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Year 2020 Vol. 28 No 4

SCIENTIFIC PUBLICATIONS
EXPERIMENTAL SURGERY

I.V. MAIBORODIN 1, A.A. SHEVELA 1, S.V. MARCHUKOV 1, V.V. MOROZOV 1, V.A. MATVEEVA 1, V.I. MAIBORODINA 2, A.M NOVIKOV 3, A.I. SHEVELA 1

REGENERATION OF THE BONE DEFECT AT EXPERIMENTAL APPLICATION OF EXTRACELLULAR MICROVESICLES FROM MULTIPOTENT STROMAL CELLS

Institute of Chemical Biology and Fundamental Medicine, The Russian Academy of Sciences, Siberian Branch 1,
Federal Research Center of Fundamental and Translational Medicine of the Ministry of Science and Higher Education of the Russian Federation, Institute of Molecular Pathology and Pathomorphology 2,
JSC Medical Center “Avicenna” 3, Novosibirsk,
The Russian Federation

Objective. To study the results of application extracellular microvesicles from rat multipotent mesenchymal stromal cells of the bone marrow origin (EMV) for the regeneration of rabbit bone defects, as well as to obtain data about the EMV preservation after their introduction into tissues.
Methods. The bone defect (2 mm diameter and 4 mm depth) was created in the proximal condyles of the outbred rabbit tibia. On the left limb the bone defect was filled with saline, on the right – the 50 μg EMV were introduced into defect.
Results. By the 12th day all control rabbits had retained a defect in the bone tissue with forming bone structures and hypertrophic scar in the border with intact areas.
In the most cases after the EMV introduction, no bone damage was found; the scar was thin with ordered structures of the intercellular matrix. 12 days after the application of Vybrant® CM-Dil-labeled EMV, in the periosteum and in adjacent bone marrow, vessels of bone tissue the single, very small, dust-like objects were found fluorescent in red on the background of rhodamine filter use. Sometimes the clear red tint of inclusions was noted in large cellular elements – macrophages. By the 21st day on the right (experimental), in 4 cases out of 5, only scar structures were found at the site of the bone tissue defect, while on the left (control) – only in 2 cases out of 5.
Conclusion. The preliminary results of the EMV application for the bone regeneration defect revealed the faster healing, the frequency of successful regeneration of the damaged bone and the formation of a less rough bone callus. In rabbits EMV are present in tissues at the site of application for at least 12 days. The number of the introduced EMV was found in macrophages.

Keywords: bone tissue, bone tissue regeneration, extracellular microvesicles, macrophages, luminescent microscopy
p. 359-369 of the original issue
References
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Address for correspondence:
630090, Russian Federation,
Novosibirsk, pr. Acad. Lavrenteva, 8,
Institute of Chemical Biology
and Fundamental Medicine,
Center for New Medical Technologies
tel. +7-913-753-0767
e-mail: imai@mail.ru,
Maiborodin Igor V.
Information about the authors:
Maiborodin Igor V., MD, Professor, Chief Researcher, Laboratory of Health Management Technologies, the Center of New Medical Technologies, Institute of Chemical Biology and Fundamental Medicine, the Russian Academy of Sciences, Siberian Branch, Novosibirsk, Russian Federation.
http://orcid.org/0000-0002-8182-5084
Shevela Aleksandr A., PhD, Doctoral Student of Laboratory of Health Management Technologies, the Center of New Medical Technologies, Institute of Chemical Biology and Fundamental Medicine, the Russian Academy of Sciences, Siberian Branch, Novosibirsk, Russian Federation.
http://orcid.org/0000-0001-9235-9384
Marchukov Sergey V., PhD, Doctoral Student of Laboratory of Health Management Technologies, the Center of New Medical Technologies, Institute of Chemical Biology and Fundamental Medicine, the Russian Academy of Sciences, Siberian Branch, Novosibirsk, Russian Federation.
https://orcid.org/0000-0002-7381-5820
Morozov Vitaly V., MD, Professor, Head of Laboratory of Health Management Technologies, the Center of New Medical Technologies, Institute of Chemical Biology and Fundamental Medicine, the Russian Academy of Sciences, Siberian Branch, Novosibirsk, Russian Federation.
https://orcid.org/0000-0002-9810-5593
Matveeva Vera A., PhD, Senior Researcher of Laboratory of Health Management Technologies, the Center of New Medical Technologies, Institute of Chemical Biology and Fundamental Medicine, the Russian Academy of Sciences, Siberian Branch, Novosibirsk, Russian Federation.
https://orcid.org/0000-0002-8706-4853
Maiborodina Vitalina I., MD, Leading Researcher, Laboratory of Ultrastructural Basis of Pathology, Institute of Molecular Pathology and Pathomorphology, Federal State Budget Scientific Institution “Federal Research Center of Fundamental and Translational Medicine”, Novosibirsk, Russian Federation.
http://orcid.org/0000-0002-5169-6373
Novikov Alexey M., Gynecologist of the Department of Gynecology, JSC Medical Center “Avicenna”, Novosibirsk, Russian Federation.
https://orcid.org/0000-0003-1371-7492
Shevela Andrey I., MD, Professor, Head of Department the Center of New Medical Technologies, Institute of Chemical Biology and Fundamental Medicine, the Russian Academy of Sciences, Siberian Branch, Novosibirsk, Russian Federation.
http://orcid.org/0000-0002-3164-9377

GENARAL & SPECIAL SURGERY

YU.V. BELOV 1, K.N. RYBAKOV 2, 3, I.A. GUBAREV 2, A.Z. SALEKH 2, I.A. VINOKUROV 3

IMMEDIATE TREATMENT RESULTS OF PATIENTS WITH AORTIC VALVE DISEASE IN COMBINATION WITH POSTSTENOTIC DILATION OF THE ASCENDING AORTA LESS THAN 5 CM

Russian Research Surgery Center named after Academician B.V.Petrovsky 1,
N.I. Pirogov Municipal Clinical Hospital No1 2,
I.M. Sechenov First Moscow State Medical University
(Sechenov University) of the Ministry of Health of Russia 3, Moscow,
The Russian Federation

Objective. To carry out a comparative evaluation of immediate results of isolated operations on the aortic valve and combined surgical intervention on the aortic valve and ascending aorta in patients with aortic valve defects in combination with poststenotic dilation of the ascending aorta less than 5 cm.
Methods. The article analyzes the results of surgical treatment of patients (n=39) with the aortic valve defects in combination with ascending aortic aneurysms. The differences were in the tactics of surgical treatment: 22 patients underwent combined surgery on the aortic valve and ascending aorta, 17 patients underwent isolated operations on the aortic valve. In each of the study groups, intraoperative data, rehabilitation period, and complications in the early postlesional period were evaluated.
Results. Statistical analysis revealed no significant difference in the rehabilitation period and complications in the early postlesional period between the main group and the comparison group except of the index of postoperative bleeding, which was significantly higher in patients who underwent combined surgery on the aortic valve and ascending aorta and recorded in 18.2% of cases (p=0.03).
Conclusion. A moderate increase in the duration of the operation and artificial blood circulation, as well as intraoperative blood loss due to the formation of an additional anastomosis in the ascending aorta in patients undergoing combined replacement of the aortic valve and ascending aorta in comparison with isolated aortic valve replacement does not significantly affect the postoperative rehabilitation period and the incidence of complications in the early postlesional period. The final decision on the feasibility of performing combined prosthetics of the aortic valve and ascending aorta in patients with aortic valve defect in combination with poststenotic dilation of the ascending aorta less than 5 cm requires additional comparative analysis of long-term results of surgical treatment of the studied groups of patients.

