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Year 2021 Vol. 29 No 4

SCIENTIFIC PUBLICATIONS
EXPERIMENTAL SURGERY

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

PROLONGATION OF CLEANSING DAMAGED TISSUES FROM DETRITUS USING EXOSOMES OF MULTIPOTENT STROMAL CELLS

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 1,
Institute of Chemical Biology and Fundamental Medicine, Russian Academy of Sciences, Siberian Branch 2,
Research Institute of Clinical and Experimental Lymphology 3, Novosibirsk,
The Russian Federation

Objective. To study the effect of exosomes of multipotent mesenchymal stromal cells (EMSCs) on soft tissues damaged during implantation of a metal screw into the bone.
Methods. A defect (2 mm in diameter and 4 mm in depth) was created in the tibial proximal condyles of outbred rabbits. Metal screws were implanted into the defect by preliminary injection of saline (control, n=9 animals) or 19.2 μg of EMSCs per limb (experiment, n=10 rabbits). After 3, 7 and 10 days following the operation, the animals were taken out from the experiment; histological sections of soft tissues from the condyle surface, stained by hematoxylin and eosin were studied using light microscopy.
Results. The use of water cooling in the process of introducing the metal implant into the tibial proximal condyle does not lead to complete removal of small bone fragments, which are subsequently either eliminated outward with wound discharge, or are destroyed and are subjected to lysis by macrophages. As a result of the EMSC effect on soft tissues near the site of damage, the activity of the postoperative inflammation reduces, leads to a slowdown in the resorption of hemorrhages, the elimination of fibrin clots, detritus and small bone fragments. Even on the 10th day after using EMSCs in the postoperative wound a structureless detritus with a small number of infiltrating cells was present, as well as a significant number of multinucleated macrophages with fused cytoplasm, non-viable lysed striated muscle symplasts and bone fragments with a low degree of degradation.
Conclusion. Suppression of inflammation by EMSCs delays the clearance of the postoperative wound, promotes the prolongation of the repair process and the attachment of the granulomatous component to the inflammation. The using EMSCs in the process of intraosseous implantation may be recommended only to control the activity of the inflammatory process and only after maximum preliminary cleansing of the postoperative wound from detritus, including non-viable muscle tissue and bone fragments.

Keywords: damaged tissues, exosomes of multipotent mesenchymal stromal cells, regeneration, inflammation, macrophages
p. 401-411 of the original issue
References
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Address for correspondence:
630090, Russian Federation,
Novosibirsk, Ak. Lavrentyev Avenue, 8,
Institute of Chemical Biology and Fundamental Medicine, Russian Academy of Sciences,
Siberian Branch Center of 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 of the Laboratory of Cell Biology and Cytology, Institute of Molecular Pathology and Pathomorphology, Federal Research Center for Fundamental and Translational Medicine of the Ministry of Science and Higher Education of the Russian Federation, Chief Researcher of the Laboratory of Health Management Technologies, Institute of Chemical Biology and Fundamental Medicine of the Russian Academy of Sciences, Siberian Branch, Novosibirsk, Russian Federation.
https://orcid.org/0000-0002-8182-5084
Shevela Aleksandr A., Ph.D, Doctoral Student, the Laboratory of Health Management Technologies, Institute of Chemical Biology and Fundamental Medicine of the Russian Academy of Sciences, Siberian Branch, Novosibirsk, Russian Federation.
http://orcid.org/0000-0001-9235-9384
Marchukov Sergey V., Ph.D, Doctoral Student, the Laboratory of Health Management Technologies, Institute of Chemical Biology and Fundamental Medicine of the Russian Academy of Sciences, Siberian Branch, Novosibirsk, Russian Federation.
https://orcid.org/0000-0002-7381-5820
Morozov Vitaly V., MD, Professor, Head of the Laboratory of Health Management Technologies, Institute of Chemical Biology and Fundamental Medicine of the Russian Academy of Sciences, Siberian Branch, Novosibirsk, Russian Federation.
https://orcid.org/0000-0002-9810-5593
Matveeva Vera A., PhD, Senior Researcher of the Laboratory of Health Management Technologies, Institute of Chemical Biology and Fundamental Medicine of the Russian Academy of Sciences, Siberian Branch, Novosibirsk, Russian Federation.
https://orcid.org/0000-0002-8706-4853
Maiborodina Vitalina I., MD, Leading Researcher, the Laboratory of Ultrastructural Basis of Pathology, Institute of Molecular Pathology and Pathomorphology, Federal ResearchCenter for Fundamental and Translational Medicine of the Ministry of Science and Higher Education of the Russian Federation, Novosibirsk, Russian Federation.
http://orcid.org/0000-0002-5169-6373
Novikov Alexey M., Junior Researcher, the Laboratory of Cell Technology, Institute of Clinical and Experimental Lymphology, the Branch of the Federal State Budgetary Scientific Institution «Federal Research Center Institute of Cytology and Genetics of the Siberian Branch of the Russian Academy of Sciences», The Russian Academy of Sciences, Siberian Branch, Novosibirsk, Russian Federation.
http://orcid.org/0000-0003-1371-7492
Tornuev Yury V., MD (Biol), Professor, Chief Researcher, the Laboratory of General Pathology and Pathomorphology, Institute of Molecular Pathology and Pathomorphology, Federal State Budgetary Scientific Institution «Federal Research Center for Fundamental and Translational Medicine» of the Ministry of Science and Higher Education of the Russian Federation, Novosibirsk, Russian Federation.
http://orcid.org/0000-0001-8629-8909
Churin Boris V., MD, Professor, Chief Researcher, the Laboratory of Cell Biology and Cytology, Institute of Molecular Pathology and Pathomorphology, Federal State Budgetary Scientific Institution «Federal Research Center for Fundamental and Translational Medicine» of the Ministry of Science and Higher Education of the Russian Federation, Novosibirsk, Russian Federation.
http://orcid.org/0000-0001-9742-6152
Shevela Andrey I., MD, Professor, Head of Department “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

