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Year 2015 Vol. 23 No 4

SCIENTIFIC PUBLICATIONS
EXPERIMENTAL SURGERY

B. S. SUKOVATYKH, A.Y. ORLOVA, E.B. ARTYUSHKOVA, M.Y. GORDOV, K.Y. VEDENEV

THE EFFECTIVENESS OF MONONUCLEAR FRACTION OF AUTOLOGOUS BONE MARROW IN TREATMENT OF EXPERIMENTAL CRITICAL LIMB ISCHEMIA

SBEE HPE "Kursk State Medical University"
The Russian Federation

Objectives. To develop an experimental model of critical limb ischemia for the further study of the effectiveness of the mononuclear fraction of autologous bone marrow in the treatment of critical limb ischemia.
Methods. The results of the application of the mononuclear fraction of autologous bone marrow in rats (Wistar) divided into four groups: intact, control, comparison and experimental have been analyzed. The intact group included 10 rats, the other groups – 30 animals in each. In all rats, except for the intact one, critical limb ischemia was created by excision of the main vessel, including the femoral artery, the popliteal artery and the initial segments of the leg arteries. Mononuclear fraction of autologous bone marrow from the femur contralateral limb of the rat in a volume of 200 μL was injected into the ischemic limb in the experimental group (every animal was given a 100 μL injection at two different injection sites: 1) directly below the inguinal ligament of the tissue in the area of the anatomical location of collaterals of the internal iliac artery; 2) intramuscularly in the gastrocnemius muscle of the anterior-lateral surface of the middle third of the tibia. In the control group the fraction was injected into the ischemic limb by infiltration at six different sites. In the control group the animals received no treatment. The treatment effectiveness was assessed by the dynamics of the microcirculation level by the 10th, 21st and 28th days by laser Doppler flowmetry.
Results. Assessment of the microcirculation in animals with experimental limb ischemia after treatment according to the original method in the experimental group with the compared group showed the increase in blood flow by the 10th days at the hip level by 1,5 folds, at leg – by 1,1 folds, by the 21st days at the level of the femur and tibia – by 1,4 folds and by the 28th days at the femur and tibia – by 1,2 folds.
Conclusion. The proposed method of treatment proven to be pathogenetically justified and effective.

Keywords: peripheral arterial disease, ischemia model, microcirculation level, model of the hind limb ischemia, therapeutic angiogenesis, bone marrow, mononuclear cells
p. 365-371 of the original issue
References
  1. Kuznetsov MR, Koshkin VM, Karalkin AV. Rannie reokkliuzii u bol'nykh obliteriruiushchim aterosklerozom [Early reocclusion in patients with atherosclerosis obliterans]. Iaroslavl'. Niuans. Meditsina, 2007. 176 p.
  2. Barsenev AV. Autogennaia transplantatsiia kletok pri ishemii konechnostei v klinike [Autologous transplantation of cells in ischemic limbs at the clinic]. Klet Transpl. 2005 Sen;I(1):40-43.
  3. Lawall H, Bramlage P, Amann B.Stem cell and progenitor cell therapy in peripheral artery disease. A critical appraisal. Thromb Haemost. 2010 Apr;103(4):696-709. doi: 10.1160/TH09-10-0688.
  4. Armstrong L, Lako M, Buckley N, Lappin TR, Murphy MJ, Nolta JA, Pittenger M, Stojkovic M. Editorial: Our top 10 developments in stem cell biology over the last 30 years. Stem Cells. 2012 Jan;30(1):2-9. doi: 10.1002/stem.1007.
  5. Walter DH, Krankenberg H, Balzer JO, Kalka C, Baumgartner I, Schlüter M, Tonn T, Seeger F, Dimmeler S, Lindhoff-Last E, Zeiher AM. Intraarterial administration of bone marrow mononuclear cells in patients with critical limb ischemia: a randomized-start, placebo-controlled pilot trial (PROVASA). Circ Cardiovasc Interv. 2011 Feb 1;4(1):26-37. doi: 10.1161/circinterventions.110.958348.
  6. Powell RJ, Comerota AJ, Berceli SA, Guzman R, Henry TD, Tzeng E, Velazquez O, Marston WA, Bartel RL, Longcore A, Stern T, Watling S. Interim analysis results from the RESTORE-CLI, a randomized, double-blind multicenter phase II trial comparing expanded autologous bone marrow-derived tissue repair cells and placebo in patients with critical limb ischemia. J Vasc Surg. 2011 Oct;54(4):1032-41. doi: 10.1016/j.jvs.2011.04.006.
  7. Nozdrachev AD, Poliakov EL. Anatomiia krysy (Laboratornye zhivotnye) [Anatomy of rats (Laboratory animals)]. Saint-Petersburg, RF: Lan', 2001. 464 p.
  8. Waterman RS, Betancourt AM. Treating Chronic Pain with Mesenchymal Stem Cells: A Therapeutic Approach Worthy of Continued Investigation. J Stem Cell Res Ther. 2011. S2:001. doi: 10.4172/2157-7633.S2-001
  9. Sukovatykh AIu, Orlova MV, Pokrovskii EB, Artiushkova BS. Sposob lecheniia khronicheskikh obliteriruiushchikh zabolevanii arterii nizhnikh konechnostei [The method of treatment of chronic obliterating diseases of arteries of the lower extremities]: patent RF A61K 35/14, A61R 9/10, A61M 5/00 / zaiavitel' Kurskii Gos Med Universitet ¹ 2392948. 2010 06. 27. Otkrytiia Izobret. 2010;(18):35.
  10. Boyum A. Separation of leukocytes from blood and bone marrow Scand J Clin Lab Investig.1998;(21)Suppl.97:1-9
  11. Tidball JG, Villalta SA. Regulatory interactions between muscle and the immune system during muscle regeneration. Am J Physiol Regul Integr Comp Physiol. 2010 May;298(5):R1173-87. doi: 10.1152/ajpregu.00735.2009.
  12. Belch J, Hiatt WR, Baumgartner I, Driver IV, Nikol S, Norgren L, Van Belle E. Effect of fibroblast growth factor NV1FGF on amputation and death: a randomised placebo-controlled trial of gene therapy in critical limb ischaemia. Lancet. 2011 Jun 4;377(9781):1929-37. doi: 10.1016/S0140-6736(11)60394-2.
  13. Tidball JG, Villalta SA. Regulatory interactions between muscle and the immune system during muscle regeneration. Am J Physiol Regul Integr Comp Physiol. 2010 May;298(5):R1173-87. doi: 10.1152/ajpregu.00735.2009.
  14. Shevchenko IuL. Mediko-biologicheskie i fiziologicheskie osnovy kletochnykh tekhnologii v serdechno-sosudistoi khirurgii [Medico-biological and physiological basis of cellular technologies in cardiovascular surgery]. Saint-Petersburg, RF: Nauka. 2006. 288 p.
  15. Fadini GP, Agostini C, Avogaro A. Autologous stem cell therapy for peripheral arterial disease meta-analysis and systematic review of the literature. Atherosclerosis. 2010 Mar;209(1):10-17. doi: 10.1016/j.atherosclerosis.2009.08.033.
Address for correspondence:
305041 Russian Federation,
Kursk, ul. K.Marksa, d. 3,
GBOU VPO "Kurskiy gosudarstvennyiy meditsinskiy universitet",
kafedra obschey khirurgii,
tel. office 8 4712 52-98-62,
e-mail: SukovatykhBS@kursksmu.net,
Sukovatykh Boris Semenovich
Information about the authors:
Sukovatykh B.S. MD, professor, a head of the general surgery chair of SBEE HPE "Kursk State Medical University".
Orlova A.Y. PhD, an assistant of the general surgery chair of SBEE HPE "Kursk State Medical University".
Artyushkova E.B. MD, a director of SRI of Ecological Medicine of SBEE HPE "Kursk State Medical University".
Gordov M.Y. A competitor of the general surgery chair of SBEE HPE "Kursk State Medical University".
Vedenev K.Y. A 3-year student of the medical faculty of SBEE HPE "Kursk State Medical University".

SCIENTIFIC PUBLICATIONS
EXPERIMENTAL SURGERY

Y.S. VINNIK 1, A.M. PLAKHOTNIKOVA 1, A.K. KIRICHENKO 1, V.A. KUKONKOV 2, O.V. TEPLYAKOVA 1

THE APPLICATION OF DIRECTIONAL FLOW OF THE OZONE-OXYGEN GASEOUS MIXTURE TO A SANITATION OF PYOGENIC WOUNDS IN THE EXPERIMENT

SBEE HPE "Krasnoyarsk State Medical University named after professor V.F. Voino-Yasenetsky" 1,
DSBME "Krasnoyarsk Interregional Clinical Hospital ¹7" 2
The Russian Federation

Objectives. To evaluate the application effectiveness of directed flow of the ozone-oxygen gaseous mixture to a sanitation of pyogenic wounds in experiment.
Methods. An experimental study was conducted in 30 male rabbits of Soviet Chinchilla breed. Each individual was simulated a pyogenic wound via daily broth culture of methicillin resistant strain of Staphylococcus aureus. In the main group (n=10) within the whole diastasis preservation period the local treatment of edgar wouhds with ozone-oxygen gaseous mixture the sanitation by the original device was performed. In the comparison group (n=10) of the wounds was carried out in sealed plastic contour chambers filled with ozone-oxygen gaseous mixture. In the control group (n=10) a consistent antiseptic treatment of pyogenic wounds with 3% hydrogen peroxide solution and 0,01% solution miramistin has been cleansed.
Evaluation of the treatment effectiveness was performed clinically and histologically on the 1st, 7th, 30th days of the experiment.
Results. In the clinical evaluation of the local status prior to treatment, the wounds consisted of soft tissue defects with specific signs of inflammation and purulent discharge. The relevant intergroup differences of biopsy results of purulent wounds histologically after the simulation also haven’t been revealed. On the 7th day in the control group preparations pronounced signs of inflammation preserved, while in the main group preparations the transition to the proliferative phase was registered. On the 30th day the shaped scar was determined clinically at the site of the wound defect in animals of all groups. Histological assessment of biopsies of scarring in the wound treatment groups with the ozone-oxygen gaseous mixture the dense connective tissue without any signs of the inflammatory response has been revealed, while in the control one the loose connective tissue with inflammatory infiltration was visualized.
Conclusion. In using the directed flow of the ozone-oxygen gaseous mixture to sanitation of pyogenic wounds in experiment, the earlier cleansing and healing with the formation of connective tissue scar without any signs of inflammatory response have been registered.

Keywords: skin and soft tissue infections, pyogenic wounds, the ozone-oxygen gaseous mixture, ozone, cleansing, sanitation, healing
p. 372-378 of the original issue
References
  1. Gul'man MI, Vinnik IS, Iakimov SV, Miller SV, Anishina OV, Karapetian GE, Dunaevskaia SV. Primenenie ozona v khirurgicheskoi klinike [The use of ozone in the surgical clinic]. Sibir Med Obozrenie. 2003;(4):84-86.
  2. Kim HS, Noh SU, Han YW, Kim KM, Kang H, Kim HO, Park YM. Therapeutic effects of topical application of ozone on acute cutaneous wound healing. J Korean Med Sci. 2009 Jun;24(3):368-74. doi: 10.3346/jkms.2009.24.3.368.
  3. Valacchi G, Lim Y, Belmonte G, Miracco C, Zanardi I, Bocci V, Travagli V. Ozonated sesame oil enhances cutaneous wound healing in SKH1 mice. Wound Repair Regen. 2011 Jan-Feb;19(1):107-15. doi: 10.1111/j.1524-475X.2010.00649.x.
  4. Sagai M, Bocci V.Mechanisms of Action Involved in Ozone Therapy: Is healing induced via a mild oxidative stress? Med Gas Res. 2011 Dec 20;1:29. doi: 10.1186/2045-9912-1-29.
  5. Zhang J, Guan M, Xie C, Luo X, Zhang Q, Xue Y. Increased growth factors play a role in wound healing promoted by noninvasive oxygen-ozone therapy in diabetic patients with foot ulcers. Oxid Med Cell Longev. 2014;2014:273475. doi: 10.1155/2014/273475.
  6. Kaptan F, Güven EP, Topcuoglu N, Yazici M, Külekçi G. In vitro assessment of the recurrent doses of topical gaseous ozone in the removal of Enterococcus faecalis biofilms in root canals. Niger J Clin Pract. 2014 Sep-Oct;17(5):573-8. doi: 10.4103/1119-3077.141421.
  7. Travagli V, Zanardi I, Valacchi G, Bocci V. Ozone and ozonated oils in skin diseases: a review. Mediators Inflamm. 2010;2010:610418. doi: 10.1155/2010/610418.
  8. Vinnik IS, Trusov IN, Bezrukikh EG, Chetvergov NV, Il'inov AV, Plakhotnikova AN. Ustroistvo dlia lokal'noi obrabotki biologicheskikh tkanei ozono-kislorodnoi smes'iu pechatnaia [The device for the local treatment of biological tissue with a mixture of ozone and oxygen circuit]. Patent ¹ 151779 RF, MPK: A61M37/00. ¹ 2014124812/14. 20.04.15. Ofits Biul. 2015. ¹ 11151779.
  9. Kabanova AA, Plotnikov FV, Khodos IuV, Golubtsov VV, Veremei EI. Morfologicheskie kharakteristiki eksperimental'nykh gnoinykh ran miagkikh tkanei [Morphological characteristics of experimental purulent wounds of soft tissues]. Perm Med Zhurn. 2015;32(1):78-83.
  10. Grigor'ian AIu, Bezhin AI, Pankrusheva TA, Ivanov AV, Zhiliaeva L.V, Kobzareva EV. Lechenie gnoinykh ran s primeneniem mnogokomponentnykh mazei na osnove enterosgelia [Treatment of festering wounds with ointments based on multicomponent enterosgels]. Nauchn Vedomosti Belgorod Gos Uni-ta. Seriia: Meditsina. Farmatsiia. 2011;16(111):205-11.
  11. Zatolokin VD, Khalilov MA. Moshkin AS, Iudina OA. Opyt primeneniia novoi metodiki lecheniia gnoinykh ran v eksperimental'nykh usloviiakh [Experience in the use of new methods of treatment of purulent wounds in the experimental conditions].Uchen Zap OGU. Ser Estestv Tekhn i Med Nauki. 2010;(2):160-62
Address for correspondence:
660022, Russian Federation, g. Krasnoyarsk,
ul. Partizana Zheleznyaka, d. 1,
GBOU VPO "Krasnoyarskiy gosudarstvennyiy
meditsinskiy universitet imeni professora
V.F. Voyno-Yasenetskogo", kafedra
obschey khirurgii im. prof. M.I. Gulmana,
e-mail: yuvinnik@yandex.ru,
Vinnik Yuriy Semenovich
Information about the authors:
Vinnik Y.S. MD, an Honored Worker of Science of RF, an Honored Physician of Russia, a Head of the general surgery chair named after M.I.Gulman of SBEE HPE "Krasnoyarsk State University named after professor V.F. Voino-Yasenetsky".
Plakhotnikova A.M. A competitor of the general surgery chair named after M.I.Gulman of SBEE HPE "Krasnoyarsk State University named after professor V.F. Voino-Yasenetsky".
Kirichenko A.K. MD, a head of the pathologic anatomy chair named after P.G. Podzolkov of SBEE HPE "Krasnoyarsk State University named after professor V.F. Voino-Yasenetsky".
Kukonkov V.A. PhD, a head of the surgical department ¹2 of the district state budgetary medical establishment "Krasnoyarsk Interregional Clinical Hospital ¹7".
Teplyakova O.V. PhD, an associate professor of the general surgery chair named after M.I.Gulman of SBEE HPE "Krasnoyarsk State University named after professor V.F. Voino-Yasenetsky".

