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Year 2015 Vol. 23 No 3

SCIENTIFIC PUBLICATIONS
EXPERIMENTAL SURGERY

A.V. BURAVSKY 1, E.V. BARANOV 1, S.I. TRETYAK 1, Z.B. KVACHEVA 2

INFLUENCE OF MONOCHROMATIC POLARISED LIGHT–EMITTING DIODE RADIATION ON THE PROLIFERATION OF CULTIVATED HUMAN DERMAL FIBROBLASTS

EE "Belarusian State Medical University" 1,
SSE "Institute of Biophysics ànd Cell Engineering
of NAS of Belarus" 2,
The Republic of Belarus

Objectives. To determine the physical parameters of a polarized light-emitting diode radiation (PLEDR) providing the stimulation of the proliferative activity (PA) of the human dermal fibroblast proliferation (HSF) in the cell culture.
Methods. Cultivated human dermal fibroblasts had not been radiated in the control group. Monolayer cell cultures in 16 experimental groups were radiated with monochromatic PLEDR, separately or sequentially using wavelengths λ1=(0,630±0,03) µm è λ2=(0,405±0,015) µm. The study of the mitotic and proliferative activity was carried out in 24-48 hours after the exposure; the morphology of the cells had been evaluated intravitally under a phase-contrast microscopy.
Results. The most pronounced stimulation of mitotic actirity (MA) was observed in the experimental groups after PLEDR with the wavelength of λ1=(0,630±0,03) µm at radiant energy density (RED) 10 J/cm2 and 15 J/cm2: the mitotic index 24 hours after radiation was 29,7±3,10 ‰ and 63,0±4,44‰, respectively, being reliably higher than in control. In 48 hours after radiation the evaluation of morphological changes and accumulation of cells in these groups had been revealed the "saturation cell density" increase in the monolayer due to their number growth at 1.6 folds in RED 10 J/cm2 and at 2.0 folds in RED 15 J/cm2 justifying increasing of proliferative activity (PA) cultured fibroblasts under the indicated photo-radiation parameters. In other experimental groups statistically significant reduction of MA or lack of difference towards the control group were observed.
Conclusion. The conducted research has confirmed the monochromatic PLEDR possibility to stimulate HSF proliferation in culture under the specific exposure parameters.

Keywords: human skin fibroblasts, monolayer cell culture, the morphology of the cell cultures, phase contrast microscopy, mitotic activity, polarized light-emitting diode radiation, proliferative activity
p. 247-255 of the original issue
References
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  3. Tret'iak SI, Baranov EV, Buravskii AV, Mostovnikov AV, Bondareva EA. Primenenie poliarizovannogo nekogerentnogo izlucheniia v kompleksnom lechenii patsientov s ranevymi defektami kozhi i miagkikh tkanei, troficheskimi iazvami, ozhogami i prolezhniami [The use of polarized incoherent radiation in complex treatment of patients with wound defects of the skin and soft tissues, trophic ulcers, burns and bedsores]. Minsk, RB: BGMU. 2012. 30 p.
  4. Tolstykh PI, Shirinskii VG, Mamontov PG, Shekhter AB, Sorokatyi AA, Romanova AS. Sravnitel'naia otsenka metodov stimuliatsii zazhivleniia lineinykh asepticheskikh ran [Comparative evaluation of stimulation methods of linear aseptic wounds healing]. Lazer Meditsina. 2009;(13)2:34-39.
  5. Iudintseva NM, Blinova MI, Pinaev GP. Osobennosti organizatsii tsitoskeleta u fibroblastov normal'noi, rubtsovoi i embrional'noi kozhi cheloveka, rasplastannykh na belkakh vnekletochnogo matriksa [Features of the organization of the cytoskeleton of normal fibroblasts, scar and embryonic human skin spread on extracellular matrix proteins]. Tsitologiia. 2008;(50)10:861-67.
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  11. Mostovnikov VA, Mostovnikova GR, Plavskii VIu, Serdiuchenko NS, Riabtsev AB, Plavskaia LG, Mostovnikov AV, Ginevich VV, Leusenko IA, Riabtseva EV, Kapskaia TS, Serdiuchenko SN. Reguliatornaia biologicheskaia aktivnost' i effektivnost' lechebnogo deistviia nizkointensivnogo lazernogo izlucheniia i izlucheniia sverkh"iarkikh svetodiodov [Regulatory biological activity and efficacy of the therapeutic effect of low-intensity laser radiation and superbright LEDs]. Lazerno-opticheskie tekhnologii v biologii i meditsine: Mat Mezhdunar Konf. Minsk, RB. 2004;(1):40-61.
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Address for correspondence:
220116, Respublika Belarus,
g. Minsk, pr. Dzerzhinskogo, d. 83,
UO "Belorusskiy gosudarstvennyiy meditsinskiy universitet",
2-ya kafedra khirurgicheskih bolezney,
tel. mob. 375 29 622-57-81,
e-mail: buravskyav@mail.ru,
Buravsky Aleksandr Vladimirovich
Information about the authors:
Buravsky A.V. An assistant of the 2nd chair of surgical diseases of EE "Belarusian State Medical University".
Baranov E.V. PhD, an associate professor of the 2nd chair of surgical diseases of EE "Belarusian State Medical University".
Tretyak S.I. Corresponding member of NAS of Belarus, MD, professor, a head of the 2nd chair of surgical diseases of EE "Belarusian State Medical University".
Kvacheva Z.B. PhD, a leading researcher of the laboratory of cell molecular biology of SSE "Institute of Biophysics and Cell Engineering of NAS of Belarus".

V.V. BOYKO1, N.A. REMNYOVA2, N.S. CHERNYAYEV3, N.N. BRISKAYA1

SOME PATHOMORPHOLOGICAL FEATURES OF THE RESECTION EDGE OF THE LIVER IMMEDIATELY AFTER USING THE APPARATUS OF HIGH-FREQUENCY ELECTROSURGICAL WELDING AND MONOPOLAR ELECTROCOAGULATOR

SE "Zaycev V.T. Institute of General and Emergency Surgery NAMS of Ukraine"1,
"Kharkov National University Named after V.N. Karazin" 2,
Kharkov National Medical University3,
Kharkov, Ukraine

Objectives. To study some pathomorphological features of resection edge of rabbit liver after using the apparatus of high-frequency electrosurgical welding "Patonmed EKVZ-300" in automatic mode and monopolar electrocoagulator in the 1st day after surgery.
Methods. Experimental animals were divided into two main groups according to the type of the coagulator used: group A – 15 cases of study of the liver resection edge after application of the high frequency electrosurgical welding "Patonmed EKVZ-300" automatically; group B – 15 cases of study of the liver resection edge after application of monopolar electrocoagulator. The edges of resected rabbit liver were withdrawn immediately after treating with electrocoagulators to achive hemostasis (the 1st day). Four liver samples of healthy rabbits were used as a control group (C). Tissues were stained with hematoxylin, eosin and by van Gieson method. The general nature of the liver resection edge tissues, morphological features of hepatocytes, Kupffer cells, and the state of the vascular bed had been assessed microscopically.
Results. Within the first 24 hours after using the apparatus of high frequency electrosurgical welding "Patonmed EKVZ-300" in the automatic mode (group A) and monopolar electrocoagulator (group B) it was revealed that in the resection edge in using of both electrocoagulation methods two morphological zones – the zone of necrosis (the 1st zone) and the zone of necrobiosis (the 2nd zone) were reliably registered.
Electrosurgical welding with the apparatus "Patonmed EKVZ-300" in the automatic mode leads to the superficial injury of the liver parenchyma (depth – 4,6±0,08 mm), minimal inflammation and the injury of the vascular endothelium, moderate impairment of hepatic microcirculation. Monopolar electrocoagulator leads to more severe injury of liver parenchyma at the resection edge (depth – 5,6±0,04 mm), causes intense inflammation significantly expanding the primary zone of the damage, leads to severe impairment of microcirculation, venous stasis and endothelial damage.
Conclusion. High-frequency electrosurgical welding "Patonmed EKVZ-300" in the automatic mode is considered as a sparing method of the liver resection.