GENERAL & SPECIAL SURGERY

V.I. PETUKHOV 1, V.I. DERKACH 1, S.N. ERMASHKEVICH 1, M.V. KUNTSEVICH 1, A.P. KUTKO 2

ANGIOPULMONOGRAPHY WITH NITROGLYCERIN TEST IN THE DIAGNOSIS OF ACUTE INFECTIOUS LUNG DESTRUCTION

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

Objective. To develop a method for additional and differential diagnosis of acute infectious lung destruction (AILD) based on angiopulmonography with the nitroglycerin test.
Methods. Angiopulmonography with the nitroglycerin test was used in 10 patients with suppurative diseases of the lung and pleura for additional and differential diagnosis of AILD The method was used in such situations when chest computed tomography did not allow to determine unambiguously the presence and / or prevalence of necrosis of the lung parenchyma.
Results. In 3 patients with the lung abscess, a clear restriction of the decay cavity was registered with the preservation of the main blood flow and weakening of the parenchymal phase of the blood circulation along the periphery of the destructive area.
During the nitroglycerin test performance there was no change in the filling of the microvascular bed with contrast along the periphery of the decay cavity, which made it possible to determine the presence of parietal sequesters. According to the results of the study, the lung gangrene was diagnosed in 6 patients. At the same time, two variants of circulatory disorders were noted: the first - with preservation of the blood flow through the main vessels and with the absence of a parenchymal phase in the lesion focus, the second - with the violation of the main blood flow. In the affected area no change in blood flow was observed after the nitroglycerin test performance. Similar results of the study indicated the development of necrosis of the pulmonary parenchyma, which was subsequently confirmed during the operations performed. In the site of inflammatory infiltration of the pulmonary parenchyma with preserved main blood flow, the depletion of the parenchymal phase of blood circulation was determined, but after the nitroglycerin test, a pronounced enrichment of the vascular architecture to the parenchymal phase in the pneumonia affecting part of the lung was noted.
Conclusion. It has been established that AILD is characterized by irreversible changes in the vascular bed of the lung parenchyma in the lesion focus. Angiopulmonography with the nitroglycerin test is considered to be an additional highly informative method improving the early and differential diagnosis of AILD in difficult clinical situations.

Keywords: angiopulmonography, nitroglycerin test, diagnostics, pneumonia, acute infectious lung destruction
p. 412-419 of the original issue
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Address for correspondence:
210009, Republic of Belarus,
Vitebsk, Frunze Av., 27,
Vitebsk State Medical University,
the Department of Hospital Surgery with the Course of the Advanced Training and Personnel Retraining
tel. mobile: + 375 29 890 64 42,
e-mail: derkach_v1991@mail.ru,
Derkach Vladislav I.
Information about the authors:
Petukhov Vladimir I., MD, Professor, Head of the Department of Hospital Surgery with the Course of the Advanced Training and Personnel Retraining, Vitebsk State Medical University, Vitebsk, Republic of Belarus.
https://orcid.org/0000-0002-4042-3978
Derkach Vladislav I., Post-Graduate Student of the Department of Hospital Surgery with the Course of the Advanced Training and Personnel Retraining, Vitebsk State Medical University, Vitebsk, Republic of Belarus.
https://orcid.org/0000-0001-9440-9031
Yermashkevich Siarhei N., PhD, Associate Professor of the Department of Hospital Surgery with the Course of the Advanced Training and Personnel Retraining, Vitebsk State Medical University, Vitebsk, Republic of Belarus.
https://orcid.org/0000-0002-0866-9070
Kuntsevich Maksim V., Assistant of the Department of Hospital Surgery with the Course of the Advanced Training and Personnel Retraining, Vitebsk State Medical University, Vitebsk, Republic of Belarus.
https://orcid.org/0000-0002-8122-6655
Kutko Andrey P., Head of the Endovascular Surgery Department, Vitebsk Regional Clinical Hospital, Vitebsk, Republic of Belarus.
https://orcid.org/0000-0001-8484-3651

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

INFLUENCE OF VARIOUS SURGICAL INTERVENTIONS ON VASCULAR WALL APOPTOSIS INDICES IN PATIENTS WITH ATHEROSCLEROSIS OF PERIPHERAL ARTERIES

I.P. Pavlov Ryazan State Medical University, Ryazan,
Russian Federation

Objective. Assessment of apoptosis proteins Bcl-2 and Bax indices before and after the open vascular reconstructions and X-ray endovascular interventions in patients with the peripheral atherosclerosis of the arteries of the lower extremities.
Methods. The study included patients (n=40) with the peripheral atherosclerosis of the lower extremities arteries (stage III-IV) disease who underwent open surgery – group A, and patients (n=40) who underwent endovascular interventions – group B. Two apoptosis proteins were analyzed in blood serum: Bax and Bcl-2 initially before surgery, on the 1st day and after 1 month. The reference values of the studied parameters were determined in 40 healthy volunteers.
Results. Initial Bax protein index – 27.1 ng / ml (ð<0,001) were elevated in patients of group A and reduced Bax protein – 4.4 ng / ml (p=0.00008) in patients of group B compared with indices of healthy volunteers (16.5 ng / ml, 5.3 ng / ml, respectively). On the 1st day after the interventions in the patients of the operative groups there was an increasing tendency for Bax index to 35.6 ng / ml (p<0.001) – group A, to 25.6 ng/ml (p<0.001) – group B. By the end of 1st month, Bax was increased to 28 ng/ml (p<0.001) in patients of group A and Bcl-2 was reduced to 3.0 ng / ml (p=0.039) compared to the initial indices; in patients of group B, only protein Bax – 23.9 ng / ml (p<0.001) was increased.
Conclusion. Open and endovascular intervention on the arteries of the lower extremities leads to the activation of the pro-apoptotic protein Bax on the 1st day after surgery. In the postoperative period the open reconstruction leads to an evaluation of the pro-apoptotic potential in comparison with endovascular intervention in the form of increasing Bax protein and reducing Bcl-2 by the end of the first month.

Keywords: apoptosis, peripheral arterial atherosclerosis, apoptosis proteins, Bc-l2, Bax
p. 420-425 of the original issue
References
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  12. Vladimirskaya TE, Shved IA, Demidchik YuE. Ratio of expression of the Bcl-2 and Bax proteins in the atherosclerotic coronary artery wall. Proceedings of the National Academy of Sciences of Belarus, Medical Series. 2015;(4):51-55. https://vestimed.belnauka.by/jour/article/view/213?locale=ru_RU (In Russ.)
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Address for correspondence:
390026, Russian Federation,
Ryazan, Vysokovoltnaya Str., 9,
Ryazan State Medical University,
the Department of Cardiovascular,
X-ray Endovascular,
Operative Surgery and Topographic Anatomy,
tel.: +7 903ì836-24-17,
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, X-ray Endovascular, Operative Surgery and Topographic Anatomy, I.P. Pavlov 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 Department of Cardiovascular, X-ray Endovascular, Operative Surgery and Topographic Anatomy, I.P. Pavlov Ryazan State Medical University, Ryazan, Russian Federation.
https://orcid.org/0000-0002-1292-5452.
Shchul’kin Aleksey V., MD, Associate Professor of the Department of Pharmacology with the Course of Pharmacy of Continuing Professional Education Faculty, I.P. Pavlov Ryazan State Medical University, Ryazan, Russian Federation.
https://orcid.org/0000-0003-1688-0017
Klimentova Åmma A., PhD, Post-Graduate Student of the Department of Cardiovascular, X-ray Endovascular, Operative Surgery and Topographic Anatomy, I.P. Pavlov Ryazan State Medical University, Ryazan, Russian Federation.
https://orcid.org/0000-0003-4855-9068
Egorov Andrey A., MD, Associate Professor of the Department of Cardiovascular, X-ray Endovascular, Operative Surgery and Topographic Anatomy, I.P. Pavlov Ryazan State Medical University, Ryazan, Russian Federation.
https://orcid.org/0000-0003-0768-7602