GENERAL & SPECIAL SURGERY

Y.V. STRUCHKOV, A. S. VOROTYNCEV, A.G. KURMANBAEV

THE CHANGE OF BACTERIAL FLORA IN LOCAL THERAPY WITH OZONATED PHYSIOLOGICAL SOLUTION IN PATIENTS WITH OBSTRUCTIVE JAUNDICE AFTER PERFORMANCE OF MINIMALLY INVASIVE INTERVENTIONS

SBEE HPE "I.M. Sechenov First Moscow State Medical University",
The Russian Federation

Objectives. To study the effectiveness of local application of ozonated physiological solution on the bacterial microflora of the biliary tract in patients with obstructive jaundice.
Methods. The drainage of the biliary tract by retrograde or antegrade method was performed to patients with complicated jaundice (different degrees) under sonographic and fluoroscopic guidance. The intake of bile through the fixed biliary drainage (nasobiliary drainage, percutaneous transhepatic cholangiostomy (PTCS) was carried out for inoculation on the medium immediately after drainage of the biliary tract as well as to control bacteriological sowing of bile on the third and seventh days. This study was performed to determine the spectrum of bacterial flora of the biliary tract and to control the conducted local therapy with physiological solution with ozone at concentration of 5 mg/L, saline (1000 ml.) are to be done daily .
Results. On the third day after drainage of the bile ducts (BD) the bacteriological composition has been changed. The incidence of detection of Klebsiella spp. significantly reduces from 21 cases to 6 and Escherichia coli from 22 to 10 cases. The number of Pseudomona aeruginosa increases from 8 to 18 cases and Enterococcus spp – from 6 to 24 cases. The titre of microbial bodies Enterococcus spp raises from 3,77 to 4,86±0,12 of colony forming units (CFU)/ml. Daily sanitation (5 mg/l, (1000 ml) of BD with ozonated physiological solution promotes to reduce all types of microorganisms with a realiable reduction detection incidence of Pseudomona aeruginosa and Enterococcus spp up to 6 cases and a decrease of the titre of microbial cells up to 4,1±0,17 and 3,2±0,58, respectively.
Conclusion. In the hospital the number of conditionally pathogenic microflora has reduced reliably and the number of nosocomial infections increased. The conducted study has confirmed the efficacy of ozonated physiological solution for the prevention and treatment of infectious complications in patients with cholestasis.

Keywords: obstructive jaundice, ozonated physiological solution, biliary drainage, percutaneous transhepatic cholangiostomy, nosocomial infection, conditionally pathogenic microflora, cholestasis
p. 379-384 of the original issue
References
  1. Patiutko IuI, Kotel'nikov AG. Khirurgiia raka organov biliopankreatoduodenal'noi zony [Cancer surgery of biliopancreatoduodenal area]. Moscow, RF: Meditsina, 2007. 446 p.
  2. Kotovskii AE, Glebov KG. Endoskopicheskoe lechenie papillostenoza [Endoscopic treatment of papillostenosis]. Annaly Khir Gepatologii. 2010;(1):34-36.
  3. Mutignani M Shah SK, Foschia F, Pandolfi M, Perri V, Costamagna G. Transnasal extraction of residual biliary stones by Seldinger technique and nasobiliary drain. Gastrointest Endosc. 2002 Aug;56(2):233-38.
  4. Briggs CD, Irving GR, Cresswell A, Peck R, Lee F, Peterson M, Cameron IC.Percutaneous transhepatic insertion of self-expanding short metal stents for biliary obstruction before resection of pancreatic or duodenal malignancy proves to be safe and effective. Surg Endosc. 2010 Mar;24(3):567-71. doi: 10.1007/s00464-009-0598-9.
  5. Kim HM, Park JY, Kim KS, Park MS, Kim MJ, Park YN, Bang S, Song SY, Chung JB, Park SW. Intraductal ultrasonography combined with percutaneous transhepatic cholangioscopy for the preoperative evaluation of longitudinal tumor extent in hilar cholangiocarcinoma. J Gastroenterol Hepatol. 2010 Feb;25(2):286-92. doi: 10.1111/j.1440-1746.2009.05944.x.
  6. Kloek JJ, van der Gaag NA, Aziz Y, Rauws EA, van Delden OM, Lameris JS, Busch OR, Gouma DJ, van Gulik TM. Endoscopic and percutaneous preoperative biliary drainage in patients with suspected hilar cholangiocarcinoma. J Gastrointest Surg. 2010 Jan;14(1):119-25. doi: 10.1007/s11605-009-1009-1.
  7. Salminen P, Laine S, Gullichsen R.Severe and fatal complications after ERCP: analysis of 2555 procedures in a single experienced center. Surg Endosc. 2008 Sep;22(9):1965-70.
  8. Beliaev SA, Beliaev AN, Kozlov SA. Vnutriportal'nye infuzii ozonirovannogo fiziologicheskogo rastvora v korrektsii okislitel'nogo stressa pri mekhanicheskoi zheltukhe [Intraportal infusions of ozonated saline solution in the correction of oxidative stress in obstructive jaundice]. Izvestiia Vysshikh Uch Zavedenii. Povolzhskii Region. Med Nauki. 2011;18(2):74-81.
  9. Korabel'nikov AI, Andreev GN, Men'shikova IL. Vliianie ozona na viazkost' zhelchi pri ostrom gnoinom kholangite [Influence of ozone on the viscosity of bile in acute purulent cholangitis]. Annaly Khir Gepatol 1999;(4)2:107-108.
  10. Parkhisenko IuA, Rudoi VT, Filiptsova LA, Aristov AI. Lechenie i profilaktika kholangitov ozonom pri retrogradnoi kholangiopankreatografii [Treatment and prevention of cholangitis by ozone during retrograde cholangiopancreatography]. Annaly Khir Gepatol. 1999;4(2):123.
  11. Lelianov AD, Beinarovich KV, Chelombit'ko MA, Nesterov AA. Pervyi opyt ispol'zovaniia oksida azota i ozona v kompleksnom lechenii rasprostranennogo peritonita [The first experience of the use of nitrogen oxide and ozone in treatment of diffuse peritonitis]. GEOU VPO Smolensk Gos Med Akademiia. Med Al'manakh. 2013;3(27):112-13.
Address for correspondence:
109240, Russian Federation,
Moscow, ul. Yauzskaya d. 11. str. 1,
GKB im. I.V. Davyidovskogo,
GBOU VPO "Pervyiy moskovskiy
gosudarstvennyiy meditsinskiy universitet
imeni I.M. Sechenova",
kafedra obschey khirurgii,
e-mail: azamatkg.88@gmail.com,
Kurmanbaev Azamat Gultashyirovich
Information about the authors:
Struchkov Y.V. MD, professor, a senior researcher of the general surgery chair of SBEE HPE "I.M. Sechenov First Moscow State Medical University".
Vorotyncev A.S. PhD, an associate professor of the general surgery chair of SBEE HPE "I.M. Sechenov First Moscow State Medical University".
Kurmanbaev A.G. A post-graduate student of the general surgery chair of SBEE HPE "I.M. Sechenov First Moscow State Medical University".

V.M. MAYOROV 1, Z.A. DUNDAROV 1, Y.N. AVIZHETS2

SOME MORPHOLOGICAL REGULARITIES OF DAMAGE AND SPREADING OF THE DESTRUCTIVE PROCESS IN THE RETROPERITONEAL AREA IN SEVERE ACUTE NECROTIZING PANCREATITIS ACCORDING TO AUTOPSY DATA

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

Objectives. The study of regularities of spreading of the pathological process in the retroperitoneal area in severe destructive pancreatitis.
Methods. The ongoing retrospective analysis according to the report of 180 autopsy cases revealing the acute destructive pancreatitis (the data of Gomel regional clinical pathoanatomical bureau (1990-2014) was carried out during the research.
Results. The performed analysis of morphological changes of internal organs showed that the cause of early lethal outcomes is a massive enzymatic uncorrected intoxication. Fulminant necrotizing pancreatitis was registered in 70 cases, composing 38,9% of all observations. The first five days these patients have been subjected to intensive therapy due to incurable pancreatogenic shock in the intensive care unit. Particular attention was paid to the peculiarities of the anatomical relationship between destructive changes of the pancreas and affected peripancreatic cellular tissue. The obligate lesion of the peripancreatic cellular tissue in the presence of necrotic foci in the pancreatic parenchyma was established.
The actual total number of cases of total pancreatic necrosis revealed by autopsy was appeared fewer than initially assumed according to clinical and intraoperative examinations.
In case of massive pancreatic parenchymal necrosis reaching 30-60% of the pancreatic parenchyma, the formation of large peripancreatic sequesters, encapsulated in anatomically multiple closed cavities and maintaining high level of tissue intoxication has been constantly observed. Analysis of surgical treatment results detected one of the main reasons of deaths from pancreatitis surgery was suppurative necrotic parapancreatitis.
Conclusion. Pancreatogenic shock with its complications was detected as a main cause of death. Morphological manifestations of pancreatogenic shock were: enzymatic serosanguineous peritonitis and generalized parapancreatitis, massive atelectasis and pulmonary edema with hemorrhages, edema, and swelling of the brain as well as the marked dystrophic changes of parenchymal organs.

Keywords: acute necrotizing pancreatitis, parapancreatitis, total and large focal pancreatic necrosis, pancreatogenic shock, tissue intoxication, multiple organ failure, autopsy study
p. 385-390 of the original issue
References
  1. Miller SV, Vinnik IS, Tepliakova OV. Lechenie bol'nykh ostrym destruktivnym pankreatitom [Treatment of patients with acute destructive pancreatitis]. Khirurgiia. Zhurn im NI Pirogova. 2012;(5):24–30.
  2. Balnykov SI, Petrenko TF. Prognozirovanie iskhoda zabolevaniia u bol'nykh nekroticheskim pankreatitom [Predicting the outcome of the disease in patients with necrotizing pancreatitis]. Khirurgiia. 2010;(3):37-40.
  3. Dunaevskaia SS. Antiufrieva DA. Prognozirovanie vozmozhnosti iskhoda pri tiazhelom ostrom pankreatite [Predicting possible outcome in severe acute pancreatitis]. Vrach-Aspirant. 2013;56(11):203-207.
  4. Afanas'ev AN, Kirillin AV, Shalygin AB. Otsenka rezul'tatov khirurgicheskogo lecheniia ostrogo destruktivnogo pankreatita [Evaluation of the results of surgical treatment of acute destructive pancreatitis]. Vestn Eksperiment i Klin Khirurgii. 2010;4(3):308-16.
  5. Tolstoi A, Panov V, Krasnorogov V, Vashetko R, Skorodumov A. Parapankreatit. Etiologiia, patogenez, diagnostika, lechenie [Parapancreatitis. Etiology, pathogenesis, diagnosis, treatment]. Saint-Petersburg, RF: Iasnyi Svet, 2003. 256 p.
  6. Bradley EL 3rd, Dexter ND. Management of severe acute pancreatitis: a surgical odyssey. Ann Surg. 2010 Jan;251(1):6-17. doi: 10.1097/SLA.0b013e3181c72b79
  7. Bradley EL 3 rd. A clinically based classification system for acute pancreatitis. Summary of the international symposium on acute pancreatitis. Arch Surg. 1993 May;128(5):586-90.
  8. Doroshkevich SV, Doroshkevich EIu. Eksperimental'noe modelirovanie ostrogo pankreatita [Experimental modeling of acute pancreatitis]. Novosti Khirurgii. 2008;16(2):14-21.
  9. Zinenko DIu, Sukhina TV. Izmeneniia struktury podzheludochnoi zhelezy v usloviiakh modelirovaniia eksperimental'nogo ostrogo pankreatita [Changes in the structure of the pancreas in a simulation of experimental acute pancreatitis]. Morfologiia. 2010;4(1):17-21.
  10. Hartwig W, Schimmel E, Hackert T, Fortunato F, Bergmann F, Baczako A, Strobel O, Büchler MW, Werner J. A novel animal model of severe pancreatitis in mice and its differences to the rat. Surgery. 2008 Sep;144(3):394-403. doi: 10.1016/j.surg.2008.04.006.
  11. Ushkevich AL, Zhandarov KN, Prokopchik NI. Modelirovanie ostrogo destruktivnogo pankreatita, parapankreatita v eksperimente [Simulation of acute destructive pancreatitis, parapancreatitis in experiment]. Novosti Khirurgii. 2010;18(2):8-14
Address for correspondence:
246000, Republic of Belarus,
g. Gomel, ul. Bratev Lizyukovyih, d. 5,
UO "Gomel'skii gosudarstvennyi
meditsinskii universitet"
kafedra khirurgicheskih bolezney ¹2
s kursami anesteziologii i detskoy khirurgii,
tel.mob. 375 29 328 54 43,
e-mail: vadim.mayorov.1973@mail.ru,
tel.mob. 375 29 328 54 43,
Mayorov Vadim Mihaylovich
Information about the authors:
Dundarov Z.A. MD, professor, a head of the surgical diseases chair ¹2 with a course of anesthesiology and pediatric surgery of EE "Gomel State Medical University".
Mayorov V.M. PhD, an associate professor of the surgical diseases chair ¹2 with a course of anesthesiology and pediatric surgery of EE "Gomel State Medical University".
Avizhets Y.N. A head of the pathoanatomical department ¹1 of E "Gomel Regional Clinical Pathoanatomical Bureau".

V.I. PETUKHOV1, S.M. YERMASHKEVICH1, M.O. RUSETSKAYA1, M.M. KANDZERSKI2, A.I. YANKOYSKI2, M.U. KUNTSEVICH1

THE TREATMENT RESULTS OF PATIENTS WITH ACUTE INFECTIOUS DESTRUCTIONS OF LUNGS

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

Objectives. To analyze the treatment results of acute infectious pulmonary destruction and to identify the most efficient ways of treating this severe disease.
Methods. 81 cases of treatment of patients with acute infectious pulmonary destructions have been analyzed. The clinical, laboratory, radiological and statistical methods have been used.
Results. Depending on performed treatment the patients were divided into three groups. Conservative treatment was carried out in 7 (9%) patients of the first group. 5 of them died (mortality – 71%). 74 (91%) patients were operated on. At the first stage the patients with intrapleural complications underwent tube thoracostomy with the further passive or active aspiration. 5 patients of the second group were subjected to video-assisted thoracoscopy with an atypical lung resection, conversion and pulmonary lobectomy – in 1 case. In 3 patients lobectomy was repeatedly performed. In the second group the mortality rate was 40%. Thoracotomy was carried out in 69 patients of the third group. Necrosequestrectomy was conducted in 22 patients, lobectomy – in 30, bilobectomy – in 10, pneumonectomy – in 7. In 24 cases out of 69 (35%) the operation is completed by thoracostomy to conduct in a subsequent scheduled sanitation. 19 patients of the third group died (mortality rate – 27,5%). Overall mortality was 32,1%, postoperative mortality – 28%.
Conclusion. The mortality rate for patients treated conservatively was significantly higher than those who had undergone surgery (ðFisher=0,0319). In the case of thoracostomy performance with gradual sanitation and simultaneous radical surgery the mortality rate was not statistically significally differed (χ2=1,45; p=0,2279), and not associated with the size of a resected pathologically changed segment of a lung (p>0,05 ). The choice of the volume and option for intervention should be based on the prevalence of a lesion and technical ability to perform an operation.

Keywords: acute infectious destruction of lung, lung gangrene, conservative treatment, necrosectomy, lobectomy, pneumonectomy, thoracostomy
p. 391-397 of the original issue
References
  1. Bisenkov LN / red, Bebiia NV, Grishakov SV. Torakal'naia khirurgiia [Thoracic surgery]: rukovodstvo dlia vrachei. Saint- Petersburg, RF: Gippokrat; 2004. 1918 p.
  2. Kutushev FK/ red, Bisenkov LN, Popov VI, Shalaev SA. Khirurgiia ostrykh infektsionnykh destruktsii legkikh [Surgery of acute infectious lung destruction]: rukovodstvo dlia vrachei. Saint-Petersburg, RF: 2003. 400 p.
  3. Mitroshin AN, Savel'ev VP. Gangrena legkogo. Khirurgicheskaia taktika [Surgical tactics]. Vestn Novykh Med Tekhnologii 2008;15(3):78-80.
  4. Chen CH, Huang WC, Chen TY, Hung TT, Liu HC, Chen CH.Massive necrotizing pneumonia with pulmonary gangrene. Ann Thorac Surg. 2009 Jan;87(1):310-1. doi: 10.1016/j.athoracsur.2008.05.077
  5. Reimel BA, Krishnadasen B, Cuschieri J, Klein MB, Gross J, Karmy-Jones R. Surgical management of acute necrotizing lung infections. Can Respir J. 2006 Oct;13(7):369-73.
  6. Furzikov DL, Gorshkov VI, Reshetov EI. Dreniruiushchie operatsii pri lechenii gangreny legkogo [Drainage operations in the treatment of lung gangrene]. Zhurn Medial' 2012;(1):53-55.
  7. Schweigert M, Giraldo Ospina CF, Solymosi N, Karmy-Jones R, Dubecz A, Fernández MJ, Quero Valenzuela F, Ofner D, Stein HJ. Emergent pneumonectomy for lung gangrene: does the outcome warrant the procedure? Ann Thorac Surg. 2014 Jul;98(1):265-70. doi: 10.1016/j.athoracsur.2014.03.007.
Address for correspondence:
210023, Republic of Belarus,
Vitebsk, prospekt Frunze, 27,
UO "Vitebskiy gosudarstvennyiy
ordena Druzhbyi narodov
meditsinskiy universitet",
kafedra khirurgii FPK i PK,
tel. mob.: 375 (29) 636-57-08,
e-mail: lancet.vip@tut.by,
Petukhov Vladimir Ivanovich
Information about the authors:
Petukhov V.I. MD, a head of the surgery chair of the advanced training and retraining faculty of EE "Vitebsk State Medical University".
Yermashkevich S.M. PhD, an associate professor of the surgery chair of the advanced training and retraining faculty of EE "Vitebsk State Medical University".
Rusetskaya M.O. PhD, an assistant of the hospital surgery chair with the courses of urology and pediatric surgery of EE "Vitebsk State Medical University".
Kandzerski N.M. A head of the thoracic purulent surgical department of ME "Vitebsk Regional Clinical Hospital".
Yankoyski A.I. A clinical intern of the thoracic purulent surgical department of ME "Vitebsk Regional Clinical Hospital".
Kuntsevich M.V. A subclinical surgical intern of the medical faculty of EE "Vitebsk State Medical University".