Keywords: ascending aortic dilation, ascending aortic aneurysm, aortic valve defect, aortic valve stenosis, aortic valve replacement, Bentall-De Bono operation
p. 370-376 of the original issue
References
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Address for correspondence:
119049, Russian Federation,
Moscow, Leninsky pr., 8,
N.I. Pirogov Municipal Clinical Hospital No1,
Center for Vascular, X-ray Endovascular Surgery
and Minimally Invasive Phlebology Unit,
tel. mobile:+7 985 353 51 90,
e-mail: angiodoc@mail.ru,
Gubarev Igor’ Aleksandrovich
Information about the authors:
Belov Yurii V., MD, Professor, Academician of RAS, Head of the Cardio-aortic Surgery, Russian Research Surgery Center named after Academician B.V.Petrovsky, Moscow, Russian Federation.
http://orcid.org/0000-0002-9280-8845
Rybakov Kirill N., Cardiovascular Surgeon, N.I. Pirogov Municipal Clinical Hospital No1, Moscow, Russian Federation.
https://orcid.org/0000-0002-6530-3382
Gubarev Igor’ A., Aspirant, Russian Research Surgery Center named after Academician B.V.Petrovsky, Cardiovascular Surgeon, N.I. Pirogov Municipal Clinical Hospital No1, Moscow, Russian Federation.
http://orcid.org/0000-0003-3961-5670
Salekh Amro Z., PhD, Cardiovascular Surgeon, N.I. Pirogov Municipal Clinical Hospital No1, Moscow, Russian Federation.
http://orcid.org/0000-0001-6479-1743
Vinokurov Ivan A., PhD, Associate Professor of the Hospital Surgery Department, I.M. Sechenov First Moscow State Medical University (Sechenov University) of the Ministry of Health of Russia, Moscow, Russian Federation
https://orcid.org/0000-0003-0433-2523

A.R. PRUDNIKOV, A.N. SHCHUPAKOVA, G.D. KOROBOV

PREDICTING OF REPEATED CARDIOVASCULAR EVENTS WITHIN 1 YEAR AMONG PATIENTS WITH MYOCARDIAL INFARCTION AFTER CORONARY ARTERY STENTING

Vitebsk State Medical University, Vitebsk,
The Republic of Belarus

Objective. To design the model to predict the recurrent cardiovascular events within 1 year including parameters of the cytokine profile and immune system in patients with myocardial infarction after coronary artery stenting.
Methods. The patients (n=23) with the diagnosis of myocardial infarction, verified according to coronary angiography, electrocardiogram results and biochemical blood test took part in the study. The stent-application procedure of symptom-related coronary arteries was performed in all symptomatic patients. The levels of interleukins 4, 6, 8, 10 and 18, tumor necrosis factor alpha (TNF-α), vascular adhesion molecule sVCAM-1, immune system parameters (T- and B- cell immunity, IgA, IgG, IgM, phagocytic number, phagocytic index of leukocytes, circulating immune complexes), activity of neutrophil elastase and BAPNA-amidase in blood serum were evaluated.
Results. Discriminant analysis with «Classification trees» revealed that age, IL-6 level and IgG could be used as parameters (reference values) for assigning patients to the group of high or low risk of recurrent cardiovascular disease. Thus, patients over 52 years old with IL-6 levels less than 1.19 pg/ml and more than 4.83 pg/ml and IgG levels more than 9.075 g/l are at high risk. An unfavorable outcome is predicted in 100% of cases, favorable – in 80% of cases, and 88.5% is the percentage of correct prognosis. Based on the obtained results of logistic regression using with subsequent ROC analysis of the studied factors, the prediction model includes the age of patients, the level of IL-6, IgG, circulating immune complexes, the number of active T-lymphocytes (CD3+CD4+HLA-DR+), and the phagocytic index of leukocytes AUC of the model (area under the curve) = 0.845 (95% CI 0.645-1.0), sensitivity – 80%, specificity – 90.9% was designed.
Conclusion. The designed model allows predicting the occurrence of recurrent cardiovascular events in patients with myocardial infarction within 1 year after coronary artery stenting.

Keywords: prediction, cardiovascular events, stenting, immune system, myocardial infarction
p. 377-386 of the original issue
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Address for correspondence:
210009, Republic of Belarus,
Vitebsk, Frunze Ave., 27,
Vitebsk State Medical University,
Department of Internal Diseases
tel. +375 029 515-80-15,
e-mail: prudnikov92@yandex.ru
Prudnikov Alexander R.
Information about the authors:
Prudnikov Alexandår R., Assistant of the Department of Internal Diseases, Vitebsk State Medical University, Vitebsk, Republic of Belarus.
https://orcid.org/0000-0001-9458-0867
Shchupacova Alina N., MD, Professor of the Deparnment of Internal Diseases, Vitebsk State Medical University, Vitebsk, Republic of Belarus.
https://orcid.org/0000-0002-7938-0610
Korobov Gennadii D., PhD, Associate Professor of the Training Center for Practical Training and Simulation Training, Vitebsk State Medical University, Vitebsk, Republic of Belarus.
https://orcid.org/0000-0001-6878-7573

E.V. MUSHENKO 1, 2, YU.V. AVDOSYEV 1, O.M. TYSHCHENKO 1, R.M. SMACHYLO 1, 2, YU.V. IVANONA 2

SURGICAL TREATMENT OF VISCERAL PSEUDOANEURYSMS

V.T. Zaycev Institute of general and urgent surgery of NAMS of Ukraine 1,
Kharkov National Medical University 2, Kharkov,
Ukraine

Objective. Optimization of surgical treatment of visceral pseudoaneurysms (PA) by means of using individualized treatment tactics and combined methods for their surgical treatment.
Methods. The treatment results of patients (n=35) with visceral PA are presented in the article. Localization of PA in the splenic artery was detected in 20 patients (57.2%), in the common hepatic artery – in 8 patients (22.8%), in the superior or inferior pancreatoduodenal artery – in 5 cases (14.3%), in the superior mesenteric artery – in 2 cases (5.7%). The asymptomatic course of PA was observed in 17 patients (48.6%), while the remaining 18 patients (51.4%) had a symptomatic course of the disease. Diagnostics of PA localization included traditional methods of medical visualization and angiography, which is used as a diagnostic and treatment procedure.
Results. Complete technical success after endovascular therapy was achieved in 20 patients (57.1%), partial – in 15 cases (42.9%), that required the use of combined interventions. The reasons of technical failure of X-ray operations were associated with the impossibility of intravascular access to the damaged artery or arteries or access to the neck of the PA, the doubt about the organ blood supply that the damaged artery after its endovascular occlusion supports, and with the large size of the PA. Partial success in this case was considered to be a decrease of the intensity of bleeding or temporary hemostasis, which made it possible to perform the intervention from the traditional approach. Morbidity rate was 34.3% (20 patients). Severe complications were identified in 6 patients (17.1%). Mortality rate was 11.4%.
Conclusion. Endovascular interventions should be considered as an option for the first line surgical treatment of patients with visceral PA. In case of technical failure or partial technical success, the combined surgical aid with using of X-ray endosurgical treatment and traditional surgical intervention are required to achieve acceptable results of treatment of these patients.