O.M. KLIMOVA 1, V.V. BOYKO 1, L.A. DROZDOVA 1, O.V. LAVINSKA 1, D.V. MINUKHIN 2, A.N. KUDREVICH 3

PROGNOSTIC MARKERS IN PATIENTS WITH THYMUS-INDEPENDENT AND THYMUS-DEPENDENT MYASTHENIA GRAVIS

Kharkiv National Medical University 2,
V. N. Karazin Kharkov National University 3, Kharkov,
Ukraine

Objective. To assess the presence of specific markers in patients with thymus-independent and thymus-dependent myasthenia gravis for choosing treatment tactics.
Methods. The presence of specific markers was assessed in 138 patients with thymus-independent (M – myasthenia gravis without thymus changes) and thymus-dependent (MH – myasthenia gravis with thymus hyperplasia, MT – myasthenia gravis with thymoma). The method ELISA (the content of antibodies to subunits 1 and 7 nAChR in blood serum, to 7 nAChR subunit in thymocyte mitochondria, a detectable level of antinuclear antibody (ANA), immunofluorescence (ANA glow) and flow cytometry (expression of CD14+CD11c+and CD14 + HLA-DR +) has been used.
Results. The relationship between the clinical phenotypes of myasthenia gravis and the variants of HLA diplotypes was revealed: in young patients with thymus-independent myasthenia gravis (M), a high heterogeneity of the genotypic markers HLA-DR (DR1, DR2, DR3, DR5, DR7) was detected. Patients with thymus-dependent myasthenia (MT) had only the HLA DR2 and HLA DR7 diplo- and haplotypes. The presence of HLA DR2 and HLA DR7 haplotypes in some young patients with progressive thymus-independent myasthenia gravis (M) led to the development of myasthenia gravis with thymoma (MT) in the elderly people. The pathogenic role also belongs to infection (ÑMV, EBV, HBV, HCV, HSV-1, HSV-2, HHV-6, mycoplasma) and food intolerance (IgE and IgG4) in the development and progression of myasthenia gravis. A four-fold prevalence of α7 subunit nicotinic acetylcholine receptors on the thymocyte mitochondria as an additional targets of autoimmune aggression in myasthenia gravis was determined. Specific antinuclear antibodies to centromere chromosome proteins were visualized in the elderly people with thymoma.
Conclusion. The prognosis of the myasthenia gravis progression and the development of remission can be made using genomic (the presence of certain HLA-DR haplotypes) and molecular (ANA antibodies to centromere chromosome proteins, expression of CD20+, CD14+CD11c+, CD14+HLA-DR+) biomarkers, that can be used for the choice of treatment tactics.

Keywords: myasthenia gravis, thymus hyperplasia, thymoma, antinuclear antibodies, differentiation cluster
p. 426-433 of the original issue
References
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  3. Klimova EM, Minuchin DV, Drozdova LA, Lavinskaya EV, Kordon TI, Kalashnykova YV. Features of self-tolerance loss in patients with different clinical phenotypes of myasthenia. Regul Mech Biosyst. 2018;9(4):561-67. doi: 10.15421/021884
  4. Farmakidis C, Pasnoor M, Dimachkie MM, Barohn RJ. Treatment of Myasthenia Gravis. Neurol Clin. 2018 May;36(2):311-37. doi: 10.1016/j.ncl.2018.01.011
  5. Schreuder GM, Hurley CK, Marsh SG, Lau M, Fernandez-Vina M, Noreen HJ, Setterholm M, Maiers M. The HLA Dictionary 2004: a summary of HLA-A, -B, -C, -DRB1/3/4/5 and -DQB1 alleles and their association with serologically defined HLA-A, -B, -C, -DR and -DQ antigens. Int J Immunogenet. 2005 Feb;32(1):19-69. doi: 10.1111/j.1744-313X.2005.00497.x
  6. Gergalova GL, Lehmus OJ, Skok MV. Possible effect of activation of α7-nicotinic acetylcholine receptors in the mitochondrial membrane on the development of apoptosis. Neurophysiology. 2011;43(3):195-197. doi: 10.1007/s11062-011-9203-7
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  8. Klimova EM, Lavinskaya EV, Minukhin DV, Syrovaya AO, Drozdova LA, Samoilova AP, Ìàkàrov VV, Ìàkàrov VA, Lukiyanova LV. On forming central and peripheral markers of self-tolerance loss in diverse clinical myasthenic phenotypes. Der Pharmacia Lettre. 2017;9(6):8-17. http://scholarsresearchlibrary.com/archive.html
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Address for correspondence:
61103, Ukraine,
Kharkov, Balakireva vyizd, 1,
V.T. Zaycev Institute of General and Urgent Surgery of National Academy of Medical Sciences of Ukraine,
Diagnostic Laboratory,
Tel. +38(057)3494115,
E-mail: klimovalena53@gmail.com,
Klimova Olena M.
Information about the authors:
Klimova Olena MD (Biol.), Professor, Head of the Diagnostic Laboratory with Enzyme Immunoassay and Immunofluorescence Analysis, V.T. Zaycev Institute of General and Urgent Surgery of NAMS of Ukraine, Kharkov, Ukraine.
https://orcid.org/0000-0002-4007-6806
Boyko Valery V., Corresponding Member of National Academy of Medical Sciences of Ukraine, MD, Professor, Director of V.T. Zaycev Institute of General and Urgent Surgery of National Academy of Medical Sciences of Ukraine, Kharkov, Ukraine. https://orcid.org/0000-0003-4771-9699
Drozdova Larisa À., Candidate of Biological Sciences, Senior Researcher, the Diagnostic Laboratory with Enzyme Immunoassay and Immunofluorescence Analysis, V.T. Zaycev Institute of General and Urgent Surgery of NAMS of Ukraine, Kharkov, Ukraine.
https://orcid.org/0000-0001-9678-4046
Lavinska Olena V., PhD(Biol.), Researcher, the Diagnostic Laboratory with Enzyme Immunoassay and Immunofluorescence Analysis, V.T. Zaycev Institute of General and Urgent Surgery of NAMS of Ukraine, Kharkov, Ukraine.
https://orcid.org/0000-0001-5813-3656
Minukhin Dmitriy V., PhD, Associate Professor Of The Surgery Department No1, V.N. Karazin Kharkiv National Medical University, Kharkov, Ukraine https://orcid.org/0000-0003-3371-1178
Kudrevych Oleksandr M., PhD, Associate Professor, Head of the Department of Surgical Diseases, Operative Surgery and Topographical Anatomy, V.N. Karazin Kharkiv National Medical University, Kharkov, Ukraine
https://orcid.org/0000-0002-2086-8822

