical case. The technique of laparoscopic duodeno-duodenal anastomosis, when a surgeon has the experience of working with newborns, is a safe, effective technique and can be a choice of surgical treatment of congenital duodenal obstruction caused by the annular pancreas.

Keywords: congenital duodenal obstruction, annular pancreas, duodeno-duodenal anastomosis, laparoscopy, newborn
p. 248-253 of the original issue
References
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Address for correspondence:
625023, The Russian Federation,
Tyumen, Odesskaya Str., 54,
Tyumen State Medical University,
Department of Pediatric Surgery,
Tel. office: 8 (3452) 28-71-66,
e-mail: oria@yandex.ru,
Emelyanova Viktoria A.
Information about the authors:
Akselrov Mikhail A., MD, Associate Professor, Head of the Department of Pediatric Surgery, Tyumen State Medical University, Head of the Pediatric Surgery Unit ¹ 1, Regional Clinical Hospital ¹ 2, Tyumen, Russian Federation.
http://orcid.org/0000-0001-6814-8894
Emelyanova Viktoria A, Anesthesiologist-Resuscitator of the Department of Anesthesiology, Resuscitation and Intensive Care for Newborns and Premature Babies, Regional Clinical Hospital ¹ 2, Tyumen, Russian Federation.
http://orcid.org/0000-0002-9857-9174
Suprunec Svetlana N., PhD, Associate Professor of the Children’s Diseases Department of the Department, Tyumen State Medical University, Head of the Department of Anesthesiology, Resuscitation and Intensive Care for Newborns and Premature Babies, Regional Clinical Hospital ¹ 2, Tyumen, Russian Federation.
http://orcid.org/0000-0001-8579-1857
Sergienko Tatyana V., Pediatric Surgeon of the Pediatric Surgery Unit ¹ 1, Regional Clinical Hospital ¹ 2, Tyumen, Russian Federation.
http://orcid.org/0000-0003-3338-1260
Anoxina Irina G., Anesthesiologist-Resuscitator of the Department of Anesthesiology, Resuscitation and Intensive Care for Newborns and Premature Babies, Regional Clinical Hospital ¹ 2, Tyumen, Russian Federation.
http://orcid.org/0000-0002-7659-2458
Kiseleva Natalya V., Anesthesiologist-Resuscitator of the Department of Anesthesiology, Resuscitation and Intensive Care for Newborns and Premature Babies, Regional Clinical Hospital ¹ 2, Tyumen, Russian Federation.
http://orcid.org/0000-0003-3310-3826
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