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Year 2017 Vol. 25 No 3

SCIENTIFIC PUBLICATIONS
EXPERIMAENTAL SURGERY

E.V. BARANOV1, A.V. BURAVSKY1, Z.B. KVACHEVA2, A.V. BUTENKO2, D.S. TRETYAK3, N.K. YURKSHTOVICH4, L.V. CEDIK5, S.I. TRETYAK1, I.D. VOLOTOVSKY2

POTENTIAL OF USING CULTIVATED DERMAL FIBROBLASTS ON THE BIODEGRADABLE POLYMERIC MATRICES FOR TREATING SKIN DAMAGES IN THE EXPERIMENT

EE "Belarusian State Medical University"1,
SRE "Institute of Biophysics and Cell Engineering of NAS of Belarus"2,
SE "The 432nd Chief Military Clinical Medical Center of the Armed Forces of the Republic of Belarus" 3,
EE "Belarusian State University"4,
SNE "Powder Metallurgy Institute"5,
Minsk
The Republic of Belarus

Objectives. To evaluate the possibility of using of cultivated dermal fibroblasts on the biodegradable polymeric matrices for treating skin damages in the experiment.
Methods. The study was performed on 90 rats of Wistar line (180-200 g weight) with pure wounds (D-2,5cm). Six groups were formed, 15 animals per each group. The culture of dermal fibroblasts was isolated from the skin of newborn rats; to accumulate the required biomass of cells subpassage was carried out.
The cellular biological products were not applied in group 1 (control). Biodegradable matrices (dextran phosphate or polylactide) were used for treating wounds in the groups 2-6 as matrices without cellular biological product and matrices with cultured fibroblasts (250×103 to 700×103 cells per wound). Conclusion about the impact of biodegradable polymeric matrices with dermal fibroblasts on the wound healing was made on the basis of a comparative analysis of the results of digital planimetry and morphological studies.
Results. At all stages (7, 14, 21, 28 days) minimal rate of healing was registered in the first group. The sixth group, where polylactide containing 700×103 cells was added in the wound, is characterized by the biggest values of the healing rate – with respect to other groups. Complete epithelization of the wound defects in the micropreparations of the sixth group was marked by the 21st day of the experiment. The strong direct correlation between the number of transplanted cells and wound rate healing was detected on the 7th day (ρ=0,923), the 14th day (ρ=0,924), and the 21st day of the experiment (ρ=0,914).
Conclusion. In the experiment it has been found out, that local application of the cultivated dermal fibroblasts on biodegradable polymer matrices (dextran phosphate and polylactide) results in a significant reduction of terms of the wound epithelization.

Keywords: rat skin fibroblasts, dextran phosphate, polylactide, biodegradable matrices, wound treatment, epithelization, experiment
p. 223-232 of the original issue
References
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  2. Abaev IuK. Rasstroistvo zazhivleniia ran i metody ikh korrektsii [Disorder of wound healing and methods of their correction]. Vestn khirurgii im II Grekova. 2005;164(1):111-13.
  3. Ehrlich HP. Understanding experimental biology of skin equivalent: from laboratory to clinical use in patients with burns and chronic wounds. Am J Surg. 2004 May;187(5A):29S-33S.
  4. Babaeva AG. Regeneratsiia – fakty i perspektivy [Regeneration - facts and perspectives]. Moscow, RF: RAMN; 2009. 334 p.
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Address for correspondence:
220116, Republic of Belarus, Minsk,
83, Dzerzhinskiyi Ave., Belarusian
State Medical University,
Department N2 of Surgical Diseases,
Tel.: 375 29 623-99-83
E-mail: doc.e.baranov@mail.ru,
Evgeniy V. Baranov
Information about the authors:
Baranov E.V. PhD, Ass. Professor of department of surgical diseases N2, EE "Belarusian State Medical University".
Buravsky A.V. PhD, Ass. Professor of department N2 of surgical diseases, EE "Belarusian State Medical University".
Kvacheva Z.B. PhD (Biology), leading researcher of Laboratory of Cellular and Molecular Biology , SRE "Institute of Biophysics and Cell Engineering of NAS of Belarus".
Butenko A.V. Junior researcher of the Laboratory of Cellular and Molecular Biology, SRE "Institute of Biophysics and Cell Engineering of NAS of Belarus".
Tretyak D.S. PhD, Major of medical service, senior resident of medical troop, SE "Main Clinical Military Medical Centre 432 of the Armed Forces of the Republic of Belarus"
Yurkshtovich N.K. PhD (chemical sciences), leading researcher of the Research Institute for Physical Chemical Problems of the Belarusian State University
Cedik L.V. Researcher of SNE "Powder Metallurgy Institute".
Tretyak S.I. Corresponding Member of NAS of Belarus, MD, Professor, Head of department of surgical diseases N2, EE "Belarusian State Medical University".
Volotovsky I.D. BD (Biology), Academician of NAS of Belarus, Head of the Laboratory of Cellular and Molecular Biology, SRE "Institute of Biophysics and Cell Engineering , NAS of Belarus".

I.V. MAIBORODIN 1, V.V. MOROZOV 1, A.A. ANIKEEV 1, N.F. FIGURENKO 1, R.V. MASLOV 1, G.A.CHASTIKIN 1, V.A. MATVEEVA 1, V.I.MAIBORODINA 2

MACROPHAGE REACTION TO MULTIPOTENT MESENCHYMAL STROMAL CELLS INTRODUCTION INTO SURGICAL TRAUMA SITE IN RATS

FSBES "Institute of Chemical Biology and Fundamental Medicine",
of Russian Academy of Sciences, Siberian Branch
FSBES "Institute of Molecular Pathology and Pathomorphology",
Novosibirsk
The Russian Federation

Objectives. To prove the possibility of phagocytosis by macrophage of autologic multipotent mesenchymal stromal cells of the bone marrow origin (AMMSCBMO) injected into the surgical site.
Methods. In 12 rats the macrophage reaction 2 weeks after the injection of AMMSCBMO with a transfected GFP-gene and additionally stained by Vybrant-CM-Dil cellular membranes into the site of a surgical trauma were investigated by light fluorescent microscopy with the application of monoclonal antibodies to CD68-antigen.
Results. AMMSCBMO injected into the site of a surgical intervention are partially phagocytized by macrophages from the tissues in the site of injection. Phagocytosis of AMMSCBMO is accompanied by rapid degradation of GFP-protein whereas Vybrant-CM-Dil either isn’t destroyed by enzymes of lisosomes or degrades very slowly. The accumulation of dye in macrophages has occured and, as a result, the phagocytes receive the ability to an intensive fluorescence in irradiation them by ultraviolet light with filter for rhodamine. AMMSCBMO and their fragments can get into the blood and lymphatic vessels and appear, at least, in the regional inguinal lymph nodes (ILN); it is possible to capture AMMSCBMO and their colored detritus from the lumen of the vessels by perivascular macrophages located in distant tissues.
In the cortex of ILN after AMMSCBMO injection in the site of lymph collection, in the sites corresponding to the location of lymphoid nodules, both the number and size of collections of large luminous macrophages, and their number in such collections have been increased. Some phagocytes from lymphoid nodules of ILN contain specifically stained AMMSCBMO fragments.
Conclusion. The macrophage phagocytosis of AMMSCBMO from the tissues in site of injection and vascular bed has been proved. Presence of macrophages with AMMSCBMO detritus in lymphoid nodules of ILN can serve the indirect confirmation of high probability of initiation of the humoral immune defense against the antigens of injected AMMSCBMO.