Keywords: high-frequency welding, electrocoagulation, liver resection, surgical hemostasis, damage of the liver parenchyma, electrosurgical instruments, microcirculation
p. 256-261 of the original issue
References
  1. Gal'perin EI, Dederer IuM. Nestandartnye situatsii pri operatsiiakh na pecheni i zhelchnykh putiakh [Non-standard situations during operations on the liver and biliary tract]. Moscow, RF: Meditsina, 1987. 336 p.
  2. Vishnevskii VA, Kubyshkin VA, Chzhao AV, Ikramov RZ. Operatsii na pecheni [Operations on the liver]. Moscow, RF: Miklosh, 2003. 156 p.
  3. Al'perovich BI, Solov'ev MM, Beloborodova EI. i dr. Khirurgiia pecheni i zhelchnykh putei [Surgery of the liver and biliary tract]. Tomsk, USSR: SGMU, 1997. 608 p.
  4. Patiutko IuI. Khirurgicheskoe lechenie zlokachestvennykh opukholei pecheni [Surgical treatment of malignant liver tumors]. Moscow, RF: 2005. 312 p.
  5. Boiko VV, Zamiatin PN, Uderbaev NN. Khirurgiia povrezhdenii pecheni [Surgery of liver damage]. Kharkov, Ukraine. 2007. 240 p.
  6. Malassagne B, Cherqui D, Alon R, Brunetti F, Humeres R, Fagniez PL. Safety of selective vascular clamping for major hepatectomies. J Am Coll Surg. 1998 Nov;187(5):482-86.
  7. Petrowsky H, Raeder S, Zuercher L, Platz A, Simmen HP, Puhan MA, Keel MJ, Clavien PA. A quarter century experience in liver trauma: a plea for early computed tomography and conservative management for all hemodynamically stable patients. World J Surg. 2012 Feb;36(2):247-54. doi: 10.1007/s00268-011-1384-0.
  8. Abdalla EK, Noun R, Belghiti J. Hepatic vascular occlusion: which technique? Surg Clin North Am. 2004 Apr;84(2):563-85.
  9. Mullin EJ, Metcalfe MS, Maddern GJ. How much liver resection is too much? Am J Surg. 2005 Jul;190(1):87-97.
  10. Furmanov IuA, Nichitailo ME, Litvinenko AN, Savitskaia IM, Gul'ko ON. Eksperimental'noe obosnovanie primeneniia metoda elektrosvarki biologicheskikh tkanei v khirurgicheskoi gepatologii [Experimental study of the method of electric biological tissues in surgical hepatology]. Kl³n Kh³rurg³ia. 2004;(8):57-59.
  11. Yoshimoto M, Endo K, Hanaki T, Watanabe J, Tokuyasu N, Sakamoto T, Honjo S, Hirooka Y, Ikeguchi M. Effectiveness of the LigaSure Small Jaw Vessel-Sealing System in Hepatic Resection. Yonago Acta Med. 2014 Jun;57(2):93-8.
  12. Babii AM, Shevchenko BF, Ratchik VM. Opyt primeneniia otechestvennoi vysokochastotnoi elektrosvarivaiushchei tekhnologii v khirurgicheskom lechenii bol'nykh s abdominal'noi patologiei [Experience of domestic high-frequency electric welding technology in the surgical treatment of patients with abdominal pathology]. Gastroenterolog³ia. 2014;(2)52:61-68.
  13. Doklestic K, Karamarkovic A, Stefanovic B, Stefanovic B, Milic N, Gregoric P, Djukic V, Bajec D. The efficacy of three transection techniques of the liver resection: a randomized clinical trial. Hepatogastroenterology. 2012 Jul-Aug;59(117):1501-6. doi: 10.5754/hge11552.
Address for correspondence:
61103, Ukraina,
g. Kharkov, v'ezd Balakireva, d. 1,
GU "Institut obschey i neotlozhnoy khirurgii im.V.T.Zaytseva NAMNU,"
otdelenie khirurgii pecheni, zhelchnyih protokov i podzheludochnoy zhelezyi,
tel.mob.: 380 506 15-45-55,
e-mail: dr.chernyayev@mail.ru,
Chernyayev Nikita Svyatoslavovich
Information about the authors:
Boyko V.V. MD, professor, director of SE "Zaycev V. T. Institute of General and Emergency Surgery NAMS of Ukraine"
Remnyova N.A. PhD, an associate professor of the general and clinical pathology chair of "Kharkov National Institute named after V.N. Karazin".
Chernyayev N.S. A day-time post-graduate student of the 3rd year of the surgery chair ¹1 of Kharkov State Medical University.
Briskaya N.N. PhD, surgeon of the department of the liver, bile ducts and pancreas surgery of SE "Zaycev V.T. Institute of General and Emergency Surgery NAMS of Ukraine".

K.S. KOMISSAROV 1, V.S. PILOTOVICH 1, M.Y. YURKEVICH 1, M.V. DMITRIEVA 2, M.M. ZAFRANSKAYA 1

TECHNICAL FEATURES OF EXPERIMENTAL MODEL OF ACUTE RENAL ISCHEMIA-REPERFUSION INJURY

SEE "Belarusian Medical Academy of Post-
Graduate Education" 1,
ME "Minsk City Pathology Bureau"2
Minsk
The Republic of Belarus

Objectives. To evaluate the reproducibility of renal ischemia-reperfusion injury model in rats using transabdominal access with bilateral renal pedicles clamping within 50 minutes.
Methods. The experiment was conducted in sexually mature, albino, purebred male rats (n=8, 270-310 g). The referent group (n=4) consisting of intact animals comparable in sex and weight was formed. The laboratory animals were anesthetized with transperitoneal sodium thiopental injection. Bilateral renal clamping through median laparotomy was used to reproduce ischemia-reperfusion (I/R) model with 50 min ischemia, the reperfusion period – 24 and 48 hours. The control (Sham) group (n=2) was allocated, the rats underwent to all stages of the surgery except renal clamping. Efficiency of ischemia development was evaluated by measuring serum creatinine and urea determined by the standard methodology and histological changes of renal tissue.
Results. None of the animals died during the post-operative period. Increasing of the serum creatinine level by 1,5 folds and more in comparison with referent data was fixed in 5 out of 6 laboratory animals whereas serum creatinine was not different from normal level in Sham group. Histological evaluation of the renal tissue revealed the different changes indicating the development of proximal tubular injury in 100% of rats.
Conclusion. The obtained results testify to the development of acute renal failure in 83,3% rats after 50 min. ischemia and independently on 24 or 48 hours reperfusion that allows using transabdominal access with bilateral renal clamping for the reproduction of the ischemia-reperfusion model of acute kidney injury.

Keywords: acute kidney injury, ischemia-reperfusion, kidneys, rats, animal model, acute tubular necrosis, renal failure
p. 262-267 of the original issue
References
  1. Andrusev AM, Zakharova EV. Ostroe pochechnoe povrezhdenie. Klin Prakt Rekomendatsii KDIGO (osnovnye polozheniia) [Acute kidney damage. Clin Pract Recommendations KDIGO (basic position)]. Nefrologiia i Dializ. 2012;(14)2:86-94.
  2. Lameire N, Van Biesen W, Vanholder R.The changing epidemiology of acute renal failure. Nat Clin Pract Nephrol. 2006 Jul;2(7):364-77.
  3. Singh AP, Junemann A, Muthuraman A, Jaggi AS, Singh N, Grover K, Dhawan. Animal models of acute renal failure. Pharmacol Rep. 2012;64(1):31-44.
  4. McWhinnie DL, Thompson JF, Taylor HM, Chapman JR, Bolton EM, Carter NP, Wood RF, Morris PJ.Morphometric analysis of cellular infiltration assessed by monoclonal antibody labeling in sequential human renal allograft biopsies. Transplantation. 1986 Oct;42(4):352-58.
  5. Shanley PF, Rosen MD, Brezis M, Silva P, Epstein FH, Rosen S.Topography of focal proximal tubular necrosis after ischemia with reflow in the rat kidney. Am J Pathol. 1986 Mar;122(3):462-68.
  6. Rosen S, Heyman SN. Difficulties in understanding human "acute tubular necrosis": limited data and flawed animal models. Kidney Int. 2001 Oct;60(4):1220-24. .
Address for correspondence:
Address for correspondence:
220013, Respublika Belarus,
g. Minsk, ul. P.Brovki, d. 3,
GUO "Belorusskaya meditsinskaya akademiya
poslediplomnogo obrazovaniya",
kafedra urologii i nefrologii,
tel. office: 375 172 92 35 34,
e-mail: kirill_ka@tut.by
Komissarov Kirill Sergeevich
Information about the authors:
Komissarov K.S. PhD, an associate professor of the urology and nephrology chair of SBE "Belarusian Medical Academy of Post-graduate Education".
Pilotovich V.S. MD, professor of the urology and nephrology chair of SBE "Belarusian Medical Academy of Post-graduate Education".
Yurkevich M.Y. A researcher of the immunological group of SBE "Belarusian Medical Academy of Post-graduate Education".
Dmitrieva M.V. A physician-pathologist of ME "Minsk City Pathology Bureau".
Zafranskaya M.M. PhD, associate professor of the immunological group of SBE "Belarusian Medical Academy of Post-graduate Education".

