Novosti
Khirurgii

 This journal is
indexed in Scopus
journal cover
android icon Android Applicaion
Ýòîò ñàéò èñïîëüçóåò îñíîâíûå ôàéëû cookie äëÿ îáåñïå÷åíèÿ åãî íîðìàëüíîé ðàáîòû è ôàéëû cookie äëÿ îòñëåæèâàíèÿ, ÷òîáû ïîíÿòü, êàê âû ñ íèì âçàèìîäåéñòâóåòå. Ïîñëåäíèå áóäóò óñòàíîâëåíû òîëüêî ïîñëå îäîáðåíèÿ.
Ñîãëàñèòüñÿ

Year 2019 Vol. 27 No 4

SCIENTIFIC PUBLICATIONS
EXPERIMENTAL SURGERY

D.B. AUZHANOV 1, M.ZH. AYMAGAMBETOV 1, ZH.A. ZHAGIPAROVA 1, Y. NOSO 2

EFFECT OF AZATHIOPRINE ON THE FORMATION OF ADHESIVE PROCESS OF THE ABDOMINAL CAVITY IN EXPERIMENT

Semey State Medical University, The Republic of Kazakhstan 1,
Shimane University, Faculty of Medicine, Izumi, Japan 2

Objective. Study of the azathioprine antimetabolite effect on the formation of postoperative adhesions in experiment on a rat model.
Methods. The main experiment was performed on 30 (4-5-month-old) male Wistar rats. The operation of Bloor was conducted in all animals for the initiation of the adhesive process. The rats were divided into 2 groups (15 in each): the main group (MG) – animals received azathioprine in a dosage of 1 mg/100 g of weight orally 1 time per day for the first 3 days (starting from the day of surgery). The control group (CG) did not receive any medications. On the 7th day, all rats were removed from the experiment. Adhesion assessment was performed by the criteria: macroscopic (quantitative assessment of adhesions – the Moreno scale, qualitative assessment - the Binda scale), histological examination. The effect of the studied method on some indicators of the immune status (leukocytes, lymphocytes, CD, CD4, CD8, PN, PI) was also studied.
Results. In CG adhesions were reported in 100% (15 rats), ÌG – 80% (12 rats). While evaluating adhesions on the Moreno and Binda scales in CG, the number of adhesions was greater – 38 versus 13 (p <0.001). Also, in CG, the thickness of adhesions and their strength prevailed (p<0.001). The volume of connective tissue, the proportion of collagen fibers, the degree of vascular proliferation, fibrosis in the adhesions in OG are less pronounced (p=0.029). The immune status indicators in MG after the treatment on the 7th day were reduced slightly.
Conclusions. Immunosuppression with azathioprine significantly reduces the frequency and severity of the adhesive process in the abdominal cavity. The use of the drug in a therapeutic dose for 3 days does not lead to a significant inhibition of some of the immunity important indicators (a slight decrease in leukocytes and lymphocytes by 0.3 and 0.9, a moderate decrease in T-lymphocytes by no more than 2.0, a decrease in phagocytic activity by 5.8).

Keywords: postoperative adhesions, prevention, experiments on animals, immunosuppression, rat, azathioprine
p. 369-378 of the original issue
References
  1. Nazarenko AA, Akimov VP, Malyshkin PO. Epidemiologiia, patogenez i profilaktika posleoperatsionnogo spaechnogo protsessa v briushnoi polosti. Vestn Khirurgii im II Grekova. 2016;175(5):114-18. (In Russ.)
  2. Ouaissi M, Gaujoux S, Veyrie N, Denève E, Brigand C, Castel B, Duron JJ, Rault A, Slim K, Nocca D. Post-operative adhesions after digestive surgery: their incidence and prevention: review of the literature. J Visc Surg. 2012 Apr;149(2):e104-14. doi: 10.1016/j.jviscsurg.2011.11.006
  3. Filenko BP, Zemlianoi VP, Borsak II, Ivanova AS. Spaechnaia bolezn’: Profilaktika i lechenie: monogr. S-Petersburg, RF; 2013. 164 p. http://baltzdrav.ru/images/files/borsak_monography.pdf (In Russ.)
  4. Stanciu D, Menzies D. The magnitude of adhesion-related problems. Colorectal Dis. 2007 Oct;9(Suppl 2):35-38. doi: 10.1111/j.1463-1318.2007.01346.x
  5. Rizzo A, Spedicato M, Mutinati M, Minoia G, Angioni S, Jirillo F, Pantaleo M, Sciorsci RL. Peritoneal adhesions in human and veterinary medicine: from pathogenesis to therapy. A review. Immunopharmacol Immunotoxicol. 2010 Sep;32(3):481-94. doi: 10.3109/08923970903524367
  6. Mais V, Cirronis MG, Peiretti M, Ferrucci G, Cossu E, Melis GB. Efficacy of auto-crosslinkedhyaluronan gel for adhesion prevention in laparoscopy and hysteroscopy: a systematic review and meta-analysis of randomized controlled trials. Eur J Obstet Gynecol Reprod Biol. 2012 Jan;160(1):1-5. doi: 10.1016/j.ejogrb.2011.08.002
  7. Kumar S, Wong PF, Leaper DJ. Intra-peritoneal prophylactic agents for preventing adhesions and adhesive intestinal obstruction after non-gynaecological abdominal surgery. Cochrane Database Syst Rev. 2009 Jan 21;(1):CD005080. doi: 10.1002/14651858.CD005080.pub2
  8. Binda MM, Molinas CR, Bastidas A, Koninckx PR. Effect of reactive oxygen species scavengers, antiinflammatory drugs, and calcium-channel blockers on carbon dioxide pneumoperitoneum-enhanced adhesions in a laparoscopic mouse model. Surg Endosc. 2007 Oct;21(10):1826-34. https://www.springermedizin.de/effect-of-reactive-oxygen-species-scavengers-antiinflammatory-dr/8531612
  9. diZerega GS, Tulandi T. Prevention of intra-abdominal adhesions in gynaecological surgery. Reprod Biomed Online. 2008 Sep;17(3):303-306. doi: 10.1016/S1472-6483(10)60211-8
  10. Arung W, Drion P, Cheramy JP, Honoré P, Meurisse M, Defraigne JO, Detry O. Intraperitoneal adhesions after open or laparoscopic abdominal procedure: an experimental study in the rat. J Laparoendosc Adv Surg Tech A. 2012 Sep;22(7):651-57. doi: 10.1089/lap.2012.0102
  11. Andreeva IV, Vinogradov AA. Atlas normal’noi i ul’trazvukovoi anatomii zhivota krysy [Elektronnyi resurs]. Moscow, RF: GEOTAR-Media; 2015. http://www.studentlibrary.ru/book/06-COS-2400.html (In Russ.)
  12. Hooker GD, Taylor BM, Driman DK. Prevention of adhesion formation with use of sodium hyaluronate-based bioresorbable membrane in a rat model of ventral hernia repair with polypropylene mesh–a randomized, controlled study. Surgery. 1999 Feb;125(2):211-16. doi: 10.1016/s0039-6060(99)70267-9
  13. Hindocha A, Beere L, Dias S, Watson A, Ahmad G. Adhesion prevention agents for gynaecological surgery: an overview of Cochrane reviews. Cochrane Database Syst Rev. 2015 Jan 6;1:CD011254. doi: 10.1002/14651858.CD011254.pub2
  14. Ahmad G, O’Flynn H, Hindocha A, Watson A. Barrier agents for adhesion prevention after gynaecological surgery. Cochrane Database Syst Rev. 2015 Apr 30;(4):CD000475. doi: 10.1002/14651858.CD000475.pub3
  15. Pados G, Venetis CA, Almaloglou K, Tarlatzis BC. Prevention of intra-peritoneal adhesions in gynaecological surgery: theory and evidence. Reprod Biomed Online. 2010 Sep;21(3):290-303. doi: 10.1016/j.rbmo.2010.04.021
  16. Gasanov N, Brezhnev V, Novikova O, Grishina O, Vatsik M. Prevention of peritoneal commissures at surgical treatment of malignant swellings of abdominal organs. Khirurg. 2013;(2):46-50. (In Russ.)
  17. Sufiyarov IF, Lalipov RZ, Sibiryak SV, Shafikov RM. Influence of immtnosl ppression indited by cyclophosphamll) on development postoperative adhesion deseases. Med Vestn Bashkortostana. 2009;4(4):64-67. https://cyberleninka.ru/article/n/vliyanie-immunosupressii-indutsirovannoy-tsiklofosfamidom-na-razvitie-posleoperatsionnyh-bryushinnyh-spaek( In Russ.)
Address for correspondence:
071400, The Republic of Kazakhstan,
Semey, Abay Kunanbayev Str., 103,
Semey State Medical University,
Hospital Surgery Department.
Tel.: +7 777 264-89-42,
e-mail: daurenchik@mail.ru,
Dauren B. Auzhanov
Information about the authors:
Auzhanov Dauren B., Applicant for Doctor’s Degree of Semey State Medical University, Semey, Republic of Kazakhstan.
https://orcid.org/0000-0001-8378-0054
Aymagambetov Meyrbek Zh., MD, Associate Professor, Head of the Surgery Internship Department of Semey State Medical University, Semey, Republic of Kazakhstan.
https://orcid.org/0000-0002-8344-4445
Zhagiparova Zhanar A., PhD, Head of the Department of Special Disciplines of Pavlodar Branch of Semey State Medical University, Semey, Republic of Kazakhstan.
https://orcid.org/0000-0002-5619-3505
Noso Yoshihiro, MD, PhD, Professor of the General Medicine Department of the Faculty of Medicine, Shimane University, Izumi, Japan.
https://orcid.org/0000-0003-3477-1260

GENERAL & SPECIAL SURGERY

E.A. ILICHEVA 1,3, D.A. BULGATOV 1,2,3, A.V. ZHARKAYA 1,3, V.N. MAKHUTOV 3, L.B. KORYAKINA 1,3, S.V. RYZHIKOVA 3, A.N. ZAGORODNYAYA 3, T.V. IVANOVA 3

EVALUATION OF FGF23 LEVEL BEFORE AND AFTER SURGICAL TREATMENT OF SECONDARY HYPERPARATHYREOSIS

Irkutsk Scientific Center of Surgery and Traumatology 1,
Irkutsk State Medical University 2,
Irkutsk Regional Clinical Hospital 3, Irkutsk,
The Russian Federation

Objective. To study the level of FGF23 before and after thesecondary hyperparathyroidism surgical treatment and in the comparison groups in patients receiving hemodialysis divided by the level of parathyroid hormone and in healthy people.
Methods. The level of FGF23; pg/ml in the blood was simultaneouslystudied before and after surgical treatment for secondary hyperparathyroidism in patients undergoing renal replacement therapy. In the comparison groups, the level of FGF23 in the blood was studied in patients receiving dialysis for the terminal stage of chronic kidney disease (CKD). The groups were divided according to the level of intact parathyroid hormone (PTH) in the blood: with hypoparathyroidism (PTH less than 130 pg/ml), with an acceptable level of PTH (130-600 pg/ml), and hyperparathyroidism (PTH more than 600 pg/ml). The level of FGF23 in healthy individuals was also studied. A total of 77 people were examined (33 females and 44 males). To assess the mineral-bone disorders, the standard laboratory examination was performed: a biochemical blood test with electrolytes (albumen, total calcium with albumin correction, phosphorus), PTH in blood.
Results. Data have been obtained that the level of FGF23 in the group of healthy individuals is statistically lower than in the other groups (pU = 0.001). Between groups of people with terminal stage of CKD, the difference in FGF23 is not statistically significant (pU > 0.05).
Conclusions. All patients receiving dialysis, regardless of the severity of secondary hyperparathyroidism before and after surgical treatment, have an increased level of FGF23 in comparison with healthy people. Statistically significant differences in level of FGF23 depending on the presence or absence of secondary hyperparathyroidism and the result of surgical treatment of SHPT were not detected. According to the data obtained, further research is needed to identify the role of FGF23 in the pathogenesis of secondary hyperparathyroidism.

Keywords: secondary hyperparathyroidism, chronic kidney disease, phosphatonin, fibroblast growth factor 23, FGF23, mineral and bone disorders
p. 379-385 of the original issue
References
  1. Egshatyan LV, Rozhinskaya LYa, Kuznetsov NS, Kim IV, Artemova AM, Mordik AI, Pushkina AV, Borisov VN, Shilo VYu, Bukhman AI, Remizov OV, Ilin AV, Sazonova NI,Chernova TO. The treatment of secondary hyperparathyroidism in haemodialysis patients’’ refractory to alfacalcidol. Endokrin Khirurgiia. 2012; (2):27-41. http://vidar.ru/Article.asp?fid=ESR_2012_2_27 (In Russ.)
  2. Assotsiatsiia nefrologov Nauchnoe obshchestvo nefrologov Rossii. Mineral’nye i kostnye narusheniia pri khronicheskoi bolezni pochek (Natsional’nye rekomendatsii) [Elektronnyi resurs]. 2015. http://www.nephro.ru/content/files/recomendations/ckdmbdNationalGuidelines.pdf (data obrashcheniia: 19.09.2018) (In Russ.)
  3. Volgina G, Seleznev D, Balkarova O, Lovchinsky E. Extraosseous calcification in patients with chronic kidney disease. Vrach. 2012;(7):2-8. http://nephro.rusvrach.ru/archive/vrach-2012-07-01.pdf (In Russ.)
  4. Volkov MM, Smirnov AV. Radiological assessment of abdominal aortic calcification in patients with chronic kidney disease receiving hemodialysis: the frequency of detection and associated factors. Íåôðîëîãèÿ. 2010;14(3):37-45. doi: 10.24884/1561-6274-2010-14-3-37-45 (In Russ.)
  5. Degtereva OA, Volkov MM, Sheviakova EV. Kal’tsifikatsiia serdechnykh klapanov u patsientov s khronicheskoi bolezn’iu pochek na dodializnom periode. Nefrologiia i Dializ. 2007;9(3):266-67. http://journal.nephro.ru/index.php?r=journal/issueView&journalId=31 (In Russ.)
  6. KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). Kidney Int Suppl. 2009 Aug;(113):S1-130. doi: 10.1038/ki.2009.188
  7. National Kidney Foundation. K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. Am J Kidney Dis. 2003 Oct;42(4 Suppl 3):S1-201. doi: 10.1016/S0272-6386(03)00905-3
  8. Bulgatov D.A., Il’icheva E.A. Spornye voprosy khirurgicheskogo lecheniia vtorichnogo giperparatireoza: obzor literatury. Nefrologiia i Dializ. 2017;19(3):359-70. doi: 10.28996/1680-4422-2017-3-359-370 (In Russ.)
  9. Shutov EV. Value of the factor of growth in the fibroblasts FGF-23 in patients with chronic renal disease. Survey. Lechashchii Vrach. 2012;8:12-19. https://www.lvrach.ru/2012/08/15435495/ (data obrashcheniia: 19.09.2018) (in Russ.)
  10. Gutierrez O, Isakova T, Rhee E, Shah A, Holmes J, Collerone G, Jüppner H, Wolf M. Fibroblast growth factor-23 mitigates hyperphosphatemia but accentuates calcitriol deficiency in chronic kidney disease. JASN. 2005 Jul;16(7):2205-15. doi: 10.1681/ASN.2005010052
  11. Gutiérrez OM, Mannstadt M, Isakova T, Rauh-Hain JA, Tamez H, Shah A, Smith K, Lee H, Thadhani R, Jüppner H, Wolf M. Fibroblast growth factor 23 and mortality among patients undergoing hemodialysis. N Engl J Med. 2008 Aug 7;359(6):584-92. doi: 10.1056/NEJMoa0706130
  12. Sato T, Tominaga Y, Ueki T, Goto N, Matsuoka S, Katayama A, Haba T, Uchida K, Nakanishi S, Kazama JJ, Gejyo F, Yamashita T, Fukagawa M. Total parathyroidectomy reduces elevated circulating fibroblast growth factor 23 in advanced secondary hyperparathyroidism. AJKD. 2004 Sep;44(3):481-87. doi: 10.1053/j.ajkd.2004.05.026
  13. Liao SC, Moi SH, Chou FF, Yang CH, Chen JB. Changes in serum concentrations of fibroblast growth factor 23 and soluble klotho in hemodialysis patients after total parathyroidectomy. Biomed Res Int. 2016; 2016:6453803. doi: 10.1155/2016/6453803
Address for correspondence:
664003, The Russian Federation,
Irkutsk, Krasnoye Vosstaniye Str., 1,
Irkutsk State Medical University,
Hospital Surgery Department.
Tel. 8 (3952) 407809,
å-mail: bbd-x@mail.ru,
Dmitriy A. Bulgatov
Information about the authors:
Ilicheva Elena A., MD, Professor, Head of the Scientific Department of Clinical Surgery, Irkutsk Scientific Center of Surgery and Traumatology, Surgeon of the Thoracic Surgical Unit, Irkutsk Regional Clinical Hospital, Irkutsk, Russian Federation.
https://orcid.org/0000-0002-2081-8665
Bulgatov Dmitriy A., Intramural Post-Graduate Student of the Hospital Surgery Department, Irkutsk State Medical University, Surgeon of the Purulent Surgery Unit ¹1, Irkutsk Scientific Center of Surgery and Traumatology, Surgeon of the Thoracic Surgical Unit, Irkutsk Regional Clinical Hospital, Irkutsk, Russian Federation.
https://orcid.org/0000-0002-2440-0813
Zharkaya Anastasia V., PhD, Junior Researcher, Irkutsk Scientific Center of Surgeryand Traumatology, Surgeon of the Endocrinology Center, Irkutsk Regional Clinical Hospital, Irkutsk, Russian Federation.
https://orcid.org/0000-0002-9337-2369
Makhutov Valerij N., PhD, Head of the Thoracic Surgical Unit, Irkutsk Regional Clinical Hospital, Irkutsk, Russian Federation.
https://orcid.org/0000-0001-7318-7193
Koryakina Larisa B., PhD, Head of the Center of the Laboratory Investigations, Irkutsk Regional Clinical Hospital, Irkutsk, Russian Federation.
https://orcid.org/0000-0002-4545-2049
Ryzhikova Svetlana V., Physician of the Center of the Laboratory Investigations, Irkutsk Regional Clinical Hospital, Irkutsk, Russian Federation.
https://orcid.org/0000-0003-3070-7720
Ivanova Tatiana V., Physician of the Center of the Laboratory Investigations, Irkutsk Regional Clinical Hospital, Irkutsk, Russian Federation.
https://orcid.org/0000-0002-9277-1587
Zagorodnyaya Anna N., Physician of the Center of the Laboratory Investigations, Irkutsk Regional Clinical Hospital, Irkutsk, Russian Federation.
https://orcid.org/0000-0003-0685-2426

