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Year 2018 Vol. 26 No 3

HISTORY

A.V. VARABEI 1, D.A. CHEPIK 2, E.I. VIZHYNIS 1, A.M. MAKHMUDOV 1

HISTORY OF CREATION OF A VIABLE INTESTINAL GRAFT FOR BRIDGING ESOPHAGOPLASTY TO THE 105TH ANNIVERSARY OF KELLING OPERATION. PART I

Belarusian Medical Academy of Postgraduate Education 1,
Minsk Regional Clinical Hospital 2, Minsk,
The Republic of Belarus

The article is devoted to the history of the development of shunting plastic of the esophagus after its post-burn cicatricial strictures and esophageal cancer. The experimental idea of Wullstein with the retrosternal jejunal transplant (1904) and the original Tavel (1906) gastrostomy allowed Roux in 1906 laying the foundation for the esophagus plasty with the small intestine. It remained popular for more than 40 years, despite the work of Kelling and Vuillet (1911) on the use of the colon for the esophagus plasty. In the 50-s of the twentieth century, thanks to the achievements of French surgeons, interest in esophagocoloplasty was revived. This was due to the worldwide rise in the incidence of esophageal cancer and its congenital and acquired benign diseases, and many disadvantages in esophagojejunoplasty.
In the second half of the twentieth century, the technique of esophagocoloplasty, indications for it, and its shortcomings were thoroughly worked out. The retrosternal way of carrying a small and large intestine graft to the neck today is the method of choice. The problem of connecting the distal end of the intestinal esophagus graft with the stomach, discussed in the first half of the twentieth century, appeared to be exaggerated.
In general, intrathoracic esophagocoloplasty, both shunting and after the subtotal resection of the esophagus, has gained wide popularity among surgeons around the world.

Keywords: cicatricial esophageal stricture, shunting esophagojejunoplasty, esophagocolotransplant, retrosternal tunnel
p. 263-275 of the original issue
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Address for correspondence:
223040, The Republic of Belarus,
Minsk region, Lesnoy-1,
Minsk Regional Clinical Hospital,
Department of Surgery,
Tel. office.: +375 17 265-22-13,
e-mail: dept-surg@hotmail.com,
Aliaksandr V. Varabei
Information about the authors:
Varabei Aliaksandr V., Corresponding Member of NAS of Belarus, MD, Professor, Head of the Department of Surgery, Head of the Republican Center for Reconstructive Surgical Gastroenterology and Coloproctology, Belarusian Medical Academy of Postgraduate Education, Minsk, Republic of Belarus.
http://orcid.org/0000-0003-4710-5996
Chepik Dmitriy A., Head of the Surgical Unit ¹1, Minsk Regional Clinical Hospital, Minsk region, Borovlyany, Republic of Belarus.
http://orcid.org/0000-0001-6299-5486
Vizhinis Egi I., PhD, Associate Professor, the Department of Surgery, Belarusian Medical Academy of Postgraduate Education, Minsk, Republic of Belarus.
http://orcid.org/0000-0002-9185-7119
Makhmudov Anvar M., Associate Professor, the Department of Surgery, Belarusian Medical Academy of Postgraduate Education, Minsk, Republic of Belarus.
http://orcid.org/0000-0001-7833-5829

SCIENTIFIC PUBLICATIONS
EXPERIMENTAL SURGERY

I.N. KLIMOVICH 1, S.S. MASKIN 1, G.L. SNIGUR 1, 2, P.V. ABRAMOV 1, A.V. PAVLOV 1

INTESTINAL INSUFFICIENCY IN PATHOGENESIS OF ENDOTOXICOSIS IN HEMORRHAGIC HYPOTENSION

Volgograd State Medical University 1,
Volgograd Medical Scientific Center 2, Volgograd,
The Russian Federation

Objective. To clarify the role of the intestine in the potentiation of the systemic endotoxicosis with medium molecular peptides and the products of lipid peroxidation when modeling in animals severe bleeding from the upper sections of the gastrointestinal tract.
Methods. Severe bleedings from the upper gastrointestinal tract were modeled in Wistar rats. In dynamics, after 4 hours, 16 and 28 hours from the beginning of the experiment, the reperfusion injuries of the small intestine wall were studied as well as the integral indices of endotoxicosis severity in different regions of the blood stream - in the peripheral (inferior vena cava) blood and the blood flowing from the intestine (portal vein).
Results. 4 hours after the beginning of the experiment, the animals were observed the effects of reperfusion injury of the intestinal wall in the form of oxidative stress. However, no death and desquamation of enterocytes in the mucosal layer were noted. After 16 hours, the level of endotoxicosis was significantly higher (ð<0.05) in the blood flowing from the intestine, in comparison with the peripheral blood flow. In the mucous layer the foci of death and desquamation of enterocytes with the exposure of the basal membrane were found. After 28 hours the level of endotoxicosis increased, but the difference in endotoxicosis rates in different regions of the blood flow decreased, due to saturation of peripheral blood flow with the intestine toxins. Histological studies revealed necrotic changes in 2/3 of the mucosal layer of the intestine with partial necrosis of the surface sections of the villi. Correlation analysis between the total index of endotoxicosis in the blood from the portal vein and the degree of morphometric disturbances in the wall of the small intestine revealed a close relationship between the damage of the cellular elements of the small intestine wall and the toxicity of the blood flowing from it.
Conclusions. It has been established that as a result of reperfusion injury of the small intestine wall, pronounced inflammatory changes occur in it and its «barrier» function is violated. Products of the blood hydrolysis discharged into the lumen of the intestine and the products of lipid peroxidation, freely enter the mesenteric bloodstream, thereby substantially potentiating systemic endotoxicosis.

