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Year 2011 Vol. 19 No 3

GALLERY OF THE NATIVE SURGEONS

KHUBULAVA G.G., SHAYDAKOV E.V., SаZONOV A.B.

OPERATION OF TROYANOV-TRENDELENBURG.
DEDICATED TO ALEXEY ALEXEEVICH TROYANOV

The article is devoted to a talented Russian surgeon, public figure and remarkable person Alexey Alexeevich Troyanov. In 1888 A.A. Troyanov performed the first ligation of the greater saphenous vein, and we have every right to assume that A.A. Troyanov is the founder of phlebology in Russia, and Obukhov Hospital is a homeland of the native phlebology.
The methods of the plastic closure of an urethral fistula and congenital ectopias of the bladder belong to A.A. Troyanov. Besides operative techniques he suggested a number of original instruments. A spit-like needle holder of Troyanov and the bed to stretch the spine at spongilitis are widely known.
Great diligence, compassion, unselfishness, active citizenship – these traits have earned the enormous prestige to Alexey Alexeevich among his colleagues. The things, done by A.A. Troyanov, permit to say for sure that he has contributed significantly to the development of surgery. His name deservedly is among the prominent representatives of domestic medicine.

Keywords: Alexey Alexeevich Troyanov, Frederick Trendelenburg, the history of surgery
p. 3 - 8 of the original issue
References
  1. Оппель, В. А. История русской хирургии / В. А. Оппель. – Вологда, 1923.
  2. Троянов, А. А. О влиянии обширных ожогов кожи на животный организм: дис. … д-ра медицины / А. А. Троянов. – СПб., МХА, 1882. – 310 с.
  3. Угрюмов, П. К. Городская Обуховская больница в С. Петербурге / П. К. Угрюмов. – СПб., 1886. – 81 с.
  4. Турнер, Г. И. Автобиографический этюд / Г. И. Турнер // Нов. хир. арх. – 1931. – Т. 23. – Кн. 3-4. – С. 44-48.
  5. Открытое письмо к заведующему хирургическим отделением мужской Обуховской больницы А. А. Троянову // Врач. – 1900. – № 52. – 1586 с.
  6. Троянов, А. А. Случай изолированной перевязки бедренной вены / А. А. Троянов // Больн. газ. Боткина. – 1891. – № 3.
  7. Троянов, А. А. Случай перфоративного перитонита в течении брюшного тифа. Лапаратомия. Резекция кишки. Выздоровление / А. А. Троянов, А. А. Нечаев // Больн. газ. Боткина. – 1894. – № 29.
  8. Троянов, А. А. Случай холецистэктомии: протоколы врачеб. заседания Обухов. больницы от 13 дек. 1896 г. / А. А. Троянов // Больн. газ. Боткина. – 1897. – № 4.
  9. Троянов, А. А. Демонстрация больной с перевязкой v. saphena majoris и с последующей прививкой кожи по Tiersch’y на варикозные язвы голени: протоколы врачеб. заседания в гор. Обухов. больнице от 4 мая 1890 г. / А. А. Троянов // Больн. газ. Боткина. – 1891. – № 1.
  10. Владиславлев, С. В. А. А. Троянов / С. В. Владиславлев // Русский врач. – 1916. – № 8. – С. 28-30.
  11. Оглоблина, 3. В. А. А. Троянов / 3. В. Оглоблина // Вестн. хирургии. – 1950. – Т. 70, № 1. – С. 14-23.
  12. Правдолюбов, В. В. К вопросу об оперативном лечении варикозного расширения вен нижних конечностей: дис. … д-ра медицины / В. В. Правдолюбов. – СПб.; МХА, 1892. – 247 с.
  13. Хольцов, Б. Н. Об остановке кровотечения при ранении больших вен и о перевязке общей бедренной вены в частности: дис. … д-ра медицины / Б. Н. Хольцов. – СПб.; МХА, 1892.
  14. Хольцов, Б. Н. Памяти А. А. Троянова / Б. Н. Хольцов // Русский врач. – 1916. – № 11. – С. 260-262.

EXPERIMENTAL SURGERY

ALEXANDROV S.V., VLADIMIRSKAYA T.Z.

EXPERIMENTAL INVESTIGATION RESULTS OF COAGULATION PROPERTIES OF HIGH-ENERGY PULSED LASER RADIATION AT THE LIVER TISSUE EXPOSURE

Objectives. To compare the depth of coagulation of the laser radiation of 1064nm, 1320nm, 1440nm when exposed to liver tissue and to monitor morphological changes within 14 days.
Methods. The depth of the damage zones was measured after exposure to laser radiation three wavelengths with an average power of 20 W at the liver tissue of experimental animals after 1 hour after exposure and after 3,7,14 hours. Morphological changes of liver tissue in the place of laser radiation were studied.
Results. The depth of coagulation and vaporization was for a wavelength of 1064 nm 446,90±12,389, for 1320 nm - 1018,8±21,983, for 1440 nm - 753,20±17,077 (data are given in microns). The depth of the perifocal zone for a wavelength of 1064 nm - 1724,9±22,673, for 1320nm - 1724,8±23,679, for 1440 nm - 1379,1±19,259 (mean±error of the mean, these are given in microns). By the 14th day after exposure of the laser pulse radiation with an average power of 20 W the liver tissue was restored.
Conclusions. The wavelength of 1320 nm has the most profound coagulation effects on liver tissue in the used modes.

Keywords: laser radiation, coagulation of the liver, laser hemostasis
p. 9 – 15 of the original issue
References
  1. Скобелкин, О. К. Лазеры в хирургии / О. К. Скобелкин. – М.: Медицина, 1989. – 256 с.
  2. Борисов, А. Е. Видеоэндоскопические вмешательства на органах живота, груди и забрюшинного пространства / А. Е. Борисов. – М.: Янус, 2002. – 416 с.
  3. Савинов, И. П. Высокие хирургические лазерные технологии в медицине Санкт-Петербурга и Северо-Западного региона Российской Федерации: перспективы дальнейшего развития / И. П. Савинов, Б. Б. Шафировский // Вестн. хирургии. – 2004. – С. 88-90.
  4. Advantages of the laser in laparoscopic cholecystectomy / R. Hoffmann [et al.] // Langenbecks Arch. Chir. Suppl. Congressed. – 1996. – Vol. 113. – Р. 589-592.
  5. Hershman, M. J. Laparoscopic laser cholecystectomy: our first 200 patients / M. J. Hershman, R. D. Rosin // Ann. R. Coll. Surg. Engl. – 1992. – Vol. 74. – Р. 242-247.
  6. Современные технологии гемостаза / Н. А. Ефименко [и др.] // Анналы хирург. гепатологии. – 1998 – Т. 3, № 3. – С. 332.
  7. Лапароскопическая холецистэктомия при остром холецистите / В. В. Грубник [и др.] // Хирургия. – 1998. – № 3. – С. 7-9.
  8. Литвин, Г. Д. Сравнительная характеристика изменений коагулограммы после операций на селезенке с применением скальпеля, СО2- и АИГ-лазеров / Г. Д. Литвин // Актуальные вопросы лазерной хирургии / Г. Д. Литвин, В. И. Корепанов, А. П. Якименко. – М., 1982. – 101 с.
  9. Корепанов, В. И. Применение Nd:YAG лазера в хирургической клинике: ил. практ. рук. / В. И. Корепанов; Рос. мед. акад. последиплом. образования. – М., 1996. – 108 с.
  10. Possibilities of laparoscopic liver resection / J. Mouiel [et al.] // J. Hepatobiliary Pancreat. Surg. – 2000. – Vol. 7. – Р. 1-8.
  11. Laser resection of a liver hydatid cyst under videocoelioscopy / N. Katkhouda [et al.] // Br. J. Surg. – 1992. – Vol. 79. – Р. 560-561.
  12. Хирургическое лечение истинных кист печени с использованием высокоинтенсивного лазерного излучения / И. Я. Бондаревский [и др.] // Лазер. медицина. – 2006. – Т. 10. – Вып. 3. – С. 33-36.
  13. Пархоменко, Ю. Г. Особенности воспалительного процесса и заживления лазерных хирургических ран / Ю. Г. Пархоменко // Труды VII Всесоюз. съезда патологоанатомов. – Ташкент, 1983. – С. 244-246.
  14. Пряхин, А. Н. Высокоинтенсивное лазерное излучение в лапароскопической гепатобилиарной хирургии / А. Н. Пряхин // Анналы хирург. гепатологии. – 2006. – Т. 11, № 4. – С. 38-43.
  15. Корепанов, В. И. Применение углекислотного лазера в хирургии / В. И. Корепанов. – М., 1996. – 111 с.
  16. Неворотин, А. И. Введение в лазерную хирургию: учеб. пособие / А. И. Неворотин. – СПб.: СпецЛит, 2000. – 175 с.
  17. Гланц, С. Медико - биологическая статистика: пер. с англ. / С. Гланц. – М.: Практика, 1998. – 459 с.

LYZIKOV A.A., VOROPAEV E.V., OSIPOV V.A., PECHENKIN A.A.

MODELING HIGH RISK CONDITIONS OF INFECTIOUS COMPLICATIONS IN EXPERIMENT

Objectives. To create the experimental model of the subcultural bacteremia to study biological reactions of the vascular conduits on the presence of pathogenic microorganisms in the dose insufficient for sepsis development.
Methods. Experimental investigations were carried out on 30 out bred dogs with an average weight 15,3±3,7 kg. Aorto-femoral bypass with a combined conduit was performed in all of them. Modeling of high-risk conditions of postoperative septic complications by a single intravenous injection of S.aureus was performed in 20 dogs before the operation. 10 other animals were used for control and were not infected.
Results. The leucocytes level and clinical parameters in the experimental group didnt reliably differ from ones in the control group. For 3–5 days 14 out of 20 animals of the experimental group died because of the massive hemorrhage from the anastomoses. PCR analysis was carried out: in some animals together with the control strain of Staphylococcus a normal micro flora was identified as well as other types of Staphylococcus.
Conclusions. The presence of subcultural bacteriemia doesn t cause clinical and laboratory manifestations of sepsis but result in complications of conduit survival similar to the septic ones. Development of infectious complications doesnt depend on the dosage of pathogenic agent.

Keywords: prosthesis infection, experiment, modeling, subcultural bacteriemia, septic complications
p. 16 – 20 of the original issue
References
  1. Kassab, G. S. Biomechanical Considerations in the Design of Graft: The Homeostasis Hypothesis / G. S. Kassab, J. A. Navia // Annu. Rev. Biomed. Eng. – 2006. – Vol. 242. – P. 19-28.
  2. Saphenous vein versus PTFE for above-knee femoropopliteal bypass: a review of the literature / P. Klinkert [et al.] // Eur. J. Vasc. Endovasc. Surg. – 2004. – Vol. 27, N 4. – P. 357-362.
  3. Neoaortic reconstruction for aortic graft infection: need for endovascular adjunctive therapies? / J. Faulk [et al.] // Ann. Vasc. Surg. – 2005. – Vol. 19, N 6. – P. 774-781.
  4. Vascular allografts are resistant to methicillin-resistant Staphylococcus aureus through indoleamine 2, 3-dioxygenase in a murine model / A. Saito [et al.] // J. Thorac. Cardiovasc. Surg. – 2008. – Vol. 136, N 1. – P. 159-167.
  5. Scales, J. T. Tissue reactions to synthetic materials / J. T. Scales // Proc. R. Soc. Med. – 1953. – Vol. 46. – P. 647-652.

GENERAL AND SPECIAL SURGERY

BELYUK K.S., ZHANDAROV K.N.

CLINICAL ESTIMATION OF DIFFERENT VARIANTS OF CHOLEDOCHOTOMY INCISION CLOSURE

Objectives. To study treatment results of different variants of choledochotomy incision closure and to estimate efficacy of new proposed methods.
Methods. Operations at 200 patients in whom open surgeries were carried out with different variants of choledochotomy closure. According to the choledochotomy closure patients were divided into three groups: the 1st one – 158 patients with external drainage of common bile duct; the 2nd – 22 patients with the precision suture of choledochtomy opening and drainage on Halsted; the 3rd – 20 patients with “deaf” precision suture of choledochtomy opening and in 12 of them drainage of common bile duct with hidden self-deleted drainage worked out in the clinic was done
Results. Adequate correction of the biliary hypertension was revealed in three groups of patients both with the external drainage of the common duct and with hidden self-deleted drainage. Application of the later in the patients of the 3rd group permitted to impose “deaf” precision suture of the choledochtomy opening without the risk of its failure and thus to reduce the number of complications as well as the duration of the postoperative treatment in comparison with the 1st and 2nd groups with the external drainage of the common bile duct.
Conclusion. Using “deaf” precision suture with hidden self-deleted drainage of the common bile duct improves treatment results of complicated gallstone disease.