I.V. KORPUSENKO

THE RESULTS OF MINIMALLY INVASIVE SURGICAL TECHNIQUES IN TREATMENT OF PATIENTS WITH BILATERAL DESTRUCTIVE PULMONARY TUBERCULOSIS

SE "Dnepropetrovsk Medical Academy of the Ministry Health of Ukraine"
Ukraine

Objectives. To improve the surgical treatment efficacy in patients with bilateral destructive forms of pulmonary tuberculosis using new minimally invasive surgical techniques.
Methods. In the thoracic department of Dnepropetrovsk regional public clinical therapeutic and prophylactic association "Phthisiology" 259 clinical records of patients with bilateral destructive pulmonary tuberculosis treated in the period from 2008 up to 2013 have been studied. Patients were divided into 2 groups: the main group (n=129) – the patients who underwent minimally invasive surgery and the control group (n=130) those, who underwent standard surgical approach; 85 of them represented retrospective analysis of clinical records and 45 patients had contraindications for video-assisted surgeries (adhesive process in the pleural cavity). Each group was divided into 3 subgroups: the 1st – radical bilateral simultaneous and staged lung resection, the 2nd – single- or double-sided collapse surgery; the 3rd – patients with fibro-cavernous pulmonary tuberculosis who underwent pleuropneumonectomy.
Results. In minimally invasive interventions the intraoperative complications were occurred in 2 (1,6%) patients and in 7 (5,3%) patients – in the control group. The average postoperative blood and plasma loss in the main group was 394,2±18,7 ml which was 1,4 folds lower than similar indices in the control group 550,8±21,4 ml. Postoperative complications were registered in 13 (10,1%) of patients of the main group and in 32 (24,6%) – in control group. Postoperative mortality rate was 1 (0,8%) in the main group and 7 (5,4%) in the control group. As a result of the surgery and subsequent treatment the cessation of bacterial excretion and closure of cavernous lesions have been achieved in 113 (87,5%) patients of the main group compared with 82 (63,0 %) – in the control group.
Conclusion. The use of minimally invasive surgical techniques in patients with bilateral destructive pulmonary tuberculosis thought to be improved the clinical efficacy of treatment by 1,4 folds.

Keywords: bilateral pulmonary tuberculosis, video-assisted thoracoscopic surgery, minimally invasive method, clinical efficacy, complications, lethality
p. 398-405 of the original issue
References
  1. Ots ON, Agkatsev TV, Perel'man MI. Khirurgicheskoe lechenie tuberkuleza legkikh pri ustoichivosti mikobakterii k khimiopreparatam [Surgical treatment of pulmonary tuberculosis in the drug resistance of mycobacteria]. Problemy Tuberkuleza i Boleznei Legkikh. 2009;(2):42-49.
  2. Petrenko VM, Cheren'ko SO, Litvinenko NA, 1vankova OV, Tarasenko OR. Tuberkul'oz ³z rozshirenoiu rezistentn³stiu do protitubekul'oznikh preparat³v: situats³ia v Ukra¿n³ [Tuberculosis with enhanced resistance to anti-TB drugs, the situation in Ukraine]. Ukr Pul'monol Zhurn. 2007;(3):35-39.
  3. Kim HJ, Kang CH, Kim YT, Sung SW, Kim JH, Lee SM, Yoo CG, Lee CT, Kim YW, Han SK, Shim YS, Yim JJ. Prognostic factors for surgical resection in patients with multidrug-resistant tuberculosis. Eur Respir J. 2006 Sep;28(3):576-80.
  4. Shiraishi Y, Katsuragi N, Kita H, Tominaga Y, Kariatsumari K, Onda T.Aggressive surgical treatment of multidrug-resistant tuberculosis. J Thorac Cardiovasc Surg. 2009 Nov;138(5):1180-4. doi: 10.1016/j.jtcvs.2009.07.018.
  5. Takeda S, Maeda H, Hayakawa M, Sawabata N, Maekura R.Current surgical intervention for pulmonary tuberculosis. Ann Thorac Surg. 2005 Mar;79(3):959-63.
  6. Feshchenko Iu². Stan nadannia ftiz³atrichno¿ dopomogi naselenniu Ukra¿ni [The situation with tuberculosis care in Ukraine]. Ukr Pul'monol Zhurn. 2008;(3):7-9.
  7. Duzhii ²D, Gres'ko ²Ia, Madiar VV. Ekstraplevral'na torakoplastika – al'ternativne operativne vtruchannia pri poshirenomu tuberkul'oz³ legen' [Extrapleural thoracoplasty - surgery alternative in advanced pulmonary tuberculosis]. Khark³v Kh³rurg Shkola. 2010;6.1(45):97-100.
  8. Duzhii ²D. Ekstraplevral'na torakoplastika ta ¯¯ m³stse v umovakh ep³dem³¿ tuberkul'ozu [Extrapleural thoracoplasty and its place in tuberculosis epidemy]. Kl³n³ch Kh³rurg³ia. 2003;(8):38-40.
  9. Porkhanov VA, Marchenko LG, Poliakov IS, Kononenko VB, Bodnia VN, Mezeria AL, Kovalenko AL, Mamelov MIu. Khirurgicheskoe lechenie dvustoronnikh form tuberkuleza legkikh [Surgical treatment of bilateral pulmonary tuberculosis]. Problemy Tuberkuleza. 2002;(4):22-25.
  10. Repin IuM. Lekarstvenno – ustoichivyi tuberkulez legkikh: khirurgicheskoe lechenie [Multidrug resistant tuberculosis: a surgical treatment]. Saint-Petersburg, RF: Gippokrat. 2007. 168 p.
  11. Asanov BM, Giller DB, Iangolenko DV, Slobodin DG. Slobodin Ekstraplevral'nyi selektivnyi ballonnyi kollaps legkogo – novyi metod khirurgicheskogo lecheniia rasprostranennogo destruktivnogo tuberkuleza legkikh [Extrapleural selective balloon collapsed lung - a new method for the surgical treatment of advanced destructive pulmonary tuberculosis]. Tuberkulez i Bolezni Legkikh. 2011;(4):40-41.
  12. Giller DB. Miniinvazivnye dostupy s ispol'zovaniem endoskopicheskoi tekhniki v torakal'noi khirurgii [Minimally invasive approaches with the use of endoscopic techniques in thoracic surgery]. Khirurgiia. 2009;(8):21-28.
  13. Porkhanov VA, Grebennikov SV, Marchenko LG, Mova VS, Poliakov IS. Khirurgicheskoe lechenie dvukhstoronnikh form tuberkuleza legkikh [Surgical treatment of bilateral pulmonary tuberculosis]. Problemy Tuberkuleza. 1998;(10):36-39.
Address for correspondence:
49044, Ukraine, g. Dnepropetrovsk,
ul. Dzerzhinskogo, d. 9,
GU "Dnepropetrovskaya meditsinskaya akademiya
MZ Ukrainyi",
kafedra khirurgii ¹2,
tel.: + 38(056)31-22-72,
e-mail: korpus_i@hotmail.com,
Korpusenko Igor Vasilevich
Information about the authors:
Korpusenko I.V. PhD, an associate professor of the surgery chair ¹ 2 of SE "Dnepropetrovsk Medical Academy of the Ministry Health of Ukraine".

I.V. MAKAROV, R.A. GALKIN, A.V. LUKASHOVA

THE COMPREHENSIVE NON-PHARMACOLOGICAL TREATMENT OF OBLITERATING ATHEROSCLEROSIS (STAGE II) BY COMBINED APPLICATION OF OZONE AND GRAVITATIONAL THERAPY. A RANDOMIZED STUDY

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

Objectives. Optimization of comprehensive treatment of patients with obliterating atherosclerosis (II stage) by combined application of ozone and gravitational therapy.
Methods. A prospective randomized controlled study in three parallel groups in 139 patients has been performed. The first group (n=57) received standard medical therapy in combination with ozone therapy; the group was divided into two subgroups: in the subgroup 1a (n=28) the patients were given intravenous ozonated saline solution (OSS), in the subgroup 1b (n=29) – major ozonated autohemotherapy (MOAT). The patients of the second group (n=62) underwent the comprehensive treatment, including gravitational therapy (GT) in addition to medical ozone. In this group two subgroups were also identified: subgroup 2a (n=31) – the patients received standard medical therapy in combination with OSS and GT, subgroup 2b (n=31) – in combination with MOAT and GT. The third group, the control one (n=20), included patients received only standard medical therapy. The results were evaluated immediately prior and after the treatment according to pain-free walking distance, ankle-brachial index, lipid metabolism and lipid peroxidation processes.
Results. The highest efficiency was observed in the subgroup 2a. A statistically significant increase of pain-free walking distance by 116,5%, ankle-brachial index – by 49,2% have been registered. The most pronounced positive dynamics of lipid metabolism has been observed: reduction of total cholesterol by 21,3%, low density lipoprotein – by 25,4%, very low density lipoprotein – by 24,2%, triglycerides – by 18,5%. The tendency towards normalization of lipid peroxidation was established: malondialdehyde decreased by 29,28%, the total antioxidant activity increased by 20,36%.
Conclusion. Combined application of ozonated physiological solution and gravity in the treatment of patients with obliterating atherosclerosis (stage II) contributes to a significant increase of pain-free walking distance and ankle-brachial index; as will as a significant correction of violations of lipid metabolism and lipid peroxidation process.

Keywords: obliterating atherosclerosis, ozone therapy, increase of pain-free walking distance, ankle-brachial index, gravitational therapy, randomized study
p. 406-415 of the original issue
References
  1. Poliakov PI, Gorelik SG, Zheleznova EA. Obliteriruiushchii ateroskleroz nizhnikh konechnostei u lits starcheskogo vozrasta [Atherosclerosis of the lower limbs in the elderly]. Vestn Novykh Med Tekhnologii. 2013;20(1):98-101.
  2. Kazantsev AV, Korymasov EA. Diagnostika progressiruiushchego techeniia obliteriruiushchego ateroskleroza bedrenno-podkolenno-bertsovoi lokalizatsii [Diagnosis of progressive course of atherosclerotic lesions of the femoropopliteal, tibial localization]. Fund Issledovaniia. 2011;(1):62-67.
  3. Andozhskaia IuS, Solntsev VN. Sostoianie lipidnogo obmena u bol'nykh s aterosklerozom v zavisimosti ot fokal'nosti porazheniia i tiazhesti ishemii nizhnikh konechnostei [Lipid metabolism in patients with atherosclerosis depending on focal lesions and severity of ischemia of the lower limbs]. Vestnik SPbGU. 2011;11(3):85-90.
  4. Kytikova OI, Novgorodtsev AD, Gvozdenko TA. Meditsinskii ozon – kak redoks-okislitel' gormetin v geriatrii [Medical ozone - as a redox oxidant gormetin in geriatrics]. Nauka i Praktika. 2014;55(1):26-30.
  5. Diagnostika i korrektsiia narushenii lipidnogo obmena s tsel'iu profilaktiki i lecheniia ateroskleroza [Diagnostics and correction of lipid disorders for the prevention and treatment of atherosclerosis]. Ross Rekomendatsii. Ross Kardio Zhurn. 2012;4(96, 1):32.
  6. Pokrovskii AV, Kharazov AV, Sapelkin SV. Konservativnoe lechenie patsientov s peremezhaiushcheisia khromotoi [Conservative treatment of patients with intermittent claudication]. Angiologiia i Sosud Khirurgiia. 2014;(1):172-80.
  7. Galkin RA, Makarov IV. Gravitatsionnaia terapiia v lechenii bol'nykh obliteriruiushchimi zabolevaniiami arterii nizhnikh konechnostei [Gravitational therapy in the treatment of patients with obliterating diseases of arteries of the lower extremities]: monografiia. Samara: Ofort; GOUVPO SamGMU. 2006. 200 p.
  8. Alekhina SP, Shcherbatiuk TG. Ozonoterapiia: klinicheskie i eksperimental'nye aspekty [Ozone: some clinical and experimental aspects]. N.Novgorod, RF: Litera. 2003. 240 p.
  9. Kostiuchenko AL. Efferentnaia terapiia [Efferent therapy]. Saint-Petersburg, RF: Foliant. 2003. 432 p.
Address for correspondence:
443099, Russian Federation,
Samara, ul. Chapaevskaya, d. 89,
GBOU VPO "Samarskiy gosudarstvennyiy
meditsinskiy universitet",
kafedra khirurgicheskih bolezney ¹1,
tel. office: 8 (846) 994-08-50,
e-mail: annalukashovaoghk@mail.ru,
Lukashova Anna Vladimirovna
Information about the authors:
Makarov I.V. MD, professor, a head of the surgical diseases chair ¹1 of SBEE HPE "Samara State Medical University".
Galkin R.A. MD, professor of the surgical diseases chair ¹1 of SBEE HPE "Samara State Medical University".
Lukashova A.V. A senior laboratory assistant of the surgical diseases chair ¹1 of SBEE HPE "Samara State Medical University".

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

EVALUATION OF EFFICACY AND SAFETY OF DIFFERENT TYPES OF ANTICOAGULANT THERAPY IN VENOUS THROMBOSIS

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

Objectives. Evaluation of efficacy and safety of different types of anticoagulant therapy (ACT) in patients with deep venous thrombosis (DVT).
Methods. The study included 119 patients with the disease duration of 1 to 15 days. The patients were divided into three groups: the 1st group included patients (n=38) received rivaroxaban, the 2nd group included patients (n=42) who received sodium enoxaparin (for 7-10 days) with subsequent administration of warfarin, the 3rd group included patients (n=39) treated with sodium enoxaparin (for 7-10 days) with subsequent administration of rivaroxaban. The efficacy and safety of ACT were assessed by duplex ultrasonography, by recurrence incidence and hemorrhagic complications.
Results. The increase in thrombus length was observed in 24% patients in the 1st group by the 4-5th days. These patients were then treated with enoxaparin which resulted in the subsequent apex attachment to the vein wall by the 12th days.
The apex of the free-floating thrombus was attached to the vein wall by the 8-10th days in 76% of patients who received rivaroxaban. DVT duration in 4 patients (24%) did not exceed 10 days, in 14 patients (76%) it was less than 5 days. In the 2nd group the apex of the thrombus attached to the vein wall by the 8-10th day in 17 patients, while in 2 patients (5%) the free-floating thrombi were detected after more than 12 days of treatment. In group 3 the apex of the free-floating thrombus was attached to the vein wall by the 8-10th days in all patients. After 1 month of rivaroxaban treatment, the recanalization was regarded as satisfactory. Recanalization in patients treated with warfarin was considered as "moderate" or "poor". The complications caused to anticoagulant therapy developed in 20 (16,8%) out of 119 patients. The significant and major complications were observed in warfarin group.
Conclusion. Parenteral administration of anticoagulants is considerted to be an effective method of lysis of free-floating thrombi in patients with different disease duration. Rivaroxaban has more advantages compared with warfarin in early terms of satisfactory recanalization, and causes fewer major hemorrhagic complications.