Keywords: visceral pseudoaneurysms, hemorrhage, interventional radiology, angiography, endovascular treatment, combined operations
p. 387-395 of the original issue
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  9. Guirgis M, Xu JH, Kaard A, Mwipatayi BP. Spontaneous superior mesenteric artery branch pseudoaneurysm: a rare case report. EJVES Short Rep. 2017 Oct 12;37:1-4. doi: 10.1016/j.ejvssr.2017.09.001. eCollection 2017.
  10. Eftimie MA, Stanciulea OM, David L, Lungu V, Dima S, Mosteanu I, Tirca L, Popescu I. Surgical treatment of splenic artery pseudoaneurysm with digestive tract communication – presentation of two cases. Chirurgia (Bucur). 2017 Mar-Apr;112(2):157-64. doi: 10.21614/chirurgia.112.2.157
  11. Hewgley WP, Webb DL, Garrett HE Jr1. Migrated embolization coil causes intestinal obstruction. J Vasc Surg Cases Innov Tech. 2017 Dec 27;4(1):8-11. doi: 10.1016/j.jvscit.2017.11.001. eCollection 2018 Mar.
  12. Rebonato A, Maiettini D, Krokidis M, Graziosi L, Rossi M. Late migration of a covered stent into the stomach after repair of a splenic artery. J Radiol Case Rep. 2016 Feb;10(2):26-32. doi: 10.3941/jrcr.v10i2.2620
  13. Branchi V, Meyer C, Verrel F, Kania A, Bolke E, Semaan A, Koscielny A, Kalff JC, Matthaei H. Visceral artery aneurysms: evolving interdisciplinary management and future role of the abdominal surgeon. Eur J Med Res. 2019;24:17-26. doi: 10.1186/s40001-019-0374-9
Address for correspondence:
61018, Ukraine,
Kharkov, Balakirev str., 1,
V.T. Zaycev Institute of General
and Urgent Surgery of NAMS of Ukraine,
the Department of the Hepatic
and Bile Ducts Surgery,
Tel.: +380 67 575-63-75,
e-mail: dr.mushenko@gmail.com,
Mushenko Evgreny V.
Information about the authors:
Mushenko Evgrene V., PhD, Senior Researcher of the Department of the Hepatic and Bile Ducts Surgery, V.T. Zaycev Institute of General and Urgent Surgery of NAMS of Ukraine, Assistant of the Surgery Department No1, Kharkov National Medical University, Kharkov, Ukraine.
https://orcid.org/0000-0003-0244-3289
Avdosyev Yury V., MD, Head of the X-ray Surgical Department, V.T. Zaycev Institute of General and Urgent Surgery of NAMS of Ukraine, Kharkov, Ukraine.
http://orcid.org/0000-0002-2677-4464
Tyshchenko Olexander M., MD, Professor, Senior Researcher of the Department of the Hepatic and Bile Ducts Surgery, V.T. Zaycev Institute of General and Urgent Surgery of NAMS of Ukraine, Kharkov, Ukraine.
https://orcid.org/0000-0002-3894-1100
Smachylo Rostislav M., MD, Professor, Head of the Department of the Hepatic and Bile Ducts Surgery, V.T. Zaycev Institute of General and Urgent Surgery of NAMS of Ukraine, Professor of the Surgery Department No1, Kharkov National Medical University, Kharkov, Ukraine.
https://orcid.org/0000-0003-1237-0255
Ivanona Yulia V., MD, Professor of the Surgery Department No1, Kharkov National Medical University, Kharkov, Ukraine.
https://orcid.org/0000-0001-8773-6827

TRAUMATOLOGY AND ORTHOPEDICS

V.G. BARSUKOV 1, V.P. DEIKALO 2, A.E. GORBACHYOV 3, G.A. KOSHMAN 4

BIOMECHANICAL ANALYSIS OF VALGUS TROCHANTERIC OSTEOTOMY FOR TREATMENT TRANSCERVIAL HIP FRACTURES

Yanka Kupala State University of Grodno 1, Grodno,
Vitebsk State Medical University 2, Vitebsk,
Grodno City Clinical Hospital of Emergency Care 3, Grodno,
Grodno State Medical University 4, Grodno,
The Republic of Belarus

Objective. To study the influence of rotation angles of a wedge-shaped resected bone fragment of the proximal femur in valgus trochanteric osteotomy, the diameter of the femur in the zone of osteotomy achieved after resection of a bone wedge using mathematical modeling methods.
Methods. The object of the study is a surgical operation of valgus trochanteric osteotomy of the femur. The method of mathematical modeling of changes in axial loads and bending moment acting on the femoral proximal part and diaphysis, as well as the value of vertical and horizontal movements of the center of the femoral head and points of the supporting surface in valgus trochanteric osteotomy of the proximal femur has been designed and used.
Results. Using the designed methods of mathematical modeling of biomechanical aspects of the valgus trochanteric osteotomy, analytical dependences were obtained that allow calculating compressive and bending loads affecting on the proximal and diaphyseal part of the femur, as well as the magnitude of vertical and horizontal displacements of the center of the head and points of the supporting surface during valgus trochanteric osteotomy of proximal part of the femur. Changes in the force and kinematic biomechanical parameters of the femur were calculated for a wide range of rotation angles of the proximal femoral part , and the most frequently encountered in practice the values of specific dimensions (diameter of the femur, lesser-trochanter-to-center-of-femoral-head-distance) were calculated. It was shown that horizontal displacement of the center of femoral head and points of the support surface creates more favorable biomechanical conditions in the zone of unstable fracture and the femoral shaft. Unfavorable displacement of the support surface in the vertical plane, which leads to elongation of the operated limb, can be neutralized by resection of a wedge-shaped femoral fragment.
Conclusion. The designed method and the results of mathematical modeling obtained on its basis make it possible to perform rational preoperative planning of valgus trochanteric osteotomy of the hip.

Keywords: biomechanical analysis, valgus trochanteric osteotomy, proximal femur, femoral head, angle of rotation, bone diameter, support surface
p. 396-404 of the original issue
References
  1. Manninger J, Bosch U, Cserháti P, Fekete K, Kazár G. Internal fixation of femoral neck fractures. An atlas. Vienna: Springer; 2007. 312 p. doi.org/10.1007/978-3-211-68585-3
  2. Said GZ, Farouk O, Said HG. Valgus intertrochanteric osteotomy with single-angled 130° plate fixation for fractures and non-unions of the femoral neck. Int Orthop. 2010 Dec;34(8):1291-95. doi: 10.1007/s00264-009-0885-z
  3. Kuzyk PRT, Angelini M, Waddell JP, McKee MD, Schemitsch EH. Surgical techniques for the management of proximal femoral fracture nonunions. Oper. Tech Orthop. 2008 Apr;18(2):114-20. doi: 10.1053/j.oto.2008.10.001
  4. Gavaskar AS, Srinivasan P, Jeyakumar B, Raj RV. Valgus intertrochanteric osteotomy for femur neck pseudoarthrosis: a simple solution to a complex problem that has stood the test of time. Int Orthop. 2020 Apr;44(4):635-43. doi: 10.1007/s00264-019-04353-7
  5. Varghese VD, Livingston A, Boopalan PR, Jepegnanam TS. Valgus osteotomy for nonunion and neglected neck of femur fractures. World J Orthop. 2016 May 18;7(5):301-7. doi: 10.5312/wjo.v7.i5.301
  6. Karev DB, Barsukov VG. Biomechanical analysis of òwo point asymmetric screw fiõation with implant for femoral neck fracture. Acta Mechanica et Automatica. 2012;6(4):19-22.
Address for correspondence:
230015, Republic of Belarus,
Grodno, Kurchatov str., 1à ,
Yanka Kupala State University of Grodno,
Department of Technical Mechanics,
tel.: 8 (0152) 410873,
e-mail: v.g.barsukov@grsu.by,
Barsukov Vladimir Georgievich
Information about the authors:
Barsukov Vladimir G., MD, Associate Professor, Head of the Department of Technical Mechanics, Yanka Kupala State University of Grodno, Grodno, Republic of Belarus.
https://orcid.org/0000-0001-5490-9293
Deikalo Valeriy P., MD, Professor of the Department of Traumatology, Orthopedics and Military Field Surgery, Vitebsk State Medical University, Vitebsk, Republic of Belarus.
https://orcid.org/0000-0001-7768-3696
Gorbachyov Alexander E., Orthopedic Surgeon of Higher Category of the Department of Traumatology and Orthopedics, Grodno City Clinical Hospital of Emergency Care, Grodno, Republic of Belarus.
https://orcid.org/0000-0002-5651-0005
Koshman Gennadiy A., PhD, Senior Lecturer of the Department of Traumatology, Orthopedics and Military Field Surgery, Grodno State Medical University, Grodno, Republic of Belarus.
https://orcid.org/0000-0001-7451-1282

