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Year 2013 Vol. 21 No 3

EXPERIMENTAL SURGERY

Y.S. VINNIK, L.À. SHESTAKOVA, O.V. TEPLYAKOVA, N.I. CEDRICK, O.V. PERYANOVA, A.G. GITLINA, S.V. YAKIMOV, A.M. PLAHOTNIKOVA

EXPERIMENTAL MODEL OF PRIMARY INFECTED PANCREATIC NECROSIS

SBEE HPE “Krasnoyarsk State Medical University named after professor V.F.Voino-Yasenetsky”,
The Russian Federation

Objectives. To study the possibilities of A. baumannii clinical strain in modeling of the primary infected pancreatic necrosis in laboratory rabbits as well as to evaluate the capability of reproduction and validity of the improved experimental model.
Methods. The research was carried out on 10 Chinchilla rabbits breed (males) aging 4-5 months. The improved technique provided the middle laparotomy, the puncture of the gallbladder with aspiration of 0,6 ml of bile. The pancreatic necrosis induction was performed with a mechanical pressure of pancreatic tissue in three standard points with Bilrot’s clips and the following intraparenchymatous injection of 0,2 ml autobile and suspension of A. baumannii clinical strain.
Results. On the second and third days after modeling the clinical symptoms of the system inflammation reaction such as tachypnea, tachycardia and hyperthermia have been registered. During relaparotomy performed 72 hours after the pancreatic necrosis induction a cloudy exudate with the presence of fibrin strands was determined in the abdominal cavity; dilatation of the stomach and small intestine was noted. The pancreas was not clearly seen on the background of small intestines mesentery and looked like a homogenous mass consisted of the confluent steatonecrosis focuses. Hystologically lysis of the acinar and glandular parenchyma was determined in the pancreas biopsies of the animals. While liver sample examining the signs of secondary acute hepatitis were detected.
The kidneys characterized by the interstitial nephritis, the signs of interstitial myocarditis were observed in myocardium. The evidence of bronchopneumonia and obstructive emphysema with formation of bullas was revealed in the lungs.
A. baumannii was identified in the amount of 5,0×107 CFU/g taken from pancreatic biopsy specimens and in the amount of 107 CFU/ml – from the peritoneal exudate. A. baumannii combined with enterobacteria and Entercoccus spp. has been detected in peritoneal exudates (4 animals).
Conclusions. The use of the improved method allowed to simulate the infected pancreatic necrosis in all the animals with clinical and morphological symptoms of the systemic inflammation reaction as well as with the generalization of bacterial peritonitis and level of superinfection of 40,0% within 72 hours from the moment of modeling.

Keywords: infected pancreatic necrosis, modeling, experiment, A. baumannii
p. 3– 8 of the original issue
References
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  2. Litvin AA, Khokha VM. Sovremennye tendentsii v khirurgicheskom lechenii ostrogo nekrotiziruiushchego pankreatita i infitsirovannogo pankreonekroza [Current trends in the surgical treatment of acute necrotizing pancreatitis and infected pancreatic necrosis]. Vestn Kluba Pankreatologov. 2012;(2):31–35.
  3. Miller SV, Vinnik IuS, Tepliakova OV. Lechenie bol'nykh ostrym destruktivnym pankreatitom [Treatment of patients with acute destructive pancreatitis]. Khirurgiia Zhurn im NI Pirogova. 2012;(5):24–30.
  4. Zinenko DIu, Sukhina TV. Izmeneniia struktury podzheludochnoi zhelezy v usloviiakh modelirovaniia eksperimental'nogo ostrogo pankreatita [Changes in the pancretic structure of the experimental model at acute pancreatitis]. Morfologiia. 2010;4(1):17–21.
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  14. Miller SV, Vinnik IuS, Tepliakova OV, Per'ianova OV. Dinamika etiologicheskoi struktury i antibiotikochuvstvitel'nosti mikroflory infitsirovannogo pankreonekroza [The dynamics of the etiological structure and flora antibiotic susceptibility of infected pancreatic necrosis]. Annaly Khirurgii. 2011;(5):54–61.
  15. Per'ianova OV, Mal'tseva OE, Osipova NP, Tepliakova OV, Kublitskaia LI, Kapustina EA, Smotrov SV, Kurchitskii AA. Antibiotikochuvstvitel'nost' mikroflory pri destruktivnykh formakh ostrogo pankreatita [Antibiotic sensitivity of microflora in destructive forms of acute pancreatitis]. Sib Med Zhurn. 2006;62(4):22–25.
  16. Dent LL, Marshall DR, Pratap S, Hulette RB. Multidrug resistant Acinetobacter baumannii: a descriptive study in a city hospital. BMC Infect Dis. 2010 Jul 7;10:196.
  17. Sheina EA, Stadnikov BA, Tret'iakov AA. Reparativnye potentsii tkanei podzheludochnoi zhelezy pri eksperimental'nom infitsirovannom pankreonekroze [Reparative potency of pancreatic tissue in experimental infected pancreatic necrosis]. Morfologiia. 2008;134(5):29–32.
Address for correspondence:
660022, g. Krasnoiarsk, ul. Partizana Zhelezniaka, d. 1, GBOU VPO "Krasnoiarskii gosudarstvennyi meditsinskii universitet imeni professora V.F. Voino-Iasenetskogo" kafedra obshchei khirurgii,
e-mail: teplyakova-olga@yandex.ru,
Teplyakova Olga Valerevna
Information about the authors:
Vinnik Y.S. A Honored Worker of Science of Russia, MD, professor, a head of the general surgery chair of SBEE HPE “Krasnoyarsk State Medical University named after professor V.F.Voino -Yasenetsky”.
Shestakova O.V. PhD, an associate professor, a head of the pathologic anatomy chair named after professor P.G. Podzolkov of SBEE HPE “Krasnoyarsk State Medical University named after professor V.F.Voino-Yasenetsky”.
Teplyakova O.V. PhD, an applicant for Doctor’s degree of the general surgery chair of SBEE HPE “Krasnoyarsk State Medical University named after professor V.F.Voino-Yasenetsky”.
Cedrick N.I. An assistant of the general surgery chair of SBEE HPE “Krasnoyarsk State Medical University named after professor V.F.Voino-Yasenetsky”. Peryanova O.V. PhD, an associate professor, a head of microbiology chair named after B.M. Zelmanovich of SBEE HPE “Krasnoyarsk State Medical University named after professor V.F.Voino-Yasenetsky”.
Gitlina A.G. A senior researcher of CSRL of SBEE HPE “Krasnoyarsk State Medical University named after professor V.F.Voino-Yasenetsky”.
Yakimov S.V. MD, professor of the general surgery chair of SBEE HPE “Krasnoyarsk State Medical University named after professor V.F.Voino-Yasenetsky”.
Plahotnikova A.M. A 6-year student of SBEE HPE “Krasnoyarsk State Medical University named after professor V.F. Voino-Yasenetsky”.

B.S. SUKOVATYKH, Y.I. VEDENEV, A.O. RODIONOV

COMPARATIVE CHARACTERISTICS OF THE WOUND PROCESS IN THE ARTERIAL WALL AFTER IMPLANTATION OF SYNTHETIC AND BIOLOGICAL ENDOPROSTHESES

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

Objectives. To compare tissue reaction of an arterial wall to implantation of synthetic and biological endoprostheses.
Methods. The analysis of the experiment study on 30 rabbits divided into one intact group numbering 6 animals and two trial groups numbering 12 animals in each one has been carried out. In the first group the animals had implantation of the synthetic polytetraftorethylene prosthesis on the aortic wall, whereas a biological vascular prosthesis made from the bovine internal chest arteries was implanted into the rabbit’s aortic wall in the second group. The areas of the abdominal aorta together with the implanted endoprostheses were subjected to the histological study on the 3, 7, 14, 21, 30 è 60 days after the operation. The preparations were studied under light microscope after being stained with hematoxylin-eosin and on Van Gieson. Morphometric study to determine the proportion of cellular composition of the connective tissue was performed.
Results. Both synthetic and biological grafts at implantation caused an acute inflammatory reaction within 7 days, which was more expressed under the biological graft on the 3rd day (3,2 folds) and on the 7th day – 1,2 folds. 2 weeks after the implantation the inflammatory reaction was stopped and reparative processes of the new granulated tissue formation began to prevail in arterial wall. Faster formation of the connective tissue capsule under the synthetic graft was registered later. On the 30th day a mature connective tissue is formed and the capsular formation processes completes on the 60th day. On the 30th day of experiment the connective tissue capsule under the biological graft was 1,8 folds thinner, on the 60th day – 3,3 folds thinner than under the synthetic graft. The connective tissue capsule surrounded the synthetic vascular prosthesis contained more cellular elements whereas the fibrous structures prevail surrounded the biological prosthesis.
Conclusions. The tissue reaction of the arterial wall to the implantation of the biological graft is less expressed than to the implantation of the synthetic graft.

Keywords: tissue reaction, artery, polytetraftorethylene prosthesis, biological prosthesis
p. 9 – 15 of the original issue
References
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  5. Pokrovskii AV, Dan VN, Zotikov AE, Chupin AV, Shubin AA, Chikharev MV. Otdalennye rezul'taty i pokazaniia k ispol'zovaniiu proteza Gore-Tex v bedrenno-podkolennoi pozitsii u bol'nykh s ateroskleroticheskim porazheniem arterii nizhnikh konechnostei [Long-term results and indications for the applicatiopn of the Gore-Tex prosthesis in the femoral-popliteal position in patients with atherosclerotic lesions of the arteries of the lower limbs]. Angiologiia i Sosud Khirurgiia. 2004;10(2):91–98.
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  14. Gusinskii AV, Sedov, VM Serebrianskii IuB, Lebedev LV, Mikhailov IV, Shlomin VV, Vorontsov MA. Rezul'taty ispol'zovaniia otechestvennykh sosudistykh protezov «Ekoflon» [The results of application of Ecoflon native vascular prostheses]. Vestn Khirurgii im II Grekova. 2002;161(1):11–15.
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Address for correspondence:
305041, Rossiiskaia Federatsiia, g. Kursk, ul. K. Marksa, d. 3, GBOU VPO "Kurskii Gosudarstvennyi meditsinskii universitet", kafedra obshchei khirurgii,
e-mail: SukovatykhBS@kursksmu.net,
Sukovatykh Boris Semenovich
Information about the authors:
Sukovatykh B.S. MD, professor, a head of the general surgery chair of SBEE HPE “Kursk State Medical University”.
Vedenev Y.I. A head of the pathoanatomical
department of the Regional budget establishment of health care of the city clinical emergency hospital of Kursk.
Rodionov A.O. An intramural post-graduate student of the general surgery chair of SBEE HPE “Kursk State Medical University”.

