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Year 2017 Vol. 25 No 4

SCIENTIFIC PUBLICATINS
EXPERIMENTAL SURGERY

A.V. ZHURA1, S.I. TRATSYAK 1, V.J. KHRYSHCHANOVICH2, Z.A. MAKAREVICH1

EXPERIMENTAL MODEL OF PERITONEAL ADHESION

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

Objectives. To develop an experimental model of peritoneal adhesions that is close to clinical practice, simple to implement, with a high incidenceof adhesion formation and a small number of complications.
Methods. Several experimental models were chosen with singling out three groups: injury of cecum serosa (group 1, n=6), ileum enterotomy with subsequent suturing of the defect (group 2, n=8), and model made by the authors, including the excision of the peritoneum on the contralateral sides of the abdominal wall (group 3, n=22). Third group was divided into two subgroups with and without bacterial contamination of the peritoneal cavity.
Results. There were no abdominal adhesions in animals of the first group. In future this model was abandoned. Opening of the intestinal lumen and its suturing (group 2) induced adhesions in all animals; however, it was variably localized in the peritoneal cavity. Intestinal insufficiency of sutures was observed in two cases. In addition, in second group operation time was the longest (17 min) in comparison with 7 minutes in the first group and 5 minutes in the third group. Excision of the parietal peritoneum with abdominal contamination (subgroup 3a) was characterized by the largest number of complications with the development of intra-abdominal abscesses and infiltrates, high lethality, and overproduction of adhesion process going beyond the limits of modeling. Excision of the parietal peritoneum without contamination (subgroup 3b) induced adhesion formation in 75 % of cases with the localization of adhesions in the regions of modeling only, without morbidity and mortality.
Conclusion. A suggested experimental model of peritoneal adhesions leads to adhesion formation in large number of cases with minimal number of complication, appears to be simple, and is thought to be recommended for research of the adhesion process.

Keywords: peritoneal adhesions, surgical treatment, experimental model, peritoneal injury, peritonitis, morbidity, mortality
p. 333-339 of the original issue
References
  1. Hwang HJ, An MS, Ha TK, Kim KH, Kim TH, Choi CS, et al. All the commercially available adhesion barriers have the same effect on adhesion prophylaxis? A comparison of barrier agents using a newly developed, severe intra-abdominal adhesion model. Int J Colorectal Dis. 2013 Aug;28(8):1117-25. doi: 10.1007/s00384-013-1679-78.
  2. Barbul A. Abdominal Adhesions. Curr Probl Surg. 2015 Jul;52(7):266-69. doi: 10.1067/j.cpsurg.2015.05.003.
  3. Oncel M, Remzi FH, Connor J, Fazio VW. Comparison of cecal abrasion and multiple-abrasion models in generating intra-abdominal adhesions for animal studies. Tech Coloproctol. 2005 Apr;9(1):29-33.
  4. Kayaoglu HA, Ozkan N, Hazinedaroglu SM, Ersoy OF, Koseoglu RD. An assessment of the effects of two types of bioresorbable barriers to prevent postoperative intra-abdominal adhesions in rats. Surg Today. 2005;35(11):946-50.
  5. Dietrich A, Bouzidi M, Hartwig T, Schütz A, Jonas S. Rapamycin and a hyaluronic acid-carboxymethylcellulose membrane did not lead to reduced adhesion formations in a rat abdominal adhesion model. Arch Gynecol Obstet. 2012 Jun;285(6):1603-9. doi: 10.1007/s00404-011-2184-3.
  6. Wang N, Shao Y, Mei Y, Zhang L, Li Q, Li D, et al. Novel mechanism for mesenchymal stem cells in attenuating peritoneal adhesion: accumulating in the lung and secreting tumor necrosis factor α-stimulating gene-6. Stem Cell Res Ther. 2012 Dec 6;3(6):51. doi: 10.1186/scrt142.
  7. Whang SH, Astudillo JA, Sporn E, Bachman SL, Miedema BW, Davis W, et al. In search of the best peritoneal adhesion model: comparison of different techniques in a rat model. J Surg Res. 2011 May 15;167(2):245-50. doi: 10.1016/j.jss.2009.06.020.
  8. Lucas PA, Warejcka DJ, Zhang LM, Walter HN, Young HE. Effect of rat mesenchymal stem cells on development of abdominal adhesions after surgery. Surg Res. 1996 May;62(2):229-32. doi: 10.1006/jsre.1996.0200.
  9. Treutner KH, Schumpelick V. Prevention of adhesions. New York: Springer; 1997.
  10. Soybir GR, Köksoy F, Polat C, Ozşeker A, Yalçln O, Aker Y, et al. The effects of sterile or infected bile and dropped gallstones in abdominal adhesions and abscess formation. Surg Endosc. 1997 Jul;11(7):711-13.
  11. Zühlke HV, Lorenz EM, Straub EM, Savvas V. Pathophysiology and classification of adhesions. Langenbecks Arch Chir Suppl II Verh Dtsch Ges Chir. 1990:1009-16. [Article in German]
  12. Lauder CI, Strickland A, Maddern GJ. Use of a modified chitosan-dextran gel to prevent peritoneal adhesions in a porcine hemicolectomy model. J Surg Res. 2012 Aug;176(2):448-54. doi: 10.1016/j.jss.2011.10.029.
  13. Ezberci F, Bulbuloglu E, Ciragil P, Gul M, Kurutas EB, Bozkurt S, et al. Intraperitoneal tenoxicam to prevent abdominal adhesion formation in a rat peritonitis model. Surg Today. 2006;36(4):361-66.
  14. Poehnert D, Abbas M, Kreipe HH, Klempnauer J, Winny M. High reproducibility of adhesion formation in rat with meso-stitch approximation of injured cecum and abdominal wall. Int J Med Sci. 2015; 12(1):1-6. doi: 10.7150/ijms.8870.
Address for correspondence:
220007, Republic of Belarus,
Minsk, Dzerzhinsky Ave., 83,
Belarusian State Medical University,
department of surgical diseases N2,
Tel.: + 375 (29) 668-50-21,
E-mail: ZhuraAV@bsmu.by,
Alexander V. Zhura
Information about the authors:
Zhura A.V. PhD, Assistant of department of surgical diseases N2, EE Belarusian State Medical University.
Tratsyak S.I. MD, Professor, Corresponding member of NAS of Belarus, Head of department of surgical diseases N2, EE Belarusian State Medical University.
Khryshchanovich V.J. MD, Ass. Professor, Head of department surgery, SEE Belarusian Medical Academy of Post-graduate Education.
Makarevich Z.A. Vivarium manager of EE Belarusian State Medical University.

GENERAL & SPECIAL SURGERY

KALASHNIK R.S., PARHISENKO Y.A.

CHOICE OF SURGICAL TREATMENT METHOD OF CHRONIC CALCULOUS PANCREATITIS

FSBEE HE Voronezh State Medical University
named after N.N.Burdenko,
Voronezh,
The Russian Federation

Objectives. The substantiation of expediency of operative methods and manuals, used in surgical treatment of chronic calculous pancreatitis, on the basis of an estimation of pathological changes of pancreatic parenchyma and pancreatic duct system.
Methods. 42 patients were involved in this study. Operative interventions were carried out in the period from January, 2011 up to March, 2016.Three main and one control group consisting of the patients (n=13) after Roux-en-Y longitudinal pancreaticojejunostomy (operation of Partington-Rochelle) were allocated. In the main groups the following patients were included: the 1st group after cutting-draining operations (n=10), the 2nd after Roux-en-Y longitudinal pancreaticojejunostomy and biliodigestive anastomosis (n=12), the 3rd after resections such as pancreatoduodenectomy, resection of the pancreas body and distal resection of the pancreas (n=7). Incidence and features of postoperative complications, hospital stay length, the quality of patients life and intensity of abdominal pain syndrome were assessed in conducting the comparative analysis.
Results. No lethal outcomes observed. The smallest number of postoperative complications and indicators of the best quality of life on all scales of the international questionnaire MOS SF-36 and all indicators of the questionnaire for postoperative patients with chronic calculous pancreatitis developed by the authors are marked in the main 1st group. Statistically significant improvement of the total values of the parameters of the quality of patients life was received after our the modification of Freys procedure in comparison with the total value of the parameters of the quality of patients life after Freys and Izbickis operations.
Conclusion. The preferential treatment is recommended in the surgery of chronic calculous pancreatitis based on pathological calculous changes of pancreatic parenchyma and pancreatic duct system. The application of a method (developed by the authors) of ultrasonic selective dissection of the pancreatic parenchyma around the pancreatolithes with subsequent removal of latter, significantly improved the treatment results of patients with chronic calculous pancreatitis.