Keywords: multipotent mesenchymal stromal cells, lymph nodes, macrophages, macrophage fluorescence, humoral immune, lymphoid nodules, phagocytes
p. 233-241 of the original issue
References
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Address for correspondence:
630090, Russian Federation, Novosibirsk,
Acad. Lavrentiev Ave 8,
FSBES "Institute of Chemical Biology
and Fundamental Medicine of
the SB RAS, stem cell laboratory
Tel.: 8-913-753-07-67,
E-mail: imai@mail.ru,
Igor V. Maiborodin
Information about the authors:
Maiborodin I.V. MD, Professor, Chief researcher of the stem cell laboratory of FSBES "Institute of Chemical Biology and Fundamental Medicine", the Russian Academy of Sciences, Siberian Branch.
Morozov V.V. MD, Professor, Head of laboratory of invasive medical technologies, FSBES "Institute of Chemical Biology and Fundamental Medicine", the Russian Academy of Sciences, Siberian Branch.
Anikeev A.A. PhD, applicant for Doctor’s degree of FSBES "Institute of Chemical Biology and Fundamental Medicine", the Russian Academy of Sciences, Siberian Branch.
Figurenko N.F. PhD, Applicant for Doctor’s degree of the stem cell laboratory, FSBES "Institute of Chemical Biology and Fundamental Medicine", the Russian Academy of Sciences, Siberian Branch.
Maslov R.V. PhD, Applicant for Doctor’s degree of the stem cell laboratory, FSBES "Institute of Chemical Biology and Fundamental Medicine", the Russian Academy of Sciences, Siberian Branch.
ChastikinG.A. PhD, Applicant for Doctor’s degree of the stem cell laboratory, FSBES "Institute of Chemical Biology and Fundamental Medicine", the Russian Academy of Sciences, Siberian Branch.
Matveeva V.A. PhD (Biology), Senior Researcher of the stem cell laboratory, FSBES "Institute of Chemical Biology and Fundamental Medicine", the Russian Academy of Sciences, Siberian Branch.
Maiborodina V.I. MD, Leading Researcher of the laboratory of pathology ultrastructural foundations, FSBES "Institute of Molecular Pathology and Pathomorphology".

GENERAL & SPECIAL SURGERY

V.I. BELOKONEV 1,2, N.E. GALSTYAN 1,2, S.Y. PUSHKIN 1,3, X.V. KOVALEVA1,2, E.V. SELEZNEVA 2

SPECIFIC FEATURES OF SURGICAL TREATMENT OF PATIENTS WITH PRIMARY AND TERTIARY HYPERPARATHYROIDISM

SMEE HPE "Samara State Medical University" 1,
MBE "City Clinical Hospital N1 named after N.I.Pirogov", 2,
SBME "Samara Regional Clinical Hospital named after V.D.Seredavin" 3,
Samara
The Russian Federation

Objectives. To substantiate the indications, volume and operation technique in patients with primary and tertiary hyperparathyroidism in combination with the pathology of the thyroid gland.
Methods. The treatment of patients (n=63) with hyperparathyroidism aged 20-80 years has been analyzed. 23 patients suffered from primary and 40 – tertiary hyperparathyroidism. There were 19 males (31,7%) and 41 females (68,3%). The diagnosis was made on the basis of patients complaints of pain in the bones, muscles, skin itching, the level of total and ionized calcium, inorganic phosphorus and value of parathyrotrophic hormone (PTH > 300 pg/ml). The operations were carried out via a Kocher’s incision on the anterior surface of the neck. In repeated interventions unilateral access according to V.I. Razumovsky was used. Surgeries in patients with primary hyperparathyroidism were aimed to remove the parathyroid adenoma, and with tertiary hyperparathyroidism – to complete removal of the parathyroid glands. Thyroidectomy was performed in combination with the thyroid disease and more rarely its subtotal resection.
Results. Out of 23 patients with primary hyperparathyroidism the removal of adenoma and thyroidectomy was performed in 14 cases, adenoma and subtotal resection of the thyroid gland – in 3. In 18 patients out of 40 with tertiary hyperparathyroidism the removal of hyperplastic parathyroid glands was combined with thyroidectomy, in 7 – with the resection of the thyroid gland. Comparison of ultrasound and CT values with the operational data showed that those methods tentatively indicated the number and locations of parathyroid adenomas. In 23 patients with primary and 37 patients with tertiary hyperparathyroidism the treatment outcomes are good; there were 3 cases of disease recurrence.
Conclusion. Treatment of patients with primary hyperparathyroidism is aimed to remove adenoma and in the case of tertiary hyperparathyroidism – to remove completely the parathyroid glands.

Keywords: primary and tertiary hyperparathyroidism, peculiarities of treatment, volume of operation, Kocher’s incision, recurrence, parathyroid adenoma, thyroidectomy
p. 242-249 of the original issue
References
  1. Zarivchatskii MF, Denisov SA, Dil'man AB, Blinov SA. Diagnostika i lechenie vtorichnogo giperparatireoza u patsientov, nakhodiashchikhsia na programmnom gemodialize [Diagnosis and treatment of secondary hyperparathyroidism in patients on programmatic hemodialysis]. V kn: Aktual'nye Voprosy Transfuziologii i Klin Meditsiny. 2015;( Vyp 10). r. 412-14.
  2. Men'kov AV, Strel'tsov AA, Goshadze KA, Zaitseva IIu, Tikhomirova OS. Znachenie perioperatsionnogo monitoringa kal'tsiia krovi v khirurgii dobrokachestvennykh zabolevanii shchitovidnoi zhelezy [The value of perioperative monitoring of blood calcium in thyroid surgery of benign diseases]. Zhurnal MediAl'. 2013;(3):72-74.
  3. Egshatian LV, Rozhinskaia LIa, Kuznetsov NS, Kim IV, Artemova AM, Mordik AI, i dr. Lechenie vtorichnogo giperparatireoza, refrakternogo k al'fakal'tsidolu, u patsientov, poluchaiushchikh zamestitel'nuiu pochechnuiu terapiiu programmnym gemodializom [Treatment of secondary hyperparathyroidism refractory to alfacalcidol in patients receiving renal replacement therapy by programmatic hemodialysis]. Endokrin Khirurgiia. 2012;(2):27-41.
  4. Chernykh AV, Maleev IuV, Cherednikov EF, Shevtsov AN, Golovanov DN. Novye dannye po khirurgicheskoi anatomii okoloshchitovidnykh zhelez [New data on the surgical anatomy of the parathyroid glands]. Novosti Khirurgii. 2016; 24(1):26-31. doi: 10.18484/2305-0047.2016.1.26.
  5. Egshatian LV, Artemova AM, Pasha PS, Rozhinskaia LIa, Kuznetsov NS, Kim IV. Otsenka vozmozhnostei dooperatsionnoi stsintigrafii i ul'trazvukovoi diagnostiki v vizualizatsii okoloshchitovidnykh zhelez u patsientov s vtorichnym giperparatireozom, poluchaiushchikh zamestitel'nuiu pochechnuiu terapiiu programmnym gemodializom [Assessing opportunities of preoperative scintigraphy and ultrasound diagnosis in visualization of parathyroid glands in patients with secondary hyperparathyroidism receiving renal replacement therapy by programmatic hemodialysis]. Nefrologiia i Dializ. 2012;14(3):174-80.
  6. Romanchishen AF. Neotlozhnye sostoianiia v tireoidnoi i paratireoidnoi khirurgii [Emergency conditions in thyroid and parathyroid surgery]. S-Petersburg, RF: Feniks; 2014. 168 p.
  7. Lennquist S. Pearls and pitfalls in thyroidectomy. Surgery of the thyroid and parathyroid glands. Boston, US: Harvard Medical School; 2004. p. 1-5.
  8. Romanchishen AF, Vabalaite KV. Rossiiskie prioritety v tireoidnoi khirurgii KhIX – nachala KhKh vekov [Russian priorities in thyroid surgery in XIX - early XX centuries]. S-Petersburg, RF: Feniks; 2013. 198 p.
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  11. Evmenova TD, Liamina LG. Otdalennye rezul'taty khirurgicheskogo lecheniia vtorichnogo giperapratireoiza u patsientov, nakhodiashchikhsia na programmnom gemodialize [Long-term results of surgical treatment of secondary hyperparathyroidism in patients on programmatic hemodialysis]. Vestn Khirurgii im II Grekova. 2014;173(6):52-53.
  12. Vachev AN, Frolova EV, Sakhipov DR, Morkovskikh NV. Klinicheskoe nabliudenie bol'noi s pervichnym giperparatireozom i uzlovym toksicheskim zobom [Clinical observation of a patient with primary hyperparathyroidism and nodular toxic goiter]. Endokrin Khirurgiia. 2015;(1):42-47.
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Address for correspondence:
443099, Russian Federation,
Samara, Chapaevskaya str., 89,
Samara State medcal Univesity
Department of surgical diseases N2.
Tel.: +7 846 207-32-83
E-mail: nbelokoneva@yandex.ru
Vladimir I. Belokonev
Information about the authors:
Belokonev V.I. MD, Professor, Honored Physician of the Russian Federation, Head, department of surgical diseases N2, SMEE HPE " Samara State Medical University".
Galastyan N.E. Surgeon, MBE "City Clinical Hospital N1 named after N.I.Pirogov", Senior Laboratory Assistant, department of surgical diseases N2, SMEE HPE "Samara State Medical University".
Pushkin S.Y. Deputy Chief on Surgery, SBME "Samara Regional Clinical Hospital named after V.D.Seredavin", MD, Ass. Professor, department of the surgical diseases N2, SMEE HPE "Samara State Medical University".
Kovaleva Z.V. PhD, Assistant, department of the surgical diseases N2, SMEE HPE "Samara State Medical University".
Starostina A.A. PhD, Surgeon, "City Clinical Hospital N1 named after N.I.Pirogov".