Keywords: gastrointestinal tract bleeding, reperfusion injury, small intestine wall, «barrier» function, endotoxicosis, mucous layer
p. 276-283 of the original issue
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Address for correspondence:
400131, The Russian Federation,
Volgograd, Pavshix Borcov Square, 1,
Volgograd State Medical University,
Department of Hospital Surgery,
Tel. office: 8(442) 71-87-62,
Tel. mobile.: +7 905-336-23-69
e-mail: klimovichigor1122@yandex.ru,
Igor’ N. Klimovich
Information about the authors:
Klimovich Igor’ N., MD, Associate Professor of the Department of Hospital Surgery, Volgograd State Medical University, Volgograd, Russian Federation.
http://orcid.org/0000-0002-7933-2635
Maskin Sergej S., MD, Professor, Head of the Department of Hospital Surgery, Volgograd State Medical University, Volgograd, Russian Federation.
http://orcid.org/0000-0002-5275-4213
Snigur Grigory L., MD, Associate Professor, Head of the Department of Biology, Volgograd State Medical University, Senior Researcher of the Laboratory of Morphology, Immunohistochemistry and Carcinogenesis, Volgograd Medical Scientific Center, Volgograd, Russian Federation.
http://orcid.org/0000-0002-8612-6186
Abramov Pavel V., Post-Graduate Student, the Department of Hospital Surgery, Volgograd State Medical University, Volgograd, Russian Federation.
http://orcid.org/0000-0002-8673-2581
Pavlov Alexandr V., Post-Graduate Student, the Department of Hospital Surgery, Volgograd State Medical University, Volgograd, Russian Federation.
http://orcid.org/0000-0002-1497-4231

N.A. SHCHUDLO, T.N. VARSEGOVA, M.M. SHCHUDLO, L.I. SBRODOVA, T.A. STUPINA

INTERRELATION BETWEEN PRIMARY AND SECONDARY CONTRACTION WITH HISTOLOGICAL STRUCTURE OF FASCIOCUTANEOUS FLAP

Russian Ilizarov Scientific Center of Restorative Traumatology and Orthopedics, Kurgan,
The Russian Federation

Objective. To conduct histomorphometric assessment of the skin in fasciocutaneous flap with regard to its primary and secondary contraction degree.
Methods. The experiments were carried out on 28 rats of the Wistar line. In animals a fasciocutaneous flap was formed according to a template with the area of 18 cm2 on the basis of a superficial epigastric artery that was clipped; after 1.5 hours the flap was reperfused and re-donated. The animals were euthanized 12 days after the operation. The methods used in the study were the analysis of the leukocyte blood formula, computerized planimetry of the digital images of flaps, histomorphometry, immunohistochemistry.
Results. Right after the flap reposition in four rats, its area increased by 6-30% compared to the template and decreased by 9-34% in 24 rats. At the end of the experiment, rats were divided into 4 groups: 1 – an increase in the flap area (+ 5-19%), 2 – a decrease in primary contraction (up to -1-14%), 3 – significant primary (-22-34%) and secondary -20-25%) contraction, 4 – expressed secondary contraction (-30-59%). Defects of the epidermis associated with delayed wound healing and partial necrosis in groups 1-3 did not exceed 3%, and in group 4 varied from 8 to 41% of the area of the flap. The highest degree of epidermal hypoplasia was registered in group 1 (47% of thickness measurements), hyperplasia in group 4 (67%). In comparison with a normal skin, the numerical densities of the skin appendages and the volume density of the adipocytes of the dermis progressively decreased in groups 1-4, the severity of postnecrotic changes in the dermis and hypodermis increased.
Conclusions. The obtained results substantiate the necessity for monitoring of the primary and secondary contraction of the vascularized fasciocutaneous flaps to elaborate individually oriented therapy protocols in order to modulate the proliferative activity of epidermis and revascularization of the vascular plexus of the skin.

Keywords: rats, diseases models, skin, contraction, tissue engraftment, histomorphometry
p. 284-292 of the original issue
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Address for correspondence:
640014, The Russian Federation,
Kurgan, M. Ulyanova Str., 6,
Russian Ilizarov Scientific Center
of Restorative Traumatology and Orthopedics,
Clinical and Experimental
Laboratory of Reconstructive-Plastic
Microsurgery and Hand Surgery,
Tel. office: +7-3522 45-18-12
e-mail: nshchudlo@mail.ru,
Nathalia A. Shchudlo
Information about the authors:
Shchudlo Nathalia A., MD, Chief Researcher of the First Scientific and Clinical Department, Russian Ilizarov Scientific Center of Restorative Traumatology and Orthopedics, Kurgan, Russian Federation.
http://orcid.org/0000-0001-9914-8563
Varsegova Tatyana N., PhD, Senior Researcher of the Morphology Laboratory, Russian Ilizarov Scientific Center of Restorative Traumatology and Orthopedics, Kurgan, Russian Federation.
http://orcid.org/0000-0001-5430-2045
Shchudlo Michael M., MD, Leading Researcher of the First Scientific and Clinical Department, Russian Ilizarov Scientific Center of Restorative Traumatology and Orthopedics, Kurgan, Russian Federation.
http://orcid.org/0000-0003-0661-6685
Sbrodova Lyudmila I., PhD, Researcher of the Scientific and Clinical Laboratory of Microbiology and Immunology, Russian Ilizarov Scientific Center of Restorative Traumatology and Orthopedics, Kurgan, Russian Federation.
http://orcid.org/0000-0002-7407-6791
Stupina Tatyana A., DS, Senior Researcher of the Morphology Laboratory, Russian Ilizarov Scientific Center of Restorative Traumatology and Orthopedics, Kurgan, Russian Federation.
http://orcid.org/0000-0003-3434-0372

GENERAL & SPECIAL SURGERY

I.S. IVANOV 1, V.I. TEMIRBULATOV 1, 2, M.E. KLETKIN 2, O.A. OKUNEV 1, I.A. IVANOVA 1

CORRELATION OF COLLAGEN TYPE I AND III IN THE SKIN AND LUNGS IN PATIENTS WITH BULLOUS EMPHYSEMA COMPLICATED BY SPONTANEOUS PNEUMOTHORAX

Kursk State Medical University 1,
Kursk regional clinical hospital 2, Kursk
The Russian Federation