GENERAL AND SPECIAL SURGERY

I.V. MAIBORODIN, A.I. SHEVELA, M.I. BARANNICK, I.V. KUZNETSOVA, V.I. MAIBORODINA

SOME MORPHOLOGICAL ASPECTS OF SILICONE MATERIALS IMPLANTATION IN CLINICAL CONDITIONS

Center of New Medical Technologies of Institute of Chemical Biology and Fundamental Medicine, the Russian Academy of Sciences, Siberian Branch, Novosibirsk
The Russian Federation

Objectives. Using morphological methods to estimate the reaction of the organism tissues and degradation processes of silicone implants after their application in clinical conditions.
Methods. The connective tissue capsules formed around various silicone mammary implants were studied by applying the method of light microscopy.
Results. It was revealed that after implantation of a volume soft foreign body (silicone mammary implants) this material presented in the tissues for a long period of time delimited by a fibrous capsule. Gradually the capsule compresses owing to the activity of myofibroblasts for minimization of the volume of an alien body, its internal surface is deformed and obtains a wavy form with a set of outgrowths or protrudes inside. The connective tissue capsule formed around silicone implants consists of dense (external, main) and friable (internal, boundary) parts. The tight part of a capsule isolates a foreign body from the organism tissues. A gradual destruction (fragmentation) and absorption of implant material by phagocytes occurs in friable part. Over time the silicone migrates to capsular tissues and out of its limits where it is absorbed by phagocytes. As the result of silicone migration in tissues and its uptake by phagocytes the volume of mammary implants gradually decreases and the capsule is reduced to meet the volume of the foreign body, the inner part of the capsule is wave-like deformed. A significant manifestation of granulomatous inflammation and the formation of a thick capsule with signs of fibrosis are considered as unfavorable prognostic signs pointing to a higher likelihood of developing various complications in the future.
Conclusions. The more inactive for a live organism the implant material is the less it will stimulate macrophage reaction. The problem of new implant design is in the search for the most bioinert materials, strong enough for compression by a capsule and fragmentation, but similar on elasticity with normal tissue of a mammary gland.

Keywords: silicone, capsular contraction, giant cells of foreign body, granulomatous inflammations
p. 16 – 22 of the original issue
References
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Address for correspondence:
630090, Rossiiskaia Federatsiia, g. Novosibirsk, pr. akad. Lavrent'eva, d. 8, Institut khimicheskoi biologii i fundamental'noi meditsiny SO RAN, Tsentr novykh meditsinskikh tekhnologii,
e-mail: imai@mail.ru,
Maiborodin Igor' Valentinovich
Information about the authors:
Maiborodin I.V. MD, professor, a leading researcher of the stem cell laboratory of Institute of Chemical Biology and Fundamental Medicine, the Russian Academy of Sciences, Siberian Branch.
Shevela A.I. Honored physician of the stem cell laboratory of Institute of Chemical Biology and Fundamental Medicine, the Russian Academy of Sciences, Siberian Branch.
Barannick M.I. PhD, an applicant for Doctor’s degree of the stem cell laboratory of Institute of Chemical Biology and Fundamental Medicine, the Russian Academy of Sciences, Siberian Branch.
Kuznetsova I.V. PhD, a researcher of the stem cell laboratory of Institute of Chemical Biology and Fundamental Medicine, the Russian Academy of Sciences, Siberian Branch.
Maiborodina V.I. MD, a senior researcher of the stem cell laboratory of Institute of Chemical Biology and Fundamental Medicine, the Russian Academy of Sciences, Siberian Branch.

E.M. MOKHOV, A.N. SERGEEV, E.V. SEROV

THE DEVELOPMENT OF NEW BIOLOGICALLY ACTIVE SUTURE MATERIALS AND USING THEM IN THE ABDOMINAL SURGERY

SBEE HPE “Tver State Medical Academy”
The Russian Federation

Objectives. Using morphological methods to estimate the reaction of the organism tissues and degradation processes of silicone implants after their application in clinical conditions.
Methods. The connective tissue capsules formed around various silicone mammary implants were studied by applying the method of light microscopy.
Results. It was revealed that after implantation of a volume soft foreign body (silicone mammary implants) this material presented in the tissues for a long period of time delimited by a fibrous capsule. Gradually the capsule compresses owing to the activity of myofibroblasts for minimization of the volume of an alien body, its internal surface is deformed and obtains a wavy form with a set of outgrowths or protrudes inside. The connective tissue capsule formed around silicone implants consists of dense (external, main) and friable (internal, boundary) parts. The tight part of a capsule isolates a foreign body from the organism tissues. A gradual destruction (fragmentation) and absorption of implant material by phagocytes occurs in friable part. Over time the silicone migrates to capsular tissues and out of its limits where it is absorbed by phagocytes. As the result of silicone migration in tissues and its uptake by phagocytes the volume of mammary implants gradually decreases and the capsule is reduced to meet the volume of the foreign body, the inner part of the capsule is wave-like deformed. A significant manifestation of granulomatous inflammation and the formation of a thick capsule with signs of fibrosis are considered as unfavorable prognostic signs pointing to a higher likelihood of developing various complications in the future.
Conclusions. The more inactive for a live organism the implant material is the less it will stimulate macrophage reaction. The problem of new implant design is in the search for the most bioinert materials, strong enough for compression by a capsule and fragmentation, but similar on elasticity with normal tissue of a mammary gland.

Keywords: silicone, capsular contraction, giant cells of foreign body, granulomatous inflammation
p. 23 – 32 of the original issue
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  10. Tolstykh PI, Gostishchev VK, Virnik AD, i dr. Biologicheski aktivnye pereviazochnye i khirurgicheskie shovnye materialy. [Biologically active dressings and surgical suture materials]. Khirurgiia. 1988(4): 3–8.
  11. Korotkov NI, Efremov AV, Boitsov NI. Sravnitel'naia otsenka sovremennykh shovnykh materialov pri rezektsii zheludka [Comparative evaluation of modern suture materials at gastrectomy]. Khirurgiia Zhurn im NI Pirogova. 2002(11): 27–31.
  12. Mokhov EM, Sergeev AN. Vozmozhnosti i perspektivy primeneniia v khirurgii novogo biologicheski aktivnogo shovnogo materiala [Feasibility and prospects of application of new biologically active suture material in surgery]. Ros Med Zhurn. 2007(2):18–21
  13. Deliaert AE, Van den Kerckhove E, Tuinder S, Fieuws S, Sawor JH, Meesters-Caberg MA, van der Hulst RR. The effect of triclosan-coated sutures in wound healing. A double blind randomised prospective pilot study. J Plast Reconstr Aesthet Surg. 2009 Jun;62(6):771–73.
  14. Storch ML, Rothenburger SJ, Jacinto G. Experimental efficacy study of coated VICRYL plus antibacterial suture in guinea pigs challenged with Staphylococcus aureus. Surg Infect (Larchmt). 2004 Fall;5(3):281–88.
  15. Ming X, Rothenburger S, Nichols MM. In vivo and in vitro antibacterial efficacy of PDS plus (polidioxanone with triclosan) suture. Surg Infect (Larchmt). 2008 Aug;9(4):451–57.
Address for correspondence:
170000, Rossiiskaia Federatsiia, g. Tver', ul. Sovetskaia, d. 4, GBOU VPO "Tverskaia gosudarstvennaia meditsinskaia akademiia", kafedra obshchei khirurgii,
e-mail: dr.nikolaevich@mail.ru,
Sergeev Aleksei Nikolaevich
Information about the authors:
Mokhov EM. MD, professor, a head of the chair of general surgery GBOU VPO "Tver State Medical Academy."
Sergeev AN. PhD, associate professor of general surgery chair GBOU VPO "Tver State Medical Academy."
Serov EV. A surgeon of Solnechnogorsk CRH of Moscow region, an applicant of general surgery chair GBOU VPO "Tver State Medical Academy."

I.S. IVANOV, V.A. LAZARENKO, S.V. IVANOV, G.N. GORYAINOVA, A.V. IVANOV, D.V. TARABRIN, M.I. LITVYAKOVA

CORRELATION OF COLLAGEN TYPE I AND III IN THE SKIN AND APONEUROSIS IN PATIENTS WITH VENTRAL HERNIAS

SBEE HPE “Kursk State Medical University”
The Russian Federation

Objectives. To study the correlation of collagen type I and III of the connective tissue in the skin and aponeurosis in patients with ventral hernias.
Methods. A comparative analysis of the content of collagen type I and III in the skin and aponeurosis in 95 patients was carried out. All examined patients were divided into 2 groups: 46 patients with the ventral hernias and 49 – with the other surgical pathology. The investigation of the collagen type I and III in the skin and aponeurosis was performed using the polarized microscopy permitting to reveal the correlation of the collagen types (CT) in patients of various groups.
Results. It was established that in patients with ventral hernias a reliably lower correlation of CT (p≤0,001) was registered both in the skin preparations and in aponeurosis in comparison with examined those without hernias. In the study of the skin structure a strong direct correlation was revealed between the ratio of collagen type (CT) of the skin connective tissue and aponeurosis of one group allowing to predict the probability of ventral hernia formation.
Conclusions. In patients with ventral hernias a reliably significant (p≤0,001) lower ratio of CT in the skin and aponeurosis has been registered. A strong direct correlation between the content of collagen different types in the skin and aponeurosis allows to reveal the systemic pathology of the connective tissue basing only according to its changes in the skin. The determination of collagen types I and III correlation in the skin and aponeurosis using the polarized microscopy is considered to be highly informative in verification of hernias.