S.A. ALEKSEEV 1, A.K. USOVICH 2, P.P. KOSHEVSKI 1, A.A. DUDKO 1, S.A. SHESTOPALOV 3, A.V. TARASENKO 4, V.S. ALEKSEEV 2

THANATOGENETIC ASPECTS OF MORPHOLOGICAL DISORDERS OF INTERNAL ORGANS AT ACUTE PANCREATITIS

EE "Belarusian State Medical University" 1 Minsk,
EE "Vitebsk State Medical University" 2, Vitebsk
ME "City Clinical Pathoanatomical Bureau"3 , Minsk,
Medical service of the 120th separate mechanized brigade of the Armed Forces of the Republic of Belarus 4,Minsk
The Republic of Belarus

Objectives. To study thanatogenetic aspects of morphological disorders causing the development of lethal outcomes in acute destructive pancreatitis in phases of fusion, sequestration and pyo-septic complications.
Methods. A retrospective analysis of 89 reports of persons died of acute destructive pancreatitis being treated in the healthcare establishments of Minsk (2005-2015) was performed. The examination of 214 histological preparations of the internal organs, stained with hematoxylin-eosin, was carried out.
Results. Subtotal and total affection of the pancreas was established in more than 88% of autopsies, the postoperative peritonitis – in 43,8%, different kinds of purulent parapancreatitis – in 55,1%, generalized phlegmon of the retroperitoneal cellular tissue – in 85,7% of cases. Leading thanatogenetic disorders in persons died of acute destructive pancreatitis were caused by the hepatoprime syndrome, respiratory distress-syndrome, renal and cardiac failure, established in 52,8%, 49,4%, 35,9% and 32,6% of cases, which was confirmed by the relevant morphological changes. The basis of morphological disorders of the internal organs of persons, died from acute destructive pancreatitis are the following: in the liver – edema of the intermediate spaces of hepatocytes (76,6%); lymphoid neutrophilic infiltration of the portal tracts (65,9%) and centrilobular hepatocyte necrosis (75,7%); in the lungs – interstitial edema (75,0%), microvascular thrombosis, desquamation of respiratory epithelium (88,6%); in the kidney – renal tubular epithelial dystrophy (90,6%) accompaying by the development of epithelium necrosis of the convoluted tubules (necrotic nephrosis) (56,3%). At 42 persons, died of the acute destructive pancreatitis, against pyo-septic complications, the signs of septic spleen with atrophy of follicles and «pulp emptying» were revealed, that testify the presence of severe secondary immunodeficiency involving the cellular and humoral components.
Conclusion. The established disorders determine the necessity of improving the diagnostic criteria of acute destructive pancreatitis, carrying out the differentiated surgical approach for performance of programmable necrosequestrectomy in generalized forms and puncture-aspiration interventions in the located restricted cystic-fluid collections, elimination of the main pathogenetic disorders - intoxication, hypoxia and secondary immunodeficiency.

Keywords: acute destructive pancreatitis, morphological disorders of the internal organs, thanatogenetic aspects of multiple organ, failure development, pancreonecrosis, phlegmon of retroperitoneal fat, intoxication, hypoxia
p. 250-256 of the original issue
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  4. Dombernowsky T, østermark Kristensen M, Rysgaard S, Lotte Gluud L, Novovic S. Risk factors for and impact of respiratory failure on mortality in the early phase of acute pancreatitis. Pancreatology. 2016 Sep-Oct;16(5):756-60.
  5. Párniczky A, Kui B, Szentesi A, Balázs A, Szucs Á, Mosztbacher D, et al. Prospective, Multicentre, Nationwide Clinical Data from 600 Cases of Acute Pancreatitis. PLoS One. 2016 Oct 31;11(10):e0165309. doi: 10.1371/journal.pone.0165309. eCollection 2016.
  6. Werge M, Novovic S, Schmidt PN, Gluud LL. Infection increases mortality in necrotizing pancreatitis: A systematic review and meta-analysis. Pancreatology. 2016 Sep-Oct;16(Is 5):698-707. doi: 10.1016/j.pan.2016.07.004.
  7. Wang M, Lei R. Organ Dysfunction in the Course of Severe Acute Pancreatitis. Pancreas. 2016 Jan;45(1):e5-7. doi: 10.1097/MPA.0000000000000450.
  8. Tarasenko AV. Analiz rezul'tatov diagnostiki i lecheniia destruktivnogo pankreatita [Analysis of diagnostic results and treatment of destructive pancreatitis]. Med Zhurn. 2014;(1):42-45.
  9. Zhou J, Li Y, Tang Y, Liu F, Yu S, Zhang L, et al. Effect of acute kidney injury on mortality and hospital stay in patient with severe acute pancreatitis. Nephrology (Carlton). 2015 Jul;20(7):485-91. doi: 10.1111/nep.12439.
  10. Bagnenko SF, Rukhliada NV, Gol'tsova VR. Diagnostika tiazhesti ostrogo pankreatita v fermentativnoi faze zabolevaniia [Diagnosis of severity of acute pancreatitis in the enzymatic phase of the disease]. Klin-Lab Konsilium. 2005;(7):18-19.
Address for correspondence:
220116, Republic of Belarus, Minsk,
Dzerzhinsky Ave., 83
Belarusian State Medical University,
Department of general surgery,
Tel.: 8 017 226-17-02,
E-mail: commonsurg@bsmu.by,
Sergey A. Alekseev
Information about the authors:
Alekseev S.A. MD, Professor, Head of department of general surgery, EE "Belarusian State Medical University".
Usovich A.K. MD, Professor, Head of department of human anatomy, EE "Vitebsk State Medical University".
Koshevski P.P. PhD, Ass. Professor of department of general surgery, EE "Belarusian State Medical University".
DudkoA.A. Post-graduate student of department of general surgery, EE "Belarusian State Medical University", Head of department of surgery, ME "The 3rd City Clinical Hospital named after E.V.Klumov".
Tarasenko A.V. PhD, Lieutenant Colonel of Medical Service, the deputy chief medical officer of the 120th separate mechanized brigade of the Armed Forces of the Republic of Belarus.
Shestopalov S.A. Head of autopsy department, ME "City Clinical Pathoanatomical Bureau", Minsk.
Alekseev V.S. Medical student of EE "Vitebsk State Medical University".