Keywords: chronic calculous pancreatitis, longitudinal pancreaticojejunostomy, Freys procedure, ultrasonic selective dissection of the pancreas parenchyma with removing pancreatolithes, pathological calculous changes of the pancreas, morbidity, mortality
p. 340-349 of the original issue
References
  1. Grinevich VB, Maistrenko NA, Priadko SA, Romashchenko PN, Shcherbina NN. Problema khronicheskogo pankreatita s pozitsii terapevta i khirurga [The problem of chronic pancreatitis from the position of a therapist and surgeon]. Med Akad Zhurn. 2011;12(2):35-55
  2. Parkhisenko IuA, Zhdanov AI, Parkhisenko VIu, Kalashnik RS. Khronicheskii kal'kuleznyi pankreatit: obzor podkhodov k khirurgicheskomu lecheniiu [Chronic calculous pancreatitis: an overview of approaches to surgical treatment]. Annaly Khirurg Gepatologii. 2014;19(2):91-98.
  3. BegerHG, BuchlerM, BittnerR, OttingerW, RoscherR. Duodenum-preserving resection of the head of the pancreas in severe chronic pancreatitis. Ann Surg. 1989 Mar;209(3):273-79.
  4. Egorov VI, Vishnevskii VA, Shchastnyi AT, Shevchenko TV, Zhavoronkova OI, Petrov RV, i dr. Rezektsiia golovki podzheludochnoi zhelezy pri khronicheskom pankreatite. Kak delat' i kak nazyvat'? [Resection of the pancreas head in chronic pancreatitis. How to do and how to call?] (analiticheskii obzor). Khirurgiia Zhurn im NI Pirogova. 2009;(8):57-66.
  5. Adamek HE, Jakobs R, Buttmann A, Adamek MU, Schneider AR, Riemann JF. Longtermfollowupofpatients with chronic pancreatitis and pancreatic stones treated with extracorporeal shock wave lithotripsy. Gut. 1999 Sep;45(3):402-5.
  6. Korpela T, Udd M, Tenca A, Lindström O, Halttunen J, Myrskysalo S, еt al. Long-term results of combined ESWL and ERCP treatment of chronic calcific pancreatitis. Scand J Gastroenterol. 2016 Jul;51(7):866-71. doi: 10.3109/00365521.2016.1150502.
  7. Andersen DK, Frey CF. The evolution of the surgical treatment of chronic pancreatitis. Ann Surg. 2010 Jan;251(1):18-32. doi: 10.1097/SLA.0b013e3181ae3471.
  8. Kubyshkin VA, Kozlov IA, Kriger AG, Chzhao AV. Khirurgicheskoe lechenie khronicheskogo pankreatita i ego oslozhnenii [Surgical treatment of chronic pancreatitis and its complications]. Annaly Khirurg Gepatologii. 2012;17(4):24-34.
  9. Klimenko AV, Klimenko VN, Steshenko AA, Tumanskii VA, Kovalenko IS. Khirurgicheskoe lechenie khronicheskogo pankreatita s protokovoi gipertenziei bez protokovoi dilatatsii [Surgical treatment of chronic pancreatitis with ductal hypertension without ductal dilatation]. Ukr Zhurn Khirurgii. 2013;(1):22-27.
  10. Vorobei AV, Shuleiko ACh, Grishin IN, Orlovskii IuN, Il'iushonok VV, Aleksandrov SV, i dr. Ispol'zovanie vysokoenergeticheskogo lazera v gepatopankreatobiliarnoi khirurgii [The use of high-energy laser in hepatopancreatobiliary surgery]. Ukr Zhurn Khirurgii. 2013;(3):63-69.
  11. Iareshko VG, Mikheev IuA. Rezektsionnye i dreniruiushchie operatsii v lechenii khronicheskogo pankreatita i ego oslozhnenii [Resection and drainage operations in the treatment of chronic pancreatitis and its complications]. Ukr Zhurn Khirurgii. 2013;(3):160-165.
  12. Lazebnik LB, Vinokurova LV, Iashina NI, Bystrovskaia EV, Bordin DS, Dubtsova EA, dr. Khronicheskii pankreatit i rak podzheludochnoi zhelezy [Chronic pancreatitis and pancreatic cancer]. Eksperim i Klin Gastroenterologiia. 2012;(7):3-9.
  13. Parkhisenko IA, ZhdanovAI, ParkhisenkoVIu, Kalashnik RS. Sposob khirurgicheskogo lecheniia khronicheskogo kal'kuleznogo pankreatita [The method of surgical treatment of chronic calculous pancreatitis]. Patent RF A61B17/00; № 2580197. 10.04.2016
Address for correspondence:
394066, Russian Federation,
Voronezh Region,
Voronezh, Moscow Pr., 151,
FSBEE HE "Voronezh State
Medical University. N.N. Burdenko,
Department of Hospital Surgery,
Tel.: +7 (473) 257-97-17,
E-mail: rsk3589@mail.ru,
Roman S. Kalashnik
Information about the authors:
Kalashnik R.S. Post-graduate student of department of the hospital surgery, FSBEE HE Voronezh State Medical University named after N.N.Burdenko.
Parhisenko Y.A. MD, Professor of departmet of the hospital surgery, FSBEE HE Voronezh State Medical University named after N.N.Burdenko.

A.F. CHERNOUSOV, T.V. KHOROBRYKH, R.V. KARPOVA, K.I. ZENKOVA

EFFECT OF CRYOPRECIPITATE ON LIVER REGENERATION IN PATIENTS WITH CIRRHOSIS

FSBEE HE I. M. Sechenov First Moscow State Medical University, Moscow,
The Russian Federation

Objectives. To improve the results of treating patients with liver cirrhosis by intrahepatic injection of cryoprecipitate, stimulating regeneration of cirrhotic liver.
Methods. The study included 72 patients who suffered from hepatitis B virus (HBV) and hepatitis C virus (HCV) and toxic liver cirrhosis. 32 (44%) patients had liver cirrhosis grading Child-Pugh class B, and 40 (56%) patients class C. Cryoprecipitate injected percutaneously into the liver by puncture method under ultrasound guidance. Dynamics of clinical and laboratory parameters, portal blood flow in all patients, morphological changes in the liver biopsy were evaluated in 42 (58%) patients and immunological parameters in 38 (53%) patients before and after administration of cryoprecipitate.
Results. The improvements of clinical and laboratory parameters were registered in 3, 6, and 12 months after the administration of cryoprecipitate in most patients. After a year 7 patients had liver cirrhosis grading Child-Pugh class C (out of 40 patients). Diameters of the portal and splenic vein significantly decreased in 65 (90%) patients in a year, the congestion index decreased in 11 patients (15%), splenoportal index in 18 (25%). During the morphological study of the liver biopsy 1 year afterward, a positive dynamics observed by a decrease in cellular infiltration and inflammatory signs so as signs of regeneration were found in 40 (95%) out of 42 patients and decrease of the severity of the stepped necrosis of hepatocytes was registered in 29 (69%) patients.
Conclusion. Cryoprecipitate injected percutaneously under ultrasound guidance is considered to be safe due to its potential to avoid damage of large liver vessels. The stimulatory effect of cryoprecipitate on liver regeneration was studied so as it improves its functional activity and extends terms prior liver transplantation.