V.V. BOYKO 1, V.A. VOVK 2

USE OF MINIMALLY INVASIVE INTERVENTIONS IN TREATMENT OF CHOLANGIOGENIC LIVER ABSCESSES

V.T. Zaycev Institute of General and Urgent Surgery of National Academy of Medical Sciences of Ukraine 1,
Kharkiv Regional Clinical Hospital 2, Kharkiv,
Ukraine

Objective. To improve surgical treatment of patients with the liver cholangiogenic abscesses of liver through the introduction of minimally invasive technologies.
Methods. In the proposed study the treatment results of 49 patients with biliary liver abscesses are presented. There were 31 women and 18 men aged 37 to 69 years. Surgical interventions for hepatic abscesses were performed simultaneously with the elimination of the primary pathological process of the biliary system, which caused the occurrence of cholangitis or in the near future (up to 3 days) after biliary drainage.
Results. Drainage under ultrasound guidance was performed in 21 patients with single and 7 patients with two or more cholangiogenic liver abscesses. At the same time, liver abscess and bile duct were drained in 8 patients in the x-ray operating room. Laparoscopic interventions were performed in 21 patients.
Among the patients operated on using minimally invasive technologies, 7 complications (14.3%) developed: 2 patients had bile leakage, 1 had the right-side hydrothorax, 1 had the right-side pleural empyema, 1 had the postoperative wound suppuration, and 2 had remaining stones in the common bile duct. One patient died (2.0%) due to the development of biliary sepsis with the obstruction of the biliary tract of malignant etiology.
Conclusions. Percutaneous drainage of liver abscesses under ultrasound control is appropriate not only for single abscesses, but also for their larger number. The possibility of simultaneous drainage of liver abscess and bile duct was proved. Percutaneous drainage of the liver abscess, drainage of the biliary tract and laparoscopic surgical intervention are complementary components of minimally invasive surgery in the treatment of the biliary origin liver abscesses. In case of localization of abscesses in the marginal segments of the liver, a laparoscopic atypical resection of the liver with an abscess is most desirable.

Keywords: liver abscess, cholangitis, minimally invasive surgical procedure,biliary drainage, liver abscess drainage
p. 386-393 of the original issue
References
  1. Rahimian J, Wilson T, Oram V, Holzman RS. Pyogenic liver abscess: recent trends in etiology and mortality. Clin Infect Dis. 2004 Dec 1;39(11):1654-59. doi: 10.1086/425616
  2. Peng YC, Lin CL, Sung FC. Risk of pyogenic liver abscess and endoscopic sphincterotomy: a population-based cohort study. BMJ Open. 2018 Mar 3;8(3):e018818. doi: 10.1136/bmjopen-2017-018818
  3. Su YJ, Lai YC, Lin YC, Yeh YH. Treatment and prognosis of pyogenic liver abscess. Int J Emerg Med. 2010 Dec;3(4):381-84. Published online 2010 Nov 5. doi: 10.1007/s12245-010-0232-6
  4. Lai SW, Liao KF, Lin CL, Chen PC. Pyogenic liver abscess correlates with increased risk of acute pancreatitis: a population-based cohort study. J Epidemiol. 2015;25(3):246-53. doi: 10.2188/jea.JE20140152
  5. Eryuhin IA, Gelfand BR, Shlyapnikov SA, red. Khirurgicheskie infektsii: ruk. S-Petersburg, RF: Piter; 2003. 864 p. http://kingmed.info/knigi/Hiryrgia/Gnoinaa_hiryrgia/book_1989/Hirurgicheskie_infektsii_2-e_izdanie- Eryuhin_IA_Gelfand_BR_Shlyapnikov_SA-2003-djvu (in Russ.)
  6. Serraino C, Elia C, Bracco C, Rinaldi G, Pomero F, Silvestri A, Melchio R, Fenoglio LM. Characteristics and management of pyogenic liver abscess: A European experience. Medicine (Baltimore). 2018 May;97(19):e0628. doi: 10.1097/MD.0000000000010628
  7. Shi S, Xia W, Guo H, Kong H, Zheng S. Unique characteristics of pyogenic liver abscesses of biliary origin. Surgery. 2016 May;159(5):1316-24. doi: 10.1016/j.surg.2015.11.012
  8. Cerwenka H. Pyogenic liver abscess: differences in etiology and treatment in Southeast Asia and Central Europe. World J Gastroenterol. 2010 May 28;16(20):2458-62. doi: 10.3748/wjg.v16.i20.2458
  9. Czerwonko ME, Huespe P, Bertone S, Pellegrini P, Mazza O, Pekolj J, de Santibañes E, Hyon SH, de Santibañes M. Pyogenic liver abscess: current status and predictive factors for recurrence and mortality of first episodes. HPB (Oxford). 2016 Dec;18(12):1023-30. Published online 2016 Oct 3. doi: 10.1016/j.hpb.2016.09.001
  10. Liu CH, Gervais DA, Hahn PF, Arellano RS, Uppot RN, Mueller PR. Percutaneous hepatic abscess drainage: do multiple abscesses or multiloculated abscesses preclude drainage or affect outcome? J Vasc Interv Radiol. 2009 Aug;20(8):1059-65. doi: 10.1016/j.jvir.2009.04.062
Address for correspondence:
61022, Ukraine,
Kharkiv, Nezalezhnosti Ave., 13,
Kharkiv Regional Clinical Hospital,
Surgical Unit.
Tel. +38(050)924-61-56,
e-mail: valery_vals@ukr.net,
Valerii A. Vovk
Information about the authors:
Boyko Valery V., Corresponding Member of National Academy of Medical Sciences of Ukraine, MD, Professor, Director of the V.T. Zaycev Institute of General and Urgent Surgery of National Academy of Medical Sciences of Ukraine, Kharkiv, Ukraine.
https://orcid.org/0000-0001-8675-2702
Vovk Valerii A., PhD, Associate Professor, Surgeon of the Surgical Unit, Kharkiv Regional Clinical Hospital, Kharkiv, Ukraine.
https://orcid.org/0000-0003-0888-1837

V.I. KOLOMIYTSEV, O.M. TERLETSKIY, M.M. BUFAN

ANALYSIS OF DIAGNOSTIC CRITERIA OF OLIGOSYMPTOMATIC CHOLEDOCHOLITHIASIS IN PATIENTS WITH ACUTE CALCULOUS CHOLECYSTITIS

Danylo Halytsky Lviv National Medical University, Lviv,
Ukraine

Objective. To identify the diagnostic criteria associated with oligosymptomatic choledocholithiasis in patients with acute calculous cholecystitis based on the combination of laboratory data and instrumental methods of examination.
Methods. The study included 219 patients, treated at the surgical department ¹ 1 of Danylo Halytsky Lviv National Medical University in the period of 2007-2017. Patients were divided into 2 groups: the1st group included patients with acute calculous cholecystitis and oligosymptomatic choledocholithiasis confirmed by endoscopic retrograde cholangiopancreatography (169 patients); the 2nd group comprised of patients with acute calculous cholecystitis without choledocholithiasis (50 patients), i.e. the comparison group.
Results. As follows from the single-factor analysis using the method of logistic regression, 5out of 47 factors were determined, indicating the presence of oligosymptomatic choledocholithiasis: the common bile duct diameter (according to transabdominal ultrasonography), alkaline phosphatase activity, alanine aminotransferase, aspartate aminotransferase, and total bilirubin level. The model of the combined effect of the above-mentioned factors on the probability of the oligosymptomatic choledocholithiasis in a patient was elaborated. The ROC curve analysis (The Receiver Operating Characteristic) of the model demonstrated its high-quality prediction for the presence of oligosymptomatic choledocholithiasis (AUC=0.97). According to the results of the analysis of the specificity, sensitivity and accuracy of the proposed model, the optimal threshold for establishing the patient belonging to the group with the oligosymptomatic choledocholithiasis was calculated accounting for 0.62. At a defined threshold, the sensitivity of the test is 93.02%, the specificity is 92.06%, and the accuracy is 92.31%.
Conclusions. Diagnostic criteria for the presence of oligosymptomatic choledocholithiasis (p<0.05) are the following: common bile duct diameter, alanine aminotransferase activity, aspartate aminotransferase, alkaline phosphatase, and total bilirubin level as well. The application of the developed multifactorial model for predicting the presence of oligosymptomatic choledocholithiasis in patients with acute calculous cholecystitis enables to reduce the need for such additional methods of examination as magnetic resonance cholangiopancreatography, computed tomography, endosonography, endoscopic retrograde cholangiography.

Keywords: acute calculous cholecystitis, choledocholithiasis, model for predicting choledocholithiasis, diagnostic criteria, endoscopic retrograde cholangiography
p. 394-401 of the original issue
References
  1. Horwood J, Akbar F, Davis K, Morgan R. Prospective evaluation of a selective approach to cholangiography for suspected common bile duct stones. Ann R Coll Surg Engl. 2010 Apr;92(3):206-10. doi: 10.1308/003588410X12628812458293
  2. Shapoval’yants SG, Ardasenov ÒB, Freydovich DA, Mylnikov AG, Pan’kov AG, Budzinsky SA, Nikonov AA. Problems of modern diagnostics of choledocholithiasis. Ros Zhurn Gastroenterologii, Gepatologii, Koloproktologii. 2011;(21)2:22-29. (In Russ.)
  3. Yokoe M, Hata J, Takada T, Strasberg SM, Asbun HJ, Wakabayashi G, Kozaka K, Endo I, Deziel DJ, Miura F, Okamoto K, Hwang TL, Huang WS, Ker CG, Chen MF, Han HS, Yoon YS, Choi IS, Yoon DS, Noguchi Y, Shikata S, Ukai T, Higuchi R, Gabata T, Mori Y, Iwashita Y, Hibi T, Jagannath P, Jonas E, Liau KH, Dervenis C, Gouma DJ, Cherqui D, Belli G, Garden OJ, Giménez ME, de Santibañes E, Suzuki K, Umezawa A, Supe AN, Pitt HA, Singh H, Chan ACW, Lau WY, Teoh AYB, Honda G, Sugioka A, Asai K, Gomi H, Itoi T, Kiriyama S, Yoshida M, Mayumi T, Matsumura N, Tokumura H, Kitano S, Hirata K, Inui K, Sumiyama Y, Yamamoto M. Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholecystitis. J Hepatobiliary Pancreat Sci. 2018 Jan;25(1):41-54. doi: 10.1002/jhbp.515
  4. Ansaloni L, Pisano M, Coccolini F, Peitzmann AB, Fingerhut A, Catena F, Agresta F, Allegri A, Bailey I, Balogh ZJ, Bendinelli C, Biffl W, Bonavina L, Borzellino G, Brunetti F, Burlew CC, Camapanelli G, Campanile FC, Ceresoli M, Chiara O, Civil I, Coimbra R, De Moya M, Di Saverio S, Fraga GP, Gupta S, Kashuk J, Kelly MD, Koka V, Jeekel H, Latifi R, Leppaniemi A, Maier RV, Marzi I, Moore F, Piazzalunga D, Sakakushev B, Sartelli M, Scalea T, Stahel PF, Taviloglu K, Tugnoli G, Uraneus S, Velmahos GC, Wani I, Weber DG, Viale P, Sugrue M, Ivatury R, Kluger Y, Gurusamy KS, Moore EE. 2016 WSES guidelines on acute calculous Cholecystitis. World J Emerg Surg. 2016 Jun;14:11-25. doi: 10.1186/s13017-016-0082-5
  5. Bourgouin S, Truchet X, Lamblin G, De Roulhac J, Platel JP, Balandraud P. Dynamic analysis of commonly used biochemical parameters to predict common bile duct stones in patients undergoing laparoscopic cholecystectomy. Surg Endosc. 2017 Nov;31(11):4725-34. doi: 10.1007/s00464-017-5549-2
  6. Chandrasekhara V, Khashab MA, Muthusamy VR, Acosta RD, Agrawal D, Bruining DH, Eloubeidi MA, Fanelli RD, Faulx AL, Gurudu SR, Kothari S, Lightdale JR, Qumseya BJ, Shaukat A, Wang A, Wani SB, Yang J, DeWitt JM. Adverse events associated with ERCP. Gastrointest Endosc. 2017 Jan;85(1):32-47. https://www.giejournal.org/article/S0016-5107(16)30335-2/fulltext
  7. Chen W, Mo JJ, Lin L, Li CQ, Zhang JF. Diagnostic value of magnetic resonance cholangiopancreatography in choledocholithiasis. World J Gastroenterol. 2015 Mar 21;21(11):3351-60. doi: 10.3748/wjg.v21.i11.3351
  8. Singh A, Mann HS, Thukral CL, Singh NR. Diagnostic accuracy of MRCP as compared to ultrasound/CT in patients with obstructive jaundice. J Clin Diagn Res. 2014 Mar;8(3):103-107. doi: 10.7860/JCDR/2014/8149.4120
  9. Jovanović P, Salkić NN, Zerem E, Ljuca F. Biochemical and ultrasound parameters may help predict the need for therapeutic endoscopic retrograde cholangiopancreatography (ERCP) in patients with a firm clinical and biochemical suspicion for choledocholithiasis. Eur J Intern Med. 2011 Dec;22(6):e110-14. doi: 10.1016/j.ejim.2011.02.008
  10. Isherwood J, Garcea G, Williams R, Metcalfe M, Dennison AR. Serology and ultrasound for diagnosis of choledocholithiasis. Ann R Coll Surg Engl. 2014 Apr;96(3):224-28. doi: 10.1308/003588414X13814021678033
  11. Sherman JL, Shi EW, Ranasinghe NE, Sivasankaran MT, Prigoff JG, Divino CM. Validation and improvement of a proposed scoring system to detect retained common bile duct stones in gallstone pancreatitis. Surgery. 2015 Jun;157(6):1073-79. doi: 10.1016/j.surg.2015.01.005
  12. Kim KM, Lee JK, Bahng S, Shin JU, Lee KH, Lee KT, Lee WJ, Lim JH. Role of endoscopic ultrasonography in patients with intermediate probability of choledocholithiasis but a negative CT scan. J Clin Gastroenterol. 2013 May-Jun;47(5):449-56. doi: 10.1097/MCG.0b013e31827130a7
  13. Rubin MI, Thosani NC, Tanikella R, Wolf DS, Fallon MB, Lukens FJ. Endoscopic retrograde cholangiopancreatography for suspected choledocholithiasis: testing the current guidelines. Dig Liver Dis. 2013 Sep;45(9):744-49. doi: 10.1016/j.dld.2013.02.005
Address for correspondence:
79010, Ukraine,
Lviv, Pekarskaya Str., 69,
Danylo Halytsky Lviv National
Medical University,
Surgery Department ¹1,
tel. mobile: + 380974655895,
e-mail: olegterletskiy@ukr.net,
Oleg M. Terletskiy
Information about the authors:
Kolomiytsev Vasyl I., MD, Professor of the Surgery Department ¹1, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.
https://orcid.org/0000-0003-0646-6306
Terletskiy Oleg M., Post-Graduate Studet of the Surgery Department ¹1, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.
https://orcid.org/0000-0001-6675-6159
Bufan Mariia M., PhD, Associate Professor of the Department of Propaedeutics of Internal Medicine ¹1, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.
https://orcid.org/0000-0002-4814-0964

S.A. PLAKSIN

LATE SEROMAS AFTER IMPLANT-BASED BREAST ENLARGEMENT SURGERY

Perm State Medical University named after Academician E.A. Wagner, Perm,
The Russian Federation

Objective. To evaluate risk factors, clinical history and surgical treatment of late seromas after implant-based breast enlargement surgery.
Methods. Late seromas were diagnosed in 19 cases (1.4%) of 1387 implant-based breast enlargement surgeries in total at the long-term follow-up, 6 months – 16 years after the first surgery. Six of these cases underwent the initial surgeries at other hospitals. The incidence of late seromas was 0.9%. Seromas were diagnosed via ultrasound and computed tomography.
Results. The origins of late seromas were related to capsular contracture (n=6), rupture of the implant (n=3), mastitis (n=4), general infection (n=1), lactation (n=1), three were discovered during surgeries, and one had no apparent risk factors for its origin. The accumulation of milk around the breast prosthesis in the early postpartum period was called “milkoma.» Late seromas were divided into three groups: small with their volume up to 50 ml (29.3±7.5 ml), discovered in 8 (42.1%) patients, medium ranged in volume between 50 to 150 ml (97.7±37.8 ml), discovered in 4 (21.1%) patients, and large – more than 150 ml (271.4±111.3 ml) in volume, discovered in 7 (36.8%) patients. Three patients with small seromas were treated with antibacterial, anti-inflammatory and physiotherapy; one case of milkoma was treated via repeated transcutaneous needle aspiration and lactation suppression, and one case of seroma was treated by drainage. 14 (73.7%) patients required repeat surgeries: 6 patients with small seromas underwent capsulectomy with the replacement of breast implants and drainage; 5 patients with large seromas or signs of mastitis, and/or infected fluid in the presence of medium seromas underwent capsulectomy with implant removal and drainage, and 3 patients required implant removal with drainage. Implants were not replaced until 6 months later.
Conclusions. Risk factors for formation of late seromas include capsular contracture, rupture of implants. Anti-inflammatory therapy or capsulectomy with the replacement of breast implants is effective in cases of small seromas. Implant removal, complete capsulectomy and drainage are required for cases of large seromas or signs of mastitis and/or infected fluid.