A.A. GLUHOV1, M.V. ARALOVA2

CLINICAL EFFICIENCY OF VARIOUS METHODS OF DEBRIDEMENT OF VENOUS ETIOLOGY TROPHIC ULCERS

FSBEE HE "Voronezh State Medical University named after N.N.Burdenko" 1,
BME VR "Voronezh Regional Clinical Hospital N 1" 2,
Voronezh
The Russian Federation

Objectives. To study the efficiency of various debridement methods of the surface of trophic ulcers in the 1st phase of wound healing process.
Methods. The regional treatment results of patients (n=53) with trophic ulcers (medium size) of the lower limbs against of varicose disease were analyzed. For excavation of the wound from necrotic masses, fibrin plaque, biofilm, pathological tissue and for stimulating the regeneration the surgical, autolytic, chemical and physical (cryodestruction) methods of treatments were used; the patients were divided into 4 groups according to those methods. The effectiveness of regional treatment was evaluated in 7th, 14th and 30th days taking into account the speed of wound cleaning, clinical manifestations of the ulcer regeneration process, subjective feelings of patients, the results of laboratory research methods (bacteriological, cytological analyses). For dynamic registration of the planimetric parameters of the wound defect, the mobile app+WoundDesk based on the usage of the smartphone camera (Android) were used.
Results. Within surgical treatment and cryodestruction in 75% of patients already after 7 days the wounds were completely cleansed from necrotic tissues, bacterial elimination was achieved 2 fold faster in comparison with hydrogels and 1,5 fold faster – enzymes. According to clinical data the stimulation of regeneration processes and the reduction of the wound surface area most effectively took place after cryosurgery and surgical treatment. The data of cytological studies confirm a more rapid transition to the regenerative cytograms during surgical treatment, the use of hydrogels and cryotherapy. Evaluating the wound healing after 30 days the greatest reduction of the defect wound area has been achieved during surgical treatment and after cryotherapy, 19 and 21%, respectively.
Conclusion. Debridement the wound from necrotic tissue, bacterial elimination, relief of local inflammatory reaction and the transition of the wound into the 2nd phase of wound process maximally quickly and effectively have occured during surgical treatment and cryodestruction.

Keywords: venous trophic ulcers, necrotic tissue, local treatment, methods of wound cleaning, cryodestruction, surgical treatment, inflammatory reaction
p. 257-266 of the original issue
References
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  4. Kuznetsov NA, Rodoman GV, Nikitin VG, Karev MA, Shalaeva TI. Kliniko-ekonomicheskie aspekty primeneniia sovremennykh pereviazochnykh sredstv pri lechenii patsientov s venoznymi troficheskimi iazvami golenei [Clinical and economic aspects of the use of modern dressings in the treatment of patients with venous trophic ulcers of the shins]. Khirurgiia Zhurn im NI Pirogova. 2009;(11):63-69.
  5. Ambrózy E, Waczulíková I, Willfort A, Böhler K, Cauza K, Ehringer H, et al. Healing process of venous ulcers: the role of microcirculation. Int Wound J. 2013 Feb;10(1):57-64. doi: 10.1111/j.1742-481X.2012.00943.x.
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  8. Lazarus G, Valle MF, Malas M, Qazi U, Maruthur NM, Doggett D, et al. Chronic venous leg ulcer treatment: future research needs. Wound Repair Regen. 2014 Jan-Feb;22(1):34-42. doi: 10.1111/wrr.12102.
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  10. Belous AM, Bondarenko AV. Mekhanizmy razvitiia kholodovogo povrezhdeniia membran kletok [Mechanisms of development of cold damage to cell membranes]. Kriobiologiia i Kriomeditsina. 1981;(9):3-17.
  11. Gliantsev SP. Poviazki s proteoliticheskimi fermentami v lechenii gnoinykh ran [Dressings with proteolytic enzymes in the treatment of purulent wounds]. Zhurn im NI Pirogova. 1998;(12):32-37.
  12. Gostishchev VK. Infektsii v khirurgii [Infections in surgery]: ruk. dlia vrachei. Moscow, RF: GEOTAR-Media; 2007. 768 p.
  13. Falanga V. Wound bed preparation and the role of enzymes: a case for multiple actions of therapeutic agents. Intern Wound J. 2002 Mar;14(2):47-57.
  14. Sibbald RG, Goodman L, Woo KY, Krasner DL, Smart H, Tariq G, et al. Special considerations in wound bed preparation 2011: an update©. Adv Skin Wound Care. 2011 Sep;24(9):415-36; quiz 437-38. doi: 10.1097/01.ASW.0000405216.27050.97.
  15. Glukhov AA, Aralova MV. Sposob lecheniia bol'nykh s troficheskimi iazvami [The method of treatment of patients with trophic ulcers]. Patent Ros Federatsii ¹ 2578382. 25.02.2015.
Address for correspondence:
394036, Russian Federation,
Voronezh, Moscow Ave, 151,
Voronezh Regional Clinical Hospital N 1,
Department of Outpatient Polyclinic Surgery,
Tel.: 8 803 854-05-43,
E-mail: Mashaaralova@mail.ru,
Mariya V. Aralova
Information about the authors:
Gluhov A.A. Professor, Head of department of the general surgery, FSBEE HE "Voronezh State Medical University named after N. N. Burdenko" .
Aralova M.V. PhD, Head of department of the out-patient policlinic, BME VR "Voronezh Regional Clinical Hospital N 1".