GENERAL & SPECIAL SURGERY

A.V. SHIDLOVSKY

TREATMENT OF NODULAR EUTHYROID GOITER BY LASER-INDUCED INTERSTITIAL THERMOTHERAPY

SHEE "Ternopil State Medical University named after I.Y. Horbachevsky of MPH of Ukraine",
Ukraine

Objectives. To study the possibility of using the laser interstitial thermotherapy (LITT) in the treatment of the nodular euthyroid goiter and factors influencing its efficacy.
Methods. Using LITT 134 patients with benign solitary thyroid nodes had been treated. Single silica fiber, the output power of 2,8-3,2 Watts, continuous mode of radiation, wavelength of 1060 nm, continuous ultrasound guidance had been used. Changes in the structure and volume of nodules according to the ultrasonography data were studied within the 1th day, in 2 weeks, 1, 3, 6, 9, 12 and 15 months, respectively. The gland function and level of antibodies to thyroid peroxidase were determined by standard tests prior treatment, 1 and 6 months after treatment. The long-term results were studied three years afterwards.
Results. After 24 hours the volume of nodes increased on the average to 12,2±1,21% (p <0,05). In subsequent periods of observation the sizes of nodes reduced. The final assessment of the complete replacement of nodes on the scar tissue occurred in 128 (95,5%) cases, and the volume of nodes reduced from 3,02 cm3 (range 1,2-10,2) up to 0,57 (range of 0,1-1,3; p<0,001).
Unsatisfactory result was registered in 6 (4,5%) cases without any complications. At control survey (36 months after) the volume of scar tissue remained unchanged and the parameters of thyrotropic hormone, antibodies to thyroid peroxidase were within the normal range in 68 cured patients.
Conclusion. Laser thermotherapy is considered to be a highly effective, minimally invasive, safe and inexpensive method of outpatient treatment of the nodular goiter. Its effectiveness depends on the echogenicity and volume of nodes. It can be used as an independent method of treatment in the period from clinically significant node up to the development of the compression syndrome. In some cases laser interstitial thermotherapy lets to avoid possible surgical treatment.

Keywords: thyroid, nodular goiter, ultrasonography, treatment, antibodies, laser interstitial thermotherapy, efficiency
p. 268-274 of the original issue
References
  1. Gharib H, Papini E, Paschke R, Duick DS, Valcavi R, Hegedüs L, Vitti P; AACE/AME/ETA Task Force on Thyroid Nodules. American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association Medical guidelines for clinical practice for the diagnosis and management of thyroid nodules: executive summary of recommendations. Endocr Pract. 2010 May-Jun;16(3):468-75.
  2. Papini E, Bizzarri G, Pacella CM. Percutaneous laser ablation of benign and malignant thyroid nodules. Curr Opin Endocrinol Diabetes Obes. 2008 Oct;15(5):434-9. doi: 10.1097/MED.0b013e32830eb89a.
  3. Barbaro D, Orsini P, Lapi P, Pasquini C, Tuco A, Righini A, Lemmi P.Percutaneous laser ablation in the treatment of toxic and pretoxic nodular goiter. Endocr Pract. 2007 Jan-Feb;13(1):30-36.
  4. Amabile G, Rotondi M, Pirali B, Dionisio R, Agozzino L, Lanza M, Buonanno L, Di Filippo B, Fonte R, Chiovato L. Interstitial laser photocoagulation for benign thyroid nodules: time to treat large nodules. Lasers Surg Med. 2011 Sep;43(8):797-803. doi: 10.1002/lsm.21114.
  5. Cakir B, Ugras NS, Gul K, Ersoy R, Korukluoglu B. Initial report of the results of percutaneous laser ablation of benign cold thyroid nodules: evaluation of histopathological changes after 2 years. Endocr Pathol. 2009 Fall;20(3):170-6. doi: 10.1007/s12022-009-9081-83.
  6. Piana S, Riganti F, Froio E, Andrioli M, Pacella CM, Valcavi R. Pathological findings of thyroid nodules after percutaneous laser ablation: a series of 22 cases with cyto-histological correlation. Endocr Pathol. 2012 Jun;23(2):94-100. doi: 10.1007/s12022-012-9192-0.
  7. Papini E, Rago T, Gambelunghe G, Valcavi R, Bizzarri G, Vitti P, De Feo P, Riganti F, Misischi I, Di Stasio E, Pacella CM.Long-term efficacy of ultrasound-guided laser ablation for benign solid thyroid nodules. Results of a three-year multicenter prospective randomized trial. J Clin Endocrinol Metab. 2014 Oct;99(10):3653-9. doi: 10.1210/jc.2014-1826.
  8. Dǿssing H, Bennedbæk FN, Hegedüs L. Long-term outcome following interstitial laser photocoagulation of benign cold thyroid nodules. Eur J Endocrinol. 2011 Jul;165(1):123-8. doi: 10.1530/EJE-11-0220.
  9. Papini E, Bizzarri G, Pacella CM. Percutaneous laser ablation of benign and malignant thyroid nodules. Curr Opin Endocrinol Diabetes Obes. 2008 Oct;15(5):434-9. doi: 10.1097/MED.0b013e32830eb89a.
  10. Gambelunghe G, Fede R, Bini V, Monacelli M, Avenia N, D'Ajello M, Colella R, Nasini G, De Feo P. Ultrasound-guided interstitial laser ablation for thyroid nodules is effective only at high total amounts of energy: results from a three-year pilot study. Surg Innov. 2013 Aug;20(4):345-50. doi: 10.1177/1553350612459276.
  11. Valcavi R, Riganti F, Bertani A, Formisano D, Pacella CM. Percutaneous laser ablation of cold benign thyroid nodules: a 3-year follow-up study in 122 patients. Thyroid. 2010 Nov;20(11):1253-61. doi: 10.1089/thy.2010.0189.
  12. Gambelunghe G, Bini V, Stefanetti E, Colella R, Monacelli M, Avenia N, De Feo P. Thyroid nodule morphology affects the efficacy of ultrasound-guided interstitial laser ablation: a nested case-control study. Int J Hyperthermia. 2014 Nov;30(7):486-9. doi: 10.3109/02656736.2014.963701.
Address for correspondence:
46001, Ukraina, g. Ternopol, maydan Voli, d. 1,
GVUZ "Ternopolskiy gosudarstvennyiy meditsinskiy universitet
imeni I. Y. Gorbachevskogo, MOZ Ukrainyi", kafedra khirurgii 2
tel.: 380 352 52-44-92,
e-mail: shovk76@mail.ru,
Shidlovskyi Aleksandr Viktorovich
Information about the authors:
Shidlovskyi A.V. PhD, an associate professor of the surgery chair ¹2 SHEE "Ternopil State Medical University named after I.Y.Horbachevsky", MPH of Ukraine.

B.F. SHEVCHENKO, A.M. BABIY, O.M. TATARCHUK, V.A. MACARCHUK, O.P. PETISHKO

NON-INVASIVE ASSESSMENT OF FIBROUS TRANSFORMATION AND INFLAMMATORY ACTIVITY OF THE PANCREAS AT CHRONIC PANCREATITIS

SE "Institute of Gastroenterology of the National Academy of Sciences",
Dnipropetrovsk,
Ukraine

Objectives. To work out the program of non-invasive assessment of inflammation activity and fibrous transformation degree of the pancreas at chronic pancreatitis.
Methods. The comparison analysis of biochemical, immunological and sonoelastometric results with those of morphological assessment of the pancreatic biopsies obtained during surgical interventions due to the complications of chronic pancreatitis had been carried out in 86 patients. Age of patients varied from 26 up to 76, there were 69 (80,2%) males and 17 (19,8%) females.
Results. The followings operative interventions had been performed in 86 patients: in 27 (31,3%) – symptomatic operations as the first stage of surgical treatment (external drainage of pseudocysts, gastroenteric bypass and others), in 16 (18,7%) – drainage operations (cystogastro-, cystojejuno-, cystopancreatico-, pancreatico-jejunostomy), in 43 (50,0%) – resection-drainages (Beger’s and Frey’s procedures so as hybrid modifications) and resections (distal resections of the pancreas).
According to ROC analysis of the non-invasive assessment of inflammation activity, the high sensitivity and specificity were typical for PMN-elastase (83,3% and 92,9%) and the ratio of TNF-α / IL-10 (91,7% and 84,6%), the evaluation of the fibrotic transformation degree of the pancreas – the ratio between protein-bonded hydroxyproline (HPð/b) and free hydroxyproline (HPf) – HPp/b / HPf (93,3% and 88,9%) and TNF-α/TGF-β1 (87,8% and 81,8%), the estimation of the severity of the fibrotic transformation according to the sonoelastometric images of anatomical parts of the pancreas – a head (83,3% and 88,9%) and a body (81,8% and 76,9%), the valuation of inflammation activity in the head of pancreas at the early (73,3% and 80,0%) and later (87,5% and 100,0%) degrees of pancreatic fibrosis at cronic pancreatitis.
Conclusion. Thus, indices of PMN-elastase, the ratio of TNF-α/IL-10, ÍPp/b/ÍPf, TNF-α/TGF-β1, sonoelastometry of pancreatic head and body in assessing of fibrotic transformation degree and pancreatic inflammation activity allowed establishing validity of each research methods and using them as diagnostic non-invasive markers of the morphological state of the pancreas at chronic pancreatitis.

