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Year 2023 Vol. 31 No 2

SCIENTIFIC PUBLICATIONS

A.I. DOVNAR

LONG-TERM RESULTS OF CRANIOPLASTY USING BELARUSIAN COMPOSITE MATERIAL IN THE EXPERIMENT

Grodno State Medical University, Grodno, Republic of Belarus

Objectives. To study the possibility of using the Belarusian composite material «Superfluvis» as a means of replacing the bone tissue of the skull in an experiment.
Material and Methods. To study the possibility of using the Belarusian composite material «Superfluvis» as a means of replacing the bone tissue of the skull in an experiment. The study was carried out on 18 mongrel rabbits of both sexes, homogeneous in weight and age. Rabbits underwent experimental trepanation of the skull with its plastic closure with the material «Superfluvis» (group «experience-1»), titanium (group «control») and without closing the trepanation defect (group «experience-2»). The animals were removed 180 days after the operation. Before removal, venous blood was taken to study the indicators of biochemical blood analysis and the mass of animals was measured. During the autopsy, the mass coefficients of the internal organs were calculated and a histological study of the internal organs, as well as the brain and its membranes, was carried out.
Results. Analysis of the results of biochemical analysis of rabbit blood showed a statistically significant low AST level on 180 days after surgery in the «experience-1» group relative to the «control» groups (p<0.05) and «experience-2» (p<0.05). At the same time, there is no statistically significant decrease in the AST index in the «experience-1» group on 180 days after surgery with preoperative values. There is a tendency to increase glucose levels 180 days after surgery to preoperative values in the group «experience-2» (p=0.08). Statistically significant differences in other indicators of the same name of biochemical blood analysis in the studied groups were not found in these terms. Calculations of the mass coefficients of the heart, lung, right and left kidney, spleen and thymus in all the studied groups of animals did not reveal statistically significant differences between the groups of rabbits. However, there was a significant increase in the liver mass coefficient in rabbits in the «control» group in comparison with the «experiment-1» group (p=0.022). There was no statistically significant increase in the mass coefficient of the liver between the groups of animals «control» and «experiment-2».
Conclusion. The composite material «Superfluvis» does not have a toxic effect on the vital organs of the experimental animal with prolonged use (180 days).

Keywords: composite material, skull defect, titanium, mass coefficient, rabbits
p. 89-97 of the original issue
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Address for correspondence:
230009, Republic of Belarus,
Grodno, Gorky Str., 80,
Grodno State Medical University,
the Department of Neurology
and Neurosurgery,
tel. +375 297 890265,
e-mail: dovnarneiro@gmail.com,
Dovnar Àndrei I.
Information about the authors:
Dovnar Andrei I., Assistant of the Department of the Department of Neurology and Neurosurgery, Grodno State Medical University, Grodno, Republic of Belarus.
http://orcid.org/0000-0001-5535-2036

A.A. KINZERSKIY 1, 2, M.S. KORZHUK 3, 4, V.T. DOLGIKH 5, T.S. SOLOV’YOVA 6, R.V. ESELEVICH 4, O.V. BALURA 4, I.I. KOTOV 2

EFFECT OF PATHOGENETIC THERAPY ON COAGULOPATHY AFTER SEVERE LIVER INJURY

Omsk City Emergency Hospital N1 1,
Omsk STATE MEDICAL UNIVERsity 2, Omsk,
NMRC of Oncology named after N.N.Petrov of MoH of Russia,
St. Petersburg, The Russian Federation 3,
Military Medical Academy named after S.M.Kirov, of MoD of Russia 4,
Federal Scientific Center of Reanimatology and Rehabilitology of Russian Academy of Science 5,
St. Petersburg clinic hospital of Russian Academy of Science 6, St. Petersburg,
Russian Federation