Keywords: postoperative hernia, ventral hernia, polarized microscopy, collagen Type I, collagen Type III
p. 33 – 36 of the original issue
References
  1. Zotov VA, Shtofin SG, Shestakov VV, Ovchinnikov VV. Khirurgiia gryzh briushnoi stenki s plastikoi "bez natiazheniia" [Hernia surgery of the abdominal wall with "tension-free" plasty]. Vestn Gerniologii. 2006;(Vyp 2):81–86
  2. Timoshin AD, Iurasov AV, Shestakov AL. Kontseptsiia khirurgicheskogo lecheniia posleoperatsionnykh gryzh perednei briushnoi stenki [The concept of surgical treatment of postoperative abdominal wall hernias]. Gerniologiia. 2004;(1):5–10.
  3. Borisov AE, Malkova SK, Toidze VV. Primenenie polipropilenovoi setki pri bol'shikh i gigantskikh gryzhakh perednei briushnoi stenki [The use of polypropylene mesh for large and giant hernias of the abdominal wall]. Vestn Khirurgii. 2002;(6):76–78.
  4. Veligotskii NN, Komarchuk VV, Komarchuk EV, Kasumba K. Khirurgicheskoe lechenie gryzh na fone displazii soedinitel'noi tkani [Surgical treatment of hernias on a background of connective tissue dysplasia]. Ukrain Zhurn Xipypgii. 2011;(3):236–39.
  5. Agrawal A, Avill R. Mesh migration following repair of inguinal hernia: a case report and review of literature. Hernia. 2006 Mar;10(1):79–82. Review.
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  8. Kakturskii LV. Poliarizatsionnaia mikroskopiia [The polarizing microscopy]. V: Mikroskop tekhnika. Moscow, RF: Meditsina; 1996. 116 p.
Address for correspondence:
305041, Rossiiskaia Federatsiia, g. Kursk, ul. Karla Marksa, d. 3, GBOU VPO "Kurskii gosudarstvennyi meditsinskii universitet", kafedra khirurgicheskikh boleznei ¹1,
e-mail: ivanov.is@mail.ru,
Ivanov Il'ia Sergeevich
Information about the authors:
Ivanov I.S. PhD, an associate professor of the surgical diseases chair ¹ 1 of SBEE HPE “Kursk State Medical University”.
Lazarenko V.A. MD, professor, rector of SBEE HPE “Kursk State Medical University”.
Ivanov S.V. MD, professor, a head of the surgical diseases chair ¹ 1 of SBEE HPE “Kursk State Medical University”.
Goryainova G.N. PhD, an associate professor of the pathological anatomy chair of SBEE HPE “Kursk State Medical University”.
Ivanov A.V. MD, professor, a head of histology, embryology, cytology chair of SBEE HPE “Kursk State Medical University”.
Tarabrin D.V. A clinical intern of the of the surgical diseases chair ¹1 of SBEE HPE “Kursk State Medical University”.
Litvyakova M.I. A 5-year student of the medical faculty of SBEE HPE “Kursk State Medical University”.

A.V. SHIDLOVSKYI, Y.R. ROZNOVSKYI

PREVENTION OF LARYNX PARESES DURING THYROID SURGERY

SHEE “Ternopil State Medical University named after I.Ya. Gorbachevsky”,
MPH of the Ukraine
The Ukraine

Objectives. To reduce frequency of larynx nerves injury by means of improvement of surgical techniques, methods and technology of their identification in the operation wound. To decrease of the incidence of per-operative laryngeal nerve injury by means of improvement of surgical techniques, methods and technology of their identification in the operation wound.
Methods. 57 patients operated on different forms of goiter were enrolled in the research. The developed technical methods of performing operations, the method and technology of electrophysiological identification of the larynx nerves among wound tissues have been approved intraoperative. The principle of the method is based on the registration of sound vibrations produced by air passage through the glottis. Changes of the tension degree of the vocal cords and the glottis lumen area due to electrophysiological stimulation of the wound tissues and larynx nerves are reflected in different degrees on the characteristics of sound waves.
Results. Application of the developed principles of technical performance of surgical interventions at cervical, cervical and retrosternal and retrosternal localization of multinodular or recurrent goiter allows to simplify the operation performance and prevent the larynx nerves injury. Intraoperative identification of larynx nerves among wound tissues has been performed by using the developed method. 57 patients were investigated 201 times. The greatest changes of the amplitude and sound frequency occurred during electrical stimulation of larynx nerves. These fonatory effects allow to identify larynx nerves with absolute reliability. There were no errors in the identification of nerves location and allocation. Post-operative pareses of the larynx was not observed.
Conclusions. The conducted research confirmed the effectiveness of the application of the developed technologies of surgical interventions at different goiter forms and the method of larynx nerves identification among wound tissue to prevent the injury and pareses of the larynx.

Keywords: thyroid surgery, injuries of the larynx nerves, pareses of the larynx, prevention
p. 37 – 41 of the original issue
References
  1. Dolidze DD, Mumladze RB, Vartanian KF, Vardanian AV, Nuzhdin OI, Lalazarian TIu, Karadimitrov GN, Aleksanian AA, Oganian AR, Sultygov AKh. Osobennosti khirurgicheskogo lecheniia bol'nykh s zabolevaniiami zagrudinno raspolozhennoi shchitovidnoi zhelezy [The specificity of the surgical treatment of patients with retrosternal thyroid gland]. Ann Khir, 2009(3):24–8.
  2. Dolidze DD, Mumladze RB, Lebedinskii IN, Karadimitrov GN, Sultygov AM, Dzhigkaev TD, Lalazarian TIu, Gobeev SV, Mkrtchian A A. Profilaktika povrezhdeniia verkhnego gortannogo nerva pri operatsiiakh na shchitovidnoi zheleze [Prevention of the superior laryngeal nerve damage in thyroid surgery]. Ann Khir. 2008(4):13–8 .
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  4. Loch-Wilkinson TJ, Stalberg PL, Sidhu SB, Sywak MS, Wilkinson JF, Delbridge LW Nerve stimulation in thyroid surgery: is it really useful? ANZ J Surg. 2007 May;77(5):377-80.
  5. Randolph GW, Dralle H; International Intraoperative Monitoring Study Group, Abdullah H, Barczynski M, Bellantone R, Brauckhoff M, Carnaille B, Cherenko S, Chiang FY, Dionigi G, Finck C, Hartl D, Kamani D, Lorenz K, Miccolli P, Mihai R, Miyauchi A, Orloff L, Perrier N, Poveda MD, Romanchishen A, Serpell J, Sitges-Serra A, Sloan T, Van Slycke S, Snyder S, Takami H, Volpi E, Woodson G. Electrophysiologic recurrent laryngeal nerve monitoring during thyroid and parathyroid surgery: international standards guideline statement. Laryngoscope. 2011 Jan;121 Suppl 1:S1–16.
  6. Chiang FY, Lu IC, Kuo WR, Lee KW, Chang NC, Wu CW. The mechanism of recurrent laryngeal nerve injury during thyroid surgery--the application of intraoperative neuromonitoring. Surgery. 2008 Jun;143(6):743–49.
  7. Thomusch O, Sekulla C, Machens A, Neumann HJ, Timmermann W, Dralle H. Validity of intra-operative neuromonitoring signals in thyroid surgery. Langenbecks Arch Surg. 2004 Nov;389(6):499–503.
  8. Sh³dlovs'kii VO, Divak MP, Sh³dlovs'kii OV, Kozak OL, Roznovs'kii IaR. Patent Ukra¿ni ¹66648. Pristr³i dlia ³dentif³kats³¿ gortannogo nerva [A device for identification of laryngeal nerve]. Biul Promislova Vlasn³st'. 2012;(1).
  9. Sh³dlovs'kii VO, Divak MP, Sh³dlovs'kii OV, Kozak OL, Roznovs'kii IaR. Patent Ukra¿ni ¹99228. Pristr³i dlia ³dentif³kats³¿ gortannogo nerva [A device for identification of laryngeal nerve]. Biul. Promislova Vlasn³st'. 2012;(14).
Address for correspondence:
46001, Ukraina, g. Ternopol', maidan Voli, d. 1, GVUZ "Ternopol'skii gosudarstvennyi meditsinskii universitet imeni I.Ia. Gorbachevskogo, MOZ Ukrainy", kafedra obshchei i operativnoi khirurgii s topograficheskoi anatomiei,
e-mail: shovk76@mail.ru,
Shidlovskii Aleksandr Viktorovich
Information about the authors:
Shidlovskyi A.V. PhD, associate professor of general and operative surgery chair with topographic anatomy of SHEE “Ternopil State Medical University named after I.Ya. Gorbachevsky, MPH of the Ukraine”.
Roznovskyi Y.R. A post-graduate student of general and operative surgery chair with topographic anatomy of SHEE “Ternopil State Medical University named after I.Ya. Gorbachevsky, MPH of the Ukraine”.