Keywords: liver cirrhosis, portal hypertension, surgical treatment, liver regeneration, minimally invasive surgery, cryoprecipitate, functional activity
p. 350-358 of the original issue
References
  1. Uryvaeva IV. Stvolovye kletki pecheni v regeneracii pecheni. V kn: Pal'cev MA, red. Biologija stvolovyh kletok i kletochnye tehnologii [Biology of stem cells and cellular technology]. Moscow, RF; 2009. p. 211-52.
  2. Sherlok Sh, Duli Dzh. Zabolevanija pecheni i zhelchnyh putej [Diseases of the liver and biliary tract:]: prakt ruk: per s angl. Moscow, RF: GJeOTAR-Med; 2002. 864 p.
  3. Chernousov AF, Horobryh TV, Pastuhov DV. Vlijanie fibrinovogo kleja na hod posttravmaticheskoj regeneracii pecheni [Effect of fibrin glue on the course of post-traumatic liver regeneration]. Annaly Hirurg Gepatologii. 2006;11(3):61.
  4. Chernousov AF, Horobryh TV, Karpova RV, Nekrasova TP. Regeneracija cirroticheski izmenennoj pecheni krolikov pri vnutripechenochnom vvedenii krioprecipitata [Regeneration of cirrhotically altered liver of rabbits with intrahepatic administration of cryoprecipitate]. Bjul Jeksperim Biologii i Mediciny. 2012;154(9):384-86.
  5. Knodell RG, Ishak KG, Black WC, Chen TS, Craig R, Kaplowitz N, Kiernan TW, Wollman J. Formulation and application of a numerical scoring system for assessing histological activity in asymptomatic chronic active hepatitis. Hepatology. 1981 Sep-Oct;1(5):431-5.
  6. Burganova GR. Ocenka jeffektivnosti transplantacii autologichnyh gemopojeticheskih stvolovyh kletok u bol'nyh cirrozom pecheni [Evaluation of the efficiency of autologous hematopoietic stem cell transplantation in patients with liver cirrhosis]. Jeksperim i Klin Gastrojenterologija. 2012;(4):91-97.
  7. Manuk'jan GV, Eramishancev AK, Suhih GT, Markarjan ASh, Musin RA, Ambarcumjan LR, i dr. Vnutriorgannaja allotransplantacija stvolovyh i progenitornyh kletok pri lechenii bol'nyh cirrozom pecheni i portal'noj gipertenziej [Intra-organ allotransplantation of stem and progenitor cells in the treatment of patients with cirrhosis and portal hypertension]. Annaly Hirurg Gepatologii. 2007;12(2):31-37.
  8. Mogilevec JeV, Gorelik PV, Batvinkov NI. Metody stimuljacii regeneracii pri cirroze pecheni [Methods of stimulation of regeneration in liver cirrhosis]. Novosti Hirurgii. 2013;21(3):103-109. doi: 10.18484/2305-0047.2013.3.103.
  9. Nartajlakov MA, Muldashev JeR, Mingazov RS, Muslimov SA, Safin IA, Musina LA, i dr. Hirurgicheskoe lechenie hronicheskogo gepatita i cirroza pecheni [Surgical treatment of chronic hepatitis and cirrhosis of the liver]. Annaly Hirurg Gepatologii. 2005;10(2):13-20.
  10. Lyra AC, Soares MB, da Silva LF, Braga EL, Oliveira SA, Fortes MF, et al. Infusion of autologous bone marrow mononuclear cells through hepatic artery results in a short-term improvement of liver function in patients with chronic liver disease: a pilot randomized controlled study. Eur J Gastroenterol Hepatol. 2010 Jan;22(1):33-42. doi: 10.1097/MEG.0b013e32832eb69a.
  11. Terai S, Takami T, Yamamoto N, Fujisawa K, Ishikawa T, Urata Y, et al. Status and prospects of liver cirrhosis treatment by using bone marrow-derived cells and mesenchymal cells. Tissue Eng Part B Rev. 2014 Jun;20(3):206-10. doi: 10.1089/ten.TEB.2013.0527.
Address for correspondence:
119991, Russian Federation, Moscow,
B. Pirogovskaya str. 6/1
University Clinical Hospital N1,
Department of Faculty Surgery N1
Tel .: +7 499 248 76 10,
E-mail: radmila.71@mail.ru,
Radmila V. Karpova
Information about the authors:
Chernousov A.F. Academician of RAMS, MD, Professor, Head of department of faculty surgery N1 of the medical faculty, FSBEE HE I.M.Sechenov First Moscow State Medical University.
Khorobrykh T.V. Professor of department of faculty surgery N1 of the medical faculty, FSBEE HE I.M.Sechenov First Moscow State Medical University.
Karpova R.V. MD, Professor of department of faculty surgery N1 of the medical faculty, FSBEE HE I.M.Sechenov First Moscow State Medical University.
Zenkova K.I. A 5-year student of the medical faculty, FSBEE HE I.M.Sechenov First Moscow State Medical University.

K.M. KURBONOV, K.R. NAZIRBOEV

ENDOTOXICOSIS AND INDICATORS OF CYTOKINE LEVEL IN PATIENTS WITH NON-TUMOR OBSTRUCTIVE JAUNDICE

Avicenna Tajik State Medical University, Dushanbe,
The Republic of Tajikistan

Objectives. To study some indices of endtoxicosis and the level of cytokines in blood serum and bile in patients with non-tumor obstructive jaundice.
Methods. The studies are based on a comparative analysis of indicators of endotoxemia and cytokine profile in the blood serum and duct bile in 38 operated patients. Patients on the basis of the severity of obstructive jaundice (OJ) were divided into 3 groups according to the classification of E.I. Galperin et al. There were 12 patients with OJ in mild form (31,6%), with moderate severity 14 (36,8%) and with severe form of OJ 12 (31,6%). To diagnose the severity of OJ, laboratory studies of endotoxemia indices and cytokine concentration in the blood serum and duct bile were performed, and morphological data of the liver biopsy samples were also studied.
Results. Analysis of the study results has shown the concentration of the proinflammatory cytokine IL-6 in OJ of medium severity is 50,4% higher than normal, and at a severe degree in the blood serum it turns out to be the highest in case of OJ complicated by purulent cholangitis by 2,4 times. The concentration of proinflammatory cytokine IL-6 in the bile has been found to be elevated in patients with OJ (a moderate severity) and OJ (severe form).
During the study, the concentration of proinflammatory cytokine IL-4 in the blood serum in OJ of a mild degree was 27% higher than normal, and in patients with OJ of a moderate severity 67,3% higher. However, the concentration of IL-4 in the bile appeared to be elevated in case of the initial forms of the disease compared with patients with OJ of a moderate severity against the destructive cholecystitis.
Conclusion. The results of a comprehensive study of patients with OJ have revealed significant changes in indices of the cytokine status and endotoxemia in the blood serum and bile as well as morphofunctional changes in the liver.

Keywords: cholelithiasis, choledocholithiasis, obstructive jaundice, endotoxemia, cytokines, bile, liver
p. 359-364 of the original issue
References
  1. Maiorov MM, Driazhenkov IG. Mekhanicheskaia zheltukha kal'kuleznoi etiologii: patogenez, oslozhneniia i lechebnaia taktika [Mechanical jaundice of calculous etiology: pathogenesis, complications and therapeutic tactics]. Klin Meditsina. 2012;(5):12-16.
  2. Brown KT, Covey AM. Management of malignant biliary obstruction. Tech Vasc Interv Radiol. 2008 Mar;11(1):43-50. doi: 10.1053/j.tvir.2008.05.005.
  3. Gal'perin EI, Akhaladze GG, Kotovskii AE, Glebov KG, Chevokin AIu, Momunova ON. Patogenez i lechenie ostrogo gnoinogo kholangita [Pathogenesis and treatment of acute purulent cholangitis]. Annaly Khirurg Gepatologii. 2009;(4):13-21.
  4. Ioffe IV, Poteriakhin VP. Pechenochnaia nedostatochnost' u bol'nykh s mekhanicheskoi zheltukhoi neopukholevogo geneza [Liver failure in patients with mechanical jaundice of non-tumor origin]. Ukr Zhurn Klіn ta Lab Meditsini. 2009;4(3):130-32.
  5. Koshevskii PP, Alekseev SA, Bovtiuk NIa. Sindrom sistemnogo vospalitel'nogo otveta i endogennaia intoksikatsiia u patsientov s mekhanicheskoi zheltukhoi i kholangitom neopukholevogo geneza [Syndrome of systemic inflammatory response and endogenous intoxication in patients with mechanical jaundice and cholangitis of non-tumor origin]. Med Zhurn. 2012;(4):50-55.
  6. Bolevich SB, Stupin VA, Gakhramanov TV, Khokonov MA, Silina EV, Men'shova NI, i dr. Osobennosti techeniia svobodnoradikal'nykh protsessov u bol'nykh s mekhanicheskoi zheltukhoi i metody ikh korrektsii [Features of the flow of free radical processes in patients with mechanical jaundice and methods for their correction]. Khirurgiia Zhurn im NI Pirogova. 2010;(7):65-70.
  7. Stupin VA, Laptev VV, Tskaev AIu, Givirovskaia NE. Pokazateli immunnoi sistemy pri mekhanicheskoi zheltukhe dobrokachestvennogo geneza [The indices of the immune system with mechanical jaundice of benign genesis]. Annaly Khirurg Gepatologii. 2008;13(2):69-75.
  8. Badger SA, Jones C, McCaigue M, Clements BW, Parks RW, Diamond T, et al. Cytokine response to portal endotoxaemia and neutrophil stimulation in obstructive jaundice. Eur J Gastroenterol Hepatol. 2012 Jan;24(1):25-32. doi: 10.1097/MEG.0b013e32834b0dd3.
  9. Katz SC, Ryan K, Ahmed N, Plitas G, Chaudhry UI, Kingham TP, et al. Obstructive jaundice expands intrahepatic regulatory T cells, which impair liver T lymphocyte function but modulate liver cholestasis and fibrosis. J Immunol. 2011 Aug 1;187(3):1150-6. doi: 10.4049/jimmunol.1004077.
  10. Koshevskii PP, Alekseev SA, Bovtiuk NIa, Kartun LV. Korrektsiia endotoksikoza i disbalansa protivovospalitel'nykh tsitokinov v rannem posleoperatsionnom periode u patsientov s mekhanicheskoi zheltukhoi i zhelchnoi gipertenziei neopukholevogo geneza [Correction of endotoxicosis and imbalance of anti-inflammatory cytokines in the early postoperative period in patients with mechanical jaundice and biliary hypertension of non-tumor origin]. Med Zhurn. 2014;(1):74-78.
  11. Gal'perin EI, Momunova ON. Klassifikatsiia tiazhesti mekhanicheskoi zheltukhi [Classification of severity of mechanical jaundice]. Khirurgiia Zhurn im NI Pirogova. 2014;(1):5-9.
  12. Gadzhiev DN, Tagiev EG, Gadzhiev ND. Sostoianie tsitokinogo statusa u bol'nykh s mekhanicheskoi zheltukhoi dobrokachestvennogo geneza [Status of cytokine status in patients with mechanical jaundice of benign origin]. Khirurgiia Zhurn im NI Pirogova. 2015;(5):56-58.
  13. Smirnova OV, Titova NM, Manchuk VT, Elmanova NG. Osobennosti tsitokinovoi reguliatsii u bol'nykh mekhanicheskoi zheltukhoi razlichnogo geneza [Features of cytokine regulation in patients with mechanical jaundice of different genesis]. Sovrem Problemy Nauki i Obrazovaniia. 2015;(4):425.
Address for correspondence:
734003, Republic of
Tajikistan, Dushanbe,
Rudaki Ave., 139,
The Tajik State
Medical University
named after Abuali ibni Sino,
Department of Surgical
Diseases N 1,
Tel .: +992 93 405-44-04,
E-mail: dr.hero85@mail.ru,
Kahramon R. Nazirboev
Information about the authors:
Kurbonov K.M. Academician of the Academy of medical sciences of the Republic of Tajikistan , Honored Worker of Science and Technology of RT, MD, Professor, Head of department of surgical diseases N1, Avicenna Tajik State Medical University.
Nazirboev K.R. PhD, Assistant of department of surgical diseases N1, Avicenna Tajik State Medical University.