I.K. VENHER1, V.I. RUSIN2, S.Y. KOSTIV1, O.I. ZARUDNA1, O.I. KOSTIV1

HYPERCOAGULABLE SYNDROME OF THE EARLY POSTOPERATIVE PERIOD IS A FACTOR OF VENOUS THROMBOEMBOLISM

SHEE "I.Y. Horbachevsky Ternopil State Medical University"
the Ministry of Health of Ukraine1,Ternopil,
Uzhhorod National University2, Uzhhorod,
Ukraine

Objectives. To study the changes in the hemostatic system during surgery and in the early incisional period in patients with the planned surgical pathology.
Methods. The study included patients (n=183) who underwent arthroplasty of the hip joint, osteosynthesis of the femur, operations on the digestive tract, hepatopancreatoduodenal region, urinary system, revascularization surgeries on aorta and main arteries. The levels of indicators of coagulative, fibrinolytic and antiplatelet blood systems were being determined at all stages of surgery.
Results. The development of hypercoagulation syndrome, with a maximum of its development by 3 hours after the operation was occurred in the intraoperative stage of the surgery and within the early incisional period. The basis of the later is the increased content of thrombin-fibrin fraction. Development of the hypercoagulation syndrome occurs in case of activation of the aggregate system against the depressed fibrinolytic link of the coagulation system.
Postoperative venous thrombosis was diagnosed in 45 (24,59%) patients: the deep vein system – 37 (82,22%) patients, and superficial vein system – 8 (17,78%) patients. In the first 72 hours postoperative venous thrombosis was diagnosed in 15 (33,33%) patients.
Conclusion. The development of the hypercoagulation syndrome immediately within the surgery and in the early incisional period has been established. The process generally develops due to the accumulation of fibrinogen and thrombin fractions on the background of low activity of the fibrinolytic system with enhanced platelet aggregation ability. Hypercoagulation syndrome leads to thrombotic events. One of the main constituent components of the hypercoagulation syndrome is considered to be fibrinogen and thrombin factor, the predominant influence on it is provided by unfractionated heparin (UFH). Thromboprophylaxis should be started at the end of surgery with UFH and be continued within the first 72 hours of the postoperative period, against the administration of low molecular heparin according to the industry specific standards showing the dominant influence on Õà factor.

Keywords: hypercoagulation, deep vein thrombosis, venous thromboembolism, thromboprophylaxis, anticoagulation, low molecular heparin, incisional period
p. 267-272 of the original issue
References
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  5. Wu PK, Chen CF, Chung LH, Liu CL, Chen WM. Population-based epidemiology of postoperative venous thromboembolism in Taiwanese patients receiving hip or knee arthroplasty without pharmacological thromboprophylaxis. Thromb Res. 2014 May;133(5):719-24. doi: 10.1016/j.thromres.2014.01.039. Epub 2014 Feb 5.
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  8. Momot AP. Patologiia gemostaza. Printsipy i algoritmy kliniko-laboratornoi diagnostiki: ucheb posobie [Principles and algorithms of clinical and laboratory diagnostics]. S-Petersburg, RF: Format; 2006. 340 p.
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  11. SergЄЄv OO, Kutovii OB, Abramova O². Nash dosv³d l³kuvannia p³sliatrombofl³b³chno¿ khvorobi [Our experience after treatment of thrombophlebitis]. Naukovii V³snik Uzhgorods'kogo Un³versitetu. Ser Meditsina. 2012;(3):105-108.
  12. Kostiv SIa, Venger IK, Chornen'kii MV. Sposob tromboprofilaktiki u bol'nykh khirurgicheskogo profilia [Thromboprophylaxis in patients with surgical profile]. Khirurg. 2013;(9):68-70.
Address for correspondence:
47001, Ukraine, Ternopil,
Maydan Voli, 1, HSE "Ternopil
State Medical
University named by I. Gorbachevsky
Ministry of Health of Ukraine",
department of surgery ¹2
Òål.:+380352272363,
E-mail: svkostiv@gmail.com
Svyatoslav Y. Kostiv
Information about the authors:
Wenger IK MD, professor, head of Surgery Department N2, State Medical Institution "Ternopil State Medical University named after I.Y. Gorbachevsky Ministry of Health of Ukraine".
Rusin V.I. MD, Professor, professor of Department of Surgical Diseases, Uzhgorod National University.
Kostiv S.Y. MD, Ass. Professor of Surgery Department N2, State Medical Academy of Ternopol "Ternopil State Medical University named after I.Y Gorbachevsky Ministry of Health of Ukraine".
Zarudna O.I. PhD, Ass. Professor of Department of clinical immunology, allergology and general care, STI "Ternopil State Medical University named after I.Y Gorbachevsky Ministry of Health of Ukraine";
Kostiv O.I. PhD, Ass. Professor of Department of anesthesiology and reanimatology "Ternopil State Medical University named after I.Y Gorbachevsky Ministry of Health of Ukraine".

I.V. SHIPITSYNA, E.V. OSIPOVA, L.V. ROZOVA

ADHESIVE POTENTIAL OF CLINICAL STRAINS OF ENTEROBACTER CLOACAE ISOLATED FROM THE WOUNDS OF PATIENTS WITH CHRONIC OSTEOMYELITIS AND THEIR SENSITIVITY TO ANTIMICROBIAL PREPARATIONS

FSB "Russian State Scientific Centre "Restorative
traumatology and orthopaedics" named after the academician G.A.Ilizarov of the Ministry of Health of the Russian Federation",
Kurgan
The Russian Federation

Objectives. To study adhesive properties of Enterobacter cloacae strains isolated from the wounds of patients with chronic osteomyelitis and to evaluate the sensitivity to the antibacterial preparations used in clinical practice.
Methods. The clinical strains of Enterobacter cloacae (n=18) isolated preoperatively from the fistulas and from the inflammatary focus within the surgery in patients (n=18) with chronic osteomyelitis of long tubular bones for the period of 2015-2016 were studied. The biofilm-forming potential of monocultures of strain E. cloacae and their associations obtained in vitro were investigated: E. cloacae+ S. aureus (n=6), E. cloacae+ S. epidermidis (n=5), E. cloacae+P. aeruginosa (n=3). The sensitivity of isolated E. cloacae strains to the antibacterial preparations used in clinical practice was determined.
Results. Strains of Enterobacter cloacae were characterized by average biofilm-forming potential, and on the 2nd day of the experiment the level of biofilm formation was reliably higher than daily values. In co-cultivation of E. cloacae and S. aureus bacteria had led to the reduction of biofilm formation. In co-cultivation of E. cloacae, P. aeruginosa, E. cloacae and S. epidermidis bacteria the potential of biofilm formation was higher comparing with pure cultures of the studied strains.
The performed study demonstrated 100% resistance of E. cloacae bacteria to ampicillin, ceftriaxone and amoksiklav. Enterobacter bacteria can produce the enzymes of ß-lactamase hydrolyzed ß-lactam antibiotics, and therefore there is a high percentage of resistant strains. Imipenem and meropenem were the most effective to E. cloacae strains among antibacterial preparations.
Conclusion. The ability of clinical strains of E. cloacae to adhesion by forming a biofilm, as well as the high resistance to antimicrobial drugs testify to a significant pathogenic potential that should be taken into account in diagnosing and treating chronic osteomyelitis.