Objective. Effect of pathogenetic therapy (PGT) and the methods of administration of its components on developing coagulopathy in the author’s model of severe closed liver injury has been studied..
Methods. Male Wistar rats (n=100) weighing 379±23 g were randomized into 3 groups: I – control (n=42), II – experimental (n=34), III - donors (n=24). The injury was modeled according to the author’s technique. The experimental group at the 60th minute after injury was randomized into 3 subgroups: II-I (n=12) – injection of PGT into the femoral vein, II-II (n=12) – injection of PGT into the portal vein, II-III (n= 10) – without PGT. PGT components: tranexamic acid solution 100 mg/kg (0.8 ml), native plasma (2 ml) and platelet rich plasma (2 ml). The rate of introduction of the mixture is 0.5 ml/min. The general and biochemical blood tests, coagulogram, parameters of low-frequency piezothromboelastography and piezoaggregatometry were studied.
Results. PGT suppresses hyperfibrinolysis at the 10th (p=0.012), 30th minute (p=0.032) after reaching the maximum thrombus density, stabilizes the levels of: protein C (p=0.14), antithrombin-III (p=1), constants of anticoagulant activity (p=0.29), fibrinogen (p=0.1), coagulation drive intensity (p=0.25), thrombin activity (p=0.65), platelet count (p=0.38), their retractions (p=1) and aggregations (p=0.058), APTT (p=0.29), despite the progression of multiple organ failure and traumatic shock (need for infusion, increase in lactate (p=0.00000036) up to the 140th minute). The effects of PGT on coagulopathy when injected into the portal vein and into the femoral vein do not differ (p=0.7). The hepatoprotective effect of PGT was found: the levels of AST (p=0.58) and ALT (p=1), bilirubin (p=1), total protein are stable (p=1), with increasing renal failure: creatinine (p=0.0042 ) and urea (p=0.049).
Conclusion. PGT, including a solution of tranexamic acid, native plasma and platelet-rich plasma, suppresses coagulopathy after severe closed liver injury in the experiment, both with the introduction of components into the femoral vein and into the portal vein, and has a hepatoprotective effect

Keywords: liver trauma, blood plasma, Wistar rats, coagulopathy, low-frequency piezothromboelastography, low-frequency piezoaggregatometry
p. 98-116 of the original issue
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Address for correspondence:
644074, Russian Federation,
Omsk, Komarova avenue, 17/3, 96, City Clinical Emergency Hospital No1,
tel.: +7-913-151-39-89,
e-mail: kinzerskij@mail.ru,
Kinzersky Alexander A.
Information about the authors:
Kinzersky A.A., Surgeon of the Surgical Department of the City Clinical Emergency Hospital No. 1, Assistant of the Department of Hospital Surgery named after A.I. N.S. Makokhi Federal State Budgetary Institution of Higher Education “Omsk State Medical University” of the Ministry of Health of Russia of the Russian Federation.
http://orcid.org/0000-0001-5749-1873
Korzhuk M.S., MD, Professor, Lecturer at the Department of Naval Surgery, Federal State Budgetary Educational Institution of Higher Education “Military Medical Academy named after A.I. CM. Kirov” of the Ministry of Defense of the Russian Federation, Researcher of the Scientific Laboratory of cancer Chemoprevention and Oncopharmacology of the Federal State Budgetary Institution “N.N. N.N. Petrov” of the Ministry of Health of Russia of the Russian Federation. Omsk, Russian Federation.
http://orcid.org/0000-0002-4579-2027
Dolgikh V.T., MD, Professor, Honored Scientist of the Russian Federation, Chief Researcher of the Research Institute of General Resuscitation named after V.I. V.A. Negovsky FGBNU “Federal Scientific and Clinical Center for Resuscitation and Rehabilitology”.
http://orcid.org/0000-0001-9034-4912
Solovieva T.S., Pathologist of the Federal State Budgetary Institution of Health “St. Petersburg Clinical Hospital of the Russian Academy of Sciences”.
http://orcid.org/0009-0005-2672-276X
Eselevich R.N., PhD, Major of the Medical Service, Head of the Oncology Department of the Clinic of the Department of Naval Surgery CM. Kirov” Ministry of Defense of the Russian Federation.
http://orcid.org/0000-0003-3249-233X
Balura O.V., PhD, Major of the Medical Service, Senior Lecturer of the Department of Naval Surgery CM. Kirov” Ministry of Defense of the Russian Federation.
http://orcid.org/0000-0001-7826-8056
Kotov I.I., MD, Associate Professor, Professor of the Department of Hospital Surgery. N.S. Makokhi Federal State Budgetary Institution of Higher Education “Omsk State Medical University” of the Ministry of Health of Russia of the Russian Federation, Omsk, Russian Federation.
http://orcid.org/0000-0002-9712-2391