Objective. To study the correlation of type I and III collagens of the connective tissue in the skin and lungs in patients with the bullous emphysema complicated by spontaneous pneumothorax and without it.
Methods. A comparative analysis of the content of type I and III collagens in the skin and lung in 32 patients with the lung bullous emphysema complicated by spontaneous pneumothorax and control group (autopsy material from 30 people without obvious pathology of the lungs) was carried out. The study of type I and III collagens in the skin and lungs was carried out using polarization microscopy, which allows revealing the correlation of collagen types in patients of the studied groups.
Results. It has been found out that patients with the bullous emphysema have a significantly lower ratio of type I and III collagens in both the skin and lung preparations in comparison with the control group. A high direct correlation has been registered between the correlation of collagen types of the skin and lungs connective tissue in both groups.
Conclusions. The patients with the bullous emphysema have a significantly lower ratio of type I and III collagens in the skin and lungs. The presence of a high direct correlation between the content of different types of collagen in the skin and lungs, both in the main and control groups, allows identifying the systemic pathology of the connective tissue only by its changes in the skin of patients. Determination of the relative ratio of type I and III collagens in preparations of the skin and lung with the use of polarization microscopy has high informative value in the verification of the bullous emphysema as one of the manifestations of connective tissue dysplasia.

Keywords: bullous emphysema, spontaneous pneumothorax, collagen type I, collagen type III, polarized microscopy
p. 293-300 of the original issue
References
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    2013; 21(3):33-36. doi: 10.18484/2305-0047.2013.3.33 (in Russ.)
Address for correspondence:
305007, The Russian Federation,
Kursk, Sumskaya Str., 45 à,
Kursk Regional Clinical Hospital,
Thoracic Surgery Unit,
Tel.: +7 903 875-30-58,
e-mail: kletkin-max@mail.ru,
Maxim E. Kletkin
Information about the authors:
Ivanov Ilia S., MD, Professor of the Department of Surgical Diseases ¹1, Kursk State Medical University, Kursk, Russian Federation.
https://orcid.org/0000-0003-4408-961X
Temirbulatov Vladimir I., MD, Professor of the Department of Surgical Diseases FPED, Kursk State Medical University, Head of the Thoracic Surgery Unit, Kursk Regional Clinical Hospital, Kursk, Russian Federation.
https://orcid.org/0000-0003-3757-924X
Kletkin Maxim E., Physician of the Thoracic Surgery Unit, Kursk Regional Clinical Hospital, Kursk, Russian Federation.
https://orcid.org/0000-0003-3886-5272
Okunev Oleg A., PhD, Assistant of the Department of Surgical Diseases ¹1, Kursk State Medical University, Kursk, Russian Federation.
https://orcid.org/0000-0002-2298-1546
Ivanova Inna A., PhD, Associate Professor of the Department of Clinical Immunology and Allergology, Kursk State Medical University, Kursk, Russian Federation. https://orcid.org/0000-0001-5175-6586

I. YA. KLETSKO, O.I. KUSHNIRUK

RISK FACTORS OF ACUTE PANCREATITIS AFTER THERAPEUTIC ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY

Danylo Halytsky Lviv National Medical University, Lviv,
Ukraine

Objective. To identify significant risk factors for the development of acute pancreatitis after therapeutic endoscopic retrograde cholangiopancreatography.
Methods. The significance of risk factors for post-manipulation pancreatitis was analyzed based on the results of 1801 therapeutic endoscopic retrograde cholangiopancreatographies performed in the clinic. To confirm the diagnosis of pancreatitis, to assess the severity stage the Cotton criteria were used. We analyzed the age and gender factors, the influence of the sphincter of Oddi syndrome in association with microlithiasis and parapapillary diverticulum, the ways of the transpapillary access, papillosphincterotomy and balloon dilatation. Possibilities of the intervention were evaluated in the absence of signs of biliary hypertension, and concrements more than 10 mm. The ratio of the chances of occurrence of the event in different periods was determined, with a calculation of 95% confidence interval.
Results. Acute pancreatitis developed in 19 (1.05%) patients. Among them, 7 (36.8%) had a severe destructive form. All cases of pancreatitis were diagnosed after primary intervention (OR 11.81, 95% CI 0.71-196.06, p = 0.011). Significant predictors of pancreatitis after transpapillary interventions were: young patients <40 years (OR 7.54, 95% CI 3.10-18.43, p = 0.00007), more often it occurred in women (OR 5.58, 95 % CI 1.22-17.35, p = 0.008), the presence of microcholedocholithiasis and concrements up to 10 mm in size (OR 4.42, 95% CI 1.23-12.44, p = 0.01), the syndrome of sphincter of Oddi dysfunction (OR 2.80, 95% CI 1.05-6.88, p = 0.03), interventions in the absence of obvious diagnostic signs of biliary hypertension (OR 2.80, 95% CI 1.16-6.96; p = 0.02).
Conclusions. Patient-related risk factors for pancreatitis development after therapeutic cholangiopancreatography remain a «weak spot» for its comprehensive prevention. The risk of developing acute pancreatitis rises 5-10 times if the patient has three or more factors. Atypical methods of papillosphincterotomy are not the significant risk factors for the development of pancreatitis when performed by an experienced specialist. It is necessary to adhere to the principle of multistage in carrying out complex or prolonged transpapillary X-ray endoscopic operations.