V.V. BALYTSKYY 1, 2, M.P. ZAKHARASH 3, Å.G. ÊURYK 3, Y.M. ZAKHARASH 3

SURGICAL TREATMENT OF COMBINED ANORECTAL PATHOLOGY USING CURRENT TECHNOLOGIES

N.I. Pirogov Vinnitsa National Medical University 1, Khmelnitsky,
Khmelnitsky Regional Hospital 2, Khmelnitsky,
A.A. Bogomolets National Medical University 3, Kiev,
Ukraine

Objective. To evaluate the effectiveness of application radio-wave surgery device “Surgitron” and high-frequency electrosurgery devices “ERBE ICC 200”, “EFA”, “KLS Martin” for treatment of patients with combined anorectal pathology.
Methods. The treatment results of patients (n=635) with a combined anorectal pathology have been analyzed. The use of the «Surgitron» radio-wave surgery apparatus 245 (38.6%) patients were operated on, the «ERBE ICC 200» high-frequency electrosurgery apparatus - 169 (26.6%) patients, the «EFA» high-frequency electrosurgery apparatus – 114 (17.9 %) patients, «KLS Martin» high-frequency electrosurgery apparatus – 107 (16.9%) patients. After those surgical interventions to assess the effectiveness of the abovementioned current technologies, patients were conducted a morphological examination to determine the depth of the necrosis of tissues.
Results. According to the study results it has been established that application of the “Surgitron” radio-wave surgery device, “ERBE ICC 200” high-frequency electrosurgical devices “EFA”, “KLS Martin” reduces duration of the operation up to 15-30 min, the volume of bleeding - up to 10-30 ml, need in narcotic drugs - up to 1-4 ml, period of hospitalization – up to 3-6 days. Using these technologies prevented the formation of anal strictures and scar pararectal deformations due to the insignificant depth of tissue necrosis (the depth 0,036 -l 0,453 mm), ensuring the cosmetic effect of combined operations.
Conclusion. Application of the “Surgitron” radio-wave surgery device and “ERBE ICC 200” high-frequency electrosurgical devices, “EFA”, “KLS Martin” for treatment of patients with combined anorectal pathology reduces the operation duration, volume of bleeding and intensity of the postoperative pain. Use of these current technologies promotes the formation of a delicate elastic scar causing faster healing of postoperative wounds and improving the terms of patients’ rehabilitation.

Keywords: combined pathology, anal canal, rectum, high-frequency electrosurgery devices, radio- wave surgery device
p. 434-444 of the original issue
References
  1. Bach HH 4th, Wang N, Eberhardt JM. Common anorectal disorders for the intensive care physician. J Intensive Care Med. 2014 Nov-Dec;29(6):334-41. doi: 10.1177/0885066613485347
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  3. Raiymbekov OR, Zholbolduev ZhM, Aidarov UA. Sovremennye vzgliady na diagnostiku i lechenie pararektal’nogo svishcha v sochetanii s khronicheskim gemorroem. Koloproktologiia. 2017;(3s Pril):37-38. https://www.ruproctology.com/jour/article/view/1360?locale=ru_RU In Russ.)
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  5. Rivadeneira DE, Steele SR, Ternent C, Chalasani S, Buie WD, Rafferty JL; Standards Practice Task Force of The American Society of Colon and Rectal Surgeons. Practice parameters for the management of hemorrhoids (revised 2010). Dis Colon Rectum. 2011 Sep;54(9):1059-64. doi: 10.1097/DCR.0b013e318225513d
  6. Xu L, Chen H, Lin G, Ge Q. Ligasure versus Ferguson hemorrhoidectomy in the treatment of hemorrhoids: a meta-analysis of randomized control trials. Surg Laparosc Endosc Percutan Tech. 2015 Apr;25(2):106-10. doi: 10.1097/SLE.0000000000000136
  7. Lohsiriwat V. Treatment of hemorrhoids: A coloproctologist’s view. World J Gastroenterol. 2015 Aug 21;21(31):9245-52. doi: 10.3748/wjg.v21.i31.9245
  8. Lohsiriwat V. Anorectal emergencies. World J Gastroenterol. 2016 Jul 14;22(26):5867-78. doi: 10.3748/wjg.v22.i26.5867
  9. Esfahani MN, Madani G, Madhkhan S. A novel method of anal fissure laser surgery: a pilot study. Lasers Med Sci. 2015 Aug;30(6):1711-17. doi: 10.1007/s10103-015-1771-0
  10. Schornagel IL, Witvliet M, Engel AF. Five-year results of fissurectomy for chronic anal fissure: low recurrence rate and minimal effect on continence. Colorectal Dis. 2012 Aug;14(8):997-1000. doi: 10.1111/j.1463-1318.2011.02840.x
Address for correspondence:
29000, Ukraine, Khmelnitsky,
Pilotskaya Str., 1 N.I. Pirogov Vinnitsa National Medical University, the Surgery
Department of the Postgraduate Training Faculty,
Khmelnitsky Regional Hospital
tel. mobile +38 097-235-96-85.
e-mail: v.balytskyy@ukr.net
Balytskyy Vitaly V.
Information about the authors:
Balytskyy Vitaly V., PhD, Associate Professor of the Surgery Department of the Postgraduate Training Faculty, N.I. Pirogov Vinnitsa National Medical University, Khmelnitsky regional hospital, Khmelnitsky, Ukraine.
http://orcid.org/0000-0003-1076-5237
Zakharash Mikhail P., MD, Corresponding member of NAMS of Ukraine, Professor of the Surgery Department No1, A.A. Bogomolets National Medical University, Kiev, Ukraine.
http://orcid.org/0000-0003-4005-5172
Kuryk Elena G., MD, Professor of the Department of Pathologic Anatomy No1, A.A. Bogomolets National Medical University, Kiev, Ukraine.
https://orcid.org/0000-0003-3093-4325
Zakharash Yury M., MD, Professor of the Surgery Department No1, A.A. Bogomolets National Medical University, Kiev, Ukraine.
https://orcid.org/0000-0003-3093-4325

