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Year 2013 Vol. 21 No 5

EXPERIMENTAL SURGERY

S.L. ZYBLEV, Z.A. DUNDAROV

THE STATE OF METABOLISM IN EXPERIMENTAL ACUTE MASSIVE BLOOD LOSS DEPENDING ON THE CONDUCTED THERAPY

EE "Gomel State Medical University",
The Republic of Belarus

Objectives. To study the impact of the conducted therapy on the metabolic state of animals with acute massive blood loss in experiment.
Methods. The experimental group of animals with acute blood loss was divided into five subgroups. The first subgroup was composed of the rats received no any treatment. The second subgroup included the rats underwent to the physiological saline injections after bleeding procedure. The third subgroup consisted of the rats underwent the injections of autologous blood with physiological saline. The fourth subgroup was made up of the rats with reinfusion of the whole autologous blood. The fifth subgroup consisted of the rats to whom the antioxidant complex “Cytoflavin” has been injected after bleeding procedure. After the treatment à red blood cell count and concentration of hemoglobin in the blood as well as indices of acid-base balance, biomedical parameters and antioxidant activity (AOA) of blood serum have been evaluated. The received data were compared with those of healthy animals (control group).
Results. It was experimentally proved that the injections of saline solution and reinfusion of autologous blood at the rate of 50% out of the blood loss volume with an equal volume of physiological saline did not significantly affect on the metabolic processes in animals after acute massive blood loss. Free-radical processes in the body with the prevalence of peroxidation and the formation of oxidative stress couldn’t be adjusted even by massive whole autologous blood transfusion. The received data indicate the high efficiency of the antioxidant complex “Cytoflavin” for the correction of metabolic post hemorrhagic disorders. The introduction of the drug “Cytoflavin” eliminates the prevalence of peroxidation processes and stops oxidative stress.
Conclusions. The activation of peroxidation leads to the growth of uric acid concentration as an active natural antioxidant. The injection of saline solutions in massive blood loss is unable to compensate the acid-base balance of the body, supply of antioxidant potential and reduce peroxidation processes. Massive blood transfusion equal to the volume of acute blood loss does not lead to a stabilization of free-radical processes in the body. The use of antioxidants in acute massive blood loss is an effective measure to prevent and relieve oxidative stress.

Keywords: blood loss, hemorrhagic shock, oxidative stress, acid-base balance, blood transfusion, cytoflavin
p. 3 – 10 of the original issue
References
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  2. Kligunenko EN, Kravets OV. Intensivnaia terapiia krovopoteri [Intensive therapy of blood loss]. Moscow, RF: MEDpress-inform; 2005. 112 p.
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  4. Golubev AM, Tamaeva FA. Korrektsiia metabolicheskikh narushenii v pochkakh pri ostroi massivnoi krovopotere (eksperimental'noe issledovanie) [Correction of metabolic abnormalities in the kidneys in acute massive blood loss (experimental study)]. Obshch Reanimatol. 2007;3(5-6):38–42.
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  11. Zyblev SL, Dundarov ZA. Antioksidantnaia aktivnost' krovi bol'nykh s ostrym gastroduodenal'nym krovotecheniem [The antioxidant activity of the blood of patients with acute gastroduodenal bleeding]. Khirurgiia. Vostochn Evropa. 2013;(1):12–23.
  12. Sirota TV. Sposob opredeleniia antioksidantnoi aktivnosti superoksiddismutazy i khimicheskikh soedinenii [Method of determination of superoxide dismutase antioxidant activity and chemical compounds]: pat. 2144674 RF, MPK7 G01N33/52, G01N33/68/ ¹ 99103192/14; zaiavl. 24.02.1999; opubl. 20.01.2000. 2000(2)2: 266 p.
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Address for correspondence:
246000, Respublika Belarus', g. Gomel', ul. Lange, d. 5, UO Gomel'skii gosudarstvennyi meditsinskii universitet, kafedra khirurgicheskikh boleznei ¹2 s kursom detskoi khirurgii,
e-mail: S.zyblev@yandex.ru,
Zyblev Sergei Leonidovich
Information about the authors:
Zyblev S.L. An assistant of the chair of surgical diseases ¹ 2 with the course of pediatric surgery of EE "Gomel State Medical University".
Dundarov Z.A. MD, professor, a head of the chair of surgical diseases ¹ 2 with the course of pediatric surgery of EE "Gomel State Medical University". Dundarov Z.A. MD, professor, a head of the chair of surgical diseases ¹ 2 with the course of pediatric surgery EE "Gomel State Medical University".