Keywords: deep vein thrombosis, ultrasound duplex scanning, anticoagulant therapy, attachment of thrombus, rivaroxaban, warfarin, hemorrhagic complications
p. 416-423 of the original issue
References
  1. Vardanian AV, Badanian AL, Mumladze RB, Patrushev LI, Roitman EV, Dolidze DD, Tokarev KIu. Idiopaticheskii tromboz glubokikh ven: sovremennye podkhody k diagnostike i lecheniiu [Idiopathic deep venous thrombosis: the current approaches to diagnosis and treatment]. Flebologiia. 2014;8(2):16-20.
  2. Savel'ev VS, Chazov EI, Gusev EI, Kirienko AI. Rossiiskie klinicheskie rekomendatsii po diagnostike, lecheniiu i profilaktike venoznykh tromboembolicheskikh oslozhnenii [Russian clinical recommendations for diagnosis, treatment and prevention of venous thromboembolic events]. Flebologiia. 2010;4(2):3-37
  3. Kalinin RE, Suchkov IA, Narizhnyi MV. Dispanserizatsiia bol'nykh s venoznymi tromboembolicheskimi oslozhneniiami [Clinical examination of patients with venous thromboembolic complications]. Ross Med-Biol Vestnk Im Akad IP Pavlova. 2011;(3):104-109.
  4. Lemenev VL, Kurguntsev EV, Gol'dina IM, Trofimova EIu, Mikhailov IP, Kudriashova NE. Klinicheskaia i ul'trazvukovaia diagnostika ostrykh venoznykh trombozov [Clinical and ultrasound diagnosis of acute venous thrombosis]. Khirurgiia. Zhurn im NI Pirogova. Moscow, RF: Media Sfera. 2008;(5):11-16.
  5. Shval'b PG, Kalinin RE, Egorov AA, Kachinskii AE. Real'naia embologennost' trombozov ven nizhnikh konechnostei [Real embologenic venous thrombosis of lower extremities]. Angiologiia i Sosud Khirurgiia. 2004;10(2):81-83.
  6. Schwarz UI, Ritchie MD, Bradford Y, Li C, Dudek SM, Frye-Anderson A, Kim RB, Roden DM, Stein CM. Genetic determinants of response to warfarin during initial anticoagulation. N Engl J Med. 2008 Mar 6;358(10):999-1008. doi: 10.1056/NEJMoa0708078.
  7. Baker WL, Cios DA, Sander SD, Coleman CI. Meta-analysis to assess the quality of warfarin control in atrial fibrillation patients in the United States. J Manag Care Pharm. 2009 Apr;15(3):244-52.
  8. Sukovatykh BS, Mikhin VP, Belikov LN, Cherniatina MA, Gladchenko MP, Savchuk OF. Optimizatsiia antikoaguliantnoi terapii venoznogo tromboembolizma [Optimization of anticoagulant therapy of venous thromboembolism]. Angiologiia i Sosud Khirurgiia. 2014;20(3):95-100.
  9. Khruslov MV. Problemy kontrolia effektivnosti profilaktiki retsidiva venoznykh tromboembolicheskikh oslozhnenii [Monitoring problems of the effectiveness of the recurrence prevention of venous thromboembolic events]. Flebologiia. 2014;(4):37-41.
  10. Bauersachs R, Berkowitz SD, Brenner B, Buller HR, Decousus H, Gallus AS, Lensing AW, Misselwitz F, Prins MH, Raskob GE, Segers A, Verhamme P, Wells P, Agnelli G, Bounameaux H, Cohen A, Davidson BL, Piovella F, Schellong S. Oral rivaroxaban for symptomatic venous thromboembolism. N Engl J Med. 2010 Dec 23;363(26):2499-510. doi: 10.1056/NEJMoa1007903
  11. Moiseev SV. Novye peroral'nye antikoagulianty v lechenii venoznykh tromboembolicheskikh oslozhnenii [New oral anticoagulants in the treatment of venous thromboembolic events]. Flebologiia. 2012;(1):32-36.
  12. Sushkov SA, Nebylitsin IS, Samsonova IV, Markautsan PV. Morfologicheskie izmeneniia sosudistoi stenki v raznye stadii eksperimental'nogo venoznogo tromboza [The morphological changes of the vascular wall at different stages of experimental venous thrombosis]. Ross Med-Biol Vestn Im Akad IP Pavlova. 2014;(3):17-27.
  13. Tsukanov IuT, Nikolaichuk AI. Otsenka faktorov, vliiaiushchikh na regress tromba podkozhnykh ven nizhnikh konechnostei pri antikoaguliantnoi terapii [Factors influencing the regression of the thrombus saphenous veins of the lower extremities during anticoagulant therapy]. Novosti Khirurgii. 2015;23(1):57-62.
  14. Camm AJ, Lip GY, De Caterina R, Savelieva I, Atar D, Hohnloser SH, Hindricks G, Kirchhof P. 2012 focused update of the ESC Guidelines for the management of atrial fibrillation. An update of the 2010 ESC Guidelines for the management of atrial fibrillation. ESC Committee for Practice Guidelines (CPG). Eur Heart J. 2012 Nov;33(21):2719-47. doi: 10.1093/eurheartj/ehs253
Address for correspondence:
390048, Russian Federation,
Ryazan, ul. Stroykova, d. 96,
GBOU VPO "Ryazanskiy gosudarstvennyiy
meditsinskiy universitet
imeni akademika I.P. Pavlova",
kafedra angiologii, sosudistoy,
operativnoy khirurgii i topograficheskoy anatomii,
tel. mob: 7 903 836-24-17,
e-mail: suchkov_med@mail.ru
Suchkov Igor Aleksandrovich
Information about the authors:
Kalinin R.E. MD, professor, a head of the angiology, vascular, operative surgery and topographic anatomy chair of SBEE HPE "Ryazan State Medical University named after Academician I.P. Pavlov".
Suchkov I.A. MD, an associate professor of the angiology, vascular, operative surgery and topographic anatomy chair of SBEE HPE "Ryazan State Medical University named after Academician I.P. Pavlov".
Pshennikov A.S. PhD, an assistant of the angiology, vascular, operative surgery and topographic anatomy chair of SBEE HPE "Ryazan State Medical University named after Academician I.P. Pavlov".
Agapov A.B. A day-time post-graduate student of the angiology, vascular, operative surgery and topographic anatomy chair of SBEE HPE "Ryazan State Medical University named after Academician I.P. Pavlov".

L.M. CHERNUKHA1, V.A. KHODOS 2, M.O. ARTEMENKO 1

THE ADVERSE EFFECTS OF SCLEROTHERAPY OF RETICULAR VEINS AND TELANGIECTASIAS

SE "National Institute of Surgery and Transplantology named after O.O. Shalimov", NAMS of Ukraine1
National Medical Academy of Post-Graduate Education named after P.L. Shupik2, Kiev
Ukraine

Objectives. To study the incidence of adverse effects in sclerotherapy of reticular veins and telangiectasia and to identify ways to optimize the method.
Methods. During the period 2009-2014 yrs. 223 women with reticular veins and telangiectasia of the lower limbs were subjected to treatment. The microfoam sclerotherapy was used in combination with liquid sclerotherapy in the first group (n=117, 52,47%) patients; the single liquid sclerotherapy was applied in the second group 9 (n=106, 47,53%). To perform microsclerotherapy Polidocanol and Lauromacrogol (0,5%, 1%) were used.
Results. The treatment results of patients in both groups were evaluated in 3, 6, 12 and 18 months. 3 months after sclerotherapy, skin hyperpigmentation was observed in all patients in the first group and in 92 (86,8%) patients in the second group (p<0,001). After 6 months hyperpigmentation disappeared in 35 (29,9%) patients in the first group and in 72 (67,9%) patients (p<0,001) in the second group. After 12 months the number of patients without skin hyperpigmentation in the first group increased up to 75 (64,1%), in the second group – up to 89 (83,9%) (p*<0,001). Skin hyperpigmentation in both groups in terms exceeding 12 months disappeared spontaneously up to 18 months. The number of patients with matting in the first group made up 32 (27,4%) compared with 14 (13,2%) – in the second group. After 6 months the ratio was the same – 25 (21,4%) compared with 12 (11,3%). After 12 months the spontaneous disappearance of matting was observed in both groups.
Conclusion. Microfoam application in combination with liquid sclerotherapy of reticular veins and telangiectasias is more economical than single liquid form, but is accompanied by significantly more side effects such as skin hyperpigmentation (p<0,001) and matting. The optimal technology of microsclerotherapy is considered to be a liquid sclerosant application in minimal concentrations.

Keywords: sclerotherapy, sclerosant, reticular veins, telangiectasia, microsclerotherapy, matting, skin hyperpigmentation
p. 424-428 of the original issue
References
  1. Rabe E, Schliephake D, Otto J, Breu FX, Pannier F. Sclerotherapy of telangiectases and reticular veins: a double-blind, randomized, comparative clinical trial of polidocanol, sodium tetradecyl sulphate and isotonic saline (EASI study). Phlebology. 2010 Jun;25(3):124-31. doi: 10.1258/phleb.2009.009043.
  2. Cavezzi A, Parsi K. Complications of foam sclerotherapy. Phlebology. 2012 Mar;27 Suppl 1:46-51. doi: 10.1258/phleb.2012.012S09.
  3. Goldman, Bergan, Guex eds. 4th edition. Sclerotherapy Treatment of Varicose and Telangiectatic Leg Veins, 2007. 314.
  4. Kern P, Ramelet AA, Wutschert R, Bounameaux H, Hayoz D. Single-blind, randomized study comparing chromated glycerin, polidocanol solution, and polidocanol foam for treatment of telangiectatic leg veins. Dermatol Surg. 2004 Mar;30(3):367-72.
  5. Jennifer D. Peterson MD, Mitchel P. Goldman MD1, Robert A. Weiss MD, David M. Duffy MD, Sabrina G. Fabi MD, Margaret A. Weiss MD, Isabella Guiha BS1. Treatment of Reticular and Telangiectatic Leg Veins: Double-Blind, Prospective Comparative Trial of Polidocanol and Hypertonic Saline. August 2012;38(8):1322-1330. DOI: 10.1111/j.1524-4725.2012.02422.x
  6. Ramelet AA. Sclerotherapy in tumescent anesthesia of reticular veins and telangiectasias. Dermatol Surg. 2012 May;38(5):748-51. doi: 10.1111/j.1524-4725.2011.02287.x.
  7. Goldman MP.My sclerotherapy technique for telangiectasia and reticular veins. Dermatol Surg. 2010 Jun;36 Suppl 2:1040-5. doi: 10.1111/j.1524-4725.2009.01408.x.
  8. Guex JJ.Complications of sclerotherapy: an update. Dermatol Surg. 2010 Jun;36 Suppl 2:1056-1063.
  9. Leach BC, Goldman MP.Comparative trial between sodium tetradecyl sulfate and glycerin in the treatment of telangiectatic leg veins. Dermatol Surg. 2003 Jun;29(6):612-14.
Address for correspondence:
04112, Ukraine, Kiev,
ul. Dorgozhitskaya, d. 9,
Natsionalnaya meditsinskaya akademiya
poslediplomnogo obrazovaniya im.P.L. Shupika,
kafedra khirurgii i
sosudistoy khirurgii,
tel. mob.: 38 050 469-56-15,
e-mail: vkhodos@ukr.net,
Khodos Valentin Andreevich
Information about the authors:
Chernukha L.M. MD, a leading researcher of the department of the main vessels surgery of SE "National Institute of Surgery and Transplantology named after O.O. Shalimov" of NAMS of Ukraine, Kiev.
Khodos V.A. MD, an assistant of surgery and vascular surgery chair of "National Medical Academy of Post-graduate Education named after P.L. Shupik", Kiev.
Artemenki M.O. PhD, a researcher of the department of the main vessels surgery of SE "National Institute of Surgery and Transplantology named after O.O. Shalimov" of NAMS of Ukraine, Kiev.

M.Y. GAIN, S.V. SHAKHRAI, Y.M. GAIN

HEMORRHOIDAL LASER COAGULATION AND MUCOPEXY IN THE SURGERY OF GRADE II AND III CHRONIC HEMORRHOIDS: A RANDOMIZED TRIAL

SEE "Belarusian Medical Academy of Post-Graduate Education"
The Republic of Belarus

Objectives. To evaluate the efficiency of hemorrhoidal laser coagulation and mucopexy in complex treatment of grade II and III chronic hemorrhoids by J. Goligher classification (1975).
Methods. The patients were divided into two groups according to the surgical intervention. In the 1st (main) (n=45) group the minimally invasive surgery – subcutaneous-submucous hemorrhoidal laser coagulation and mucopexy with proximal suture artery ligation were performed. In 34 patients (75,6%) the procedure was performed under local anesthesia, in 11 patients (24,4%) – under spinal anesthesia. In the control group (n=45) the closed Ferguson’s hemorrhoidectomy was carried out under spinal anesthesia. A comparative analysis of the results from a single-center, prospective, randomized, controlled study has been conducted.
Results. In comparability the final clinical effect and radicalism with the hemorrhoidal laser coagulation of the designed technique has surpassed the closed hemorrhoidectomy in the indices of the local edema duration (median terms of its disappearance in compared groups are 1 and 4,5 days, p=0,0000594, z=−4,01521 Mann-Whitney U Test), of pain syndrome intensity in 89,1% of patients after hemorrhoidectomy the observed pain relief associated with 1-2% promedolum injections, this was not necessary in the main group), the qualitative and quantitative characteristics of the postoperative complications (frequency of early complications lack in compared groups made up 43 (95,6%) and 29 (64,4%), p=0,0018, long-term complications – 43 (95,6%) and 31 (68,9%), p=0,0017, Chi-square), and also according to other indices have been established.
Conclusion. The designed method of subcutaneous-submucous laser coagulation with wavelength of 1,56 mn in combined with desertification hemorrhoids through suture ligation and mucopexy proven to be less invasive procedure used for treatment of grade II and III chronic hemorrhoids compared with closed hemorrhoidectomy.

Keywords: laser procedure, Ferguson’s hemorrhoidectomy, coagulation, mucopexy, hemorrhoids, postoperative complications, randomized, controlled trial
p. 429-435 of the original issue
References
  1. Vorob'ev GI, Blagodarnyi LA, Shelygin IuA. Gemorroi [Hemorrhoids]: ruk dlia vrachei. 2-e izd, pererab dop. Moscow, RF: Litterra, 2010. 200 p.
  2. Datsenko BM. Datsenko AB. Gemorroi [Hemorrhoids]. Khar'kov, Ukraina: Novoe Slovo. 2011. 144 p.
  3. Rivkin VL, Kapuller LL, Belousova E A. Koloproktologiia [Coloproctology]: ruk dlia vrachei. Moscow, RF: GEOTAR-Media, 2011. 368 p
  4. Liandres IG/red. Lazery v klinicheskoi khirurgii [Lasers in clinical surgery]. Minsk, RB: 1997. 228 p.
  5. Iaitskii HA, Vasil'ev SV, Sednev AV. Ispol'zovanie poluprovodnikovogo lazera v khirurgicheskom lechenii khronicheskogo gemorroia [The use of a semiconductor laser in the surgical treatment of hemorrhoids]. Regionar Krovoobrashchenie i Mikrotsirkuliatsiia. 2002;(2):17-21.
  6. Geinits AV, Elisova TG. Lazery v khirurgicheskom lechenii gemorroia [Lasers in surgical treatment of hemorrhoids]. Lazernaia Meditsina. 2009;(2):31-35.
  7. Chia YW, Darzi A, Speakman CT, Hill AD, Jameson JS, Henry MM. CO2 laser haemorrhoidectomy-does it alter anorectal function or decrease pain compared to conventional haemorrhoidectomy? Int J Colorectal Dis. 1995;10(1):22-24.
  8. Plapler H, de Faria Netto AJ, da Silva Pedro MS. 350 ambulatory hemorrhoidectomies using a scanner coupled to a CO2 laser. J Clin Laser Med Surg. 2000 Oct;18(5):259-62.
  9. Leff EI. Hemorrhoidectomy-laser vs. nonlaser: outpatient surgical experience. Dis Colon Rectum. 1992 Aug;35(8):743-46.
  10. Wang D, Zhong KL, Chen JL, Wang XX, Pan K, Xia LG, Chen XC, Yang XD. Effect of diode laser coagulation treatment on grade III internal hemorrhoids. [Article in Chinese] Zhonghua Wei Chang Wai Ke Za Zhi. 2005 Jul;8(4):325-47.
  11. Plapler H, Hage R, Duarte J, Lopes N, Masson I, Cazarini C, Fukuda T. A new method for hemorrhoid surgery: intrahemorrhoidal diode laser, does it work? Photomed Laser Surg. 2009 Oct;27(5):819-23. doi: 10.1089/pho.2008.2368.
  12. Giamundo P, Cecchetti W, Esercizio L, Fantino G, Geraci M, Lombezzi R, Pittaluga M, Tibaldi L, Torre G, Valente M. Doppler-guided hemorrhoidal laser procedure for the treatment of symptomatic hemorrhoids: experimental background and short-term clinical results of a new mini-invasive treatment. Surg Endosc. 2011 May;25(5):1369-75. doi: 10.1007/s00464-010-1370-x.
  13. Jongen J, Kahlke V. Randomized trial of the hemorrhoid laser procedure vs rubber band ligation: 6-month follow-up. Dis Colon Rectum. 2012 Apr;55(4):e45; author reply e45. doi: 10.1097/DCR.0b013e318246ad4a.
  14. Jahanshahi A, Mashhadizadeh E, Sarmast MH. Diode laser for treatment of symptomatic hemorrhoid: a short term clinical result of a mini invasive treatment, and one year follow up. Pol Przegl Chir. 2012 Jul;84(7):329-32. doi: 10.2478/v10035-012-0055-7.
Address for correspondence:
220013, Republic of Belarus,
Minsk, ul. P. Brovki, d. 3, korp. 3,
GUO "Belorusskaya meditsinskaya akademiya
poslediplomnogo obrazovaniya",
kafedra neotlozhnoy khirurgii,
tel. mob.: 375 44 557-88-15,
e-mail: mishahain@tut.by,
Gain Mihail Yurevich
Information about the authors:
Gain M.Y. PhD, an assistant of the emergency surgery chair of SEE "Belarusian Medical Academy of Post-graduate Education".
Shakhrai S.V. PhD, an associate professor of the emergency surgery chair of SEE "Belarusian Medical Academy of Post-graduate Education".
Gain Y.M. MD, professor, Vice-rector on scientific work of SEE "Belarusian Medical Academy of Post-graduate Education".