Keywords: gallstone disease, choledocholithiasis, obstructive jaundice, precision suture of choledochotomy incision
p. 21 – 29 of the original issue
References
  1. Брискин, Б. С. Медико-экономическая оценка различных способов выполнения холецистэктомии / Б. С. Брискин, О. В. Ломидзе // Хирургия. – 2005. – № 6. – С. 24-30.
  2. Гальперин, Э. И. Руководство по хирургии желчных путей / Э. И. Гальперин, П. С. Ветшев. – М.: Издат. дом Видар – М., 2006. – 568 с.
  3. Bingener, J. Management of common bile duct stones in a rural area of the United States / J. Bingener, W. H. Schwesinger // Surg. Endosc. – 2006. – N 20. – P. 577-579.
  4. Анализ результатов лечения осложненных форм острого холецистита / С. И. Филиппов [и др.] // Анналы хирург. гепатологии. – 2006. – Т. 11, № 3. – С. 122.
  5. Хаджибаев, A. M. Эндоскопическая хирургия калькулезного холецистита в сочетании с доброкачественными поражениями внепеченочных желчных протоков / A. M. Хаджибаев, Ш. К. Атаджанов, М. М. Хошимов // Хирургия. – 2009. – № 2. – С. 40-43.
  6. Lammert. F. Mechanisms of disease: the genetic epidemiology of gallbladder stones / F. Lammert, T. Sauerbrach // Nat. Clin. Pract. Gastroenterol. Hepatol. – 2005. – N 2 (9). – P. 423-433.
  7. Выбор метода хирургического лечения при холедохолитиазе / Г. И. Веронский [и др.] // Анналы хирург. гепатологии. – 2006. – Т. 11, № 3. – С. 75.
  8. Лапароскопическая фиброхоледохоскопия в хирургии холедохолитиаза / С. И. Возлюбленный [и др.] // Хирургия. – 2009. – № 2. – С. 44-46.
  9. Использование малоинвазивных технологий в лечении желчнокаменной болезни у лиц пожилого и старческого возраста / Е. Ю. Евтихова [и др.] // Анналы хирург. гепатологии. – 2002. – Т. 7, № 1. – С. 107-108.
  10. Современные аспекты диагностики и хирургического лечения больных с механической желтухой неопухолевого генеза / Р. Б. Мумладзе [и др.] // Анналы хирургии. – 2004. – № 4. – С. 41-45.
  11. Comparison of laparascopic cholecystectomy combined intraoperative endoscopic sphincterotomy and laparoscopic exploration common bile duct for cholecystocholedocholithiasis / D.-F. Hong [et al.] // Surg. Endosc. – 2006. – N 20. – P. 424-427.
  12. Миронов, В И. Дренирование желчевыводящих протоков при желчнокаменной болезни, осложненной механической желтухой / В. И. Миронов // Анналы хирург. гепатологии. – 2005. – Т. 10, № 2. – С. 59-60.
  13. Хирургия печени и желчевыводящих путей / А. А. Шалимов [и др.]. – Киев: Здоровье, 1993. – 512 с.
  14. Гришин, И. Н. Холецистэктомия / И. Н. Гришин. – Минск: Высшая шк., 1989. – 198 с.
  15. Гальперин, Э. И. Заболевание желчных путей после холецистэктомии / Э. И. Гальперин, Н. В. Волкова. – М.: Медицина, 1988. – 272 с.
  16. Способ антеградной папиллосфинктеротомии: пат. 4658 Респ. Беларусь, МПК А61В17/32 / К. Н. Жандаров, В. Н. Колоцей; заявитель Гродн. гос.мед. ун-т. - № а19980537; заявл. 02.06.1998; опубл. 30.09.2002 // Афiцыйны бюл. / Нац. цэнтр iнтэлектуал. уласнасцi. – 2002. – № 3 (34). – С. 99.
  17. Потеряный самоудаляющийся дренаж для дренирования общего желчного протока: пат. 5406 Респ. Беларусь, МПК А 61М 27/00 / К.Н. Жандаров, К.С. Белюк, С.Э. Савицкий, А.Л. Ушкевич, Т.И. Михович; заявитель УО «ГрГМУ». – № u 20080957; заявл. 29.12.08; опубл. 30.08.09 // Афiцыйны бюл. / Нац. цэнтр iнтэлектуал. уласнасцi. – 2009. – № 4. – С. 183-184.
  18. Виноградов, В. В. Рентгеноманометрическое исследование желчных путей / В.В. Виноградов, П.Н. Мазаев, Э.В. Гришкевич. – Ленинград: Медицина, 1996. – 161 с.
  19. Пауткин, Ю.Ф. Хирургия желчных путей / Ю.Ф. Пауткин, А.Е. Климов. – М.: Мед. информ. агенство, 2007. – 368 с.
  20. Виноградов, В.В. Непроходимость желчных путей / В.В. Виноградов, П.И. Зима, В.И. Кочиашвили. – М.: Медицина, 1977. – 312 с.

SHCHASTNY A.T.

POSTOPERATIVE COMPLICATIONS OF THE PROXIMAL PANCREAS RESECTIONS IN PATIENTS WITH CHRONIC PANCREATITIS

Objectives. To work out tactical and technical recommendations concerning complication prevention of proximal resection of the pancreas.
Methods. Retrospective investigation of the results of 22 pancreas proximal resection was carried out. 102 (45,7%) duodenum-saving proximal resections the pancreas head on Beger were done. Berns modification of Beger operation was done in 46 (20,6%) patients. Frey operation was done in 13 (5,8%) patients. Pancreatoduodenal resection was performedin 62 (27,8%) patients, from them in 41 patients a pylori-saving variant was used.
Results. Postoperative lethality composed 3,1%; postoperative complications incidence composed 3, 8%. The greatest share of early postoperative complications was in the postoperative pancreatitis – 15 (21,1%) patients; insufficiency of various forms of anastomoses - in 14 (20%) and pancreatic fistulas – in 14 (20) cases. Bile outflow was diagnosed in 8,5% cases. Intra-abdominal hemorrhages and bleedings in the intestinal lumen composed 8,5%
Conclusions. Duodenum-saving techniques permit to obtain low parameters of the postoperative complications and lethality. Mini-invasive interventions allow eliminating adequately the postoperative complications without repeated operations in the majority of operated patients. It is necessary to concentrate patients with chronic pancreatitis in large medical institutions, employing surgeons-pancreatologists.

Keywords: chronic pancreatitis, proximal resection, postoperative complications, pancreato-digestive anastomosis
p. 30 – 43 of the original issue
References
  1. Pancreatic head resection: the risk for local and systemic complications in 1315 patients – a monoinstitutional experience / H. G. Beger [et al.] // Am. J. Surg. – 2007. – Vol. 194. – P. S16-S19.
  2. Changes in mortality after pancreatic resection: towards the end of completion pancreatectomy / M. W. Buchler [et al.] // Arch. Surg. – 2003. – Vol. 138. – P. 1310-1314.
  3. Frey, C. F. Comparison of local resection of the head of the pancreas combined with longitudinal pancreaticojejunostomy (Frey procedure) and duodenum-preserving resection of the pancreatic head (Beger procedure) / C. F. Frey, L. M. Kathrin // World J. Surg. – 2003. – Vol. 27. – P. 1217-1230.
  4. Bruns, C. J. Surgical treatment of pancreatic cancer / C. J. Bruns, K. W. Jauch // Dtsch. Med. Wochenschr. – 2007. – Vol. 132. – P. 798-802.
  5. Pancreac Cancer Resection Outcome in Fmerican University Centers in 1989-1990 / S. B. Edge [et al.] // Cancer. – 1993. – Vol. 71, N 11. – P. 3502-3508.
  6. Pancreatic fistula and relative mortality in malignant disease after pancreaticoduodenectomy: review and statistical meta-analysis regarding 15 years of literature / F. G. Bartoli [et al.] // Anticancer Res. – 1991. – Vol. 11. – P. 1831-1848.
  7. Comparison of Wirsung-jejunal duct-to-mucosa and dunking technique for pancreatojejunostomy after pancreatoduodenectomy / G. Batignani [et al.] // Hepatobiliary Pancreat. Dis. Int. – 2005. – Vol. 4. – P. 450-455.
  8. Meta-analysis of pancreaticojejunostomy versus pancreaticogastrostomy reconstruction after pancreaticoduodenectomy / A. McKay [et al.] // Br. J. Surg. – 2006. – Vol. 93. – P. 929-936.
  9. Prevention and treatment of complications in pancreatic cancer surgery / P. O. Berberat [et al.] // Dig. Surg. – 1999. – Vol. 16. – P. 327-336.
  10. Pancreatic fistula after pancreatic head resection / M. W. Buchler [et al.] // BJS. – 2000. – Vol. 87. – P. 883-889.
  11. One hundred and forty-five consecutive pancreaticoduodenectomies without mortality / J. L. Cameron [et al.] // Ann. Surg. – 1993. – Vol. 217. – P. 430-435. – Disc. 435-8.
  12. Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS)definition / M. N. Wente [et al.] // Surgery. – 2007. – Vol. 142. – P. 20-25.
  13. Management of delayed visceral arterial bleeding after pancreatic head resection / F. Makowiec [et al.] // J. Gastrointest. Surg. – 2005. – Vol. 9. – P. 1293-1299.
  14. Risk factors for and management of delayed intraperitoneal hemorrhage after pancreatic and biliary surgery / Y. Yamashita [et al.] // Am. J. Surg. – 2007. – Vol. 193. – P. 454-459.
  15. Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS) / M. N. Wente [et al.] // Surgery. – 2007. – Vol. 142. – P. 761-768.
  16. Pancreaticoduodenectomy with or without extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma: comparison of morbidity and mortality and short-term outcome / C. J. Yeo [et al.] // Ann. Surg. – 1999. – Vol. 229. – P. 613-622. – Disc. 622-4.
  17. Meta-analysis of the value of somatostatin and its analogues in reducing complications associated with pancreatic surgery / S. Connor [et al.] // Br. J. Surg. – 2005. – Vol. 92. – P. 1059-1067.
  18. Prevention of pancreaticojejunal anastomotic leakage after pancreaticoduodenectomy with separate internal drainage of bile and pancreatic fluid / X. W. Dai [et al.] // Hepatobiliary Pancreat. Dis. Int. – 2003. – Vol. 2. – P. 131-134.
  19. A prospective analysis of factors influencing pancreaticojejunostomy performed using a single method, in 100 consecutive pancreaticoduodenectomies / S. Matsusue [et al.] // Surg. Today. – 1998. – Vol. 28. – P. 719-726.
  20. Pancreatic anastomoses after pancreatico-duodenectomy: do we need further studies? / S. V. Shrikhande [et al.] // World J. Surg. – 2005. – Vol. 29. - P. 1642-1649.
  21. Патютко, Ю. И. Хирургия рака органов билиопанкреатодуоденальной зоны / Ю. И. Патютко, А. Г. Котельников. – М.: Медицина, 2007. – 448 c.
  22. A controlled randomized multicenter trial of pancreatogastrostomy or pancreatojejunostomy after pancreatoduodenectomy / J. P. Duffas [et al.] // Am. J. Surg. – 2005. – Vol. 189. – P. 720-729.
  23. Duct-to-mucosa versus end-to-side pancreatico-jejunostomy reconstruction after pancreatico-duodenectomy: results of a prospective randomized trial / C. Bassi [et al.] // Surgery. – 2003. – Vol. 134. – P. 766-771.
  24. Postoperative pancreatic fistula: an international study group (ISGPF) definition / C. Bassi [et al.] // Surgery. – 2005. – Vol. 138. – P. 8-13.
  25. Кубышкин, В. А. Рак поджелудочной железы / В. А. Кубышкин, В. А. Вишневский. – М.: Медпрактика–М, 2003. – 386 с.
  26. Hemorrhage after duodenopancreatectomy: impact of neoadjuvant radiochemotherapy and experience with sentinel bleeding / O. Turrini [et al.] // World J. Surg. – 2005. – Vol. 29. – P. 212-216.
  27. Kurosaki, I. Omental wrapping of skeletonized major vessels after pancreaticoduodenectomy / I. Kurosaki, K. Hatakeyama // Int. Surg. – 2004. – Vol. 89. – P. 90-94.
  28. Schafer, M. Evidence-based pancreatic head resection for pancreatic cancer and chronic pancreatitis / M. Schafer, B. Mullhaupt, P. A. Clavien // Ann. Surg. – 2002. – Vol. 236, N 2. – P. 137-148.

REVEL-MUROZ J.A., SOVTSOV S.A.

LOW-INVASIVE LASER TECHNOLOGIES IN TREATMENT OF PATIENTS WITH CHRONIC PANCREATITIS

Objectives. To improve the effectiveness of chronic fibrosing pancreatitis treatment by means of low-invasive technologies with the application of high-intensity laser radiation.
Methods. 20 patients with parenchymal and fibro-sclerotic chronic pancreatitis were operated on. Nine of them were men and eleven were women. The age of patients ranged from 27 to 71 years. All the patients had persistent pain and dyspeptic syndromes, with negligible effect on antispasmodics. Medical history of the disease was from 6 months to 15 years, the frequency of severe attacks requiring hospitalization was from 2 to 6 per year. The laparoscopic technique and mini laparotomic access using the O-ring retractor were performed. The diode laser device “LS-0, 97 - IRE-Polus” (wavelength 970 nm) was used as a source of laser radiation.
Results. All the patients noted the disappearance of pain, improvement of general condition, quality of life. No complications were observed in the immediate and distant period after laser tunnelization.
Conclusions. The results of clinical studiestestify to the possibility of safe and effective use of laser tunnelization of pancreas in the patients with chronic pancreatitis. One of the highlights of the surgical treatment in these patients is the relief of pain and improvement of life quality.