Y.V. MELEKHOVETS, V.A. SMIIANOV, .. MELEKHOVETS, E.A. SHVIDUN

ASSESSMENT OF QUALITY OF LIFE AS A CRITERION OF THE EFFICIENCY OF LOW-ENERGY MODE ENDOVENOUS LASER COAGULATION

Sumy State University, Sumy,
Ukraine

Objectives. To analyze the quality of life (QL) dynamics in patients with varicose disease of the lower limbs after endovenous laser coagulation (EVLC) with the source of laser radiation at 1 470 nm with different power modes (10 W, 30 J/cm and 15 W, 45 J/cm).
Methods. The study of the life quality was carried out in 219 patients before and after EVLC: group 1 (115 patients) EVLC with a linear energy density (LED) of 45 J/m, group 2 (104 patients) with LED 30 J/m. A control group included 30 healthy persons. CIVIQ questionnaire was used to evaluate the life quality dynamics prior and 1, 8 weeks and 1 year afterward.
Results. The quality of life of patients with the varicose veins of the lower extremities is 2,5 times worse in relation to the control group, justifying a significant effect of chronic venous insufficiency on it. In a week after low-energy EVLC, reliably better results have been achieved: total score (TS) decreased by 24,2% in the 2nd group, in the 1st group by 14,2 % which is caused by smaller degree of paravasal injury. In 8 weeks the results in both groups were comparable: TS decreased by 12% and 13,1% in the 1st and 2nd groups, respectively. The TS estimation one year afterward didnt show any reliable difference between the groups: TS decreased up to 34,8 and 34,6, respectively in the 1st and 2nd groups that corresponded to a significant improvement in quality of life by 46,3% and 47,5% in both groups.
Conclusion. Rapid improvement in quality of life within the first week in low-energy EVLC and absence of the reliable differences in LQ between patients of both groups 1 year afterwards, confirms the adequacy and advisability of the application of linear energy density (30 J/cm2) to obtain stable clinical and aesthetic treatment outcomes.

Keywords: varicose disease, endovenous laser coagulation, termal ablation, life quality, CIVIQ, 1470 nm, treatment outcomes
p. 365-372 of the original issue
References
  1. Fronek KS, Zolotukhin IA, red. Zabolevaniia ven [Varicous diseases]: monografiia. Minsk, RB: GEOTAR-Media; 2010. 208 p.
  2. Rabe E, Guex JJ, Puskas A, Scuderi A, Fernandez Quesada F. Epidemiology of chronic venous disorders in geographically diverse populations: results from the Vein Consult Program. Int Angiol. 2012 Apr;31(2):105-15.
  3. Wittens C, Davies AH, Bækgaard N, Broholm R, Cavezzi A, Chastanet S, et al. Editor's choice – management of chronic venous disease: clinical practice guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2015 Jun;49(6):678-37. doi: 10.1016/j.ejvs.2015.02.007.
  4. Grunebaum LD, Bartlett K. Complications of vascular laser treatment. In: Bard S, Goldberg DJ, eds. Laser treatment of vascular lesions. Aesthet Dermatol. Basel, Karger; 2014;1. p. 121-42. doi: 10.1159/000355061.
  5. Lozano Sánchez FS, Sánchez Nevarez I, González-Porras JR, Marinello Roura J, Escudero Rodríguez JR, et al. Quality of life in patients with chronic venous disease: influence of the socio-demographical and clinical factors. Int Angiol. 2013 Aug;32(4):433-41.
  6. Guex JJ, Zimmet SE, Boussetta S, Nguyen C, Taieb C. Construction and validation of a patient-reported outcome dedicated to chronic venous disorders: SQOR-V (specific quality of life and outcome response – venous). J Mal Vasc. 2007 Jul;32(3):135-47.
  7. Kuet ML, Lane TR, Anwar MA, Davies AH. Comparison of disease-specific quality of life tools in patients with chronic venous disease. Phlebology. 2014 Dec;29(10):648-53. doi: 10.1177/0268355513501302.
  8. Davies AH, Rudarakanchana N. Quality of life and outcome assessment in patients with varicose veins. In: Davies AH, Lees TA, Lane IF, eds. Venous disease simplified. Shropshire, England: TFM Publishing Ltd; 2006. р. 59-75.
  9. Vasquez MA, Munschauer CE. Venous Clinical Severity Score and quality-of-life assessment tools: application to vein practice. Phlebology. 2008;23(6):259-75. doi: 10.1258/phleb.2008.008018.
  10. Biemans AAM. Treatment and Quality of life of patients with Varicose veins. Erasmus University Rotterdam; 2013. 152 р.
  11. Shaidakov EV, Iliukhin EA, Petukhov AV, Grigorian AG, Rosukhovskii DA. Radiochastotnaia obliteratsiia ClosureFAST i endovazal'naia lazernaia obliteratsiia 1470 nm: mnogotsentrovoe prospektivnoe nerandomizirovannoe issledovanie [Radiofrequency obliteration ClosureFAST and endovasal laser obliteration 1470 nm: multicenter prospective nonrandomized study]. Flebologiia. 2012;6(3):20-27.
  12. Shevchenko IuL, Stoiko IuM, red. Osnovy klinicheskoi flebologii [Fundamentals of clinical phlebology]. 2-e izd, ispr. i dop. Moscow, RF: Shiko; 2013. 336 p.
  13. Savel'ev VS, Pokrovskii AV, Zatevakhin II, Kirienko AI, nats koordinatory. Rossiiskie klinicheskie rekomendatsii po diagnostike i lecheniiu khronicheskikh zabolevanii ven [Russian clinical recommendations for the diagnosis and treatment of chronic vein diseases]. Flebologiia. 2013;7(2 vyp 2). 48 p.
Address for correspondence:
40018, Ukraine, Sumy,
Sanatornaya str., 31, Medical Institute
of Sumy State University, department
of family medicine,
Tel.: +380 66-09-49,
E-mail: meloksana@yandex.ru. Oksana K. Melekhovets
Information about the authors:
Melekhovets Y.V.Post-graduate student of Department of Surgical and Oncology, Medical Institute of the Sumy State University
Smiianov VA, Ass. Professor, Director of the Medical Institute, Sumy State University
Melekhovets OK, Ass. Professor, Department of Family Medicine, Medical Institute, Sumy State University
Shvydun EA. Graduate student of Department of Family Medicine, Medical Institute of the Sumy State University

Y.I. YARETS 1, L.N. RUBANOV 1,Z.A. DUNDAROV 2

INDICATORS OF NEUTROPHIL FUNCTIONAL ACTIVITY AS PREDICTORS OF AUTODERMOPLASTY RESULTS

SI "Republican Scientific and Practical Center for Radiation Medicine and Human Ecology"
EE Gomel State Medical University 2, Gomel,
The Republic of Belarus