B.S. SUKOVATYKH, A.V. IVANOV, N.M. VALUSKAYA, E.V. GERASIMCHUK

THE INFLUENCE OF LATE IMPLANTATION FABRIC REACTION ON THE CHOICE OF POLYPROPYLENE ENDOPROSTHESIS FOR PREVENTIVE SUBAPONEUROTIC PLASTY OF THE ABDOMINAL WALL

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

Objectives. To study the late fabric reaction of the abdominal wall to subaponeurotic implantation of easy polypropylene endoprostheses and determine the most optimal material for the preventive endoprostheses on this basis.
Methods. Two facilitated endoprostheses served as the materials for the research: easy polypropylene and super easy polypropylene polyvinylidene fluoride mesh endoprostheses. The standard polypropylene endoprosthesis was used as control one. Thread thickness of a standard polypropylene endoprosthesis is 0,12 mm, an easy one – 0,09 mm, a super easy one – 0,07 mm. Experimental study was carried out in the central research laboratory of Kursk State Medical University on 33 Chinchilla rabbits, divided into 3 groups, 9 animals in each. A standard endoprosthese was implanted subaponeurotically on the muscles of the abdominal wall in the control group, in the first experimental one – easy endoprosthese, in the second experimental – super easy endoprostheses. Microscoping and microphotographing have been performed by means of the optical system consisting of the light microscope of Leica CME, DCM 500 digital ocular camera and the FUTURE WINJOE program included in the package of an ocular camera.
Results. The standard polypropylene endoprosthesis possesses ability of fast and reliable formation of a rough deformed connective-tissue capsule by the 30th day of the experiment. Inflammatory aseptic reaction to implantation of an easy polypropylene endoprosthesis remains within 120 days then the soft connective-tissue capsule is formed. Inflammatory aseptic reaction in response to implantation of a super easy endoprosthesis is twice shorter in comparison with an easy artificial one and is completed after 60 days with the formation of a very fine capsule.
Conclusions. The super easy polypropylene polyvinylidene endoprosthesis doesn’t cause the long inflammatory reaction and is considered as an optimal material for a preventive endoprosthesis.