Keywords: Enterobacter cloacae, chronic osteomyelitis, biofilm, adhesion, antibiotic resistant, wounds, high resistance
p. 273-278 of the original issue
References
  1. Zuluaga AF, Galvis W, Saldarriaga JG, Vesga O. Arch Intern Med. 2006;166(1):95-100. doi:10.1001/archinte.166.1.95.
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  8. Shipitsyna IV, Osipova EV, Godovykh NV. Otsenka adgezivnoi aktivnosti bakterii, vydelennykh u patsientov s infitsirovannymi endoprotezami krupnykh sustavov [Assessment of the adhesive activity of bacteria isolated from patients with large joint endoprostheses infected]. Klin Lab Diagnostika. 2014;59(6):59-61.
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  10. . Bukharin O.V., Ginzburg A.L., Romanova Iu.M., El'-Registan G.I. Mekhanizmy vyzhivaniia bakterii [Mechanisms of survival of bacteria]. Moscow, RF: Meditsina; 2005. 367 p.
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Address for correspondence:
640014, Russia, Kurgan, M. Ulyanova str.,
6, FSB "Russian State Scientific Centre
"Restorative traumatology and orthopaedics" named after the academician G.A.Ilizarov of the Ministry of Health of the Russian Federation,
laboratory of microbiology and immunology, Tel.: 8-909-179-26-01,
E-mail: IVSchimik@mail.ru.
Irina V. Shipitsyna
Information about the authors:
Shipitsyna I.V. PhD (Biology), Researcher of laboratory of microbiology and immunology, FSB "Russian State Scientific Centre "Restorative traumatology and orthopaedics" named after the academician G.A.Ilizarov of the Ministry of Health of the Russian Federation.
Osipova E.V. PhD (Biology), Leading Researcher of laboratory of microbiology and immunology of FSB "Russian State Scientific Centre
"Restorative traumatology and orthopaedics" named after the academician G.A.Ilizarov of the Ministry of Health of the Russian Federation.
Rozova L.V. Junior researcher of laboratory of microbiology and immunology, of FSB "Russian State Scientific Centre "Restorative traumatology and orthopaedics" named after the academician G.A.Ilizarov of the Ministry of Health of the Russian Federation.

TRAUMATOLOGY AND ORTHOPEDICS

O.N. BONDAREV

MINIMALLY INVASIVE OSTEOSYNTHESIS OF FRACTURES OF THE TIBIAL CONDYLES.

SE "Republican Scientific and Practical Center of Traumatology and Orthopedics"
Minsk
The Republic of Belarus

Objectives. To carry out a comparative analysis of the results of minimally invasive and traditional open osteosynthesis in patients with fractures of the tibial condyles.
Methods. The patients were divided into two groups depending on the performed surgical treatment method of the fractures of the tibial condyles. In the first group (n=70) the open reposition of the fracture with the internal fixation was applied. In the second group (n=70) minimally invasive treatment methods were used: the closed reposition and percutaneous fixation with cannulated screws, reposition through the trepanation window with screws/plate fixation, minimally invasive osteosynthesis by plates, arthroscopically-assisted osteosynthesis. The following parameters were evaluated in the compared groups: the duration of the operation, the radiographic result of the treatment, the functional condition of the lower limb and the duration of temporary work incapacity.
Results. It has been found out that use of minimally invasive surgical treatment of fractures of the tibial condyles reduces the operative time from 100 (90-120) to 70 (60-90) minutes, but does not affect the quality of the reposition, and the number of infectious complications. It is also noted that the use of minimally invasive osteosynthesis of fractures of the tibial condyles permits to reduce the time of temporary disability from 24 (22-41) weeks to 21 (17-33,5) and achieve better functional outcomes compared with traditional open procedures. The study of long-term radiographic results of treatment showed that both methods of treatment permit to achieve a satisfactory reposition of bone fragments. In Schatzker type I and II fracture the advantages of minimally invasive treatment methods have been determined. The quality of reposition of Schatzker type III and VI fracture in both groups is comparable. It should be pointed out that regardless of the treatment technique used, reposition of the bicondylar fractures (Schatzker type V and VI) was accompanied by worse radiological outcomes in comparison with the results of single condyle damage.
Conclusion. The performed research has proved the efficacy of minimally invasive surgical procedures for the treatment of patients with tibial condylar fractures.

Keywords: tibial condylar fractures, minimally invasive osteosynthesis, tibial plateau, radiological outcome, complications, reposition
p. 279-285 of the original issue
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Address for correspondence:
220004, Republic of Belarus, Minsk, Kizhevatov str., 60/4, State Institution "Republican Scientific and Practical Center of Traumatology and Orthopedics", Laboratory of Adult Traumatology
Tel.: 375 29 613-18-08,
E-mail: zayonts@mail.ru,
Oleg N. Bondarev
Information about the authors:
Bondarev O.N. Researcher of Laboratory of adult traumatology,
SE "Republican Scientific-Practical Center of Traumatology and Orthopedics", Minsk

ONCOLOGGY

I.V. MIKHAILOV1, V.M. BONDARENKO2, T.N. NESTEROVICH1, V.A. KUDRYASHOV2, S.L. ACHINOVICH.2

SURGICAL TREATMENT RESULTS OF CANCER OF THE PANCREATIC HEAD DEPENDING ON PREOPERATIVE BILIARY DRAINAGE

EE "Gomel State Medical University"1,
E "Gomel Regional Clinical Oncology Dispensary"2,
Gomel
The Republic of Belarus

Objectives. To determine the impact of preoperative biliary drainage (PBD) on the surgical treatment results of patients with the pancreatic head cancer.
Methods. Short-term surgical treatment results were evaluated in 87 patients with cancer of the pancreatic head who undergo the operation on (March 1994 – February 2016). The group I includes 40 patients with pancreatoduodenectomy without preoperative biliary drainage (PBD), group II – 47 patients with pancreatoduodenectomy and with preoperative biliary drainage for the obstructive jaundice. Long-term results were evaluated in 38 patients of the first group and 41 patients of the second group.
Results. Post-operative complications occurred in 14 (35,0%) patients of the group I and 20 (42,5%) patients of the group II. The most frequent complication was pancreatitis of the stump, including the development of the pancreatojejunoanastomosis leakaqe (PJA). 1 (2,5%) patient of the group I and 4 (8,5%) patients of the group II died (P=0,22). No statistically significant differences for incidence rates complications in the patients of the studied groups were not revealed. Most important factors affecting the long-term results were similar clinical-morphological factors as PBD, histological type and the degree of the tumor differentiation. Significantly higher survival rates were obtained among the patients who underwent one-step surgical treatment (group I). The survival median time for the patients of the I and II groups, taking into account the postoperative lethality made 15,0 and 11,5 months, 3-year survival – 33,4±7,8% and 3,2±3,1%, 5-year survival – 26,7±7,5% and 0% respectively.
Conclusion. The extremely low survival rate of patients underwent two-step treatment testifies to the expediency of extension for the indications of one-step surgery for cancer of the pancreatic head, complicated by the obstructive jaundice.

Keywords: cancer of the pancreas head, gastropancreatoduodenectomy, biliary drainage, survival rates, pancreatojejunoanastomosis failure, complications, lethality
p. 286-291 of the original issue
References
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Address for correspondence:
246012, Republic of Belarus,
Gomel, Medicinskaya, 2, Gomel State Medical University,
Department of oncology
tel.: 375 29 7346860,
e-mail: igor-mikhailov-2014@yandex.ru,
Igor V. Mihailov
Information about the authors:
Mikhailov I.V. PhD, Ass. Professor, Head of department of the oncology, EE "Gomel State Medical University".
Bondarenko V.M. Oncosurgeon of the oncologic abdominal department, E "Gomel Regional Clinical Oncology Dispensary".
Nesterovich T.N. Assistant of department of the oncology, EE "Gomel State Medical University".
Kudryashov V.A. Head of oncologic abdominal department of E "Gomel Regional Clinical Oncology Dispensary".
Achinovich S.L. PhD, Head of pathoanatomical department of E "Gomel Regional Clinical Oncology Dispensary".