Objectives. To estimate the possibility of using the laboratory tests for evaluating the functional activity of the blood polymorphonuclear leukocytes (PNL) to predict skin grafting (SG) results in patients with chronic wounds (CW).
Methods. The analysis of the functional activity of peripheral blood neutrophils was carried out in patients with chronic wounds (n=148) requiring skin grafting (SG). Ingestion capacity of neutrophils was determined in the phagocytosis reaction with the evaluation of phagocytic index (PhI) and phagocytic number (PhN). Oxygen-producing activity of neutrophils was estimated in response of the spontaneous NBT-test (NBTsp) and S. aureus-stimulated (NBTst) nitroblue tetrazolium restoration. Activity of neutrophil extracellular traps (NET) in the blood were quantified prior (spontaneous; NETsp) and after neutrophils incubation with the stimulator (stimulated; NETst). Taking into account the differences of autodermoplasty outcomes within the incisional period all the patients were divided into 2 groups: group 1 (n=126) favorable results of skin grafting and group 2 (n=22) SG was complicated by lysis of autodermograft.
Results. With the usage of logistic regression and ROC-curves methods the informativeness of NBTsp, NETsp, NETst for flap viability prognosis was established in patients with chronic wounds. The optimal cut-off value for NBTsp is 15% (86,5% sensitivity and 93% specificity), NETsp 7% (97% sensitivity and 95,2% specificity), NETst 15% (86,4% sensitivity and 90% specificity). At preoperative values of NBT, NETsp, NETst below cut-off, rejection of the autodermotransplant is considered to be predicted, and at NBT, NETsp, NETst above cut-off values, analysis demonstrates engraftment rates with a probability up to 92%.
Conclusion. The values of functional activity of neutrophils (NBTsp, NETsp, NETst) are considered to be the informative predictors of the final outcome in patients with chronic wounds and they are also recommended for monitoring the efficiency of additional preoperative preparation in SG planning.

Keywords: chronic wound, skin grafting, NBT-test, neutrophils extracellular traps, skin grafting prognosis, efficiency, logical regression
p. 373-381 of the original issue
References
  1. Sen CK. Wound healing essentials: let there be oxygen. Wound Repair Regen. 2009 Jan-Feb;17(1):1-18. doi: 10.1111/j.1524-475X.2008.00436.x.
  2. Nathan C. Points of control in inflammation. Nature. 2002 Dec 19-26;420(6917):846-52.
  3. Mengi S, Vohra P, SawhneyN, SinghVA. Biofilms: a diagnostic challenge in persistent infections. Int J Med Res Health Sci. 2013;2(Is 3):4.
  4. Leid JG, Shirtliff ME, Costerton JW, Stoodley AP. Human leukocytes adhere to, penetrate, and respond to Staphylococcus aureus biofilms. Infect Immun. 2002 Nov; 70(11): 6339-45.doi: 10.1128/IAI.70.11.6339-6345.2002.
  5. Lotze MT, Zeh HJ, Rubartelli A, Sparvero LJ, Amoscato AA, Washburn NR, et al. The grateful dead: damage-associated molecular pattern molecules and reduction/oxidation regulate immunity. Immunol Rev. 2007 Dec;220:60-81.
  6. Obolenskij VN, Rodoman GV, Nikitin VG, Karev MA. Troficheskie jazvy nizhnih konechnostej – obzor problemy [Trophic ulcers of the lower extremities - an overview of the problem]. RMZh. 2009;17(25):1647-63.
  7. Bogdan VG, Tolstov DA, Bagatka SS, Zafranskaja MM Biologicheskie jeffekty trombocitarnyh koncentratov v kul'ture fibroblastov kozhi cheloveka [Biological effects of platelet concentrates in human fibroblast cultures]. Med Zhurn. 2012;(2):22-25.
  8. Leaper DJ, Schultz G, Carville K, Fletcher J, Swanson T, Drake R. Extending the TIME concept: what have we learned in the past 10 years? Int Wound J. 2012 Dec;9(Suppl 2):1-19. doi: 10.1111/j.1742-481X.2012.01097.x.
  9. Schultz GS, Sibbald RG, Falanga V, Ayello EA, Dowsett C, HardingK, et al. Woundbedpreparation: asystematicapproachtowoundmanagement. Wound Repair Regen. 2003 Mar;11(Suppl 1):S1-28.
  10. Rubanov LN, Jarec JuI, Dundarov ZA Autodermoplastika v lechenii hronicheskih ran: kriterii jeffektivnosti podgotovki k plasticheskomu zakrytiju i prognozirovanie rezul'tata [Autodermoplasty in the treatment of chronic wounds: the criteria for the effectiveness of preparation for plastic closure and the prediction of the result]. Hirurgija. VostochnajaEvropa. 2016;(3):455-68.
  11. Soloshenko VV. Profilaktika lizisa autodermotransplantatov v hirurgicheskom lechenii glubokih ozhogov [Prevention of lysis of autodermotransplants in the surgical treatment of deep burns]. Med Akad Zhurn. 2015;15(2):69-72.
  12. Gusakova NV. Obrazovanie jekstracelljuljarnyh setej nejtrofilami perifericheskoj krovi [Formation of extracellular networks by peripheral blood neutrophils]. Problemy Zdorov'ja i Jekologii. 2011; (3):27-31.
  13. Dolgushin II, Shishkova JuS, Savochkina AJu Tehnologii opredelenija i rol' nejtrofil'nyh vnekletochnyh lovushek v antimikrobnoj zashhite [Detection technologies and the role of neutrophil extracellular traps in antimicrobial protection]. Vestn RAMN. 2010;(4):26-30.
  14. Ganzhij VV, Tancura PJu Kachestvo zhizni pacientov s troficheskimi jazvami razlichnogo geneza do i posle autodermoplastiki [Quality of life of patients with trophic ulcers of different genesis before and after autodermoplasty]. Zaporozh Med Zhurn. 2010;12(1):7-9.
  15. Sopko OI, Zarja IL, Kozubovich RM, Molnar IM. Nash opyt autodermoplastiki pri troficheskih jazvah nizhnih konechnostej razlichnoj jetiologii [Our experience of autodermoplasty with trophic ulcers of lower extremities of different etiology]. Hirurgija Ukrainy. 2010;(3):63-66.
  16. Risman BV Differencirovannaja taktika zakrytija posleoperacionnyh defektov kozhi u pacientov s gnojno-nekroticheskimi oslozhnenijami sindroma diabeticheskoj stopy [Differential tactics of closing postoperative skin defects in patients with purulent-necrotic complications of the diabetic foot syndrome]. Novosti Hirurgii. 2011;19 (2):66-71.
Address for correspondence:
246040, Gomel, Ilyich str., 290. SI " Republican Scientific
and Practical Center for Radiation
Medicine and Human Ecology".
Clinical diagnostic laboratory,
Tel.: 37529 335-34-72,
E-mail: artyut@mail.ru
Yuliya I. Yarets
Information about the authors:
Yarets Y.I. PhD, Ass. Professor, Head of clinical-diagnostic laboratory, SI "Republican Scientific and Practical Center for Radiation Medicine and Human Ecology".
Rubanov L.N. Head of department of esthetic medicine, SI " Republican Scientific and Practical Center for Radiation Medicine and Human Ecology".
Dundarov Z.A. MD, Professor, Head of department of surgical diseases N2 with the course of pediatric surgery of EE "Gomel State Medical University".

N.M. KLYUSHIN, M.V. STOGOV, L.A. GREBENYUK, A.S. SUDNITSYN, E.A. KIREEVA

COMPARATIVE ANALYSIS OF PATHOPHYSIOLOGICAL SIGNS OF OSTEOMYELITIS OF NEUROGENIC- TROPHIC AND POSTTRAUMATIC ETIOLOGY

FSBE Russian Scientific Center Restorative Traumatology and Orthopedics Named after Academician G.A. Ilizarov,
Kurgan
The Russian Federation

Objectives. Comparative evaluation of the pathophysiological manifestations of the calcaneal osteomyelitis of neurogenic-trophic and post-traumatic etiology.
Methods. 19 patients were examined (mean age 45,34,8, history of disease: 2-5 years) with neurogenic-trophic osteomyelitis of the calcaneus (group 1) and 42 patients (mean age 41,75,0, history of disease: from 7 months to 6 years) with post-traumatic osteomyelitis of the calcaneus (group 2). Evaluation of clinical and radiological picture of patients was carried out; physiological and laboratory tests were performed.
Results. A comprehensive study has revealed the characteristic pathological features of patients with osteomyelitis of neurogenic-trophic and post-traumatic etiology. In patients of the 1st group osteomyelitic focus was localized mainly on the supporting surface of the calcaneus; in patients of the 2nd group it was localized in the area of the consolidated fracture or false joint of the calcaneus. Body mass index of patients in the 1st group was 30,92,4, in the 2nd group 27,42,2 (p<0,05). In patients of the 1st group the tissue perfusion in the damaged foot segment tissues relatively to the contralateral parameters was 17-32% higher (p<0,05), which was not observed in patients of the 2nd group. According to infrared thermometry the tendency of local temperature reduction on the affected foot and leg was registered in patients of the 1st group. The concentration of fibrinogen in group 1 was reliably higher than in the group 2 (p<0,05). The activity of bone isoenzyme of acid and alkaline phosphatase in the serum of patients in the 1st group was within the normal range; in patients of the 2nd group it was elevated.
Conclusion. The patients with neurogenic-trophic osteomyelitis are characterized by the following pathophysiological features: impaired neurogenic vascular response in the tissues of the segment affected by osteomyelitis, hypercoagulation and loss of neurotrophic control.