Keywords: mesh endoprostheses, abdominal wall plasty, late fabric reaction
p. 11 – 17 of the original issue
References
  1. Grubnik VV, Losev AA, Baiazitov NR, Parfent'ev RS. Sovremennye metody lecheniia briushnykh gryzh [Current methods of treatment of abdominal hernias]. Kiev, Ukraina: Zdorov'e, 2001. 280 p.
  2. Egiev VN, red. Nenatiazhnaia gernioplastika [Tension free hernioplastics]. Moscow, RF: 2002. 148 p.
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  4. Sukovatykh BS, Valuiskaia NM, V.A. Zhukovskii NV, Pravednikova N.V. Profilaktika posleoperatsionnykh ventral'-nykh gryzh pri pomoshchi polipropilenovogo endoproteza [Prevention of postoperative ventral hernias using a polypropylene prosthesis]. Khirurgiia. Zhurnal im NI Pirogova.2007;(9):46–50.
  5. Sukovatykh BS, Netiaga AA, Valuiskaia NM, Zhukovskii VA. Preventivnaia plastika briushnoi stenki endoprotezom Esfil pri operatsiiakh na organakh briushnoi polosti [Preventive plasty of abdominal wall by Esfil stent in abdominal operations]. Vestn Khirurgii. 2006;165(3):61–66.
  6. Sukovatykh BS, Valuiskaia NM, Netiaga AA, Zhukovskii VA, Pravednikova NV, Kas'ianova MA. Pokazaniia i rezul'taty preventivnogo endoprotezirovaniia briushnoi stenki vo vremia operatsii na organakh briushnoi polosti i zabriushinnogo prostranstva [Indications and results of preventive replacement of the abdominal wall during abdominal and retroperitoneal operations]. Vestn Khirurgii im II Grekova. 2011;(3):53–57.
  7. Bart II, Ivanov VP, Ivanov SV. Funktsional'naia aktivnost' ribosomnykh genov i ee vovlechennost' v formirovanie ventral'nykh gryzh u cheloveka [The functional activity of ribosomal genes and their involvement in the formation of ventral hernias in humans]. Chelovek i Ego Zdorov'e. 2012;(3):37–41.
  8. Bolton MA, Pruzinsky T, Cash TF, Persing JA. Measuring outcomes in plastic surgery: body image and quality of life in abdominoplasty patients. Plast Reconstr Surg. 2003 Aug;112(2):619–25.
  9. Janes A, Cengiz Y, Israelsson LA. Randomized clinical trial of the use of a prosthetic mesh to prevent parastomal hernia. Br J Surg. 2004 Mar;91(3):280–82.
  10. Gonzalez R, Ramshaw BJ. Comparison of tissue integration between polyester and polypropylene prostheses in the preperitoneal space. Am Surg. 2003 Jun;69(6):471–6.
  11. Scheidbach H, Tannapfel A, Schmidt U, Lippert H, Kockerling F. Influence of titanium coating on the biocompatibility of a heavyweight polypropylene mesh. An animal experimental model. Eur Surg Res. 2004 Sep-Oct;36(5):313–17.
  12. Timoshin AD, Iurasov AV, Shestakov AL. Khirurgicheskoe lechenie pakhovykh i posleoperatsionnykh gryzh briushnoi stenki [Surgical and post-surgical treatment of inguinal hernias of the abdominal wall]. Moscow, RF: Triada-X 2003; 144 p.
  13. Ivanov SV, Ivanov IS, Goriainova GI, Tsukanov AV, Katunina TP. Sravnitel'naia morfologiia tkanei pri ispol'zovanii protezov iz polipropilena i polivinilidenftorida [Comparison tissue morphology in using prostheses from polypropylene and polyvinylidene fluoride]. Tsitologiia. 2012;(2) 54:158–64.
  14. 14. Ivanov SV, et al. [Comparative tissue morphology in using prostheses from polypropylene and polytetrafluoretilen cell and tissue biology. Cell and Tissue Biology. 2012;6(3):309–15.
  15. Vaz M, Krebs RK, Trindade EN, Trindade MR. Fibroplasia after polypropylene mesh implantation for abdominal wall hernia repair in rats. Acta Cir Bras. 2009 Jan-Feb;24(1):19-25.
Address for correspondence:
305041, Rossiiskaia Federatsiia, g. Kursk. ul. K. Marksa, d. 3, GBOU VPO Kurskii gosudarstvennyi meditsinskii universitet, kafedra obshchei khirurgii,
e-mail: SukovatykhBS@kursksmu.net,
Sukovatykh Boris Semenovich
Information about the authors:
Sukovatykh B.S. MD, professor, a head of the chair of general surgery SEI HPE of "Kursk State Medical University"
Ivanov A.V. MD, professor, a head of the chair of histology, cytology and embryology of SEI HPE "Kursk State Medical University".
Valuskaya N.M. PhD, a n assistant of the chair of general surgery of SEI HPE "Kursk State Medical University"
Gerasimchuk E.V. An ordinator of the chair of general surgery of SEI HPE "Kursk State Medical University"