Keywords: breast implants, late seroma, treatment, risk factors, augmentation mammaplasty, capsular contracture
p. 402-408 of the original issue
References
  1. Botti J. Aesthetic Mammaplasties. Practical Atlas of Plastic Surgery. SEE-FIRENZE; 2008. 628 p.
  2. Mazzocchi M, Dessy LA, Corrias F, Scuderi N. A clinical study of late seroma in breast implantation surgery. Aesthetic Plast Surg. 2012 Feb;36(1):97-104. doi: 10.1007/s00266-011-9755-3
  3. Loch-Wilkinson A, Beath KJ, Knight RJW, Wessels WLF, Magnusson M, Papadopoulos T, Connell T, Lofts J, Locke M, Hopper I, Cooter R, Vickery K, Joshi PA, Prince HM, Deva AK. Breast implant-associated anaplastic large cell lymphoma in Australia and New Zealand: high-surface-area textured implants are associated with increased risk. Plast Reconstr Surg. 2017 Oct;140(4):645-54. doi: 10.1097/PRS.0000000000003654
  4. Meggiorini ML, Maruccia M, Carella S, Sanese G, De Felice C, Onesti MG. Late massive breast implant seroma in postpartum. Aesthet Plast Surg. 2013 Oct;37(5):931-35. doi: 10.1007/s00266-013-0164-7
  5. Di Napoli A, Pepe G, Giarnieri E, Cippitelli C, Bonifacino A, Mattei M, Martelli M, Falasca C, Cox MC, Santino I, Giovagnoli MR. Cytological diagnostic features of late breast implant seromas: From reactive to anaplastic large cell lymphoma. PLoS One. 2017 Jul 17;12(7):e0181097. doi: 10.1371/journal.pone.0181097. eCollection 2017.
  6. Sforza M, Husein R, Atkinson C, Zaccheddu R. Unraveling factors influencing early seroma formation in breast augmentation surgery. Aesthet Surg J. 2017 Mar 1;37(3):301-307. doi: 10.1093/asj/sjw196
  7. McGuire P, Reisman NR, Murphy DK. Risk factor analysis for capsular contracture, malposition, and late seroma in subjects receiving natrelle 410 form-stable silicone breast implants. Plast Reconstr Surg. 2017 Jan;139(1):1-9. doi: 10.1097/PRS.0000000000002837
  8. Zelken J, Huang JJ, Wu CW, Lin YL, Cheng MH. The Transareolar-Periareolar Approach. Plast Reconstr Surg Glob Open. 2016 Sep 7;4(9):e1020. eCollection 2016 Sep. doi: 10.1097/GOX.0000000000001020
  9. Hall-Findlay EJ. Breast implant complication review: double capsules and late seromas. Plast Reconstr Surg. 2011 Jan;127(1):56-66. doi: 10.1097/PRS.0b013e3181fad34d
  10. Efanov JI, Giot JP, Fernandez J, Danino MA. Breast-implant texturing associated with delamination of capsular layers: A histological analysis of the double capsule phenomenon. Ann Chir Plast Esthet. 2017 Jun;62(3):196-201. doi: 10.1016/j.anplas.2017.02.001
  11. Pinchuk V, Tymofii O. Seroma as a late complication after breast augmentation. Aesthetic Plast Surg. 2011 Jun;35(3):303-14. doi: 10.1007/s00266-010-9607-6
  12. Cheng NX, Zhang YL, Luo SK, Zhang XM, Hui L, Chen YL, Sheng SY, Wu DH, Wang HB, Li P. Late hematoma, seroma, and galactocele in breasts injected with polyacrylamide gel. Aesthetic Plast Surg. 2011 Jun;35(3):365-72. doi: 10.1007/s00266-010-9617-4
  13. Spear SL, Rottman SJ, Glicksman C, Brown M, Al-Attar A. Late seromas after breast implants: theory and practice. Plast Reconstr Surg. 2012 Aug;130(2):423-35. doi: 10.1097/PRS.0b013e3182589ea9
  14. Becker H, Klimczak J. Aspiration of periprosthetic seromas using the blunt seroma cath. Plast Reconstr Surg. 2016 Feb;137(2):473-75. doi: 10.1097/01.prs.0000475795.84725.c4
Address for correspondence:
614990, The Russian Federation,
Perm, Petropavlovskaya Str., 26,
Perm State Medical University
Named after Academician E.A. Wagner,
Surgery Department of the Faculty of
Advanced ProfessionalEducation.
Tel. +7 342 239-29-72,
e-mail: splaksin@mail.ru,
Sergei A. Plaksin
Information about the authors:
Plaksin Sergei A., MD, Professor of the Surgery Department of the Faculty of Advanced Professional Education, Perm State Medical University named after Academician E.A. Wagner, Perm, Russian Federation.
http://orcid.org/0000-0001-8108-1655

TRANSPLANTOLOGY

A.V. NOSIK 1, S.V. KOROTKOV 1, 2, V.V. SMOLNIKOVA 2, V.YU. HRYNEVICH 2, M.V. DMITRIEVA 3, A.A. DOLGOLIKOVA 2, I.I. PIKIRENIA 1, 2, S.I. KRIVENKO 2, O.V. KALACHIK 1, 2, A.E. SHCHERBA 1, 2, O.O. RUMMO 1, 2

VALUE OF ASSESSMENT OF LYMPHOCYTES SUBPOPULATIONS NUMBERS IN PERIPHERAL BLOOD FOR DIAGNOSIS OF CELLULAR REJECTION AFTER KIDNEY TRANSPLANTION

Belarusian Medical Academy of Postgraduate Education 1,
Minsk Scientific and Practical Center of Surgery, Transplantology and Hematology 2,
City Clinical Pathologoanatomic Bureau 3, Minsk
The Republic of Belarus

Objective. To study the possibility of assessing the number of peripheral blood lymphocyte subpopulations as biomarkers of late kidney transplant rejection.
Methods. This is a report of retrospective single center case-control study involving 44 patients who underwent kidney transplantation. The first group (AR) includes patients with chronic graft dysfunction, caused by biopsy proven late cellular rejection (22 patients). The second group (STA) contains recipients, who haven’t any dysfunction in the post-transplant period (22 patients). Flow cytometry of the peripheral blood cells was performed to evaluate the immune status of recipients.
Results. As a result of the research, accurate differences of absolute account of effector memory T cellwere determined, which accounted for in REJ group 0.147 (0.115-0.260)×109 cell/l, and in STA group 0.106 (0.067-0.136)×109 cell/l (ð=0.0167). Relative and absolute accounts of myeloid dendritic cells were different as well: 0.65 (0.36-0.73) vs 1.05 (0.67-1.4) % and 0.039 (0.028-0.056) vs 0.063 (0.049-0.076)×109 cell/l, respectively (ð=0.0009, ð=0.003). Number of plasmacytoid dendritic cells was also different between study groups: absolute account 0.0038 (0.0021-0.0054) vs 0.005 (0.0035-0.007)×109 cell/l (ð=0.0414), and relative account 0.055 (0.04-0.085) vs 0.09 (0.05-0.12) % (ð=0.0197).
The evaluation of diagnostic characteristic of revealed biomarkers was performed by using ROC-analysis. The area under ROC-curve (AUC) for absolute number of effector CD4+ memory T cells accounted for 0.711 (95 % CI: 0.55-0.84), ð=0.007. AUC for relative and absolute number of myeloid dendritic cells was assessed respectively as 0.784 (95% CI: 0.63-0.89) and 0.758 (95 % CI: 0.6-0.87), at significance values respectively – ð=0.0001 and ð=0.0004. For relative and absolute number of plasmacytoid dendritic cells AUC accounted for respectively to 0.7 (95% CI: 0.55-0.83) and 0.68 (95% CI: 0.51-0.8), at significance values ð=0.01 and ð=0.0357.
Conclusions. The received data showed that blood level of dendritic cells and the level of effector helper T memory cells can be reasonably considered as diagnostic markers of kidney transplant cellular rejection in late period after operation.

Keywords: kidney transplantation, kidney allograft, immune monitoring, biomarkers, rejection
p. 409-420 of the original issue
References
  1. Tonelli M, Wiebe N, Knoll G, Bello A, Browne S, Jadhav D, Klarenbach S, Gill J. Systematic review: kidney transplantation compared with dialysis in clinically relevant outcomes. Am J Transplant. 2011 Oct;11(10):2093-109. doi: 10.1111/j.1600-6143.2011.03686.x
  2. Koo EH, Jang HR, Lee JE, Park JB, Kim SJ, Kim DJ, Kim YG, Oh HY, Huh W. The impact of early and late acute rejection on graft survival in renal transplantation. Kidney Res Clin Pract. 2015 Sep;34(3):160-64. Published online 2015 Jul 26. doi: 10.1016/j.krcp.2015.06.003
  3. Hanssen O, Erpicum P, Lovinfosse P, Meunier P, Weekers L, Tshibanda L, Krzesinski JM, Hustinx R, Jouret F. Non-invasive approaches in the diagnosis of acute rejection in kidney transplant recipients. Part I. In vivo imaging methods. Clin Kidney J. 2017 Feb;10(1):97-105. Published online 2016 Jul 28. doi: 10.1093/ckj/sfw062
  4. Reschen ME, Mazzella A, Sharples E. A retrospective analysis of the utility and safety of kidney transplant biopsies by nephrology trainees and consultants. Ann Med Surg (Lond). 2018 Feb 9;28:6-10. doi: 10.1016/j.amsu.2018.02.001
  5. Salvadori M, Tsalouchos A. Biomarkers in renal transplantation: an updated review. World J Transplant. 2017 Jun 24;7(3):161-78. doi: 10.5500/wjt.v7.i3.161
  6. Woo J, Baumann A, Arguello V. Recent advancements of flow cytometry: new applications in hematology and oncology. Expert Rev Mol Diagn. 2014 Jan;14(1):67-81. doi: 10.1586/14737159.2014.862153
  7. Maguire O, Tario JD Jr, Shanahan TC, Wallace PK, Minderman H. Flow cytometry and solid organ transplantation: a perfect match. Immunol Invest. 2014;43(8):756-74. doi: 10.3109/08820139.2014.910022
  8. Borghans J, Ribeiro RM. The maths of memory. eLife. 2017;6:e26754. Published online 2017 Apr 28. doi: 10.7554/eLife.26754
  9. Benichou G, Gonzalez B, Marino J, Ayasoufi K, Valujskikh A. Role of memory t cells in allograft rejection and tolerance. Front Immunol. 2017;8:170. Published online 2017 Feb 28. doi: 10.3389/fimmu.2017.00170
  10. Zhou H, Wu L. The development and function of dendritic cell populations and their regulation by miRNAs. Protein Cell. 2017 Jul;8(7):501-13. doi: 10.1007/s13238-017-0398-2
  11. Zhuang Q, Lakkis FG. Dendritic cells and innate immunity in kidney transplantation. Kidney Int. 2015 Apr;87(4):712-18. doi: 10.1038/ki.2014.430
Address for correspondence:
220013, The Republic of Belarus,
Minsk, P.Brovko Str., 3, build. 3,
Belarusian Medical Academy of Postgraduate Education,
Transplantology Department.
Tel. +375 (33) 312-86-24,
e-mail: doctornosik@gmail.com,
Alexander V. Nosik
Information about the authors:
Nosik Alexander V., Assistant of the Transplantology Department, Belarusian Medical Academy of Postgraduate Education, Surgeon of the Transplantation Unit, Minsk Scientific and Practical Center of Surgery, Transplantology and Hematology, Minsk, Republic of Belarus.
https://orcid.org/0000-0002-3500-0866
Korotkov Sergey V., PhD, Associate Professor of the Transplantology Department, Belarusian Medical Academy of Postgraduate Education, Head of the Transplantation Unit (Liver Transplantation and Hepatobiliary Surgery), Minsk Scientific and Practical Center of Surgery, Transplantology and Hematology, Minsk, Republic of Belarus.
https://orcid.org/0000-0002-8536-6911
Smolnikova Viktoryia V., Senior Researcher, the Research Department, Minsk Scientific and Practical Center of Surgery, Transplantology and Hematology, Minsk, Republic of Belarus.
https://orcid.org/0000-0001-5947-8285
Hrynevich Viktoryia Yu., Physician of Laboratory Diagnostics, Clinical-Diagnostic Laboratory, Minsk Scientific and Practical Center of Surgery, Transplantology and Hematology, Minsk, Republic of Belarus.
https://orcid.org/0000-0002-4505-4884
Krivenko Svetlana I., MD, Associate Professor, Deputy Directorfor Science, Minsk Scientific and Practical Center of Surgery, Transplantology and Hematology, Minsk, Republic of Belarus.
https://orcid.org/0000-0002-6813-4465
Dmitrieva Margarita V., Pathologist, City Clinical Pathologoanatomic Bureau, Minsk, Republic of Belarus.
https://orcid.org/0000-0002-2958-9424
Pikirenia Ivan I., PhD, Associate Professor, Head of the Transplantology Department, Belarusian Medical Academy of Postgraduate Education, Surgeon of the Surgery Unit, Minsk Scientific and Practical Center of Surgery, Transplantology and Hematology, Minsk, Republic of Belarus.
https://orcid.org/0000-0001-8907-4601
Dolgolikova Anna A., PhD, Nephrologist of the Nephrology Unit, Minsk Scientific and Practical Center of Surgery, Transplantology and Hematology, Minsk, Republic of Belarus.
https://orcid.org/0000-0003-3576-2235
Kalachik Oleg V., MD, Associate Professor of the Transplantology Department, Belarusian Medical Academy of Postgraduate Education, Deputy Director for the Medical Affairs, Minsk Scientific and Practical Center of Surgery, Transplantology and Hematology, Head of the Republican Center for Nephrology, Renal Replacement Therapy and Kidney Transplantation,Minsk, Republic of Belarus.
https://orcid.org/0000-0002-8993-0292
Shcherba Aliaksei E., MD, Associate Professor of the Transplantology Department, Belarusian Medical Academy of Postgraduate Education, Deputy Director for Surgery, Minsk Scientific and Practical Center of Surgery, Transplantology and Hematology, Minsk, Republic of Belarus.
https://orcid.org/0000-0003-0569-6150
Rummo Oleg O., MD, Professor, Corresponding Member of the National Academy of Sciences of Belarus, Professor of the Transplantology Department, Belarusian Medical Academy of Postgraduate Education, Director, Minsk Scientific and Practical Center of Surgery, Transplantology and Hematology, Minsk, Republic of Belarus.
https://orcid.org/0000-0001-7023-4767

PEDIATRIC SURGERY

O.A. GOVORUKHINA

CAUSES OF POSTOPERATIVE ENTEROCOLITIS IN HIRSCHSPRUNG DISEASE IN CHILDREN

Republican Research and Practical Center for Pediatric Surgery, Minsk,
The Republic of Belarus

Objective. To analyze the causes for the development of enterocolitis in the group of patients with Hirschsprung disease after radical surgical treatment in order to prevent its occurrence and improve treatment outcomes.
Methods. During the period for 2010-2018, 92 patients with Hirschsprung disease at the age of 1 month up to 16 years were operated at the Center for Pediatric Surgery by the transanal endorectal pull-through (TEPT) method (in various versions). All patients with the signs of postoperative enterocolitis were included in this study. The clinical manifestations of the disease, age of patients at the time of radical surgical treatment, the form of Hirschsprung disease, changes in the morphological picture of bowel biopsy material were assessed.
Results. During the period of 2010-2018, cases of enterocolitis of mild and moderate severity prevailed in the study group (19 patients with postoperative enterocolitis – 27.2% of the total number of patients). Surgery was required in 8 cases of severe postoperative enterocolitis. The occurrence of postoperative enterocolitis was established to not depend on the patient’s age at the time of the radical operation (p>0.05). The main causes for the occurrence of postoperative enterocolitis were the following: a long zone of bowel resection in the extended agangliosis and the presence of previous enterocolitis in the history prior to radical surgery. Also, during the morphological study of the operative material with electron microscopic examination, it was revealed that immune cells (eosinophils, mast cells) and endocrinocytes were subjected to destructive processes during enterocolitis in Hirschsprung disease, which contributed to the occurrence of recurrent enterocolitis after radical surgery.
Conclusions. The identification of the main causes of postoperative enterocolitis permitted to identify the group of patients who are likely to develop this serious complication of Hirschsprung disease. Timely and adequate prevention and treatment of postoperative enterocolitis improved patients’ treatment outcomes.