Keywords: endoscopic retrograde cholangiopancreatography, complications, post-ERCP pancreatitis, risk factors; guidewire-assisted cannulation
p. 301-310 of the original issue
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  3. Mantserov MP, Moroz YeV. Secondary pancreatitis after endoscopic manipulations on the major duodenal papilla. Ros Zhurn Gastroenterologii Gepatologii Koloproktologii. 2007;17(3):14-23. http://www.gastro-j.ru/files/s2_1297619598.pdf (in Russ.)
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Address for correspondence:
290059, Ukraine,
Lviv, Mikolaychuk Str., 9,
Danylo Halytsky Lviv
National Medical University,
Department of Radiation Diagnostics
of the Faculty of Postgraduate Education
Tel. mobile: +380 93 750-98-24,
e-mail: iv17@ukr.net,
Ivan Ya. Kletsko
Information about the authors:
Kletsko Ivan Ya., Assistant of the Department of Radiation Diagnostics of the Faculty of Postgraduate Education, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.
https://orcid.org/0000-0001-8942-0754
Kushniruk Oleksiy I., PhD, Associate Professor of the Department of Surgery and Endoscopy of the Faculty of Postgraduate Education, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.
https://orcid.org/0000-0003-3812-9339

A.A. GLUKHOV 1, V.A. SERGEEV 2

ASSESSMENT OF EFFICIENCY OF THE PROGRAMMED ASPIRATION AND IRRIGATION REHABILITATION METHOD IN SUPPURATIVE NECROTIC COMPLICATIONS OF DIABETIC FOOT SYNDROME

Voronezh State Medical University named after N.N. Burdenko 1, Voronezh,
Orel Regional Clinical Hospital 2, Orel
The Russian Federation

Objective. To assess the efficiency of the programmed aspiration and irrigation rehabilitation (PAIR) method in the combined treatment of patients with suppurative necrotic complications of diabetic foot syndrome (DFS).
Methods. The treatment results of 84 patients with suppurative necrotic complications of DFS without critical ischemia of 52 to 63 years of age have been analyzed. The patients with DFS were divided into two groups depending on the way of postoperative rehabilitation of the suppurative focus. In the reference group, conventional therapy was carried out with the use of iodophors and polyethylene glycol ointments. In the study group, postoperative rehabilitation of the suppurative foci was performed using the programmed technique with the original equipment. The device was equipped with a pressure switch providing automatic setting and maintenance of a definite vacuum level in the cavity of a suppurative focus.
Results. In the study group, the reduction below the threshold levels in the bacterial load for suppurative necrotic foci proved to occur earlier than in the reference group (p<0.001). Alkalinization of the wound effluent and reduction in the protein amount in the wound discharge were faster in the study group (p<0.001). Hospital length of stay in the study group was significantly lower compared to the reference group (p<0.001). The number of suppurative complications was significantly smaller (p=0.014) than in the reference group. The frequency of high amputations performed in the study group was less than in the reference group.
Conclusions. The results of the conducted investigations confirmed the efficiency of programmed aspiration and irrigation rehabilitation method in the combined treatment of patients with suppurative necrotic tissue injury in diabetic foot syndrome, which significantly improves the rehabilitation of the suppurative focus, providing in turn the significant improvement of the treatment efficacy.
Keywords: diabetic foot syndrome, suppurative necrotic complications, active surgical approach, programmed aspiration and irrigation rehabilitation, surgical treatment of suppurative focus, plastic resection of the foot

Keywords: diabetic foot syndrome, suppurative necrotic complications, active surgical approach, programmed aspiration and irrigation rehabilitation, surgical treatment of suppurative focus, plastic resection of the foot
p. 311-320 of the original issue
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Address for correspondence:
302000, The Russian Federation,
Orel, Pobedy Boul., 10,
Orel Regional Clinical Hospital,
Coloproctological unit,
Tel: +7 905 165 09 92,
e-mail: sergeevdoc60@yandex.ru
Vladimir A. Sergeev
Information about the authors:
Glukhov Alexksandr A., MD, Professor, Head of the Department of General Surgery, Director of the Institute of Surgical Infection, Voronezh State Medical University named after N.N. Burdenko, Voronezh, Russian Federation.
https://orcid.org/0000-0001-9675-7611
Sergeev Vladimir A., PhD, Surgeon, the Coloproctological Unit, Orel Regional Clinical Hospital, Orel, Russian Federation.
https://orcid.org/0000-0002-6201-2440

MILITARY FIELD SURGERY

IE.V. TSEMA 1, 2, A.A. BESPALENKO 1, 3, A.V. DINETS 1, B.M. KOVAL 1, V.G. MISHALOV 1

STUDY OF DAMAGING FACTORS OF CONTEMPORARY WAR, LEADING TO THE LIMB LOSS

A.A. Bogomolets National Medical University 1, Kiev
National Military Medical Clinical Center of Ministry of Defense of Ukraine 2, Kiev,
Military Medical Clinical Center for Occupational Pathology of Personnel of the Ministry of Defense of Ukraine 3, Irpin,
Ukraine

Objective. To study the main damaging factors and causes of limb amputations in the contemporary war conflict.
Methods. 191 cases of limb amputations in 159 injured persons from 01.06.2014 to 30.06.2016 have been analyzed. The mean age of patients at the moment of getting a wound was 33±8.9 years (M±σ) (ranging from 18 to 60). There were 158 (99.4%) males and 1 (0.6%) female. The mean term of military service at the moment of injury was 2.0±3.7 years (M±σ) (ranging from 11 days to 25 years).
Results. One limb amputation was performed in 130 (81.8%) injured persons, two limbs – in 27 (17.0%), three/four limbs – in 2 (1.3%) patients. 62 upper limb amputations were carried out: 18 (29.0%) – of the arm, 25 (40.3%) – of the forearm, 19 (30.7%) – of the hand. 129 lower limb amputations were performed: 55 (42.6%) – of thigh, 53 (41.1%) – of the leg, 21 (16.3%) – of the foot. In 140 (73.3%) cases, the reason for the limb amputation was mine-explosive injury which in 93 (66.4%) cases caused traumatic limb avulsion. In 16 (8.4%) cases, multiple shrapnel wounds were the main cause of the limb loss; 15 (7.9%) – frostbit injuries; 11 (5.8%) – bullet gunshot wounds; 4 (2,1%) – explosive behind-armor injuries; 3 (1.6%) cases – train accident with traumatic limb avulsion; 2 (1.0%) – concrete constructions collapse.
Conclusions. In the modern war conflict, limb amputation is determined by both combat (90.6%) and non-combat damaging factors (9.4%). The causes of limb amputations in 69.1% cases were associated with simultaneous occurrence of severe irreversible changes which were inevitable; potential opportunity to prevent limb amputation (or change amputation level) was in 28.8% cases.