T.I. KALENCHIC 1, S.L. KABAK 2, L.G. CEDRIC 2

SPONTANEOUS SOFT TISSUE HEMATOMA IN PATIENTS WITH COVID-19 INFECTION

Belarusian State Medical University 1,
6th City Clinical Hospital 2, Minsk,
Republic of Belarus

Objectives. The aim of this study is to determine the localization of spontaneous subcutaneous and muscle hematomas in patients with the SARS-CoV-2 infection, as well as to analyze changes in the main indicators of blood coagulation.
Material and Methods. The clinical data and the results of laboratory and instrumental studies of 12 patients (five men and seven women, aged 57 to 99 years) with coronavirus infection COVID-19 and spontaneous soft tissue hematomas, who were hospitalized in the therapeutic departments of the 6th Minsk’s city clinical hospital in 2021 - 2022, were analyzed. On the day of admission all patients were prescribed anticoagulants.
Results. Ultrasound and CT revealed 17 hematomas, which were localized in the retroperitoneal space, muscles of the anterior and lateral walls of the abdomen, as well as in the muscles of the thigh and gluteal region. Most often, hemorrhages were found in the soft tissues of the thigh. The volume of fluid in hematomas ranged from 25 to 1200 ml. In five cases, two isolated areas of hemorrhage were identified. In the projection of hematomas subcutaneous hemorrhages were detected. As the hematoma formed, in most cases there was a significant decrease in the level of hemoglobin, which was accompanied by tachycardia and a drop in blood pressure. Hemorrhagic shock of varying severity was diagnosed in all patients using the Algover index. All patients had comorbidities. All of them had a high risk of bleeding according to the HAS-BLED scale (from 3 to 5 points). After discontinuing anticoagulation, hemostatic therapy was prescribed. In 6 cases puncture drainage of the hematoma was performed. Four patients were transfused with red blood cells and fresh frozen plasma. Nine patients after 12-21 days of hospitalization in a satisfactory condition were discharged for outpatient aftercare, one was transferred to the Department of Purulent Surgery. In two cases, death from coronavirus infection and comorbid pathology was ascertained.
Conclusion. Elderly patients with severe and moderate SARS-CoV-2 viral pneumonia may develop spontaneous soft tissue hematomas, including multiple and large ones. Spontaneous hematomas of soft tissues in combination with advanced age, the presence of several concomitant illnesses are a risk factor for death.

Keywords: hematoma, COVID-19 infection, computed tomography, ultrasound, anticoagulants, comorbidity
p. 117-126 of the original issue
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Address for correspondence:
220116, Republic of Belarus,
Minsk, Dzerzhinsky Avenue, 83,
Belarusian State Medical University,
Department of Human Morphology,
tel. +375 (29) 6588339,
e-mail: kabakmorph@gmail.com.
Kabak Sergey Lvovich
Information about the authors:
Kalenchits Tamara Ivanovna, PhD, Associate Professor of the Department of Medical Rehabilitation and Physiotherapy, Belarusian State Medical University; Minsk, Republic of Belarus.
http://org/0000-0003-0387-4937
Kabak Sergey Lvovich, MD, Professor, Head of the Department of Human Morphology, Belarusian State Medical University, Minsk, Republic of Belarus,
http://org/0000-0002-7173-1818
Tsedrik Lyudmila G., Physician, Department of Functional Diagnostics, 6th City Clinical Hospital, Minsk, Republic of Belarus.