Keywords: Hirschsprung disease, agangliosis, colon, enterocolitis, transanal endorectal pull-through, postoperative complications
p. 421-427 of the original issue
References
  1. Swenson O. Hirschsprung’s disease: a review. Pediatrics. 2002 May;109(5):914-18.
  2. Holschneider AM, Puri P, eds. Hirschsprung’s disease and allied disorders. 3rd ed. New York, NY: Springer; 2008. 414 p.
  3. Dasgupta R, Langer JC. Hirschsprung disease. Curr Probl Surg. 2004 Dec;41(12):942-88. doi: 10.1067/j.cpsurg.2004.09.004
  4. Langer JC, Rollins MD, Levitt M, Gosain A, Torre L, Kapur RP, Cowles RA, Horton J, Rothstein DH, Goldstein AM. Guidelines for the management of postoperative obstructive symptoms in children with Hirschsprung disease. Pediatr Surg Int. 2017 May;33(5):523-26. doi: 10.1007/s00383-017-4066-7
  5. Thakkar HS, Bassett C, Hsu A, Manuele R, Kufeji D, Richards CA, Agrawal M, Keshtgar AS. Functional outcomes in Hirschsprung disease: A single institution’s 12-year experience. J Pediatr Surg. 2017 Feb;52(2):277-80. doi: 10.1016/j.jpedsurg.2016.11.023
  6. Adıgüzel Ü, Ağengin K, Kırıtıoğlu I, Doğruyol H. Transanal endorectal pull-through for Hirschsprung’s disease: experience with 50 patients. Ir J Med Sci. 2017 May;186(2):433-37. doi: 10.1007/s11845-016-1446-2
  7. Khazdouz M, Sezavar M, Imani B, Akhavan H, Babapour A, Khademi G. Clinical outcome and bowel function after surgical treatment in Hirschsprung’s disease. Afr J Paediatr Surg. 2015 Apr-Jun;12(2):143-47. doi: 10.4103/0189-6725.160403
  8. Yan Z, Poroyko V, Gu S, Zhang Z, Pan L, Wang J, Bao N, Hong L. Characterization of the intestinal microbiome of Hirschsprung’s disease with and without enterocolitis. Biochem Biophys Res Commun. 2014 Mar 7;445(2):269-74. doi: 10.1016/j.bbrc.2014.01.104
  9. Gosain A, Brinkman AS. Hirschsprung’s associated enterocolitis. Curr Opin Pediatr. 2015 Jun;27(3):364-69. doi: 10.1097/MOP.0000000000000210
  10. Kwendakwema N, Al-Dulaimi R, Presson AP, Zobell S, Stevens AM, Bucher BT, Barnhart DC, Rollins MD. Enterocolitis and bowel function in children with Hirschsprung disease and trisomy 21. J Pediatr Surg. 2016 Dec;51(12):2001-2004. doi: 10.1016/j.jpedsurg.2016.09.026
  11. Lu C, Hou G, Liu C, Geng Q, Xu X, Zhang J, Chen H, Tang W. Single-stage transanal endorectal pull-through procedure for correction of Hirschsprung disease in neonates and nonneonates: A multicenter study. J Pediatr Surg. 2017 Jul;52(7):1102-1107. doi: 10.1016/j.jpedsurg.2017.01.061
  12. Wang X, Li Z, Xu Z, Wang Z, Feng J. Probiotics prevent Hirschsprung’s disease-associated enterocolitis: a prospective multicenter randomized controlled trial. Int J Colorectal Dis. 2015 Jan;30(1):105-10. doi: 10.1007/s00384-014-2054-0
  13. Bogolepov NN. Metody elektronno-mikroskopicheskogo issledovaniia mozga [Elektronnyi resurs]. Moscow: Izd in-ta mozga AMN SSSR; 1976. 72 p. http://freakbooks.ru/item/7419401-metody-elektronno-mikroskopicheskogo-issledovaniya-mozga (In Russ.)
Address for correspondence:
220013, The Republic of Belarus,
Minsk, Nezavisimosti Ave., 64,
Republican Research and Practical Center for Pediatric Surgery,
Purulent Unit ¹2 (Surgical),
Tel. +375 29 772-31-34,
e-mail: govorukhina@mail.ru,
Olga A. Govorukhina
Information about the authors:
Govorukhina Olga A., PhD, Associate Professor, Head of the Purulent Unit ¹2 (Surgical), Republican Research and Practical Center for Pediatric Surgery, Minsk, Republic of Belarus.
https://orcid.org/0000-0002-1605-7031

INFORMATION TECHNOLOGIES IN SURGERY

V.². HUTSULIAK 1, R.D.BORODAJKEVYCH 2, À.². HUTSULIAK 1, T.M.KOVALYSHYN 1

DEVELOPMENT AND APPLICATION FEATURES OF 3-D ATLAS OF TRANSOSSEOUS ELEMENTS POSITIONS FOR PRE-SURGERY PLANNING OF THE SHIN BONES OSTEOSYNTHESIS

Ivano-Frankivsk National Medical University 1, Ivano-Frankivsk,
Specialized (special) sanatorium "Girske povitria" 2, Yaremche,
Ukraine

Objective. To improve the pre-surgery planning of transosseous osteosynthesis in the shin bone fractures by developing and applying the 3-D atlas of transosseous elements positions.
Methods. On the basis of transverse computer tomographic scans of the intact lower limb of an adult using the 3-D Doctor software package, three-dimensional simulation models of the shin bones and surrounding soft tissue structures were created in the automatic mode. These models were exported as separate files into the Autodesk Inventor 11 software package. In Part Modeling mode, the division of the model of the soft tissue structures of the shin into 96 parts was carried out - the segments corresponding to the positions for passing the transosseous elements according to the method of the unified marking of transosseous osteosynthesis and their preservation in separate files. In Assembly mode, the assemblage of the shin segments has been performed.
Results. The algorithm for the creation of 3-D atlas of transosseous elements positions was proposed, according to which the three-dimensional simulation models of the «shin - external fixation device» system were created in the Autodesk Inventor 11 program and the analysis of their possibilities regarding pre-surgery planning of transosseous osteosynthesis was conducted.
As a result of the research, it was found out that the use of the 3-D atlas of positions provides an opportunity for selecting the optimal design and the most efficient layout of the external fixation device in each particular clinical situation; determination of the number and optimal layout levels of the supports; the choice of the type and the most appropriate places for passing of the transosseous elements.
Conclusions. The application of 3-D Atlas of transosseous elements positions permits to approach the solution of the problem of pre-surgery planning from the standpoint of an integrated approach to choosing the type of external fixation device that is adequate to the existing clinical situation, its layout, determining the number of transosseous elements, directions and planes for passing them, which will allow reducing significantly the number of technical errors, reducing the risk of complications and promoting the achievement of positive anatomical and functional results in the vast majority of clinical cases.

Keywords: three-dimensional model, external fixation device, transosseous osteosynthesis, transosseous elements, pre-surgery planning
p. 428-434 of the original issue
References
  1. Hughes A, Parry M, Heidari N, Jackson M, Atkins R, Monsell F. Computer Hexapod-Assisted Orthopaedic Surgery for the Correction of Tibial Deformities. J Orthop Trauma. 2016 Jul;30(7):e256-61. doi: 10.1097/BOT.0000000000000544
  2. Murase T, Oka K, Moritomo H, Goto A, Sugamoto K, Yoshikawa H. Correction of severe wrist deformity following physeal arrest of the distal radius with the aid of a three-dimensional computer simulation. Arch Orthop Trauma Surg. 2009;129:1465-71. doi: 10.1007/s00402-008-0800-x
  3. Rozbruch SR, Fragomen AT, Ilizarov S. Correction of tibial deformity with use of the Ilizarov-Taylor spatial frame. J Bone Joint Surg Am. 2006 Dec;88(Suppl 4):156-74. doi: 10.2106/JBJS.F.00745
  4. Solomin LN. Osnovy chreskostnogo osteosinteza apparatom GA. Ilizarova. S-Petersburg, RF; 2005. 544 p. http://www.medliter.ru/?page=get&id=015127 (In Russ.)
  5. Catagni MA. Atlas for the insertion of transosseous wires and half-pins. Ilizarov method. 2nd ed. Milan: Medicalplastic; 2003. 51 p. Available from: http://osteosyntese.dk/3033/Smith-Nephew-Pin-atlas.pdf
  6. Solomin L. The basic principles of external skeletal fixation using the Ilizarov and other devices. 2nd ed. Milan: Springer-Verlag; 2012. 1593 p. https://www.springer.com/us/book/9788847026186
  7. Okada T, Iwasaki Y, Koyama T, Sugano N, Chen YW, Yonenobu K, Sato Y. Computer-assisted preoperative planning for reduction of proximal femoral fracture using 3-D-CT data. IEEE Trans Biomed Eng. 2009 Mar;56(3):749-59. doi: 10.1109/TBME.2008.2005970
  8. Fürnstahl P, Székely G, Gerber C, Hodler J, Snedeker JG, Harders M. Computer assisted reconstruction of complex proximal humerus fractures for preoperative planning. Med Image Anal. 2012 Apr;16(3):704-20. doi: 10.1016/j.media.2010.07.012
  9. Buschbaum J, Fremd R, Pohlemann T, Kristen A. Computer-assisted fracture reduction: a new approach for repositioning femoral fractures and planning reduction paths. Int J Comput Assist Radiol Surg. 2015 Feb;10(2):149-59. doi: 10.1007/s11548-014-1011-2
  10. Qiao F, Li D, Jin Z, Hao D, Liao Y, Gong S. A novel combination of computer-assisted reduction technique and three dimensional printed patient-specific external fixator for treatment of tibial fractures. Int Orthop. 2016 Apr;40(4):835-41. doi: 10.1007/s00264-015-2943-z
  11. Wei M, Chen J, Guo Y, Sun H. The computer-aided parallel external fixator for complex lower limb deformity correction. Int J Comput Assist Radiol Surg. 2017 Dec;12(12):2107-17. doi: 10.1007/s11548-017-1654-x
  12. Kontsevich VG. Tverdotel’noe modelirovanie v Autodesk Inventor. Kiev, Moscow: Dia-SoftIuP: DMK Press; 2008. 672 p. http://www.okindiansbc.org/articles/60337-koncevich-v.-tverdotelnoe-modelirovanie.html (In Russ.)
  13. Jiménez-Delgado JJ, Paulano-Godino F, PulidoRam-Ramírez R, Jiménez-Pérez JR. Computer assisted preoperative planning of bone fracture reduction: Simulation techniques and new trends. Med Image Anal. 2016 May;30:30-45. doi: 10.1016/j.media.2015.12.005
  14. Willis A, Anderson DD, Thomas T, Brown T, Marsh JL. 3D reconstruction of highly fragmented bone fractures. Medical Imaging. 2007: Image Processing: art. 65121P. doi: 10.1117/12.708683
Address for correspondence:
76000, Ukraine,
Ivano-Frankivsk, Galitskaya Str., 2,
Ivano-Frankivsk National Medical University,
Department of Traumatology and Orthopedics.
Tel. mobile+38050-960-59-23,
e-mail: vitaliy.ivf@ukr.net,
Vitalii I.Hutsuliak
Information about the authors:
Hutsuliak Vitalii I., PhD, Associate Professor of the Department of Traumatology and Orthopedics, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine.
https://orcid.org/0000-0003-1041-6424
Borodajkevych Roman D., PhD, Chief Physician of the Specialized (Special) Sanatorium «Girske Povitria», Yaremche, Ukraine.
https://orcid.org/0000-0003-2841-7572
Hutsuliak AndriiI., MD, Associate Professorofthe Surgery Department ¹ 1, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine.
https://orcid.org/0000-0002-3665-7798
Kovalyshyn Taras M., PhD, Associate Professor of the Department of Traumatology and Orthopedics, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine.
https://orcid.org/0000-0003-2388-1149

REVIEWS

F.SH. AKHMETZYANOV 1, 2, V.I. EGOROV 1, 2

CHRONIC PRESACRAL SINUS AS THE OUTCOME OF TOTAL MESORECTUMECTOMY IN RECTAL CANCER

Kazan State Medical University 1,
Republican Clinical Cancer Center 2, Kazan,
The Russian Federation

Total mesorectumectomy is a risk factor of development and formulation of pathological presacral sinuses. In the result of the rectum resection with total mesorectumectomy, the volumetric cavity is formed in the pelvisbounded by thebone structures. In case of accumulation of the liquid and blood in it, the risk of infection and the formation of presacral abscesses increases. If the pathological cavity does not heal during 12 months, such sinus is considered to be chronic. The chronic presacral sinus is formed in 5-9.5% of patients, those who underwent total mesorectumectomy. The main causes of development are neoadjuvantchemotherapy, high intraoperative bleeding, tumors of large size. The diagnostics includes the following instrumental methods: rectoscopy, proctography, magnetic resonance imaging of the pelvic organs. The basic methods of treatment in small sinuses are the application of fibrin glue and the EndoVac system. Fibringluecloses defects mechanically, stimulates proliferation of fibroblasts and provides matrix for the synthesis of collagen and for the processes of the wound healing. Fibrin glue is most often used as the final stage of the EndoVac system therapy, when a sponge, corresponding to the defect sizes, is placed in the abscess cavity, and is replaced every 48-72 hours. Treatment effectiveness is 66-100%. In the case of a large sinus, drained through a small defect in anastomosis or inefficiency of the EndoVac system, the method of endoscopic marsupialization is appropriate to be used. The given method allows saving the colorectal anastomosis. In patients with symptomatic presacral sinus in whom stoma reversionis impossible, transversal proctectomy with the cavity tamponade by greater omentum is advisable.