Keywords: war-related injuries, armed conflicts and wars, limbs, amputation
p. 321-331 of the original issue
References
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Address for correspondence:
01601, Ukraine,
Kiev, Shevchenko Boul., 13,
A.A. Bogomolets National Medical University,
Department of Surgery ¹ 4,
tel.: +38 063 731-59-95,
e-mail: hemorrhoid@ukr.net,
Ievgen V. Tsema
Information about the authors:
Tsema Ievgen V., MD, Associate Professor, Associate Professor of the Department of Surgery ¹4, A.A. Bogomolets National Medical University, Surgeon of the Abdominal Surgery Department, National Military Medical Clinical Center of Ministry of Defense of Ukraine, Kiev, Ukraine.
http://orcid.org/0000-0002-1178-7529
Bespalenko Artem A., Post-graduate Student, the Department of Orthopedics and Traumatology, A.A. Bogomolets National Medical University, Head of the Traumatology Department, Military Medical Clinical Center for Occupational Pathology of Personnel of Ministry of Defense of Ukraine, Irpin, Ukraine
http://orcid.org/0000-0003-2498-4334
Dinets Andrii V., PhD, Associate Professor of the Department of Surgery ¹4, A.A. Bogomolets National Medical University, Kiev, Ukraine.
http://orcid.org/0000-0001-9680-7519
Koval Boris M., PhD, Associate Professor of the Department of Surgery ¹4, A.A. Bogomolets National Medical University, Kiev, Ukraine.
http://orcid.org/0000-0003-0166-8603
Mishalov Vladimir G., MD, Professor, Head of the Department of Surgery ¹4, A.A. Bogomolets National Medical University, Kiev, Ukraine.
http://orcid.org/0000-0001-7263-7375

TRAUMATOLOGY & ORTHOPEDICS

G.P. KOTELNIKOV, YU.V. LARTSEV, I.G. TRUKHANOVA, A.D. GUREEV, O.V. FIRSTOVA, D.S. KUDASHEV

POSTOPERATIVE PROLONGED INFILTRATION ANESTHESIA FOR MMULTIMODAL PERIOPERATIVE PAIN MANAGEMENT IN PATIENTS WITH HIP REPLACEMENT ARTHROPLASTY

Samara State Medical University, Samara,
The Russian Federation

Objective. To improve the efficiency of multimodal perioperative pain management in patients in case of the hip replacement arthroplasty using postoperative prolonged infiltration anesthesia in the area of surgical intervention.
Methods. A prospective comparative analysis of the treatment results of 78 patients underwent the primary hip replacement arthroplasty was performed. The patients were divided into two groups: (1) the first group of patients was treated with prolonged epidural analgesia in the postoperative period, while (2) in the second group, the patients were treated with prolonged 24-hour infiltration anesthesia at the area of the surgical intervention by 0.2% of the ropivacaine hydrochloride solution, administered using microinfusion pump with a constant rate of 8 ml per hour. All patients were assessed for intensity of the pain syndrome, plasma concentrations of the cortisol and blood glucose levels. Also, trimeperidine consumption rate and the start of patient’s activity were assessed. The evaluation was conducted 24 hours prior to the surgical intervention, as well as 6 and 24 hours after.
Results. 24 hours after the surgery, the pain intensity scores assessed by the VAS were 2.2±0.35 and 1.5±0.42 points in the first and second clinical groups, respectively; the cortisol plasma levels 24 hours after the surgical intervention were 768.5±45.8 nmol/l and 584.6±54.2 nmol/l in the first and second clinical groups, respectively; the blood glucose levels after the surgical intervention were 7.03±0.34 mmol/l and 5.91±0.27 mmol/l in the first and second clinical groups, respectively. Trimeperidine consumption rates for the first 24 hours after the surgical intervention were 38.6±2.95 mg and 21.3±3.17 mg in the first and second clinical groups, respectively. The first sitting and complete verticalization of patients in the first group were performed in 24.8±2.4 and 28±1.4 hours, while in the second clinical group, these activities were performed in 4.5±0.5 and 6.3±0.7 hours respectively.
Conclusions. The use of the prolonged infiltration anesthesia allowed by 46.7% more effectively arresting pain syndrome, by 55.2% reducing trimeperidine consumption rate for the first 24 hours after the surgical intervention and by 20.3±1.4 hours earlier starting activation of patients if compared to the prolonged epidural analgesia.

Keywords: hip replacement arthroplasty, epidural anesthesia, infiltration anesthesia, ropivacaine hydrochloride, microinfusion pump
p. 332-339 of the original issue
References
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  14. Koriachkin VA, Geras’kov EV, Korshunov DIu. Evaluation of Infiltration Anesthesia Safety in Total Knee Joint Arthroplasty. Novosti Khirurgii. 2015;23(4):436-39. doi: 10.18484/2305-0047.2015.4.436 (in Russ.)
Address for correspondence:
443099, The Russian Federation,
Samara, Chapayevskaya Str., 89,
Samara State Medical University,
Department of Traumatology,
Orthopedics and Extreme Surgery
named after Acad. of RAS A.F. Krasnov,
Tel.: +79276076209,
e-mail: dr.kudashev@gmail.com,
dmitrykudashew@mail.ru,
Dmitrij S. Kudashev
Information about the authors:
Kotelnikov Gennady P., Academician of RAS, MD, Professor, Head of the Department of Traumatology, Orthopedics and Extreme Surgery named after Acad. of RAS A.F. Krasnov, Samara State Medical University, Samara, Russian Federation.
https://orcid.org/0000-0001-7456-6160
Lartsev Yuri V., MD, Head of the Traumatology and Orthopedics unit ¹2 of Clinic of Samara State Medical University, Professor of the Department of Traumatology, Orthopedics and Extreme Surgery named after Acad. of RAS A.F. Krasnov, Samara State Medical University, Samara, Russian Federation.
https://orcid.org/0000-0003-4450-2486
Trukhanova Inna G., MD, Head of the Department of Anesthesiology, Reanimatology and Emergency Medical Care of the Institute of Vocational Education, Samara State Medical University, Samara, Russian Federation.
https://orcid.org/0000-0002-2191-1087
Gureev Anton D., Head of the Anaesthesiology-Resuscitation Unit of Clinic of Samara State Medical University, Assistant of the Department of Anesthesiology, Reanimatology and Emergency Medical Care of the Institute of Vocational Education, Samara State Medical University, Samara, Russian Federation.
https://orcid.org/0000-0001-8389-7244
Firstova Ol’ga V., Anesthetist-Resuscitator of the Anaesthesiology-Resuscitation Unit of Clinic of Samara State Medical University, Samara, Russian Federation.
https://orcid.org/0000-0002-8920-0433
Kudashev Dmitrij S., MD, Traumatologist-Orthopedist of the Traumatology and Orthopedics unit ¹2 of Clinics of Samara State Medical University, Assistant of the Department of Traumatology, Orthopedics and Extreme Surgery named after Acad. of RAS A.F. Krasnov, Samara State Medical University, Samara, Russian Federation.
https://orcid.org/0000-0001-8002-7294