TRAUMATOLOGY & ORTHOPEDICS

V.A. KORYACHKIN 1, V.V. GERASKOV2, D.Y. KORSHUNOV 2

EVALUATION OF INFILTRATION ANESTHESIA SAFETY IN TOTAL KNEE JOINT ARTHROPLASTY

FSBE "P.P. Vreden Russian Research Institute of Traumatology and Orthopedics", Saint-Petersburg 1,
FSBE "Federal Center of Traumatology, Orthopedics and Joint Replacement" of the Ministry of Health of Russia, Smolensk2,
The Russian Federation

Objectives. Evaluation of the local infiltration anesthesia safety in primary total knee joint arthroplasty.
Methods. The level of total and free plasma concentrations of ropivacaine following the local infiltration anesthesia in 26 patients aged 66,2±9,7 years undergoing total knee arthroplasty has been studied. Patients were subjected to knee tissue infiltration with 150 mg of 0,2% ropivacaine solution followed by intraarticular anesthetic infusion at a rate of 6-8 mL/h. Total and free plasma concentration of ropivacaine was measured at 30-min, and then 4-6 hours, and 24 hours intervals after the infusion onset.
Results. After 30 min the level of plasma total ropivacaine made up 0.696±0,2 μg/ml, after 4-6 h – 1,58±0,1 μg/ml and after 24 h. 1,039±0,04 μg/ml. After 30 min the level of plasma free ropivacaine was 0,049±0,02 μg/ml, after 4-6 h – 0,065±0,02 μg/ml, and after 24 h – 0,079±0,012 μg/ml. 4 hours after the intra-articular infusion of ropivacaine onset, transient dizziness, nausea and disturbance of vision were registered in two patients but they did not require any special treatment. It appears that at this moment total levels of plasma ropivacaine varied from 1,789 and 1,805 μg/ml, level of the free ropivacaine – 0,078 μg/ml and 0,095 μg/ml, respectively. No specific therapy is required. An increase in total plasma ropivacaine concentrations in 4-6 hours after the infusion onset was caused by the reduction of the level of alpha-1-acid glycoprotein associated with the conducted infusion therapy and hemodilution.
Conclusion. The application of high-dose ropivacaine for the local infiltration anesthesia with further intra-articular infusion of the local anesthetic for pain relief is considered to be as a sufficiently safe method: the level of free plasma concentrations of ropivacaine does not reach statistical significance associated with clinical manifestations of local anesthetic toxicity.

Keywords: local infiltration analgesia, local anesthetics, concentration of free ropivacaine, concentration of ropivacaine in blood, toxicity of local anesthetics, total knee joint arthroplasty
p. 436-339 of the original issue
References
  1. Bogomolov BI. Vybor metoda anestezii i posleoperatsionnogo obezbolivaniia pri total'nom endoprotezirovanii kolennogo sustava [The choice of anesthesia and postoperative analgesia in total knee arthroplasty]. Voen Meditsina. 2013;(1):39-44.
  2. Kornilov NN, Kuliaba TA. Artroplastika kolennogo sustava [Knee arthroplasty]. Saint-Petersburg, RF: 2012. 228 p.
  3. Frassanito L, Vergari A, Zanghi F, Messina A, Bitondo M, Antonelli M. Post-operative analgesia following total knee arthroplasty: comparison of low-dose intrathecal morphine and single-shot ultrasound-guided femoral nerve block: a randomized, single blinded, controlled study. Eur Rev Med Pharmacol Sci. 2010 Jul;14(7):589-96.
  4. Wyatt C M, Wright T, Locker J, Stout K, Chapple C, Theis JC. Femoral nerve infusion after primary total knee arthroplasty: a prospective, double-blind, randomised and placebo-controlled trial. Bone Joint Res. 2015 Feb;4(2):11-16. doi: 10.1302/2046-3758.42.2000329.
  5. Komkin VA, Babushkin VN, Zhirova TA, Rudnov VA. Mestnaia odnokratnaia infil'tratsionnaia anal'geziia posleoperatsionnoi rany u patsientov posle endoprotezirovaniia kolennogo i tazobedrennogo sustavov [Local single infiltration analgesia of postoperative wounds in patients after knee and hip joints]. Fund Issledovaniia. 2014;(4-3):524-29.
  6. Banerjee P, Rogers BA Systematic review of high-volume multimodal wound infiltration in total knee arthroplasty. Orthopedics. 2014 Jun;37(6):403-12. doi: 10.3928/01477447-20140528-07.
  7. Fowler SJ, Christelis N. High volume local infiltration analgesia compared to peripheral nerve block for hip and knee arthroplasty-what is the evidence? Anaesth Intensive Care. 2013 Jul;41(4):458-62.
  8. Medvedev IuV, Ramenskaia GV, Shokhin IE, Iarushok TA. VEZhKh i SVEZhK kak metody dlia opredeleniia lekarstvennykh veshchestv v krovi [HPLC and SHPLC as the methods for the determination of drugs in the blood]. Khimiko-Farmatsevt Zhurn. 2013;47(4):45-51.
  9. Knudsen K, Beckman Suurküla M, Blomberg S, Sjövall J, Edvardsson N. Central nervous and cardiovascular effects of i.v. infusions of ropivacaine, bupivacaine and placebo in volunteers. Br J Anaesth. 1997 May;78(5):507-14.
  10. Wiedemann D, Mühlnickel B, Staroske E, Neumann W, Röse W. Ropivacaine plasma concentrations during 120-hour epidural infusion. Br J Anaesth. 2000 Dec;85(6):830-35.
  11. Koriachkin VA, Strashnov VI. Anesteziia i intensivnaia terapiia [Anesthesia and intensive care]. Saint-Petersburg, RF; 2004. 465p.
  12. Essving P. Local infiltration analgesia in knee arthroplasty. Örebro Univesity. 2012. 64 ð.
  13. Brydone AS, Souvatzoglou R, Abbas M, Watson DG, McDonald DA, Gill AM. Ropivacaine plasma levels following high-dose local infiltration analgesia for total knee arthroplasty. Anaesthesia. 2015 Feb 22. doi: 10.1111/anae.13017.
Address for correspondence:
195427, g. Saint-Petersburg,
ul. Akademika Baykova, d. 8,
FGBU "RNIITO imeni P.P. Vredena"
Minzdrava Rossii, ,
nauchnoe otdelenie diagnostiki zabolevaniy
i povrezhdeniy oporno-dvigatelnoy sistemyi,
tel.: 79052111429,
e-mail: vakoryachkin@mail.ru,
Koryachkin Viktor Anatolevich
Information about the authors:
Koryachkin V.A. MD, professor, a head of the research department of diagnostics of diseases and traumas of the musculoskeletal system of FSBE "P.P. Vreden Russian Research Institute of Traumatology and Orthopedics", Saint-Petersburg.
Geraskov E.V. An anesthetist-reanimatologist of the department of anesthesiology and resuscitation of FSBE "Federal Center of Traumatology, Orthopedics and Joint Replacement" of the Ministry of Health of Russia, Smolensk
Korshunov D.Y. A head of the traumatology and orthopedics department ¹1 of FSBE "Federal Center of Traumatology, Orthopedics and Joint Replacement" of the Ministry of Health of Russia, Smolensk

NEUROSURGERY

K.M. KUBRAKOV 1, V.M. SEMENOV 1, I.A. KOVALEVA 2

BETA-LACTAMASE LIQUOR ACTIVITY IN ACINETOBACTER PURULENT MENINGOENCEPHALITIS

EE "Vitebsk State Medical University"1
ME "Vitebsk Regional Clinical Hospital" 2
The Republic of Belarus

Objectives. To determine the role of Acinetobacter spp. in the development of purulent meningoencephalitis, to assess the level of beta-lactamase activity (BLA) of liquor and to analyze its clinical significance in neurosurgical patients.
Methods. Positive bacteriological liquor samples obtained from 52 patients with purulent meningoencephalitis of neurosurgery department of ME "Vitebsk Regional Clinical Hospital" in 2010-2015 have been studied. Identification and sensitivity of microorganisms were performed by test systems (ATB Expression Microbiological Culture Analyzer). To assess the beta-lactamase activity (BLA) of liquor the test system "Biolactam" (LTD "Sivital", the Republic of Belarus) was applied.
Results. Gram-positive flora composed 38,60% (95% CI: 25,56-51,63) out of 57 isolated strains, gram-negative microorganisms – 61.40% (95% CI: 48,37-74,44). Gram-positive flora was represented by native Staphylococcus 21,05%, (95% CI: 10,14-31,97) and the family Streptococcaseae 17,54% (95% CI: 7,36-27,73). The Gram-positive bacteria include A. baumannii – 36,84% (95% CI: 23,93-49,76), P. aeruginosa – 12.28% (95% CI: 3,49-21,07), K. pneumonia – 10 53% (95% CI: 2,53-18,74) and Cirtobacter – 1,75%.
The median of BLA of liquor (n=17) was equal to 41.82% (95% CI: 27,22-56,44); min 5,60%, max 78,29%. When A. baumannii (n=8), the value BLA of liquor was 43,01% (95% CI: 17,63%-68,49%). Pathogen was resistant to the third/fourth-generation cephalosporin and imipenem in 100% of cases; to meropenem and amikacin – in 83% of cases, to ofloxacin and ciprofloxacin – in 66%, to levofloxacin in 50%, to ampicillin/sulbactam in 0% of cases.
Conclusion. In the late postoperative period purulent meningoencephalitis is caused by gram-negative pathogens in 61,40% of cases. The common causative agent of purulent meningoencephalitis is considred to be A. baumannii (36,84%). The value BLA of liquor with A. baumannii (43,01%) is two folds higher than the threshold one (20%). This pathogen reveals high resistance to the third/fourth-generation cephalosporin, carbapenems and fluoroquinolones. High value of BLA of liquor is the guarantor of the pathogen resistance to antibacterial drugs.

Keywords: meningoencephalitis, neurosurgery, pathogen, antibiotics, resistance, beta-lactamase activity, Biolactam
p. 440-446 of the original issue
References
  1. Starchenko AA, Khil'ko VA/red. Rukovodstvo po klinicheskoi neiroreanimatologii. Moscow, RF: Binom, 2013. 824 p.
  2. De Bels D, Korinek AM, Bismuth R, Trystram D, Coriat P, Puybasset L. Empirical treatment of adult postsurgical nosocomial meningitis. Acta Neurochir (Wien). 2002 Oct;144(10):989-95.
  3. McClelland S 3rd, Hall WA. Postoperative central nervous system infection: incidence and associated factors in 2111 neurosurgical procedures. Clin Infect Dis. 2007 Jul 1;45(1):55-9.
  4. Kubrakov KM, Semenov VM, Kovaleva IA, Zen'kova SK, Skvortsova VV. Antibiotikorezistennost' osnovnykh vozbuditelei gnoinykh meningitov u neirokhirurgicheskikh patsientov [Antibiotic resistance is the main pathogen of purulent meningitis in neurosurgical patients]. Novosti Khirurgii. 2013;21(6):78-83.
  5. Chang CJ, Ye JJ, Yang CC, Huang PY, Chiang PC, Lee MH. Influence of third-generation cephalosporin resistance on adult in-hospital mortality from post-neurosurgical bacterial meningitis. J Microbiol Immunol Infect. 2010 Aug;43(4):301-9. doi: 10.1016/S1684-1182(10)60047-3.
  6. Paramythiotou E, Karakitsos D, Aggelopoulou H, Sioutos P, Samonis G, Karabinis A. Post-surgical meningitis due to multiresistant Acinetobacter baumannii. Effective treatment with intravenous and/or intraventricular colistin and therapeutic dilemmas. Med Mal Infect. 2007 Feb;37(2):124-25.
  7. Kourbeti IS, Vakis AF, Ziakas P, Karabetsos D, Potolidis E, Christou S, Samonis GJ. Infections in patients undergoing craniotomy: risk factors associated with post-craniotomy meningitis. Neurosurg. 2015 May;122(5):1113-9. doi: 10.3171/2014.8.JNS132557.
  8. Yang M, Hu Z, Hu F. Nosocomial meningitis caused by Acinetobacter baumannii: risk factors and their impact on patient outcomes and treatments. Future Microbiol. 2012 Jun;7(6):787-93. doi: 10.2217/fmb.12.42.
  9. Briggs S, Ellis-Pegler R, Raymond N, Thomas M, Wilkinson L. Gram-negative bacillary meningitis after cranial surgery or trauma in adults. Scand J Infect Dis. 2004;36(3):165-73.
  10. Tuon FF, Penteado-Filho SR, Amarante D, Andrade MA, Borba LA. Mortality rate in patients with nosocomial Acinetobacter meningitis from a Brazilian hospital. Braz J Infect Dis. 2010 Sep-Oct;14(5):437-40.
  11. Moosavian M, Shoja S, Nashibi R, Ebrahimi N, Tabatabaiefar MA, Rostami S, Peymani A.Post Neurosurgical Meningitis due to Colistin Heteroresistant Acinetobacter baumannii. Jundishapur J Microbiol. 2014 Oct;7(10):e12287. doi: 10.5812/jjm.12287.
  12. Semenov VM, Zhil'tsov IV, Dmitrachenko TI, Zen'kova SK, Skvortsova VV, Kubrakov KM, Veremei IS. Vyiavlenie produktsii beta-laktamaz bakteriiami pri pomoshchi test-sistemy "Biolaktam" [Detection of beta-lactamase production by bacteria with a test system of "Biolaktam"]. Vestn Vitebsk Gos Med Uni-ta. 2014;13(4):84-89.
  13. Samaha-Kfoury JN, Araj GF. Recent developments in beta lactamases and extended spectrum beta lactamases. BMJ. 2003 Nov 22;327(7425):1209-13.
  14. Tängdén T, Enblad P, Ullberg M, Sjölin J. Neurosurgical gram-negative bacillary ventriculitis and meningitis: a retrospective study evaluating the efficacy of intraventricular gentamicin therapy in 31 consecutive cases. Clin Infect Dis. 2011 Jun;52(11):1310-6. doi: 10.1093/cid/cir197.
Address for correspondence:
210023, Republic of Belarus,
g. Vitebsk, pr. Frunze, d. 27,
UO "Vitebskiy gosudarstvennyiy
meditsinskiy universitet",
kafedra nevrologii i neyrokhirurgii,
tel. office: 375 212 22-71-94,
e-mail: k-kubrakov@yandex.ru,
Kubrakov Konstantin Mihaylovich
Information about the authors:
Kubrakov K.M. PhD, an associate professor of the neurology and neurosurgery chair of EE "Vitebsk State Medical University".
Semenov V.M. MD, professor, a head of the infectious diseases chair of EE "Vitebsk State Medical University".
Kovaleva I.A. A doctor-intern of ME "Vitebsk Regional Clinical Hospital".

REVIEWS

A.A. SMIRNOV, L.K. KULIKOV, U.A. PRIVALOV, V.F. SOBOTOVICH

RECURRENCE OF LOWER LIMB VARICOSE VEINS

SBEE DPE "Irkutsk State Medical Academy of Post-Graduate Education"
The Russian Federation

The article presents an overview of domestic and foreign literature on the etiology, diagnosis and treatment of recurrent varicose veins. Two current classification schemes to assess the recurrence of varicose veins of the lower limbs, depending on the primary surgery: REVAS and PREVAIT have been proposed. Moreover the incidence of recurrence of varicose veins after different methods of eliminating of primary disease has been analyzed. The literature review summarizes the views of a number of foreign authors concerning the definition of the concept of "recurrence of varicose veins of the lower extremities". The conventional concepts and current hypotheses concerning the causes of this complication are presented. The significance of ultrasound duplex angioscanning leg veins as the best diagnostic method to identify accurately the main pathological and hemodynamic causes of disease recurrence has been highlighted. The feature of both classical and current correction methods of recurrent lower limb varicose veins is given in the review. The using of the combination of various non-surgical treatment techniques depending on the definite clinical situation allows increasing the modern high quality medical aid provided to such severe patients is demonstrated.