Keywords: chronic pancreatitis, laser radiation
p. 44 – 50 of the original issue
References
  1. Комаров, Ф. И. Хронические панкреатиты: рук. по гастроэнтерологии / под. ред. Ф.И. Комарова, А.Л. Гребнева. – М.: Медицина, 1996. – Т. 3. – 719 с.
  2. Маев, И.В. Хронический панкреатит / И.В. Маев, А.Н. Козюлин, Ю.А. Кучерявый. – М.: Медицина, 2005. – 504 с.
  3. Лопаткина, Т.Н. Хронический панкреатит / Т.Н. Лопаткина // Новый мед. журн. – 1997. – № 2. – С. 7-11.
  4. Мараховский, Ю. Х. Хронический панкреатит. Новые данные об этиологии и патогенезе. Современная классификация. Успехи в диагностике и лечении / Ю.Х. Мараховский // Рус. мед. журн. – 1996. – Т. 4. – Вып. 3. – С. 156-160.
  5. Лопаткина, Т. Н. Диагностика и консервативное лечение хронического панкреатита / Т. Н. Лопаткина, В. Г Авдеев // Клин. фармакол. и терапия. – 2003. – Т. 12. – Вып. 1. – С. 13-17.
  6. Хронический панкреатит. Современные концепции патогенеза, диагностики и лечения / А. А. Шалимов [и др.]. – Киев: Здоров’я, 2000. – 142 с.
  7. Данилов, М. В. Хирургическая тактика при хроническом панкреатите / М. В. Данилов // Рос. журн. гастроэнтерол., гепатол., колопроктол. – 2000. – № 2. – С. 75-80.
  8. О классификации хронического панкреатита / В.Т. Ивашкин [и др.] // Клин. мед. – 1990. – № 10. – С. 96-99.
  9. Циммерман, Я. С. Принципы построения рабочей классификации хронического панкреатита / Я.С. Циммерман // Клин. мед. – 1995. – № 1. – С. 61-64.
  10. Хронический панкреатит: рук. для врачей / С.Ф. Багненко [и др.]. – СПб.: Питер, 2000. – 416 с.
  11. Губергриц, Н. Б. Лечение панкреатитов. Ферментные препараты в гастроэнтерологии / Н.Б.Губергриц. – М.: Медпрактика–М., 2003. – 100 с.
  12. Головнева, Е. С. Механизм универсальной активации неоангиогенеза после воздействия высокоинтенсивного лазерного излучения на ишемизированные ткани / Е. С. Головнева // Вестн. новых мед. технологий. – 2003. – Т. X, № 1-2. – С. 15-17.
  13. Шалимов, С. А. Руководство по экспериментальной хирургии / С. А. Шалимов, А. П. Радзиховский, Л. В. Кейсевич. – М.: Медицина, 1989. – 270 с.
  14. Ревель-Муроз, Ж. А. Лазерная туннелизация поджелудочной железы при хроническом панкреатите / Ж. А. Ревель-Муроз, С. А. Совцов, Р. У. Гиниатуллин // Эксперим. и клин. гастроэнтерология. – 2009. – № 7. – С. 48-52.
  15. Кудряшова, И. В. Ранняя диагностика хронического панкреатита с позиции использования ультразвуковой томографии и индекса качества жизни / И.В. Кудряшова. – Смоленск, 2003. – 20 с.
  16. Новик, А. А. Концепция исследования качества жизни в медицине / А.А. Новик, Т.И. Ионова, П. Кайнд. – СПб.: ЭЛБИ, 1999. – 140 с.
  17. Новик, А. А. Руководство по исследованию качества жизни в медицине / А.А. Новик, Т.И. Ионова. – СПб.: Издат. дом «Нева», М.: «ОЛМА-ПРЕСС» Звездный мир, 2002. – 320 с.
  18. Устройство для подведения лазерного излучения к тканям: пат. 66184РФ / Ж. А. Ревель-Муроз, С. А. Совцов, А. И. Козель; заявитель Челяб. гос. ин-т лазер. хирургии. – № 2007109619; заявл. 15.03.2007; опубл. 10.09.2007 // Официальный бюл. / Федерал. служба по интеллект. собственности, патентам и товарным знакам. – М.: ФГУ ФИБС, 2007. – № 25. – С. 540.
  19. Способ хирургического лечения воспалительно-дегенеративных заболеваний поджелудочной железы: пат. 2279259РФ / Ж. А. Ревель-Муроз, С. А. Совцов, А. И. Козель; заявитель Челяб. гос. ин-т лазер. хирургии. - № 2004130197; заявл. 13.10.2004; опубл. 10.07.2006 // Официальный бюл. / Федерал. служба по интеллект. собственности, патентам и товарным знакам. – М.: ФГУ ФИБС, 2006. – № 19. – С. 464-465.
  20. Применение СО2-лазера в хирургии паренхиматозных органов / О. К. Скобелкин [и др.] // Хирургия. – 1979. – № 10. – С. 98-101.
  21. Самохвалов, В. И. Применение СО2-лазера при обработке огнестрельных ран поджелудочной железы / В. И. Самохвалов, Е. И. Брехов, Б. П. Кудрявцев // Воен. мед. журн. – 1983. – № 2. – С. 64-65.
  22. Fine reconstruction of the pancreatic ductular system at the onset of pancreatitis / H. Endo [et al.] // Histol. Histopathol. – 2002. – Vol. 17, N 1. – P. 107-112.
  23. Pancreaticoduodenectomy with external drainage of residual pancreatic duct / G. H. Schoretsanitis [et al.] // Europ. J. Surg. – 1993. – Vol. 159, N 8. – P. 421-424.

SUKOVATYKH B.S., BLINKOV YU.YU., IVANOV P.A.

NEW APPROACH TO THE CHOICE OF TREATMENT METHOD AT DIFFUSE PURULENT PERITONITIS

Objectives. To improve the treatment results in patients with diffuse purulent peritonitis by means of objectification of the indications for the choice of surgical treatment.
Methods. The analysis of the complex diagnostics and the following treatment of 380 patients with diffuse purulent peritonitis was performed. According to the choice of treatment method the patients were divided into two groups. Control group included 245 patients; the choice of treatment method for them was made without quantitative characteristics of risk factors for progressing peritonitis. The basic group included 135 patients; the choice of treatment method for them was made on the base of the scale developed by the authors using quantitative assessment of risk factors for progressing peritonitis.
Results. On determining the indications for the choice of the treatment method of diffuse peritonitis it is necessary to perform quantitative assessment of 6 risk factors directly influencing the outcome of the disease: severity of the abdominal sepsis, degrees of intra-abdominal hypertension, the source of peritonitis, types of exudates, amount and properties of fibrin on peritoneum, severity of paralysis of the intestines. Depending on the score, if the number of points varies from 1 to 7, the choice is made in favor of traditional (semi-closed) method of treatment, the range from 8 to 14 means that combined method should be applied, if the score is 15 points and above - semi-opened method of treatment is preferred.
Conclusions. In the basic group the number of patients with post-operative complications decreased by 10% and lethality decreased by 8,2%.

Keywords: diffuse purulent peritonitis, choice of the treatment method
p. 51 – 56 of the original issue
References
  1. Абдоминальный сепсис, возможности антибактериальной и иммунокорригирующей терапии / Б. С. Брискин [и др.] // Хирургия. – 2002. – № 4. – С. 69-74.
  2. Антибактериальная терапия хирургической абдоминальной инфекции и абдоминального сепсиса / Б. Р. Гельфанд [и др.] // Consilium medicum. – 2000. – № 9. – С. 374-379.
  3. Зубарев, П. Н. Способы завершения операций при перитоните / П.Н. Зубарев, Н.М. Врублевский, В.И. Данилин // Вестн. хирургии. – 2008. – № 6. – С. 110-113.
  4. Суковатых, Б. С. Выбор способа хирургического вмешательства при распространенном гнойном перитоните / Б. С. Суковатых, Ю. Ю. Блинков, А. В. Неласов // Вестн. хирургии. – 2009. – № 6. – С. 29-33.
  5. Костюченко, К. В. Принципы определения хирургической тактики лечения распространенного перитонита / К. В. Костюченко, В. В. Рыбачков // Хирургия. – 2005. – № 4. – С. 9-13.
  6. Сажин, В. П. Современные тенденции хирургического лечения перитонита / В. П. Сажин // Хирургия. – 2007. – № 11. – С. 36-39.
  7. Выбор лечебной тактики при распространенном перитоните / В. С. Савельев [и др.] // Анналы хирургии. – 1998. – № 6. – С. 32-36.
  8. Савельев, В. С. Перитонит / В. С. Савельев, Б. Р. Гельфанд, М. И. Филимонов. – М.: Литера, 2006. – 206 с.
  9. Schein, M. Surgical management of intra-abdominal infection: is there any evidence? / M. Schein // Langenbecks Arch. Surg. – 2002. – Vol. 387. – P. 1-7.
  10. Гостищев, В. К. Перитонит / В.К. Гостищев, В.П. Сажин, А. П. Авдовенко. – М.: ГЭОТАР Медицина, 2002. – 224 с.

HUDAYBERGENOV SH.N., PAKHOMOV G.L., HAYALIEV R.YA., IRISOV O.T., ESHONKHODZHAYEV O.D.

SURGICAL TACTICS IN PATIENTS WITH BRONсHOPLEURAL FISTULAS AFTER PNEUMONECTOMY

Objectives. To improve the treatment tactics of patients with bronchial fistulas after pneumonectomy.
Methods. The analysis of treatment results in 109 patients with bronchopleural fistulas after pneumonectomy was performed. Primary operations were carried out because of the ontological diseases in 79 (72,5%) cases; in the rest 30 cases (27,5%) - because of the purulent pulmonary diseases.
Results. The patients were divided into 3 groups. 35 patients composed the 1st group, to whom an active tactics of the surgical treatment was applied, that is after state stabilization of patients with purulent complications (thoracoscopy with the drainage) on average after 6,1±1,2 days, they underwent the surgical treatment of fistulas. In 31 patients a delaying surgical tactics was used; in 43 patients endoscopic techniques were used at bronchopleural fistulas (BPF) closure. Use of the active surgical tactics appeared to be the most justified, in 31 (88,6%) patients, good results were registered. Complications were registered in 4 (11,4%) patients, lethality – in 3 (8,6%) cases. Delaying tactics determined satisfactory results only in 21 (67,7%) patients and complicated course – in 10 (32,3%) with lethality in 5 (16,1%) cases. Efficacy of BPF bronchoscopic elimination composed 62, 8% only; lethality outcomes were registered in 5 (11%) cases.
Conclusions. The active surgical tactics is the most justified at the bronchial stump failure after pneumonectomy regardless of the character and the side of the lesion.

Keywords: pneumonectomy, bronchial stump failure, treatment tactics, omenoplastics, lethality
p. 57 – 62 of the original issue
References
  1. Полоцкий, Б. Е. Результаты хирургического лечения немелкоклеточного рака легкого и факторы прогноза / Б. Е. Полоцкий, М. И. Давыдов, В. А. Нормонтович // 1 съезд онкологов стран СНГ. – 1996. – Ч. 2. – С. 387.
  2. Хирургическое лечение пациентов с IIIА стадией немелкоклеточного рака / В. А. Порханов [и др.] // Вопросы онкологии. – 2000. – № 1. – С. 74-76.
  3. Чичеватов, Д. А. Методика подготовки нижнедиафрагмального лоскута / Д. А. Чичеватов, А. И. Горшгнев, Е. Н. Синев // Вестн. хир. – 2005. – Т. 164, № 1. – С. 29-32.
  4. Asamura, M. / M. Asamura, H. Kondo, R. Tsuchiya // Eur. J. Cardiothorac Surg. – 2000. – Vol. 17, N 2. – P. 106-110.
  5. Лишенко, В. В. Профилактика и лечение несостоятельности культи бронха и бронхиальных свищей после пневмонэктомии / В. В. Лишенко // Материалы 1 междунар. конф. по торако-абдоминальной хирургии, Москва, 5–8 июня 2008 г. – С. 292.
  6. Анализ результатов профилактики и лечения несостоятельности культи бронха после пневмонэктомии / В. А. Порханов [и др.] // Материалы 1 междунар. конф. по торако-абдоминальной хирургии, Москва, 5–8 июня 2008 г. – С. 292-293.
  7. Pericardial flap for bronchial stump coverage after extrapleural pneumonectomy; is it feasible? / A. M. Hamad [et al.] // Eur. J. Cardiothorac Surg. – 2008. – Vol. 34, N 6. – P. 1255-1256.
  8. Eur. J. Cardiothorac Surg. / V. Porhanov [et al.]. – 2002. – Vol. 22. – P. 685-694.
  9. Ann. Thorac Surg. / W. Trigui [el al.]. – 2002. – Vol. 74, N 3. – P. 923-924.
  10. West, D. Are bronchoscopic approaches to post-pneumonectomy bronchopleural fistula an effective alternative to repeat thoracotomy? / D. West, A. Togo, A. J. Kirk // Interact. Cardiovasc. Thorac Surg. – 2007. – Vol. 6, N 4. – P. 547-550.
  11. Эндоскопическая торакальная хирургия: рук. для врачей / А. М. Шулутко [и др.]. – М.: ОАО Изд-во «Медицина», 2006. – 392 с.
  12. Tracheobronchial stenting for management of bronchopleural fistula: a novel solution to an old problem / M. Tulloch-Reid [et al.] // West Indian Med. J. – 2006. – Vol. 55, N 4. – P. 288-290.
  13. Effective approach for the treatment of bronchopleural fistula: application of endovascular metallic ring-shaped coil in combination with fibrin glue / C. M. Sivrikoz [et al.] // Ann. Thorac Surg. – 2007. – Vol. 83, N 6. – P. 2199-2201.
  14. Use of Amplatzer device for endobronchial closure of bronchopleural fistulas / M. R. Kramer [et al.] // Chest. – 2008. – Vol. 133, N 6. – P. 1481-1484.
  15. Use of endobronchial valve in postresection empyema and residual cavities with bronchopleural fistulas / A. V. Levin [et al.] // Probl. Tuberk. Bolezn. Legk. – 2007. – N 6. – P. 46-49.
  16. Fibrin glue closure of persistent bronchopleural fistula following pneumonectomy for post-tuberculosis bronchiectasis / P. Goussard [et al.] // Pediatr. Pulmonol. – 2008. – Vol. 43, N 7. – P. 721-725.
  17. Treatment of bronchopleural fistula with small intestinal mucosa and fibrin glue sealant / S. J. Keckler [et al.] // Ann. Thorac Surg. – 2007. – Vol. 84, N 4. – P. 1383-1386.
  18. Finch, C. K. Use of fibrin glue to treat a persistent pneumothorax with bronchopleural fistula / C. K. Finch, A. L. Pittman // Am. J. Health Syst. Pharm. – 2008. – Vol. 15. – Vol. 65, N 4. – P. 322-324.
  19. Fibrin glue administration to support bronchial stump line / S. Gursoy [et al.] // Asian Cardiovasc. Thorac Ann. – 2008. – Vol. 16, N 6. – P. 450-453.
  20. Бисенков, Л. Н. Эндоскопическое лечение бронхиальных свищей подслизистыми инъекциями / Л. Н. Бисенков // Вестн. хирургии им. И. И. Грекова. – 2005. – Т. 164, № 1. – С. 38-41.
  21. Лечение бронхиальных свищей / Е. А. Вагнер [и др.]. – Пермь: Изд-во Перм. ун-та, 1993. – 109 с.