N.I. KHRAMTSOVA, S.A. PLAKSIN, A.YU. SOTSKOV, D.N. PONOMAREV

CHARACTERISTIC OF VIABILITY OF LIPORAFT CELLS AT VARIOUS TECHNIQUES OF ITS SELECTION AND PROCESSING

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

Objective. To determine the predictors of adipocytes and fibroblast-like cells survival in the lithographt using various techniques of lipoaspiration and adipose tissue preparation to autotraslantation.
Methods. Cellular viability was analyzed in 57 adipose tissue samples prepared by various techniques of lipoaspiration, and analysis of damage to adipocytes and fibroblast-like cells – in 73 smears after passing of adipose tissue through filters of different diameters.
Results. The average adipocyte viability in untreated lipoaspirate was 59%. Using water-jet technique, it was 65% (median 61%), syringe technique – 65% (median 74%), suction-assisted lipectomy – 55% (median 44%), p=0.18. The number of viable adipocytes depending on donor sites: thighs – 76%, waist – 67%, abdomen – 57%, buttocks – 50%, shoulders – 38%, knees – 35%. The number of intact adipocytes after 1.4 mm filter processing was 62-68%, fibroblast-like cells – 24-28%. The number of viable cells reduced with each passage. The number of intact adipocytes after 1.2 mm filter was 42-52%; of non-damaged fibroblast-like cells were 24-26% which located among connective tissue. The number of intact cells after emulsifying filter elevated up to 4-16% of adipocytes and 6-16% of fibroblast-like cells with a reduction of viable cells number with increasing of each passage. Single connective tissue fibers were determined, most content of the smear was represented by homogeneous fat.
Conclusion. The viability of adipocytes is higher when using the syringe lipoaspiration technique with sampling from the inner and outer surfaces of the thighs and lower back. For regenerative purposes, it is preferable to use emulsified fat, characterized by the destruction of adipocytes and the elimination of connective tissue fibers, keeping intact up to 16% of fibroblast-like cells. The defects of soft tissue is better to fill with washed «macro-fat» without filtration, or use a 1.4 mm cell filter. For a combination of regenerative and volumizing purposes, it is advisable to use anaerobic cell filters.

Keywords: adipocytes, regenerative medicine, adipose tissue mesenchymal stem cells, fat grafting, nanofat, lipectomy
p. 445-453 of the original issue
References
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Address for correspondence:
614000, Russian Federation,
Perm, Petropavlovskaya Str., 26,
Perm State Medical University Named After Academician E.A. Vagner,
the Dean’s Office of the Medical Faculty
tel.mobile: +7 909 107-12-34,
e-mail: renelve@gmail.com,
Khramtsova Natalya I.
Information about the authors:
Khramtsova Natalya I., PhD, Associate Professor of the Hospital Surgery Department, Perm State Medical University Named After Academician E.A. Vagner, Perm, Russian Federation.
http://orcid.org/0000-0001-6097-6855
Plaksin Sergey A., MD, Professor of the Surgery Department with the Course of Cardiovascular Surgery and Invasive Cardiology, Perm State Medical University Named After Academician E.A. Vagner, Perm, Russian Federation.
http://orcid.org/0000-0001-8108-1655
Sotskov Artem Yu., Student, Perm State Medical University Named After Academician E.A. Vagner, Perm, Russian Federation.
https://orcid.org/0000-0003-0225-2925
Ponomarev Danil N., Student, Perm State Medical University Named After Academician E.A. Vagner, Perm, Russian Federation.
https://orcid.org/0000-0001-5324-7515

TRAUMATOLOGY AND ORTHOPEDICS

T.A. STUPINA, T.N. VARSEGOVA

PATHOMORPHOLOGIC CHARACTERISTICS OF PALMAR APONEUROSIS IN PATIENTS WITH DUPUYTREN’S CONTRACTURE AND VIRAL HEPATITIS

G.A.Ilizarov National Medical Research Centre
for Traumatology and Orthopedics of the Ministry of Health of Russia, Kurgan,
The Russian Federation

Objective. To establish pathomorphologic peculiarities of palmar aponeurosis in the patients with Dupuytren’s contracture and concomitant virus hepatitis B and C.
Methods. The data analysis of histomorphometric studies of the operation samples of 122 patients with Dupuytren’s contracture («Control» group, n=100) and Dupuytren’s contracture with virus hepatitis B and C («Hepatitis» group, n=22) were analyzed.
Results. In patients of the «Hepatitis» group, the content of adiposed tissue in the palmar aponeurosis was 40.9% less (p <0.01) than in the «Control» group, and the content of dense connective tissue was 18.9% higher (p <0, 05). In all patients, arteries with the diameter up to 150 µm prevailed in the palmar aponeurosis, but in the «Hepatitis» group their percentage was reduced by 20%, with higher proportions of vessels with the diameter of 150–450 µm and the absence or recalibration of the largest arteries. In the «Control» group, the arteries had diameters from 50 to 660 µm, in the «Hepatitis» group they did not exceed 370 µm. Vessels less than 300 µm in diameter in both groups had comparable values of the Kernogan’s index. Arteries with a diameter of more than 300 microns in the «Hepatitis» group had higher values of the Kernogan’s index, which indicated a low conductance capacity compared to the vessels in the «Control» group. Most of the nerve trunks of the palmar aponeurosis in the patients of «Hepatitis» group showed signs of necrobiotic changes, i.e. fibrotic or swollen perineurium, with inflammatory cell infiltration, sometimes lost lamellar structure, and nerve fibers with signs of Wallerian degeneration.
Conclusion. Obtained histomorphometric data of the tissue composition of palmar fascial fibromatosis, less amount of adiposed tissue and higher amount of dense connective one and more pronounced disorder of hemodynamics and innervation of the palmar aponeurosis in the group with concomitant virus hepatitis indicate significant effect of the liver pathology on the progression of the disease.