G.P. KOTELNIKOV, I.I. LOSEV, Y.V. SIZONENKO, S.E. KATORKIN

PECULIARITIES OF DIAGNOSTICS AND TREATMENT TACTICS OF PATIENTS WITH COMBINED LESION OF THE MUSCULOSKELETAL AND THE VENOUS SYSTEMS OF THE LOWER LIMBS

SBEE HPE “Samara State Medical University”
The Russian Federation

Objectives. To improve the treatment of patients with a combined pathology of the musculoskeletal and venous systems of the lower limbs through a comprehensive multidisciplinary approach to choice the optimal treatment tactics.
Methods. The results of a comprehensive survey of 452 patients with a combined pathology of the musculoskeletal and venous systems of the lower limbs have been analyzed. Clinical and instrumental studies (ultrasound dopplerography, computer tomography, plantography, goniometry, functional electromyography) were carried out. The patients with the pathology of the musculoskeletal system and accompanying chronic venous diseases of C3-C6 classes were subjected to a combined operative intervention (n=401) aimed to correct insufficiency of the peripheral venous hemodynamics and lymph outflow. Evaluation of life quality of patients was done using the questionnaire “SF-36 Healf Status Survey”. Criteria of the evidence-based medicine were used to evaluate the long-term results of surgical treatment (up to 3 years).
Results. C3 class was diagnosed in 168 (37%), C4 – in 124 (27%), C5 – in 102 (23%) and C6 – in 58 (13%) of all patients. Non-traumatic pathology of the feet was diagnosed in 404 (89%), arthrosis of the foot joints – in 203 (45%) patients. Clinical analysis of movements revealed the abnormalities of the step cycle and functional insufficiency of the lower limbs. Density of the skin and subcutaneous tissue increased up to 8,2±0,16 HU, the muscles in the back compartment of the shin – up to 4,3±0,18 HU. A combined pathology of the musculoskeletal and venous systems leads to the development of congestive arthrogenic syndrome. At C5-C6 classes the formation of chronic compartment syndrome is considered to be possible. At comorbidity of venous pathology of C3-C6 classes it is required to correct firstly the venous insufficiency. Orthopedic surgery was performed within 1-3 months after rehabilitation.
Conclusions. During medical rehabilitation of patients with combined lesions of the musculoskeletal and the venous system of the lower limbs, the multidisciplinary approach is considered to be necessary. The designed criteria of the systemic functional approach in diagnostics and treatment help to avoid common mistakes in treatment of the given category of patients.

Keywords: chronic venous insufficiency, foot deformation, functional diagnostics, correction
p. 42 – 53 of the original issue
References
  1. Kotel'nikov GP, Ryzhov PV, Losev II, Chernov A.P. Lechenie povrezhdenii i zabolevanii golenostopnogo sustava i stopy [Treatment of injuries and diseases of the ankle and foot]: monografiia. Moscow, RF: GEOTAR-Media; 2012.– 362 p.
  2. Zhukov BN, Katorkin SE, Iarovenko GV, Myshentsev PN, Sizonenko IaV. Biomekhanika dvizhenii pri khronicheskoi limfovenoznoi nedostatochnosti nizhnikh konechnostei [Biomechanics of movements in chronic lymphatic venous insufficiency of the lower extemities]. Flebologiia. 2011;5(2):33–37.
  3. Sushkou SA, Kukhtenkov PA, Nebylitsin IuS, Sushkova OS. Fenotipicheskii simptomokompleks displazii soedinitel'noi tkani pri nedostatochnosti glubokikh ven u bol'nykh varikoznoi bolezn'iu [Phenotypic symptom complex of connective tissue dysplasia with deep vein insufficiency in patients with varicose disease]. Novosti Khirurgii. 2006; 14(2):32–37.
  4. Sushkou SA. Oslozhneniia pri operativnom lechenii varikoznoi bolezni nizhnikh konechnostei [Complications of the surgical treatment of the lower extremities varicose veins]. Novosti Khirurgii. 2008;16(1):140–51.
  5. Grinevich TN. Venoznye trombozy v travmatologii i ortopedii: trudnosti diagnostiki [Venous thrombosis in traumatology and orthopedics: difficulty of diagnosing]. Novosti Khirurgii. 2010;18(1):124–32.
  6. Jablonski M, Turzanska K, Gorzelak M, Posturzynska A, Wojcik B, Pluta R. Asymptomatic thrombo-embolic venous disease before total hip replacement--when the risk is important? Chir Narzadow Ruchu Ortop Pol. 2008 Nov-Dec;73(6):381–85.
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  8. Kotel'nikov GP, Shpigel' AS. Dokazatel'naia meditsina. Nauchno obosnovannaia praktika [Evidence-based medicine. Evidence-based practice]: monografiia. Moscow, RF: GEOTAR-Media; 2012. 336 p.
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  12. Shurnas PS. Hallux rigidus: etiology, biomechanics, and nonoperative treatment. Foot Ankle Clin. 2009 Mar;14(1):1–8.
  13. Schuh R, Trnka HJ, Sabo A, Reichel M, Kristen KH. Biomechanics of postoperative shoes: plantar pressure distribution, wearing characteristics and design criteria: a preliminary study. Arch Orthop Trauma Surg. 2011 Feb;131(2):197–203.
  14. Christenson JT, Prins C, Gemayel G. Subcutaneous fasciotomy and eradication of superficial venous reflux for chronic and recurrent venous ulcers: mid-term results. Phlebology. 2011 Aug;26(5):197–202.
  15. Zhukov BN, Katorkin SE, Zhukov AA, Kravtsov PF, Isaeva ES. Kliniko-funktsional'nyi analiz variantov operativnykh vmeshatel'stv pri oslozhnennykh formakh khronicheskoi venoznoi nedostatochnosti s pozitsii dokazatel'noi meditsiny [Clinical and functional analysis of the choice surgery in complicated forms of chronic venous insufficiency from the point of evidence-based medicine]. Khirurg. 2012;(7):45–51.
Address for correspondence:
443079, Rossiiskaia Federatsiia, g. Samara, pr. K. Marksa, d. 165 "B", Kliniki Samarskogo gosudarstvennogo meditsinskogo universiteta, kafedra i klinika travmatologii, ortopedii i ekstremal'noi khirurgii, laboratoriia klinicheskoi biomekhaniki,
e-mail: ysizonenko@yandex.ru,
Sizonenko Iaroslav Vladimirovich
Information about the authors:
Kotelnikov G.P. Academician of RAMS, Honoured Science Worker of the Russian Federation, MD, professor, a head of the department and clinic of traumatology, orthopedics and emergency surgery, Rector of SBEE HPE “Samara State Medical University”.
Losev I.I. MD, professor of the department and clinic of traumatology, orthopedics and emergency surgery, Vice-rector on clinical affairs of SBEE HPE “Samara State Medical University”.
Sizonenko Y.V. PhD, a head of the clinical biomechanics laboratory of SBEE HPE “Samara State Medical University”.
Katorkin S.E. PhD, an associate professor of the hospital surgery chair and clinics of SBEE HPE “Samara State Medical University”.

S.D. SHAPOVAL, I.L. SAVON, D.A. SMIRNOVA, M.M. SOFILKANYCH

CHARACTERISTIC OF MICROCIRCULATION OF THE LOWER EXTREMITIES IN PATIENTS WITH COMPLICATED DIABETIC FOOT

SE “Zaporozhye Medical Academy of Post-graduate Education”,
The Ukraine

Objectives. Using laser Doppler flowmetry technique to study the blood flow in the lower extremities in patients with the complicated diabetic foot syndrome (DFS) and to reveal the specific microcirculatory disturbances for each clinical form.
Methods. 246 patients with the complicated DFS were investigated. Patients’ age was 59,4±3,3 years. There were 155 males (63%) and 91 females (37%). All the patients had diabetes mellitus (DM) of the 2nd type, the average duration of disease made up 12,3±1,5 years. In accordance with the classification of the International Working Group on the problems of diabetic foot (Netherlands, 1991), the patients were divided according to clinical forms. The study of microcirculation was carried out using laser Doppler flowmetry.
Results. At the neuropathic form of complicated DFS peripheral autosympathectomy results in loss of neurogenic control. Despite of increasing of arterial blood inflow due to the lack of sympathetic regulation of microcirculation an accelerated discharge of the blood through arteriovenous shunts occurs. At the ischemic form the microcirculation parameters indicate the blood stagnation in the arterioles and venular link. Increasing of the variable component of the microcirculation is due to both more intense functioning of mechanisms of the active control of microcirculation and as a result of increasing of cardiac and respiratory rhythms. At the mixed form more intense functioning of mechanisms of the active control of the microcirculation was revealed. Increasing of the neurogenic oscillations amplitude leads to the increase in the arteriolar tonus and myogenic vibrations that contributes to reduction of the peripheral resistance in the capillary network.
Conclusions. At the neuropathic form of the complicated DFS the loss of neurogenic control results in precapillary vasoconstriction, increase of intracapillary pressure and amplification of the blood flow through the arteriolovenular shunts. At the ischemic form the presence of irregularities associated with a decrease of arterial blood flow volume and sympathetic regulation. At the mixed form the disturbances in the regulation on account of reducing of endothelial secretion, activation of neurogenic and myogenic control mechanisms are registered.