CHERNUKHA L.M., NIKULNIKOV P.I., KASHIROVA O.V., VLAYKOV G.G., ALTMAN I.V., GUCH A.A., MATYASHCHUK A.S.

POSSTRAUMATIC ARTERIOVENOUS FISTULAS: TREATMENT EXPERIENCE

Objectives. To improve the outcomes of surgical treatment in patients with chronic posttraumatic arteriovenous vascular lesions (PAVL) on the basis of etiology and pathogenesis of the condition studying.
Methods. 18 patients with PAVL were examined for the period from 2005 to 2009; 16 of them were males, 2 females; aged 25-59 years, 50% of the subjects were aged 25-40 years. The systemic hemodynamic changes according to echocardiography data before and after surgery were analyzed in 2 patients with PAVL of the femoral, posterior tibial vessels.
Results. Mainly the damage of the lower extremities arteries (in 10 patients) were observed; 8 of them (66, 7%) needed reoperation, the duration of disease ranged from 3 months to 36 years. In this group ligation of the arteriovenous fistula was conducted in 2 patients, end-to-end arterial anastomosis in 1, lateral suture of artery in 1 patient, artery replacement with explants in 3; endovascular embolization in 1, stent-grafting of arteriovenous arteriovenous fistula with following surgical removal of pseudoaneurysm - 1.
Conclusions. The outcome of surgical treatment depends on the timeliness of special surgery done. Radical reconstructive surgery in patients with PAVL contributes to normalization of the general hemodynamic in early postoperative period. Combined use of surgical and endovascular methods allow decreasing considerably the intraoperative hemorrhage risk and surgical trauma in patients with chronic PAVL.

Keywords: chronic posttraumatic arteriovenous lesions, systemic hemodynamic disturbances, echocardiography, radical reconstructive surgery, endovascular, combined treatment
p. 63 – 69 of the original issue
References
  1. Coimbra, R. Epidemiology of vascular trauma / R. Coimbra, D. B. Hoyt. // Vascular surgery / Eds. R. B. Rutherford. – 2005. – Vol. 2. – 1001 p.
  2. Петровский, Б. В. Хирургия аневризм периферических сосудов / Б. В. Петровский, О. Б. Милонов. – М.: Медицина, 1970. – 276 с.
  3. Князев, М. Д. Ошибки в диагностике и лечении больных с повреждением магистральных кровеносных сосудов / М. Д. Князев, И. А. Комаров, В. Я. Киселев // Вестн. хирургии им. И. И. Грекова. – 1985. – Т. 134, № 5. – C. 139-141.
  4. Шор, Н. А. К вопросу классификации повреждений магистральных сосудов конечностей / Н. А. Шор // Ортопедия, травматология и протезирование. – 2007. – № 4. – C. 116-118.
  5. Мкртчян, А. А. Хирургическое лечение травматических и артериовенозных свищей в аспекте недостаточности сердца / А. А. Мкртчян // Кровообращение. – 1977. – Т. X, № 1. – C. 37-41.
  6. Hafez, H. M. Lower extremity arterial injury: results of 550 cases and review of risk factors associated with limb loss / H. M. Hafez, J. Woolgar J. V. Robbs // J. Vasc. Surg. – 2001. – Vol. 33, N 6. – P. 1212-1219.
  7. Возможности комбинированного хирургического и рентгенхирургического лечения травматических повреждений магистральных артерий / И. В. Альтман [и др.] // Серце і судини. – 2006. – № 4 (додаток). – С. 28-30.
  8. Москаленко, Ю. Д. Состояние сосудистого русла при длительно существующих травматических артериовенозных свищах до и после операции / Ю. Д. Москаленко, Л. С. Зингерман, И. И. Рушанов // Вестн. хирургии им. И. И. Грекова. – 1972. – Т. 109, № 12. – С. 43-47.
  9. Гемодинамика при артерио-венозных свищах (по данным радиокардиографии и зондирования полостей сердца) / Г. А. Малов [и др.] // Кардиология. – 1970. – Т. Х, № 6. – C. 61-71.
  10. Endovascular treatment of a post-traumatic tibial pseudoaneurysm and arteriovenous fistula: case report and review of the literature / R. Spirito [et al.] // J. Vasc. Surg. – 2007. – Vol. 45. – P. 1076-1079.
  11. Абышов, Н. С. Ближайшие и отдаленные результаты аутовенозных реконструкций артерий конечностей при травматических повреждениях / Н. С. Абышов // Ангиология и сосудистая хирургия. – 2002. – Т. 8, № 4. – C. 103-109.
  12. Endovascular repair of post-traumatic, concomitant popliteal artery pseudoaneurysm and arteriovenous fistula / R. W. Franz [et al.] // Int. J. Angiol. – 2009. – Vol. 18, N 1. – P. 41-44.
  13. Arthurs, Z. M. Vascular trauma: endovascular management and techniques / Z. M. Arthurs, V. Y. Sohn, B. W. Starnes // Surg. Clin. North Am. – 2007. – Vol. 87, N 5. – P. 1179-1192.

IGNATOVICH I.N.

PECULIARITIES OF ARTERIES LESIONS AND WAYS OF REVASCULARIZATION IN PATIENTS WITH NEUROISCHEMIC FORM OF DIABETIC FOOT

Objectives. To study the peculiarities of occlusive-stenotic arterial lesions influencing the character of revascularization in the patients with neuroischemic form of diabetic foot.
Methods. 106 patients with neuroischemic form of diabetic foot, who were treated in Minsk city center of diabetic foot, were investigated. For the arteries visualization contrast angiography was used in 82 cases (77,4%), CT- angiography was applied in 16 cases (15,1%), the combination of both methods was used in 8 cases (7,5%) .
Results. The vast majority of patients had distal occlusion with the lesions of three and two tibial arteries. When significant lesions of superficial femoral artery are absent, transluminal endovascular procedures can be performed. At critical stenosis of the superficial femoral artery one also has conditions for the endovascular plastics of at least one tibial artery to improve blood flow to the tissues of the foot. At the occlusion of the superficial femoral artery only in rare cases, there is at least one traversed tibia artery, which can provide a “flight path, this limits the number of shunt operations. In the research group of patients revascularization was performed in 46 (43,9%) patients.
Conclusion. The prospect of improving care to the patients with neuroischemic form of diabetic foot, the decrease of number of high amputations implicates further working out and introduction of the hybrid technologies of the limb revascularization as well as the adequate material-technical support of such interventions.

Keywords: diabetic foot, revascularization, artery
p. 70 – 76 of the original issue
References
  1. Дедов, И. И. Диабетическая стопа / И. И Дедов, О. В. Удовиченко, Г. Р. Галстян. – М., 2005. – 175 с.
  2. Nonatheromatous peripheral vascular disease of the lower extremity in diabetes mellitus / S. Goldenberg [et al.] // Diabetes. – 1959. – N 8. – Р. 261-273.
  3. LoGerfo, F. W. Current concepts vascular and microvascular disease of the foot in diabetes. Implications for foot care / F. W. LoGerfo, J. D. Coffman // N. Engl. J. Med. – 1984. – Vol. 3, N 11. – Р. 1615-1619.
  4. Hemodynamic factors in the genesis of diabetic microangiopathy / H. H. Parving [et al.] // Metabolism- Sep. – 1983. – Vol. 32. – P. 943-949.
  5. Boulton, A. The foot in diabetes / A. Boulton, P. Cavanagh, G. Rayman. – 4th ed. – Wiley, 2006. – 471 р.
  6. Гавриленко, А. В. Хирургическое лечение больных с критической ишемией конечностей / А. В. Гавриленко, С. И. Скрылев. – М., 2005. – 176 с.
  7. Гавриленко, А. С. Хирургическое лечение больных с критической ишемией нижних конечностей, обусловленной поражениями артерий инфраингвинальной локализации / А. С. Гавриленко, С. И. Скрылев // Ангиология и сосудистая хирургия. – 2008. – № 4. – С. 111-118.
  8. Исмаилов, Н. Б. Лечебная и диагностическая тактика при атеросклеротическом окклюзионно-стенотическом поражении артерий нижних конечностей у геронтологических больных / Н. Б. Исмаилов, А. В. Веснин // Ангиология и сосудистая хирургия. – 2008. – № 3. – С. 27-31.
  9. Малахов, Ю. С. Анализ результатов хирургического лечения больных с гнойно-некротическими поражениями нижних конечностей ишемического генеза / Ю. С. Малахов, Д. А. Аверьянов, А. В. Иванов // Ангиология и сосудистая хирургия. – 2009. – № 1. – С. 133-138.
  10. Peripheral arterial disease in diabetic and nondiabetic patients: a comparison of severity and outcome / E. B. Jude [et al.] // Diabetes Care. – 2001. – Vol. 24. – P. 1433-1437.
  11. Гибридные операции у больных атеросклерозом нижних конечностей при развившейся критической ишемии / А. Н. Вачев [и др.] // Ангиология и сосудистая хирургия. – 2010. – Т. 16. – Прил. № 4: Нерешенные вопросы сосудистой хирургии: материалы 22 Междунар. конф., 22–24 нояб. 2010 г. – С. 61-62.
  12. Recommended standards for reports dealing with lower extremity ischemia: revised version / R. B. Rutherford [et al.] // J. Vasc. Surg. – 1997. – Vol. 26. – P. 517-538.

SHVALB P.G., KALININ P.E., PSHENNIKOV A.S., SUCHKOV I.A.

EFFECT OF INTERMITTENT PNEUMOCOMPRESSION ON THE NITRIC OXIDE PRODUCTION AS THE MAIN MARKER OF ENOTHELIAL DYSFUNCTION IN PATIENTS WITH PERIPHERAL OCCLUSSIVE ARTERIAL DISEASE

Objectives. To evaluate the efficacy of intermittent pneumocompression (IPC) in the complex treatment of the peripheral occlusive arterial disease (POAD).
Methods. In the investigation 2 groups of patients were included: the first study group included 64 patients, who underwent the pneumocompression course) and the second one (60 patients) and they included patients with POAD at the stage IIА - IIB according to the classification of Fontaine in modification of Pokrovsky. We used a special program to register the levels of metabolites of nitric oxide, ankle-brachial pressure index, “reactive hyperemia” test (RH - test), pain-free walking distance which were monitored before IPC and after 1-month follow-up.
Results. It was found out that the use of IPC in treatment of patients with POAD is pathogenetically based upon the normalization of functional state of endothelium and has some advantages compared to the classical methods of conservative treatment. We observed the elevation of nitric oxide level which is the key mechanism of clinical improvement such as the increase of pain-free walking distance, ankle-brachial pressure index as well as improved RH-test.
Conclusion. A short-course intermittent pneumocompression is one of the methods of endotheliotropic treatment and is an aspect to be considered in combination therapy in patients with peripheral occlusive arterial disease.