Keywords: lower limb varicose veins, recurrence, operation, foam sclerotherapy, laser obliteration, radiofrequency obliteration, miniphlebectomy
p. 447-451 of the original issue
References
  1. Winterborn RJ, Foy C, Earnshaw JJ.Causes of varicose vein recurrence: late results of a randomized controlled trial of stripping the long saphenous vein. J Vasc Surg. 2004 Oct;40(4):634-9.
  2. Robertson L, Evans C, Fowkes FG. Epidemiology of chronic venous disease. 2008;23(3):103-11. doi: 10.1258/phleb.2007.007061.
  3. Beebe-Dimmer JL, Pfeifer JR, Engle JS, Schottenfeld D. The epidemiology of chronic venous insufficiency and varicose veins. Ann Epidemiol. 2005 Mar;15(3):175-84.
  4. Kostas T, Ioannou CV, Touloupakis E, Daskalaki E, Giannoukas AD, Tsetis D, Katsamouris AN.Recurrent varicose veins after surgery: a new appraisal of a common and complex problem in vascular surgery. Eur J Vasc Endovasc Surg. 2004 Mar;27(3):275-82.
  5. Chapman-Smith P, Browne A. Prospective five-year study of ultrasound-guided foam sclerotherapy in the treatment of great saphenous vein reflux. Phlebology. 2009 Aug;24(4):183-88. doi: 10.1258/phleb.2009.008080.
  6. Perrin MR, Guex JJ, Ruckley CV, dePalma RG, Royle JP, Eklof B, Nicolini P, Jantet G.Recurrent varices after surgery (REVAS), a consensus document. REVAS group. Cardiovasc Surg. 2000 Jun;8(4):233-45.
  7. Eklof B, Perrin M, Delis KT, Rutherford RB, Gloviczki P.Updated terminology of chronic venous disorders: the VEIN-TERM transatlantic interdisciplinary consensus document. J Vasc Surg. 2009 Feb;49(2):498-501. doi: 10.1016/j.jvs.2008.09.014.
  8. Gloviczki P, Comerota AJ, Dalsing MC, Eklof BG, Gillespie DL, Gloviczki ML, Lohr JM, McLafferty RB, Meissner MH, Murad MH, Padberg FT, Pappas PJ, Passman MA, Raffetto JD, Vasquez MA, Wakefield TW. The care of patients with varicose veins and associated chronic venous diseases: clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg. 2011 May;53(5 Suppl):2S-48S. doi: 10.1016/j.jvs.2011.01.079.
  9. Perrin MR, Labropoulos N, Leon LR Jr.Presentation of the patient with recurrent varices after surgery (REVAS). J Vasc Surg. 2006 Feb;43(2):327-34.
  10. Rasmussen L, Lawaetz M, Bjoern L, Blemings A, Eklof B.Randomized clinical trial comparing endovenous laser ablation and stripping of the great saphenous vein with clinical and duplex outcome after 5 years. J Vasc Surg. 2013 Aug;58(2):421-26. doi: 10.1016/j.jvs.2012.12.048.
  11. Jones L, Braithwaite BD, Selwyn D, Cooke S, Earnshaw JJ. Neovascularisation is the principal cause of varicose vein recurrence: results of a randomised trial of stripping the long saphenous vein. Eur J Vasc Endovasc Surg. 1996 Nov;12(4):442-45.
  12. Pittaluga P, Chastanet S, Rea B, Barbe R. Midterm results of the surgical treatment of varices by phlebectomy with conservation of a refluxing saphenous vein. J Vasc Surg. 2009 Jul;50(1):107-18. doi: 10.1016/j.jvs.2008.12.067.
  13. Blomgren L, Johansson G, Dahlberg-AKerman A, Norén A, Brundin C, Nordström E, Bergqvist D. Recurrent varicose veins: incidence, risk factors and groin anatomy. Eur J Vasc Endovasc Surg. 2004 Mar;27(3):269-74.
  14. Theivacumar NS, Dellagrammaticas D, Darwood RJ, Mavor AI, Gough MJ Fate of the great saphenous vein following endovenous laser ablation: does re-canalisation mean recurrence? Eur J Vasc Endovasc Surg. 2008 Aug;36(2):211-15. doi: 10.1016/j.ejvs.2008.03.014.
  15. Theivacumar NS, Dellagrammaticas D, Beale RJ, Mavor AI, Gough MJ. Factors influencing the effectiveness of endovenous laser ablation (EVLA) in the treatment of great saphenous vein reflux. Eur J Vasc Endovasc Surg. 2008 Jan;35(1):119-23
  16. Brittenden J, Cotton SC, Elders A, Tassie E, Scotland G, Ramsay CR, Norrie J, Burr J, Francis J, Wileman S, Campbell B, Bachoo P, Chetter I, Gough M, Earnshaw J, Lees T, Scott J, Baker SA, MacLennan G, Prior M, Bolsover D, Campbell MK. Clinical effectiveness and cost-effectiveness of foam sclerotherapy, endovenous laser ablation and surgery for varicose veins: results from the Comparison of LAser, Surgery and foam Sclerotherapy (CLASS) randomised controlled trial. Health Technol Assess. 2015 Apr;19(27):1-342. doi: 10.3310/hta19270.
  17. Rabe E, Pannier F, Ko A, Berboth G, Hoffmann B. Incidence of Varicose Veins, Chronic Venous Insufficiency, and Progression of the Disease in the Bonn Vein Study II. S. HertelDOI: http://dx.doi.org/10.1016/j.jvs.2009.11.014 March 2010;51(3):791.
  18. De Maeseneer MG. The role of postoperative neovascularisation in recurrence of varicose veins: from historical background to today's evidence. Acta Chir Belg. 2004 Jun;104(3):283-89.
  19. van Rij AM, Jones GT, Hill GB, Jiang P.Neovascularization and recurrent varicose veins: more histologic and ultrasound evidence. J Vasc Surg. 2004 Aug;40(2):296-302.
  20. Theivacumar NS, Darwood R, Gough MJ. Neovascularisation and recurrence 2 years after varicose vein treatment for sapheno-femoral and great saphenous vein reflux: a comparison of surgery and endovenous laser ablation. Eur J Vasc Endovasc Surg. 2009 Aug;38(2):203-7. doi: 10.1016/j.ejvs.2009.03.031
  21. Lurie F, Creton D, Eklof B, Kabnick LS, Kistner RL, Pichot O, Sessa C, Schuller-Petrovic S. Prospective randomised study of endovenous radiofrequency obliteration (closure) versus ligation and vein stripping (EVOLVeS): two-year follow-up. Eur J Vasc Endovasc Surg. 2005 Jan;29(1):67-73.
  22. De Maeseneer MG, Vandenbroeck CP, Van Schil PE. Silicone patch saphenoplasty to prevent repeat recurrence after surgery to treat recurrent saphenofemoral incompetence: long-term follow-up study. J Vasc Surg. 2004 Jul;40(1):98-105.
  23. Maleti O, Perrin M. Reconstructive surgery for deep vein reflux in the lower limbs: techniques, results and indications. Eur J Vasc Endovasc Surg. 2011 Jun;41(6):837-48. doi: 10.1016/j.ejvs.2011.02.013.
  24. Castenmiller PH, de Leur K, de Jong TE, van der Laan L. Clinical results after coil embolization of the ovarian vein in patients with primary and recurrent lower-limb varices with respect to vulval varices. Phlebology. 2013 Aug;28(5):234-38. doi: 10.1258/phleb.2012.011117.
  25. Darvall KA, Bate GR, Adam DJ, Silverman SH, Bradbury AW. Duplex ultrasound outcomes following ultrasound-guided foam sclerotherapy of symptomatic recurrent great saphenous varicose veins. Eur J Vasc Endovasc Surg. 2011 Jul;42(1):107-14. doi: 10.1016/j.ejvs.2011.03.010.
  26. Hinchliffe RJ, Ubhi J, Beech A, Ellison J, Braithwaite BD. A prospective randomised controlled trial of VNUS closure versus surgery for the treatment of recurrent long saphenous varicose veins. Eur J Vasc Endovasc Surg. 2006 Feb;31(2):212-18.
Address for correspondence:
664013, Russian Federation,
g. Irkutsk, m-n Yubileynyiy d. 100, GBOU DPO "Irkutskaya gosudarstvennaya meditsinskaya akademiya poslediplomnogo obrazovaniya", kafedra khirurgii,
tel. office: 8 3952 638-176,
e-mail: giuv.surgery@yandex.ru,
Smirnov Aleksey Anatolevich
Information about the authors:
Smirnov A.A. PhD, an assistant of the surgery chair of SBEE DPE "Irkutsk State Medical Academy of Post-graduate Education".
Kulikov L.K. MD, professor of the surgery chair of SBEE DPE "Irkutsk State Medical Academy of Post-graduate Education".
Privalov U.A. MD, an associate professor of the surgery chair of SBEE DPE "Irkutsk State Medical Academy of Post-graduate Education".
Sobotovich V.F. PhD, an associate professor of the surgery chair of SBEE DPE "Irkutsk State Medical Academy of Post-graduate Education".

Y.G. SHAPKIN, P.A. SELIVERSTOV

STRATEGY FOR SURGICAL TREATMENT OF POLYTRAUMA WITH UNSTABLE PELVIC INJURIES

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

A review of the scientific literature identified the main factors influencing the choice of therapeutical strategy in polytrauma with unstable pelvic injuries; the options for surgical treatment as well as the advantages and disadvantages of current methods of continuous intrapelvic hemorrhage stopping, external and internal fixation of the pelvis injuries in polytrauma are also presented.
The high incidence of development of shock, massive interstitial hemorrhage, endogenous intoxication syndrome, hypostatic complications, the importance of an anatomically accurate reconstruction of the pelvic ring for functional outcome require special treatment tactics in polytrauma with pelvic injuries. Fixation of unstable pelvic ring injuries with a fixator and continuous intrapelvic hemorrhage stopping using angiographic arterial embolization, extraperitoneal tamponade in polytrauma proven to be some anti-shock urgent measures. Early surgical fixation of unstable pelvic injuries in polytrauma can prevent the development of endogenous intoxication syndrome, disseminated intravascular coagulation, multiple organ failure, to reduce the frequency of hypostatic complications, mortality rate and to improve functional outcomes. Terms and extent of surgical interventions for pelvic injuries in polytrauma are based on the severity of the patient’s condition, the period of traumatic disease. In patients in critical condition the staged surgical treatment of unstable pelvic injuries with temporary external fixation devices and the subsequent final stabilization of the internal fixator correspond to the concept of "Damage Control" and this allows obtaining maximum benefit from both techniques. Treatment of acetabulum fractures and damages in the structural integrity of the pelvic ring should comply with the treatment principles of intra-articular fractures and requires accurate anatomical reposition and pelvic stability.