PEDIATRIC SURGERY

M.A. AKSELROV 1, 2, S.M. PANTELEEV 1, A.V. STOLYAR 2, A.V. MARGARYAN 1, L.V. VIHAREVA 1

CLINICAL ANATOMY, TYPES OF OBLIQUE CONGENITAL INGUINAL HERNIAS AND FEATURES OF LAPAROSCOPIC HERNIORRHAPHY

Tyumen State Medical University 1,
Regional Clinical Hospital No2 2, Tyumen,
The Russian Federation

Objective. To optimize the operation of the extraperitoneal laparoscopic hernia repair in children by LASSO method, using the individual approach to carrying out a ligature depending on the anatomic type of the internal inguinal ring revealed on diagnostic laparoscopy.
Methods. Case histories (n=350) of children, from January, 2018 till May, 2019 were analyzed. There were 256 boys (73,14%) and 94 girls (26,86%). The age of children varied from 1 to 204 months. The operation method in all patients was the modified LASSO technique. The point was to use the original device for implementation of an extracorporeal ligation of the internal inguinal ring. Direct intraoperative data, such as the type of an inguinal ring and duration of operation were evaluated retrospectively.
Results. 545 inguinal rings on the right and on the left (taking into account uni- and bilateral inguinal hernia) were revealed. There are five types of rings: type 1 – with slit-shaped opening, slit shaped; type 2a – with a triangle shaped opening, triangular without peritoneal folds; type 2b – triangular with peritoneal folds; type 3a – oval without peritoneal folds; type 3b – oval with peritoneal folds.
Type 3a was the most common type of ring (n=246). Type 2b (n=45) was the most rare. Implementation of the additional manipulator was carried out in 33 cases, in 22 of them the ring was of 3b type. In these 22 patients (24 inguinal rings) the reduction of mean duration of operation with 39,58±5,82 min. up to 20±5,77 min was obtained.
Conclusion. In laparoscopic treatment of inguinal hernia it is necessary to consider visual structure of an internal inguinal ring. There are five types of them in total: 1, 2a, 2b, 3a, 3b. When the internal inguinal ring (3b type) is revealed, it is necessary to introduce an additional trocar for the manipulator that facilitates extra peritoneal carrying out ligature during such operation and significantly reduces intervention duration.

Keywords: inguinal hernia, children, internal inguinal ring, inguinal region, laparoscopic hernia repair, pediatric surgery
p. 404-411 of the original issue
References
  1. Umesh AU. Some features of the treatment of inguinal hernias in children. Vestn AGIUV.2011;(2):67–69. https://cyberleninka.ru/article/n/nekotorye-osobennosti-lecheniya-pahovyh-gryzh-u-detey (In Russ.)
  2. Takehara H, Ishibashi H, Satoh H, Fukuyama T, Iwata T, Tashiro S. Laparoscopic surgery for inguinal lesions of pediatric patients. In: Proceedings of the 7th World Congress of Endoscopic Surgery; Singapore, June 1-4, 2000. ð. 537-42.
  3. Esposito C, St Peter SD, Escolino M, Juang D, Settimi A, Holcomb GW 3rd. Laparoscopic versus open inguinal hernia repair in pediatric patients: a systematic review. J Laparoendosc Adv Surg Tech A. 2014 Nov;24(11):811-18. doi: 10.1089/lap.2014.0194
  4. Draus JM, Kamel S, Seims A, Rescorla FJ. The role of laparoscopic evaluation to detect a contralateral defect at initial presentation for inguinal hernia repair. Am Surg. 2011 Nov;77(11):1463-66. doi: 10.1177/000313481107701134
  5. Shalaby R, Ismail M, Samaha A, Yehya A, Ibrahem R, Gouda S, Helal A, Alsamahy O. Laparoscopic inguinal hernia repair; experience with 874 children. J Pediatr Surg. 2014 Mar;49(3):460-64. doi: 10.1016/j.jpedsurg.2013.10.019
  6. Spakhi OV, Kopylov EP, Pakhol’chuk AP. Laparoskopicheskoe lechenie pakhovykh gryzh u detei. Meditsina Neotlozh Sostoianii. 2016;(1):84-87. http://www.mif-ua.com/archive/article/42349ÎÂ (In Ukr)
  7. Kimura T, Yamauchi K, Ihara Y, Sawai T, Kosumi T, Yonekura T. Single-site laparoscopic herniorrhaphy using needle instruments for inguinal hernias in children: a novel technique. Surg Today. 2012 Jan;42(1):100-3. doi: 10.1007/s00595-011-0020-9.
  8. Slalmakhovich VN. Reasonable approach to the surgical treatment of inguinal hernia in children. Sib Med Zhurn (Irkutsk) 2001;24(1):50-52. https://cyberleninka.ru/article/n/vybor-ratsionalnogo-sposoba-lecheniya-pahovyh-gryzh-u-detey (In Russ.)
  9. Kozlov YuA, Novozhilov VA, Rasputin AA, Kovalkov KA, Chubko DM, Baradieva PZh, Zvonkov DA, Timofeev AD, Ochirov ChB, Rasputina NV, Us GP, Kuznetsova NN. Treatment of inguinal hernias in children: review of laparoscopic techniques, or history of «hooks and needles». Endoskop Khirurgiia. 2017;23(1):33-43. doi: 10.17116/endoskop201723133-43 (In Russ.)
  10. brahim MM. Two ports laparoscopic inguinal hernia repair in children. Minim Invasive Surg. 2015;2015:821680. Published online 2015 Feb 16. doi: 10.1155/2015/821680
  11. Helal AA. Laparoscopic single instrument closure of inguinal hernia in female children: A novel technique. J Pediatr Surg. 2015 Sep;50(9):1613-16. doi: 10.1016/j.jpedsurg.2015.05.003
  12. Li S, Li M, Wong KK, Liu L, Tam PK. Laparoscopically assisted simple suturing obliteration (LASSO) of the internal ring using an epidural needle: a handy single-port laparoscopic herniorrhaphy in children. J Pediatr Surg. 2014 Dec;49(12):1818-20. doi: 10.1016/j.jpedsurg.2014.09.027
  13. Kozlov YuA, Novozhilov VA, Rasputin AA., Krasnov P.A. Technology of the single-incision laparoscopic surgery in the treatment of inguinal hernias in infants. Annaly Khirurgii . 2013;(6):31-37. https://elibrary.ru/item.asp?id=21474770 (In Russ.)
  14. Stolyar AV, Akselrov MA, Saharov SP. Congenital inguinal hernia - how to operate? Med Nauka i Obrazovanie Urala. 2016;17(2):111-15. https://elibrary.ru/item.asp?id=26283619 (In Russ.)
Address for correspondence:
625027 Russian Federation,
Tyumen region, Tyumen, Melnikayte str., 75, 2
Regional Clinical Hospital No2,
Surgical Unit No1
tel.: +7 92 22 67 52 92,
e-mail: stolyar.al@yandex.ru,
Stolyar Aleksandr V.
Information about the authors:
Akselrov Mikhail A., MD, Head of the Pediatric Surgery Department, Tyumen State Medical University, Head of the Surgical Unit No1, Regional Clinical Hospital No2, Tyumen, Russian Federation.
https://orcid.org/0000-0001-6814-8894
Panteleev Sergei M., MD, Head of the Department of Human Anatomy, Topographic Anatomy and Operative Surgery, Tyumen State Medical University, Tyumen, Russian Federation.
https://orcid.org/0000-0002-3006-6620
Stolyar Aleksandr V., Pediatric Surgeon, the Surgical Unit No1, Regional Clinical Hospital No2, Tyumen, Russian Federation.
https://orcid.org/0000-0002-0704-5418
Margaryan Artur V., MD, Professor of the Pediatric Surgery Department, Tyumen State Medical University, Tyumen, Russian Federation.
https://orcid.org/0000-0003-3497-8157
Vikhareva Larisa V., MD, Professor of the Pediatric Surgery Department, Tyumen State Medical University, Tyumen, Russian Federation.
https://orcid.org/0000-0001-6864-4417