ONCOLOGY

I.A. ILYIN

RESULTS OF THREE-STAGE ESOPHAGECTOMY WITH ONE-PHASE ESOPHAGOCOLONOPLASTY IN ESOPHAGEAL AND GASTROESOPHAGEAL JUNCTION CARCINOMAS TREATMENT

N.N. Alexandrov National Cancer Centre of Belarus, Minsk,
The Republic of Belarus

Objective. To evaluate the results of three-stage esophagectomy with one-phase esophagocolonoplasty in surgical treatment of esophageal and gastroesophageal junction carcinomas depending on graft translocation route to the neck.
Methods. Åsophagectomy with one-phase esophagocolonoplasty was performed in 30 patients. Depending on the graft translocation route to the neck, two groups of patients were formed: the 1st group — with retrosternal route (n=13) and the 2nd — with posterior mediastinal one (n=17). The groups did not differ in morphology, pT and pN, stages, age, body mass index and sex.
Results. Time of procedures in the 1st and 2nd groups was 435.0 (390.0, 477.5) and 425.0 (352.5, 467.5) minutes (p=0.691), blood loss volume — 400 (325.0, 525.0) and 500.0 (475.0, 725.0) ml (p=0.020), in-hospital stay — 30.0 (23.0, 36.0) and 32.0 (20.0, 57.5) days respectively (p=0.900). Esophago-colonic anastomotic leakage and graft proximal necrosis was detected by physical examination and X-rays on 7th day after the procedure. Anastomotic leakage in the 1st and 2nd groups developed in 2 (15.4%) and 2 (11.8%) cases (p=0.776), graft necrosis — in 1 (7.7%) and 1 (5.9% %) (p=0.846). Late anastomotic stricture of the esophageal-colonic anastomosis, determined endoscopically 3 months after the procedure developed in 2 (15.4%) and 1 (5.9%) patients respectively (p=0.398). Hospital and 30-day mortality did not differ — 1 (7.7%) and 1 (5.9%) (p=0.846); overall 5-year survival made up 18.6 and 20.6% respectively (plogrank=0.804).
Conclusions. Esophagectomy with one-stage esophageal replacement by primary coloplasty in surgical treatment of esophageal and gastroesophageal junction carcinomas regardless of graft translocation route to the neck is a complex procedure that allows achieving long-term treatment results comparable to those in the standard procedures.

Keywords: esophageal carcinoma, gastroesophageal junction carcinoma, three-stage esophagectomy, one-phase esophageal replacement by primary coloplasty, graft translocation route, posterior mediastinal route, retrosternal route
p. 340-347 of the original issue
References
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  12. Reslinger V, Tranchart H, D’Annunzio E, Poghosyan T, Quero L, Munoz-Bongrand N, Corte H, Sarfati E, Cattan P, Chirica M. Esophageal reconstruction by colon interposition after esophagectomy for cancer analysis of current indications, operative outcomes, and long-term survival. J Surg Oncol. 2016 Feb;113(2):159-64. doi: 10.1002/jso.24118
  13. Saeki H, Morita M, Harada N, Egashira A, Oki E, Uchiyama H, Ohga T, Kakeji Y, Sakaguchi Y, Maehara Y. Esophageal replacement by colon interposition with microvascular surgery for patients with thoracic esophageal cancer: the utility of superdrainage. Dis Esophagus. 2013 Jan;26(1):50-56. doi: 10.1111/j.1442-2050.2012.01327.x
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Address for correspondence:
223040, The Republic of Belarus,
Minsk region, Lesnoy village 2,
N.N. Alexandrov National Cancer
Centre of Belarus
Surgical Department,
Tel. office: 8 017 389 95 32,
e-mail: ileus@tut.by,
Ilya A. Ilyin
Information about the authors:
Ilyin Ilya A., PhD, Leading Researcher of the Surgical Department, N.N. Alexandrov National Cancer Centre of Belarus Minsk, Republic of Belarus.
http://orcid.org/0000-0002-5314-7618

ANESTHESIOLOGY-REANIMATOLOGY

D.P. MARKEVICH 1, A.V. MAROCHKOV 2

FEATURES OF ELECTROENCEPHALOGRAPHIC MONITORING IN ANESTHESIOLOGICAL SUPPORT OF NEUROSURGERICAL INTERVENTIONS IN THE HEAD

Mogilev Emergency City Hospital 1,
Mogilev Regional Hospital 2, Mogilev,
The Republic of Belarus