Keywords: pancreas, chronic pancreatitis, fibrous transformation, inflammation, non-invasive markers
p. 275-285 of the original issue
References
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  3. Sukhodolia A², Petrushenko VV, P³dmurniak OO, Grishchuk OV, Sukhodolia SA, Chubar ²V. Etapn³ kh³rurg³chn³ vtruchannia pri uskladnenomu khron³chnomu pankreatit³ [Landmark surgery in complicated chronic pancreatitis]. Khark³v Kh³rurg Shkola. 2013;(2)59:85-88.
  4. Shchastnyi AT. Posleoperatsionnye oslozhneniia proksimal'nykh rezektsii podzheludochnoi zhelezy u patsientov s khronicheskim pankreatitom [Postoperative complications proximal resection of the pancreas in patients with chronic pancreatitis]. Novosti Khirurgii. 2011;(3)19:30-43.
  5. Shevchenko BF, Babii AM, Makarchuk VA, Oshmianskaia NIu, Petishko OP. Morfofunktsional'noe sostoianie podzheludochnoi zhelezy na etapakh ee fibroznoi transformatsii pri khronicheskom pankreatite [Morphofunctional state of the pancreas at stages of its fibrous transformation in chronic pancreatitis]. V³sn Problem B³olog³¿ ³ Meditsini. 2014;(4)1:305-12. Mode of access: http://nbuv.gov.ua/j-pdf/Vpbm_2014_4(1)__64.pdf
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  10. S³renko OIu. Pankreatichn³ z³rchast³ kl³tini iak morfolog³chna osnova rozvitku f³brozu p³dshlunkovo¿ zalozi [Pancreatic stellate cells as the basis of morphological development of fibrosis of the pancreas]. Morfolog³ia. 2010;(4)1:5-12.
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  13. EditorsIn: Grippo PJ, Munshi HG, editors. Imaging the pancreatic ECM. AuthorsVenkatasubramanian PN. Source Pancreatic Cancer and Tumor Microenvironment. Trivandrum (India): Transworld Research Network; 2012. Chapter 2.
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  15. Saba, Khan S, Parvez S, Chaudhari B, Ahmad F, Anjum S, Raisuddin S.Ellagic acid attenuates bleomycin and cyclophosphamide-induced pulmonary toxicity in Wistar rats. Food Chem Toxicol. 2013 Aug;58:210-19. doi: 10.1016/j.fct.2013.03.046.
  16. Sandrin L, Fourquet B, Hasquenoph JM, Yon S, Fournier C, Mal F, Christidis C, Ziol M, Poulet B, Kazemi F, Beaugrand M, Palau R.Transient elastography: a new noninvasive method for assessment of hepatic fibrosis. Ultrasound Med Biol. 2003 Dec;29(12):1705-13.
  17. Săftoiu A, Vilmann P, Gorunescu F, Janssen J, Hocke M, Larsen M, Iglesias-Garcia J, Arcidiacono P, Will U, Giovannini M, Dietrich C, Havre R, Gheorghe C, McKay C, Gheonea DI, Ciurea T. European EUS Elastography Multicentric Study Group. Accuracy of endoscopic ultrasound elastography used for differential diagnosis of focal pancreatic masses: a multicenter study. Endoscopy. 2011 Jul;43(7):596-603. doi: 10.1055/s-0030-1256314.
Address for correspondence:
49074, Ukraina, g.Dnepropetrovsk,
prospekt im. Gazetyi "Pravda", d. 96,
GU "Institut gastroenterologii NAMN Ukrainyi",
otdelenie khirurgii organov pischevareniya,
tel. office: 38 0562 27 05 59,
e-mail: aleksandr_babiy@ukr.net,
Babiy Aleksandr Mihaylovich
Information about the authors:
Shevchenko B.F. MD, professor, a chief researcher of the department of surgery of the digestive organs of SE "Institute of Gastroenterology of NAMS of Ukraine".
Babiy À.Ì. PhD, a senior researcher of the department of surgery of the digestive organs of SE "Institute of Gastroenterology of NAMS of Ukraine".
Tàtarchuk Î.Ì. PhD, a senior researcher of the laboratory of microbiology and immunology of SE" Institute of Gastroenterology of NAMS of Ukraine".
Macarchuk V.A. A researcher of the biochemistry laboratory of SE "Institute of Gastroenterology of NAMS of Ukraine".
Petishko O.P. A researcher of the department of the scientific-organizational, methodical work and informative technologies of SE "Institute of Gastroenterology of NAMS of Ukraine".

Y.P. ORLOV, V.N. LUKACH, V.T. DOLGIKH, N.V. GOVOROVA, A.V. GLUSCHENKO

DEFEROXAMINE AS PATHOGENETICALLY VALID PREPARATION FOR COMPLEX THERAPY OF PATIENTS WITH ACUTE PANCREATITIS

SBEE HPE "Omsk State Medical University",
The Russian Federation

Objectives. To study the correlation between the severity of systemic inflammatory reaction, polyorganic failure and iron metabolism parameters in a course of severe acute pancreatitis, to determine the efficacy of iron metabolism disorders correction with deferoxamine to prevent organ failure and septic process.
Methods. 63 patients with complicated acute pancreatitis have been examined in the resuscitation and intensive care unit. 31 patients received standard intensive therapy, whereas deferoxamine therapy was applied for other 32 patients (6-12 mg/kg/day). Ranson’s criteria (RC) were used to determine the severity of the attack of AP thrice (on admission to the hospital, after the 1st and the 3rd days) which values for these components (activity of erythrocyte superoxide dismutase, catalase, total serum bilirubin concentration and its fractions, transferrin, iron, ferritin and free hemoglobin) were calculated. The severity of endotoxemia was defermined by concentration of low and medium molecular-weight substances (LMMWS) in plasma and erythrocytes.
Results. The close correlation was revealed between the changes of free hemoglobin level and total bilirubin concentration. A similar relationship has been determined between the concentration of ferritin, manifesting the iron storage in the body, and a concentration of LMMWS in the blood plasma. In addition, the similar high direct relationship has been established between ferritin concentration and the severity of the general condition of patients measured by APACHE II scale and firmed the ability of intensive therapy with deferoxamine for patients with severe forms of acute pancreatitis to reduce the incidence of systemic hemodynamic and respiratory failure, damage of the liver and kidneys, to decrease the incidence of pancreatogenic sepsis and retroperitoneal phlegmons by 3 folds so as to diminish mortality rate by 19,6%.
Conclusion. Using of deferoxamine in the intensive therapy program is pathogenetically justified due to its ability to bind the iron ions excess in blood plasma, thereby the drug prevents the development of severe, sometimes fatal, complications of acute pancreatitis.

Keywords: acute pancreatitis, iron metabolism, deferoxamine, systemic inflammatory response syndrome, polyorganic failure, retroperitoneal phlegmon, mortality rate
p. 286-295 of the original issue
References
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  13. Ranson JH, Rifkind KM, Roses DF, Fink SD, Eng K, Spencer FC.Prognostic signs and the role of operative management in acute pancreatitis. Surg Gynecol Obstet. 1974 Jul;139(1):69-81.
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  15. Bukharin OV, Ginzburg AL, Romanova IuM, El'-Registan GI. Mekhanizmy vyzhivaniia bakterii [Mechanisms of bacterial survival]. Moscow, RF: Meditsina, 2005. 367 p.
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Address for correspondence:
Address for correspondence:
644119, Rossiyskaya Federatsiya,
g. Omsk, ul. Pereleta, d. 9.
MUZ GK BSMP¹ 1,
kafedra anesteziologii i reanimatologii,
tel. mob.: 8-960-981-82-52,
e-mail: orlov-up@mail.ru,
Orlov Yuriy Petrovich
Information about the authors:
Orlov Y.P. MD, professor of the anesthesiology and resuscitation chair of SBEE HPE "Omsk State Medical University".
Lukach V.N. An Honored Worker of Higher School, MD, professor of the anesthesiology and resuscitation chair of SBEE HPE "Omsk State Medical University".
Dolgikh V.T. An Honored Worker of Science of the Russian Federation, MD, professor, a head of the pathological physiology chair with the course of clinical pathological physiology of SBEE HPE "Omsk State Medical University".
Govorova N.V. MD, professor, a head of the anesthesiology and resuscitation chair of SBEE HPE "Omsk State Medical University".
Gluschenko A.V. PhD, an assistant of the anesthesiology and resuscitation chair of SBEE HPE "Omsk State Medical University".

B.M. BELIK, S.U. EFANOV, A.I. MASLOV,
V.A. SUYARKO, A.R. SAPRALIEV

THE ROLE OF INTRAPORTAL INFUSIONS IN CORRECTION OF FUNCTIONAL LIVER FAILURE AND ENDOTOXICOSIS IN GENERALIZED PERITONITIS

SBEE HPE "Rostov State Medical University"
The Russian Federation

Objectives. Comparative estimation of the clinical efficiency of traditional intravenous (intracaval) and intraportal infusion therapy (IPIT) in correction of functional liver failure and endotoxicosis (ET) in generalized peritonitis (GP).
Methods. The patients with GP (n=324) manifesting abdominal sepsis and ET had been enrolled in the study and divided into 2 groups according to the principle approach to treatment. In the first group (n=175) the patients were traditionally treated with intracaval infusion therapy according to the conventional standards. In the second group (n=167), redrainage and catheterization of the umbilical vein were performed intraoperatively and further combined with a standard therapy IPIT was applied. In the comparative aspect the laboratory indicators of the liver functional status and endotoxicosis had been investigated, including the severity of the systematic inflammatory reaction (SIR) as well as the immediate treatment results of both groups.
Results. In the second group, on the IPIT background in the early stages the leukocytosis, concentration of C-reactive protein, fibrinogen, general bilirubin, concentration of cytolysis markers of hepatocytes, laboratory indicators of ET (urea, creatinine, myoglobin, Leukocyte Index of Intoxication and Average Molecular Peptide) were reduced as well as a distinct increase of general protein and albumins in comparison with the analogical values was registered in the first group of patients. The complication rate (the average) in the main group was lower by 9,1% and the postoperative mortality – 8,2% compared with the control group.
Conclusion. In the early postoperative period using IPIT in patients with GP promotes the rehabilitation of the functional liver failure and significantly reduces the severity of ET allowing improving the immediate treatment Results.