ANESTHESIOLOGY-REANIMATOLOGY

V.G. PIACHERSKI 1, 2, L.V. MUZYKA 1

COMPARISON OF EFFICIENCY OF SPINAL ANESTHESIA WITH BUPIVACAINE AND LEVOBUPIVACAINE FOR LOWER EXTREMITY SURGERY

Mogilev Regional Hospital 1, Mogilev,
Vitebsk State Medical University 1, 2, Vitebsk,
The Republic of Belarus

Objective. To evaluate efficiency of bupivacaine and levobupivacaine for spinal anesthesia for lower limb surgery.
Methods. Anesthesia indicates in patients undergoing operations on the hip joint, thigh, knee joint. Patients were randomly divided into two groups: in group 1 (1B) spinal anaesthesia with 0.5% bupivacaine 3 ml: (38 patients); in group 2 (2L) – 0.5% levobupivacaine 3 ml (38 patients) was performed. Intrathecal administrations were performed with “Pencil point” needle (24G or 25G caliber) into the intervertebral space L3-L4. Spinal puncture was performed in sitting position on the table. The primary endpoint was the need switching from one drug to another type of analgesia, or the need for additional use of narcotic analgesics, or the use of local anesthesia at the onset or during surgery.
Results. During surgery in 6 patients (15.7%) of group 2L, there was a need to relieve pain by narcotic analgesics (fentanyl) intraoperatively or using local anesthesia. The reliable differences between the groups regarding the need for additional intraoperative analgesia were obtained: p <0.05.
All patients in group 1B developed a complete sensory block within 4 (3; 5) min. In group 2L, the full sensory block developed in 34 patients (89.4%) within 9 (5; 14) minutes; statistically significant differences between the groups were obtained, p <0.05 (p = 0.000001).
The duration of the analgesia period between the groups did not statistically differ and amounted to 242 (212; 270) min in the 1B group, 250 (204; 288) min. in the 2L group, p>0.05.
Conclusion. The research results demonstrated that levobupivacaine has been found to be efficacious (84,3%) compared with bupivacaine in the case of intrathecal administration (equal doses and quantity of both drugs).
Further studies with a large number of patients are necessary in order to determine whether levobupivacaine has been to be equally efficacious as bupivacaine.

Keywords: spinal anesthesia, levobupivacaine, bupivacaine, intrathecal administration, efficacy
p. 412-417 of the original issue
References
  1. Foster RH, Markham A. Levobupivacaine: a review of its pharmacology and use as a local anaesthetic. Drugs. 2000 Mar;59(3):551-79. doi: 10.2165/00003495-200059030-00013
  2. del-Rio-Vellosillo M, Garcia-Medina JJ, Abengochea-Cotaina A, Pinazo-Duran MD, Barbera-Alacreu M. Spinal anesthesia for knee arthroscopy using isobaric bupivacaine and levobupivacaine: anesthetic and neuroophthalmological assessment. Biomed Res Int. 2014;2014:349034, 7p. doi: 10.1155/2014/349034
  3. Glaser C, Marhofer P, Zimpfer G, Heinz MT, Sitzwohl C, Kapral S, Schindler I. Levobupivacaine versus racemic bupivacaine for spinal anesthesia. Anesth Analg. 2002 Jan;94(1):194-98, table of contents. doi: 10.1097/00000539-200201000-00037
  4. Alley EA, Kopacz DJ, McDonald SB, Liu SS. Hyperbaric spinal levobupivacaine: a comparison to racemic bupivacaine in volunteers. Anesth Analg. 2002 Jan;94(1):188-93, table of contents. doi: 10.1097/00000539-200201000-00036
  5. Burke D, Kennedy S, Bannister J. Spinal anesthesia with 0.5% S(-)-bupivacaine for elective lower limb surgery. Reg Anesth Pain Med. 1999 Nov-Dec;24(6):519-23. doi: 10.1016/s1098-7339(99)90042-1
  6. Fattorini F, Ricci Z, Rocco A, Romano R, Pascarella MA, Pinto G. Levobupivacaine versus racemic bupivacaine for spinal anaesthesia in orthopaedic major surgery. Minerva Anestesiol. 2006 Jul-Aug;72(7-8):637-44. https://www.minervamedica.it/en/journals/minerva-anestesiologica/article.php?cod=R02Y2006N07A0637 [Article in English, Italian]
  7. Gautier P, De Kock M, Huberty L, Demir T, Izydorczic M, Vanderick B. Comparison of the effects of intrathecal ropivacaine, levobupivacaine, and bupivacaine for Caesarean section. Br J Anaesth. 2003 Nov;91(5):684-89. doi: 10.1093/bja/aeg251
  8. Singh A, Gupta A, Datta PK, Pandey M. Intrathecal levobupivacaine versus bupivacaine for inguinal hernia surgery: a randomized controlled trial. Korean J Anesthesiol. 2018 Jun;71(3):220-25. doi: 10.4097/kja.d.18.27191
  9. Dizman S, Turker G, Gurbet A, Mogol EB, Turkcan S, Karakuzu Z. Comparison of two different doses of intrathecal levobupivacaine for transurethral endoscopic surgery. Eurasian J Med. 2011 Aug;43(2):103-8. doi: 10.5152/eajm.2011.23
  10. Attri JP, Kaur G, Kaur S, Kaur R, Mohan B, Kashyap K. Comparison of levobupivacaine and levobupivacaine with fentanyl in infraumbilical surgeries under spinal anaesthesia. Anesth Essays Res. 2015 May-Aug;9(2):178-84. doi: 10.4103/0259-1162.152148
  11. Şahin AS, Türker G, Bekar A, Bilgin H, Korfali G. A comparison of spinal anesthesia characteristics following intrathecal bupivacaine or levobupivacaine in lumbar disc surgery. Eur Spine J. 2014 Mar;23(3):695-700. Published online 2013 Nov 9. doi: 10.1007/s00586-013-3082-0
  12. Elsharkawy RA, Messeha MM, Elgeidi AA. The influence of different degrees of temperature of intrathecal levobupivacaine on spinal block characteristics in orthopedic surgeries: a prospective randomized study. Anesth Essays Res. 2019 Jul-Sep;13(3):509-14. doi: 10.4103/aer.AER_76_19
  13. Ngan Kee WD, Ng FF, Khaw KS, Tang SPY, Koo AGP. Dose-response curves for intrathecal bupivacaine, levobupivacaine, and ropivacaine given for labor analgesia in nulliparous women. Reg Anesth Pain Med. 2017 Nov/Dec;42(6):788-792. doi: 10.1097/AAP.0000000000000657
  14. Lv BS, Wang W, Wang ZQ, Wang XW, Wang JH, Fang F, Mi WD. Efficacy and safety of local anesthetics bupivacaine, ropivacaine and levobupivacaine in combination with sufentanil in epidural anesthesia for labor and delivery: a meta-analysis. Curr Med Res Opin. 2014 Nov;30(11):2279-89. doi: 10.1185/03007995.2014.946127
Address for correspondence:
212026, Republic of Belarus,
Mogilev, B.Biruli str, 12,
Mogilev Regional Hospital,
Anesthesiology and Intensive Care Unit,
e-mail: pechersky.v@yandex.ru,
Piacherski Valery G.
Information about the authors:
Piacherski Valery G., PhD, Head of Anesthesiology and Intensive Care Unit, Mogilev Regional Hospital, Trainee Teacher of the Branch of the Department of Anesthesiology and Reanimatology with a Course of the Advanced Training and Retraining Faculty and Surgery with a Course of the Advanced Training and Retraining Faculty, Vitebsk State Medical University, Mogilev, Republic of Belarus.
https://orcid.org/0000-0002-6237-8063
Muzyka Lidziya V., Anesthesiologist-resuscitator of Anesthesiology and Intensive Care Unit, Mogilev Regional Hospital, Mogilev, Republic of Belarus.
http://orcid.org/0000-0003-4546-3300