Objective. To determine the diagnostic importance of electroencephalographic (EEG) monitoring together with different methods of anesthesia and at different stages of the surgery during neurosurgical interventions in the head.
Methods. Perioperative EEG monitoring of 34 patients operated because of the intracranial hematomas, brain tumors, and postoperative skull defects was analyzed. The first group consisted of 16 patients with the combined anesthesia (general with conductor blockades of the peripheral nerves of the scalp part of the head), the second group – 18 patients with the general anesthesia. The groups did not differ by sex, age, body weight. General anesthesia in groups was total intravenous with the mechanical ventilation with fentanyl and propofol. Blockade of nerves was performed with 0.5% bupivacaine or 0.75-1.0% ropivacaine. Cerebral state monitor was used for electroencephalographic monitoring and the cerebral state index (CSI) was monitored.
Results. There were no significant differences between CSI groups. CSI parameters at the moment of the surgery onset were 45.7±5.9 un. in 1-st group, in the 2-nd group – 54.2±17.5 un.; at trepanation: 1-st group – 51.2±15.1 un., 2-nd group – 63.1±18.3 un.; main stage of the surgery: 1-st group – 43.0±6.3 un., 2-nd group – 44.8±8.9 un.; end of operation: 1-st group – 48.1±9.9 un., 2-nd group: – 52.1±13 un.
In 5 (31.2%) patients of the 1-st group and 8 (44.4%) of 2-st group, during the skull trepanation, CSI increased more than 60 un., which required additional deepening of anesthesia by bolus injections of fentanyl and propofol.
Conclusions. There were no significant differences in CSI between the groups with the combined and general anesthesia. Taking into account the increase in CSI by more than 60 un. in 5 (31.2%) patients in the 1-st group and 8 (44.4%) of the 2-st group, preliminary additional deepening of anesthesia is necessary 3-5 minutes before the braincase trepanation.

Keywords: electroencephalographic monitoring, conductor blockades, general anesthesia, neuroanesthesiology, cerebral state index in neurosurgery, anesthetic depth monitoring
p. 348-357 of the original issue
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  11. Markevich DP, Marochkov AV. Blokady perifericheskikh nervov v anesteziologicheskom obespechenii neirokhirurgicheskikh vmeshatel’stv na golove. Regionarnaia Anesteziia i Lechenie Ostroi Boli. 2017;11(4):270-78. (in Russ)
  12. Weber F, Kriek N, Blussé van Oud-Alblas HJ. The effects of mivacurium-induced neuromuscular block on Bispectral index and cerebral state index in children under propofol anesthesia – a prospective randomized clinical trial. Paediatr Anaesth. 2010 Aug;20(8):697-703. doi: 10.1111/j.1460-9592.2010.03327.x
Address for correspondence:
212030, The Republic of Belarus,
Mogilev, Botkin Str., 2,
Mogilev Emergency City Hospital,
Anesthesiology and Intensive Care Unit.
Tel./fax: +375(222) 22-16-26,
+375(222) 29-16-42,
e-mail: snyter1977@gmail.com,
Denis P. Markevich
Information about the authors:
Markevich Denis P., Head of Anesthesiology and Intensive Care Unit, Mogilev Emergency City Hospital, Mogilev, Republic of Belarus.
http://orcid.org/0000-0002-1117-3877
Marochkov Alexey V., MD, Professor, Anesthesiologist-Resuscitator, Mogilev Emergency City Hospital, Mogilev, Republic of Belarus.
http://orcid.org/0000-0001-5092-8315

REVIEWS

A.I. CHERNOOKOV 1, A.YU. BOZHEDOMOV 2, A.A. ATAYAN 1, 2, E.N. BELYKH 1, E.S. SYLCHUK 3, E.O. KHACHATRYAN 1

NEW BIOMARKERS OF ACUTE MESENTERIC ISCHEMIA

I.M. Sechenov First Moscow State Medical University (Sechenov University) 1,
City Clinical Hospital ¹29 named after N. E. Bauman, Moscow Healthcare Department 2,
Center of Phlebology 3, Moscow,
The Russian Federation

The acute mesenteric ischemia is one of the most complex problems in the urgent surgery because of the high mortality, the cause of which is late diagnosis. The operation treatment is often provided in the phase of diffuse peritonitis.
This literature review is done in order to identify the most accessible and accurate methods of early diagnosis of the acute mesenteric ischemia.
At present time rather a small number of biomarkers for diagnosing the acute mesenteric ischemia are used, such as α-glutamate-S-transferase, D-dimers, procalcitonin, D-lactate, intestinal fatty acid binding protein (I-FABP), ischemia-modified albumin. According to the literature the highest sensitivity and specificity were found in I-FABP (75-85% and 70-80% respectively), α-glutamate-S-transferase (67.8% and 84.2%), ischemia-modified albumin (94.7% and 86.4%). In addition, expensive and invasive methods are currently used for early diagnosis, such as CT angiography, contrast-enhanced MRI, selective angiography. However, these technologies are not available to all medical institutions.
We should continue further search of various biomarkers and their more widespread introduction to clinical practice in order to solve the problem of early acute mesenteric ischemia diagnostics.

Keywords: acute mesenteric ischemia, biomarkers, diagnostics, mesenteric thrombosis, intestinal fatty acid binding protein (I-FABP)
p. 358-365 of the original issue
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Address for correspondence:
111020, The Russian Federation,
Moscow, Hospital Square, 2,
City Clinical Hospital ¹29
named after N. E. Bauman,
Moscow Healthcare Department,
Endovascular Surgery Unit,
Tel. office: +7(499) 263-21-30,
e-mail: alecso_84@mail.ru,
Aleksey Yu. Bozhedomov
Information about the authors:
Chernookov Alexandr I., MD, Professor, Head of the Department of Hospital Surgery ¹2, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation. http://orcid.org/0000-0003-3124-4860
Bozhedomov Aleksey Yu., PhD, Surgeon of the Surgical Unit ¹3, City Clinical Hospital ¹29 named after N. E. Bauman, Moscow Healthcare Department, Moscow, Russian Federation. http://orcid.org/0000-0002-8544-932X
Atayan Andrey A., PhD, Assistant of the Department of Hospital Surgery ¹2, I.M. Sechenov First Moscow State Medical University (Sechenov University), Surgeon of the Endovascular Surgery Unit, City Clinical Hospital ¹29 named after N. E. Bauman, Moscow Healthcare Department, Moscow, Russian Federation.
http://orcid.org/0000-0001-8914-7735
Belyx Elena N., PhD, Associate Professor of the Department of Hospital Surgery ¹2, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation.
http://orcid.org/0000-0001-5864-7892
Silchuk Evgenii S., PhD, Surgeon, Head of the Lymphology Unit, Center of Phlebology, Moscow, Russian Federation. http://orcid.org/0000-0003-4018-4468
Hachatryan Edita O., Fourth–Year Medical Student, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation.
http://orcid.org/0000-0003-2636-3945