Keywords: osteomyelitis of calcaneus, pathophysiology, microcirculation, infrared thermometry, blood biochemistry, haemostasis, hypercoagulation
p. 382-388 of the original issue
References
  1. Tikhilov RM, Kochish AIu, Filimonova MN, Kozlov IV. Nesvobodnaia plastika osevymi myshechnymi loskutami pri osteomielite stopy (obzor literatury) [Non-free plastic by axial muscle grafts in osteomyelitis of the foot (review of literature)]. Travmatologiia i Ortopediia Rossii. 2009;52(2): 136-43.
  2. Vinnik IS, Shishatskaia EI, Markelova NM, Zuev AP. Khronicheskii osteomielit: diagnostika, lechenie, profilaktika [Chronic osteomyelitis: diagnosis, treatment, prevention]. Mosk Khirurg Zhurn. 2014;(2):50-53.
  3. Arias Arias C, Tamayo Betancur MC, Pinzón MA, Cardona Arango D, Capataz Taffur CA, Correa Prada E. Differences in the clinical outcome of osteomyelitis by treating specialty: orthopedics or infectology. PLoS One. 2015;10(12):e0144736. doi: 10.1371/journal.pone.0144736.
  4. Lindbloom BJ, James ER, McGarvey WC. Osteomyelitis of the foot and ankle: diagnosis, epidemiology, and treatment. Foot Ankle Clin. 2014 Sep;19(3):569-88. doi: 10.1016/j.fcl.2014.06.012.
  5. Arsent'eva NI, Butukhanov VV. Adaptivnye reaktsii nervnoi, serdechno-sosudistoi i dykhatel'noi sistem u bol'nykh khronicheskim osteomielitom [Adaptive reactions of the nervous, cardiovascular and respiratory systems in patients with chronic osteomyelitis]. Ortopediia Travmatologiia i Protezirovanie. 1985;(9):44-47.
  6. Leonova SN, Malyshev VV. Mekhanizmy narusheniia protsessa regeneratsii pri khronicheskom travmaticheskom osteomielite [Mechanisms of disruption of the regeneration process in chronic traumatic osteomyelitis]. Vestn RAMN. 2009;(4):13-16.
  7. Motorina RA. Immunologicheskie izmeneniia pri gematogennom osteomielite [Immunological changes in hematogenous osteomyelitis]. Med Vestn Sever Kavkaza. 2007;7(3):64-67.
  8. Birt MC, Anderson DW, Bruce Toby E, Wang J. Osteomyelitis: Recent advances in pathophysiology and therapeutic strategies. J Orthop. 2016 Oct 26;14(1):45-52. eCollection 2017.
  9. Vlasov PV. Rentgenodiagnostika neirogennykh osteoartropatii [X-ray diagnostics of neurogenic osteoarthropathies] Med Vizualizatsiia. 2006;(4):78-84.
  10. Aragón-Sánchez J, Lázaro-Martínez JL, Hernández-Herrero MJ. Triggering mechanisms of neuroarthropathy following conservative surgery for osteomyelitis. Diabet Med. 2010 Jul;27(7):844-47. doi: 10.1111/j.1464-5491.2010.03019.x.
  11. Miromanov AM, Mironova OB, Miromanova NA, Shapovalov KG. Znachenie pokazatelei mikrokrovotoka v otsenke razvitiia khronicheskogo posttravmaticheskogo osteomielita dlinnykh kostei konechnostei [The value of microcirculation indices in the evaluation of the development of chronic posttraumatic osteomyelitis of long limb bones]. Zabaikal Med Vestn. 2011;(2):60-65.
  12. Leonova SN, Rekhov AV, Kameka AL. Issledovanie perifericheskogo krovoobrashcheniia u patsientov s lokal'noi formoi khronicheskogo osteomielita [Study of peripheral circulation in patients with a local form of chronic osteomyelitis]. Biul VSNTs SO RAMN. 2013;89(1):54-58.
Address for correspondence:
640014, Russian Federation,
Kurgan, M. Ulyanova str.,
6, FSBE "Russian Research
Center "Restorative Traumatology and
Orthopedics" named after
Academician G.A. Ilizarov"
Tel.: 8 (3522) 45-05-38,
E-mail: stogo_off@list.ru,
Maxim V. Stogov
Information about the authors:
Klyushin N.M. MD, Head of clinic of purulent osteology, FSBE Russian Scientific Center Restorative Traumatology and Orthopedics named after Academician G.A.Ilizarov.
Stogov M.V. MD, Ass. Professor, Leading Researcher of the biochemistry laboratory, FSBE Russian Scientific Center Restorative Traumatology and Orthopedics named after Academician G.A.Ilizarov.
Grebenyuk L.A. PhD (Biology), Senior Researcher of laboratory of purulent osteology and replacement of limb defects of FSBE Russian Scientific Center Restorative Traumatology and Orthopedics named after Academician G.A.Ilizarov.
Sudnitsyn A.S. Traumatologist- orthopedist of the clinic of purulent osteology, FSBE Russian Scientific Center Restorative Traumatology and Orthopedics named after Academician G.A.Ilizarov.
Kireeva E.A. PhD (Biology), Senior Researcher of the biochemistry laboratory, FSBE Russian Scientific Center Restorative Traumatology and Orthopedics named after Academician G.A.Ilizarov.

TRAUMATOLOGY AND ORTHOPEDICS

K.B. BALABOSHKA, Y.K. KHADZKOU

BLOOD-SAVING EFFECT OF AMINOCAPROIC ACID IN TOTAL KNEE JOINT REPLACEMENT

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

Objectives. To evaluate the effectiveness of aminocaproic acid for reducing the perioperative blood loss in primary total knee joint replacement.
Methods. The patients (n=82) with the total knee joint replacement were included in the study. In the study group (n=42) parenteral administration of aminocaproic acid (100 mg/kg, 5% solution) was administered before applying the tourniquet, with repeated administration of the calculated dose of the drug in 4 hours. Patients of the control group (n=40) did not receive aminocaproic acid. The following indicators were compared: hemoglobin concentration, erythrocyte count, hematocrit volume of red blood cells prior to surgery and in the postoperative period (5 days). Drainage blood was recorded within 24 hours after the operation.
Results. In the study group blood loss/drainage volume was significantly reduced (300, 200-350 ml (Me 25%, 75%)) compared to the control group (600, 525-725 ml (Me, 25%, 75%)), p<0,001. In the postoperative period the drainage blood loss and calculated blood loss volumes were significantly higher for the control group (mean value of blood indicators in the study group: hemoglobin 118, 105 124 g/l, erythrocytes 3,95, 3,7 4,2×1012/l, hematocrit 36,55, 32,8 39,6 (Me 25%, 75%) and mean value of blood indicators: hemoglobin 105,5, 95 119 g/l, erythrocytes 3,45, 3,1 3,9×1012/ l, hematocrit 30, 95, 29,65 34,05 (Me, 25%, 75%)), p<0,05, respectively. In the control group, 11 patients (27,5%) were subjected to massive red blood cell transfusion. Donor blood component transfusion was not performed in the patients of the study group. No complication associated with aminocaproic acid application was registered.
Conclusion. The use of aminocaproic acid has proved to be an efficient and practical method of treatment patients with degenerative dystrophic diseases of the knee joint by eliminating the need for surgical blood transfusion in the total knee joint replacement, as well as by decreasing reimbursement for surgical procedures.