Keywords: generalized peritonitis, liver insufficiency, endotoxicosis, intraportal infusions, rehabilitation, complications, postoperative mortality
p. 296-301 of the original issue
References
  1. Savel'ev VS, Gel'fand BR, Filimonov MI. Peritonit: Prakticheskoe rukovodstvo [Peritonitis: a practical guide]. Moscow, RF: Litterra, 2006. 205 p.
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  15. Puga R, Rodríguez R, González C, Muñoz J. Ozone Therapy in the Treatment of Patients with Secondary Immunodeficiencies. 2nd International Symposium on Ozone Applications Havana, Cuba - Mach 24-26, 1997.
Address for correspondence:
344010, Rossiyskaya Federatsiya,
g. Rostov-na-Donu, pr. Voroshilovskiy, d. 105,
GBOU VPO "Rostovskiy gosudarstvennyiy meditsinskiy universitet,"
kafedra obschey khirurgii,
tel. mob. 7 903 406-00-97,
e-mail: efanov_su@mail.ru,
Efanov Sergey Yurevich
Information about the authors:
Belik B.M. MD, a head of the general surgery chair of SBEE HPE "Rostov State Medical University".
Efanov S.U. PhD, an assistant of the general surgery chair of SBEE HPE "Rostov State Medical University"
Maslov A.I. PhD, an associate professor of the general surgery chair of SBEE HPE "Rostov State Medical University."
Suyarko V.A. A post-graduate student of the general surgery chair of SBEE HPE "Rostov State Medical University".
Sapraliev A.R. A senior laboratory assistant of the general surgery chair of SBEE HPE "Rostov State Medical University".

S.A. SUSHKOU, I.V. SAMSONOVA, M.M. GALISHEVICH

CD34 EXPRESSION PATOGENETIC VALUE IN LOWER LIMB VARICOSE VEINS

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

Objective. To study the CD34 expression in the leg vein wall of patients with the lower limb varicose veins.
Methods. The study included 18 patients who were subjected to the resection of the posterior tibial veins together with phlebectomy because of the diagnosed deep venous valvular insufficiency. For morphological examination the resected specimens of the posterior tibial veins and the distal fragment of the vena saphena magna taken by phlebectomy were used. The samples of the corresponding veins without any pathology obtained from died patients not suffering from the lower limb varicose veins were used for control.
Serial sections were stained with routine histological methods and immunohystochemically using monoclonal antibodies against CD34. The degree of CD34 expression in the specimens was evaluated by light microscopy.
Results. In the posterior tibial vein wall of the patients with lower limb varicosity and deep venous valvular insufficiency, the degree of its expression in the endothelium comparing was different from the control group. The total area of expression was 0,0085±0,0004 μm2, in control samples it was significantly less – 0,004±0,0003 μm2; (p<0,05). In the vena saphena magna the specimens taken from the patients with varicose veins, CD34 expression area was also significantly higher than in the control group – 0,0116±0,0009 μm2 (in control group – 0,005±0,0004 μm2; p<0,05). Comparison of CD34 expression in the specimens of the vena saphena magna and posterior tibial veins taken from the patients with lower limb varicose veins showed reliably higher parameters in the vena saphena magna (p<0,05).
Conclusion. At lower limbs superficial varicose veins the unidirectional changes in the endothelium of the superficial and deep leg veins are developing; it’s proved by change in the CD34 expression on the endothelial cell surface.

Keywords: primary varicose veins, endothelium, vein wall, immunohistochemistry, CD34 expression, light microscopy, phlebectomy
p. 302-308 of the original issue
References
  1. Bergan J. Molecular mechansms in chronic venous insufficiency. Ann Vasc Surg 2007 May;21(3):260-66.
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  7. Ojdana D, Safiejko K, Lipska A, Sacha P, Wieczorek P, Radziwon P, Dadan J, Tryniszewska E. The inflammatory reaction during chronic venous disease of lower limbs. Folia Histochem Cytobiol 2009; 47(2):185-89.
  8. Raffetto JD. Dermal pathology, cellular biology, and inflammation in chronic venous disease. Thromb Res 2009; 123(Suppl 4):S66–71.
  9. Liu YC, Margolis DJ, Isseroff RR. Does inflammation have a role in the pathogenesis of venous ulcers? A critical review of the evidence. J Invest Dermatol. 2011 Apr;131(4):818-27. doi: 10.1038/jid.2010.428.
  10. Lim CS, Davies AH. Pathogenesis of primary varicose veins. Br J Surg 2009 Nov; 96(11):1231-42.
  11. Pascarella L, Penn A, Schmid-Schönbein GW. Venous hypertension and the inflammatory cascade: major manifestations and trigger mechanisms. Angiology 2005 Sep-Oct; 56(Suppl 1):S3–10.
  12. Simovart HE, Aunapuu M, Lieberg J, Roosaar P, Arend A. Age-related changes in apoptosis and expressions of intercellular adhesion molecule-1 and vascular endothelial growth factor receptor type 2 in the wall of varicose veins. Int Angiol. 2010 Dec;29(6):507-13.
  13. Erguzel N, Yetkin E, Erdem G, Erdil N, Yetkin G, Heper G, Celik T, Senen K. Plasminogen activator inhibitor-1 levels in patients with primary varicose vein. Int Angiol. 2012 Apr;31(2):176-80.
  14. Zhukov BN, Katorkin SE, Kravtsov PF. Optimizatsiia diagnosticheskoi programmy i pokazanii k khirurgicheskoi korrektsii nedostatochnosti klapannogo apparata glubokikh ven u bol'nykh varikoznoi bolezn'iu nizhnikh konechnostei [Optimization of the diagnostic program and the indications for surgical correction of deep vein valve failure in patients with varicose veins of the lower extremities]. Novosti Khirurgii. 2010;8(1):46-51.
  15. Sushkou SA. Korregiruiushchie vmeshatel'stva na zadnikh bol'shebertsovykh venakh pri varikoznoi bolezni [Corregiall interventions on the posterior tibial veins with varicose veins]. Novosti Khirurgii 2008;16(3):42-52.
  16. Kachlík D, Stingl J, Sosna B, Straka Z, Lametschwandtner A, Minnich B, Fára P. Morphological features of vasa vasorum in pathologically changed human great saphenous vein and its tributaries. Vasa. 2008 May;37(2):127-36. doi: 10.1024/0301-1526.37.2.127.
  17. Aunapuu M, Arend A. Histopathological changes and expression of adhesion molecules and laminin in varicose veins. Vasa. 2005;(34)3:170-75.
Address for correspondence:
210023, Respublika Belarus,
g. Vitebsk, pr. Frunze, d. 27,
UO "Vitebskiy gosudarstvennyiy meditsinskiy universitet",
kafedra obschey khirurgii,
e-mail: sergery@nm.ru,
Sushkov Sergey Albertovich
Information about the authors:
Sushkov S.A.PhD, an associate professor, Vice-rector (Science) of EE "Vitebsk State Medical University".
Samsonova I.V. PhD, an associate professor, a head of the pathological anatomy chair of EE "Vitebsk State Medical University".
Galishevich M.M. The 6th-year student of the medical faculty of EE "Vitebsk State Medical University".

L.M. CHERNUHA 1, O.M. SKUPII 2, O.I. MITIUK 3, Y.V. KHREBTIY3

SOME ASPECTS OF TREATMENT OF DEEP VENOUS THROMBOSIS OF THE INFERIOR VENA CAVA SYSTEM COMPLICATED BY PULMONARY EMBOLISM - OPPORTUNITIES AND OUTCOMES

National Institute of Surgery and Transplantology of AMS Ukraine Named after O.O. Shalimov1
Vinnitsa Regional Hospital Named after N.I. Pirogov2
Vinnitsa National Medical University Named after N.I. Pirogov3
Ukraine

Objectives. To develop differentiated surgical tactics in treatment of patients with deep venous thrombosis (DVT) complicated by pulmonary embolism (PE).
Methods. The treatment results of 58 patients with DVT complicated by PE had been analyzed. There were 9 (15,5%) patients with higher early risk of death according to the classification of European Society of Cardiology (ESC), 14(24%) – with intermediate risk and 35 (60,5%) – with a low risk. In 55 cases (94%) a majority of pulmonary embolism are caused by DVT, and in 3 cases (6%) the cause of pulmonary embolism could not be found. DVT of the proximal localization was observed in 46 (79%) cases. Systemic thrombolysis of DVT complicated by PE was carried out in the group of patients with higher and intermediate early risk of death in 16 (69,5%) cases. Catheter-guided thrombolysis was conducted at ileo-femoral DVT complicated by PE in the group of patients with low risk of early death and in terms up to 7 days in 10 (28,5%) cases.
Results. Significant improvement for patients who received thrombolytic therapy was identified in 21 (82%) cases. Partial improvement in the patients who used anticoagulant therapy was registered in 17 (67%) cases. It manifested in the reduction of dyspnea, tachypnea, chest pain, and cough. According to the CT data the total desobstruction of the pulmonary tree was found in 3 (5%) cases. No hemorrhagic complications were observed and no fatal outcomes were reported. Within the study period, recurrent pulmonary embolism has not been ascertained.
Conclusion. Systemic thrombolysis of DVT complicated by pulmonary embolism is indicated in the group of patients with higher and intermediate risk of early death. Catheter-guided thrombolysis is indicated for ileo-femoral DVT, complicated by PE, in patients with low early risk of death and in terms up to 7 days.