S.P. DOSMAGAMBETOV 1, B.K. DZHENALAEV 1, G.D. ZHUMAGALIYEVA 1, A.B. TUSSUPKALIEV 1, B.N. BISSALIYEV 1, G.Z. ABDULLAEVA 2

DIFFERENTIAL DIAGNOSIS OF ACUTE APPENDICITIS IN CHILDREN WITH COVID-19 ASSOCIATED MULTISYSTEM INFLAMMATORY SYNDROME

West Kazakhstan Medical University named after Marat Ospanov 1,
Motherhood and Childhood Care Center 2, Aktobe,
Republic of Kazakhstan

The publication describes clinical observations of children with multisystem inflammatory syndrome (MSIS) associated with SARS-CoV-2. The difficulties of diagnosis and differential diagnosis with acute appendicitis, peritonitis are shown. In April 2020, in the UK, there were reports of children having a picture of the disease similar to incomplete Kawasaki syndrome or toxic shock syndrome. Many researchers have concluded that MSVS is a dangerous systemic infectious disease characterized by extreme inflammation, fever, abdominal symptoms, conjunctivitis, and rash.
It is believed that the cause of abdominal pain in MSIS is mesenteric lymphadenitis, serous peritonitis. Ignorance of the manifestations of MSVS in children leads to late diagnosis of this severe pathology and futile surgical intervention.
Currently, many publications have appeared describing MSIS associated with SARS-CoV-2. WHO has developed a preliminary case definition and a case report form for multisystem inflammatory syndrome in children and adolescents. The preliminary case determination reflects the clinical and laboratory features observed in children that have been reported to date, and serves to identify suspected or confirmed cases, both for the purpose of providing treatment, and for preliminary reporting and follow-up. Therefore, there is an urgent need to collect standardized data describing clinical manifestations, severity, outcomes, and epidemiology.
During the current pandemic, paediatric surgeons should be more alert to MSIS when treating children with fever and acute abdomen. Early diagnosis of MSIS will allow you to avoid unnecessary operations that can worsen the already serious condition of the patient.
Taking into account the difficulties in the differential diagnosis of MSIS with acute surgical pathology of the abdominal cavity, it is important to ensure a multidisciplinary approach in the timely diagnosis of MSIS in seriously ill children. Only a joint examination of such specialists as an infectious disease specialist, cardiologist, pulmonologist, hematologist, nephrologist, pediatrician, pediatric surgeon and laboratory tests (clinical blood test, C-reactive protein, D-dimer, coagulogram), echocardiography, CT will allow timely detection of MSIS in children, to exclude surgical pathology of the abdominal cavity.

Keywords: multisystem inflammatory syndrome, acute appendicitis, peritonitis, mesadenitis, multidisciplinary approach
p. 127-136 of the original issue
References
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Address for correspondence:
030019, the Republic of Kazakhstan,
Aktobe, Maresyev st., 68,
West Kazakhstan Medical University
Named after Marat Ospanov,
Department of Pediatric Surgery,
Tel. +7 701 559-68-10,
e-mail: Dossag2011@mail.ru,
Dosmagambetov Sagidulla P.
Information about the authors:
Dosmagambetov Sagidulla P., Candidate of medical sciences (PhD), associate professor of the chair of pediatric surgery, West Kazakhstan Marat Ospanov Medical University, Aktobe, Republic of Kazakhstan.
http://orcid.org/0000-0002-6525-8438
Dzhenalaev Bulat K., Doctor of medical sciences (PhD, MD), professor of the chair of pediatric surgery, West Kazakhstan Marat Ospanov Medical University, Aktobe, Republic of Kazakhstan.
http://orcid.org/0000-0001-7494-5072
Zhumagaliyeva Galina D., Candidate of medical sciences (PhD), associate professor of the course of infectious diseases in children, West Kazakhstan Marat Ospanov Medical University, Aktobe, Republic of Kazakhstan.
http://orcid.org/0000-0002-5448-072X
Tussupkaliev Assylbek B., Candidate of medical sciences (PhD), associate professor of the chair of pediatric surgery, West Kazakhstan Marat Ospanov Medical University, Aktobe, Republic of Kazakhstan.
http://orcid.org/0000-0003-2386-2984
Bissaliyev Bauyrzhan N., Candidate of medical sciences (PhD), associate professor of the chair of pediatric surgery, West Kazakhstan Marat Ospanov Medical University, Aktobe, Republic of Kazakhstan. http://orcid.org/0000-0002-4875-1140
Abdullaeva Gulzhamal Z., Head of the Intensive Care Unit of the pediatric in-patient department of Aktyubinsk Medical Centre, Aktobe, Republic of Kazakhstan.
http://orcid.org/0000-0002-9018-5891