Keywords: Intermittent pneumocompression, endothelial dysfunction, nitric oxide
p. 77 – 81 of the original issue
References
  1. Eastwood, H. D. The social consequences of surgical complications for patients with proximal femoral fractures / H. D. Eastwood // Age Ageing. – 1993. – Vol. 22, N 5. – P. 360-364.
  2. Vossinakis, I. C. Management of pertrochanteric fractures in high-risk patients with an external fixator / I. C. Vossinakis, L. S. Badras // Orthop. – 2001. – Vol. 25. – P. 219-222.
  3. Heinz, T. Komplikationen und Fehler bei der Anwendung des Gammanagels / T. Heinz, V. Vecsei // Chirurg. – 1994. – Vol. 65. – P. 943-952.
  4. Hesse, B. Complications following the treatment of trochanteric fractures with the Gamma nail / B. Hesse, A. Gachter // Arch. Ortho Trauma Surg. – 2004. – Vol. 124. – P. 692-698.
  5. Prevention of fracture at the distal locking site of the gamma nail / H. Lacroix [et al.] // J. Bone Joint Surg. [Br]. – 1995. – Vol. 77-B. – P. 274-276.
  6. Radford, P. J. A prospective randomized comparison of the dynamic hip screw and the gamma locking nail / P. J. Radford, M. Needof, J. K. Webb // J. Bone Joint Surg. [Br.]. – 1993. – Vol. 75-B. – P. 789-793.
  7. Bartoniсek, J. Short gamma nail for internal fixation of proximal femur fractures / J. Bartoniсek, P. Dousa, M. Krbec // Acta Chir. Orthop. Traum. Cechoslov. – 1998. – Vol. 65. – P. 74-83.
  8. Skala- Rosenbaum, J. Is distal locking with IMHN necessary in every pertrochanteric fractures? / J. Skala- Rosenbaum, J. Bartonicek, R. Bartoska // International Orthopaedics. – 2010. – Vol. 34, N 7. – P. 1041-1047.
  9. Baumgaetner, M. R. The pertrochanteric external fixator reduced pain, hospital stay, and mechanical complications in comparison with the sliding hip screw / M. R. Baumgaetner // J. Bone Joint Surg. – 2002. – Vol. 84-A. – P. 1988.
  10. Dhal, A. Biological fixation of subtrochanteric fractures by external fixation / A. Dhal, S. S. Singh // Injury. – 1996. – Vol. 27. – P. 723-731.
  11. External fixation in unstable intertrochanteric fractures of femur / K. T. Kamble [et al.] // Injury. – 1996. – Vol. 2, N 7. – P. 139-142.
  12. Badras, L. The use of external fixation in the treatment of trochanteric fractures / L. Badras, E. Skretas, E. D. Vayanos // Rev. Chir. Orthop. – 1997. – Vol. 83. – P. 461-465.
  13. Джанбахышов, Г. С. Оперативное лечение переломов проксимального конца бедренной кости аппаратами внешней фиксации / Г. С. Джанбахышов // Азербайдж. журн. ортопедии и травматологии. – 2008. – № 2. – С. 51-53.

TRAUMATOLOGY AND ORTHOPEDICS

TALYSHINSKY R.R., GADZHIEV SH.SH.

OSTEOSYNTHESIS OF FEMUR PERTROCHANTERIC AND INTERTROCHANTERIC FRACTURES IN ELDERLY PATIENTS TREATED BY EXTERNAL FIXATION PIN APPARATUS

Objectives. To estimate effectiveness of pin apparatus use at osteosynthesis of the pertrochanteric and intertrochanteric fractures of the femur in elderly patients.
Methods. 116 patients with AO/ASIF type 31A1, 31A2 and 31A3 fractures who had been treated at the acute trauma department of Scientific Research Traumatology and Orthopaedics Institute of Ministry of Health of Azerbaijan Republic from 2006 to 2011 were included into the research.
Results. It has been established, that pin apparatus use at osteosynthesis of pertrochanteric and intertrochanteric fractures of the femur in elderly patients has a number of advantages in comparison with other methods such as mini invasive and short-term of surgery procedure, a little blood loss during surgery, possibility to obtain and maintain stable fixation of fragments during all treatment period up to fracture jointing, as well as early activation of patients along with functional treatment.
Conclusion. The use of pin apparatus at osteosynthesis of pertrochanteric and intertrochanteric fractures of the femur in elderly patients is an effective and mini invasive method of functional treatment. The method is simple and especially useful to treat elderly patients with aggravated general condition.

Keywords: osteosynthesis, pin apparatus, pertrochanteric and intertrochanteric fractures
p. 82 – 85 of the original issue
References
  1. Применение ритмической пневмокомпрессии для лечения больных хроническими облитерирующими заболеваниями артерий нижних конечностей / Е. М. Липницкий [и др.] // Ангиология и сосудистая хирургия. – 2007. – Т. 13, № 3. – С. 22-26.
  2. Intermittent pneumatic compression in stable claudicants: effect on hemostasis and endothelial function / E. Sutkowska [et al.] // International Angiology. – 2009. – Vol. 28, N 5. – P. 373-379.
  3. Intermittent compression pump for non-healing wounds in patients with limb ischemia. The Mayo Clinic experience (1998-2000) / V. M. Montori [et al.] // International Angiology. – 2002. – Vol. 21. – Р. 360-369.
  4. A prospective randomized controlled study with intermittent mechanical compression of the calf in patiants with claudication / J. De Haro [et al.] // Journal of Vascular and Endovascular Surgery. – 2010. – Vol. 51, N 4. – P. 857-862.
  5. Randomized study on the effects of different strategies of intermittent pneumatic compression for lower limb claudication / A. Berni [et al.] // Giornale di Chirurgia. – 2009. – Vol. 30, N 6-7. – Р. 269-273.
  6. Киричук, В. Ф. Дисфункция эндотелия / В. Ф. Киричук, П. В. Глыбочко, А. И. Пономарева. – Саратов: Изд-во Сарат. мед.ун-та, 2008. – 129 с.
  7. Пшенников, А. С. Одноэтапный метод определения уровня метаболитов оксида азота в сыворотке крови / А. С. Пшенников // Актуальные вопросы современной медицины: взгляд молодого специалиста: материалы науч.-практ. конф. – Рязань: РИО РязГМУ, 2010. – С. 183-185.
  8. Национальные рекомендации по ведению пациентов с сосудистой артериальной патологией. Ч. 1: Периферические артерии. – М., 2010. – 78 с.
  9. Клиническая ангиология: рук.: в 2 т. / под ред. А. В. Покровского. – М.: Медицина, 2006. – Т. 1. – 808 с.; Т. 2. – 888 с.

UROLOGY

KOCHOYAN T.M., KOMOV D.V., MATVEEV V.B., KOMAROV I.G., KERIMOV R.A., LOGACHEV A.V.

SURGICAL TREATMENT OF KIDNEY TUMORS WITH ENDOSCOPIC TECHNIQUES

Objectives. To carry out the comparative analysis of the distant survival of patients with the kidney tumor depending on the access: the open or the endoscopic methods.
Methods: 214 patients with the kidney cancer were included into the investigation (90 males and 124 females) in whom nephrectomy was performed. All the patients were divided into two groups. 164 patients with the clinical diagnosis of the kidney cancer Т1-3N0M0 who underwent laparoscopic nephrectomy composed the main group. In the control group 50 patients were retrospectively selected in whom radical nephrectomy by the laparotomy access because of the localized kidney cancer was carried out.
Results. General survival of the patients with the renal-cell cancer after the laparoscopic nephrectomy made up 100%. 4-year survival without recurrences of the radically operated patients composed 94, 4%. General 1-year and 4-year survival of the patients who underwent the open nephrectomy composed 98, 9% and 96, 45, without recurrences 100% and 96,2% respectively.
Conclusions. Laparoscopic access for nephrectomy performing in patients with early kidney cancer stages is an acceptable one from the oncologic positions as well as less traumatic and safe in comparison with open surgeries.

Keywords: kidney tumors, kidney cancer, laparoscopic nephrectomy
p. 86 – 90 of the original issue
References
  1. Аксель, Е. М. Злокачественные новообразования в России и странах СНГ в 2002 г. / Е. М. Аксель, М. И. Давыдов. – М., 2004. – 281 с.
  2. Renal cell carcinoma: prognostic significance of incidentally detected tumors / K. H. Tsui [et al.] // J. Urol. – 2000. – Vol. 162, N 2. – P. 436-441.
  3. Матвеев, В. Б. Лапароскопическая хирургия в онкоурологии / В. Б. Матвеев, И. Г. Комаров, М. И. Волкова // Материалы Х Рос. онколог. конгр. – М., 2006. – С. 42-46.
  4. Lymphadenectomy in renal cell carcinoma / J. P. Siminovitch, J. E. Montie, R. A. Straffon // J. Urol. – 1992. – Vol. 127, N 6. – P. 1090-1091.
  5. Tan, A. V. Transperitoneal Radical Nephrectomy / A. V. Tan, A. D. Joice // Laparoscopic Urologic. Surgery in Malignances / Eds. J. Rosette, I. Gill. – Berlin: Springer, New York: Hiedelberg, 2005. – P. 19-28.
  6. Laparoscopic radical nephrectomy: cancer control f or renal cell carcinoma / D. Y. Chan [et al.] // J. Urol. – 2001. – Vol. 166. – P. 2095-2100.
  7. Long-term follow-up after laparoscopic radical nephrectomy / J. A. Portis [et al.] // J. Urol. – 2002. – Vol. 167, N 3. – P. 1257-1262.

ANESTHESIOLOGY-REANIMATOLOGY

PECHERSKY V.G., MAROCHKOV A.V.

PECULIARITIES OF THE LOCAL ANESTHETIC DISTRIBUTION AT THE SCIATIC NERVE BLOCKADE

Objectives. To investigate the peculiarities of distribution of the local anesthetic solution at the sciatic nerve blockade depending on the preparation volume and anatomical constitution peculiarities.
Methods. 166 sciatic nerve blockades were analyzed which were performed under ultrasound visualization control. The blockade of the sciatic nerve was done with lidocaine in the volume of 30 ml; 25 ml; 20 ml; 15 ml; 12,5 ml; 10 ml; 7,5 ml; 6,5 ml; 5 ml; 4,5 ml. The cross-sectional area corresponding to the local anesthetic was determined; the length of anesthetic distribution along the sciatic nerve was calculated.
Results. The anesthetic is spreading along the sciatic nerve in the proximal and distal directions, forming a kind of a cylinder. Minimal volume of the local anesthetic which is able to obduce the sciatic nerve completely is 5ml. A rare variant of the sciatic nerve structure is described where one of the branches of the sacral plexus was immediately formed by the tibial and by the common peroneal nerves.
Conclusions. At the preparation volume decreasing the reducing of the length of anesthetic distribution as well as the cross-sectional area, occupied by it around the nerve can be observed. Ultrasound visualization allows taking into account anatomical peculiarities of the sciatic nerve which can influence the quality of the carried out blockade.

Keywords: sciatic nerve blockade, ultrasound visualization, local anesthetic distribution
p. 91 – 95 of the original issue
References
  1. Кузин, М. И. Местное обезболивание / М. И. Кузин, С. Ш. Харнас. – М.: Медицина, 1993. – 224 с.
  2. Малрой, М. Местная анестезия: ил. практ. рук.: пер. с англ. / М. Малрой. – М.: БИНОМ. Лаборатория знаний, 2003. – 301 с.
  3. Рафмелл, Д. Р. Регионарная анестезия: самое необходимое в анестезиологии: пер. с англ. / Д. Р. Рафмелл, Дж. М. Нил, М. К. Вискоуми. – М.: МЕДпресс-информ, 2007. – 272 с.
  4. van Geffen, G.-J. The value of ultrasonography for performing peripheral nerve blocks / G.-J. van Geffen // Theory, practice and clinical experience in adults and children. – Rotterdam: Optima Grafische Communicatie, 2008. – 234 р.

ОTORHINOLARINGOLOGY

SITNIKOV V.P., HUSAM EL-REFAI, KOLESNIK T.I.

SIMULTANEOUS BILATERAL STAPEDOPLASTY IN PATIENTS WITH OTOSCLEROSIS

Objectives. Improvement of the surgical treatment effectiveness in patients suffering from otosclerosis by means of the simultaneous obtaining of binaural hearing.
Methods. During the period 2008-2010 on the basis of the ENT clinic of Gomel Regional Specialized Hospital a one-time (simultaneous) bilateral stapedoplasty was carried out in 12 patients suffering from the tympanum and tympano-cochlear forms of deafness. Before surgery, all patients underwent a full range of clinical-audiological examination.
Results. Evaluating the effectiveness of simultaneous bilateral stapedoplasty results was estimated by the closure of airbone interval (ABI) and by the postoperative level of auditory function according to the conventional tone threshold audiometry. Almost in all patients ABI was closed. Excellent functional results were achieved in 91,6%, good - in 8,4% of patients in the distant terms of the observation.
Conclusions. Simultaneous bilateral stapedoplasty is a highly-effective hearing improving surgery in patients suffering from otosclerosis with the presence of symmetrical conductive hearing loss and can be introduced into the arsenal of microsurgical interventions of highly qualified otosurgeon.