Keywords: deep veins thrombosis, pulmonary embolism, classification of European Society of Cardiology, thrombolytic therapy, systemic thrombolysis, catheter-guided thrombolysis
p. 309-313 of the original issue
References
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  5. Konstantinides SV, Torbicki A, Agnelli G, Danchin N, Fitzmaurice D, Galiè N, Gibbs JS, Huisman MV, Humbert M, Kucher N, Lang I, Lankeit M, Lekakis J, Maack C, Mayer E, Meneveau N, Perrier A, Pruszczyk P, Rasmussen LH, Schindler TH, Svitil P, Vonk Noordegraaf A, Zamorano JL, Zompatori M. 2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J. 2014 Nov 14;35(43):3033-69, 3069a-3069k. doi: 10.1093/eurheartj/ehu283.
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  7. Akin H, Al-Jubouri M, Assi Z1, Acino R, Sepanski D, Comerota AJ. Catheter-directed thrombolytic intervention is effective for patients with massive and submassive pulmonary embolism. Ann Vasc Surg. 2014 Oct;28(7):1589-94. doi: 10.1016/j.avsg.2014.05.004.
  8. Schweizer J, Kirch W, Koch R, Elix H, Hellner G, Forkmann L, Graf A. Short- and long-term results after thrombolytic treatment of deep venous thrombosis. J Am Coll Cardiol. 2000 Oct;36(4):1336-43.
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  11. Bashir R, Zack CJ, Zhao H, Comerota AJ, Bove AA. Comparative outcomes of catheter-directed thrombolysis plus anticoagulation vs anticoagulation alone to treat lower-extremity proximal deep vein thrombosis. JAMA Intern Med. 2014 Sep;174(9):1494-501. doi: 10.1001/jamainternmed.2014.3415.
  12. Heit JA. The epidemiology of venous thromboembolism in the community. Arterioscler Thromb Vasc Biol. 2008 Mar;28(3):370-72. doi: 10.1161/ATVBAHA.108.162545.
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  14. Prevention and treatment of venous thromboembolism: international consensus statement (guidelines according to scientific evidence). Clin Appl Thromb Hemost. 2013 Mar-Apr;19(2):116-8. doi: 10.1177/1076029612474840.
  15. Baeshko AA. Risk i profilaktika venoznykh tromboembolicheskikh oslozhnenii v khirurgii [The risk and prevention of venous thromboembolic complications in surgery]. Khirurgiia. 2001;(4):61-69.
  16. Geerts WH, Bergqvist D, Pineo GF, Heit JA, Samama CM, Lassen MR, Colwell CW. Prevention of venous thromboembo
Address for correspondence:
21000, Ukraina,
g. Vinnitsa, ul. Pirogova, d. 46,
otdelenie khirurgii sosudov
Vinnitskaya oblastnaya klinicheskaya
bolnitsa im. N.I. Pirogova,
otdelenie khirurgii sosudov,
tel. mob.: 380969917476,
e-mail: hrebtiy@ukr.net,
Khrebtiy Yaroslav Vitalevich
Information about the authors:
Chernuha L.M. MD, a leading researcher of the department of the vascular surgery of the National Institute of Surgery and Transplantology of AMS of Ukraine named after A.A. Shalimov.
Skupii O.M. MD, a head of the vascular surgery unit of Vinnitsa Regional Clinical Hospital named after N.I. Pirogov.
Mitiuk A.I. PhD, an associate professor of the surgery chair ¹2 of Vinnitsa National Medical University named after N.I. Pirogov.
Khrebtiy Y.V. PhD, an assistant of the surgery chair ¹2 of Vinnitsa National Medical University named after N.I. Pirogov.

MAXILLOFACIAL SURGERY

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

SURGICAL TREATMENT OF ODONTOGENIC CHRONIC SINUSITIS IN THE FUNDUS OF THE MAXILLARY SINUS

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

Objectives. To justify expediency of the tooth-preserving operations in the area of premolars and molars of the maxilla and sparing sinusotomy in patients with chronic odontogenic sinusitis of the maxillary sinus (MS) in the ambulatory conditions.
Methods. 41 patients with chronic apical periodontitis and its complications in the MS fundus were observed (23 patients with chronic granulomatous periodontitis, 18 patients with cystogranulomas and cysts). The operation was performed by proposed author’s method. Treatment efficacy was assessed by clinical examination, taking into account the cone beam computed tomography (CBCT) data.
Results. The immediate result of the operation in all patients was considered as positive. Postoperative wounds healed by primary intention. The pain in the operated teeth was absent. The nasal breathing was free without any nasal discharge on the side of lesion.
After 1 month there was no any signs of inflammation in the area of postoperative scar. The percussion of operated tooth was painless. Free breathing through the nose was noted without any nasal discharge on the affected side. After 3 months the fistulous passages with the segregated pyogenic exudate in the projection of the apexes of the operated teeth were registrated in 12,2% of patients. In the group of patients with chronic granulomatous periodontitis the number of complications was 13%. In the group of patients with cystogranulomas and cysts the number of complications – 11,1%. All complications were regarded as negative results of endodontic preparation of "causal" tooth. There were no recurrences or signs of inflammation of the maxillary sinus mucous membrane subjected to the operative intervention within 6 and 12 months according to CBCT.
Conclusion. The presented results show the validity and expediency of performance of preserving tooth operations in the region of premolars and molars of the upper jaw and sparing sinusotomy in patients with chronic odontogenic sinusitis of maxillary sinus in the ambulatory conditions.

Keywords: odontogenic maxillary sinusitis, apical periodontitis, percussion, nasal breathing, surgical treatment, sparing sinusotomy, ambulatory conditions
p. 314-320 of the original issue
References
  1. Ialymova D, Vishniakov V, Talalaev V. Khirurgicheskoe lechenie khronicheskogo odontogennogo verkhnecheliustnogo sinusita [Surgical treatment of chronic odontogenic maxillary sinusitis]. Vrach. 2014;(11):51-54.
  2. Malakhova MA. Kompleksnoe lechenie bol'nykh khronicheskim odontogennym perforativnym verkhnecheliustnym sinusitom [Complex treatment of patients with chronic odontogenic perforated maxillary sinusitis]. Stomatologiia. 2005;(4):25-26.
  3. Lazarev AI, Chestnikova SE, Erofeeva LN, Pankrusheva T A. Ispol'zovanie polimernykh applikatsionnykh antibakterial'nykh plenok dlia lecheniia bol'nykh s perforativnymi odontogennymi verkhnecheliustnymi sinusitami [Using of polymer antibacterial application films for the treatment of patients with perforated odontogenic maxillary sinusitis]. Ross Otorinolaringologiia. 2007;(2):3-6.
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  5. Venetis G, Bourlidou E, Liokatis PG, Zouloumis L. Endoscopic assistance in the diagnosis and treatment of odontogenic maxillary sinus disease. Oral Maxillofac Surg. 2014 Jun;18(2):207-12. doi: 10.1007/s10006-013-0413-6.
  6. Grigor'iants LA, Sirak SV, Zeker'iaev RS, Arutiunian K E. Pokazaniia i effektivnost' ispol'zovaniia razlichnykh khirurgicheskikh vmeshatel'stv pri lechenii bol'nykh s odontogennym gaimoritom, vyzvannym vyvedeniem plombirovochnogo materiala v verkhnecheliustnoi sinus [Indications and effectiveness of different surgical procedures for the treatment of patients with odontogenic sinusitis caused by entering of the filling material in the maxillary sinus]. Stomatologiia 2007; (3):42-45.
  7. Belli E, Matteini C, Marini Balestra F.Rhino-sinusal endoscopy as a diagnostic and therapeutic treatment in patients undergoing a bone marrow transplantation. Minerva Stomatol. 2002 Dec;51(11-12):515-21. [Article in Italian].
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  9. Sysoliatin SP, Sysoliatin PG, Palkina MO, Ashurko IP. Diagnostika i lechenie oslozhnenii, sviazannykh s vyvedeniem stomatologicheskikh plombirovochnykh materialov v verkhnecheliustnoi sinus [Diagnosis and treatment of complications associated with the entering of dental filling materials in the maxillary sinus]. Stomatologiia. 2009;(1):47-50.
  10. Khudaibergenov GG, Gun'ko VI. Opyt diagnostiki i lecheniia bol'nykh s odontogennym verkhnecheliustnym sinusitom [Experience of diagnosis and treatment of patients with odontogenic maxillary sinusitis]. Stomatologiia 2011;(3):59-61.
  11. Baidik OD, Sysoliatin PG. Sluchai dvustoronnego odontogennogo verkhnecheliustnogo sinusita s formirovaniem aspergillemy [The case of bilateral odontogenic maxillary sinusitis with the formation of aspergilloma]. Problemy Med Mikologii. 2014;(2):26-30.
  12. Lopatin AS, Allakhverdiev SA. Vybor optimal'nogo khirurgicheskogo dostupa pri kistakh verkhnecheliustnykh pazukh [Option of the optimal surgical approach in the cysts of the maxillary sinuses]. Ross Rinologiia. 2010;(1):32-35.
  13. Iaremenko AI, Galetskii DV, Korolev VO. Oslozhneniia i oshibki pri osteoaugumentatsii dna verkhnecheliustnoi pazukhi [Complications and errors of osteoaugumentatsii bottom of the maxillary sinus]. Stomatologiia. 2013;(3):114-18.
  14. Sieśkiewicz A, Piszczatowski B, Olszewska E, Lukasiewicz A, Tarasow E, Rogowski M. Minimally invasive transnasal medial maxillectomy for treatment of maxillary sinus and orbital pathologies. Acta Otolaryngol. 2014 Mar;134(3):290-5. doi: 10.3109/00016489.2013.857786.
  15. Baptista PM, Abaj Jd, Secundino F. Stratus relieva: treatment for chronic rhinosinusitis. Otolaryngol Head Neck Surg August 2012;(147) (suppl 2):255-56 uz Barona doi: 10.1177/0194599812451426a416
  16. Dudka VT, Chestnikova SE, Bocharova IG. Morfologicheskie aspekty primeneniia obogashchennoi trombotsitami i fibrinom autoplazmy pri plastike sinooral'nykh svishchei [Morphologic aspects of the use of platelet-rich fibrin and autoplasma in plastic sinooralnyh fistula]. Ross Rinologiia. 2008;(1):23-25.
Address for correspondence:
220116, Respublika Belarus,
g. Minsk, pr. Dzerzhinskogo, d. 83,
UO "Belorusskiy gosudarstvennyiy meditsinskiy universitet",
kafedra khirurgicheskoy stomatologii,
tel. office: 375 17 254 32-44,
e-mail: ip-c@yandex.ru,
Pohodenko-Chudakova Irina Olegovna
Information about the authors:
Pohodenko-Chudakova I.O. MD, professor, a head of the surgical dentistry chair of EE "Belarusian State Medical University".
Barmutzkaya A.Z. PhD, an associate professor of the surgical dentistry chair of EE "Belarusian State Medical University".
Surin A.V. A post-graduate student of the surgical dentistry chair of EE "Belarusian State Medical University".