REVIEWS

R.E. KALININ, I.A. SUCHKOV, E.A. KLIMENTOVA, A.A. EGOROV

TO THE QUESTION OF THE ROLE OF APOPTOSIS IN THE DEVELOPMENT OF ATHEROSCLEROSIS AND RESTENOSIS OF THE RECONSTRUCTION ZONE

Ryazan State Medical University, Ryazan,
The Russian Federation

Apoptosis is a model of genetically programmed cell death and the main mechanism that allows to remove the unwanted, old or damaged cells. In both physiological and pathophysiological conditions, various factors, including mechanical forces, reactive oxygen and nitrogen forms, cytokines, oxidized lipoproteins can affect vascular cell apoptosis. The signaling pathway of Fas / Fas- ligand / caspase death, the Bcl-2 / mitochondria family of proteins, the p53 tumor suppression gene, and the c-myc protooncogene can be activated in atherosclerotic lesions and mediate cell death during the development of atherosclerosis. Abnormal expression apoptosis-regulating genes and their dysfunction can weaken or accelerate apoptosis of vascular cells and affect the integrity and stability of atherosclerotic plaques. Further findings of the mechanism that regulates apoptosis can help develop a new treatment strategy for atherosclerosis and its main complication, restenosis of the reconstruction zone. At present, the role of apoptosis indicators in the development of atherosclerosis and its main complications remains unclear. Further study of this problem is required for a deeper understanding of atherosclerosis pathogenesis and restenosis of the reconstruction zone and the development of effective treatment methods.

Keywords: apoptosis, restenosis, atherosclerosis, Bcl-2 proteins, caspases
p. 418-427 of the original issue
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Address for correspondence:
390026, Russian Federation, Ryazan,
Vysokovoltnaya str. 9,
Ryazan State Medical University,
the Department of Cardiovascular,
Endovascular, Operative Surgery
and Topographic Anatomy
tel. +7 4912 46-08-03,
e-mail: Suchkov_med@mail.ru
Suchkov Igor A.
Information about the authors:
Kalinin Roman E., MD, Professor, Rector, Head of the Department of Cardiovascular, Endovascular, Operative Surgery and Topographic Anatomy, Ryazan State Medical University, Ryazan, Russian Federation.
https://orcid.org/0000-0002-0817-9573
Suchkov Igor A., MD, Professor, Vice-Rector for Research and Innovative Development, Professor of the Departmentr of Cardiovascular, Endovascular, Operative Surgery And Topographic Anatomy, Ryazan State Medical University, Ryazan, Russian Federation.
https://orcid.org/0000-0002-1292-5452
Klimentova Åmma A., Post-Graduate Student of the Department of Cardiovascular, Endovascular, Operative Surgery and Topographic Anatomy, Ryazan State Medical University, Ryazan, Russian Federation.
https://orcid.org/0000-0003-4855-9068
Egorov Andrei A., PhD, Associate Professor of the Departmentr of cardiovascular, endovascular, operative surgery and topographic anatomy, Ryazan State Medical University, Ryazan, Russian Federation.
https://orcid.org/0000-0003-0768-7602

V.V. POVOROZNYUK, N.V. DEDUKH, M.A. BYSTRYTSKA

VITAMIN D IN BONE REGENERATION: FROM EXPERIMENTAL RESEARCH TO CLINICAL PRACTICE

D. F. Chebotarev Institute of Gerontology of the National Academy of Medical Sciences of Ukraine, Kiev
Ukraine

Vitamin D has a pleiotropic effect, affecting the organs and tissues of the body. It affects the bone tissue by controlling calcium and phosphates homeostasis, as well as by direct affect on the bone tissue cells and their metabolism. The study of bone regeneration under conditions of vitamin D deficiency is under active research. The literature review summarizes the mechanisms of vitamin D action on a bone, the features of bone regeneration and the role of vitamin D deficiency at the stages of regeneration (inflammation, the formation of soft and hard regenerates with its subsequent remodeling). It is noted that the data presented in the literature are fragmented, but make it possible to evaluate vitamin D significance in this complex process. Data from experimental animal studies indicate that in most of the studies, the addition of vitamin D to diet of the animals with experimentally modeled traumatic damage contributed to the formation of full-fledged regeneration. We examined the results of clinical trials in three aspects: the prevalence of vitamin D deficiency in patients with a fracture, the role of vitamin D in prevention and the effect of vitamin D preparations on fracture healing. A high percentage of the presence of vitamin D deficiency in patients with impaired consolidation of fragments is shown; however, with regard to the prevention of fracture risk and the treatment of patients with fractures, the data are contradictory, which prompts further research in this direction.