Keywords: total mesorectumectomy, colorectal anastomosis, anastomosis leak, anterior rectal resection, rectal cancer, chronic pelvis sinus
p. 435-442 of the original issue
References
  1. van Groningen JT, van Hagen P, Tollenaar RAEM, Tuynman JB, Marang-van de Mheen PJ, Doornebosch PG, Tanis PJ, de Graaf EJR. Evaluation of a completion total mesorectal excision in patients after local excision of rectal cancer: a word of caution. J Natl Compr Canc Netw. 2018 Jul;16(7):822-28. doi: 10.6004/jnccn.2018.7026
  2. Baik SH, Kim NK, Lim DR, Hur H, Min BS, Lee KY. Oncologic outcomes and perioperative clinicopathologic results after robot-assisted tumor-specific mesorectal excision for rectal cancer. Ann Surg Oncol. 2013 Aug;20(8):2625-32. doi: 10.1245/s10434-013-2895-8
  3. Lee L, de Lacy B, Gomez Ruiz M, Liberman AS, Albert MR, Monson JRT, Lacy A, Kim SH, Atallah SB. A multicenter matched comparison of transanal and robotic total mesorectal excision for mid and low-rectal adenocarcinoma. Ann Surg. 2018 Jun 18. doi: 10.1097/SLA.0000000000002862 [Epub ahead of print]
  4. Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery–the clue to pelvic recurrence? Br J Surg. 1982 Oct;69(10):613-16. doi: 10.1002/bjs.1800691019
  5. Muratore A, Mellano A, Marsanic P, De Simone M. Transanal total mesorectal excision (taTME) for cancer located in the lower rectum: short- and mid-term results. Eur J Surg Oncol. 2015 Apr;41(4):478-83. doi: 10.1016/j.ejso.2015.01.009
  6. Zarnescu EC, (Vasiliu), Zarnescu NO, Costea R, Neagu S. Review of risk factors for anastomotic leakage in colorectal surgery. Chirurgia (Bucur). 2015 Jul-Aug;110(4):319-26. http://www.revistachirurgia.ro/pdfs/2015-4-319.pdf
  7. Liu L, Wang T, Zhang G, Dai R, Liang H, Tang L. Risk factors for early complications after laparoscopic total mesorectal excision for locally advanced rectal cancer: A single center experience. J Cancer Res Ther. 2016 Jan-Mar;12(1):350-54. doi: 10.4103/0973-1482.139273
  8. Tortorelli AP, Alfieri S, Sanchez AM, Rosa F, Papa V, Di Miceli D, Bellantone C, Doglietto GB. Anastomotic leakage after anterior resection for rectal cancer with mesorectal excision: incidence, risk factors, and management. Am Surg. 2015 Jan;81(1):41-47. http://www.ingentaconnect.com/contentone/sesc/tas/2015/00000081/00000001/art00028
  9. Whitlow CB, Opelka FG, Gathright JB Jr, Beck DE. Treatment of colorectal and ileoanal anastomotic sinuses. Dis Colon Rectum. 1997 Jul;40(7):760-63. https://link.springer.com/article/10.1007%2FBF02055427
  10. Enker WE, Merchant N, Cohen AM, Lanouette NM, Swallow C, Guillem J, Paty P, Minsky B, Weyrauch K, Quan SH. Safety and efficacy of low anterior resection for rectal cancer: 681 consecutive cases from a specialty service. Ann Surg. 1999 Oct;230(4):544-52; discussion 552-54. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420903/
  11. McDermott FD, Heeney A, Kelly ME, Steele RJ, Carlson GL, Winter DC. Systematic review of preoperative, intraoperative and postoperative risk factors for colorectal anastomotic leaks. Br J Surg. 2015 Apr;102(5):462-79. doi: 10.1002/bjs.9697
  12. Kawada K, Takahashi R, Hida K, Sakai Y. Impact of transanal drainage tube on anastomotic leakage after laparoscopic low anterior resection. Int J Colorectal Dis. 2018 Mar;33(3):337-40. doi: 10.1007/s00384-017-2952-z
  13. Law WL, Chu KW. Anterior resection for rectal cancer with mesorectal excision: a prospective evaluation of 622 patients. Ann Surg. 2004 Aug;240(2):260-68. doi: 10.1097/01.sla.0000133185.23514.32
  14. Hoshino N, Hida K, Sakai Y, Osada S, Idani H, Sato T, Takii Y, Bando H, Shiomi A, Saito N. Nomogram for predicting anastomotic leakage after low anterior resection for rectal cancer. Int J Colorectal Dis. 2018 Apr;33(4):411-18. doi: 10.1007/s00384-018-2970-5
  15. Matsuda K, Yokoyama S, Hotta T, Watanabe T, Tamura K, Iwamoto H, Mizumoto Y, Yamaue H. Pelvic drain after laparoscopic low anterior resection for rectal cancer in patients with diverting stoma. Surg Laparosc Endosc Percutan Tech. 2018 Apr;28(2):82-85. doi: 10.1097/SLE.0000000000000517
  16. Brehant O, Hanes A, Fuks D, Sabbagh C, Blanpain S, Brazier F, Regimbeau JM. Stapled marsupialisation of chronic low rectal anastomotic sinuses. Int J Colorectal Dis. 2009 Oct;24(10):1233-37. doi: 10.1007/s00384-009-0780-5
  17. van Koperen PJ, van der Zaag ES, Omloo JM, Slors JF, Bemelman WA. The persisting presacral sinus after anastomotic leakage following anterior resection or restorative proctocolectomy. Colorectal Dis. 2011 Jan;13(1):26-29. doi: 10.1111/j.1463-1318.2010.02377.x
  18. Arumainayagam N, Chadwick M, Roe A. The fate of anastomotic sinuses after total mesorectal excision for rectal cancer. Colorectal Dis. 2009 Mar;11(3):288-90. doi: 10.1111/j.1463-1318.2008.01585.x
  19. Borstlap WAA, Westerduin E, Aukema TS, Bemelman WA, Tanis PJ. Anastomotic Leakage and Chronic Presacral Sinus Formation After Low Anterior Resection: Results From a Large Cross-sectional Study. Ann Surg. 2017 Nov;266(5):870-77. doi: 10.1097/SLA.0000000000002429
  20. Patsouras D, Schizas A, George ML. Novel application of anal fistula plug for the treatment of chronic anastomotic sinus. Int J Colorectal Dis. 2015 Dec;30(12):1735-36. doi: 10.1007/s00384-015-2142-9
  21. Sloothaak DA, Buskens CJ, Bemelman WA, Tanis PJ. Treatment of chronic presacral sinus after low anterior resection. Colorectal Dis. 2013 Jun;15(6):727-32. doi: 10.1111/codi.12094
  22. Musters GD, Borstlap WA, Bemelman WA, Buskens CJ, Tanis PJ. Intersphincteric completion proctectomy with omentoplasty for chronic presacral sinus after low anterior resection for rectal cancer. Colorectal Dis. 2016 Feb;18(2):147-54. doi: 10.1111/codi.13086
  23. Ming LI, Wei CUI, Teng MA, Weijun KOU, Liang ZHOU, Mingwen KOU, Wenbo ZHANG. Value of CRP and MMP-9 detection for diagnosis of anastomotic leakage after rectal cancer anterior resection. Chongqing Medicine. 2017;46(25):3506-8,3511.
  24. Daams F, Wu Z, Lahaye MJ, Jeekel J, Lange JF. Prediction and diagnosis of colorectal anastomotic leakage: a systematic review of literature. World J Gastrointest Surg. 2014 Feb 27;6(2):14-26. doi: 10.4240/wjgs.v6.i2.14
  25. Gessler B, Eriksson O. Angenete E. Diagnosis, treatment, and consequences of anastomotic leakage in colorectal surgery. Int J Colorectal Dis. 2017; 32(4):549-56. doi: 10.1007/s00384-016-2744-x
  26. Vermeer TA, Orsini RG, Daams F, Nieuwenhuijzen GA, Rutten HJ. Anastomotic leakage and presacral abscess formation after locally advanced rectal cancer surgery: Incidence, risk factors and treatment. Eur J Surg Oncol. 2014 Nov;40(11):1502-9. doi: 10.1016/j.ejso.2014.03.019
  27. Veenhof AA, Brosens R, Engel AF, van der Peet DL, Cuesta MA. Risk factors and management of presacral abscess following total mesorectal excision for rectal cancer. Dig Surg. 2009;26(4):317-21. doi: 10.1159/000231882
  28. Weidenhagen R, Gruetzner KU, Wiecken T, Spelsberg F, Jauch KW. Endoscopic vacuum-assisted closure of anastomotic leakage following anterior resection of the rectum: a new method. Surg Endosc. 2008 Aug;22(8):1818-25. doi: 10.1007/s00464-007-9706-x
  29. D’Hondt M, De Hondt G, Malisse P, Vanden Boer J, Knol J. Chronic pelvic abscedation after completion proctectomy in an irradiated pelvis: another indication for ENDO-sponge treatment? Tech Coloproctol. 2009 Dec;13(4):311-14. doi: 10.1007/s10151-009-0505-3
  30. Prasad LM, deSouza AL, Blumetti J, Marecik SJ, Park JJ. Endoscopic-assisted closure of a chronic colocutaneous fistula. Gastrointest Endosc. 2010 Sep;72(3):662-64. doi: 10.1016/j.gie.2009.12.028
  31. Nagell CF, Holte K. Treatment of anastomotic leakage after rectal resection with transrectal vacuum-assisted drainage (VAC). A method for rapid control of pelvic sepsis and healing. Int J Colorectal Dis. 2006 Oct;21(7):657-60. doi: 10.1007/s00384-005-0083-4
  32. Riss S, Stift A, Meier M, Haiden E, Grünberger T, Bergmann M. Endo-sponge assisted treatment of anastomotic leakage following colorectal surgery. Colorectal Dis. 2010 Jul;12(7 Online):e104-8. doi: 10.1111/j.1463-1318.2009.01885.x
  33. Swain BT, Ellis CN. Fibrin glue treatment of low rectal and pouch-anal anastomotic sinuses. Dis Colon Rectum. 2004 Feb;47(2):253-55. doi: 10.1007/s10350-003-0040-7
  34. Abild N, Bulut O, Nielsen CB. Endoscopic stapled marsupialisation of chronic presacral sinus following low anterior resection: a simple option in selected cases. Scand J Surg. 2012;101(4):307-10. doi: 10.1177/145749691210100416
  35. Hammond TM, Grahn MF, Lunniss PJ. Fibrin glue in the management of anal fistulae. Colorectal Dis. 2004 Sep;6(5):308-19. doi: 10.1111/j.1463-1318.2004.00676.x
  36. López V, Abrisqueta J, LujÁn J, Serrano A, Parrilla P. Endoscopic treatment with biologic glue of chronic presacral sinus after low anterior resection. Cirugía Española. 2015 Mar;93(3):133-10. doi: 10.1016/j.cireng.2014.09.004
  37. Lippert E, Klebl FH, Schweller F, Ott C, Gelbmann CM, Schölmerich J, Endlicher E, Kullmann F. Fibrin glue in the endoscopic treatment of fistulae and anastomotic leakages of the gastrointestinal tract. Int J Colorectal Dis. 2011 Mar;26(3):303-11. doi: 10.1007/s00384-010-1104-5
  38. Mees ST, Palmes D, Mennigen R, Senninger N, Haier J, Bruewer M. Endo-vacuum assisted closure treatment for rectal anastomotic insufficiency. Dis Colon Rectum. 2008 Apr;51(4):404-10. doi: 10.1007/s10350-007-9141-z
  39. Verlaan T, Bartels SA, van Berge Henegouwen MI, Tanis PJ, Fockens P, Bemelman WA. Early, minimally invasive closure of anastomotic leaks: a new concept. Colorectal Dis. 2011 Nov;13 Suppl 7:18-22. doi: 10.1111/j.1463-1318.2011.02775.x
  40. Arezzo A, Verra M, Passera R, Bullano A, Rapetti L, Morino M. Long-term efficacy of endoscopic vacuum therapy for the treatment of colorectal anastomotic leaks. Dig Liver Dis. 2015 Apr;47(4):342-45. doi: 10.1016/j.dld.2014.12.003
  41. Strangio G, Zullo A, Ferrara EC, Anderloni A, Carlino A, Jovani M, Ciscato C, Hassan C, Repici A. Endo-sponge therapy for management of anastomotic leakages after colorectal surgery: a case series and review of literature. Dig Liver Dis. 2015 Jun;47(6):465-69. doi: 10.1016/j.dld.2015.02.007
  42. Goldsmith HS, Griffith AL, Kupferman A, Catsimpoolas N. Lipid angiogenic factor from omentum. JAMA. 1984 Oct 19;252(15):2034-36. doi: 10.1001/jama.1984.03350150034017
  43. Konturek SJ, Brzozowski T, Majka I, Pawlik W, Stachura J. Omentum and basic fibroblast growth factor in healing of chronic gastric ulcerations in rats. Dig Dis Sci. 1994 May;39(5):1064-71. doi: 10.1007/BF02087559
  44. Walker FC, Rogers AW. The greater omentum as a site of antibody synthesis. Br J Exp Pathol. 1961 Jun; 42(3):222-31. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2082470/
  45. Gultekin FA, Bakkal BH, Tayfun S, Babuccu O, Comertet M. Chronic pelvic abscedation after completion proctectomy in a rectal stump insufficiency; treatment with gracilis muscle flap following vacuum assisted closure therapy. Ann Coloproctol. 2013 Aug;29(4):172-76. doi: 10.3393/ac.2013.29.4.172
Address for correspondence:
420000, The Russian Federation,
Kazan, Baturin Str., 49,
Kazan State Medical University,
Department of Oncology, X-ray Diagnostics and Radiotherapy,
Tel. +79274299671,
e-mail: drvasiliy21@gmail.com,
Vasiliy I. Egorov
Information about the authors:
Akhmetzyanov Foat Sh., MD, Professor, Head of the Department of Oncology, X-ray Diagnostics and Radiotherapy, Kazan State Medical University, Head of the Surgery Clinic, Republican Clinical Cancer Center, Kazan, Russian Federation.
https://orcid.org/0000-0002-4516-1997
Egorov Vasiliy I., PhD, Assistant of the Department of Oncology, X-ray Diagnostics and Radiotherapy, Kazan State Medical University, Oncologist, Republican Clinical Cancer Center, Kazan, Russian Federation.
https://orcid.org/0000-0002-6603-1390

M.V. YAKIMAVA, K.N. ZHYLIAEVA, A.V. MIADZVEDZ, L.V. NAUMENKO, A.I. SUBACH

MOLECULAR MARKERS OF UVEAL MELANOMA

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

The literature review is dedicated to the molecular aspects of uveal melanoma.
Although uveal melanoma is a rare pathology, it is characterized by poor prognosis associated with a high probability of tumor progression. According to current conceptions, the availability of clinical and pathomorphological criteria is insufficient for making a correct differential diagnosis of the disease, stratification of metastatic disease risk, evaluation of the disease prognosis and the tumor response to therapy. The molecular genetic study is a valuable supplement to the current techniques.
A number of molecular-biological features are characteristic for uveal melanoma, which could be used as diagnostic criteria of this tumor, as well as for evaluation of its metastatic potential. The review presents the current notion of the benefits and limitations in application of cytogenetic markers, gene expression profiling and driver mutations as prognostic factors of uveal melanoma. Nevertheless, despite the considerable number of articles, there is no ambiguity in understanding molecular mechanisms of uveal melanoma carcinogenesis and especially in the disease progression. Today there are neither reliable criteria for predicting the neoplastic process nor the algorithm for the early detection of metastatasis, which makes further research a high-priority task.