Keywords: laser Doppler flowmetry, microcirculation, diabetic foot syndrome
p. 54 – 60 of the original issue
References
  1. Leonovich SI, Kondratenko GG, Bezvoditskaia AA, Taganovich DA. Sindrom diabeticheskoi stopy aktual'nost' problemy sokhraniaetsia [Diabetic foot syndrome - the actuality of the problem remains]. Belorus Med Zhurn. 2003(1); 8–11.
  2. Monami M, Vivarelli M, Desideri CM, Colombi C, Marchionni N, Mannucci E. Pulse pressure and prediction of incident foot ulcers in type 2 diabetes. Diabetes Care. 2009 May;32(5):897–9.
  3. Izumi Y, Satterfield K, Lee S, Harkless LB, Lavery LA. Mortality of first-time amputees in diabetics: a 10-year observation. Diabetes Res Clin Pract. 2009 Jan;83(1):126–31.
  4. Andrukhova R V, Zaitsev MV. D³abetichna stopa – problema suchasnogo susp³l'stva [Diabetic foot - a problem of modern society]. Ortopediia, Travmatol i Protez. 2005(3); 85–88.
  5. Efimov AS, Bolgarskaia SV, Taran EV. Sindrom diabeticheskoi stopy [Diabetic foot syndrome]. S³meina Meditsina. 2008(1);45–5.
  6. Gracheva OA, Smirnova ON, Nosenko EM. Porazhenie perifericheskikh sosudov u bol'nykh sakharnym diabetom [Peripheral vascular disease in patients with diabetes mellitis]. Kremlevskaia meditsina. Klin Vestn. 2003(1); 36–40.
  7. Pavlova MG, Gusev GV, Lavritseva NV. Sindrom diabeticheskoi stopy [Diabetic foot syndrome]. Trudnyi patsient. 2006;4 (1):32–8.
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  10. Balabolkin MI, Klebanova EM, Kreminskaia VM. Patogenez i mekhanizm razvitiia angiopatii pri sakharnom diabete [The pathogenesis and mechanism of the development of angiopathy in diabetes mellitis]. Kardiol. 2000(10): 47-87.
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  12. Faglia E, Clerici G, Clerissi J, Gabrielli L, Losa S, Mantero M, Caminiti M, Curci V, Quarantiello A, Lupattelli T, Morabito A. Long-term prognosis of diabetic patients with critical limb ischemia: a population-based cohort study. Diabetes Care. 2009 May;32(5):822–27.
  13. Chuian EN, Tribrat NS. Metodicheskie aspekty primeneniia metoda lazernoi dopplerovskoi floumetrii [Methodological aspects of laser Doppler flowmetry application]. Uchenye zapiski TNU Biologiia.Khimiia.2008;21(2):156-172.
  14. Svetukhin AM, Amirmanov IuA, Zemlianoi AB i dr. Osobennosti narushenii sistemy mikrotsirkuliatsii i ikh korrektsiia u bol'nykh s gnoino-nekroticheskimi formami sindroma diabeticheskoi stopy [Features of microcirculation disorders and correction them in patients with pyonecrotic forms of diabetic foot]. Khirurgiia. Zhurn. im NI Pirogova. 2006(10): 30–40.
  15. Hunt D. Diabetes: foot ulcers and amputations. Clin Evid (Online). 2009 Jan 12;2009. pii: 0602.
  16. Edmonds M. Double trouble: infection and ischemia in the diabetic foot. Int J Low Extrem Wounds. 2009 Jun;8(2):62–3.
  17. Alwakeel JS, Al-Suwaida A, Isnani AC, Al-Harbi A, Alam A. Concomitant macro and microvascular complications in diabetic nephropathy. Saudi J Kidney Dis Transpl. 2009 May;20(3):402–9.
Address for correspondence:
69096, Ukraina, g. Zaporozh'e, bul. Vintera, d. 20, GU "Zaporozhskaia meditsinskaia akademiia poslediplomnogo obrazovaniia", kafedra ambulatornoi, gnoino-septicheskoi khirurgii i ul'trazvukovoi diagnostiki,
e-mail: konsilium@ukr.net,
Shapoval Sergei Dmitrievich
Information about the authors:
Shapoval S.D. MD, professor, the first vice-rector, a head of ambulatory, pyoseptic surgery and ultrasound diagnostics chair of SE “Zaporozhye Medical Academy of Post-graduate Education”.
Savon I.L. PhD, an applicant for Doctor’s degree of ambulatory, pyoseptic surgery and ultrasound diagnostics chair of SE “Zaporozhye Medical Academy of Post-graduate Education”.
Smirnova D.A. A clinical intern of ambulatory, pyoseptic surgery and ultrasound diagnostics chair of SE “Zaporozhye Medical Academy of Post-graduate Education”.
Sofilkanych M.M. An extramural post-graduate student of ambulatory, pyoseptic surgery and ultrasound diagnostics chair of SE “Zaporozhye Medical Academy of Post-graduate Education”.

S.N. EROSHKIN1, A.P. KUTKO2, V.P. BULAVKIN1

EFFICACY OF LOWER LIMBS REVASCULARIZATION METHODS IN PATIENTS WITH PURULENT-NECROTIC FORMS OF DIABETIC FOOT SYNDROME

EE “Vitebsk State Medical University” 1,
ME “Vitebsk Regional Clinical Hospital” 2,
The Republic of Belarus

Objectives. To compare the short-term results of treatment of patients with purulent-necrotic forms of diabetic foot syndrome (DFS) by using various methods of the peripheral blood flow improvement in the limbs (medical, direct and indirect revascularization).
Methods. Analysis of data on the treatment of 100 patients with purulent-necrotic forms of diabetic foot syndrome (DFS) is presented; the following various types of revascularization were applied: medical one (n=47); percutaneous balloon angioplasty (n=35); a revascularizating osteotrepanation of the tibia using the method of F.N. Zusmanovich (n=18). Critical ischemia of the lower limb was confirmed by ultrasound duplex results of angioscaning and angiography. To assess impact of various revascularization methods on the lower limb blood supply the partial pressure of oxygen, carbon dioxide and lactate content in the venous blood of the affected limb was determined; dermal thermometry was conducted. The main clinical criteria of efficacy were considered to be the trophic ulcers closure, the number of the resection interventions on the foot and the number of amputations performed above the talocrural joint gap.
Results. Statistically reliable enhancement of the Doppler ultrasound parameters in relation to the preoperative level was obtained only after the percutaneous balloon angioplasty (three investigated groups). Reduction of lactate, increase of the oxygen partial pressure in the venous blood of the limb as well as increase of dermal temperature in the limb after revascularization was registered both after the percutaneous balloon angioplasty and after the revascularizating osteotrepanation. No reliable changes of the given parameters were obtained after the conservative treatment. The percentage of amputations performed in the recent period above the talocrural joint gap after medical revascularization made up 19,1%, after the percutaneous balloon angioplasty – 2,8% and after the revascularizating osteotrepanation – 11,1%.
Conclusions. Efficacy of the conservative treatment aimed to enhancement of the blood flow in the lower limb at DFS remains low. The percutaneous balloon angioplasty is considered to be the optimal method of the limb revascularization at the purulent-necrotic forms of DFS. In cases of impossibility to perform the percutaneous balloon angioplasty due to peculiarities of the vascular bed lesions, the revascularizating osteotrepanation is justified with the aim of limb revascularization.

Keywords: diabetic foot syndrome, lower limb revascularization, oxygen partial pressure, blood lactate, resection of the foot
p. 61 – 68 of the original issue
References
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Address for correspondence:
210023, Respublika Belarus', g. Vitebsk, pr-t Frunze, d. 27, UO "Vitebskii gosudarstvennyi ordena Druzhby narodom meditsinskii universitet", kafedra gospital'noi khirurgii s kursami urologii i detskoi khirurgii,
e-mail: eroshki@rambler.ru,
Eroshkin Sergei Nikolaevich
Information about the authors:
Eroshkin SN. Assistant of the hospital surgery chair with the courses of urology and pediatric surgery of EE “Vitebsk State Medical University”.
Kutko AP. A head of the angiography study of ME “Vitebsk regional clinical hospital”.
Bulavkin VP. PhD, associate professor of surgery chair of the faculty of training and retraining of the staff of EE “Vitebsk State Medical University”.

TRANSPLANTOLOGY

A.F. MINOU, A.M. DZYADZKO, A.E. SHCHERBA, O.O. RUMO

INFLUENCE OF THE TACTICS OF INTENSIVE THERAPY OF HEMOSTATIC DISORDERS ON INTRAOPERATIVE BLOOD TRANSFUSION REQUIREMENTS AND COURSE OF POSTOPERATIVE PERIOD FOLLOWING LIVER TRANSPLANTATION

RSPC "Transplantation of Organs and Tissues",
EHP "The 9th City Clinical hospital of Minsk"
The Republic of Belarus

Objectives. To compare the efficiency of intensive therapy of hemostatic disorders based on thromboelastometric data with the efficiency of intensive therapy of hemostatic disorders according to standard coagulation tests results.
Methods. 70 patients who underwent liver transplantation were enrolled in the study. Patients were randomized into two groups. The study group comprised of 35 patients to whom hemostatic abnormalities were corrected according to the thromboelastometric data, the control group comprised of 35 patients to whom hemostatic abnormalities were corrected according to standard coagulation tests results.
Results. Intensive therapy of hemorrhagic syndrome based on thromboelastometric data permits to reduce the blood loss from 1800 (1300-2000) ml to 1200 (1000-1700) ml and the amount of transfusions of RBCand FFP from 1447 (920-2120) ml and 2600 (2000-3400) ml to 1056 (692-1286) ml and 500 (0-1200) ml, respectively. Reduction of blood transfusions has led to decrease of the incidence of acute kidney injuries (from 88,6% to 65,7%) and shortening of the length of stay in intensive care units (from 6 to 5 days) and in the hospital (from 18 to 16 days).
Conclusions. The study confirmed the high efficiency of intensive therapy of hemostasis disorders based on thromboelastometric data compared with intensive therapy of hemostasis disorders based on the results of standard coagulation tests.