Keywords: vitamin D, deficiency, risk of fracture, bone regeneration, experimental studies, clinical observations
p. 428-438 of the original issue
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Address for correspondence:
04114, Ukraine,
Kiev, Vushgorodskaja str., 67,
D. F. Chebotarev Institute
of Gerontology of the National Academy
of Medical Sciences of Ukraine,
the Department of Clinical Physiology
and Pathology of the Musculoskeletal System
tel. +380 97 664-80-65,
e-mail: dedukh_ninel@ukr.net,
Dedukh Ninel Vasilyevna
Information about the authors:
Povoroznyuk Vladyslav V., MD, Professor, Honored Worker of Science and Technology of Ukraine, Head of the Department of Clinical Physiology and Pathology of the Musculoskeletal System, D. F. Chebotarev Institute of Gerontology of the National Academy of Medical Sciences of Ukraine, Kiev, Ukraine.
https://orcid.org/0000-0002-8855-482X
Dedukh Ninel V., MD, Leading Researcher of the Department of Clinical Physiology and Pathology of the Musculoskeletal System, D. F. Chebotarev Institute of Gerontology of the National Academy of Medical Sciences of Ukraine, Kiev, Ukraine.
https://orcid.org/0000-0003-0307-2328
Bystrytska Maryna A., PhD, Senior Researcher of the Department of Clinical Physiology and Pathology of the Musculoskeletal System, D. F. Chebotarev Institute of Gerontology of the National Academy of Medical Sciences of Ukraine, Kiev, Ukraine.
https://orcid.org/0000-0001-7755-1247

Y.V. PEROV 1, I.S. POPOVA 2, A.V. BYKOV 2

ENTEROCELE

City Clinical Emergency Hospital No25 1,
Volgograd State Medical University 2, Volgograd,
The Russian Federation

Enterocele is a common problem that is usually faced in practice by gynecologists, urologists and coloproctologists. This term in the medical literature refers to one of the disorders of the pelvic floor – a pelvic hernia containing loops of the small intestine. A pelvic hernia is a protrusion of the peritoneum between the rectum and the vagina. The content of the hernia sac can be not only the loops of the small intestine, but also the sigmoid, omentum or does not contain the abdominal organs at all, but in fact only a protrusion of the perineal body. It is difficult to determine the content of the bag during physical preoperative examination, it is only possible to reliably identify the bulge of the rectum in the back wall of the vagina. Thus, «enterocele» is not the preferred terminology. Pelvic floor prolapse is a complex and multifactorial process and enterocele is always accompanied by prolapse of one or more pelvic organs. The problems of treatment of enterocele consist in the correct choice of conservative and operative methods of treatment and their combinations. The purpose of the operation is to restore the normal supporting system of the vagina with a decrease in capacity and preservation of sexual function. Understanding pelvic anatomy, the pathophysiology of the vagina and posterior pelvis, and their role in clinical symptoms is crucial in the diagnosis and treatment of this disease. There are many approaches to surgical treatment of enterocele, and the experience of the surgeon and his preferences determine the choice of treatment method.

Keywords: enterocele, rectocele, pelvic organ prolapse, pelvic floor, hernia
p. 439-448 of the original issue
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Address for correspondence:
400131, Russian Federation,
Volgograd, sq. Pavshikh Boytsov 1,
Volgograd State Medical University,
the Department of Surgical
Diseases and Neurosurgery,
tel. office +7 (8442) 59-55-64,
e-mail: yvperov@list.ru,
Perov Yurii V.
Information about the authors:
Perov Yurii V., PhD, Coloproctologist, City Clinical Emergency Hospital No25, Volgograd, Russian Federation
https://orcid.org/0000-0003-4280-689X
Popova Irina S., MD, Professor of the Department of Surgical Diseases and Neurosurgery, Volgograd State Medical University, Volgograd, Russian Federation
https://orcid.org/0000-0002-1166-0579
Bykov Alexandr V., MD, Professor, Head of the Department of Surgical Diseases and Neurosurgery, Volgograd State Medical University, Volgograd, Russian Federation
https://orcid.org/0000-0001-9891-5150

CASE REPORTS

A.V. KOLSANOV, S.E. KATORKIN, P.N. MYSHENTSEV, P.M. ZELTER, A.V. KAPISHNIKOV, K.V. ZAGIDULLINA

THE ROLE OF COMPUTED TOMOGRAPHY IN PLANNING OPERATIVE TREATMENT OF A PATIENT WITH LYMPHEDEMA OF THE LOWER LIMBS

Samara State Medical University, Samara,
The Russian Federation

A 57-year-old patient was under observation; she had been suffering from the stage IV secondary lymphedema of the lower limbs for 16 years. During the examination, the clinical, laboratory studies, ultrasound scanning, computed tomography with 3D reconstruction and processing according to the “Autoplan” program were used. According to the preoperative examination, the patient underwent sequential partial dermalipofasciectomy operations.
This observation showed that the progressive course of the disease in the patient contributed to the development of a severe form of the secondary stage IV lymphedema with disfiguring deformity and significant dysfunction of the lower limbs. Computed tomography data showed that the density of soft tissues was increased almost throughout the thighs (-80, -93 HU). This indicated the complete replacement of adipose tissue with coarse connective tissue. Fibrous changes spread from the skin to the fascia and were circular. Due to the pronounced deforming edema, the volume of the right lower limb in the patient was 21576 cm3, and 23139 cm3 in the left one. During the operation, the computed tomography data processed using the “Autoplan” program provided a choice of tissue dissection method. In case of fragmented localization of fibrosis with density of -100 to -50 HU, tissue dissection was performed using a monopolar electrosurgical method. In case of widespread fibrosis with density below -50 HU, the optimal method of tissue dissection was mechanical, with consistent use of the monopolar coagulation mode. According to the results of computed tomography after the operation, not only thickness, but also density of the tissues significantly decreased with a tendency to an increase in the values of the Hounsfield index (-95, -105HU).
Qualitative and quantitative indicators obtained by computed tomography using 3D modeling and the «Autoplan» program make it possible to establish indications for surgical treatment, to determine the optimal resection volume, as well as parameters for dissection of pathologically affected tissue, and to ensure control in the postoperative period.

Keywords: lymphedema of the lower limbs, lymphatic edema, surgical treatment, computed tomography, 3D modeling
p. 449-455 of the original issue
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Address for correspondence:
443013, Russian Federation,
Samara, Karl Marks pr., 165b,
Samara State Medical University,
the Department and Clinic
of Hospital Surgery
Tel. +7 927 206-71-02,
e-mail: katorkinse@mail.ru
Katorkin Sergei Evgenyevich
Information about the authors:
Kolsanov Alexandr V., MD, Professor of RAS, Rector, Head of the Department of Operative Surgery and Clinical Anatomy with the Course of Innovative Technologies, Samara State Medical University of the Ministry of Health of Russia, Samara, Russian Federation.
https://orcid.org/0000-0002-4144-7090
Katorkin Sergei E., MD, Associate Professor, Head of the Department and Clinic of Hospital Surgery, Samara State Medical University of the Ministry of Health of Russia, Samara, Russian Federation.
https://orcid.org/0000-0001-7473-6692
Myshentsev Pavel N., PhD, Associate Professor of the Hospital Surgery Deparment, Samara State Medical University of the Ministry of Health of Russia, Samara, Russian Federation.
https://orcid.org/0000-0001-7564-8168
Zelter Pavel M., PhD, Assistant of the Department of Radiation Diagnostics and Radiation Therapy with the Course of Medical Informatics, Samara State Medical University of the Ministry of Health of Russia, Samara, Russian Federation.
https://orcid.org/0000-0003-1346-5942
Kapishnikov Alexandr V., MD, Head of the Department of Radiation Diagnostics and Radiation Therapy with the Course of Medical Informatics, Samara State Medical University of the Ministry of Health of Russia, Samara, Russian Federation.
https://orcid.org/0000-0002-6858-372X
Zagidullina Ksenia V., Clinical Resident, the Deparment of Radiation Diagnostics and Radiation Therapy with the Course of Medical Informatics, Samara State Medical University of the Ministry of Health of Russia, Samara, Russian Federation.
https://orcid.org/0000-0003-4576-3709