N.A. KARPUK 1, S.P. RUBNIKOVICH 2, I.V. ZHYLTSOU 1, O.C. MAZUR 3, I.YU. KARPUK 1, A.P. MIKHALENKA3

SOMATIC MUTATIONS IN ORAL SQUAMOUS CELL CARCINOMAS

Vitebsk State Medical University 1, Vitebsk,
Belorusian State Medical University 2, Republic of Belarus
Institute of Genetics and Cytology of the Belorusian National Academy of Sciences, Laboratory of Environmental Genetics and Biotechnology 3, Minsk,
Republic of Belarus

Objective. The number of cases of oral squamous cell carcinoma (OSCC) is increasing annually all over the world. At the same time, the prediction of the development and early diagnosis of OSCC are consided to be the most important health problems. By using high throughput DNA sequencing (DNA-seq) technologies, it is possible to identify genetic variants that play a role in human health.
Methods. The samples (n=48) of altered oral mucosal epithelium of patients with oral mucosal leukoplakia (n=24) and oral squamous cell carcinomas (n=24) were the material for the study. The QIAamp DNA FFPE Tissue Kit (Qiagen, Germany) was used to isolate DNA from the samples. DNA sequencing was performed with Illumina NextSeq 550 sequencer and TruSight™ Oncology 500 DNA Kit, For Use with NextSeq (Illumina, USA). All operations for DNA extraction from biological samples, preparation of DNA libraries, and sequencing were performed step by step in strict accordance with the instructions supplied with the reagent kits. The bioinformatic analysis was performed by an experienced professional using Illumina BaseSpace and Galaxy Project specialized software and in accordance with current guidelines.
Results. Identified pathogenic and probably pathogenic variants in ERCC3, HOXB13, KRAS, MSH3, MSH6, PIK3CA, and TP53 genes are associated with a high probability (RR 90-22000) of oral squamous cell carcinomas development.
Conclusion. This information allows working out PCR and NGS test systems for predicting the development and early diagnosis of oral squamous cell carcinomas.

Keywords: DNA sequencing, somatic mutations, oral squamous cell carcinomas
p. 137-145 of the original issue
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Address for correspondence:
210009, Republic of Belarus,
Vitebsk, Frunze Ave., 27,
Vitebsk State Medical University,
tel.: +375-29-596-10-83,
e-mail: ms.karpuk@mail.ru,
Karpuk Natalia A.
Information about the authors:
Karpuk Natalia A., PhD, Associate Professor, Associate Professor of the Department of General and Orthopedic Dentistry with the Course of FAT and RP Vitebsk State Medical University, Vitebsk, Republic of Belarus.
http://orcid.org/0000-0001-9991-7034
Rubnikovich Sergey P. Corresponding Member of NASB, MD, Professor, Rector of Belarusian State Medical University, Minsk, Republic of Belarus.
http://orcid.org/0000-0002-7450-3757
Zhyltsou Ivan V, MD, Professor, Head of the Department of Evidence-Based Medicine and Clinical Diagnostics of the Faculty of Advanced Training and Retraining of Vitebsk State Medical University, Vitebsk, Republic of Belarus.
http://orcid.org/0000-0002-4912-2880
Mazur Oksana C., Researcher, Laboratory of Environmental Genetics and Biotechnology, Institute of Genetics and Cytology of the National Academy of Sciences of Belarus, Minsk, Belarus
http://orcid.org/0000-0002-6093-4548
Karpuk Ivan Yu., MD, Dean of the Faculty of Dentistry, Professor of the Department of General Dentistry with the Course of Prosthodontic Dentistry of. Vitebsk State Medical University, Vitebsk, Republic of Belarus.
http://orcid.org/0000-0001-9991-7035
Mikhalenka Alena P., PhD (Biol.), Senior Researcher, Laboratory of Environmental Genetics and Biotechnology, Institute of Genetics and Cytology of the National Academy of Sciences of Belarus , Minsk, Belarus.
http://orcid.org/0000-0003-4543-2862.