V.E. MILYUKOV 1, A.V. BOGDANOV 2

THE ROLE OF ADRENAL GLANDS IN THE MECHANISMS OF STRESS EFFECTS ON PATHOGENESIS
OF COMPLICATIONS IN ACUTE SMALL BOWEL OBSTRUCTION (REVIEW)

I.M. Sechenov First Moscow State Medical University (Sechenov University)1,
Medical-Sanitary Unit of the Ministry of Internal Affairs of the Russian Federation in Moscow2, Moscow,
The Russian Federation

The aim of this review is a detailed description of the alleged mechanisms of involving the adrenal glands, as a key element of the system of nonspecific protection of an organism and adaptation to stress, in the pathogenesis of clinical manifestations of acute small bowel obstruction and developing complications, including peritonitis, sepsis and multiple organ failure.
In the discussion of the pathogenesis of clinical manifestations of acute small bowel obstruction and its complications, leading to the disappointing results of treatment of patients on a large sample of contemporary scientific publications, it is noted that many researchers see a close connection between the influence of various stress effects on humans and the functioning of internal organs and systems. It is demonstrated that in the literature there is growing evidence of the negative effects of stress and related affective disorders on the course of inflammatory bowel diseases and gastrointestinal tract, which is one of the targets of stress, and hormones of the hypothalamic-pituitary-adrenal system, especially the adrenal glands take an active part in the mediation of these reactions.
The conducted analysis of the current literature demonstrates a large number of unsolved issues in this direction, that proves the need for a comprehensive experimental and morphological studies to clarify and detail all pathogenetic links of dependent morpho-functional transformations in the dynamics of development of acute small bowel obstruction which may lead to adrenal insufficiency and disruption of adaptation mechanisms that maintain the stability of homeostasis.

Keywords: acute small bowel obstruction, peritonitis, sepsis, stress, adrenal insufficiency
p. 366-375 of the original issue
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Address for correspondence:
103904, The Russian Federation,
Moscow, Mokhovaya Str., 11, b.10,
I.M. Sechenov First Moscow
State Medical University,
Department of Human Anatomy,
Tel. mobile: +7-916-156-41-27,
e-mail: Milyucov@mail.ru,
Vladimir E. Milyukov
Information about the authors:
Milyukov Vladimir E., MD, Professor of the Department of Human Anatomy of the Medical Faculty, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation.
http://orcid.org/0000-0002-8552-6727
Bogdanov Alexandr V., Surgeon, Head of the Admission Unit, Medical-Sanitary Unit of the Ministry of Internal Affairs of the Russian Federation in Moscow, Moscow, Russian Federation
http://orcid.org/0000-0002-3222-9462

CASE REPORTS

M.A. AKSELROV 1, 2, V.N. EVDOKIMOV 1, V.V. SVAZYAN 1, A.V. STOLYAR 2, P.A. GOROKHOV 2

FOURNIER GANGRENE IN ADOLESCENT

Tyumen State Medical University 1,
Regional Clinical Hospital ¹ 2, Tyumen 2,
The Russian Federation

Acute infectious necrotizing fasciitis with the lesion of the external genitalia and perineum (Fournier gangrene) refers to a rare disease that develops mainly in elderly male people with a burdened comorbid background, and as a rule, has a fulminant course. The prognosis for this disease directly depends on the timing of the qualified surgical care rendering. The delay in treatment, even for only a few hours, leads to an increase in mortality, which reaches 88% in this pathology. In children, the cases of Fournier gangrene are extremely rare and are represented by single descriptions in the literature. The article presents the clinical observation of the surgical treatment of a 15-year-old child with Fournier gangrene of the scrotum. This clinical case is given by us with the purpose of acquaintance with a rarely observed pathology in childhood, which can be met by every pediatric surgeon or a pediatric urologist. Perhaps the suggested approach to diagnosis and treatment can help in a timely manner to determine the diagnosis and make the right decision concerning surgical tactics.

Keywords: Fournier gangrene, fulminant gangrene of the scrotum, necrotizing fasciitis, rare diseases, prognosis, child
p. 376-379 of the original issue
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Address for correspondence:
625007, The Russian Federation,
Tyumen, Odesskaya Str., 38,
Tyumen State Medical University,
Department of Pediatric Surgery,
Tel. mobile: +7–961-207-63-10,
+7 (3452) 28-71-23,
e-mail: evn-tym@mail.ru,
Vladimir N. Evdokimov
Information about the authors:
Akselrov Mikhail A., MD, Associate Professor, Head of the Department of Pediatric Surgery, Tyumen State Medical University, Tyumen, Russian Federation.
http://orcid.org/0000-0001-6814-8894
Svazyan Vadim V., PhD, Associate Professor of the Department of Pediatric Surgery, Tyumen State Medical University, Tyumen, Russian Federation.
http://orcid.org/0000-0002-6217-8600
Evdokimov Vladimir N., PhD, Assistant of the Department of Pediatric Surgery, Tyumen State Medical University, Tyumen, Russian Federation. http://orcid.org/0000-0002-0331-3438
Stolyar Aleksandr V., Pediatric Urologist-Andrologist, Physician of the Pediatric Surgery Unit ¹ 1, Regional Clinical Hospital ¹ 2, Tyumen, Russian Federation. http://orcid.org/0000-0002-0704-5418
Gorokhov Pavel A., Pediatric Urologist-Andrologist, Physician of the Pediatric Surgery Unit ¹ 1, Regional Clinical Hospital ¹ 2, Tyumen, Russian Federation. http://orcid.org/0000-0001-6830-1094
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