A.P. TRUKHAN, S.A. ZHIDKOV, V.E. KORIK, T.A. LETKOVSKAYA, A.S. ZHIDKOV, D.G. TERESHKO

THE INFLUENCE OF LIMB COMPRESSION FORCE ON THE EXPRESSION OF MORPHOLOGICAL CHANGES DURING CRUSH SYNDROME

EE "Belarusion State Medical University"
The Republic of Belarus

Objectives. To determine the influence of different force of the limb compression on the severity of changes in the internal organs during crush syndrome.
Methods. 15 guinea pigs were subjected to the research. Crush syndrome was modeled using the device of adjustable compression (DAC-1). Depending on the compression force the animals were divided into three groups: 1 group (5 animals) – 10 kg/cm2, 2 group (5 animals) – 25 kg/cm2, 3 group (5 animals) – 75 kg/cm2. The morphological analysis of the tissues was carried out on the muscle of the compressed limb, kidney, liver, lung and heart.
Results. The expression of morphological changes in the muscles and internal organs was in direct proportion from the compression force of the limb and duration of post-compression period. In the first group combined with the damage of the limb muscle the changes in the kidney with slight alterations in other internal organs have been observed. In the second group the more pronounced morphological changes both in the damaged limb and in the internal organs have been noted. This became the basis of multiple organ dysfunctions and resulted in death of the animals on the first day of early post-compression period. The third group of animals died during the compression period. The cause of death was an expressed traumatic shock confirmed by corresponding changes in the internal organs.
Conclusions. The specific changes at the crush syndrome occur not only in the limb muscles but also in the internal organs. Knowledge of these features is the basis for crush syndrome treatment.

Keywords: Crush syndrome, morphological changes, internal organs
p. 18 – 23 of the original issue
References
  1. Tsybuliak GN. Obshchaia khirurgiia povrezhdenii [General surgery of damages]. Rukovodstvo dlia vrachei. Saint-Petersburg, RF: Gippokrat, 2005. 648 p.
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  3. Garkavi AV. Sindrom dlitel'nogo sdavleniia miagkikh tkanei konechnostei [Crush syndrome of soft tissues of the extremities]. Med pomoshch'. 2000;(2):23–28.
  4. Scharman EJ, Troutman WG. Prevention of kidney injury following rhabdomyolysis: a systematic review. Ann Pharmacother. 2013 Jan;47(1):90-105.
  5. Nechaev EA, Revskii AK, Savitskii GG. Sindrom dlitel'nogo sdavleniia [Crush syndrome: rukovodstvo dlia vrachei. Moscow, RF: Meditsina, 1993. 208 p.
  6. Sever MS, Vanholder R. Management of crush victims in mass disasters: highlights from recently published recommendations. Clin J Am Soc Nephrol. 2013 Feb;8(2):328-35.
  7. Speck K, Schneider BS, Deashinta N. A rodent model to advance the field treatment of crush muscle injury during earthquakes and other natural disasters. Biol Res Nurs. 2013 Jan;15(1):17-25.
  8. Murata I, Ooi K, Sasaki H, Kimura S, Ohtake K, Ueda H, Uchida H, Yasui N, Tsutsui Y, Yoshizawa N, Hirotsu I, Morimoto Y, Kobayashi J. Characterization of systemic and histologic injury after crush syndrome and intervals of reperfusion in a small animal model. J Trauma. 2011 Jun;70(6):1453-63.
  9. Trukhan AP, Zhidkov SA, Korik VE, Kiselev MG, Es'man GA, Zhidkov AS, Tereshko DG. Eksperimental'noe modelirovanie sindroma dlitel'nogo sdavleniia [Experimental modeling of crush syndrome].Khirurgiia. Vostochn Evropa. 2013;(1):70–75.
Address for correspondence:
220034, Respublika Belarus', g. Minsk, ul. Azgura, d. 4, UO Belorusskii gosudarstvennyi meditsinskii universitet, voenno-meditsinskii fakul'tet, kafedra voenno-polevoi khirurgii
e-mail: aleksdoc@yandex.ru,
Trukhan Aleksei Petrovich
Information about the authors:
Trukhan A.P. PhD, an associate professor of military field surgery of the Faculty of Military Medicine of EE "Belarusian State Medical University".
Zhidkov S.A. MD, professor of military field surgery of the Faculty of Military Medicine of EE "Belarusian State Medical University".
Korik V.E. PhD, an associate professor, a head of the chairt of military field surgery of the Faculty of Military Medicine of EE "Belarusian State Medical University".
Letkovskaya T.A. PhD, an associate professor of the chair of pathological anatomy of EE "Belarusian State Medical University".
Zhidkov A.S. A clinical ordinator of military field surgery of the Faculty of Military Medicine of EE "Belarusian State Medical University".
Tereshko D.G. A 6th year student of military field chair of the Faculty of Military Medicine of EE "Belarusian State Medical University".