Keywords: Dupuytren’s contracture, viral hepatitis, palmar aponeurosis, tissue composition, arteries, nerve fibers, pathomorphology
p. 454-461 of the original issue
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  6. Ùóäëî ÍÀ, Ùóäëî ÌÌ, Ñòóïèíà ÒÀ, Âàðñåãîâà ÒÍ, Ìèãàëêèí ÍÑ, Øèõàëåâà ÍÃ, Êîñòèí ÂÂ. Ïàòîìîðôîëîãè÷åñêèå îñîáåííîñòè êîíòðàêòóðû Äþïþèòðåíà ó ïàöèåíòà ñ áîëåçíüþ ïå÷åíè (ñëó÷àé èç ïðàêòèêè). Ãåíèé Îðòîïåäèè. 2019;25(4):576-79. doi: 10.18019/1028-4427-2019-25-4-576-579
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Address for correspondence:
640014, Russian Federation,
Kurgan, M.Ulyanova Str., 6,
G.A. Ilizarov National Medical Research
Centre for Traumatology and Orthopedics
of the Ministry of Health of Russia,
tel. +7 905 850-67-89,
e-mail: StupinaSTA@mail.ru,
Stupina Tatyana A.
Information about the authors:
Stupina Tatyana A., MD(Biol.), Leading Researcher of the Morphology Laboratory, G.A.Ilizarov National Medical Research Centre for Traumatology and Orthopedics of the Ministry of Health of Russia, Kurgan, Russian Federation.
https://orcid.org/0000-0003-3434-0372.
Varsegova Tatyana N., PhD(Biol.), Senior Researcher of the Morphology Laboratory, G.A.Ilizarov National Medical Research Centre for Traumatology and Orthopedics of the Ministry of Health of Russia, Kurgan, Russian Federation.
https://orcid.org/0000-0001-5430-2045

ANESTHESIOLOGY-REANIMATOLOGY

À.V. MAROCHKOV 1, 2, A.L. LIPNITSKI 1, 2, I.A. KUPREYEVA 1, V.U. DAZORTSAVA 1

COAGULATION BALANCE AND PLATELET AGGREGATION INDICATORS IN PATIENTS WITH INFECTION COVID-19

Mogilev Regional Clinical Hospital 1, Mogilev,
Vitebsk State Order of Peoples’ Friendship Medical University 2, Vitebsk,
The Republic of Belarus

Objective. To determine changes in coagulation balance and platelet aggregation in patient during the treatment of COVID-19 infection.
Methods. A pilot non-randomized prospective clinical study of coagulation balance and platelet aggregation in patients admitted to the intensive care unit with acute respiratory distress syndrome and the diagnosis of COVID-19 (n=50) was performed. Out of 50 patients, 19 patients died, 31 patients were transferred to the therapeutic department. The study of indicators of coagulation balance and platelet aggregation was carried out once in 1-3 days starting from the patient’s admission to the hospital using coagulation analyzer ACL 10000 (Instrumentation Laboratory, USA) and platelet aggregation analyzer AP 2110 (ZAO “SOLAR”, Republic of Belarus).
Results. In 45 (90%) patients with COVID-19, there is a significant increase of von Willebrand factor activity 350 (244.5; 480) %. There were no statistically significant differences in the level of von Willebrand factor activity among the deceased and surviving patients: 450.0 (338.8; 530.5) % in deceased patients and 342.0 (188.8; 480.0) % in survivors. At von Willebrand factor activity level of up to 250%, the mortality rate was 8.3%, at a level of 250-400% – 31.3%, at a level of more than 400% – 59.1%. Significantly above the normal range in most patients were fibrinogen (above normal in 68% of patients, 4.63 (3.49; 5.87) g/L) and D-dimers (above normal in 88% of patients, 0.73 (0,31; 1.4) μg/ml). Antithrombin III was below normal in 56% of patients (82 (67.1; 97.2) %). The degree of platelet aggregation has a strong direct correlation with the von Willebrand factor level: with an ADP inducer 0.3 μg/ml (R=0.71, ð=0.003); ADP 0.6 μg/ml (R=0.74, ð=0.0001); ADP 1.25 μg/ml (R=0.53, ð=0.01).
Conclusion. Analysis and evaluation of coagulation balance and platelet aggregation should be an integral part in the treatment of patients with COVID-19 infection.

Keywords: COVID-19, àãðåãàöèÿ òðîìáîöèòîâ, ôàêòîð Âèëëåáðàíäà, D-äèìåðû, ôèáðèíîãåí, òðîìáîöèòû
p. 462-469 of the original issue
References
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  11. Zubovskaia ET, Iurkevich TIu, Mitroshenko IV, Demidova RN. Trombotsitarnaia agregatometriia v klinicheskoi praktike: posobie dlia vrachei. Minsk, RB: ProniaPlius; 2018. 67 p. (In Russ.)
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Address for correspondence:
212016, Republic of Belarus,
Mogilev, Belynitskii-Biruli Str., 12,
Mogilev Regional Clinical Hospital,
the Department for Coordination of Organ
and Tissue Collection for Transplantation,
tel.: +375 222 62-75-95,
e-mail: Lipnitski.al@gmail.com,
Lipnitski Artur L.
Information about the authors:
Marochkov Alexey V., MD, Professor, Anesthesiologist of Anesthesiology and Intensive Care Unit, Mogilev Regional Clinical Hospital, the Branch of the Departments of Anesthesiology and Resuscitation with a Course of the Faculty of the Advanced Training and Retraining and Surgery of the Faculty of the Advanced Training and Retraining of Vitebsk State Medical University, Mogilev, Republic of Belarus.
https://orcid.org/0000-0001-5092-8315
Lipnitski A.L., PhD, Anesthesiologist, Head of the Department Coordination for Organ and Tissue Transplantation .Mogilev Regional Clinical Hospital, the Branch of the Departments of Anesthesiology and Resuscitation with a Course of the Faculty of the Advanced Training and Retraining and Surgery of the Faculty of the Advanced Training and Retraining of Vitebsk State Medical University, Mogilev, Republic of Belarus.
https://orcid.org/0000-0002-2556-4801
Kupreyeva Irina A., Head of the Centralized Laboratory of Clinical Biochemistry, Mogilev Regional Clinical Hospital, Mogilev, Republic Of Belarus.
https://orcid.org/0000-0002-5745-1203
Dazortsava Olga V., Physician of Laboratory Diagnostics of the Centralized Laboratory of Clinical Biochemistry, Mogilev Regional Clinical Hospital, Mogilev, Republic of Belarus.
https://orcid.org/0000-0001-9258-4514

REVIEWS

O. L. EISMONT

ADHESIVE CAPSULITIS OF THE SHOULDER JOINT

The Republican Scientific and Practical Centre for Traumatology and Orthopedics, Minsk,
The Republic of Belarus