Keywords: uveal melanoma, prognostic markers, cytogenetic aberrations, gene expression profiling, mutations
p. 443-452 of the original issue
References
  1. Damato B. Progress in the management of patients with uveal melanoma. The 2012 Ashton Lecture. Eye (Lond). 2012 Sep;26(9):1157-72. doi: 10.1038/eye.2012.126
  2. Kowal J, Strzałka A, Markiewicz A, Romanowska-Dixon B, Bogdali A. Bilateral choroidal melanoma - case analysis and literature review. Klin Oczna. 2015;117(2):92-95. https://www.ncbi.nlm.nih.gov/pubmed/26638545
  3. Shields CL, Kaliki S, Arepalli S, Atalay HT, Manjandavida FP, Pieretti G, Shields JA. Uveal melanoma in children and teenagers. Saudi J Ophthalmol. 2013 Jul;27(3):197-201. doi: 10.1016/j.sjopt.2013.06.013
  4. Andreoli MT, Mieler WF, Leiderman YI. Epidemiological trends in uveal melanoma. Br J Ophthalmol. 2015 Nov;99(11):1550-53. doi: 10.1136/bjophthalmol-2015-306810
  5. Virgili G, Gatta G, Ciccolallo L, Capocaccia R, Biggeri A, Crocetti E, Lutz JM, Paci E. Incidence of uveal melanoma in Europe. Ophthalmology. 2007 Dec;114(12):2309-15. doi: 10.1016/j.ophtha.2007.01.032
  6. Buzzacco DM, Abdel-Rahman MH, Park S, Davidorf F, Olencki T, Cebulla CM. Long-term survivors with metastatic uveal melanoma. Open Ophthalmol J. 2012 Jun;6:49-53. doi: 10.2174/1874364101206010049
  7. Brovkina AF, Stoyukhina AS, Chesalin IP. Size-based classification of choroidal melanoma and its role in treatment decision-making. Vestn Oftalmol. 2016 Mar-Apr;132(2):4-7. doi: 10.17116/oftalma201613224-7. [Article in Russian; Abstract available in Russian from the publisher]
  8. Shields CL, Kaliki S, Furuta M, Fulco E, Alarcon C, Shields JA. American Joint Committee on Cancer classification of posterior uveal melanoma (tumor size category) predicts prognosis in 7,731 patients. Ophthalmology. 2013 Oct; 120(10):2066-71. doi: 10.1016/j.ophtha.2013.03.012
  9. Shields CL, Kaliki S, Furuta M, Fulco E, Alarcon C, Shields JA. American Joint Committee on Cancer classification of uveal melanoma (anatomic stage) predicts prognosis in 7,731 patients: the 2013 Zimmerman Lecture. Ophthalmology. 2015 Jun;122(6):1180-86. doi: 10.1016/j.ophtha.2015.01.026
  10. Damato B, Eleuteri A, Taktak AF, Coupland SE. Estimating prognosis for survival after treatment of choroidal melanoma. Prog Retin Eye Res. 2011 Sep;30(5):285-95. doi: 10.1016/j.preteyeres.2011.05.003
  11. Hsueh EC, Essner R, Foshag LJ, Ye X, Wang HJ, Morton DL. Prolonged survival after complete resection of metastases from intraocular melanoma. Cancer. 2004 Jan 1;100(1):122-29. doi: 10.1002/cncr.11872
  12. Rietschel P, Panageas KS, Hanlon C, Patel A, Abramson DH, Chapman PB. Variates of survival in metastatic uveal melanoma. J Clin Oncol. 2005 Nov 1;23(31):8076-80. doi: 10.1200/JCO.2005.02.6534
  13. Mallikarjuna K, Pushparaj V, Biswas J, Krishnakumar S. Expression of epidermal growth factor receptor, ezrin, hepatocyte growth factor, and c-Met in uveal melanoma: an immunohistochemical study. Curr Eye Res. 2007 Mar;32(3):281-90. doi: 10.1080/02713680601161220
  14. Carvajal RD, Schwartz GK, Tezel T, Marr B, Francis JH, Nathan PD. Metastatic disease from uveal melanoma: treatment options and future prospects. Br J Ophthalmol. 2017 Jan;101(1):38-44. doi: 10.1136/bjophthalmol-2016-309034
  15. Coupland SE, Lake SL, Zeschnigk M, Damato BE. Molecular pathology of uveal melanoma. Eye (Lond). 2013 Feb;27(2):230-42. doi: 10.1038/eye.2012.255
  16. van Engen-van Grunsven AC, Baar MP, Pfundt R, Rijntjes J, Küsters-Vandevelde HV, Delbecq AL, Keunen JE, Klevering JB, Wesseling P, Blokx WA, Groenen PJ. Whole-genome copy-number analysis identifies new leads for chromosomal aberrations involved in the oncogenesis and metastastic behavior of uveal melanomas. Melanoma Res. 2015 Jun;25(3):200-9. doi: 10.1097/CMR.0000000000000152
  17. Metz CH, Lohmann D, Zeschnigk M, Bornfeld N. Uveal melanoma: current insights into clinical relevance of genetic testing. Klin Monbl Augenheilkd. 2013 Jul;230(7):686-91. doi: 10.1055/s-0033-1350628. [Article in German]
  18. Ewens KG, Kanetsky PA, Richards-Yutz J, Al-Dahmash S, De Luca MC, Bianciotto CG, Shields CL, Ganguly A. Genomic profile of 320 uveal melanoma cases: chromosome 8p-loss and metastatic outcome. Invest Ophthalmol Vis Sci. 2013 Aug;54(8):5721-29. doi: 10.1167/iovs.13-12195
  19. Harbour JW, Chen R. The decisiondx-UM gene expression profile test provides risk stratification and individualized patient care in uveal melanoma. PLoS Curr. 2013 Apr 9;5. pii: ecurrents.eogt.af8ba80fc776c8f1ce8f5dc485d4a618. doi: 10.1371/currents.eogt.af8ba80fc776c8f1ce8f5dc485d4a618
  20. Plasseraud KM, Wilkinson JK, Oelschlager KM, Poteet TM, Cook RW, Stone JF, Monzon FA. Gene expression profiling in uveal melanoma: technical reliability and correlation of molecular class with pathologic characteristics. Diagn Pathol. 2017 Aug;12(1):59. doi: 10.1186/s13000-017-0650-3
  21. Aberg TM Jr, Cook RW, Oelschlager K, Maetzold D, Rao PK, Mason JO 3rd. Current clinical practice: differential management of uveal melanoma in the era of molecular tumor analyses. Clin Ophthalmol. 2014 Dec 3;8:2449-60. doi: 10.2147/OPTH.S70839. eCollection 2014.
  22. Walter SD, Chao DL, Feuer W, Schiffman J, Char DH, Harbour JW. Prognostic implications of tumor diameter in association with gene expression profile for uveal melanoma. JAMA Ophthalmol. 2016 Jul;134(7):734-40. doi: 10.1001/jamaophthalmol.2016.0913
  23. Onken MD, Worley LA, Char DH, Augsburger JJ, Correa ZM, Nudleman E, Aaberg TM Jr, Altaweel MM, Bardenstein DS, Finger PT, Gallie BL, Harocopos GJ, Hovland PG, McGowan HD, Milman T, Mruthyunjaya P, Simpson ER, Smith ME, Wilson DJ, Wirostko WJ, Harbour JW. Collaborative ocular oncology group report number 1: prospective validation of a multi-gene prognostic assay in uveal melanoma. Ophthalmology. 2012 Aug;119(8):1596-603. doi: 10.1016/j.ophtha.2012.02.017
  24. Harbour JW. A prognostic test to predict the risk of metastasis in uveal melanoma based on a 15-gene expression profile. Methods Mol Biol. 2014;1102:427-40. doi: 10.1007/978-1-62703-727-3_22
  25. Onken MD, Worley LA, Ehlers JP, Harbour JW. Gene expression profiling in uveal melanoma reveals two molecular classes and predicts metastatic death. Cancer Res. 2004 Oct;64(20):7205-9. doi: 10.1158/0008-5472.CAN-04-1750
  26. Onken MD, Worley LA, Tuscan MD, Harbour JW. An accurate, clinically feasible multi-gene expression assay for predicting metastasis in uveal melanoma. J Mol Diagn. 2010 Jul;12(4):461-68. doi: 10.2353/jmoldx.2010.090220
  27. Gill HS, Char DH. Uveal melanoma prognostication: from lesion size and cell type to molecular class. Can J Ophthalmol. 2012 Jun;47(3):246-53. doi: 10.1016/j.jcjo.2012.03.038
  28. Field MG, Harbour JW. Recent developments in prognostic and predictive testing in uveal melanoma. Curr Opin Ophthalmol. 2014 May;25(3):234-39. doi: 10.1097/ICU.0000000000000051
  29. Amaro A, Gangemi R, Piaggio F, Angelini G, Barisione G, Ferrini S, Pfeffer U. The biology of uveal melanoma. Cancer Metastasis Rev. 2017 Mar;36(1):109-40. doi: 10.1007/s10555-017-9663-3
  30. Van Raamsdonk CD, Griewank KG, Crosby MB, Garrido MC, Vemula S, Wiesner T, Obenauf AC, Wackernagel W, Green G, Bouvier N, Sozen MM, Baimukanova G, Roy R, Heguy A, Dolgalev I, Khanin R, Busam K, Speicher MR, O’Brien J, Bastian BC. Mutations in GNA11 in uveal melanoma. N Engl J Med. 2010 Dec;363(23):2191-99. doi: 10.1056/NEJMoa1000584
  31. Van Raamsdonk CD, Bezrookove V, Green G, Bauer J, Gaugler L, O’Brien JM, Simpson EM, Barsh GS, Bastian BC. Frequent somatic mutations of GNAQ in uveal melanoma and blue naevi. Nature. 2009 Jan;457(7229):599-602. doi: 10.1038/nature07586
  32. Decatur CL, Ong E, Garg N, Anbunathan H, Bowcock AM, Field MG, Harbour JW. Driver mutations in uveal melanoma: associations with gene expression profile and patient outcomes. JAMA Ophthalmol. 2016 Jul;134(7):728-33. doi: 10.1001/jamaophthalmol.2016.0903
  33. Koopmans AE, Vaarwater J, Paridaens D, Naus NC, Kilic E, de Klein A. Rotterdam ocular melanoma study group. Patient survival in uveal melanoma is not affected by oncogenic mutations in GNAQ and GNA11. Br J Cancer. 2013 Jul; 109(2):493-96. doi: 10.1038/bjc.2013.299
  34. Yu FX, Luo J, Mo JS, Liu G, Kim YC, Meng Z, Zhao L, Peyman G, Ouyang H, Jiang W, Zhao J, Chen X, Zhang L, Wang CY, Bastian BC, Zhang K, Guan KL. Mutant Gq/11 promote uveal melanoma tumorigenesis by activating YAP. Cancer Cell. 2014 Jun;25(6):822-30. doi: 10.1016/j.ccr.2014.04.017
  35. Moroishi T, Hansen CG, Guan KL. The emerging roles of YAP and TAZ in cancer. Nat Rev Cancer. 2015 Feb;15(2):73-79. doi: 10.1038/nrc3876
  36. Sorrentino G, Ruggeri N, Specchia V, Cordenonsi M, Mano M, Dupont S, Manfrin A, Ingallina E, Sommaggio R, Piazza S, Rosato A, Piccolo S, Del Sal G. Metabolic control of YAP and TAZ by the mevalonate pathway. Nature Cell Biology. 2014 Apr;16(4):357-66. doi: 10.1038/ncb2936
  37. Johansson P, Aoude LG, Wadt K, Glasson WJ, Warrier SK, Hewitt AW, Kiilgaard JF, Heegaard S, Isaacs T, Franchina M, Ingvar C, Vermeulen T, Whitehead KJ, Schmidt CW, Palmer JM, Symmons J, Gerdes AM, Jönsson G, Hayward NK. Deep sequencing of uveal melanoma identifies a recurrent mutation in PLCB4. Oncotarget. 2016 Jan;7(4):4624-31. doi: 10.18632/oncotarget.6614
  38. Moore AR, Ceraudo E, Sher JJ, Guan Y, Shoushtari AN, Chang MT, Zhang JQ, Walczak EG, Kazmi MA, Taylor BS, Huber T, Chi P, Sakmar TP, Chen Y. Recurrent activating mutations of G-protein-coupled receptor CYSLTR2 in uveal melanoma. Nat Genet. 2016 Jun;48(6):675-80. doi: 10.1038/ng.3549
  39. Harbour JW, Onken MD, Roberson ED, Duan S, Cao L, Worley LA, Council ML, Matatall KA, Helms C, Bowcock AM. Frequent mutation of BAP1 in metastasizing uveal melanomas. Science. 2010 Dec;330(6009):1410-13. doi: 10.1126/science.1194472
  40. Helgadottir H, Höiom V. The genetics of uveal melanoma: current insights. Appl Clin Genet. 2016 Sep;9:147-55. doi: 10.2147/TACG.S69210
  41. Koopmans AE, Verdijk RM, Brouwer RW, van den Bosch TP, van den Berg MM, Vaarwater J, Kockx CE, Paridaens D, Naus NC, Nellist M, van IJcken WF, KiliÇ E, de Klein A. Clinical significance of immunohistochemistry for detection of BAP1 mutations in uveal melanoma. Mod Pathol. 2014 Oct;27(10):1321-30. doi: 10.1038/modpathol.2014.43
  42. van de Nes JA, Nelles J, Kreis S, Metz CH, Hager T, Lohmann DR, Zeschnigk M. Comparing the prognostic value of BAP1 mutation pattern, chromosome 3 status, and BAP1 immunohistochemistry in uveal melanoma. Am J Surg Pathol. 2016 Jun;40(6):796-805. doi: 10.1097/PAS.0000000000000645
  43. Staby KM, Gravdal K, Mørk SJ, Heegaard S, Vintermyr OK, Krohn J. Prognostic impact of chromosomal aberrations and GNAQ, GNA11 and BAP1 mutations in uveal melanoma. Acta Ophthalmol. 2018 Feb;96(1):31-38. doi: 10.1111/aos.13452
  44. Masoomian B, Shields JA, Shields CL. Overview of BAP1 cancer predisposition syndrome and the relationship to uveal melanoma. J Curr Ophthalmol. 2018 Jun;30(2):102-109. doi: 10.1016/j.joco.2018.02.005
  45. Field MG, Decatur CL, Kurtenbach S, Gezgin G, van der Velden PA, Jager MJ, Kozak KN, Harbour JW. PRAME as an independent biomarker for metastasis in uveal melanoma. Clin Cancer Res. 2016 Mar;22(5):1234-42. doi: 10.1158/1078-0432.CCR-15-2071
  46. Harbour JW, Roberson ED, Anbunathan H, Onken MD, Worley LA, Bowcock AM. Recurrent mutations at codon 625 of the splicing factor SF3B1 in uveal melanoma. Nat Genet. 2013 Feb;45(2):133-35. doi: 10.1038/ng.2523
  47. Yavuzyigitoglu S, Koopmans AE, Verdijk RM, Vaarwater J, Eussen B, van Bodegom A, Paridaens D, KiliÇ E, de Klein A. Uveal melanomas with SF3B1 mutations: a distinct subclass associated with late-onset metastases. Ophthalmology. 2016 May;123(5):1118-28. doi: 10.1016/j.ophtha.2016.01.023
  48. Ewens KG, Kanetsky PA, Richards-Yutz J, Purrazzella J, Shields CL, Ganguly T, Ganguly A. Chromosome 3 status combined with BAP1 and EIF1AX mutation profiles are associated with metastasis in uveal melanoma. Invest Ophthalmol Vis Sci. 2014 Jun 26;55(8):5160-67. doi: 10.1167/iovs.14-14550
  49. Martin M, Maßhöfer L, Temming P, Rahmann S, Metz C, Bornfeld N, van de Nes J, Klein-Hitpass L, Hinnebusch AG, Horsthemke B, Lohmann DR, Zeschnigk M. Exome sequencing identifies recurrent somatic mutations in EIF1AX and SF3B1 in uveal melanoma with disomy 3. Nat Genet. 2013 Aug;45(8):933-36. doi: 10.1038/ng.2674
Address for correspondence:
223040, The Republic of Belarus,
Lesnoy,
N.N. Alexandrov National Cancer Centre of Belarus,
Republican Molecular-Genetic
Laboratory of Carcinogenesis,
Oncologic Unit (Genetics).
Tel. +375 (29) 667 93 34,
e-mail: helen_suboch@mail.ru,
Elena I. Suboch
Information about the authors:
Yakimava Maryia V., Physician of Laboratory Diagnostics of the Oncology Unit (Genetics) of the Republican Molecular-Genetic Laboratory of Carcinogenesis, N.N. Alexandrov National Cancer Centre of Belarus, Minsk, Republic of Belarus.
http://orcid.org/0000-0002-5522-3223
Zhyliaeva Katsiaryna P., Ophthalmologist of the Consultative-Out-Patient Department, N.N. Alexandrov National Cancer Centre of Belarus, Minsk, Republic of Belarus.
https://orcid.org/0000-0003-2964-6895
Miadzvedz Antanina V., Physician of Laboratory Diagnostics of the Oncology Unit (Cellular Technologies) of the Republican Molecular-Genetic Laboratory of Carcinogenesis, N.N. Alexandrov National Cancer Centre of Belarus, Minsk, Republic of Belarus.
http://orcid.org/0000-0002-5687-1775
Naumenko Larisa V., PhD, Ophthalmologist of the Unit of Head and Neck Tumors, N.N. Alexandrov National Cancer Centre of Belarus, Minsk, Republic of Belarus.
http://orcid.org/0000-0002-1875-9176
Subach Alena I., PhD, Physician of Laboratory Diagnostics (Head) of the Oncology Unit (Genetics) of the Republican Molecular-Genetic Laboratory of Carcinogenesis, N.N. Alexandrov National Cancer Centre of Belarus, Minsk, Republic of Belarus.
http://orcid.org/0000-0002-3939-6597

V.P. ZEMLYANOI 1, B.V. SIGUA 1, S.V. PETROV 2, V.A. IGNATENKO 2, P.A. KOTKOV 2

SURGICAL TREATMENT OF PATIENTS WITH TERTIARY PERITONITIS

North-Western State Medical University named after I.I. Mechnikov 1,
St. Petersburg State Health Care Institution "Elizabethan Hospital" 2, Saint-Petersburg,
The Russian Federation

The problems of tertiary peritonitis treating are described in a large amount of scientific papers covering various aspects of this disease. The analysis of the literature shows an increased frequency of persistent peritonitis among patients of surgical units and the lack of unified approaches to its treatment. The diagnostic criteria of tertiary peritonitis are extremely non-specific, which makes it difficult to work out an effective treatment program. This article focuses on adequate sanitation of the abdominal cavity as one of the main therapeutic components. The use of planned and “on demand” relaparotomies was introduced into clinical practice long ago, however, no clear indications for the use of specific operational tactics were found in the available literature. A comparative assessment is given to different ways of abdominal cavity managing (open, closed, half-open, half-closed). The main ways of operative injury minimizing, that inevitably accompanies repeated surgical interventions and leads to the development of abdominal complication, are considered. Obviously, the problem of tertiary peritonitis is far from its final decision, and further scientific research aimed at surgical approaches upgrade should help to improve the results of treatment.