Keywords: liver transplantation, blood loss, thromboelastometrys
p. 69 – 78 of the original issue
References
  1. Ozier Y, Pessione F, Samain E, Courtois F. Institutional variability in transfusion practice for liver transplantation. Anesth Analg. 2003 Sep;97(3):671–79.
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  6. Minou AF, Dziadz'ko AM, Rummo OO. Tromboelastometricheskie kriterii korrektsii narushenii gemostaza pri transplantatsii pecheni [The thromboelastometric criteria of hemostasis disorders correction during liver transplantation]. Anesteziol i Reanimatol. 2012;(2):35–41.
  7. Stevens LA, Coresh J, Schmid CH, Feldman HI, Froissart M, Kusek J, Rossert J, Van Lente F, Bruce RD 3rd, Zhang YL, Greene T, Levey AS. Estimating GFR using serum cystatin C alone and in combination with serum creatinine: a pooled analysis of 3,418 individuals with CKD. Am J Kidney Dis. 2008 Mar;51(3):395–406.
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  13. Gorlinger K, Dirkmann D, Muller-Bei?enhirtz H, Paul A, Hartmann M, Saner F. Thromboelastometry-based perioperative coagulation management in visceral surgery and liver transplantation: experience of 10 years and 1105 LTX. Liver Transplant. 2010;16(Suppl. 1):S86.
  14. Schochl H, Nienaber U, Hofer1 G, Voelckel W, Jambor C, Scharbert G, S Kozek-Langenecker, C Solomon. Goal-directed coagulation management of major trauma patients using thromboelastometry (ROTEM®)-guided administration of fibrinogen concentrate and prothrombin complex concentrate. Critical Care. 2010;14(Issue 2):R55.
  15. Minou A. Assessment of hemostatic balance in patients with liver cirrhosis with thromboelastometry: 6AP1?2. Eur J Anaesthesiol. 2012 June;29(Issue):91.
  16. Fishman JA, Rubin RH. Infection in organ-transplant recipients. N Engl J Med. 1998 June 11;338(24):1741–51.
  17. Brand A. Immunological aspects of blood transfusions. Transpl Immunol. 2002 Aug;10(2–3):183–90.
  18. Fugger R, Hamilton G, Steininger R, Mirza D, Schulz F, Muhlbacher F. Intraoperative estimation of endotoxin, TNF alpha, and IL-6 in orthotopic liver transplantation and their relation to rejection and postoperative infection. Transplantation. 1991 Aug;52(2):302–6.
  19. Lee KW, Son TS, Joh JW, Kim SJ, Park JH, Chon SE, Choi SH, Heo JS, Kim YI, Lee BB, Lee SK. Perioperative cytokine response after liver transplantation. Transplant Proc. 2003 Feb;35(1):407–8.
Address for correspondence:
220116, Respublika Belarus', g. Minsk, ul. Semashko, d. 8, UZ "9-ia Gorodskaia klinicheskaia bol'nitsa g. Minska", RNPTs Transplantatsii organov i tkanei, otdelenie anesteziologii,
e-mail: andrei.minou@gmail.com,
Minov Andrei Fedorovich
Information about the authors:
Minou A.F. A head of the anesthesiology and resuscitation department of RSPC “Transplantation of organs and tissues”, ME “The 9th Minsk city clinical hospital”.
Dzyadzko A.M. PhD, a head of the anesthesiology and resuscitation department of RSPC “Transplantation of organs and tissues”, ME “The 9th Minsk city clinical hospital”.
Shcherba A.E. PhD, a head of the transplantation department of RSPC “Transplantation of organs and tissues”, ME “The 9th Minsk city clinical hospital”.
Rumo O.O. MD, a head of RSPC “Transplantation of organs and tissues”, deputy chief physician on surgery of ME “The 9th Minsk city clinical hospital”.

MAXILLOFACIAL SURGERY

I.O. POHODENKO-CHUDAKOVA, A.V. SURIN

COMPARATIVE CORRELATION OF MICROCRYSTALLIZATION OF BIOLOGICAL MEDIA IN PATIENTS WITH CHRONIC ODONTOGENIC SINUSITIS OF THE MAXILLARY SINUS

EE “Belarusian State Medical University”,
The Republic of Belarus

Objectives. To make a comparative correlation of microcrystallization data of the biological media in patients with chronic odontogenic sinusitis of the maxillary sinus.
Methods. The object of the research was the parameter of microsrystallization of three biological liquids (oral fluid, exudation of the nasal cavity (24 patients), intraoperational materials from the maxillary sinus during the radical operation (15 patients). All indicated patients had odontogenic sinusitis of the maxillary sinus. The age of the patients varied from 20 up to 49 years.
Results. According to parameters of the oral fluid microcrystallization the I type was identified in 9 quadrants (3%), the II type – in 84 quadrants (29%), the III type –in 195 quadrants (68%). Examination of the nose exudation on the injured side has detected the I type in 11 quadrants (4%), II type – in 78 quadrants (27%), III type – in 199 quadrants (69%). During the examination of microsrystallization parameter of the intraoperational materials the I type was determined in 2 quadrants (1%), the II type – in 52 quadrants (29%), the III type – in 126 quadrants (70%). Microcrystallization parameters of the oral fluid – 2,7 (2,3-2,75), exudation from the nasal cavity – 2,6 (2,3-2,7), the intraoperational materials – 2,7 (2,2-2,7) had no statistically significant differences.
Conclusions. Taking into consideration the high percent of correlation level of microcrystal structures in the examined biological liquids in patients with odontogenic sinusitis of the maxillary sinus the authors conclude that data of microcrystallization of biological media is considered as a general parameter of the patient’s homeostasis which could be used as for effectiveness evaluation of prophylactic, therapeutic and rehabilitative procedures as for prognostication of disease course.

Keywords: maxillary sinus, sinusitis, biological liquid, microcrystallization,
p. 79 – 83 of the original issue
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  4. Sakovich AR. Sravnitel'noe issledovanie sistemnoi i lokal'noi kontsentratsii S-reaktivnogo belka u patsientov s ostrym gnoinym sinusitom [Comparative study of systemic and local concentrations of C-reactive protein in patients with acute purulent sinusitis]. Meditsin Zhurn. 2012;(2):102–4.
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  6. Sakovich AR. Prognosticheskaia otsenka gematologicheskikh leikotsitarnykh indeksov pri orbital'nykh oslozhneniiakh ostrogo sinusita [Prognostic evaluation of hematological leukocyte indices in orbital complications of acute sinusitis]. Voennaia Meditsina 2012;(3): 62–5.
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  8. Pokhodenko-Chudakova IO, Kazakova IuM. Refleksoterapiia v kompleksnom lechenii odontogenykh abstsessov cheliustno-litsevoi oblasti: monografiia [Reflexology in combined treatment of odontogenic abscesses in maxillofacial area]. Minsk, RB: Izd. tsentr BGU, 2011. 133 p.
  9. Hoshi K, Ejiri S, Ozawa H. Ultrastructural, cytochemical and biophysical aspects of mechanisms of bone matrix calcification. Kaibogaku Zasshi. 2000 Oct;75(5):457-65.
  10. Skripkina G.I., Pitaeva A.N., Suntsov V.G. Tipy mikrokristallizatsii sliuny v sovokupnosti s fiziko-khimicheskimi parametrami rotovoi zhidkosti u kariesrezistentnykh detei shkol'nogo vozrasta [The types of saliva microcrystallisation in conjunction with physical and chemical parameters of oral liquid in caries resistant school-age children]. Institut Stomatologii. 2011;(1)50:118–21.
  11. Alekseeva OP, Vorob'ev AV. Kristallografiia sliuny - novyi neinvazivnyi metod diagnostiki infektsii H. Pylori [Crystallography of saliva - a new noninvasive method for diagnosis of H. Pylori]. Nizhegorodskii Med Zhurn. 2003;(2):73–8.
  12. Timofeeva AA. Kristallograficheskii metod issledovaniia sliuny pri odontogennykh vospalitel'nykh zabolevaniiakh cheliusti [Saliva crystallographic method of studies in odontogenic inflammatory diseases of the jaw]. Stomatologiia. 1987;(60)3:15–7.
  13. Shatokhina SN. Funktsional'naia morfologiia biologicheskikh zhidkostei – novoe napravlenie v klinicheskoi laboratornoi diagnostike [Functional morphology of biological fluids - a new direction in the clinical laboratory diagnostics]. Al'manakh Klin Med. 2008;(18): 50–6.
  14. Pokhodenko-Chudakova IO, Kazakova IuM, Adamchik IuA. Kompleksnoe lechenie odontogennykh sinusitov s primeneniem refleksoterapii [Comprehensive treatment of odontogenic sinusitis by reflexology application]. Stomatol Zhurn. 2005;(2):28–30.
  15. Pokhodenko-Chudakova IO, Kazakova IuM, Pokhoden'ko ND. Sposob otsenki effektivnosti provedennogo lechebnogo meropriiatiia pri gnoino-vospalitel'nom zabolevanii cheliustno-litsevoi oblasti [A method for evaluation of the treatment effectiveness in chronic inflammatory disease of the maxillofacial area]. ¹ 14565 Resp. Belarus / zaiavitel': UO «Belorusskii gosudarstvennyi meditsinskii universitet».¹ a 20090082; zaiavl. 23.01.2009; opubl. 23.03.2011 // Afitsyiny biuleten'. Vynakhodstva, karysnyia madeli, pramyslovyia ¢zory. 2011;(3)80:137.
Address for correspondence:
220116, Respublika Belarus', g. Minsk, pr-t. Dzerzhinskogo, d. 83, UO "Belorusskii gosudarstvennyi meditsinskii universitet", kafedra khirurgicheskoi stomatologii,
e-mail: ip-c@yandex.ru,
Pokhoden'ko-Chudakova Irina Olegovna
Information about the authors:
Pokhodenko-Chudakova I.O. MD, professor, a head of the surgical dentistry chair of EE “Belarusian State Medical University”.
Surin A.V. Post-graduate student of the surgical dentistry chair of EE “Belarusian State Medical University”.