The article presents a current view of the etiology and pathogenesis of adhesive capsulitis of the shoulder joint and the basic principles of conservative and surgical treatmen. Idiopathic adhesive shoulder capsulitis is a self-limiting disease with gradual improvement in symptoms, sometimes demanding surgical treatment. Currently, the role of both inflammatory and fibrotizing processes in the pathogenesis of adhesive capsulitis is generally recognized, when the inflammatory process ultimately leads to fibrotic changes. The disease is associated with diabetes mellitus, thyroid disease, cerebrovascular disease, coronary heart disease, autoimmune diseases, and Dupuytren’s contracture. In the literature there is no consensus on the unified treatment modality for adhesive capsulitis: conservative, operative, or combined. In a number of patients, improvement is achieved spontaneously, the recommended methods of treatment range from follow-up to invasive open capsulotomy. There is no universal treatment algorithm, so treatment should be individualized. By all accounts, conservative treatment is the first treatment of choice for adhesive capsulitis and includes physical therapy in combination with physiotherapy, anti-inflammatory drugs, corticosteroid injection, and hydrodilation. Surgical treatment of adhesive capsulitis is indicated for patients with persistent symptoms of the disease and ineffectiveness of conservative treatment. Surgical treatment includes manipulation under anesthesia and / or shoulder capsulotomy (arthroscopic or open). Treatment of adhesive shoulder capsulitis remains an unresolved clinical problem. The existing treatment regimens are not universal and further studies with long-term outcomes are needed to develop more effective treatment modality.

Keywords: adhesive shoulder capsulitis, shoulder joint, arthrofibrosis, humeroscapular periarthritis, capsulotomy
p. 470-479 of the original issue
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  52. Ibrahim IO, Nazarian A, Rodriguez EK. Clinical Management of Arthrofibrosis: State of the Art and Therapeutic Outlook. JBJS Rev. 2020 Jul;8(7):e1900223. doi: 10.2106/JBJS.RVW.19.00223
Address for correspondence:
220024, Republic of Belarus,
Minsk, Leytenant Kizhevatov Str., 60-4,
the Republican Scientific and Practical
Centre for Traumatology and Orthopedics,
tel. mobile+375 29 6787904,
e-mail: oleismont@tut.by,
Eismont Oleg L.
Information about the authors:
Eismont Oleg L., MD, Associate Professor, Deputy Director for Research, the Republican Scientific and Practical Centre for Traumatology and Orthopedics, Minsk, the Republic of Belarus.
http://orcid.org/0000-0002-1002-4132

R.I. DOVNAR

MODELING OF SKIN WOUNDS IN LABORATORY ANIMALS

Grodno State Medical University, Grodno,
The Republic of Belarus

The creation and implementation of new methods of study and local wound care occur in stages: in vitro, in vivo and clinical trials. The fundamental point of this process is to study the effect of the proposed agent on the experimental wound healing models of laboratory animals taking into consideration the common healing phases of course and similarity of animal wound healing with human one. At the initial stage the main problems faced by the researcher include the selection of the optimal experimental animal, while animal models are suitable for many skin disorders. The lack of strong evidence and relevant guidelines regarding the most appropriate form of local-wound care in literature and the fragmentation of the available information lead to the fact that during the development of the experiment, the scientists spend time, resources and operate on an additional number of animals. This article summarizes the literature data on the applied modeling methods as for the most common and rare types of skin wounds including burns and trophic ulcers in various laboratory animals. Those who prepared the experiment should have paid closer attention to the features of creating such wounds and nuances so as the proven techniques of their creation in various species are shown. Variants of the course and prospects for the development of this area of surgery are presented.

Keywords: animals, disease models, wound healing, skin injuries, burns, laboratory, ulcer
p. 480-489 of the original issue
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Address for correspondence:
230009, Belarus,
Grodno, Gorkii Str., 80,
Grodno State Medical University,
the 2nd Surgery Department,
tel.: +375 297 868643,
e-mail: dr_ruslan@mail.ru,
Dovnar Ruslan I.
Information about the authors:
Dovnar Ruslan I., PhD, Associate Professor of the 2nd Surgery Department Grodno State Medical University, Grodno, Republic of Belarus.
https://orcid.org/0000-0003-3462-1465.

S.N. YAROSHKIN, S.A. SUSHKOU, L.A. FRALOU

POTENTIAL AND PERSPECTIVES OF INDIRECT REVASCULARIZATION IN TREATMENT OF LOWER LIMBS CRITICAL ISCHEMIA

Vitebsk State Medical University, Vitebsk,
The Republic of Belarus

This review was undertaken by a literature search of the International scientific database PubMed and Cochrane library. The review highlights the issues and perspectives of indirect revascularization in the patients with lower limbs critical ischemia. The study revealed that lower limbs critical ischemia remains the actual problem of angiosurgery, despite of the widespread introduction of angioplasty and open vascular reconstruction. However, angioplasty and bypass surgery revascularization cannot be performed in some category of patients, so that the further improvement of indirect revascularization techniques has been of great interest to researchers. The severity of the ischemic process is determined not only by the mechanical blood flow restriction but also by the angiogenic potential of the surrounding soft tissues, foremost muscular one. Therefore, in the case of technical irreparability of the main blood flow it remains possible to preserve the limb by creating new vascular networks in the muscular tissue. Revascularizing osteotrepanation of the lower limb bones is considered to be the optimal variant to achieve this result. The discontent of clinical outcomes occurred due to the slow development of the angiogenic effect, which in critical ischemia is fraught with loss of a limb until the maximal angiogenesis is reached. In recent years, cell therapy has become a very promising and advanced scientific research topic. So that its methods have been actively introduced into practice; they are easily combined with revascularizing osteotrepanation and are able significantly accelerate angiogenesis induced by surgical bone injury. In this regard, there is reason to believe that curative effect increases when revascularising osteotrepanation is combined with cell therapy, including the use of bone marrow aspirates.

Keywords: angiogenesis, arteriogenesis, cell therapy, critical limb ischemia, peripheral arteries diseases, revascularization
p. 490-503 of the original issue
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Address for correspondence:
210027, Republic of Belarus,
Vitebsk, Frunze Avenue, 27,
Vitebsk State Medical University,
the Department of General Surgery,
e-mail: sergionik@gmail.com,
Yaroshkin Siarhei N.
Information about the authors:
Yaroshkin Siarhei N., PhD, Associate Professor of the Department of General Surgery, Vitebsk State Medical University, Vitebsk, Republic of Belarus.
http://orcid.org/0000-0003-2764-1812
Sushkou Siarhei A., PhD, Associate Professor, Vice-Rector for Research Work, Vitebsk State Medical University, Vitebsk, Republic of Belarus.
http://orcid.org/0000-0002-7524-6182
Fralou Leanid A., PhD, Associate Professor, Head of the Department of General Surgery, Vitebsk State Medical University, Vitebsk, Republic of Belarus.
http://orcid.org/0000-0003-3357-4409