REVIEWS

A.V. ROMANOVICH 1, V.Y. KHRYSHCHANOVICH 2

PARAPROSTHETIC INFECTION IN VASCULAR SURGERY: CURRENT STATE OF THE PROBLEM

EE "Belarusian State Medical University" 1,
SEE "Belarusian Medical Academy of Post-Graduate Education" 2,
Minsk
The Republic of Belarus

Infection of synthetic vascular grafts after the emergency and scheduled arterial reconstructive operations is considered to be the most dangerous complication in vascular surgery. Postoperative wound suppuration occurred in 0.2-5% of patients and mortality rate varies from 25% to 88% of cases; the risk to lose the lower limbs reaches 60%. The article presents the etiology, symptoms, clinical presentation and diagnosis of synthetic prosthesis suppuration after the arterial reconstructive surgery. The existing treatment methods of the infected synthetic vascular grafts are described in details; the advantages and disadvantages of then each are discussed. Immediate and long-term results of various kinds of surgical treatment of local prosthetic graft infection have been presented. Then short-term high complications and amputation rates related to extra-anatomic bypass requires a search for alternative technique for infective paraprosthetic leakage repair. The advantages of reconstruction-associated procedure in situ are the adequate lower-limb revascularization and the best long-term treatment results compared with extra-anatomic bypass. This article reviews the currently available biological and synthetic graft materials routinely used in world practice for the repeated reconstructive surgeries: coated synthetic vascular prostheses, autovenous grafts, native and cryopreserved arterial allografts.

Keywords: aorta, diagnosis, graft, infection, prosthetic, treatment outcomes, complications
p. 292-299 of the original issue
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Address for correspondence:
210024, Republic of Belarus,
Minsk, Kizhevatov str., 58,
UZ "City Clinical Hospital of Emergency Medical Care"
department of surgical diseases N2, Belarusian State Medical University
Tel.: 375 44 760 33 70,
E-mail: romanovicha.v@mail.ru,
Aleksander V. Romanovich
Information about the authors:
Romanovich A.V. Assistant of department of surgical diseases N2, EE "Belarusian State Medical University".
Khryshchanovich V.Y. MD, Ass. Professor, Head of department of the emergency surgery, SEE "Belarusian Medical Academy of Post-graduate Education".

I.R. SALDAN 1, A.V. ARTEMOV 2, Y.I. SALDAN 1, G.G. NAZARCHUK 1,S.V. VERNYHORODSKYI 1

TO THE PROBLEM OF ETIOPATHOGENESIS OF THE PRIMARY OPEN ANGLE GLAUCOMA

Vinnitsa National Medical University named after N.I.Pirogov1.
Vinnytsia
SE "Filatov Institute of Eye Diseases and Tissue Therapy"2 of the NAMS of Ukraine
Odessa
Ukraine

Degeneration of the endothelium of the anterior chamber and the drainage system of the eye is one of the key elements of etiopathogenesis of the primary open-angle glaucoma (POAG). Morphological, histogenetic and functional alliance of the corneal endothelium and trabecular meshwork, visible only by electronic microscopy, indicates a unified charaeter of the pathologicul changes. Such approach permits to see the general etiopathogenetic mechanism of age-related pathology in the trabecular zone, leading to POAG, and in the posterior corneal epithelium resulted in the bullous keratopathy.
Insufficient number of endothelial cells lining the trabecular meshwork loses its ability to hold the intraocular fluid and initiates the process of similar bullous keratopathy. Swelling of trabecular collagen fibers leads to the narrowing of the inter-trabecular gaps’ lumen and the increase of resistance to intraocular fluid outflow.
A hypothesis of POAG pathogenesis based on the unity of histogenesis and morphological composition of the trabecular structures and the posterior segment of the cornea («Dua’s layer») is proposed. The main reason of these pathological changes is considered to be an age-related reduction of the endothelial cell density. Thus, the common nature of the pathological changes leading to glaucoma, keratoconus, bullous keratopathy is grounded, based on the proximity of the composition and functions of these structures.

Keywords: open-angle glaucoma, etiology, pathogenesis, trabecular meshwork, endothelium, keratoconus, bullous keratopathy
p. 300-305 of the original issue
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Address for correspondence:
21018, Ukraine, Vinnitsa, Pirogov str., 56, Vinnytsia National Medical University named after NI Pirogov,
Department of eye diseases

Email:shepelyuk.g.g@gmail.com,
Galina G. Nazarchuk
Information about the authors:
Saldan I.R. MD, Professor of department of eye diseases, Vinnytsia National Medical University named after N.I.Pirogov..
Artemov A.V. PhD, supervisor of laboratory of pathologic anatomy and donor’s tissues conservation of SE "V.P.Filatov Institute of eye diseases and tissue therapy of NAMSU".
Saldan Y.Y. PhD, Ass. Professor of department of eye diseases, Vinnytsia National Medical University named after N.I.Pirogov.
Nazarchuk G.G. PhD, Assistant of department of eye diseases, Vinnytsia National Medical University named after N.I.Pirogov.
Vernyhorodskyi S.V. MD, Professor of department of pathologic anatomy, Vinnytsia National Medical University named after N.I. Pirogov.

NEW METHODS

A.N. OSMOLOVSKY

THE SUBCLAVIAN VEIN PUNCTURE TECHNIQUE

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

Objectives. To work out the effective and safe technique of the subclavian vein puncture without damaging dome of the pleura and pneumothorax.
Methods. The subclavian vein puncture by the own original methodology was carried out in 34 patients aging from 19 to 88 years (the main group). Control group consisted of 50 cases of the subclavian vein catheterization in the manner of Aubaniac. 50 case histories of patients were selected by the continuous sampling method. The incidence of major complications after the subclavian vein puncture was analyzed in patients of the main and control groups including unsuccessful puncture on the selected side (failed puncture); damage of the subclavian artery; subcutaneous hematoma; pneumothorax; damage of the internal thoracic duct, trachea; thrombotic complications. The data which is given in the literature on the puncture-related complications of central veins were taken for the standard.
Results. All major complications of the subclavian vein puncture were registered in the control group, except for the damage of the thoracic duct and the trachea. The incidence of major complications in the control group was in the digital range of literature data that indicates the independent nature of the complications in using the same methodology under different conditions. Only two kinds of complications, unsuccessful puncture (6%) and subcutaneous bruise (6%) were registered in the main group. The incidence of these complications was comparable with the results of the control group and literature data. At the same time this group had no serious complications such as pneumothorax, subclavian artery damage and thromboembolic complications.
Conclusion. The designed technique of the subclavian vein puncture permits to avoid the subclavian artery injury, damaging the dome of the pleura and pneumothorax and is considered to be more effective and safer than the existing methods.