UROLOGY

V.M. POPKOV, D.Y. POTAPOV, A.N. PONUKALIN

THE FEASIBILITY OF MATHEMATICAL MODELING FOR HEMOSTATIC SUTURES COMPARISON IN A PARTIAL NEPHRECTOMY

SBEE HPE "Saratov State Medical University Named after V.I. Razumovsky",
The Russian Federation

Objectives. On the basis of the proposed model to study effect of different modifications of hemostatic sutures on the renal parenchyma in the site of resection.
Material and Methods. To study the deformation degree of the renal parenchyma in tightening of the hemostatic suture and the compression degree of the parenchyma by threads during partial nephrectomy 3 different finite element models using modified technique of double interrupted, U-shaped sutures have been created. The force equal to 1N as an equivalent of thread tightening was applied to them. Thread thickness was 0,2 mm.
Results. The simulation results have found the double ligature suture considered to be the most parenchyma-sparing procedure. The narrow zone of excessive compression allows applying much more force to tightening of the suture without any fear of its eruption and increasing bleeding as within the operation as in the immediate postoperative period. In tightening of the double ligature suture the most displacement falls on the suture exit points on the parenchymal surface and a thick layer of perinephric adipose tissue obligatory used in the imposition of given suture. Meanwhile, the segments of the parenchyma as inside of an organ as between the superposed sutures remain practically intact to the displacement and, therefore, are under the best conditions for primary healing of surgical wounds.
Conclusion. The application of continuous suture is considered to be expedient in its imposition only on the renal capsule which is hermetically closed afterwards. The most suitable method recommended for use is thought to be a double ligature suture providing optimal conditions for successful tissue healing in the resection area.

Keywords: kidney, kidney resection, hemostasis, hemostatic suture, numerical simulation, method of finite elements, tissue healing
p. 320-325 of the original issue
References
  1. Aivazian AV. Gemostaz pri operatsiiakh na pochke [Hemostasis in the kidney surgery]. Moscow, USSR: Nauka. 1982. 280 p.
  2. Aliaev IuG, Krapivin AA. Rezektsiia pochki pri rake [Resection of kidney cancer]. Moscow, RF: Meditsina, 2001. 224 p.
  3. Kazimirov VG, Butrin SV. Anatomo-funktsional'noe obosnovanie rezektsii pochki [Anatomical and functional justification of nephrectomy]. Volgograd: Izdatel', 2011. 168 p.
  4. Kural AR, Demirkesen O, Onal B, Obek C, Tunc B, Onder AU, Yalcin V, Solok V. Outcome of nephron-sparing surgery: elective versus imperative indications. Urol Int. 2003;71(2):190-96.
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  6. Matveev VB, Matveev BP, Volkova MI, Perlyn DV, Fyguryn KM. Rol' organosokhraniaiushchego khirurgicheskogo lecheniia raka pochki na sovremennom etape [The role organ preservation surgery of kidney cancer at the present stage]. Onkourologiia. 2007;(2):5-11
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  14. Snedeker JG, Barnstuble BB, Iaizzo PA, Farshad M, Niederer P, Schmidlin FR. A comprehensive renal injury concept based on a validated finite element model of the human abdomen. J Trauma. 2007 May;62(5):1240-49.
  15. Popkov VM, Ponukalin AN, Potapov DIu, Malysheva Iu A. Eksperimental'noe obosnovanie gemostaticheskikh shvov pri rezektsii pochki po povodu opukholi [Experimental justification of hemostatic sutures during partial nephrectomy for tumors]. Onkourologiia. 2012;(4):15-22.
Address for correspondence:
410012, Rossiyskaya Federatsiya,
g. Saratov, ul. B. Kazachya d. 112,
GBOU VPO "Saratovskiy gosudarstvennyiy
meditsinskiy universitet
im. V.I. Razumovskogo," kafedra urologii,
tel.: 7 927 104-80-68,
e-mail: potapovmed@rambler.ru,
Potapov Dmitriy Yurevich
Information about the authors:
Popkov V.M. MD, professor, Rector of HBEE HPE "Saratov State Medical University named after V.I. Razumovsky", a head of the urology chair.
Potapov D.Y. PhD, a surgeon, clinical hospital named after S.R. Mirotvortsev of "Saratov State Medical University named after V.I. Razumovsky".
Ponukalin A.N. PhD, an associate professor of the urology chair of "Saratov State Medical University named after V.I. Razumovsky".

ONCOLOGY

O.S. OLIFIROVA, S.V. KNALYAN

THE ROLE OF TUMOR MARKERS FOR THE DIFFERENTIAL DIAGNOSIS OF NODULAR THYROID NODULES

SBEE HPE "Amur State Medical Academy",
Blagoveshchensk,
The Russian Federation

Objectives. To assess the diagnostic significance of tumor markers of galectin-3, thyroglobulin (TG), carcinoembryonic antigen (CEA) and human chorionic gonadotropin (HCG) in the blood serum and aspirate washout in patients with nodular thyroid disease.
Methods. The study involved 80 patients with nodular thyroid diseases. Highly differentiated cancer was registered in 37 patients and benign nodular disease – in 43 ones. In the preoperative period tumor markers (galectin-3, thyroglobulin, CEA and HCG) were determined by enzyme immunoassay in blood serum and aspirate washout obtained by fine-needle aspiration biopsy of thyroid nodules.
Results. In highly differentiated cancer of thyroid gland a significant increase of galectin-3 and CEA in the blood serum galectin-3 and thyroglobulin in aspirate washout were found in comparison with benign nodular thyroid disease. The sensitivity and specificity of galectin-3 in blood serum were 51,4% and 95,3%; galectin-3 in aspirate washout – 59,7% and 90,7%; TG in aspirate washout – 64,9% and 93%; serum CEA – 66,7% and 91,3%, respectively.
Conclusion. Study of tumor markers in the blood serum (galectin-3, CEA) and aspirate washout (galectin-3, thyroglobulin) as the additional parameters with standard methods allows increasing the efficiency of diagnosis of nodular thyroid diseases. Due to the determination of galectin-3 in the blood serum the sensitivity in differentiated diagnosis of thyroid cancer has increased from 83,8% up to 92%, galectin-3 in thyroid aspirate washout - up to 97, 3%, TG thyroid aspirate washout – up to 89,2%, CEA in blood serum – up to 94,4%.