NEW METHODS

S.V. SHALASHOV 2, L.K. KULIKOV 1, I.A. EGOROV 2, A.L. MIKHAILOV 2, O.A. BUSLAEV 2, I.A. GORBUNOV 2, YU.V. MANN 2

Y-PLASTY AT INGUINAL HERNIAS

SBEE APE “Irkutsk State Medical Academy of Postgraduate Education of the Ministry of Health of Russian Federation” 1
NGHA “Railway Clinical Hospital at the Station Irkutsk-Passenger” of JSC “Russian Railways” 2,
The Russian Federation

Objectives. To estimate efficiency of Y-plasty at inguinal hernias.
Methods. The research covering 80 patients has been conducted. The operation by the technique of I.L. Lichtenstein was carried out in 42 patients; they made up the group of clinical comparison (GCC).Using own designed technique of Y-plasticity 38 patients who made up the main group (MG) were operated on.
Results. While performing the herniaplasty by I.L. Lichtenstein (GCC) the time of surgery was 52,5±13,3 minutes. Using our own designed surgical technique (MG) the duration of the operation made up 41,6±13,9 minutes. There was no any complications during the early postoperative period both in GCC and in MG. Within the period from 12 months up to 2 years the results of surgical treatment in 30 patients from MG and in 36 of GCC were analyzed. Recurrence of hernias and the late complications were not observed. Applying the Y-plasty technique fewer cases of the postoperative pains and discomfort in the operation zone in comparison with I.L. Lichtenstein technique has been revealed. In GCC patients unpleasant feelings (discomfort, sensation of a foreign body) and pain in the operation field were registered in 22% of cases. In MG unpleasant feelings and rare pains in the field of operation were noted in 3 (10%) the patients.
Conclusions. The Y-plasty technique at inguinal hernias has all advantages of the present “tension-free” techniques and in patients less than 50 years with hernias of II, IIIÀ, and IIIÂ types can compete in efficiency with prosthetic techniques. The “tension-free” technique at inguinal hernias is simple in use and can reliably and quickly repair inguinal hernia without the application of prosthetic material. At Y-plasty of inguinal hernias the smaller number of cases of the postoperative painful manifestations and discomfort in the intervention zone in comparison with the operation by I.L. Lichtenstein is registered.

Keywords: inguinal hernia, hernioplasty, “tension-free” method
p. 84 – 89 of the original issue
References
  1. Kukudzhanov NI. Pakhovye gryzhi [Inguinal hernias]. Moscow, RF: Meditsina; 1969. 440 p.
  2. Protasov AV, Krivtsov GA, Tabuika AV, Mikhaleva AM, Shukhtin NIu. Vliianie setchatogo implantata na reproduktivnuiu funktsiiu pri pakhovoi gernioplastike (eksperimental'noe issledovanie) [The influence of the mesh implant on reproductive function in inguinal hernia repair (experimental study)]. Khirurgiia Zhurn im NI Pirogova. 2010;(8):28–32.
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  4. Baburin AB, Fedaev AA, Loginov VI, Romanov RV, Parshikov VV. Otkrytye nenatiazhnye vmeshatel'stva po povodu pakhovykh gryzh u muzhchin molodogo vozrasta [Open tension – free interventions of inguinal hernias in young men]. Sovrem Problemy Nauki i Obrazovaniia. 2012;(5):18.
  5. Bendavid R. Dysejaculation. Hernia. 2009;(1):24.
  6. Dohle GR, van Roijen JH, Pierik FH, Vreeburg JT, Weber RF. Subtotal obstruction of the male reproductive tract. Urol Res. 2003 Mar;31(1):22–4.
  7. Kusnierczuk R, Lorek M. Inguinal hernia repair using own surgical technique -results of 500 operative procedures. Chirurgia Polska. 2003; 5(3):145–53.
  8. Mikhaleva LM, Protasov AV, Tabuika AV. Morfofunktsional'naia kharakteristika reproduktivnykh organov posle provedeniia operatsii modelirovaniia gernioplastiki v eksperimente [Morpho-functional characteristics of the reproductive organs after hernia repair in experiment]. Uspekhi Sovrem Estestvoznaniia. 2009;(7):78–79.
  9. Protasov A.V. Morfologicheskaia kharakteristika polovykh organov samtsov posle allotransplantatsii pri modelirovanii operatsii gernioplastiki v eksperimente [Morphological characteristics of male sex organs after allotransplantation in modeling of hernia repair]. Gerniologiia. 2009;(1):30–31.
  10. Hallen M, Sandblom G, Nordin P, Gunnarsson U, Kvist U, Westerdahl J. Male infertility after mesh hernia repair: A prospective study. Surgery. 2011 Feb;149(2):179–84.
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  12. Mitura K, Romanczuk M. Comparison between two methods of inguinal hernia surgery – Lichtenstein and Desarda. Pol Merkur Lekarski. 2008; 24(143): 392–95.
  13. Vlasov VV, Mikitiuk SR, Greshilo OO, Zagoruiko VV. Operatsiia Desarda – sozdanie «novoi» zadnei stenki pakhovogo kanala v lechenii pakhovoi gryzhi [Operation Desarda - the creation of a "new" back wall of the inguinal canal in the treatment of inguinal hernia]. Gerniologiia. 2008;2:11–17.
  14. Shalashov SV, Kulikov LK, Egorov IA, Mikhailov AL, Buslaev OA. Sposob plastiki pri pakhovykh gryzhakh [Method of inguinal hernias plasty]. Patent Ros Federatsii. ¹2452405 MPK7 A61V 17/00; zaiavitel' Irkut gos med akad poslediplom obrazovaniia MZ RF. ¹2011102411/14; zaiavl. 21.01.2011; opubl. 10.06.12. Biul;(16).
  15. Nyhus LM. Classification of groin hernia: milestones. Hernia. 2004 May;8(2):87–8.
Address for correspondence:
664013, Rossiiskaia Federatsiia, g. Irkutsk, ul. Obraztsova, d. 27, NUZ "Dorozhnaia klinicheskaia bol'nitsa na stantsii Irkutsk-Passazhirskii" OAO "RZhD",
e-mail: Sersha62@gmail.com
Shalashov Sergei Vladimirovich  
Information about the authors:
Shalashov S.V. PhD, a surgeon of the surgical department of NGHA “Railway clinical hospital at the station Irkutsk-Passenger” of JSC “Russian Railways”.
Kulikov L.K. MD, professor, a head of the surgery chair of SBEE APE “Irkutsk State Medical Academy of Postgraduate Education of the Ministry of Health of the Russian Federation.
Egorov I.A. A surgeon of the surgical department of NGHA “Railway clinical hospital at the station Irkutsk- Passenger” of JSC “Russian Railways”.
Mikhailov A.L. A surgeon of the surgical department of NGHA “Railway clinical hospital at the station Irkutsk- Passenger ” of JSC “Russian Railways”.
Buslaev O.A. A head of the surgical department of NGHA “Railway clinical hospital at the station Irkutsk-Passenger” of JSC “Russian Railways”.
Gorbunov I.A. An anesthesiologist of the anesthesiology and intensive care unit of NGHA “Railway clinical hospital at the station Irkutsk- Passenger” of JSC “Russian Railways”.
Mann Yu.V. A head of the surgical department of the policlinic of NGHA “Railway clinical hospital at the station Irkutsk-Passenger” of JSC “Russian Railways”.

INFORMATION TECHNOLOGIES IN SURGERY

S.A. SUSHKOU, G.D. KOROBOV, O.D. MYADELETS

A METHOD OF DETECTION OF POSTERIOR TIBIAL VENOUS WALL ATROPHY AT VARICOSE DISEASE

EE “Vitebsk State Medical University”
The Republic of Belarus

Objectives. To work out the diagnostic method of atrophy of the posterior tibial veins wall at varicose disease.
Methods. Morphological changes in the wall of the posterior tibial veins at varicose disease were studied in 43 patients (females – 26/60,5%, males – 17/39,5%). The patient’s age varied between 24-66, the average age – 46,9±8,5 years (̱σ). Disease duration oscillated between 1-30 years (the average – 12,7±7,3 ëåò years, ̱σ). The material for histological studies was taken during operations from the posterior tibial veins. The histological preparations were stained with hematoxylin-eosin, examined by Heidenhain and studied by means of light microscopy. Volumetric ratios of tissue components were evaluated by the method of G.G. Avtandilov. The age, duration of disease, character of work activity, body mass index, degree of retrograde flow in the femoral and popliteal veins were considered as the influencing factors. For probabilistic model providing the diagnostics of atrophic processes in the deep veins the discriminant analysis, logistic regression, ROC-analysis have been used as a basis of the most available clinical data.
Results. The simulative probabilistic model permitted to suggest a diagnostic method providing the detection of atrophic processes in the posterior tibial veins on the results basis of available instrumental and clinical studies has been worked out. Verification of the method in the control samples showed that all cases of diseases for which presence of atrophy was revealed by using the expert way (conclusion of a histologist), have been classified correctly with the help of calculated values (there were no false-negative diagnoses). Only in one case among patients without histologically detected arthrophy the calculated value turned out to be false positive which composed 10%. The sensitivity of the worked out method was 88,2%, specificity – 88,5%.
Conclusions. The worked out non-invasive evaluation method of the venous wall of the posterior tibial vein can be used to determine the tactics and choice of treatment of varicose disease.

Keywords: primary varicose veins, condition of deep veins, morphological changes of the venous wall, diagnostics
p. 90 – 102 of the original issue
References
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  14. Zhukov BN, Katorkin SE, Zhukov AA, Kravtsov PF, Isaeva ES. Kliniko-funktsional'nyi analiz variantov operativnykh vmeshatel'stv pri oslozhnennykh formakh khronicheskoi venoznoi nedostatochnosti s pozitsii dokazatel'noi meditsiny [Clinical and functional analysis of the options for surgery in complicated forms of chronic venous insufficiency in terms of evidence based medicine]. Khirurg, 2012(7):45–51
  15. Sushkov SA, Miadelets OD, Samsonova IV, Nebylitsin IuS, Sushkova OS, Kugaev MI. Morfologicheskie izmeneniia v stenke zadnikh bol'shebertsovykh ven pri varikoznoi bolezni nizhnikh konechnostei [Morphological changes in the posterior tibial vein wall with varicose disease of the lower extremities]. Vestn VGMU. 2006;.5(2):73–9.
  16. Sushkov SA, Miadelets OD, Korobov GD. Sravnitel'nyi analiz morfologicheskikh izmenenii v glubokikh venakh pri raznykh formakh varikoznoi bolezni [Comparative analysis of morphological changes in the deep veins of various forms of varicose disease]. Flebologiia. 2012;.6(3): 46-51.
Address for correspondence:
210023, Respublika Belarus', g. Vitebsk, pr. Frunze, d. 27, UO "Vitebskii gosudarstvennyi meditsinskii universitet", kafedra obshchei khirurgii,
e-mail: sergery@nm.ru,
Sushkou Sergei Al'bertovich
Information about the authors:
Sushkou S.A. PhD, associate professor, vice-rector on scientific research work of EE “Vitebsk State Medical University”.
Korobov G.D. PhD, associate professor of public health and public health care of EE “Vitebsk State Medical University”.
Myadelets O.D. MD, professor, a head of histology, cytology and embryology chair of EE “Vitebsk State Medical University”.