Keywords: knee joint replacement, blood loss, fibrinolysis inhibitors, aminocaproic acid, blood transfusion, economic costs, surgical intervention
p. 389-393 of the original issue
References
  1. Beletskii AV, Lomat' LN, Borisov AV, Mukhlia AM, Skakun PG, Vorobei EA. Sostoianie problemy i perspektivy razvitiia endoprotezirovaniia sustavov v Respublike Belarus' [The state of the problem and the development of arthroplasty prospects in the Republic of Belarus]. Zhurn GrGMU. 2010;(2):94-96
  2. Kurtz SM1, Ong KL, Lau E, Widmer M, Maravic M, Gómez-Barrena E, de Pina Mde F, Manno V, Torre M, Walter WL, de Steiger R, Geesink RG, Peltola M, Röder C. International survey of primary and revision total knee replacement. Int Orthop. 2011 Dec;35(12):1783-9. doi: 10.1007/s00264-011-1235-5. Epub 2011 Mar 15.
  3. Shah NA, Gupta A, Patel DV. Strategies do decrease blood loos in patients who undergo total knee replacement: a prospective study of one hundred and fifty cases. JISRF Reconstructive Review. 2013 Dec;3(4):18-26.
  4. Sehat KR1, Evans RL, Newman JH. Hidden blood loss following hip and knee arthroplasty. Correct management of blood loss should take hidden loss into account. J Bone Joint Surg Br. 2004 May;86(4):561-5.
  5. Bogomolov AN, Kanus II. Anesteziologicheskoe obespechenie i posleoperatsionnoe obezbolivanie pri total'nom endoprotezirovanii kolennogo sustava [Anesthesia and postoperative analgesia with total knee arthroplasty]. Novosti khirurgii. 2012;20(6):102-10.
  6. Lin ZX, Woolf SK. Safety, Efficacy, and Cost-effectiveness of Tranexamic Acid in Orthopedic Surgery. Orthopedics. 2016 Mar-Apr;39(2):119-30. doi: 10.3928/01477447-20160301-05. Epub 2016 Mar 4.
  7. Borisov DB, Kirov MIu. Primenenie traneksamovoi kisloty pri endoprotezirovanii krupnykh sustavov [The use of tranexamic acid in endoprosthetics of large joints]. Novosti khirurgii. 2013;21(4):107-12.
  8. Lemaire R1. Strategies for blood management in orthopaedic and trauma surgery. J Bone Joint Surg Br. 2008 Sep;90(9):1128-36. doi: 10.1302/0301-620X.90B9.21115.
  9. Lee QJ1, Mak WP, Yeung ST, Wong YC, Wai YL. Blood management protocol for total knee arthroplasty to reduce blood wastage and unnecessary transfusion. J Orthop Surg (Hong Kong). 2015 Apr;23(1):66-70.
  10. Henry DA1, Carless PA, Moxey AJ, O'Connell D, Stokes BJ, Fergusson DA, Ker K. Anti-fibrinolytic use for minimising perioperative allogeneic blood transfusion. Cochrane Database Syst Rev. 2011 Jan 19;(1):CD001886. doi: 10.1002/14651858.CD001886.pub3.
  11. Kopanidis P1, Hardidge A2, McNicol L3,4, Tay S5, McCall P6, Weinberg L7,8,9 Perioperative blood management programme reduces the use of allogenic blood transfusion in patients undergoing total hip and knee arthroplasty. J Orthop Surg Res. 2016 Feb 29;11:28. doi: 10.1186/s13018-016-0358-1.
  12. Zufferey P1, Merquiol F, Laporte S, Decousus H, Mismetti P, Auboyer C, Samama CM, Molliex S. Do antifibrinolytics reduce allogeneic blood transfusion in orthopedic surgery? Anesthesiology. 2006 Nov;105(5):1034-46.
  13. Ortega-Andreu M, Pérez-Chrzanowska H, Figueredo R, Gómez-Barrena E. Blood loss control with two doses of tranexamic acid in a multimodal protocol for total knee arthroplasty. OpenOrthop J. 2011 Mar;16(5):44-8. doi: 10.2174/1874325001105010044.
  14. Churchill JL, Toney VA, Truchan S, Anderson MJ1. Using Aminocaproic Acid to Reduce Blood Loss After Primary Unilateral Total Knee Arthroplasty. Am J Orthop (Belle Mead NJ). 2016 Jul-Aug;45(5):E245-8.
  15. Shevchenko IuL, Stoiko IuM, Zamiatin NM, Teplykh BA, Karpov IA, Smol'kin DA. Krovosberegaiushchii effekt traneksamovoi kisloty pri protezirovanii kolennogo sustav [The cost-saving effect of tranexamic acid in prosthetic knee replacement ]. Obshchaia reanimatologiia. 2008;4(6):21-25.
Address for correspondence:
210023, Republic of Belarus,
Vitebsk, Frunze ave., 27,
Vitebsk State Medical University,
department of traumatology,
orthopedics and military field surgery,
tel.office: +375 29 654-45-99,
e-mail: bkb@tut.by,
Konstantin B. Balaboshka
Information about the authors:
Balaboshka K.B. PhD, Ass.Professor, Head of department of traumatology, orthopedics and military field surgery, EE Vitebsk State Medical University.
Khadzkou Y.K. teacher trainee of department of traumatology, orthopedics and military field surgery, EE Vitebsk State Medical University.

ONCOLOGY

M.S. ABDULLAYEV 1, .S. NURGAZIEV 2, .Z. ZHYLKAYDAROVA3, .B. MANSUROVA4

EPIDEMIOLOGICAL ASPECTS OF COLORECTAL CANCER IN KAZAKHSTAN

Central City Clinical Hospital1,
National Center for Medicines, Medical Devices and Medical Equipment Expertise2,
Kazakhstan Research Institute of Oncology and Radiology 3,
Kazakhstan National Medical University named after S.D.Asfendilyarov4,
Almaty,
The Republic of Kazakhstan

Objectives. To study epidemiological aspects of colorectal cancer in the Republic of Kazakhstan for 2004-2014 years.
Methods. A retrospective statistical analysis of the epidemiological status of colorectal cancer in Kazakhstan for 11 years has been carried out (standardized rate indicators of WHO World per 100 000 population and intensive values of morbidity, mortality and distribution according to stages, age, sex), as well as the results of the population-based colorectal screening from 2011 to year 2014 are presented.
Results. The statistical data on the morbidity, distribution by sex and age of colorectal cancer in the Republic of Kazakhstan testify to its stable ongoing growth presented in the article. However, the main challenge is an evident demonstration of the effectiveness of colorectal screening; the growth of the number of patients with cancer stage I-II from 29,7% in 2008 to 48,7% in 2014 and the reduction of the number of patients with cancer stage IV from 21,2 % in 2008 to 15,7% in 2014. Since 2011 the improvement of colorectal screening has been observed, that manifested in the increasing of "detection" of colon cancer, rate to the number of coverage incidence from 0.02 in 2011 to 0,05 in 2014 and the increasing of the proportion with I-II stages, rate of the diagnosed cases from 71,4% in 2011 to 81,1% in 2014.
Conclusion. According to the obtained results the incidence of colorectal cancer is increasing from year to year, as well as the mortality caused by this disease. The population colorectal screening introduced in 2011 in the Republic of Kazakhstan aimed to identify pre-cancer and cancer in the early stages shows quite optimistic results within the recent period (2011-2014.).

Keywords: colorectal cancer, screening, colon, rectum, epidemiology of colorectal cancer, morbidity, mortality
p. 394-403 of the original issue
References
  1. Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, et al. GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide. IARC CancerBase N 11 [Electronic resource]. Lyon, France: International Agency for Research on Cancer; 2013. Available from: http://globocan.iarc.fr, accessed on day/month/year.
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Address for correspondence:
050012, Republic of Kazakhstan, Almaty, Tole bi str., 94,
Kazakh National Medical University named after S.D. Asfendiyarova,
department of postgraduate education (doctorate, postgraduate study, magistracy)
Tel.: 77077613019,
E-mail: ainur_mansurova@mail.ru,
Aynur B. Mansurova
Information about the authors:
Abdullayev M.S. MD, Professor, Director of Central City Clinical Hospital of Almaty.
Nurgaziev K.S. MD, Head of Department of Strategic Development and Legislation Improvement, National Center for Medicines, Medical Devices and Medical Equipment Expertise
Zhylkaydarova A.Z. PhD, Head of specialized consultative and diagnostic department of Kazakhstan Research Institute of Oncology and Radiology.
Mansurova A.V. Applicant for Doctors degree of Kazakhstan National Medical University.

REVIEWS

K.A. BATSIKOV, M.M. MAGOMEDOV

REPERFUSION SYNDROME IN ACUTE INTESTINAL OBSTRUCTION

FSBEE HE Dagestan State Medical University,
Makhachkala,
The Russian Federation

The paper aims to present the review of literature on acute intestinal obstruction in case of the reperfusion syndrome. Ischaemia reperfusion syndrome is a complex pathological process characterized by initial restriction of blood supply to the organ followed by subsequent restoration of blood flow, has a significant impact on cell membrane integrity and activation of the lipid peroxidation process. Resulted from the cell membrane permeability, excessive cytokine and proteolytic enzymatic activity leads to the dysfunction of the kallikrein-kinin and hemostasis system and thus plays an important role in the mechanism of the perfusion development. Ischemia/reperfusion syndrome is characterized by mostly nonspecific abnormalities in coagulation profile, general and biochemical analysis. However, dynamics of the syndrome can be based on changing the levels of more specific markers that are not routinely assessed yet, probably due to expensive reagents. Presently, there is no uniform tactics of treatment and prevention of reperfusion syndrome despite the attempts to treat patients by hypothermia, antioxidants, protease inhibitors, and anticoagulants. Therefore, basing on the literature data it should be noteworthy that early diagnostics and treatment of reperfusion syndrome still remain difficult not completely solved issue.