V.A. PODKAMENNIY 1, 2, A.A. SHARAVIN 1, Y.V. ZHELTOVSKY 1, 2, 3, A.V. VYRUPAEV 1, S.V. IMSYROV 1

SHOTGUN PELLET EMBOLISM TO THE GREAT SAPHENOUS VIEN

Irkutsk Regional Clinical Hospital 1,
Irkutsk Medical Academy of Post-graduate Education 2,
Irkutsk State Medical University 3, Irkutsk,
The Russian Federation

A gunshot wound is the main type of injury during combat operations. In peacetime, it is relatively rare and can be the result of criminal incidents or hunting accidents. In this clinical case, the pellet embolism due to the sacrum gunshot wound is described. The pellet from the inferior Vena cava or iliac vein retrograde under its own weight descended into the femoral and then into the large saphenous vein of the thigh, where it stopped thanks to the valves. For 21 years after the injury and embolism of the great saphenous vein of the thigh, the patient made no complaints. The presence of pellet in the vein was a godsend for mammarocoronary bypass surgery for the coronary heart disease. A fragment of the large saphenous vein of the femur on the right thigh was isolated endoscopically. When processing the vein, two pellets with obliteration of the lumen were found. Publications on intravascular embolism by pellet or bullet after gunshot trauma are rare. Embolisms can be observed in both the arterial and venous systems. According to the authors, venous embolisms are less common than arterial ones. Due to the small number of publications, this clinical case is of interest.

Keywords: shotgun wound, venous bullet embolism, pellet, coronary heart disease, coronary bypass surgery
p. 456-459 of the original issue
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Address for correspondence:
664049, Russian Federation,
Irkutsk, mcr. Yubileynyiy, 100,
Irkutsk Regional Clinical Hospital,
the Cardiac Surgery Unit No1,
tel. mobile: +7 950 125-63-90,
e-mail: trew1986@list.ru,
Sharavin Anatoliy A.l
Information about the authors:
Podkamenniy Vladimir A., MD, Professor of the Department of Cardiovascular Surgery, Cardiovascular Surgeon, Cardiac Surgery Unit No1, Irkutsk Regional Clinical Hospital, Irkutsk, Russian Federation.
http://orcid.org/0000-0002-3465-792X
Sharavin Anatoliy A., Cardiovascular Surgeon, Cardiac Surgery Unit No1, Irkutsk Regional Clinical Hospital, Irkutsk, Russian Federation.
http://orcid.org/ 0000-0003-1073-1213
Zheltovskyi Yurii V., MD, Professor of the Department of Cardiovascular Surgery, Cardiovascular Surgeon, Cardiac Surgery Unit No1, Irkutsk Regional Clinical Hospital, Irkutsk, Russian Federation.
http://orcid.org/0000-0002-3269-0195
Vyrupaev Alexei V., Cardiologist, Cardiac Surgery Unit No1, Irkutsk Regional Clinical Hospital, Irkutsk, Russian Federation.
http://orcid.org/0000-0001-6474-2917
Imsyrov Sergei V., Anesthesiologist, Cardiac Surgery Unit No1, Irkutsk Regional Clinical Hospital, Irkutsk, Russian Federation.
http://orcid.org/0000-0003-4465-4199

EXCHANGE OF EXPERIENCE

V.I. RUSIN, K.YE. RUMIANTSEV, V.V. RUSIN, V.V. MASHURA

GASTROJEJUNODUODENOSTOMY IN PROPHYLAXIS AND TREATMENT OF DUODENAL STUMP LEAKAGE AFTER PREVIOUS DISTAL GASTRECTOMY DUE TO PEPTIC ULCER

Uzhhorod National University, Uzhhorod,
Ukraine

Objective. To evaluate the clinical efficacy of gastrojejunoduodenostomy for the repair of a «difficult» or incompetent duodenal stump after gastrectomy.
Methods. The experience of gastrojejunoduodenostomy application after distal gastrectomy for peptic ulcer is represented in the paper. Gastroenoduodenostomy was performed using a small intestine loop, isolated according to Roux, on which a gastrojejunoanastomosis was first applied according to the “end-to-end” or “side-to-side” type, and then duodenojejunostomy “end of the duodenal stump-in-side Roux” was performed. 5 consequent clinical cases of the gastrojejunostomy application for the period of 2018-2019 are described. All patients were male, aged 51 to 68 years. In 3 patients gastrojejunoduodenostomy was performed after the previous operation, and in 2 patients – initially, due to the impossibility of the duodenal stump primary closure.
Results. In the early postoperative period complications occurred in 2 patients: bilateral deep vein thrombosis of the lower limbs and postoperative wound suppuration. The patient with suppuration died due to progression of chronic heart failure 27 days after surgery.
Conclusion. The positive aspects of the gastrojejunoduodenostomy are: universality – the possibility of application both in case of «difficult» stump, and in case of its incompetence treatment; simplicity – the surgeon only cuts and creates anastomoses without any plasty or cutouts, etc.; applicability for «low» and juxtapapillary ulcers – suturing of the small intestine to the stump which is possible even along 1 mm wide edge of the mucous membrane; applicability in the absence of the anterior wall of the duodenum – after previously applied Finney and Jaboulay pyloroplasty, after the Judd’ excision of the perforated ulcer; plastic properties – the use of a well-perfused loop of the small intestine to close a defect with inflamed edges is akin to a skin flap transplantion onto a wound; decompression of the duodenum; reduodenization of food passage.

Keywords: peptic ulcer of duodenum, distal gastrectomy, duodenal stump leakage, gastrojejunoduodenostomy; Roux-en-Y loop
p. 460-469 of the original issue
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Address for correspondence:
88018, Ukraine,
Uzhhorod,
Kapushanskaya str., 22,
Uzhhorod National University,
The Department of Surgical Diseases.
Tel. +380 (50) 950-95-84,
e-mail: roff75@gmail.com,
Rumiantsev Kostiantyn E.
Information about the authors:
Rusyn Vasyl I., MD, Professor of the Department of Surgical Diseases, Uzhhorod National University, Uzhhorod, Ukraine.
https://orcid.org/0000-0001-5688-9951
Rumiantsev Kostiantyn E., MD, Professor of the Department of Surgical Diseases, Uzhhorod National University, Uzhhorod, Ukraine.
https://orcid.org/0000-0002-8154-0601
Rusyn Vasyl V., MD, Professor of the Department of Surgical Diseases, Uzhhorod National University, Uzhhorod, Ukraine.
https://orcid.org/0000-0002-0794-6777
Mashura Valerii V., PhD, Assistant of the Department of Surgical Diseases, Uzhhorod National University, Uzhhorod, Ukraine.
https://orcid.org/0000-0001-9066-7228
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