REVIEWS

E.V. MAHILIAVETS, P.V. GARELIK, N.I. BATVINKOV

METHODS OF LIVER REGENERATION STIMULATION AT LIVER CIRRHOSIS

EE “Grodno State Medical University”
The Republic of Belarus

The article analyses the results of the applied methods of the liver regeneration stimulation in terminal stages of chronic diffuse diseases.
Among the concepts of the given therapy one considers the following: growth factors, drugs of similar action, cell therapy, activation of regeneration by the action of damaging factors. Intensive search of new pharmacological methods of liver regeneration stimulating having reflected in numerous scientific publications testifies about dissatisfaction of clinicians and researchers by the effectiveness of available resources. Stimulation resection techniques of the liver cirrhosis are invasive and often there is a risk of induction of the liver failure due to a reduction of liver parenchyma volume. For a cell therapy some problematic questions concerning the percentage of newly formed hepatocytes replacement of the hepatic parenchyma and the absence of morphological selectivity have remained.

Keywords: liver cirrhosis, reparative regeneration, growth factors, cell therapy
p. 103 – 109 of the original issue
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Address for correspondence:
230023 Respublika Belarus' g. Grodno, ul. Gor'kogo, d. 80, UO "Grodnenskii gosudarstvennyi meditsinskii universitet", kafedroi obshchei khirurgii,
e-mail: emogilevec@yandex.ru,
Mahiliavets Eduard Vladislavovich
Information about the authors:
Mahiliavets E.V. PhD, an associate professor of the 1st chair of surgical diseases of EE “Grodno State Medical University”.
Garelik P.V. MD, a head of the general surgery chair of EE “Grodno State Medical University”.
Batvinkov N.I. MD, a head of the 1st chair of surgical diseases of EE “Grodno State Medical University”.

S.I. TRATSIAK, M.A. GERASIMENKO

MODERN ASPECTS OF SURGICAL TREATMENT OF KNEE JOINT SYNOVITIS OF RHEUMATOID GENESIS IN CHILDREN

EE “Belarusian State Medical University”, Minsk
The Republic of Belarus

Statistics of the current decade shows a significant negative contribution of rheumatic diseases to the structure of children’s morbidity and disability. Currently juvenile rheumatoid arthritis is considered as one of the actual problems of modern rheumaorthopedic due to significant growth of morbidity in recent years
Treatment of patients with juvenile rheumatoid arthritis is one of the complex and actual problems today. Dissatisfaction with the results of conservative treatment the severity of the musculoskeletal system lesion and the high disability of pediatric patients testify about the need of measures or interventions aimed at preventing the deformities and contractures, preservation and restoration of the knee joint mobility. Some aspects of conservative orthopedic and surgical treatment in children with a primary lesion of the knee in different clinical forms of juvenile rheumatoid arthritis, variations of treatment and activity of the process have insufficiently covered in the literature. The experience gained so far concerning the surgical treatment of synovitis in children suffering from rheumatoid arthritis is primarily attributable to the adult population. There is no consensus among the most authors concerning the indications for surgical treatment of synovitis in children with juvenile rheumatoid arthritis. According to many authors the timely removal of the inflamed synovial membrane allows not only stopping the phenomenon of synovitis, but also preventing or slowing down the degeneration of the articular cartilage, influencing on the overall activity of the disease and in some cases reaching the stage of clinical and immunological remission. Thus, the treatment of synovitis of the knee at juvenile rheumatoid arthritis in children is considered rather difficult and actual problem required further research.

Keywords: rheumatoid arthritis, synovitis, arthroscopy, knee joint
p. 110 – 115 of the original issue
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Address for correspondence:
220037, Respublika Belarus', g. Minsk, pr-t. Dzerzhinskogo, d. 83, UO "Belorusskii gosudarstvennyi meditsinskii universitet", kafedra travmatologii i ortopedii,
e-mail: s.i.tratsiak@tut.by,
Tret'iak Stanislav Iosifovich
Information about the authors:
Tratsiak S.I. An assistant of the traumatology and orthopedics chair of EE “Belarusian State Medical University”.
Gerasimenko M.A. MD, an associate professor, a head of the traumatology and orthopedics chair of EE “Belarusian State Medical University”.

CASE REPORTS

A.E. MISHINA 1, S.E. GLADUN 2, G.M. ZASTAVNITSKY 2, I.V. MISHIN 2,3

ENDOMETRIOSIS IN POSTOPERATIVE SCAR

SRI of Mother and Child Health Protection 1,
State University of Medicine and Pharmacy named after N. Testemitsanu 2,
National Scientific Practical Center of Emergency Medicine 3,
Kishinev,
The Republic of Moldova

Postoperative scar endometriosis (PSE) is considered to be a rare form of extragenital endometriosis and some case reports or small case series are published in the literature. Most frequently PSE is diagnosed after cesarean sections although observations of the given pathology after transabdominal gynecological and surgical procedure are also described. The authors present the case of preoperatively diagnosed and surgically treated PSE three years after cesarean section. The diagnosis was confirmed after morphological research of the removed macropreparation. There was no PSE recurrence in the long-term follow up period. We propose the literature review regarding the etiology, pathogenesis, particularities of the clinical signs, sensitivity and specificity of the radiological methods of diagnosis, as well as the principles of PSE surgical management.

Keywords: extragenital endometriosis, anterior abdominal wall
p. 116 – 119 of the original issue
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  13. Goel P, Devi L, Tandon R, Saha PK, Dalal A. Scar endometriosis - a series of six patients. Int J Surg. 2011;9(1):39–40.
  14. Pechenikova VA, Kostiuchek DF. Ekstragenital'nyi endometrioz: kliniko-morfologicheskii i immunogistokhimicheskii analiz 45 nabliudenii razlichnoi organnoi lokalizatsii [Extragenital endometriosis: clinical, morphological and immunohistochemical analysis of 45 cases of various organ localization]. Zhurn Akusherstva i Zhen Boleznei. 2010;LIX(Vyp 2):69–77.
Address for correspondence:
2004, Respublika Moldova, g. Kishinev, ul. Toma Chorbe, d. 1, Natsional'nyi nauchno-prakticheskii tsentr urgentnoi meditsiny,
e-mail: mishin_igor@mail.ru,
Mishin Igor' Valentinovich
Information about the authors:
Mishina A.E. PhD, a head of the operative gynecology, SRI of mother and child health protection of the Republic of Moldova.
Gladun S.E. PhD, an assistant of the obstetrics and gynecology chair of the faculty of the Postgraduate Educational of State University of Medicine and Pharmacy named after N.Testemitsanu.
Zastavnitsky G.M. PhD, a researcher of the laboratory of hepato-pancreato-biliary surgery of State University of Medicine and Pharmacy named after N. Testemitsanu.
Mishin I.V. MD, a deputy director on scientific-research work of National Scientific Practical Center of Emergency Medicine, a leading researcher of the laboratory of hepato-pancreato-biliary surgery of State University of Medicine and Pharmacy named after N.A. Testemitsanu.

TO HELP THE PRACTITIONER

V.J. KHRYSHCHANOVICH

POST-THROMBOTIC DISEASE: DIAGNOSTICS, TREATMENT, PREVENTION

EE “Belarusian State Medical University”,
The Republic of Belarus

Post-thrombotic disease (PTD) influences negatively on patient health and have a major economic impact to health-care services. Being the sequence of deep venous thrombosis (DVT) due to partial or complete venous occlusion and valvular reflux leading to increasing of venous pressure in the microcirculatory vascular bed.
The inflammatory process at DVT can contribute to the resorption of blood thrombus and it causes the destruction of venous valves. The diagnosis of PTD is principally based on clinical manifestations such as feelings of heaviness or pain in the leg, swelling, itch, convulsions, trophic ulcer and lipodermatosclerosis. Villalta scale is considered to be the most preferable among some clinical scales or classification of PTD. Risk factors for PTD development include a proximal DVT and recurrent thrombosis as well as obesity and varicose veins, non-adequate anticoagulation therapy of DVT. The treatment of PTD is usually performed according to the same principles as chronic venous insufficiency with compression therapy application and lower extremities elevation position. The role of vasoactive drugs in prevention and treatment of PTD has been studied insufficiently. Surgery can be applied only to very limited number of patients. Further studies are desperately needed to find out the role of thrombolysis and thrombectomy which by this time seem to be promising treatment. For patients with DVT more attention should be given to prescribing and application of compression hosiery.

Keywords: post-thrombotic disease, deep venous thrombosis, conservative treatment, surgical treatment, prevention
p. 120 – 128 of the original issue
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Address for correspondence:
220116, Respublika Belarus', g. Minsk, pr-t Dzerzhinskogo, d. 83, UO "Belorusskii Gosudarstvennyi Meditsinskii universitet", 2-ia kafedra khirurgicheskikh boleznei,
e-mail: vladimirkh77@mail.ru,
Khryshchanovich Vladimir Ianovich
Information about the authors:
Khryshchanovich V.J. PhD, an associate professor of the 2nd chair of surgical diseases of EE “Belarusian State Medical University”.
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