REVIEWS

K.S. RUSSKOVA, K.F. CHERNOUSOV, R.V. KARPOVA

THE ROLE OF ANGIOGENESIS AND COAGULOPATHY IN PATHOGENESIS OF PORTAL HYPERTENSION IN LIVER CIRRHOSIS

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

Portal hypertension is the most dangerous complication of chronic liver diseases. There are three closely related processes leading to this: inflammation, fibrosis and pathological angiogenesis. A number of studies showed that antiangiogenic therapy prevents the progression of cirrhosis and portal hypertension. Recent studies suggest that the role of angiogenesis in the progression of fibrotic changes and their reorganization is complex and ambiguous. Such processes as sinusoidal angiogenesis and perisinusoidal fibrolysis, their contribution to the reduction of intrahepatic resistance and compensation of portal hypertension are discussing. Historically, hemorrhagic complications have been considered the main manifestation of coagulation disorders in patients with liver cirrhosis, however, portal vein thrombosis occurs in 16-23% of cirrhosis patients. Currently, liver cirrhosis is considered as a prothrombotic condition that requires careful diagnosis and the corrective drug therapy. It was that patients with cirrhosis taking anticoagulants have a lower risk of bleeding from varicose veins of esophagus and are less likely to become decompensated. However, there are not enough results of clinical studies to form clear indications for drug and surgical treatment of thrombotic complications in liver cirrhosis, therefore this question requires further investigation.

Keywords: portal hypertension, liver cirrhosis, angiogenesis, fibrosis reorganization, coagulation blood properties, hypercoagulation
p. 146-156 of the original issue
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Address for correspondence:
119435, Russian Federation,
Moscow, Bolshaya Pirogovskaya str., 6-1,
I.M. Sechenov First Moscow
State Medical University,
the Faculty Surgery Department No1
tel. +7 905-016-40-54,
e-mail: russkova.ksy@gmail.com,
Russkova Ksenia S.
Information about the authors:
Russkova Ksenia S., Post-Graduate Student, the Department of Faculty Surgery No1 of N.V. Sklifosovsky Institute of Clinical Medicine I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation. https://orcid.org/0000-0003-2150-7567
Chernousov Kirill F., Post-Graduate Student, the Department of Faculty Surgery No1 of N.V. Sklifosovsky Institute of Clinical Medicine I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation. https://orcid.org/0000-0002-1751-4601
Karpova Radmila V., MD, Professor of the Department of Faculty Surgery No1 of N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation. https://orcid.org/0000-0003-0608-9846

S.A. PLAKSIN

DIAGNOSIS AND TREATMENT OF HEMOTHORAX IN BLUNT CHEST TRAUMA. A REVIEW OF THE LITERATURE

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

Hemothorax occurs in 15-58% of cases of blunt chest trauma. Computed tomography and echosonography data improved the diagnosis and changed the tactics of treating hemothorax. The presented literature review is devoted to topical issues of comparative assessment of routine x-ray examination and new methods for recognition of hemothorax and changes of surgical tactics according to the obtained results. Criteria of hemothorax classification i.e. acute, retained, late and latent are described. Up to 28-80% of hemothoraxes not found during radiography turn out to be revealed on computer tomography. Conservative treatment and dynamic monitoring is possible in the cases of a small hemothorax, based on the quantitative results of the separation of the pleura sheets according to ultrasound and computed tomography. Videothoracoscopy has been reported as a useful approach in the management of patients with stable hemodynamic conditions for persistent, residual, late, clotted hemothorax or in the cases of other interventions in the pleural cavity. The best results of thoracoscopy are noted in the first 48-72 hours after an injury. If a patient is actively bleeding and remains hemodynamically unstable, thoracotomy is the procedure of choice. The frequency of drainage complications of the pleural cavity is 19% and remains at the same level. They are divided into complications of insertion, malposition, removal, infectious-immunological and functioning of the drainage. Multiple reports have suggested that smaller bore tubes may be just as effective as larger bore tubes. Video-assisted thoracoscopy is used to treat clotted hemothorax; the possibility to evacuate a retained hemothorax successfully by administration of intrapleural fibrinolytic agents and fresh frozen plasma has resulted in resolution of clotted hemothoraxi has been demonstrated.