Keywords: otosclerosis, simultaneous bilateral stapedoplasty, audiometry
p. 96 – 100 of the original issue
References
  1. Овчинников, Ю. М. Результаты хирургического лечения больных кохлеарной формой отосклероза / Ю. М. Овчинников, Л. А. Кулакова // Рос. науч. практ. конф. оториноларингол.: материалы конф. – Оренбург, 2002. – С. 80-90.
  2. Hildmann, H. Middle ear surgery / Н. Hildmann, H. Sudhoff. – Berlin: Springer-Verlag, New York: Heidelberg, 2006. – 188 p.
  3. Розенблюм, А. С. Кратковременная слуховая адаптация у больных отосклерозом / А. С. Розенблюм // Актуальные проблемы тугоухости: сб. тр. – М., 1981. – Т. 24. – С. 14-20.
  4. Tinnitus and otsclerosis / M. Gersdorff [et al.] // Eur. Arch. Otol. Rhinol. Laryngol. – 2000. – Vol. 6. – P. 257-314.
  5. Хиллов, К. Л. Асимметрия слуха в прогнозе фенестрации лабиринта при отосклерозе / К. Л. Хилов // Журн. ушн., нос. и горл., бол. – 1960. – № 6. – C. 49-53.
  6. Correlations pathologic changes in the stapes and conductive hearing loss otosclerosis / S. R. Cherukupally [et al.] // Ann. Otol. Rhinol. Laryngol. – 1998. – Vol. 107. – P. 319-325.
  7. Ludman, H. The case against bilateral stapedectomy and problems of postoperative follow-up from the Kings College Hospital series / H. Ludman, H. Grant // J. Laryngol. Otol. – 1976. – Vol. 87. – P. 833-843.
  8. Сагалович, Б. М. Субъективная и объективная аудиометрия - принципы взаимоотношений и методологическая характеристика / Б. М. Сагалович // Патология уха и реабилитация больных с тугоухостью: Респ. сб. тр. – М., 1987. – Вып. 33. – С. 10-17.
  9. Ситников, В. П. Одноэтапная двусторонняя стапедопластика. Преимущества и недостатки / В. П. Ситников, М. В. Левинина // Рос. оториноларингология. – 2004. – № 1. – С. 17-22.
  10. Browning, G. Sensorineural hearing loss in stapedial otosclerosis / G. Browning, S. Gatehouse // Ann. Otol. – 1984. – Vol. 93. – P. 13-1.
  11. Juuso, K. Simultaneous bilateral stapes surgery / K. Juuso, A. Heikki, R. Hans, T. P. Hirvonen // Acta oto-laryngol. – 2008. – Vol. 128, N 4. – С. 347-351.
  12. Одноэтапная двусторонняя стапедопластика как метод единовременного восстановления бинаурального слуха у больных отосклерозом / В. П. Ситников [и др.] // Рос. оториноларингол. – 2005. – № 4. – С. 157-161.

LECTURES, REVIEWS

VINNIK YU.S., SALMINA A.B., DROBUSHEVSKAYA A.I., TEPLYAKOVA O.V., POGILENKOVA E.A., KOTIKOV A.R.

PATHOGENESIS PECULIARITIES OF LONG-HEALING WOUNDS

This review shows modern views on the molecular mechanisms of the main phases of normal and complicated wound healing process. Significance of functional capabilities of fibroblasts and keratinocytes has been shown as well as the properties of the extra cellular matrix, microbial contamination, cytokine and protease activation in the pathogenesis of chronic wound healing. Data concerning the role of the protein expression connexin in providing the processes of direct intercellular interaction at wound healing are presented.

Keywords: chronic wounds, fibroblasts, keratinocytes, connexins, cell growth factors
p. 101 – 110 of the original issue
References
  1. Блатун, Л. А. Местное медикаментозное лечение ран. Проблемы и новые возможности их решения / Л. А. Блатун // Сonsilium medicum. Хирургия. – 2007. – № 1. – Прил. № 1. – С. 9-16.
  2. Гавриленко, А. В. Использование фибробластов и кератиноцитов в комплексном лечении венозных трофических язв / А. В. Гавриленко, О. В. Павлова, П. Е. Вахратьян // Хирургия. Журн. им. Н. И. Пирогова. – 2008. – № 10. – С. 25-28.
  3. Кириенко, А. И. Лечение трофических язв венозной этиологии: пособие для врачей / А. И. Кириенко. – М.: Изд–во НЦССХ РАМН, 2000. – 22 с.
  4. Кириенко, А. И. Современные принципы лечения хронической венозной недостаточности / А. И. Кириенко, Р. А. Григорян, И. А. Золотухин // Consilium medicum. – 2003. – Т. 5, № 6. – C. 18-25.
  5. Комплексное лечение трофических язв / М. Н. Кудыкин [и др.] // Флебология. – 2008. – № 3. – С. 16-20.
  6. Трофические язвы нижних конечностей – обзор проблемы / В. Н. Оболенский [и др.] // РМЖ. – 2010. – № 4. – С. 28-55.
  7. Флебология: рук. для врачей / В. С. Савельев [и др.]; под ред. В. С. Савельева. – М.: Медицина, 2001. – 664 с.
  8. Хроническая венозная недостаточность нижних конечностей как общемедицинская проблема / B. C. Савельев [и др.] // Consilium medicum. – 2004. – № 6 . – С. 30-41.
  9. Torre, J. I. Wound healing, chronic wounds / J. I. Torre, J. A. Chambers [Electronic resourse]. – 2008. – Mode of access: http://emedicine.medscape.com/article/1298452–overview. – Date of access: 10.01.2011.
  10. Schultz, G. S. Extracellular matrix: review of its roles in acute and chronic wounds / G. S. Schultz, G. Ladwig, А. Wysocki [Electronic resourse]. – 2005. – Mode of access: http://www.worldwidewounds.com/2005/august/Schultz/Extrace–Matric–Acute–Chronic–Wounds.html. – Date of access: 10.01.2011.
  11. Slavin, J. The role of cytokines in wound healing / J. Slavin // J. Pathol. – 1996. – Vol. 178, N 1. – P. 5-10.
  12. Harding, K. G. Healing chronic wounds / K. G. Harding, H. L. Morris, G. K. Patel // BMJ. – 2002. – 324. – Р. 160-163.
  13. Современные представления о регуляции процесса заживления ран (обзор литературы) / С. Л. Вялов [и др.] // Анналы пласт. реконструктив. и эстет. хирургии. – 1999. – № 1. – С. 49-56.
  14. Mustoe, T. Dermal ulcer healing: Advances in understanding / T. Mustoe // Tissue repair and ulcer/wound healing: molecular mechanisms, therapeutic targets and future directions. EUROCONFERENCES – Paris, 2005 [Electronic resourse]. – Mode of access: http://www.pasteur.fr/applications/euroconf/tissuerepair/Mustoe_abstract.pdf. – Date of access: 10.06.2010.
  15. Hartmann, A. G. P. Методическое руководство по лечению ран / A. G. P. Hartmann: под ред. A. G. P. Hartmann. – М.: Пауль Хартманн, 2000. – 106 с.
  16. Tonnesen, M. G. Angiogenesis in wound healing / M. G. Tonnesen, X. Feng, R. A. Clark // J. Investig. Dermatol. Symp. Proc. – 2000. – Vol. 5, N 1. – P. 40-06.
  17. Enoch, S. Cellular, molecular and biochemical differences in the pathophysiology of healing between acute wounds, chronic wounds and wounds in the aged / S. Enoch, P. Price // World Wide Wounds [Electronic resourse]. – 2004. – Mode of access: http://www.worldwidewounds.com/2004/august/Enoch/Pathophysiology–Of–Healing.html. – Date of access: 10.02.2011.
  18. Gibson, D. J. Chronic wound diagnostic for matrix metalloproteinase / D. J. Gibson, G. Schulftz // Wound healing Southern Africa. – 2009. – Vol. 2, N 2. – P. 68-70.
  19. Moore, K. T-lymphocytes and the lack of activated macrophages in wound margin biopsies from chronic leg ulcers / K. Moore, F. Ruge, K. G. Harding // Br. J. Dermatol. – 1997. – Vol. 137, N 2. – P. 188-194.
  20. Changes in cellular motility and cytoskeletal actin in fibroblasts from patients with chronic venous insufficiency and in neonatal fibroblasts in the presence of chronic wound fluid / J. D. Raffetto[et al.] // J. Vasc. Surg. – 2001. – Vol. 33, N 6. – P. 1233-1241.
  21. Schultz, G. S. Molecular analysis of the environment of healing and chronic wounds: cytokines, proteases and growth factors / G. S. Schultz, B. A. Mast // Wounds. – 1998. – Vol. 10. – Suppl. F. – P. 1F-9F.
  22. Cook, H. Defective extracellular matrix reorganization by chronic wound fibroblasts is associated with alterations in TIMP–1, TIMP–2, and MMP–2 activity / H. Cook [et al.] // J. Invest. Dermatol. – 2000. – Vol. 115, N 2. – P. 225-233.
  23. Protease inhibitors protect growth factor activity in chronic wounds / M. Wlaschek [et al.] // Br. J. Dermatol. – 1997. – Vol. 137, N 4. – P. 646.
  24. Expression and proteolysis of vascular endothelial growth factor is increased in chronic wounds / G. Lauer [et al.] // J. Invest. Dermatol. – 2000. – Vol. 115, N 1. – P. 12-18.
  25. Sequential changes in histologic pattern and extracellular matrix deposition during the healing of chronic venous ulcers / S. E. Herrick [et al.] // Am. J. Pathol. – 1992. – Vol. 141, N 5. – P. 1085-1095.
  26. Grinnell, F. Fibronectin degradation in chronic wounds depends on the relative levels of elastase, alpha1–proteinase inhibitor, and alpha2–macroglobulin / F. Grinnell, M. Zhu // J. Invest. Dermatol. – 1996. – Vol. 106, N 2. – P. 335-341.
  27. Trengove, N. J. Mitogenic activity and cytokine levels in non–healing and healing chronic leg ulcers / N. J. Trengove, H. Bielefeldt–Ohmann, M. C. Stacey // Wound Repair Regen. – 2000. – Vol. 8, N 1. – P. 13-25.
  28. The proliferative capacity of neonatal skin fibroblasts is reduced after exposure to venous ulcer wound fluid: A potential mechanism for senescence in venous ulcers / M. V. Mendez [et al.] // J. Vasc. Surg. – 1999. – Vol. 30, N 4. – P. 734-743.
  29. Differences in cellular infiltrate and extracellular matrix of chronic diabetic and venous ulcers versus acute wounds / M. A. Loots // J. Invest. Dermatol. – 1998. – Vol. 111, N 5. – P. 850-857.
  30. Романовский, А. В. Особенности иммунореактивности у больных варикозной болезнью нижних конечностей, осложненной трофическими язвами / А. В. Романовский, В. К. Макаров // Флебология. – 2006. – Т. 5, № 2. – C. 57-62.
  31. Proliferative capacity of venous ulcer wound fibroblasts in the presence of platelet –derived growth factor / R. Vasquez [et al.] // Vasc. Endovascular Surg. – 2004. – Vol. 38, N 4. – P. 355-360.
  32. Fibroblasts cultured from distal lower extremities in patients with venous reflux display cellular characteristics of senescence / M. V. Mendez [et al.] // J. Vasc. Surg. 1998. – Vol. 28, N 6. – P. 1040-1050.
  33. Causes and effects of chronic inflammation in venous leg ulcers / M. S. Agren [et al.] // Acta Derm. Venereol. – Suppl. (Stockh). – 2000. – Vol. 210. – P. 3-17.
  34. Мантурова, Н. Е. Старение кожи: механизмы формирования и структурные изменения / Н. Е. Мантурова, Р. В. Городилов, А. В. Кононов // Анналы пласт., реконструктив. и эстет. хирургии. – 2010. – № 1. – C. 88-93.
  35. Telgenhoff1, D. Cellular senescence mechanisms in chronic wound healing / D. Telgenhoff1, B. Shroot // Cell Death and Differentiation. – 2005. – N 12. – P. 695-698.
  36. Venous ulcer fibroblasts compared with normal fibroblasts show differences in collagen but not fibronectin production under both normal and hypoxic conditions / S. E. Herrick [et al.] // J. Invest. Dermatol. – 1996. – Vol. 106, N 1. – P. 187-193.
  37. Gilchrest, B. A. In vitro assessment of keratinocyte aging / B. A. Gilchrest // J. Invest. Dermatol. – 1983. – Vol. 81. – Suppl. 1. – P. 184-189.
  38. Salim, A. S. The role of oxygen–derived free radicals in the management of venous (varicose) ulceration: a new approach / A. S. Salim // World J. Surg. – 1991. – Vol. 15, N 2. – P. 264-269.
  39. Howlader, M. H. Increased plasma total nitric oxide among patients with severe chronic venous disease / M. H. Howlader, P. D. Smith // Int. Angiol. – 2002. – Vol. 21, N 2. – P. 180-186.
  40. Jude, E. B. Role of neuropathy and plasma nitric oxide in recurrent neuropathic and neuroischemic diabetic foot ulcers / E. B. Jude // Wound Repair Regen. – 2001. – Vol. 9, N 5. – P. 353-359.
  41. Роль локальной тканевой гипоксии в развитии венозных трофических язв / Н. Б. Захарова [и др.] // Регионарное кровообращение и микроциркуляция. – 2006. – № 5–2. – С. 57-62.
  42. Davey, M. E. Microbial biofilms: from ecology to molecular genetics / M. E. Davey, G. A. O’Toole // Microbiol. Mol. Biol. Rev. – 2000. – Vol. 64. – P. 847-867.
  43. Gosain, A. Aging and wound healing / A. Gosain, L. A. DiPietro // World Journal of Surgery. – 2004. – Vol. 28, N 3. – P. 321-326.
  44. Ratios of activated matrix metalloproteinase–9 to tissue inhibitor of matrix metalloproteinase–1 in wound fluids are inversely correlated with healing of pressure ulcers / G. P. Ladwig [et al.] // Wound Repair Regen. – 2002. – Vol. 10, N 1. – P. 26-37.
  45. Ashcroft, G. S. Ageing and wound healing / G. S. Ashcroft, S. J. Mills, J. J. Ashworth // Biogerontology. – Vol. 3, N 6. – P. 337-345.
  46. A biomarker that identifies senescent human cells in culture and in aging skin in vivo / G. P. Dimri [et al.] // Proc. Natl. Acad. Sci. U S A. – 1995. – Vol. 92, N 20. – P. 9363-9367.
  47. Richard, G. Connexins: a connection with the skin / G. Richard // Exp. Dermatol. – 2000. – Vol. 9. – P. 77-96.
  48. Connexins 26, 30, and 43: differences among spontaneous, chronic, and accelerated human wound healing / J. M. Brandner [et al.] // J. Invest. Dermatol. – 2004. – Vol. 122. – P. 1310-1320.
  49. Mesёe, G. Gap Junctions: basic structure and function / G. Mesёe, G. Richard, T. W. White // Journal of Investigative Dermatology. – 2007. – Vol. 127. – P. 2516-2524.
  50. Altered intercellular communication in lung fibroblast cultures from patients with idiopathic pulmonary fibrosis / A. Trovato–Salinaro [et al.] // Respiratory Research. – 2006. – Vol. 7. – P. 122-131.
  51. Abnormal connexin expression underlies delayed wound healing in diabetic skin / С. M. Wang [et al.] // Diabetes. – 2007. – Vol. 56. – P. 2809-2817.
  52. Sohl, G. Gap junctions and the connexin protein family / G. Sohl, K. Willecke // Cardiovasc. Res. – 2004. – Vol. 62. – P. 228-232.
  53. Сonnexin levels regulate keratinicyte differention in epidermis / S. Langlois [et al.] // J. biological chemistry. – 2007. – Vol. 282, N 41. – P. 30171-30180.
  54. Dynamic changes in connexin expression correlate with key events in the wound healing process / P. Coutinho [et al.] // Cell Biol. Int. – 2003. – Vol. 27, N 7. – P. 525-541.
  55. Wei, C. J. Connexins and cell signaling in development and disease / C. J. Wei, X. Xu, C. W. Lo // Annu. Rev. Cell Dev. Biol. – 2004. – Vol. 20. – P. 811-838.
  56. Acute downregulation of connexin43 at wound sites leads to a reduced inflammatory response, enhanced keratinocyte proliferation and wound fibroblast migration / R. Mori [et al.] // Journal of Cell Science. – 2006. – Vol. 119. – P. 5193-5203.