GENERAL AND SPECIAL SURGERY

U.A. PRIVALOV1, L.K. KULIKOV1, N.M. BYKOVA2, V.F. SOBOTOVICH1

DIAGNOSTICS AND SURGICAL TREATMENT FOR PHEOCHROMOCYTOMAS IN PATIENTS WITH ADRENAL INCIDENTALOMAS

SBEE APE "Irkutsk State Medical Academy of Post-Graduate Education"1
MAME "Municipal Clinical Hopital ¹ 10"2, Irkutsk,
The Russian Federation

Objectives. To evaluate efficacy of diagnostics and surgical treatment of pheochromocytomas among patients with incidental adrenal mass.
Methods. Within the prospective cohort study 322 patients with incidental adrenal mass have been investigated. Indications for surgery were defined to 169 patients. Pheochromocytoma (adrenal paraganglioma) was hystlogically verified in 15 patients. The effectiveness of clinical, laboratory and radiological methods of diagnosis of pheochromocytomas, intraoperative complications, the results of surgical treatment have been analyzed.
Results. Combination of arterial hypertension, tachycardia, hyperhidrosis and pallor among clinical signs of hypercatecholamine was considered as the highest diagnostics value (sensitivity 84%, specificity 86%). Multispiral computer tomography (MCT) with contrast is highly sensitive (96%) but low specific (56%) method in the differential diagnostics of pheochromocyte. Diagnostic value of determination of the catecholamine excretion with the urine turned out to be low (sensitivity – 66% and specificity – 96%). The test for dayly metanephrine urine had a great diagnostic significance (sensitivity – 96% and specificity – 100%). Despite on all pheochromocytomas were initially detected as incidentalomas, only 4 (26,6%) cases were referred as silent pheochromocytomas. Intraoperative catecholamine crisis developed in 3 (20%) patients undergoing open surgery and in 1 patient – during laparoscopy. There were no postoperative complications and lethal outcomes. Residual arterial hypertension in long-term period after surgery was detected in 6 (40%) patients.
Conclusion. Clinical patterns of hypercatecholaminemia were observed in the majority of patients with adrenal pheochromocytoma previously verified as incidental adrenal mass. The main cause of delay diagnostics of pheochromacytomas was considered as noncompliance by general practitioners of the investigation algorithm of patients observation with arterial hypertension. Silent pheochromocytoma is the most dangerous one which can result as life threaten complication both during examination and surgery. Laparoscopic adrenalectomy is the operation of choice in the case when tumor size > 6 cm.