Keywords: blunt chest trauma, hemothorax, thoracoscopy, computed tomography, ultrasound, tube thoracostomy, chest injury
p. 157-165 of the original issue
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Address for correspondence:
614990, Russian Federation, Perm,
Petropavloskaya, st. 26,
Perm State Medical University
named after Academician E. A. Wagne,
Department of Surgery with a Course of Cardiovascular Surgery and Invasive Cardiology,
tel.: +7 342 239-29-72,
e-mail: splaksin@mail.ru,
Plaksin Sergey A.
Information about the authors:
Plaksin Sergei A, MD, Professor, Perm State Medical University named after Academician E.A. Wagner of the Ministry of Healthcare of the Russian Federation, Perm, Russian Federation.
http://orcid.org/0000-0001-8108-1655

CASE REPORTS

S.A. GOLOBOROD’KO 1, 2, O.E. GAVRYKOV 1, 2

ANOMALOUS ABDUCTOR OF THE POLLICIS LONGUS: CASE REPORT

Kharkov Medical Academy for Postgraduate Education 1,
KNP HOS “Regional Clinical Traumatological Hospital” 2, Kharkov,
Ukraine

In the article a clinical observation of a patient with an anomalous abductor pollicis longus is described.
Usually, one muscle belly of the abductor pollicis longus arises from the posterior surface of the ulna just distal to the place of attachment of the supinator muscle, from the interosseous membrane and the posterior surface of the radius, then passes in the form of a tendon through the first extensor fibro-osseous tunnel and inserts into the base of the first metacarpal bone. The abductor pollicis longus is innervated by the posterior interosseous nerve. However, there are many structural anatomical variations. The clinical case, which is described in the article, is an illustration of one unusual variant of the anatomical structure of the abductor pollicis longus. A 15-year-old girl complained of a tumor-like formation in the area of the thenar of the right hand, periodic pains at rest and significant during physical exertion, dysfunction of the hand. Instrumental methods for studying did not reveal any pathologic changes.. A preliminary clinical diagnosis was established: soft tissue tumor-like formation of the thumb of the right hand. During the operation it was revealed, that somewhat proximal to the carpometacarpal joint from the most radially located thenar muscle in the proximal direction a common tendon branched out, which was located in the first extensor fibro-osseous tunnel somewhat more radially than the tendon of the abductor pollicis longus. Atypical muscle belly in the distal direction continued to the metacarpophalangeal joint of the thumb. Ligamentotomy of the first extensor fibro-osseous tunnel was performed. A positive long-term result of the operation confirmed the accuracy of the chosen treatment tactic.

Keywords: anomalous abductor pollicis longus, clinical observation
p. 166-170 of the original issue
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Address for correspondence:
61145, Ukraine,
Kharkov, ul. Novgorodskaya 8, kv. 31,
ó-mail: golosa@ukr.net,
tel: +38-068-919-89-14,
Goloborod’ko Sergey A.
Information about the authors:
Goloborod’ko Sergey A., MD, An Associate Professor, Kharkov Medical Academy for Postgraduate Education, Department of Combustiology, Reconstructive and Plastic Surgery; Orthopedic Traumatologist, KNP HOS “Regional Clinical Traumatological Hospital”, Kharkîv, Ukraine.
https://orcid.org/0000-0002-0153-8158
Gavrykov Oleksandr E., MD, An Associate Professor, Kharkov Medical Academy for Postgraduate Education, Department of Emergency Care and Disaster Medicine Director, KNP HOS “Regional Clinical Traumatological Hospital”, Kharkîv, Ukraine.
https://orcid.org/0000-0002-6711-3689
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