CASE REPORTS

V.S. ZHUKOVSKIY, M.V. PANKIV, V.V. CHAPLYK, V.S. KOZOPAS, V.V. HUMENIUK

INFECTED URACHAL CYST IN AN ADULT

Danylo Halytskyy Lviv National Medical University, Lviv,
Ukraine

Urachus is a tubular formation originating from the top of the urinary bladder and directed to the umbilicus between the peritoneum and the transverse fascia of the abdomen. In an embryo, it serves to divert primary urine to the amniotic fluid. In case, if obliteration of the duct does not occur until the birth, various pathological processes can develop in it. The most common abnomalies of urachus reported in adults are an infected urachal cyst and urachal carcinoma. These diagnoses are not always easy to make due to atypical symptoms of their manifestation and the rarity of these diseases – just two cases per 100,000 hospitalizations of adults. A 22-year-old man with a subcutaneous abscess and an external fistula located in the umbilical region with redness of the surrounding skin. 16 hours after dissection and drainaging of the abscess, the patient’s condition worsened, pain in the lower parts of the abdomen began, muscle tension of the anterior abdominal wall and inflammatory changes in blood tests were revealed. The patient was operated on for peritonitis. A two-chambered urachus cyst of the «hourglass» type, with the formation of a dense consistency calculus in one of the cavities, which perforated into the abdominal cavity This clinical case is of the great interest from the point of view of the atypical course and the treatment of a rather rare anomaly in adults. The publication will remind emergency medicine physicians about the possibility of infected urachus in patients with symptoms of acute abdomen.

Keywords: infected urachal cyst in an adult, complications, acute abdomen, diagnosis, surgical management
p. 504-509 of the original issue
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Address for correspondence:
79010, Ukraine, Lviv, Pekarskaya Str. 69,
Danylo Halytskyy Lviv National Medical University, the Department of Emergency Medicine
and Military Medicine
tel. mobile: +38 067 725 32 39,
e-mail: zukovskiy@ukr.net,
Zhukovskiy Vladimir S.
Information about the authors:
Zhukovskiy Vladimir S., PhD, Associate Professor of the Department of Emergency Medicine and Military Medicine, Danylo Halytskyy Lviv National Medical University, Lviv, Ukraine.
http://orcid.org/ 0000-0002-0594-5316
Pankiv Maryana V., PhD, Post-Graduate Student, of the Anatomy Department , Danylo Halytskyy Lviv National Medical University, Lviv, Ukraine.
http://orcid.org/ 0000-0002-3714-2577
Chaplyk Viktor V., PhD, Associate Professor, Head of the Depatment of Emergency Medicine and Military Medicine, Danylo Halytskyy Lviv National Medical University, Lviv , Ukraine.
https://orcid.org/0000-0002-1633-0712
Kozopas Viktor S., PhD, Associate Professor of the Department of Emergency Medicine and Military Medicine, Danylo Halytskyy Lviv National Medical University, Lviv , Ukraine.
http://orcid.org/0000-0003-3451-6016
Humeniuk Vasiliy V., PhD(Ped.), Associate Professor of the Department of Emergency Medicine and Military Medicine, Danylo Halytskyy Lviv National Medical University, Lviv , Ukraine.
https://orcid.org/0000-0003-2736-3875

G.I. YEMETS, O.V. TELEHUZOVA, YE.A. CHERNETSKYI, G.B. MANKOVSKYI, YE.YU. MARUSHKO

MINI-INVASIVE AORTIC VALVE REPLACEMENT IN 97-YEAR PATIENT

Ukrainian Children’s Cardiac Center of the Ministry of Health of Ukraine, Kiev,
Ukraine

This review focuses on the choice of treatment strategy in elderly patients with severe aortic stenosis. The variability of surgical approaches and options, often limited due to excessive caution associated with the age-relative peculiarities of such patients has been shown in this study. The effectiveness of a multidisciplinary and integrated approach has been demonstrated, the result of which is measured by improving the quality and duration of the patient’s life. A case of mini-invasive aortic valve replacement in a 97-year-old patient is unique for the world literature. The key indicators that undoubtedly influence the choice of treatment tactics for an elderly patient are: the patient’s general condition, comorbidity and the ability of quick postoperative rehabilitation. Thus, minimally invasive surgery and transcatheter aortic valve implantation (TAVI) are considered to be the methods of choice for these patients. TAVI as an option is not always available, particular in countries with unstable economic conditions. In the given case, a multi-stage preoperative preparation of patient was performed to stabilize the general condition and to compensate the comorbidity. Thus, the preoperative period optimization for high-risk patients facilitated the rapid rehabilitation and adaptation after the operation. Any surgical procedure has risks associated with it, so the hybrid approach, widely used in a current clinical cardiac surgery, is especially valuable in the context of treating elderly patients, since it minimizes these risks.

Keywords: minimally invasive surgery, clinical observation, aortic valve stenosis, the elderly patients, cardiac surgery
p. 510-517 of the original issue
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Address for correspondence:
04050 Ukraine, Kiev,
Ilyenko Str., Ukrainian Children’s Cardiac
Center of the Ministry of Health of Ukraine,
tel. +3 80687044822,
e-mail: teleguzova5@gmail.com,
Telehuzova Alexandra V.
Information about the authors:
Yemets Gleb I., Cardiovascular Surgeon, the Department of Congenital and Acquired Heart Defects in Adults and Adolescents, Ukrainian Children’s Cardiac Center of the Ministry of Health of Ukraine, Kiev, Ukraine.
https://orcid.org/0000-0002-6139-6235
Telehuzova Alexandra V., Cardiologist, the Department of Congenital and Acquired Heart Defects in Adults and Adolescents, Ukrainian Children’s Cardiac Center of the Ministry of Health of Ukraine, Kiev, Ukraine.
https://orcid.org/0000-0003-4801-093X
Chernetskiy Yevheniy A., Cardiologist, the Department of Congenital and Acquired Heart Defects in Adults and Adolescents, Ukrainian Children’s Cardiac Center of the Ministry of Health of Ukraine, Kiev, Ukraine.
https://orcid.org/0000-0002-4487-6819
Mankovsky Georgiy B., PhD, Interventional Cardiologist, the Department of Emergency X-Ray Diagnostics, Ukrainian Children’s Cardiac Center of the Ministry of Health of Ukraine, Kiev, Ukraine.
https://orcid.org/0000-0003-4980-4571
Marushko Yevheniy Yu., PhD, Interventional Cardiologist, the Department of Emergency X-Ray Diagnostics, Ukrainian Children’s Cardiac Center of the Ministry of Health of Ukraine, Kiev, Ukraine.
https://orcid.org/0000-0002-0696-9926
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