Keywords: tertiary peritonitis, planned relaparotomy, laparostomy, “on demand” relaparotomy, sanitation of the abdominal cavity
p. 453-460 of the original issue
References
  1. Sartelli M, Viale P, Koike K, Pea F, Tumietto F, van Goor H, Guercioni G, Nespoli A, Tranà C, Catena F, Ansaloni L, Leppaniemi A, Biffl W, Moore FA, Poggetti R, Pinna AD, Moore EE, WSES consensus conference: Guidelines for first-line management of intra-abdominal infections. World J Emerg Surg. 2011;6:2. Published online 2011 Jan 13. doi: 10.1186/1749-7922-6-2
  2. Budamala S, Penugonda A, Prakash G, Ramaniah NV, Muralikrishna K, Gopikrishna B. Evaluation of various prognostic factors in perforative peritonitis management. J Evid Based Healthc (JEBH). 2015 Sep;2(38):6027-35. doi: 10.18410/jebmh/2015/831
  3. Ballus J, Lopez-Delgado JC, Sabater-Riera J, Perez-Fernandez XL, Betbese AJ, Roncal JA. Factors Associated with the Development of Tertiary Peritonitis in Critically Ill Patients. Surg Infect (Larchmt). 2017 Jul;18(5):588-95. doi: 10.1089/sur.2016.018
  4. Nathens AB, Rotstein OD, Marshall JC. Tertiary peritonitis: clinical features of a complex nosocomial infection. World J Surg. 1998 Feb;22(2):158-63. doi: 10.1007/s002689900364
  5. De Waele JJ. Abdominal Sepsis. Curr Infect Dis Rep. 2016 Aug;18(8):23. doi: 10.1007/s11908-016-0531-z
  6. Tolonen M, Mentula P, Sallinen V, Rasilainen S, Bäcklund M, Leppäniemi A. Open abdomen with vacuum-assisted wound closure and mesh-mediated fascial traction in patients with complicated diffuse secondary peritonitis: A single-center 8-year experience. J Trauma Acute Care Surg. 2017 Jun;82(6):1100-05. doi: 10.1097/TA.0000000000001452
  7. Shlyapnikov SA, Nasser NR, Batyrshin IM. Tertiary peritonitis and antibacterial therapy: solution approach (analytical review). Klin i Eksperim Khirurgiia. Zhurn im akad BV Petrovskogo. 2013;(1):47-53. https://cyberleninka.ru/article/v/tretichnyy-peritonit-i-antibakterialnaya-terapiya-puti-resheniya-analiticheskiy-obzor (in Russ.)
  8. Stawicki SP, Brooks A, Bilski T, Scaff D, Gupta R, Schwab CW, Gracias VH. The concept of damage control: extending the paradigm to emergency general surgery. Injury. 2008 Jan;39(1):93-101. doi: 10.1016/j.injury.2007.06.011
  9. Zharikov AN, Lubianskii VG, Aliev AR. Khirurgicheskie tekhnologii otkrytogo vedeniia briushnoi polosti u bol’nykh posleoperatsionnym peritonitom. Biul Med Nauki. 2018;(2):76-80. https://bmn.asmu.ru/wp-content/uploads/2018/10/%E2%84%962102018.pdf (in Russ.)
  10. Schein M. Surgical management of intra-abdominal infection: is there any evidence? Langenbecks Arch Surg. 2002 Apr;387(1):1-7. doi: 10.1007/s00423-002-0276-z
  11. Rakić M, Popović D, Rakić M, Druzijanić N, Lojpur M, Hall BA, Williams BA, Sprung J. Comparison of on-demand vs planned relaparotomy for treatment of severe intra-abdominal infections. Croat Med J. 2005 Dec;46(6):957-63. http://www.cmj.hr/2005/46/6/16342350.pdf
  12. Maskin SS, Karsanov AM, Derbenzeva TV. Klimovich IN, Pavlov AV, Matyukhin VV, Erofitskaya VV. The basics of a differentiated approach to the treatment of colonic peritonitis. Vestn Khirurg Gastroenterologii. 2017;(1):17-23. https://elibrary.ru/item.asp?id=29842769 (in Russ.)
  13. Avakimyan VA, Karipidi GÊ, Avakimyan SV, Aluhanyan OA, Potyagajlo EG, Marchenko NV, Didigov MT, Babenko ES. Programmed relaparotomy in the treatment of general purulent peritonitis. Kuban Nauch Med Vestn. 2017;24(6):12-16. doi: 10.25207/1608-6228-2017-24-6-12-16 (in Russ.)
  14. Sukovatykh BS, Blinkov IuIu. New methods of treatment of the diffused peritonitis. Vestn Eksperim i Klin Khirurgii. 2014;(2):165-76. https://vestnik-surgery.com/index.php/journal/article/download/100/71 (in Russ.)
  15. Malkov IS. Filippov VA, Korobkov VN, Tagirov MR. Generalized peritonitis: evolution of surgical treatment methods. Prakt Meditsina. 2017;(6):46-49. https://www.yumpu.com/xx/embed/view/OnuWIhG1Lt3QmKEk (in Russ.)
  16. Tskhai VF, Merzlikin NV, Sorokin RV, Barabash VI, Khlebnikova IuA. Relaparotomy and laparostomy in treatment of early postoperative complications. Khirurgiia. Zhurn im NI Pirogova. 2011;(6):27-31. https://www.mediasphera.ru/issues/khirurgiya-zhurnal-im-n-i-pirogova/2011/6/030023-1207201165 (in Russ.)
  17. van Ruler O, Mahler CW, Boer KR, Reuland EA, Gooszen HG, Opmeer BC, de Graaf PW, Lamme B, Gerhards MF, Steller EP, van Till JW, de Borgie CJ, Gouma DJ, Reitsma JB, Boermeester MA. Comparison of on-demand vs planned relaparotomy strategy in patients with severe peritonitis: a randomized trial. JAMA. 2007 Aug 22;298(8):865-72. doi: 10.1001/jama.298.8.865
  18. Zügel N, Siebeck M, Geissler B, Lichtwark-Aschoff M, Gippner-Steppert C, Witte J, Jochum M. Circulating mediators and organ function in patients undergoing planned relaparotomy vs conventional surgical therapy in severe secondary peritonitis. Arch Surg. 2002 May;137(5):590-99. doi: 10.1001/archsurg.137.5.590
  19. Lamme B, Boermeester MA, Belt EJ, van Till JW, Gouma DJ, Obertop H. Mortality and morbidity of planned relaparotomy versus relaparotomy on demand for secondary peritonitis. Br J Surg. 2004 Aug;91(8):1046-54. doi: 10.1002/bjs.4517
  20. Atema JJ, Ram K, Schultz MJ, Boermeester MA. External validation of a decision tool to guide post-operative management of patients with secondary peritonitis. Surg Infect (Larchmt). 2017 Feb/Mar;18(2):189-95. doi: 10.1089/sur.2016.017
  21. van Ruler O, Kiewiet JJ, Boer KR, Lamme B, Gouma DJ, Boermeester MA, Reitsma JB. Failure of available scoring systems to predict ongoing infection in patients with abdominal sepsis after their initial emergency laparotomy. BMC Surg. 2011 Dec 23;11:38. doi: 10.1186/1471-2482-11-38
  22. Novotny AR, Emmanuel K, Hueser N, Knebel C, Kriner M, Ulm K, Bartels H, Siewert JR, Holzmann B. Procalcitonin ratio indicates successful surgical treatment of abdominal sepsis. Surgery. 2009 Jan;145(1):20-26. doi: 10.1016/j.surg.2008.08.009
  23. Bader FG, Schröder M, Kujath P, Muhl E, Bruch HP, Eckmann C. Diffuse postoperative peritonitis – value of diagnostic parameters and impact of early indication for relaparotomy. Eur J Med Res. 2009 Nov 3;14(11):491-96. doi: 10.1186/2047-783x-14-11-491
  24. Zdzitovetskiy DE, Borisov RN. Analysis of the frequency of general peritonitis and results his treatment in big hospital. Sovrem Problemy Nauki i Obrazovaniia. 2012;(2):47-52. https://www.science-education.ru/ru/article/view?id=5771
  25. van Westreenen M, Mul FJ, Pronk A, Hoynck van Papendrecht AA, Diepersloot RJ, Roos D, Leguit P. Influence of peroperative lavage solutions on peritoneal defence mechanisms in vitro. Eur J Surg. 1999 Nov;165(11):1066-71. doi: 10.1080/110241599750007919
  26. KoÇ TR, Tarhan ÖR, Sar?c?k B. Effects of peritoneal lavage and dry cleaning on bacterial translocation in a model of peritonitis developed using cecal ligation and puncture. Ulus Travma Acil Cerrahi Derg. 2018 Jul;24(4):281-86. doi: 10.5505/tjtes.2017.97838
  27. Savel’ev VS, Gel’fand BR, Filimonov MI. Peritonit. Moscow, RF: Litterra; 2006. 206 p. https://studfiles.net/preview/1564175/ (in Russ.)
  28. Xian-Wen D, Shi-Liang H, Zhou-Hua J, Yu-Fei S, Xue-Song Z. Nasointestinal tubes versus nasogastric tubes in the management of small-bowel obstruction. Medicine (Baltimore). 2018;97(36):e12175. doi: 10.1097/MD.0000000000012175
  29. Fazel MZ, Jamieson RW, Watson CJE. Long-Term Follow-Up of the Use of the Jones’ Intestinal Tube in Adhesive Small Bowel Obstruction. Ann R Coll Surg. 2009;91(1):50-54. doi: 10.1308/003588409X358999
  30. Rebibo L, Ebosse I, Iederan C, Mahjoub Y, Dupont H, Cosse C, Regimbeau JM. Does drainage of the peritoneal cavity have an impact on the postoperative course of community-acquired, secondary, lower gastrointestinal tract peritonitis? Am J Surg. 2017 Jul;214(1):29-36. doi: 10.1016/j.amjsurg.2016.09.031
  31. Müller V, Koplin G, Pratschke J, Raue W. The treatment of acute secondary peritonitis: A retrospective analysis of the use of continuous negative pressure therapy. Med Klin Intensivmed Notfmed. 2018 May;113(4):299-304. doi: 10.1007/s00063-017-0309-6
  32. Hofmann AT, Gruber-Blum S, Lechner M, Petter-Puchner A, Glaser K, Fortelny R. Delayed closure of open abdomen in septic patients treated with negative pressure wound therapy and dynamic fascial suture: the long-term follow-up study. Surg Endosc. 2017 Nov;31(11):4717-24. doi: 10.1007/s00464-017-5547-4
  33. Mintziras I, Miligkos M, Bartsch DK. High risk of fistula formation in vacuum-assisted closure therapy in patients with open abdomen due to secondary peritonitis-a retrospective analysis. Langenbecks Arch Surg. 2016 Aug;401(5):619-25. doi: 10.1007/s00423-016-1443-y
  34. van Ruler O, van Boermeester MA. Surgical treatment of secondary peritonitis: a continuing problem. Chirurg. 2017 Jan;88(Suppl 1):1-6. doi: 10.1007/s00104-015-0121-x
  35. Pommerening MJ, DuBose JJ, Zielinski MD, Phelan HA, Scalea TM, Inaba K, Velmahos GC, Whelan JF, Wade CE, Holcomb JB, Cotton BA. Time to first take-back operation predicts successful primary fascial closure in patients undergoing damage control laparotomy. Surgery. 2014 Aug;156(2):431-38. doi: 10.1016/j.surg.2014.04.019
  36. Goussous N, Jenkins DH, Zielinski MD. Primary fascial closure after damage control laparotomy: sepsis vs haemorrhage. Injury. 2014 Jan;45(1):151-55. doi: 10.1016/j.injury.2013.01.039
  37. Atema JJ, Gans SL, Boermeester MA. Systematic review and meta-analysis of the open abdomen and temporary abdominal closure techniques in non-trauma patients. World J Surg. 2015 Apr;39(4):912-25. doi: 10.1007/s00268-014-2883-6
  38. Karakose O, Benzin MF, Pülat H, Sabuncuoglu MZ, Eken H, Zihni I, Barut I. Bogota bag use in planned re-laparotomies. Med Sci Monit. 2016 Aug 17;22:2900-4. doi: 10.12659/MSM.897109
  39. Regner JL, Kobayashi L, Coimbra R. Surgical strategies for management of the open abdomen. World J Surg. 2012 Mar;36(3):497-510. doi: 10.1007/s00268-011-1203-7
  40. Stevens P. Vacuum-assisted closure of laparostomy wounds: a critical review of the literature. Int Wound J. 2009 Aug;6(4):259-66. doi: 10.1111/j.1742-481X.2009.00614.x
Address for correspondence:
191015, The Russian Federation,
Saint Petersburg, Kirochnaya Str., 41,
North-Western State Medical
University named after I.I. Mechnikov,
Department of the Faculty Surgery named after I.I. Grekov.
Tel. +790626192131,
e-mail: kotkovdr@mail.ru
Pavel A. Kotkov
Information about the authors:
Zemlianoi Viacheslav P., MD, Professor, Head of the Department of the Faculty Surgery named after I.I. Grekov, North-Western State Medical University named after I.I. Mechnikov, Saint Petersburg, Russian Federation.
https://orcid.org/0000-0003-2329-0023
Sigua Badri V., MD, Professor of the Department of the Faculty Surgery named after I.I. Grekov, North-Western State Medical University named after I.I. Mechnikov, Saint Petersburg, Russian Federation.
https://orcid.org/0000-0002-4556-4913
Petrov Sergey V., MD, Professor, Chief Physician of St. Petersburg State Health Care Institution Elizabethan Hospital, Saint Petersburg, Russian Federation.
https://orcid.org/0000-0003-4398-5770
Ignatenko Viktor A., Head of the Surgical Unit ¹2, St. Petersburg State Health Care Institution Elizabethan Hospital, Saint Petersburg, Russian Federation.
https://orcid.org/0000-0002-6615-3005
Kotkov Pavel A., PhD, Surgeon of the Surgical Unit¹2, St. Petersburg State Health Care Institution Elizabethan Hospital, Saint Petersburg, Russian Federation.
https://orcid.org/0000-0002-9762-9854

CASE REPORTS

E.V. KRASNIKOVA, L.A. POPOVA, R.V. TARASOV, V.K. ALIEV, JU.V. TUROVTñEVA, À.S. IBRIEV, S.S. SADOVNIKOVA, M.A. BAGIROV

A ÑASE OF BILATERAL SILICONE PLOMBAGE AND VALVE BRONCHOBLOCATION IN A PATIENT WITH WIDESPREAD FIBRO-CAVERNOUS DRUG RESISTANT TUBERCULOSIS OF THE OPERATED LUNG

Central Tuberculosis Research Institute, Moscow,
The Russian Federation

A case report describes a patient with chronic bilateral drug resistant lung tuberculosis, who had previously undergone an ineffective resection of one lung. For the first time bilateral extrapleural pneumolysis surgery with silicone plombage has been performed. From the side of the operated lung the effect of collapse was boosted by installation of an endobronchial valve. This case demonstrates a typical situation of chronization of the destructive process due to a long-term treatment without taking into account the data of drug sensitivity of mycobacterium tuberculosis and performing surgery without combination with adequate chemotherapy. Resection surgery is ineffective due to the limitation of functional reserves of the patient. The combination of collapse-forming surgical and endoscopic techniques aimed to form compression and artificial atelectasis are being worked out contributing to the preservation of the entire volume of lung tissue and the healing of cavities. Traditional thoracoplasty is traumatic enough, especially in patients with low respiratory reserves and leads to a significant cosmetic damage. The clinic of Central Tuberculosis Research Institute has experience in performing effective and low-traumatic surgery of extrapleural silicone plombage. An indwelling silicone implant is not rejected by human body, provides a high compression effect and does not lead to cosmetic damage.
The use of the collapse-forming techniques led to clinical recovery of the patient, what was proved by the long-term examination data.