Keywords: treatment strategy, polytrauma, unstable pelvic injuries, treatment of intra-articular fractures, hypostatic complications, external fixation, internal fixation
p. 452-459 of the original issue
References
  1. Bondarenko AV, Kruglykhin IV, Plotnikov IA, Voitenko AN, Zhmurkov OA. Osobennosti lecheniia povrezhdenii taza pri politravme [Features of treatment of pelvic injuries in polytrauma]. Politravma. 2014;(3):46-62.
  2. Burkhardt M, Nienaber U, Pizanis A, Maegele M, Culemann U, Bouillon B, Flohé S, Pohlemann T, Paffrath T.Acute management and outcome of multiple trauma patients with pelvic disruptions. Crit Care. 2012 Aug 22;16(4):R163. doi: 10.1186/cc11487.
  3. Stewart KE, Cowan LD, Thompson DM.Changing to AIS 2005 and agreement of injury severity scores in a trauma registry with scores based on manual chart review. Injury. 2011 Sep;42(9):934-39. doi: 10.1016/j.injury.2010.05.033.
  4. Ankin LN, Pipiia GG, Ankin NL. Lechenie povrezhdenii taza u postradavshikh s izolirovannoi i sochetannoi travmoi [Treatment of pelvic injuries in victims with isolated and combined injury]. Vestn Travmatologii i Ortopedii Im NN Priorova. 2007;(3):32-35.
  5. Tiliakov AB, Valiev EIu, Ubaidullaev BS. Primenenie sterzhnevogo apparata vneshnei fiksatsii v kompleksnom lechenii nestabil'nykh perelomov kostei taza pri sochetannoi travme [The use of the rod external fixation in treatment of unstable pelvic fractures in combined injury]. Zhurn Im NV Sklifosovskogo. Neotlozhn Med Pomoshch'. 2014;(2):32-37.
  6. Davis JM, Stinner DJ, Bailey JR, Aden JK, Hsu JR. Factors associated with mortality in combat-related pelvic fractures. J Am Acad Orthop Surg. 2012;20 Suppl 1:S7-12. doi: 10.5435/JAAOS-20-08-S7.
  7. Al-Hassani A, Afifi I, Abdelrahman H, El-Menyar A, Almadani A, Recicar J, Al-Thani H, Maull K, Latifi R.Concurrent rib and pelvic fractures as an indicator of solid abdominal organ injury. Int J Surg. 2013;11(6):483-86. doi: 10.1016/j.ijsu.2013.04.002.
  8. Girshin SG. Klinicheskie lektsii po neotlozhnoi travmatologii [Clinical lectures on emergency traumatology]. Saint-Petersburg, RF: Azbuka, 2004. 544 p.
  9. Khanin MIu, Minasov BSh, Minasov TB, Iakupov RR, Zagitov BG. Ortopedicheskii damage-control pri povrezhdeniiakh taza u patsientov s politravmoi [Orthopedic damage-control in injuries of the pelvis in patients with polytrauma]. Prakt Meditsina. 2011;6(54):122-25.
  10. Marzi I, Lustenberger T. Management of Bleeding Pelvic Fractures. Scand J Surg. 2014 Apr 15;103(2):104-11.
  11. Holstein JH, Culemann U, Pohlemann T. What are predictors of mortality in patients with pelvic fractures? Clin Orthop Relat Res. 2012 Aug;470(8):2090-97. doi: 10.1007/s11999-012-2276-9.
  12. Voronin NI, Borozda IV. Vnutritkanevoe krovotechenie u bol'nykh s sochetannoi travmoi taza. Osnovnye kontseptsii patogeneza, diagnostiki i lecheniia [Interstitial bleeding in patients with combined trauma of the pelvis. The basic concepts of the pathogenesis, diagnosis and treatment]. Dal'nevostochnyi Med Zhurn. 2008;(3):112-15.
  13. Gumanenko EK/red, Kozlova VK. Politravma: travmaticheskaia bolezn', disfunktsiia immunnoi sistemy, sovremennaia strategiia lecheniia [Polytrauma: traumatic disease, immune system dysfunction, modern treatment strategy]. Moscow, RF: GEOTAR-Media. 2008. 608 p.
  14. Pavić R, Margetić P.Emergency treatment for clinically unstable patients with pelvic fracture and haemorrhage. Coll Antropol. 2012 Dec;36(4):1445-52.
  15. Sokolov VA, Bialik EI, Fain AM, Smoliar AN, Evstigneev DV. Lechenie nestabil'nykh povrezhdenii taza na reanimatsionnom etape u postradavshikh s politravmoi [Treatment of unstable pelvic injuries in the intensive care stage, patients with multiple injuries]. Politravma. 2011;(2):30-35.
  16. Kalinkin OG. Itogi mnogoletnego opyta lecheniia postradavshikh s tiazhelymi povrezhdeniiami taza v ostrom i rannem periodakh travmaticheskoi bolezni [The results of many years of experience treating patients with severe pelvic injuries in the acute and early periods of traumatic disease]. Travma. 2013;14(2):80-84.
  17. Gridasova EI. Infuzionno-transfuzionnaia terapiia v lechenii endotoksemicheskogo sindroma u bol'nykh s tiazheloi travmoi taza [Infusion-transfusion therapy in the treatment of endotoxic syndrome in patients with severe pelvic injury]. Travma. 2013;14(5):47-50.
  18. Godzik J, McAndrew CM, Morshed S, Kandemir U, Kelly MP. Multiple lower-extremity and pelvic fractures increase pulmonary embolus risk. Orthopedics. 2014 Jun;37(6):e517-24. doi: 10.3928/01477447-20140528-50.
  19. Smirnov A.A. Operativnoe lechenie vertikal'no-nestabil'nykh povrezhdenii taza (tip S po klassifikatsii AO) [Surgical treatment of vertically unstable pelvic injuries (type C by AO classification)]. Travmatologiia i Ortopediia Rossii. 2012;1(63):73-76.
  20. Kanakaris NK, Angoules AG, Nikolaou VS, Kontakis G, Giannoudis PV. Treatment and outcomes of pelvic malunions and nonunions: a systematic review. Clin Orthop Relat Res. 2009 Aug;467(8):2112-24. doi: 10.1007/s11999-009-0712-2.
  21. Shkoda AS, Pokrovskii KA, Cheremukhin OI, Semenov AIu, Ivashkin AN, Sorokin AA, Fedorov DIu. Optimizatsiia organizatsii lecheniia postradavshikh s sochetannoi travmoi taza [Optimization of the organization of treatment of patients with associated trauma of the pelvis]. Meditsina Nev³dkladnikh Stan³v. 2011;(5):85-89.
  22. Vallier HA, Cureton BA, Ekstein C, Oldenburg FP, Wilber JH. Early definitive stabilization of unstable pelvis and acetabulum fractures reduces morbidity. J Trauma. 2010;69(3):677-84.
  23. Hou Z, Smith WR, Strohecker KA, Bowen TR, Irgit K, Baro SM, Morgan SJ.Hemodynamically unstable pelvic fracture management by advanced trauma life support guidelines results in high mortality. Orthopedics. 2012 Mar 7;35(3):e319-24. doi: 10.3928/01477447-20120222-29.
  24. Spahn DR, Cerny V, Coats TJ, Duranteau J, Fernández-Mondéjar E, Gordini G, Stahel PF, Hunt BJ, Komadina R, Neugebauer E, Ozier Y, Riddez L, Schultz A, Vincent JL, Rossaint R. Management of bleeding following major trauma: a European guideline. Crit Care. 2007 Apr 24;11(2):414.
  25. Brun J, Guillot S, Bouzat P, Broux C, Thony F, Genty C, Heylbroeck C, Albaladejo P, Arvieux C, Tonetti J, Payen JF. Detecting active pelvic arterial haemorrhage on admission following serious pelvic fracture in multiple trauma patients. Injury. 2014 Jan;45(1):101-6. doi: 10.1016/j.injury.2013.06.011.
  26. Scaglione M, Parchi P, Digrandi G, Latessa M, Guido G. External fixation in pelvic fractures. Musculoskelet Surg. 2010 Nov;94(2):63-70. doi: 10.1007/s12306-010-0084-5.
  27. Wang G, Zhou D, Shen WJ, Xin M, He J, Li Q, Tan G. Management of partial traumatic hemipelvectomy. Orthopedics. 2013 Nov;36(11):e1340-5. doi: 10.3928/01477447-20131021-12.
  28. Hornez E, Maurin O, Bourgouin S, Cotte J, Monchal T, de Roulhac J, Meyrat L, Platel JP, Delort G, Meaudre E, Thouard H.Management of exsanguinating pelvic trauma: Do we still need the radiologist? J Visc Surg. 2011 Oct;148(5):e379-84. doi: 10.1016/j.jviscsurg.2011.09.007.
  29. El-Haj M, Bloom A, Mosheiff R, Liebergall M, Weil YA. Outcome of angiographic embolisation for unstable pelvic ring injuries: Factors predicting success. Injury. 2013 Dec;44(12):1750-5. doi: 10.1016/j.injury.2013.05.017.
  30. Balbachevsky D, Belloti JC, Doca DG, Jannarelli B, Junior JA, Fernandes HJ, Dos Reis FB.Treatment of pelvic fractures - a national survey. Injury. 2014 Nov;45 Suppl 5:S46-51. doi: 10.1016/S0020-1383(14)70021-X.
  31. Abrassart S, Stern R, Peter R. Unstable pelvic ring injury with hemodynamic instability: what seems the best procedure choice and sequence in the initial management? Orthop Traumatol Surg Res. 2013 Apr;99(2):175-82. doi: 10.1016/j.otsr.2012.12.014.
  32. Metsemakers WJ, Vanderschot P, Jennes E, Nijs S, Heye S, Maleux G. Transcatheter embolotherapy after external surgical stabilization is a valuable treatment algorithm for patients with persistent haemorrhage from unstable pelvic fractures: outcomes of a single centre experience. Injury. 2013 Jul;44(7):964-68. doi: 10.1016/j.injury.2013.01.029.
  33. Morozumi J, Homma H, Ohta S, Noda M, Oda J, Mishima S, Yukioka T. Impact of mobile angiography in the emergency department for controlling pelvic fracture hemorrhage with hemodynamic instability. J Trauma. 2010 Jan;68(1):90-95. doi: 10.1097/TA.0b013e3181c40061.
  34. Probst C, Probst T, Gaensslen A, Krettek C, Pape HC. Timing and duration of the initial pelvic stabilization after multiple trauma in patients from the German trauma registry: is there an influence on outcome? J Trauma. 2007 Feb;62(2):370-77.
  35. Vallier HA, Wang X, Moore TA, Wilber JH, Como JJ. Timing of orthopaedic surgery in multiple trauma patients: development of a protocol for early appropriate care. J Orthop Trauma. 2013 Oct;27(10):543-51. doi: 10.1097/BOT.0b013e31829efda1.
  36. Böhme J, Höch A, Gras F, Marintschev I, Kaisers UX, Reske A, Josten C. Polytrauma with pelvic fractures and severe thoracic trauma: does the timing of definitive pelvic fracture stabilization affect the clinical course? Unfallchirurg. 2013 Oct;116(10):923-30. doi: 10.1007/s00113-012-2237-5.
  37. Fain AM, Bialik EI, Makedonskaia TP. Vybor optimal'noi taktiki okazaniia pomoshchi postradavshim s tiazhelymi perelomami kostei taza i travmoi nizhnikh mochevyvodiashchikh putei [Selection of the optimal tactics to assist victims with serious fractures of the pelvis and lower urinary tract injury]. Politravma. 2013;(3):30-36.
  38. Menges P, Kessler W, Kloecker C, Feuerherd M, Gaubert S, Diedrich S, van der Linde J, Hegenbart A, Busemann A, Traeger T, Cziupka K, Heidecke CD, Maier S. Surgical trauma and postoperative immune dysfunction. Eur Surg Res. 2012;48(4):180-86. doi: 10.1159/000338196.
  39. Pape HC, Tornetta P 3rd, Tarkin I, Tzioupis C, Sabeson V, Olson SA. Timing of fracture fixation in multitrauma patients: the role of early total care and damage control surgery. J Am Acad Orthop Surg. 2009 Sep;17(9):541-49.
  40. Džupa V, Pavelka T, Taller S. Pelvic ring injury as part of multiple trauma. [Article in Czech]. Rozhl Chir. 2014 May;93(5):292-96.
  41. Culemann U, Oestern HJ, Pohlemann T. [Current treatment of pelvic ring fractures]. [Article in German] Unfallchirurg. 2014 Feb;117(2):145-59; quiz 160-1. doi: 10.1007/s00113-014-2558-7.
  42. Ivanov PA, Fain AM, Smoliar AN, Shchetkin VA. Osobennosti diagnostiki i lecheniia sochetannoi travmy taza [Diagnosis and treatment of associated injuries of the pelvis]. Khirurgiia. Zhurn im NI Pirogova. 2014;(10):64-67.
  43. Hu SB, Xu H, Guo HB, Sun T, Wang CJ.External fixation in early treatment of unstable pelvic fractures. Chin Med J (Engl). 2012 Apr;125(8):1420-24.
  44. Sokolov VA. Mnozhestvennye i sochetannye travmy [Multiple and combined injuries]. Moscow, RF: GEOTAR-Media, 2006. 512 p.
  45. Mardanpour K, Rahbar M.The outcome of surgically treated traumatic unstable pelvic fractures by open reduction and internal fixation. J Inj Violence Res. 2013 Jul;5(2):77-83. doi: 10.5249/jivr.v5i2.138.
  46. Bialik EI, Fain AM. Etapnoe lechenie povrezhdenii v oblasti lonnogo sochleneniia s primeneniem original'nogo fiksatora u postradavshikh s sochetannoi travmoi taza [Staged treatment of injuries in the area of the symphysis pubis with the original lock in victims with concomitant pelvic trauma]. Politravma. 2013;(4):30-34.
  47. Hiesterman TG, Hill BW, Cole PA.Surgical technique: a percutaneous method of subcutaneous fixation for the anterior pelvic ring: the pelvic bridge. Clin Orthop Relat Res. 2012 Aug;470(8):2116-23. doi: 10.1007/s11999-012-2341-4.
  48. Chen HW, Liu GD, Ou S, Zhao GS, Pan J.Treatment of unstable sacral fractures with percutaneous reconstruction plate internal fixation. Acta Cir Bras. 2012 May;27(5):338-42.
  49. Li CL.Clinical comparative analysis on unstable pelvic fractures in the treatment with percutaneous sacroiliac screws and sacroiliac joint anterior plate fixation. Eur Rev Med Pharmacol Sci. 2014;18(18):2704-8.
  50. Donchenko SV, Dubrov VE, Sliniakov LIu, Cherniaev AV, Lebedev AF, Alekseev DV. Algoritm khirurgicheskogo lecheniia nestabil'nykh povrezhdenii tazovogo kol'tsa [The algorithm of surgical treatment of unstable pelvic ring injuries]. Vestn Travmatologii i Ortopedii Im NN Priorova. 2013;(4):9-16.
  51. Enninghorst N, Toth L, King KL, McDougall D, Mackenzie S, Balogh ZJ.Acute definitive internal fixation of pelvic ring fractures in polytrauma patients: a feasible option. J Trauma. 2010 Apr;68(4):935-41. doi: 10.1097/TA.0b013e3181d27b48
  52. Miliukov AI. Formirovanie taktiki lecheniia postradavshikh s povrezhdeniiami taza [Formation of the tactics of treatment of patients with pelvic injuries]. 2013;(3):22-29.
Address for correspondence:
410028, Russian Federation,
Saratov, ul. Chernyishevskogo, d. 141,
GBOU VPO "Saratovskiy gosudarstvennyiy
meditsinskiy universitet
imeni V.I. Razumovskogo",
kafedra obschey khirurgii,
tel. office: 7-(845-2)-63-32-66, mobile tel: 7(960)340-73-84,
e-mail: seliwerstov.pl@yandex.ru,
Seliverstov Pavel Andreevich
Information about the authors:
Shapkin Y.G. MD, professor, a head of the general surgery chair, SBEE HPE "Saratov State Medical University named after V.I. Razumovsky".
Seliverstov P.A. PhD, an assistant of the general surgery chair, SBEE HPE "Saratov State Medical University named after V.I. Razumovsky".

T.K. VOLKOVICH

OCULAR SURFACE SQUAMOUS NEOPLASIA

SEE "Belarusian Medical Academy of Post-Graduate Education", Minsk
The Republic of Belarus

The article presents a scientific literature review devoted to studying the features of epidemiology, pathogenesis, diagnosis and treatment of ocular surface squamous neoplasia (OSSN). In different countries morbidity rate varies significantly from 0,03 to 3,5 cases per 100 000 population. The most important and studied causes of ocular surface neoplasia development are considered to be solar insolation, human papilloma virus, human immunodeficiency virus.
Variability of the clinical picture requires the proper differential diagnostics, since OSSN often masks as degenerative diseases of the conjunctiva (pinguecula, pterygium), vascularized corneal opacity, and can also manifest itself as melanoma or nevus.
Difficulties in the differential diagnostics based on clinical examination data necessitate the usage of high-tech research methods (optical coherence tomography of the ocular anterior segment) and the obligatory morphological diagnostics (cytological and histological diagnosis). Treatment of OSSN includes various medical and surgical approaches, more often their combination – surgical removal of tumors or usage of cytostatics or the medication interferon without taking into consideration the etiology. The high recurrence rate of OSSN is still remained – 10-56% of cases depending on the growth type, volume of surgery and duration of postoperative care of patients.
It is relevant to further studying the etiology and pathogenesis of ocular surface squamous neoplasia, as well as the development of integrated approaches in diagnosis and treatment taking into account the etiology of disease.