Keywords: diagnostics, tumor markers, thyroid nodules, highly-differentiated thyroid cancer, enzyme immunoassay, thyroglobulin, galectin-3
p. 326-331 of the original issue
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Address for correspondence:
675000, Rossiyskaya Federatsiya,
g. Blagoveschensk, ul. Gorkogo, d. 95,
GBOU VPO "Amurskaya gosudarstvennaya meditsinskaya akademiya",
fakultet poslediplomnogo obrazovaniya,
kafedra khirurgicheskih bolezney,
tel. mob: 7 914 554-46-52,
e-mail: olif.oc@mail.ru,
Olifirova Olga Stepanovna
Information about the authors:
Olifirova O.S. MD, an associate professor, a head of the surgical diseases chair of the advanced training faculty of SBEE HPE "Amur State Medical Academy".
Knalyan S.V. A post-graduate student of the surgical diseases chair of the advanced training faculty of SBEE HPE "Amur State Medical Academy".

REVIEWS

E.V. MAHILIAVETS

CORRECTION OF HYPERSPLENISM IN PATIENTS WITH SURGICAL COMPLICATIONS OF PORTAL HYPERTENSION

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

In some cases in surgical the clinical situation is aggravated by the development of the hypersplenism syndrome in patients with complications of portal hypertension the departments of surgery. It negatively affects the overall disease course and the results of treatment. Substitution therapy with appropriate drugs is used in case of concomitant deficit of cyanocobalamin or folic acid as a conservative therapy of thrombocytopenia.
Platelet transfusion prior invasive procedures is performed at the level of platelets less than 40×109/L. Among the available arsenal methods to correct immune-mediated reduction of the platelet the intravenous immunoglobulin forms are used.
The cytokine thrombopoietin stimulates the production of megakaryocytes and separation from them of platelets, promotes to a long-term functioning and division of hematopoietic stem cells. Splenectomy is considered to be a profitable method of treatment in the conservative correction of hypersplenism, X-ray endovascular embolization of the spleen artery and other minimally invasive methods of the platelets inhibition destruction in the spleen.
The absence of effect of the conservative therapy (3-6 months), uncontrolled or recurrent bleeding in case of the reduction of corticosteroids dose, platelet level 10×109/l and less without bleeding, inefficiency of the correction of thrombocytopenia at the level of platelet counts less than 30×109/l within three months are considered as the indications for the spleen removal. Development of preoperative preparation methods contributing to the increase concentration of cellular elements in the peripheral blood is considered to be topical to improve operation tolerability, correcting complications of portal hypertension.

Keywords: hypersplenism, thrombocytopenia, embolization of the sleen artery, splenectomy, liver cirrhosis, bleeding, platelet counts, portal hypertension
p. 332-338 of the original issue
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Address for correspondence:
230023, ul. Gorkogo, 80, g.
Grodno, UO "Grodnenskiy gosudarstvennyiy
meditsinskiy universitet",
1-ya kafedra khirurgicheskih bolezney,
tel.mob.: 375 29 586 16 00,
e-mail: emogilevec@yandex.ru
Mogilevets 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".

I.V. MAIBORODIN, 1, S.E. KRASILNIKOV2, A.E. KOZJAKOV2, E.V. BABAYANTS2, A.P. KULIDZHANYAN2

THE FEASIBILITY OF TUMOR-RELATED ANGIOGENESIS STUDY AS A PROGNOSTIC FACTOR FOR CANCER DEVELOPMENT

FSBES "Institute of Chemical Biology and Fundamental Medicine", of SB of RAS, Novosibirsk1,
SBEE HPE "Novosibirsk State Medical University" 2
The Russian Federation

Objectives. To study a scientific literature review devoted to tumor-related angiogenesis and peculiarities of malignant tumors vascularization.
Methods. The analysis of about 50 foreign literature publications has been carried out.
Results. Numerous and often inconsistent results of studies specify that vascularization of malignant tumors can be considered to be an independent prognostic factor of a cancer progression, its invasion, appearance of local and distant metastases. Also there are a lot of publications calling into question a significance of the tumor angiogenesis as a predictor of tumor aggressiveness. The existence of the questionable publications containing statistically doubtful data with the improper interpretation of the received results should be mentioned. Only a few papers indirectly devoted to an angiogenesis in the distant organs and tissues were found.
Conclusion. The changes of tumor vascularization happen as a result of influence of various factors and releases produced by both cancerous cells and surrounding tissues at their hypoxia. All these cytokines and, partially, cellular elements are disseminated throughout the whole body and also have to manifest their pro- and antiangiogenic effect in the distant organs and tissues. Therefore, studying of angiogenesis in the places, distant from a tumor node, determination and specification of the predictors of intensity of a cancer progression and appearance of metastases, effectiveness of treatment and prospect of recurrence seems to be expedient. It is not excluded that analyzing vascularization changes, (for example, a skin), the prediction of angiogenesis intensity in the primary tumor and assessment of the main pathology prediction and effectiveness of the treatment will be possible in future.

Keywords: angiogenesis, pathology, hypoxia, tumor vascularization, prognostic factors of cancer progression, effectiveness of the treatment, recurrence
p. 339-347 of the original issue
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Address for correspondence:
630090, Rossiskaya Federatsiya,
g. Novosibirsk, pr-t. akad. Lavrenteva, 8,
Institut khimicheskoy biologii
i fundamentalnoy meditsinyi SO RAN,
Tsentr novyih meditsinskih tehnologiy,
tel.mob.: 7-913-753-0767,
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 FSBES "Institute of Chemical Biology and Fundamental Medicine", of SB of RAS.
Krasilnikov S.E. MD, professor of the oncology chair of SBEE HPE "Novosibirsk State Medical University".
Kozjakov A.E. A post-graduate student of the oncology chair of SBEE HPE "Novosibirsk State Medical University".
Babayants E.V. PhD, an applicant for Doctor’s degree of the oncology chair of SBEE HPE "Novosibirsk State Medical University".
Kulidzhanyan A.P. A post-graduate student of the oncology chair of SBEE HPE "Novosibirsk State Medical University".

CASE REPORTS

R.E. KALININ, A.S. PSHENNIKOV, I.A. SUCHKOV

REPERFUSION INJURY OF TISSUES IN LOWER LIMB ARTERIAL RECONSTRUCTIVE SURGERY

SBEE HPE "Ryazan State Medical University named after I.P. Pavlov",
The Russian Federation

This work represents the analysis of clinical cases of treatment patients suffering from obliterating arterial atherosclerosis of the lower limbs.
In all cases in the early postoperative period providing an adequate main blood flow restoring an acute disease progressing took place that required limb amputation.
The initial levels of nitric oxide metabolites (NO), vascular endothelial growth factors (VEGF), pro-apoptotic proteins (Bcl-2), heat shock proteins (HSP70) were determined in patients by standard methods (biological material – blood, ELISA analyzers – EKS 715 – Hsp70, BMS244 – Bcl – 2, KHG 0111 – VEGF; Griess reagent) prior and after surgery.
The reduction of the studied parameters (NO, VEGF, and HSP70) reflects the severity and depth of the endothelial vascular and tissue lesion of the limb within the reperfusion injury in the postoperative period. The above-mentioned phenomena manifest the inhibition of the microcirculatory bed function.
In the postoperative period the elevation of Bcl-2 protein level should be regarded as a mechanism of the positive feedback in the regulation of apoptotic process in the limb affected by severe necrotic changes.
Conclusion. The clinical cases show an obvious reduction of the endothelial reserves and as a consequence an inhibition of vascular endothelial function in patients with peripheral arterial occlusive disease Pokrovsky-Fontaine stage IV.
The outcome of the successful reconstructive procedure on the main vessels is mainly caused by tissue tolerance to reperfusion injury while a profound biochemical analysis of stress-limiting system may reveal a predictive model of the initial post-operative course of the disease from the post-ischemic injury point of view.

Keywords: reperfusion, post ischemic syndrome, classification of Pokrovsky- Fontaine, reconstructive surgery of the main arteries, tissue tolerance, necrotic changes, a predictive model
p. 348-352 of the original issue
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Address for correspondence:
390028, Rossiyskaya Federatsiya,
g. Ryazan, ul. Vyisokovoltnaya 9,
GBOU VPO "Ryazanskiy gosudarstvennyiy meditsinskiy universitet
imeni akademika I.P. Pavlova",
kafedra angiologii, sosudistoy,
operativnoy khirurgii i topograficheskoy anatomii,
tel.: 7-910-900-95-23,
e-mail: Pshennikov1610@rambler.ru,
Pshennikov Aleksandr Sergeevich
Information about the authors:
Kalinin P.E. MD, professor, a head of the chair of angiology, vascular, operative surgery and topographical anatomy, Rector of SBEE HPE "Ryazan State Medical University named after I.P. Pavlov".
Pshennikov A.S. PhD, an assistant of the chair of angiology, vascular, operative surgery and topographical anatomy of SBEE HPE "Ryazan State Medical University named after I.P. Pavlov".
Suchkov I.A. MD, an associate professor of the chair of angiology, vascular, operative surgery and topographical anatomy of SBEE HPE "Ryazan State Medical University named after I.P. Pavlov".
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