Keywords: incidental adrenal mass, silent pheochromacytoma, differential diagnostics, adrenalectomy
p. 24 – 30 of the original issue
References
  1. Dedov II, Bel'tsevich DG, Kuznetsov NS, Mel'nichenko GA. Feokhromotsitoma [Pheochromocytoma]. Moscow, RF: Prakt. meditsina. 2005. p. 47–70.
  2. Dedov I I. Ob"emnye obrazovaniia nadpochechnikov (diagnostika i differentsial'naia diagnostika) [Adrenal incidentaloma (diagnosis and differential diagnosis]: metod.rekomendatsii. CONSILIUM MEDICUM: Endokrinol. 2009;12(11):76–94.
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  4. Yu R, Nissen NN, Chopra P, Dhall D, Phillips E, Wei M. Diagnosis and treatment of pheochromocytoma in an academic hospital from 1997 to 2007. Am J Med. 2009 Jan;122(1):85–95.
  5. Fischer E, Beuschlein F. Incidentaloma and subclinical disorders of the adrenal gland. Dtsch Med Wochenschr. 2013 Feb;138(8):375-80.
  6. Androulakis II, Kaltsas G, Piaditis G, Grossman AB. The clinical significance of adrenal incidentalomas. Eur J Clin Invest. 2011 May;41(5):552-60.
  7. Nieman LK. Approach to the patient with an adrenal incidentaloma J Clin Endocrinol Metab. 2010 Sep;95(9):4106-13.
  8. Pacak K, Eisenhofer G, Ahlman H, Bornstein SR, Gimenez-Roqueplo AP, Grossman AB, Kimura N, Mannelli M, McNicol AM, Tischler AS; Pheochromocytoma: recommendations for clinical practice from the First International Symposium. October 2005. Nat Clin Pract Endocrinol Metab. 2007 Feb;3(2):92-102.
  9. Tabarin A, Bardet S, Bertherat J, Dupas B, Chabre O, Hamoir E, Laurent F, Tenenbaum F, Cazalda M, Lefebvre H, Valli N, Rohmer V; Exploration and management of adrenal incidentalomas. French Society of Endocrinology Consensus. Ann Endocrinol (Paris). 2008 Dec;69(6):487–500.
  10. Kanagarajah P, Ayyathurai R, Manoharan M, Narayanan G, Kava BR. Current concepts in the management of adrenal incidentalomas. Urol Ann. 2012 Sep;4(3):137-44.
  11. Leung K, Stamm M, Raja A, Low G. Pheochromocytoma: the range of appearances on ultrasound, CT, MRI, and functional imaging. AJR Am J Roentgenol. 2013 Feb;200(2):370-8.
  12. Hariskov S, Schumann R. Intraoperative management of patients with incidental catecholamine producing tumors: A literature review and analysis. J Anaesthesiol Clin Pharmacol. 2013 Jan;29(1):41-6.
  13. Scholten A, Cisco RM, Vriens MR, Cohen JK, Mitmaker EJ, Liu C, Tyrrell JB, Shen WT, Duh QY. Pheochromocytoma crisis is not a surgical emergency. J Clin Endocrinol Metab. 2013 Feb;98(2):581-91
  14. Conzo G, Musella M, Corcione F, De Palma M, Ferraro F, Palazzo A, Napolitano S, Milone M, Pasquali D, Sinisi AA, Colantuoni V, Santini L. Laparoscopic adrenalectomy, a safe procedure for pheochromocytoma. A retrospective review of clinical series. Int J Surg. 2013;11(2):152-6
Address for correspondence:
664079, Rossiiskaia Federatsiia, g. Irkutsk, m-n. Iubileinyi, d. 100, GBOU DPO Irkutskaia gosudarstvennaia meditsinskaia akademiia poslediplomnogo obrazovaniia, kafedra khirurgii,
e-mail: privalov@smtp.ru,
Privalov Yurii Anatol'evich
Information about the authors:
Privalov Yu.A. PhD, an associate professor of the chair of surgery of SEI DPO "Irkutsk State Medical Academy for Postgraduate Education".
Kulikov L.K. MD, professor, a head of the chair of surgery of SEI DPO "Irkutsk State Medical Academy for Postgraduate Education".
Bykova N.M. PhD, a head of the endocrinology department of Irkutsk MAEH "Municipal clinical hospital ¹ 10".
Sobotovich V.F. PhD, an associate professor of the chair of surgery of SEI DPO "Irkutsk State Medical Academy for Postgraduate Education".

B.M. DATSENKO, V.B. BORISENKO

MECHANICAL JAUNDICE, ACUTE CHOLANGITIS, BILIARY SEPSIS: PATHOGENIC RELATIONSHIP AND PRINCIPLES OF DIFFERENTIAL DIAGNOSTICS

Kharkov Medical Academy for Post-Graduate Education,
The Ukraine

Objectives. Clinico-morphological research is directed toward the study of pathogenetic relationship between biliary sepsis, mechanical jaundice and acute cholangitis as well as elaboration of the complex program differential diagnostics of these diseases.
Methods. The experimental-clinical research directed toward the study of pathogenic interrelations between mechanical jaundice, acute cholangitis and biliary sepsis has been carried out. The experimental part of the work has been done on 90 Wistar mature rats. The clinical part of the work was based on the study of 92 patients with the mechanical jaundice syndrome.
Results. Firstly it has been determined that besides the activity of two well- known factors of acute cholangitis pathogenesis as cholestasis and infection, the presence of the third pathogenic factor in the form of an lesion (destruction) of bile ducts mucosa is necessary for its origin. A number of diagnostically important criteria permitt to carry out the differential diagnostics between mechanical jaundice, acute cholangitis and biliary sepsis in a short time in all cases. Uncomplicated course of mechanical jaundice was diagnosed in 30 (32,6%), complicated course with the development of acute cholangitis was determined in 42 (45,7%) and biliary sepsis – in 20 (21,7%) patients.
Conclusions. The conducted study allowed to define the main factors of acute cholangitis and biliary sepsis pathogenesis. The worked out program of differential diagnostics of uncomplicated mechanical jaundice, acute cholangitis and biliary sepsis allow to perform the differential approach to the choice the rational treatment tactics, different for each disease, that is of great economical importance