Keywords: cornea, conjunctiva, ocular surface, squamous neoplasia, neoplasm, morbidity rate, etiology of the disease
p. 460-466 of the original issue
References
  1. Saornil MA, Becerra E, Méndez MC, Blanco G. [Conjunctival tumors]. Arch Soc Esp Oftalmol. 2009 Jan;84(1):7-22. [Article in Spanish]
  2. Lee GA, Hirst LW. Ocular surface squamous neoplasia. Surv Ophthalmol. 1995 May-Jun;39(6):429-50.
  3. Basti S, Macsai MS. Ocular surface squamous neoplasia: a review. Cornea. 2003 Oct;22(7):687-704.
  4. Maudgil A, Patel T, Rundle P, Rennie IG, Mudhar HS.Ocular surface squamous neoplasia: analysis of 78 cases from a UK ocular oncology centre. Br J Ophthalmol. 2013 Dec;97(12):1520-24. doi: 10.1136/bjophthalmol-2013-303338.
  5. McKelvie PA, Daniell M, McNab A, Loughnan M, Santamaria JD.Squamous cell carcinoma of the conjunctiva: a series of 26 cases. Br J Ophthalmol. 2002 Feb;86(2):168-73.
  6. Lee GA, Hirst LW.Retrospective study of ocular surface squamous neoplasia. Aust N Z J Ophthalmol. 1997 Nov;25(4):269-76.
  7. Mittal R, Rath S, Vemuganti GK. Ocular surface squamous neoplasia - Review of etio-pathogenesis and an update on clinico-pathological diagnosis. Saudi J Ophthalmol. 2013 Jul;27(3):177-86. doi: 10.1016/j.sjopt.2013.07.002.
  8. Pola EC, Masanganise R, Rusakaniko S. The trend of ocular surface squamous neoplasia among ocular surface tumour biopsies submitted for histology from Sekuru Kaguvi Eye Unit, Harare between 1996 and 2000. Cent Afr J Med. 2003 Jan-Feb;49(1-2):1-4.
  9. Mahomed A, Chetty R. Human immunodeficiency virus infection, Bcl-2, p53 protein, and Ki-67 analysis in ocular surface squamous neoplasia. Arch Ophthalmol. 2002 May;120(5):554-58.
  10. Toopalli K, Namala V, Pandharpukar M, Bharadwaj N, Jayalaxmi S. Ocular surface squamous neoplasia impression cytology V/S histopathology. Sch J App Med Sci. 2014; 2(lD):461-65. Available from: www.saspublisher.com
  11. Tulvatana W, Bhattarakosol P, Sansopha L, Sipiyarak W, Kowitdamrong E, Paisuntornsug T, Karnsawai S. Risk factors for conjunctival squamous cell neoplasia: a matched case-control study. Br J Ophthalmol. 2003 Apr;87(4):396-98.
  12. Ng J, Coroneo MT, Wakefield D, Di Girolamo N. Ultraviolet radiation and the role of matrix metalloproteinases in the pathogenesis of ocular surface squamous neoplasia. Invest Ophthalmol Vis Sci. 2008 Dec;49(12):5295-306. doi: 10.1167/iovs.08-1988.
  13. Nakamura Y, Mashima Y, Kameyama K, Mukai M, Oguchi Y. Detection of human papillomavirus infection in squamous tumours of the conjunctiva and lacrimal sac by immunohistochemistry, in situ hybridisation, and polymerase chain reaction. Br J Ophthalmol. 1997 Apr;81(4):308-13.
  14. Scott IU, Karp CL, Nuovo GJ.Human papillomavirus 16 and 18 expression in conjunctival intraepithelial neoplasia. Ophthalmology. 2002 Mar;109(3):542-47.
  15. Giaconi JA, Karp CL.Current treatment options for conjunctival and corneal intraepithelial neoplasia. Ocul Surf. 2003 Apr;1(2):66-73.
  16. Verma V, Shen D, Sieving PC, Chan CC. The role of infectious agents in the etiology of ocular adnexal neoplasia. Surv Ophthalmol. 2008 Jul-Aug;53(4):312-31. doi: 10.1016/j.survophthal.2008.04.008.
  17. Karcioglu ZA, Issa TM. Human papilloma virus in neoplastic and non-neoplastic conditions of the external eye. Br J Ophthalmol. 1997 Jul;81(7):595-98.
  18. Ateenyi-Agaba C, Weiderpass E, Smet A, Dong W, Dai M, Kahwa B, Wabinga H, Katongole-Mbidde E, Franceschi S, Tommasino M. Epidermodysplasia verruciformis human papillomavirus types and carcinoma of the conjunctiva: a pilot study. Br J Cancer. 2004 May 4;90(9):1777-79.
  19. Porges Y, Groisman GM. Prevalence of HIV with conjunctival squamous cell neoplasia in an African provincial hospital. Cornea. 2003 Jan;22(1):1-4.
  20. Spitzer MS, Batumba NH, Chirambo T, Bartz-Schmidt KU, Kayange P, Kalua K, Szurman P. Ocular surface squamous neoplasia as the first apparent manifestation of HIV infection in Malawi. Clin Experiment Ophthalmol. 2008 Jul;36(5):422-25.
  21. Waddell KM, Lewallen S, Lucas SB, Atenyi-Agaba C, Herrington CS, Liomba G. Carcinoma of the conjunctiva and HIV infection in Uganda and Malawi. Br J Ophthalmol. 1996 Jun;80(6):503-8.
  22. Newton R, Ziegler J, Ateenyi-Agaba C, Bousarghin L, Casabonne D, Beral V, Mbidde E, Carpenter L, Reeves G, Parkin DM, Wabinga H, Mbulaiteye S, Jaffe H, Bourboulia D, Boshoff C, Touzé A, Coursaget P; Uganda Kaposi's Sarcoma Study Group. The epidemiology of conjunctival squamous cell carcinoma in Uganda. Br J Cancer. 2002 Jul 29;87(3):301-8.
  23. Jeng BH, Holland GN, Lowder CY, Deegan WF 3rd, Raizman MB, Meisler DM. Anterior segment and external ocular disorders associated with human immunodeficiency virus disease. Surv Ophthalmol. 2007 Jul-Aug;52(4):329-68.
  24. Simbiri KO, Murakami M, Feldman M, Steenhoff AP, Nkomazana O, Bisson G, Robertson ES. Multiple oncogenic viruses identified in Ocular surface squamous neoplasia in HIV-1 patients. Infect Agent Cancer. 2010 Mar 26;5:6. doi: 10.1186/1750-9378-5-6.
  25. Flynn TH, Manzouri B, Tuft SJ. Ocular surface squamous neoplasia in an immunosuppressed patient with atopic keratoconjunctivitis. Int Ophthalmol. 2012 Oct;32(5):471-73.
  26. Shome D, Honavar SG, Manderwad GP, Vemuganti GK. Ocular surface squamous neoplasia in a renal transplant recipient on immunosuppressive therapy. Eye (Lond). 2006 Dec;20(12):1413-14.
  27. Shelil AE, Shields CL, Shields JA, Eagle RC Jr. Aggressive conjunctival squamous cell carcinoma in a patient following liver transplantation. Arch Ophthalmol. 2003 Feb;121(2):280-82.
  28. Ramasubramanian A, Shields CL, Sinha N, Shields JA. Ocular surface squamous neoplasia after corneal graft. 2010 Jan;149(1):62-65. doi: 10.1016/j.ajo.2009.07.026.
  29. Sun EC, Fears TR, Goedert JJ. Epidemiology of squamous cell conjunctival cancer. Cancer Epidemiol Biomarkers Prev. 1997 Feb;6(2):73-77.
  30. Napora C, Cohen EJ, Genvert GI, Presson AC, Arentsen JJ, Eagle RC, Laibson PR.Factors associated with conjunctival intraepithelial neoplasia: a case control study. Ophthalmic Surg. 1990 Jan;21(1):27-30.
  31. Jain RK, Mehta R, Badve S. Conjunctival squamous cell carcinoma due to ocular prostheses: a case report and review of literature. Pathol Oncol Res. 2010 Dec;16(4):609-12. doi: 10.1007/s12253-010-9251-0.
  32. Guex-Crosier Y, Herbort CP. Presumed corneal intraepithelial neoplasia associated with contact lens wear and intense ultraviolet light exposure. Br J Ophthalmol. 1993 Mar;77(3):191-92.
  33. Hirst LW, Axelsen RA, Schwab I. Pterygium and associated ocular surface squamous neoplasia. 2009 Jan;127(1):31-32. doi: 10.1001/archophthalmol.2008.531.
  34. Shields CL, Manchandia A, Subbiah R, Eagle RC Jr, Shields JA. Pigmented squamous cell carcinoma in situ of the conjunctiva in 5 cases. Ophthalmology. 2008 Oct;115(10):1673-78. doi: 10.1016/j.ophtha.2008.01.020.
  35. Gupta S, Sinha R, Sharma N, Titiyal JS. Ocular surface squamous neoplasia. Delhi Journal of Ophthalmology. 2012;(23):89–96. Doi: 10.7869/djo.2012.49
  36. Mondal SK. Fine-needle aspiration cytology and scrape cytology of conjunctival squamous cell carcinoma: Report of a rare case. Remove suggestion. Clinical Cancer Investigation Journal 01/2015; 4(1):78. Doi: 10.4103/2278-0513.149056
  37. Font RL, Croxatto JO, Rao NA. Tumors of the conjunctiva and caruncle. In: Tumors of the eye and ocular adnexa. Tumors of the eye and ocular adnexa. AFIP Atlas of tumor pathology. Washington, DC: Armed Forces Institute of Pathology; 2006.
  38. Aoki S, Kubo E, Nakamura S, Tsuzuki A, Tsuzuki S, Takahashi Y, Akagi Y.Possible prognostic markers in conjunctival dysplasia and squamous cell carcinoma. Jpn J Ophthalmol. 1998 Jul-Aug;42(4):256-61.
  39. Dudney BW, Malecha MA. Limbal stem cell deficiency following topical mitomycin C treatment of conjunctival-corneal intraepithelial neoplasia. Am J Ophthalmol. 2004 May;137(5):950-51.
  40. Khong JJ, Muecke J.Complications of mitomycin C therapy in 100 eyes with ocular surface neoplasia. Br J Ophthalmol. 2006 Jul;90(7):819-22.
  41. Roy A, Rath S, Das S, Vemuganti GK, Parulkar G.Penetrating sclerokeratoplasty in massive recurrent invasive squamous cell carcinoma. Ophthal Plast Reconstr Surg. 2011 Mar-Apr;27(2):e39-40. doi: 10.1097/IOP.0b013e3181eea1d4.
  42. Dogru M, Erturk H, Shimazaki J, Tsubota K, Gul M. Tear function and ocular surface changes with topical mitomycin (MMC) treatment for primary corneal intraepithelial neoplasia. Cornea. 2003 Oct;22(7):627-39.
  43. Frucht-Pery J, Rozenman Y. Mitomycin C therapy for corneal intraepithelial neoplasia. Am J Ophthalmol. 1994 Feb 15;117(2):164-68.
  44. Huerva V. [Topical interferon alfa-2b or surgical excision for primary treatment of conjunctiva-cornea intraepithelial neoplasia]. Arch Soc Esp Oftalmol. 2009 Jan;84(1):5-6. [Article in Spanish]
  45. Khong JJ, Muecke J.Complications of mitomycin C therapy in 100 eyes with ocular surface neoplasia. Br J Ophthalmol. 2006 Jul;90(7):819-22.
  46. Sturges A, Butt AL, Lai JE, Chodosh J. Topical interferon or surgical excision for the management of primary ocular surface squamous neoplasia. Ophthalmology. 2008 Aug;115(8):1297-302, 1302.e1. doi: 10.1016/j.ophtha.2008.01.006.
  47. Holcombe DJ, Lee GA. Topical interferon alfa-2b for the treatment of recalcitrant ocular surface squamous neoplasia. Am J Ophthalmol. 2006 Oct;142(4):568-71.
  48. Galor A, Karp CL, Oellers P, Kao AA, Abdelaziz A, Feuer W, Dubovy SR.Predictors of ocular surface squamous neoplasia recurrence after excisional surgery. Ophthalmology. 2012 Oct;119(10):1974-81. doi: 10.1016/j.ophtha.2012.04.022.
  49. Kim HJ, Shields CL, Shah SU, Kaliki S, Lally SE. Giant ocular surface squamous neoplasia managed with interferon alpha-2b as immunotherapy or immunoreduction. Ophthalmology. 2012 May;119(5):938-44. doi: 10.1016/j.ophtha.2011.11.035.
Address for correspondence:
220013, Respublika Belarus, g. Minsk,
ul. P. Brovki, d. 3, korp. 3,
GUO "Belorusskaya meditsinskaya akademiya
poslediplomnogo obrazovaniya",
kafedra oftalmologii,
tel. mob. 375 44 7949610,
e-mail: t.volkovich@rambler.ru,
Volkovich Tatyana Kazimirovna
Information about the authors:
Volkovich T.K. PhD, an associate professor of the ophthalmology chair of SEE "Belarusian Medical Academy of Post-graduate Education".

CASE REPORTS

B.N. KOTIV1, I.I. DZIDZAVA1, A.O. BREDNEV1, E.E. FUFAEV1, V.L. BELEVICH1, V.I. EGOROV2, I.V. DEYNEGA2

MINIMALLY INVASIVE METHODS IN TREATMENT OF SPONTANEOUS ESOPHAGEAL RUPTURE

FSBMEE HPE "Military Medical Academy named after S.M. Kirov" of the Ministry of Defense of the Russian Federation 1,
FBME "Pokrovskaya City Hospital "2,
Saint-Petersburg,
The Russian Federation

Objectives. To demonstrate the possibilities of minimally invasive surgical approach in the treatment of esophageal rupture – Boerhaave syndrome.
A clinical case of a patient treatment (48 yrs old) with spontaneous rupture of the esophagus, bilateral esophageal-pleural fistula, bilateral pleural empyema. The patient admitted to the hospital in 2 weeks of disease onset. At the early stages of the treatment the closure of the esophagus was not performed. The patient’s condition was heavy due to respiratory failure, and characterized by hemodynamic instability and endogenous intoxication.
In Fibroesophagogastroduodenoscopy two linear ruptures in the lower third of the esophagus were identified: the 1st rupture (a length 25 mm) – on the left lateral esophageal wall, the 2nd – on the right wall (a length ≈5 mm).
In an X-ray contrast study of the esophagus and spiral computed tomography of the chest a rupture of the lower third of the esophagus with the transport of the contrast medium in both pleural cavities and the left-sided hydropneumothorax have been observed. Due to the continuing significant contributions of discharge with an admixture of gastric contents along the pleural drains the stenting of lower third of esophagus by self-expanding nitinol – coated stents has been performed.
Analysis of the radiography dynamics showed no leakage of contrast medium. A week later a distal shift of the stent was observed so that the stent was extracted. According to the results of the control endoscopy the mucosal defect on the right wall of the esophagus was healed, on the left wall – the size of fistula reduced to 12 mm. To reduce the diameter of the rupture and reflux of the esophageal-gastric contents into the left pleural cavity, the endoclips were applied on the edge of the mucosa in the area of defect. On the 26th days after clipping an esophago-pleural fistula was completely obliterated and the mucosal rupture epithelizied. The drainage from the left pleural cavity was removed; the patient was discharged in a satisfactory condition.

Keywords: esophageal diseases, surgery, esophageal perforation, esophagoscopy, mortality, mediastinal diseases, spontaneous rupture
p. 467-473 of the original issue
References
  1. Wahed S, Dent B, Jones R, Griffin SM. Spectrum of oesophageal perforations and their influence on management. Br J Surg. 2014 Jan;101(1):e156-62. doi: 10.1002/bjs.9338.
  2. Shestiuk AM, Karpitskii AS, Pan'ko SV, Boufalik RI. Pronikaiushchie povrezhdeniia grudnogo otdela pishchevoda: sovremennoe sostoianie problemy [Penetrating damage to the thoracic esophagus: a current status]. Novosti Khirurgii. 2010;18(3):129-37.
  3. Ben-David K, Lopes J, Hochwald S, Draganov P, Forsmark C, Collins D, Chauhan S, Wagh MS, Carreras J, Vogel S, Sarosi G.Minimally invasive treatment of esophageal perforation using a multidisciplinary treatment algorithm: a case series. Endoscopy. 2011 Feb;43(2):160-62. doi: 10.1055/s-0030-1256094.
  4. Zavgorodnev SV, Kornienko VI, Pashkov VG, Khitov RA, Rusiaeva TV, Naumov AIu, Timofeev DA. Spontannyi razryv grudnogo otdela pishchevoda, oslozhnennyi gnoinym mediastinitom, dvustoronnim gidropnevmotoraksom, empiemoi plevry i bronkhial'nym svishchom [Spontaneous rupture of the thoracic esophagus, complicated purulent mediastinitis, bilateral hydropneumothorax, pleural empyema and bronchial fistula]. Khirurgiia. Zhurn im NI Pirogova. 2007;(4):54-56.
  5. Ivatury RR, Moore FA, Biffl W, Leppeniemi A, Ansaloni L, Catena F, Peitzman A, Moore EE. Oesophageal injuries: Position paper, WSES, 2013. World J Emerg Surg. 2014 Jan 21;9(1):9. doi: 10.1186/1749-7922-9-9.
  6. Søreide JA, Viste A.Esophageal perforation: diagnostic work-up and clinical decision-making in the first 24 hours. Scand J Trauma Resusc Emerg Med. 2011 Oct 30;19:66. doi: 10.1186/1757-7241-19-66.
  7. Chen YH, Li SH, Chiu YC, Lu HI, Huang CH, Rau KM, Liu CT. Comparative study of esophageal stent and feeding gastrostomy/jejunostomy for tracheoesophageal fistula caused by esophageal squamous cell carcinoma. PLoS One. 2012;7(8):e42766. doi: 10.1371/journal.pone.0042766
  8. Mennigen R, Senninger N, Laukoetter MG. Novel treatment options for perforations of the upper gastrointestinal tract: endoscopic vacuum therapy and over-the-scope clips. World J Gastroenterol. 2014 Jun 28;20(24):7767-76. doi: 10.3748/wjg.v20.i24.7767.
  9. Van Boeckel PG, Sijbring A, Vleggaar FP, Siersema PD. Systematic review: temporary stent placement for benign rupture or anastomotic leak of the oesophagus. Aliment Pharmacol Ther. 2011 Jun;33(12):1292-301. doi: 10.1111/j.1365-2036.2011.04663.x.
  10. Jougon J, Mc Bride T, Delcambre F, Minniti A, Velly JF. Primary esophageal repair for Boerhaave's syndrome whatever the free interval between perforation and treatment. Eur J Cardiothorac Surg. 2004 Apr;25(4):475-79.
  11. Weed M, Ganesan S. An Endoclip in Time Saves Nine. Swapna Gayam, Matthew Weed Srinivasan Ganesan Pract Gastroenterol. 2011:8-31.
  12. Von Renteln D, Denzer UW, Schachschal G, Anders M, Groth S, Rösch T.Endoscopic closure of GI fistulae by using an over-the-scope clip (with videos). Gastrointest Endosc. 2010 Dec;72(6):1289-96. doi: 10.1016/j.gie.2010.07.033.
  13. Mennigen R, Senninger N, Laukoetter MG. Novel treatment options for perforations of the upper gastrointestinal tract: endoscopic vacuum therapy and over-the-scope clips. World J Gastroenterol. 2014 Jun 28;20(24):7767-76. doi: 10.3748/wjg.v20.i24.7767.
  14. Okonta KE, Kesieme EB.Is oesophagectomy or conservative treatment for delayed benign oesophageal perforation the better option? Interact Cardiovasc Thorac Surg. 2012 Sep;15(3):509-11. doi: 10.1093/icvts/ivs190.
  15. Hasimoto CN, Cataneo C, Eldib R, Thomazi R, Pereira RS, Minossi JG, Cataneo AJ. Efficacy of surgical versus conservative treatment in esophageal perforation: a systematic review of case series studies. Acta Cir Bras. 2013 Apr;28(4):266-71.
Address for correspondence:
194044, Russian Federation,
g. Sankt-Peterburg, ul. Akademika Lebedeva, d. 6,
FGBVOU VPO "Voenno-meditsinskaya akademiya im. S.M. Kirova" MO RF,
kafedra gospitalnoy khirurgii,
tel. 8-911-969-28-06,
e-mail: antonbrednev@rambler.ru,
Brednev Anton Olegovich
Information about the authors:
Kotiv B.N. MD, professor, a Deputy chief for educational and scientific work of FSBMEE "Military Medical Academy named after S.M.Kirov", the Ministry of Defense of the Russian Federation, Major General of medical service.
Dzidzava I.I. MD, a head of the hospital surgery chair of FSBMEE "Military Medical Academy named after S.M.Kirov", the Ministry of Defense of the Russian Federation, Colonel of medical service.
Brednev A.O. An adjunct of the hospital surgery chair of FSBMEE "Military Medical Academy named after S.M.Kirov", the Ministry of Defense of the Russian Federation, Captain of medical service.
Fufaev E.E. PhD, an applicant for Doctor’s degree of the hospital surgery chair of FSBMEE "Military Medical Academy named after S.M. Kirov", the Ministry of Defense of the Russian Federation, Lieutenant colonel of medical service.
Belevich V.L. PhD, a senior lecturer of the hospital surgery chair of FSBMEE "Military Medical Academy named after S.M. Kirov", the Ministry of Defense of the Russian Federation, Colonel of medical service.
Egorov V.I. PhD, a head of the thoracic department of SBME "Pokrovskaya City Hospital".
Deynega I.V. A physician of the thoracic department of SBME "Pokrovskaya City Hospital".
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