Keywords: acute intestinal obstruction, reperfusion syndrome, lipid peroxidation, hemostasis system, oxidative distress, treatment, prevention, endothelial dysfunction
p. 404-411 of the original issue
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Address for correspondence:
367000, Russian Federation,
Republic of Dagestan, Makhachkala,
Pirogov st., 3, FSBEE HE "Dagestan State
Medical University", Department of Surgery
Tel.: 79282308646,
E-mail: muxuma@mail.ru; hairula_dgma@mail.ru.
Muhuma M. Magomedov
Information about the authors:
Magomedov M.M. MD, Professor of department of the advanced training and retraining of the medical specialists.
Batsikov K.A. Post-graduate student of department of the advanced training and retraining of the medical specialists, FSBEE HE Dagestan State Medical University.

S.V. JANUSKEVICS 1,2, V.Y. JANUSKEVICS 2

PROTECTION OF AN ANASTOMOSIS IN RECTAL CANCER SURGERY

University of Latvia 1
Latvian Oncology Center of Riga Eastern Clinical University Hospital 2,
Riga
Latvia

The incidence of anastomotic leakage (AL) after low or ultralow rectal resections ranges between 1.8% and 24%, although, postoperative mortality associated with AL can reach up to 32%. Preventive enterostomy reduces rate and degree of surgical complications by almost three times. However, both stoma-related problems and following stoma closure disasters may occur later on.
The given literature review explores the relevance of the topic. It does not analyze rectal diverting stomas only, but also other alternative ways to protect the anastomosis. It has been marked that ileostomy, colostomy, ghost ileostomy, additional reinforcement and transanal decompression methods reduce the incidence of AL and give similar results comparing to diverting stoma. The reason why these methods, despite being easy to perform, have not been widely adopted in coloproctology, might be conservatism of surgeons or relative lack of literature. The use of several protection methods (VIB-valtrac secured intracolonic bypass ɢ C-seal) is limited due to the peculiar properties of the bioconfigured devices, the technical features of the implementation, the absence of randomized controlled trials (RCT). Unfortunately, the literature on combined use of different anastomotic protective methods, depending on specific intraoperative events, is not widely available. The introduction of prospective RCT would allow a more reasonable approach to indications for both the anastomotic protection and diverting stoma creation.

Keywords: rectal cancer, low anterior resection, anastomotic leakage, coloproctology, diverting stoma, stomal complications, protection of an anastomosis
p. 412-420 of the original issue
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  52. Totikov ZV, Totikov VZ, Kachmazov AK, Medoev VV, Kalicova MV, Mal'sagov RJu. Sposob profilaktiki nesostojatel'nosti anastomoza posle perednih rezekcij prjamoj kishki i rekonstruktivno-vosstanovitel'nyh operacij [The method of preventing the anastomosis failure after anterior rectal resections and reconstructive-reconstructive operations]. Kuban Nauch Med Vestn. 2013;(4):109-11.
Address for correspondence:
RAKUS, Latvian Oncology Center,
Department of oncosurgery N4,
Hipokrat 4,
Riga, Latvia, LV-1079,
Tel.: +371 29 25-25-51,
E-mail: sergejs.jan@gmail.com,
Sergey V. Januskevics
Information about the authors:
Januskevics S.V. MD, PhD, Ass. Professor of department of surgery, Medical Faculty, the University of Latvia at Latvian Oncology Center, Riga Eastern Clinical University Hospital.
Januskevics V.Y. MD, Oncologist, Consultant of Latvian Oncology Center, Riga Eastern Clinical University Hospital.

O.L. BOCKERIA, K.A.VULF, V.A. SHVARTZ

HEART RATE VARIABILITY IN INTERATRIAL SEPTAL DEFECT

FSBE A.N. Bakulev National Scientific and Practical Center for Cardiovascular Surgery ,
Moscow,
The Russian Federation

Over recent decades effect of the autonomic nervous system on heart has raised considerable interest so as its evaluation as a predictor of mortality due to cardiac problems and development of cardiovascular complications. Heart rate variability (HRV) analysis has emerged as a simple, noninvasive and safe method to study the autonomic control of the human cardiovascular system. In the view of some authors in patients suffering from structural heart disease due to volume overload may cause a decrease in HRV via the elevation of pressure, possible dysfunction of ventricular baroreceptor and resulted in autonomic imbalance. Within the surgery neurovegetative homeostasis is extremely vulnerable that makes one think about the surgical stress influence on the autonomic nervous system. Despite numerous studies to date to clinicul research has shown a logistic approach for determining the bodys response to cardiac operation. Generally, reduced heart rate variability gradually recovers in the incisional period within the several months. This paper is performed as a literature review of the data concerning HRV features in the patients with interatrial septal defects (IASD), as well as of the regularities of its dynamics after the surgical or X-ray endovascular correction. The issues of possible pathophysiology of these autonomic abnormalities are also discussed.

Keywords: cardiovascular system, heart rate variability, interatrial septum defect, children, neurovegetative homeostasis, autonomic abnormalities, mortality.
p. 421-430 of the original issue
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Address for correspondence:
121552, Russian Federation, Moscow,
Rublyovskoye sh., 135,
FSBE A.N. Bakulev National Scientific
and Practical Center for
Cardiovascular Surgery,
department of surgical treatment
of interactive pathology,
Tel.: +7 903 261-92-92,
E-mail: shvartz.va@ya.ru,
Vladimir A. Shvarts
Information about the authors:
Bockeria O.L. Corresponding member of RAS, MD, Professor, Chief Researcher of FSBE A.N. Bakulev National Scientific and Practical Center for Cardiovascular Surgery .
Vulf K.A. Post-graduate student, Fellow Worker of FSBE A.N. Bakulev National Scientific and Practical Center for Cardiovascular Surgery .
Shvartz V.A. PhD, Researcher of FSBE A.N. Bakulev National Scientific and Practical Center for Cardiovascular Surgery .

CASE REPORTS

L.V. VALIOK1, V.I. AVERIN2 A.A. SVIRSKY1

GASTRIC PHLEGMON IN A 10-YEAR-OLD CHILD

SE "Republican Scientific and Practical Center of Pediatric Surgery"1
EE "Belarusian State Medical University"2
Minsk,
The Republic of Belarus

The clinical observation of a gastric phlegmon in a 10-year-old child is presented in this paper. Difficulties of diagnosis and choice of treatment of this pathology in children are shown; the efficiency of surgical treatment (atypical hardware stomach resection) of the disease is demonstrated in an extremely debilitated patient.
This disease is described in patients of different age groups starting from 3-month old babies and ending by elderly patients. Overall mortality of this pathology is quite high and according to some data reaches 92%; the postoperative mortality is about 18%. The development of this disease is due to penetration of pathogenic and opportunistic pathogens n the stomach wall. This inflammatory process is localized mainly in the submucosal layer. The clinical picture of a gastric phlegmon cannot be called specific. In general, it be may singled out three main syndromes: pain syndrome, dyspeptic syndrome and intoxication syndrome. Radiological and endoscopic methods of examination, ultrasound examination of the abdominal cavity and laparoscopic surgery can help in diagnosing this pathology. At present treatment tactics generally accepted for patients with a gastric phlegmon has not been worked out. In choose a treatment method the localization of the process, its prevalence, the stage of the disease, presence of complications should be taken into account. In the choice of treatment tactics is equally important to take into consideration the patients age and presence of accompanying diseases.
A gastric phlegmon in children is an extremely rare disease and in most cases is described as casuistry. Efficacy of treatment, including surgery, depends on early diagnosis and subsequent intervention tactics. Gentle methods of surgical treatment (atypical hardware stomach resection) can be used in extremely debilitated patients.

Keywords: gastric phlegmon, clinical observation, atypical hardware stomach resection, children, debilitated patients, abdominal cavity, laparoscopic surgery
p. 431-436 of the original issue
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Address for correspondence:
220013, Republic of Belarus, Minsk,
64 Nezavisimost ave.,
Republican Scientific and
Practical Center for Children's Surgery,
Tel. +375 29 633 23 76,
E-mail: larisavalek@mail.ru,
Larisa V. Valek
Information about the authors:
Averin V.I. MD, Professor, Head of department of the pediatric surgery, EE "Belarusian State Medical University".
Valiok L.V. Surgeon of department of surgery N4, SE "Republican Scientific and Practical Center of Pediatric Surgery".
Svirsky A.A. PhD, Ass. Professor, Head of the pediatric surgery department, SE "Republican Scientific and Practical Center of Pediatric Surgery".

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