Keywords: mechanical jaundice, acute cholangitis, biliary sepsis, pathogenetic interrelation, diagnostic program
p. 31 – 39 of the original issue
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  2. Bagnenko SF, Shliapnikov SA, Korol'kov AIu. Sovremennye podkhody k etiologii, patogenezu i lecheniiu kholangita i biliarnogo sepsisa [Current approaches to the etiology, pathogenesis and treatment of cholangitis and biliary sepsis]. Biull Sib Meditsiny. 2007;(6)3:27–32.
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  4. Stolin AV, Prudkov MI, Nishnevich EV. Vybor taktiki lecheniia u bol'nykh obturatsionnym gnoinym kholangitom [The choice of treatment in patients with obstructive suppurative cholangitis]. Vestn Ural Med Akadem Nauki. 2009;3(26):126–29.
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  6. Kan³kovs'kii, O.V. Kharchuk, Iu.P. Gnatiuk ta ³n. Obgruntuvannia pokaz³v do metod³v korekts³¿ b³l³arno¿ g³pertenz³¿ [Justification of indications for the methods of biliary hypertension correction]. Aktual Problem Suchasn Meditsin. 2009;11(1):59–63.
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  8. Kloek JJ, van der Gaag NA, Aziz Y, Rauws EA, van Delden OM, Lameris JS, Busch OR, Gouma DJ, van Gulik TM.Endoscopic and percutaneous preoperative biliary drainage in patients with suspected hilar cholangiocarcinoma. J Gastrointest Surg. 2010 Jan;14(1):119-25.
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  11. Datsenko BM, Borisenko VB. Vliianie sposoba vosstanovleniia zhelchetoka na morfofunktsional'noe sostoianie dvenadtsatiperstnoi kishki u bol'nykh s akholiei [Effect of restoration method of bile deflux on duodenum morphofunctional state of patients with acholy]. Kl³n Kh³rurg³ia. 2006;(9):29–31.
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  13. Shapoval SD, Datsenko BM, Lednev DA. Kriterii diagnostiki khirurgicheskogo sepsisa [Criteria for diagnosis of surgical sepsis]. Khark³v Kh³r Shk. 2009;(4.1.): 371–73.
  14. Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, Cohen J, Opal SM, Vincent JL, Ramsay G. 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med. 2003 Apr;31(4):1250–56.
  15. Gel'fand BR, Rudnov VA, Protsenko DN, Gel'fand EB. Sepsis: opredelenie, diagnosticheskaia kontseptsiia, patogenez i intensivnaia terapiia [Sepsis: definition, diagnostic concept, pathogenesis and intensive care]. Infektsii v Khirurgii. 2004;(2)2:217.
Address for correspondence:
61037, Ukraina, g. Khar'kov, pr-t Moskovskii, d. 197, gorodskaia klinicheskaia bol'nitsa ¹2, kafedra khirurgii i proktologii Khar'kovskoi meditsinskoi akademii poslediplomnogo obrazovaniia,
e-mail: vabodoc@ukr.net,
Borisenko Vadim Borisovich
Information about the authors:
Datsenko B.M. An Honoured worker of science and technology, MD, professor of the chair of surgery and proctology of Kharkiv Medical Academy of Postgraduate Education.
Borisenko V.B. PhD, an associate professor of the chair of surgery and proctology of Kharkov Medical Academy for Postgraduate Education.