Keywords: subclavian vein, puncture of the subclavian vein, complications of vein catheterization, pneumothorax, dome of the pleura, subcutaneous hematoma
p. 306-311 of the original issue
References
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Address for correspondence:
210023, Republic of Belarus,
Vitebsk, Frunze pr., 27, EE "Vitebsk State Medical University",
Department of anesthesiology and reanimation with the course of FPK and PK,
Tel.: 375 29 599 17 97,
E-mail: Lariza_1970@mail.ru,
Aleksander N. Osmolovsky
Information about the authors:
Osmolovsky A.N. PhD, Ass. Professor of department of anesthesiology and intensive care with the course of the faculty of the advanced training and retraining of medical specialists, EE "Vitebsk State Medical University"

CASE REPORTS

V. I. TEMIRBULATOV1, 2, M. E. KLETKIN2

POSTTRAUMATIC LEFT-SIDED DIAPHRAGMATIC HERNIA COMPLICATED BY STRANGULATION

FSEE HE "Kursk State Medical University" MH RF 1
BME "Kursk regional clinical hospital" 2
Kursk
The Russian Federation

Post-traumatic strangulated diaphragmatic hernia is characterized by the complexity of diagnosis and a significant number of diagnostic errors, which are fraught with the occurrence of severe complications, up to a lethal outcome. Significant difficulties in diagnosing occur in patients with previously undiagnosed lesions of the diaphragm with thoracoabdominal injuries. Even small-sized diaphragm wounds can lead at various intervals after injury to the dislocation of abdominal organs into the pleural cavity through defects in the diaphragm.Even small-sized diaphragm injury can lead and to the dislocation of abdominal organs into the thoracic cavity through a defect in the diaphragm at various intervals after the injury. The paper presents a clinical case of the posttraumatic strangulated left-sided diaphragmatic hernia complicated by gangrene of the jejunum and transverse colon in a 24 year-old patient. The incarceration occurred 16 months after the undiagnosed left-sided stabbing – cutting thoracoabdominal injury and it was diagnosed only on the third day due to the indistinct clinical symptoms, and the surgery due to organizational issues was carried out in four days after the incarceration in another hospital (regional clinical hospital with a specialized department of thoracic surgery). Despite the severity of complications caused by the strangulated hernia and a long time period priota surgery as well as the traumatic character of the operation, performed consistently via thoracotomy and laparotomy bypass, the patient has recovered.

Keywords: posttraumatic diaphragmatic hernia, diaphragm injury, incarceration, bowel obstruction, gangrene, thoracotomy, laparotomy
p. 312-316 of the original issue
References
  1. Aliev SA, Rafiev SF, Zeinalov BM. Diagnostika i khirurgicheskoe lechenie razryvov diafragmy [Diagnosis and surgical treatment of diaphragm ruptures]. Khirurgiia Zhurn im NI Pirogova. 2010;(10):22-28.
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  5. Sotnichenko BA, Salienko SV, Sotnichenko AB. Diagnostika i lechenie travmaticheskikh ushchemlennykh diafragmal'nykh gryzh [Diagnosis and treatment of traumatic strangulated diaphragmatic hernias]. Grudnaia i Serdechno-Sosudistaia Khirurgiia. 2006;(4):67-71.
  6. Plaksin SA, Kotel'nikova LP. Dvustoronnie posttravmaticheskie diafragmal'nye gryzhi [Bilateral traumatic diaphragmatic hernia]. Vestn Khirurgii im II Grekova. 2015;174(1):47-51.
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  8. Hirano ES, Silva VG, Bortoto JB, Barros RH, Caserta NM, Fraga GP. Plain chest radiographs for the diagnosis of post-traumatic diaphragmatic hernia. Rev Col Bras Cir. 2012 Jul-Aug;39(4):280-85.[Article in English, Portuguese]
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  11. Altyev BK, Shukurov BI, Kuchkarov OO. Diagnostika i khirurgicheskoe lechenie postravmaticheskikh diafragmal'nykh gryzh [Diagnosis and surgical treatment of post-traumatic diaphragmatic hernias]. Vestn Khirurg Gastroenterologii. 2016(3):147.
Address for correspondence:
305007, the Russian Federation, Kursk, Sumskaya str., 45a,
BMU "Kursk Regional Clinical Hospital"
department of thoracic surgery
Tel.: 7 903 875-30-58,
E-mail: kletkin-max@mail.ru,
Maksim E. Kletkin
Information about the authors:
Temirbulatov V.I. MD, Professor of department of surgical diseases, FSEE HE "Kursk State Medical University" MH RF, Head of department of thoracic surgery, BME "Kursk regional clinical hospital".
Kletkin M.E. Physician of department of thoracic surgery, BME "Kursk regional clinical hospital".

EXCHANGE OF EXPERIENCE

V.I. AVERYN¹, S.B. HALUBITSKI², A.V. ZAPALIANSKI³, L.V. VàLIOK³, A.V. NIKULENKOV4

DIAGNOSTICS AND MEDICAL TACTICS IN MAGNETIC FOREIGN BODIES GASTROINTESTINAL TRACT IN CHILDREN

EE "Belarusian State Medical University"¹,
ME "Brest Regional Pediatric Hospital"²,
SI "Republican Scientific And Practical Center of Pediatric Surgery" ³,
ME "Minsk Regional Pediatric Clinical Hospital" 4,
Minsk,
The Republic of Belarus

Objectives. To carry out the analysis of treatment results and to justify therapeutic tactics in patients with in magnetic foreign bodies gastrointestinal tract in children
Methods. From November, 2012 to September 2016, 11 children (6 boys and 5 girls) with magnetic foreign bodies (MFB) were being monitored. The age of the patients ranged from 1 year 10 months to 14 years.
In suspection of the presence of MFB in the gastrointestinal tract all patients underwent conventional radiography of the abdomen, resulted in detection of single or multiple foreign bodies. If MFB were visualized in the projection of the esophagus and the stomach, a child was underwent to fibroesophagogastroduodenoscopy under the endotracheal anesthesia to remove the magnetic foreign bodies.
Results. Many magnetic foreign bodies like any other foreign bodies pass through the gastrointestinal tract spontaneously. If more than one magnet is swallowed, the balls can pull together inside the child’s digestive system, resulting in intestinal obstraction, internal fistulas or perforation of the intestine with the development of peritonitis. The exact time of development of complications is unknown, but there is always a certain time interval within which the damage of the walls of the stomach and intestines develops. Therefore, such patients should be obligatorily hospitalized in the surgical hospital.Accurate localization of a foreign body before it removal is important because tactics of treatment depends on the localization, the time from the moment foreign bodies located in the lumen of the digestive tract and the presence of complications. Retained foreign bodies the gastrointestinal tract are common emergency presentations and their removal prevents the development of severe complications.
Conclusion. The magnets are a special kind of aggressive foreign bodies of the digestive tract, if can cause dangerous complications: intestinal obstruction, perforation of a hollow organ, peritonitis. The «Algorithm for helping children with magnetic foreign bodies of the gastrointestinal tract» is proposed.

Keywords: gastrointestinal tract, foreign bodies, rare-earth magnets, perforation, internal fistulas, peritonitis, intestinal obstruction
p. 317-324 of the original issue
References
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Address for correspondence:
220116, Republic of Belarus,
Minsk, Dzerzhinsky Ave, 83,
Belarusian State Medical University,
Department of pediatric surgery,
Tel.: 375 017 290-49-23,
E-mail: averinvi@mail.ru
Vasiliy I. Averin
Information about the authors:
Averyn V.I. MD, Professor, Head of department of pediatric surgery, EE "Belarusian State Medical University".
Halubitski S.B. Head of surgical department, ME "Brest Regional Pediatric Hospital".
Zapalianski A.V. PhD, pediatric surgeon, SI "Republican Scientific and Practical Center of Pediatric Surgery".
Valiok L.V. Pediatric surgeon, SI "Republican Scientific and Practical Center of Pediatric Surgery".
Nikulenlov A.V. Head of surgical department, ME "Minsk Regional Pediatric Clinical Hospital".
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