MAGDIEV D.A., EGIZARYAN K.A.

TREATMENT OF DISTAL RADIOULNAR JOINT INJURIES

On the basis of both native and foreign literature studying, the data concerning the urgency of the problem of the ligament apparatus of the distal radioulnar joint (DRUJ) are presented in the review. In 51-65% of cases the fractures of the distal epimetafis of the radius with displacement of the bone fragments are the reasons of the DRUJ ligament apparatus injuries. The main mechanism of the isolated DRUI injury is falling down on the outstretched hand or forearm bones injury caused by the excessive rotation.
The fractures of the radius penetrating into DRUI remand a thorough reposition. Insignificant displacement left is known to result in deforming arthritis within 5 years in 100% of patients.
Up to present the indications to the conservative or operative treatment havent been completely determined. The operative techniques, used at the given injuries, are described in details in the review as well as the operation technology; the advantages and disadvantages of each method are studied.

Keywords: distal radioulnar joint, triangular fibro-cartilage complex, treatment
p. 111 – 117 of the original issue
References
  1. Essex–Lopresti, P. Fractures of the radial head with distal radio–ulnar dislocation; report of two cases/ P. Essex–Lopresti // J. Bone Joint Surg. Br. – 1951. – Vol. 33B, N 2. – P. 244-247.
  2. Galleazzi, R. Ueber ein besonderes Syndrom bei Verletzungen im Bereich der Unteramknocken / R. Galleazzi // Arch. Orthop. Unfallchir. – 1934. – Vol. 35. – P. 557-562.
  3. Lawler, E. A. Total wrist arthroplasty / E. A. Lawler, N. Paksima // Bull. NYU Hosp. Jt. Dis. – 2006. – Vol. 64, N 3–4. – P. 98-105.
  4. Knirk, J. L. Intra–articular fractures of the distal end of the radius in young adults / J. L. Knirk, J. B. Jupiter // J. Bone Joint Surg. Am. – 1986. – Vol. 68, N 5. – P. 647-659.
  5. Morisawa, Y. Dorsoradial avulsion of the triangular fibrocartilage complex with an avulsion fracture of the sigmoid notch of the radius / Y. Morisawa, T. Nakamura, K. Tazaki // J. Hand Surg. Eur. Vol. – 2007. – Vol. 32, N 6. – P. 705-708.
  6. Operative treatment of volar intra–articular fractures of the distal end of the radius / J. B. Jupiter [et al.] // J. Bone Joint Surg. [Am.]. – 1996. – Vol. 78, N 12. – P. 1817-1828.
  7. Bowers, W. H. The distal radioulnar joint / W. H. Bowers // Operative hand surgery / Ed. D. P. Green. – 3rd ed. – New York, 1993. – P. 973-1019.
  8. Distal radioulnar instability is an independent worsening factor in distal radial fractures / T. Lindau [et al.] // Clin. Orthop. Relat Res. – 2000. – Vol. 376. – P. 229-235.
  9. Arthroscopic diagnosis of intra–articular soft tissue injuries associated with distal radial fractures / R. S. Richards [et al.] // J. Hand Surg. [Am.]. – 1997. – Vol. 22, N 5. – P. 772-776.
  10. The role of the distal radioulnar ligaments, interosseous membrane, and joint capsule in distal radioulnar joint stability / L. D. Ward [et al.] // J. Hand Surg. [Am.]. – 2000. – Vol. 25, N 2. – P. 341-351.
  11. May, M. M. Ulnar styloid fractures associated with distal radius fractures: incidence and implications for distal radioulnar joint instability / M. M. May, J. N. Lawton, P. E. Blazar // J. Hand Surg. [Am.]. – 2002. – Vol. 27, N 6. – P. 965-971.
  12. Dingman, P. V. Resection of the distal end of the ulna (Darrach operation); an end result study of twenty four cases / P. V. Dingman // J. Bone Joint Surg. [Am.]. – 1952. – Vol. 34, N 4. – P. 893-900.
  13. Darrach, W. Partial excision of the lower shaft of the ulna for deformity following Colles‘ fracture / W. Darrach // Ann. Surg. – 1913. – Vol. 57, N 4. – P. 482-491.
  14. George, M. S. The Sauve–Kapandji procedure and the Darrach procedure for distal radio–ulnar joint dysfunction after Colles’ fracture / M. S. George, T. R. Kiefhaber, P. J. Stern // J. Hand Surg. [Br.]. – 2004. – Vol. 29, N 6. – P. 608-613.
  15. Bruckner, J. D. Complex dislocations of the distal radioulnar joint. Recognition and management / J. D. Bruckner, D. M. Lichtman, A. H. Alexander // Clin. Orthop. Relat. Res. – 1992. – N 275. – P. 90-103.
  16. Garrigues, G. E. Acute irreducible distal radioulnar joint dislocation. A case report / G. E. Garrigues, J. M. Aldridge 3rd. // J. Bone Joint Surg. [Am.]. – 2007. – Vol. 89, N 7. – P. 1594-1597.
  17. Nishikawa, S. Anatomical study of the carpal attachment of the triangular fibrocartilage complex / S. Nishikawa, S. Toh // J. Bone Joint Surg. [Br.]. – 2002. – Vol. 84, N 7. – P. 1062-1065.
  18. Adolfsson, L. Currrent trend in hand surgery: Proceeding of the 6th Congress of the International Federation of Societies for Surgery of the Hand / L. Adolfsson. – Helsinki, 1995. – P. 21-28.
  19. Geissler, W. B. Wrist Arthroscopy / W. B. Geissler. – New York: Springer, 2005. – 215 р.
  20. Голубев, И. О. Повреждения и заболевания дистального лучелоктевого сустава / И. О. Голубев // Вестн. травматологии и ортопедии им. Н. Н. Приорова. – 1998. – № 4. – Ч. 2. – С. 60-63.
  21. Козлов, И. А. Застарелые вывихи и переломовывихи лучевой кости в дистальном лучелоктевом суставе и их лечение / И. А. Козлов, В. Ф. Коршунов, Л.И. Шелухина // Ортопедия, травматология и протезирование. – 1989. – № 1. – С. 49-51.
  22. Adams, B. D. Distal radioulnar joint instability / B. D. Adams // Operative hand surgery / Eds. D. P. Green. – 3rd ed. – New York, 1993. – P. 605-644.
  23. Palmer, A. K. Triangular fibrocartilage complex lesions: a classification / A. K. Palmer // J. Hand Surg. [Am.]. – 1989. – Vol. 14, N 4. – P. 594-606.
  24. Elkowitz, S. J. Wrist arthroscopy / S. J. Elkowitz, M. A. Posner // Bull. NYU Hosp. Jt. Dis. – 2006. – Vol. 64, N 3–4. – P. 156-165.
  25. Osterman, A. L. Arthroscopic debridement of triangular fibrocartilage complex tears / A. L. Osterman // Arthroscopy. – 1990. – Vol. 6, N 2. – P. 120-124.
  26. Clinical results of treatment of triangular fibrocartilage complex tears by arthroscopic debridement / A. Minami [et al.] // J. Hand Surg. [Am.]. – 1996. – Vol. 21, N 3. – P. 406-411.
  27. Bednar, J. M. Arthroscopic treatment of triangular fibrocartilage tears / J. M. Bednar // Hand Clin. – 1999. – Vol. 15, N 3. – P. 479-488.
  28. Palmer, A. K. The triangular fibrocartilage complex of the wrist–anatomy and function / A. K. Palmer, F. W. Werner // J. Hand Surg. [Am.]. – 1981. – Vol. 6, N 2. – P.153-162.
  29. Cooney,W . P. Distal radius fractures: external fixation proves best // J. Hand Surg. [Am.]. – 1998. – Vol. 23, N 6. – P. 1119-1121.
  30. Husby, T. Long–term results after arthroscopic resection of lesions of the triangular fibrocartilage complex / T. Husby, J. R. Haugstvedt // Scand J. Plast. Reconstr. Surg. Hand Surg. – 2001. – Vol. 35, N 1. – P. 79-83.
  31. Mikic, Z. D. Treatment of acute injuries of the triangular fibrocartilage complex associated with distal radioulnar joint instability // J. Hand Surg. [Am.]. – 1995. – Vol. 20, N 2. – P. 319-323.
  32. Sagerman, S. D., Arthroscopic repair of radial–sided triangular fibrocartilage complex tears / S. D. Sagerman, W. Short // Arthroscopy. – 1996. – Vol. 12, N 3. – P. 339-342.
  33. Shih, J. T. Early isolated triangular fibrocartilage complex tears: management by arthroscopic repair / J. T. Shih, H. M. Lee, C. M. Tan // J. Trauma. – 2002. – Vol. 53, N 5. – P. 922-927.
  34. Pilny, J. Arthroscopy in the diagnosis and therapy of wrist disorders / J. Pilny // Acta Chir. Orthop. Traumatol. Cech. – 2004. – Vol. 71, N 2. – P. 106-109.
  35. Hauck, R. M. Classification and treatment of ulnar styloid nonunion / R. M. Hauck, J. Skahen 3rd., A. K. Palmer // J. Hand Surg. [Am.]. – 1996. – Vol. 21, N 3. – P. 418-422.
  36. Palmer, A. K. Fractures of the distal radius / A. K. Palmer // Operative hand surgery / Ed. D. P. Green. – 3rd ed. – New York, 1993. – P. 929-972.
  37. Абдулхабиров, М. А. Переломы и вывихи головки локтевой кости и их лечение: учеб. пособие / М. А. Абдулхабиров, А. Я. Плахов. – М., 1990. – 28 с.
  38. Failed distal ulna resections / E. J. Bieber [et al.] // J. Hand Surg. [Am.]. – 1988. – Vol. 13, N 2. – P. 193-200.
  39. Kleinman, W. B. Salvage of the failed Darrach procedure / W. B. Kleinman, J. A. Greenberg // J. Hand Surg. [Am.]. – 1995. – Vol. 20, N 6. – P. 951-958.
  40. Green, D. P. Green’s operative hand surgery / D. P. Green. – 5rd ed. – New York: Churchill Livingstone. – 1160 р.
  41. Berger, R. A. Hand Surgery / R. A. Berger, A.P. C. Weiss. – Philadelphia: Wolter Kluwer Company, 2004. – Vol. II. – 1990 p.
  42. Scheker, L. R. Distal ulnar prosthetic replacement / L. R. Scheker, B. A. Babb, P. E. Killion // Orthop. Clin. North Am. – 2001. – Vol. 32, N 2. – P. 365-376.
  43. Willis, A. A. Arthroplasty of the distal radioulnar joint using a new ulnar head endoprosthesis: preliminary report / A. A. Willis, R. A. Berger, W. P. Cooney // J. Hand Surg. [Am.]. – 2007. – Vol. 32, N 2. – P. 177-89.
  44. Bowers, W. H. Distal radioulnar joint arthroplasty: the hemiresection–interposition technique / W. H. Bowers // J. Hand Surg. [Am.]. – 1985. – Vol. 10, N 2. – P. 169-178.
  45. Sauve, L. Nouvelle technique de traitement chirurgical ties luxations recidivantes isolees de lextremite inferieure de cubitus / L. Sauve, M. Kapandji // J. de Chirurgue. – 1936. – Vol. 47. – P. 589-594.
  46. Sauve–Kapandji operation for disorders of the distal radioulnar joint after Colles’ fracture. Good results in 12 patients followed for 1.5–4 years / S. S. Mikkelsen [et al.] // Acta Orthop. Scand. – 1997. – Vol. 68, N 1. – P. 64-66.
  47. Ahn, A. K. Triangular fibrocartilage complex tears: a review / A. K. Ahn, D. Chang, A. M. Plate // Bull. NYU Hosp. Jt. Dis. – 2006. – Vol. 64, N 3–4. – P. 114-118.
  48. Saffar, P. The pathology of the long ulna: anatomy and treatment / P. Saffar // J. Hand Surg. Eur. – 2007. – Vol. 32, N 6. – P. 608-619.
  49. Feldon, P. Wafer distal ulna resection for triangular fibrocartilage tears and/or ulna impaction syndrome / P. Feldon, A. L. Terrono, M. R. Belsky // J. Hand Surg. [Am.]. – 1992. – Vol. 17, N 4. – P. 731-737.