Keywords: tuberculosis, multidrug-resistant tuberculosis, collapse surgery, extrapleuralpneumolysis with silicone plombage, bilateral silicone plombage, operated lung
p. 461-468 of the original issue
References
  1. Sterlikov SA (red), Nechaeva OB, Son IM, Popov SA, Burykhin VS, Ponomarev SB, Testov VV, Rusa-
    kova LI, Kornienko SV, Strukova OV, Kucheriavaia DA, Obukhova OV, Dergachev AV. Otraslevye i ekonomicheskie pokazateli protivotuberkuleznoi raboty v 2016–2017 gg. Analiticheskii obzor osnovnykh pokazatelei i statisticheskie materialy. Moscow, RF: RIO TsNIIOIZ; 2018. 81 p. http://mednet.ru/images/stories/files/CMT/optb2016-2017.pdf (In Russ.)
  2. Testov VV, Sterlikov SA, Vasil’eva IA, Erokhin VV, Kesaeva TCh. Results of chemotherapy in patients with multidrug-resistant tuberculosis in the regions of the Russian Federation. Tuberkulez i Bolezni Legkikh. 2014;(4):9-13. https://www.tibl-journal.com/jour/article/view/56/57 (In Russ.)
  3. Falzon D, Schünemann HJ, Harausz E, GonzÁlez-Angulo L, Lienhardt Ch, Jaramillo E, Weyer K. World Health Organization treatment guidelines for drug-resistant tuberculosis, 2016 update. Eur Respir J. 2017 Mar;49(3):1602308. Published online 2017 Mar 23. doi: 10.1183/13993003.02308-2016
  4. Kang MW, Kim HK, Choi YS, Kim K, Shim YM, Koh WJ, Kim J. Surgical treatment for multidrug-resistant and extensive drug-resistant tuberculosis. Ann Thorac Surg. 2010 May;89(5):1597-602. doi: 10.1016/j.athoracsur.2010.02.020
  5. Dara M, Sotgiu G, Zaleskis R, Migliori GB. Untreatable tuberculosis: is surgery the answer? Eur Respir J. 2015 Mar;45(3):577-82. doi: 10.1183/09031936.00229514
  6. Shapovalov AS, Polezhaev AA, Belov SA. Collapse therapy in pulmonary tuberculosis: a return to basics. Tikhookean Med Zhurn. 2017;(1):84-87. doi: 10.17238/PmJ1609-1175.2017.1.84–87 (In Russ.)
  7. Belov SÀ. Thoracoplasty with polypropylene mesh in pulmonary tuberculosis treatment. Tuberculosis and Lung Diseases. 2017;95(12):6-9. doi: 10.21292/2075-1230-2017-95-12-6-9 (In Russ.)
  8. Sinitsyn MV, Agkatsev TV, Reshetnikov MN, Pozdnyakova EI, Itskov AV, Gazdanov TA, Plotkin DV. Extrapleural pneumolysis with filling in treatment of patients with destructive pulmonary tuberculosis. Khirurg. 2018;(1-2):54-63 https://elibrary.ru/item.asp?id=36921348 (In Russ.)
  9. Jouveshomme S, Dautzenberg B, Bakdach H, Derenne JP. Preliminary results of collapse therapy with plombage for pulmonary disease caused by multidrug-resistant mycobacteria. Am J Respir Crit Care Med. 1998 May;157(5 Pt 1):1609-15. doi: 10.1164/ajrccm.157.5.9709047
  10. Xie D, Huang D, Jiang G, Zhou X, Zhou Y, Ding J. Thoracic wall abscess as a late complication of extrapleural plombage. Ann Thorac Surg. 2013 Oct;96(4):e107. doi: 10.1016/j.athoracsur.2013.07.032
  11. Lovàchevà OV, Bàgirov MA, Bàgdàsàryan TR, Kràsnikovà EV, Sherginà EA, Gritsày IYu. Use of endobronchial valves and extrapleural sealing for treatment of bilateral massive cavities in a female patient with multiple drug resistant pulmonary tuberculosis. Tuberculosis and Lung Diseases. 2017;95(9):60-67. doi: 10.21292/2075-1230-2017-95-9-60-67. (In Russ.)
Address for correspondence:
107564, The Russian Federation,
Moscow, Yauz Alley Str., 2,
Central Tuberculosis Research Institute,
Surgery Department.
Tel.mobile +7(916) 573-29-76,
e-mail: el.krasn@gmail.com,
Elena V. Krasnikova
Information about the authors:
Krasnikova Elena V., PhD, Senior Researcher of the Surgery Department, Head of the Operative Unit of Central Tuberculosis Research Institute, Moscow, Russian Federation.
https://orcid.org/0000-0002-5879-7062
Popova Lydi A., PhD, Senior Researcher of the Functional Diagnostic Unit of the Clinical-Diagnostic Department of Central Tuberculosis Research Institute, Moscow, Russian Federation.
https://orcid.org/0000-0003-4571-8772
Aliev Vilayat K., Junior Researcher of the Surgery Department of Central Tuberculosis Research Institute, Moscow, Russian Federation.
https://orcid.org/0000-0002-0105-1980
Tarasov Ruslan V., Laboratory Assistant Researcher of the Surgery Department of Central Tuberculosis Research Institute, Moscow, Russian Federation.
https://orcid.org/0000-0001-9498-1142
Turovtceva Julia V., Physician of the Endoscopy Unit of the Clinical Diagnostic Department of Central Tuberculosis Research Institute, Moscow, Russian Federation.
https://orcid.org/0000-0002-7943-7285
Ibriev Adam S., Physician of the First Surgery Unit of the Surgical Department of Central Tuberculosis Research Institute, Moscow, Russian Federation.
https://orcid.org/0000-0002-9712-4442
Sadovnikova Svetlana S., MD, Head of the First Surgery Unit of the Surgical Department of Central Tuberculosis Research Institute, Moscow, Russian Federation.
https://orcid.org/0000-0002-6589-2834
Bagirov Mamed A., MD, Professor, Head of the Surgical Department of Central Tuberculosis Research Institute, Moscow, Russian Federation.
https://orcid.org/0000-0001-9788-1024

A.L. PETRUSHIN, A.V. PRYALUHINA, A.A. SIDOROV

NICOLAU SINDROME

Karpogory Central District Hospital,
The Russian Federation

The objective of this study is the clinical case of the Nicolau syndrome demonstration and a brief review of the literature on its diagnosis and treatment. Nicolau syndrome is a rare post-injection complication, characterized by the development of ischemic necrosis of the skin, subcutaneous tissue, and in some cases, muscle tissue, in the injection zone. The description of the clinical case is presented, in which after intramuscular injection of diclofenac the tissue and subcutaneous tissue of the gluteal region necrosis developed, requiring necrectomy and replacement of a soft tissue defect. The most common cause of Nicolau syndrome development is the non-steroidal anti-inflammatory drugs injections. Predisposing factors are overweight and accidental subcutaneous instead of intramuscular injection. Among the causes of development, most authors call angiospasm, small and medium artery embolism, and subsequent ischemia. Diagnosis based on clinical signs: the appearance immediately after injection of a clearly delineated ischemia patch, followed by the development of necrosis. In the early stages, conservative management, including anticoagulants, disaggregants and corticosteroids, is possible. In the presence of necrosis, their excision and replacement of the defect are indicated. Plastics with local tissues coverage can replace the extensive defects without large scars formation. Prevention of the Nicolau syndrome mainly consists of accidental subcutaneous and intravascular drug administration preventing.
The presented clinical case and a review of the literature suggest that Nicolau syndrome is a rare post-injection complication with unclear etiology and pathogenesis. A typical manifestation of this syndrome is necrosis of soft tissues in the injection site. The local skin-fascial flaps using is the effective method of the defects coverage after debridement necrectomy.

Keywords: Nicolau syndrome, livedoid dermatitis, skin necrosis, intramuscular injection, post-injection complications
p. 469-474 of the original issue
References
  1. Dadaci M, Altuntas Z, Ince B, Bilgen F, Tufekci O, Poyraz N. Nicolau syndrome after intramuscular injection of non-steroidal anti-inflammatory drugs (NSAID). Bosn J Basic Med Sci. 2015 Jan 8;15(1):57-60. doi: 10.17305/bjbms.2015.1.190
  2. Senel E. Nicolau syndrome: a review of the literature. Clin Med Insight Dermatol. 2010 Feb;3:1-4. doi: 10.4137/CMD.S363
  3. Lie C, Leung F, Chow SP. Nicolau syndrome following intramuscular diclofenac administration: a case report. J OrthopSurg (Hong Kong). 2006 Apr;14(1):104-7. doi: 10.1177/230949900601400123
  4. Madke B, Kar S, Prasad K, Yadar N, Singh N. A fatal case of Nicolau syndrome. Ind J PaediatrDermatol. 2014;15(2):92-93. doi: 10.4103/2319-7250.139510
  5. Nischal KC, Basavarai HB, Swaroop MR, Agrawal DP, Sathyanarayana BD, Umashankar NP. Nicolau syndrome: an iatrogenic cutaneous necrosis. J CutanAesthet Surg. 2009 Jul-Dec;2(2):92-95. doi: 10.4103/0974-2077.58523
  6. Rygnestad T, Kvam AM. Streptococcal myositis and tissue necrosis with intramuscular administration of diclofenac (Voltaren). Acta Anaesthesiol Scand. 1995 Nov;39(8):1128-30.doi: 10.1111/j.1399-6576.1995.tb04243.x
  7. Kim KK.,Chae DS. Nicolau syndrome: a literature review. World J Dermatol. 2015 May 2;4(2):103-107. doi: 10.5314/wjd.v4.i2.103
  8. Kilic I, Kaya F, Ozdemir AT, Demirel T, Celik I. Nicolau syndrome due to diclofenac sodium (Voltaren) injection: a case report. J Med Case Rep. 2014;8:404. doi: 10.1186/1752-1947-8-404
  9. Silva AMM, Loureiro TF, Ton A, Agrizzi BL. Late development of Nicolau syndrome – case report. An Bras Dermatol. 2011;86(1):157-59. doi: 10.1590/S0365-05962011000100026
  10. Okan G, Canter HI. Nicolau syndrome and perforator vessels: a new viewpoint for an old problem. Cutan Ocul Toxicol. 2010 Mar;29(1):70-72. doi: 10.3109/15569520903496753
  11. Nisbet AC. Intramuscular gluteal injections in the increasingly obese population: retrospective study. BMJ. 2006 Mar 18;332(7542):637-38.doi: 10.1136/bmj.38706.742731.47
  12. Park HJ, Kim MS, Park NH, Jung SW, Park SI, Park CS. Sonographic findings in Nicolau syndrome following intramuscular diclofenac injection: a case report. J Clin Ultrasound. 2011 Feb;39(2):111-13. doi: 10.1002/jcu.20743
  13. Chagas C, Leite T, Pires L. Post-injection embola cutis medicamentosa - Nicolau syndrome: case report and literature review. J Vasc Bras. 2016;15(1). doi: 10.1590/1677-5449.008315
  14. Maneshi A, Ravi S, Salehi MR, Hasannezhad M, Khalili H. Nicolau syndrome. ArchIranMed. 2017;20(1):60-64. http://ams.ac.ir/AIM/NEWPUB/17/20/1/0013.pdf
Address for correspondence:
164600, The Russian Federation,
Arkhangelsk region, Karpogory, Lenin Str., 47,
Karpogory Central District Hospital,
Surgery Unit,
Tel.mob. +7 921076-73-29,
e-mail: petrushin.59@mail.ru
Alexander L. Petrushin
Information about the authors:
Petrushin Alexander L., PhD, Head of the Surgery Unit, Karpogory Central District Hospital, Arkhangelsk Region, Karpogory, Russian Federation.
https://orcid.org/0000-0002-3246-7452
Pryaluhina Anastasia V., Gynecologist, Karpogory Central District Hospital, Arkhangelsk Region, Karpogory, Russian Federation.
https://orcid.org/0000-0002-9801-5782
Sidorov Alexey A., Surgeon, Karpogory Central District Hospital, Arkhangelsk Region, Karpogory, Russian Federation.
https://orcid.org/0000-0002-1345-6352

S.A. MARKOSYAN, N.S. MARKOSYAN

TERMINAL ILEITIS, COMPLICATED BY DOUGLAS SPACE ABSCESS IN 8-YEAR-OLD CHILD

National Research Ogarev Mordovia State University, Institute of Medicine, Saransk,
The Russian Federation

The report describes a clinical case of a child of 8 years old with terminal ileitis, complicated by Douglas space abscess. With performing ultrasound of the abdominal cavity organs, the appendicular infiltrate was suspected, and therefore the patient was transferred from the infectious diseases hospital to the children’s surgical hospital. After a re-ultrasound examination of the abdominal organs, the diagnosis was confirmed. The child underwent diagnostic laparoscopy, which allowed diagnosing terminal ileitis in the exacerbation stage, and laparoscopic appendectomy. After the operation the girl was observed in the resuscitation and intensive care unit, in which she got pathogenetic and symptomatic therapy. Despite the treatment, carried out in the early postoperative period, Douglas space abscess developed, accompanied by the abdominal pain, increase in body temperature to febrile numbers, appearance of biliary vomiting. Repeated laparoscopic surgery was carried out, aimed at sanitation and drainage of the abscess cavity. In the postoperative period, the intestinal peristalsis was additionally stimulated, physiotherapy treatment was conducted, and antibiotic therapy was corrected. As a result of treatment, the patient’s condition improved. The patient was transferred to another medical institution to provide her with high-technological medical care.

Keywords: terminal ileitis, small intestine, Douglas space abscess, laparoscopy, child
p. 475-479 of the original issue
References
  1. Ozhegov EV, Zhivotova EYu, Lebed’ko OA, Flejshman MYu, Alekseenko SA, Timoshin SS. Sostojanie proliferativnyh processov i vyrazhennost’ oksidativnogo stressa v slizistoj obolochke podvzdoshnoj kishki pri bolezni Krona. Bjul Jeksperim Biologii i Mediciny. 2011;152(10):400-403. (in Russ.)
  2. Levchenko SV, Samsonova NG, Orlova NV, Pavlov MV, Karpeeva AA, Lunin MA. Radiological small bowel imaging in Crohn’s disease patients. Eksperim Klin Gastroenterologiia. 2014;(7):38-44. https://elibrary.ru/item.asp?id=22565513 (in Russ.)
  3. Sobko VYu, Karpenko AK, Shchukina OB, Dementeva TV, Bogdanova EO. MRI Semiotics of Crohn’s Disease. Med Vizualizatsiia. 2013;(4):54-60. http://vidar.ru/Article.asp?fid=MV_2013_4_54 (in Russ.)
  4. Tatianina OF, Potapov AS, Namazova-Baranova LS, Tsimbalova YeG, Kucherenko AG. Calprotectin in diagnostics of the inflammatory bowel diseases in children. Vopr Diagnostiki v Pediatrii. 2009;1(1): 42-48. https://elibrary.ru/item.asp?id=12861661 (in Russ.)
  5. Stepanov IuM, Psar’ova IB. Rol’ biomarkeriv u diagnostitsi khronichnikh zapal’nikh zakhvoriuvan’ kishechnika. Gastroenterologiia. 2017;51(1):56-63. doi: 10.22141/2308-2097.51.1.2017.97872 (in Russ.)
  6. Budzak IIa. On the problem of differential diagnosis of inflammatory and functional bowel diseases. Gastroenterologiia. 2013;(2):81-85. https://docplayer.ru/59957745-K-voprosu-o-differencialnoy-diagnostike-vospalitelnyh-i-funkcionalnyh-zabolevaniy-kishechnika.html (in Russ.)
  7. Adamek HE, Schantzen W, Rinas U, Goyen M, Ajaj W, Esser C. Ultra-high-field magnetic resonance enterography in the diagnosis of ileitis (Neo-)terminalis: a prospective study. J Clin Gastroenterol. 2012 Apr;46(4):311-16. doi: 10.1097/MCG.0b013e31822fec0c
  8. Mege D, Panis Y. Laparoscopic surgery for inflammatory bowel disease. Koloproktologiia. 2018;(2):14-24. https://elibrary.ru/item.asp?id=35085420 (in Russ.)
  9. Dubrova SE, Stashuk GA. The potential of radiologic procedures in the diagnosis of inflammatory bowel disease. Al’m Klin Meditsiny. 2016 Avg-Sent;44(6):757-69. doi: 10.18786/2072-0505-2016-44-6-757-769 (in Russ.)
Address for correspondence:
430032, The Russian Federation,
Saransk, Ulyanov Str., 26à,
National Research Ogarev
Mordovia State University,
Institute of Medicine,
Department of the Faculty Surgery
with the Courses of Topographic Anatomy and
Operative Surgery, Urology and Pediatric Surgery.
Tel. mob. +79176990604,
e-mail: ru»markosyansa@mail.ru,
Sergey A. Markosyan
Information about the authors:
Markosyan Sergey A., MD, Associate Professor, Professor of the Department of the Faculty Surgery with the Courses of Topographic Anatomy and Operative Surgery, Urology and Pediatric Surgery, National Research Ogarev Mordovia State University, Institute of Medicine, Saransk, Russian Federation.
http://orcid.org/0000-0002-9876-4433
Markosyan Natalia S., PhD, Associate Professor of the Department of Infectious Diseases with the Coursesin Epidemiology, Phthisiology, Skin and Sexually Transmitted Diseases, National Research Ogarev Mordovia State University, Institute of Medicine, Saransk, Russian Federation.
http://orcid.org/0000-0003-3563-1075
Contacts | ©Vitebsk State Medical University, 2007-2023