MALINOVSKAYA I.I.

INHIBITORS OF THE VASCULAR ENDOTHELIAL GROWTH FACTOR IN TREATMENT OF DIABETIC MACULAR EDEMA

Diabetic retinopathy and its manifestation, diabetic macular edema, are one of the leading causes of blindness worldwide. In the last decade many papers have appeared proving the key role of the vascular endothelial growth factor (VEGF) in the etiopathogenesis of these diseases, its effect on the development of the retinal neovascularization and increased vascular permeability. This article focuses on the results of a new direction in the treatment of diabetic macular edema - intravitreal inhibitors of VEGF.

Keywords: vascular endothelial growth factor, diabetic macular edema, inhibitors of vascular endothelial growth factor
p. 118 – 125 of the original issue
References
  1. Скоробогатова, Е. С. Инвалидность вследствие офтальмологических осложнений сахарного диабета в России / Е. С. Скоробогатова, Е. С. Либман // Тезисы докл. VIII съезда офтальмологов, Москва, 1–4 июня 2005 г. – М., 2005. – С. 88.
  2. Early vitrectomy for severe proliferative diabetic retinopathy in eyes with useful vision. Results of a randomized trial Diabetic Retinopathy Vitrectomy Study report 3 / Diabetic Retinopathy Vitrectomy Study Research Group // Ophthalmology. – 1988. – Vol. 95. – P. 1307-1320.
  3. Photocoagulation for diabetic macular edema. Early Treatment Diabetic Retinopathy Study report number 1 / Early Treatment Diabetic Retinopathy Study Research Group // Arch. Ophthalmol. – 1985. – Vol. 103. – P. 1796-1806.
  4. The Wisconsin epidemiologic study of diabetic retinopathy. IV. Diabetic Macular Edema / R. Klein [et al.] // Ophthalmology. – 1984. – Vol. 91. – P. 1464-1474.
  5. Ferris, F. Macular edema: a complication of diabetic retinopathy / F. Ferris, A. Patz // Surv. Ophthalm. – 1984. – Vol. 28. – P. 452-461.
  6. Vascular endothelial growth factor-induced retinal permeability is mediated by protein kinase C in vivo and suppressed by an orally effective beta-isoform-selective inhibitor / L. Aiello [et al.] // Diabetes. – 1997. – Vol. 46. – P. 1473-1480.
  7. Pigment epithelium-derived factor: neurotrophic activity and identification as a member of the serine protease inhibitor gene family / F. R. Steele [et al.] // Proc. Natl. Acad. Sci. USA. – 1993. – Vol. 90. – P. 1526-1530.
  8. Regression of ocular neovascularization in response to increased expression of pigment epithelium-derived factor / K. Mori [et al.] // Invest. Ophthalmol. Vis. Sci. – 2002. – Vol. 43, N 7. – P. 2428-2434.
  9. Analysis of biological effects and signaling properties of Flt-1 (VEGFR-1) and KDR (VEGFR-2). A reassessment using novel receptor–specific vascular endothelial growth factor mutants / H. Gille [et al.] // J. Biol. Chem. – 2001. – Vol. 276. – P. 3222-3230.
  10. Expression, secretion, and age-related downregulation of pigment epithelium-derived factor, a serpin with neurotrophic activity / J. Tombran-Tink [et al.] // Neurosci. – 1995. – Vol. 15. – P. 4992-5003.
  11. A pilot study of multiple intravitreal injections of ranibizumab in patients with center-involving clinically significant diabetic macular edema / D. W. Chun [et al.] // Ophthalmology. – 2006. – Vol. 113. – P. 1706-1712.
  12. Vascular endothelial growth factor is a critical stimulus for diabetic macular edema / Q. D. Nguyen [et al.] // Am. J. Ophthalmol. – 2006. – Vol. 142. – P. 961-969.
  13. READ–2 Study Group: Primary endpoint (6 months) results of the ranibizumab for edema of the macula in diabetes (READ-2) study / Q. D. Nguyen [et al.] // Ophthalmology. – 2009. – Vol. 116. – P. 2175-2178.
  14. RESOLVE Study Group: Safety and efficacy of ranibizumab treatment in patients with diabetic macular edema: 12-month results of the RESOLVE study / A. Wolf [et al.] // ARVO Meeting. – Fort Lauderdable, 2009.
  15. Randomized trial evaluating Ranibizumab Plus Prompt or Deferred Laser or Triamcinolone Plus Prompt Laser for Diabetic Macular Edema / M. J. Elman [et al.] // Ophthalmology. – 2010. – Vol. 117. – P. 1064-1077.
  16. Macugen Diabetic Retinopathy Study Group: A phase II randomized double-masked trial of pegaptanib, an antivascular endothelial growth factor aptamer, for diabetic macular edema / E. T. Jr. Cunningham [et al.] // Ophthalmology. – 2005. – Vol. 112. – P. 1747-1757.
  17. Changes in retinal neovascularization after pegaptanib therapy in diabetic individuals / A. P. Adamis [et al.] // Ophthalmology. – 2006. – Vol. 113. – P. 23-28.
  18. Intravitreal injection of pegaptanib sodium for proliferative diabetic retinopathy / V. H. Gonzales [et al.] // Br. J. Ophthalmol. – 2009. – Vol. 93. – P. 1474-1478.
  19. Electrophysiologic and retinal penetration studies following intravitreal injection of bevacizumab (avastin) / J. Shahar [et al.] // Retina. – 2006. – Vol. 26. – P. 262-269.
  20. Testing intravitreal toxicity of bevacizumab (avastin) / R. P. A. Manzano [et al.] // Retina. – 2006. – Vol. 26. – P. 257-261.
  21. A phase II randomized clinical trial of intravitreal bevacizumab for diabetic macular edema / I. U. Scott [et al.] // Ophthalmology. – 2007. – Vol. 114. – P. 1860-1867.
  22. Efficacy of 1, 25 vs. 2, 5 mg intravitreal bevacizumab for diabetic macular edema: six-month results of a randomized controlled trial / D. S. Lam [et al.] // Retina. – 2009. – Vol. 29. – P. 292-299.
  23. Long-term effect of intravitreal bevacizumab in patients with chronic diffuse diabetic macular edema / D. Kook [et al.] // Retina. – 2008. – Vol. 28 – P. 1053-1060.
  24. Randomized trial of intravitreal bevacizumab alone or combined with triamcinolone versus macular photocoagulation in diabetic macular edema / M. Soheilian [et al.] // Ophthalmology. – 2009. – Vol. 116. – P. 1142-1150.
  25. Intravitreal bevacizumab in the treatment of proliferative diabetic retinopathy / R. L. Avery [et al.] // Ophthalmology. – 2006. – Vol. 113. – P. 1695.el-15.
  26. Intravitreal bevacizumab for persistent new vessels in diabetic retinopathy (IBEPE study) / R. Jorge [et al.] // Retina. – 2006. – Vol. 26. – P. 1006-1013.
  27. Intravitreal bevacizumab in active progressive proliferative diabetic retinopathy / S. Moradian [et al.] // Graefes. Arch. Clin. Exp. Ophthalmol. – 2008. – Vol. 246. – P. 1699-1705.
  28. Intravitreal bevacizumab and panretinal photocoagulation for proliferative diabetic retinopathy associated with vitreous haemorrhage / Y. H. Huang [et al.] // Retina. – 2009. – Vol. 29. – P. 1134-1140.
  29. Cytokine traps: multi-component, high-affinity blocker of cytokine action / A. N. Economides [et al.] // Nat. Med. – 2003. – Vol. 9. – P. 47-52.
  30. VEGF Trap: a VEGF blocker with potent antitumor effects / J. Holash [et al.] // Proc. Natl. Acad. Sci. USA. – 2002. – Vol. 99. – P. 11393-11398.
  31. Stewart, M. W. Predicted biological activity of intravitreal VEGF Trap / M. W. Stewart, P. J. Rosenfeld // Br. J. Ophthalmol. – 2008. – Vol. 92. – P. 667-668.
  32. An exploratory study of the safety, tolerability and bioactivity of a single intravitreal injection of vascular endothelial growth factor Trap-eye in patients with diabetic macular edema / D. V. Do [et al.] // Br. J. Ophthalmol. – 2009. – Vol. 93. – P. 144-149.
  33. Singerman, L. J. Intravitreal bevasiranib in exudative age-related macular degeneration or diabetic macular edema / L. J. Singerman // 25-th Annual Meeting of the American Society of Retina Specialists, Indian Wells, December 1–5, 2007.
  34. Risks of proteinuria and hypertension with bevacizumab, an antibody against vascular endothelial growth factor: systematic review and meta-analysis / X. Zhu [et al.] // Am. J. Kidney. Dis. – 2007. – Vol. 49. – P. 186-193.
  35. Scott, I. U. Reducing the risk of endophthalmitis following intravitreal injections / I. U. Scott, H. W. Jr. Flynn // Retina. – 2007. – Vol. 27. – P. 10-12.
  36. Endophthalmitis associated with intravitreal anti–vascular endothelial growth factor therapy injections in an office setting / P. Suman [et al.] // Am. J. Ophthalmol. – 2008. – Vol. 145. – P. 879-882.
  37. Pegaptanib for neovascular age-related macular degeneration / E. S. Gragoudas [et al.] // N. Engl. J. Med. – 2004. – Vol. 351. – P. 2805-2816.
  38. Ranibizumab versus verteporfin for neovascular age–related macular degeneration / D. M. Brown [et al.] // N. Engl. J. Med. – 2006. – Vol. 355. – P. 1432-1444.
  39. Ranibizumab for neovascular age–related macular degeneration / P. J. Rosenfeld [et al.] // N. Engl. J. Med. – 2006. – Vol. 355. – P. 1419-1431.

PRACTICAL CASES

ERMASHKEVICH S.N.

PARTIAL NECROSIS OF THE CECUM

The article describes a case of partial cecal necrosis, developed without visible reasons in the 20-aged patient. Its clinical picture simulated an acute appendicitis and was characterized by the pain in the right iliac region, fever and hyperleukocytosis. The patient underwent right hemicolectomy resulted in a favorable outcome. According to the literature cecal necrosis development analysis, a clinical picture, diagnostic and treatment tactics are presented.

Keywords: cecum, partial necrosis of the wall, acute appendicitis
p. 126 – 128 of the original issue
References
  1. Schuler, J. G. Cecal necrosis: infrequent variant of ischemic colitis. Report of five cases / J. G. Schuler, М. М. Hudlin // Dis. Colon. Rectum. – 2000. – Vol. 43, N 5. – Р. 708-712.
  2. “Cecal gangrene”: a rare cause of right–sided inferior abdominal quadrant pain, fever, and leukocytosis / W. Wiesner [et al.] // Emergency Radiology. – 2002. – Vol. 9, N 5. – Р. 292-295.
  3. Isolated cecal necrosis mimicking acute appendicitis / G. Kiuak [et al.] // The Turkish J. of Gastroenterol. – 2008. – Vol. 19, N 1. – P. 71-72.
  4. Isolated cecal necrosis mimicking acute appendicitis: a case series / А. Dirican [et al.] // J. Med. Case Reports. – 2009. – Vol. 3. – Р. 7443.
  5. Schmidt, W. A. Necrotizing vasculitis of the appendix and cecum in systemic lupus erythematosus / W. A. Schmidt, W. Schneider, E. J. Gromnica-Ihle // Z. Rheumatol. – 1996. – Vol. 55, N 4. – Р. 267-271.
  6. Two cases of rheumatoid arthritis complicated with vasculitis–induced ischemic enterocolitis / Y. Okuda [et al.] // Ryumachi. – 1990. – Vol. 30, N 5. – Р. 403-408.
  7. Intestinal necrosis as clinical presentation of Takayasu arteritis / R. Cornejo [et al.] // Rev. Med. Chil. – 2002. – Vol. 130, N 10. – Р. 1159-1164.
  8. Marquez–Diaz, A. A right sided colon volvulus with necrosis in a young patient. A case reported / А. Marquez–Diaz, М. А. Ramirez–Ortega // Rev. Med. Inst. Mex. Seguro. Soc. – 2010. – Vol. 48, N 2. – Р. 209-214.
  9. A rare case of acute cecal necrosis / M. Grande [et al.] // Tech. Coloproctol. – 2007. – Vol. 11, N 2. – Р. 161-164.
  10. Болезнь Крона, осложненная некрозом сегмента купола слепой кишки и флегмонозным аппендицитом / В. З. Маховский [и др.] // Хирургия. – 2010. – № 11. – С. 73-75.
  11. Partial cecal necrosis treated by laparoscopic partial cecal resection / Z. Perko [et al.] // Col. Antropol. – 2006. – Vol. 30, N 4. – Р. 937-939.
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