E.V. SHAIDAKOV1, V.L BULATOV1,2, O.I. TSAREV1, S.M. HMELNIKER3, D.A. ROSUHOVSKY1

VIABILITY OF ENDOTHELIUM AT SHORT-TERM STORAGE OF VEIN SEGMENTS IN PERFTORAN AND IN OTHER CONSERVATION MEDIA

FSBE "Scientific Research Institute of Experimental Medicine NWD OF RAMS"1,
Saint-Petersburg,
Saint-Petersburg Institute of Bioregulation and Gerontology, NWD RAMS2,
Saint-Petersburg,
MBE "Municipal clinical hospital ¹14"3,
Yekaterinburg,
The Russian Federation

Objectives. To compare the indicators of endotheliumum viability at short-term conservation of vein segments in Perftoran, physiological solutionvenous, arterial blood of a patient in vitro.
Methods. Fragments of the great saphenous vein taken intraoperatively during the coronary artery bypass surgery in 58 patients with the ischemic heart disease have been examined. The examined fragments were placed in the test tubes with the equal volume of 10 ml each. 0,9% NaCl solution, heparinized auto-arterial and auto-venous blood and perftoran were used as preservatives. The control brush biopsy of intima was performed immediately after the surgery material taking. The following ones were performed on the 15th and 30th minutes of conservation. 522 membranous specimens of endothelium were examined. They included 58 control specimens, 232 specimens were taken on the 15th minute and 232 – on the 30th minute of conservation in the test media. A quantitative calculation of the proportion of endotheliocytes with the signs of necrobiosis was carried out in 5 fields of vision of each membranous specimen.
Results. On the control membranous specimens the median of the proportion of endotheliocytes with signs of necrosis made up 10%, the interquartile range (IQR) – 8-13%. On the 15th minute of conservation the minimum proportion of cells with irreversible endothelium changes was observed in the sample with Perftoran: median – 18%, interquartile range – 16-20%. On the 30th minute of conservation a considerable proportion of necrosis was observed in all specimens, the minimum one was in the sample with Perftoran: median – 29%, interquartile range – 26-32%; the maximum ones were in auto-venous blood and in physiological solution.
Conclusions. The determinant factor for preservation of vein graft endothelium is considered to be time. The minimum degradation of the venous segment with endothelium was observed immediately after taking a vein graft from the blood flow. If a vein segment is kept for less than 15 minutes Perftoran is recommended to be used as a conservation medium. Conservation for more than 15 minutes is undesirable due to many indicators of endothelium necrosis in all test media.

Keywords: perftoran, venous valve, transplantation, transposition, endothelium, media of conservation, post-thrombotic syndrome
p. 40 – 44 of the original issue
References
  1. Vedenskii AN, Sabel'nikov VV, Ignat'ev IM. Svobodnaia peresadka venoznykh klapanov pri posttromboticheskoi bolezni [Free transplantation of venous valves in the post-thrombotic disease]. Vestn Khirurgii im II Grekova. 1988;141(11):40–45.
  2. Ignat'ev IM. Sposob obrazovaniia mikroanastomoza pri svobodnoi peresadke venoznykh klapanov [A method of forming a microanastomosis with free transplantation of venous valves]. RU2130291 C1 MPK 6 A61B17/11 Zaiavka: 97108726/14, 28.05.1997 Opublikovano: 20.05.1999. Zaiavitel': Kazan gos med un-t; patentoobladatel': Kazan gos med un-t.
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  5. Guyatt GH, Akl EA, Crowther M, Gutterman DD, Schuunemann HJ; American college of chest physicians antithrombotic therapy and prevention of thrombosis panel. Executive summary: antithrombotic therapy and prevention of thrombosis, 9th ed: American college of chest physicians evidence-based clinical practice guidelines. Chest. 2012 Feb;141(2 Suppl):7S–47S.
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Address for correspondence:
197376, Rossiiskaia Federatsiia, g. Sankt-Peterburg, ul. akad. Pavlova, d. 12, FGBU NII Eksperimental'noi Meditsiny SZO RAMN,
e-mail: bulatovvas@gmail.com,
Bulatov Vasilii Leonidovich
Information about the authors:
Shaidakov E.V. MD, professor, deputy director of FSBY "Scientific Research Institute of Experimental Medicine" RAMS, Saint- Petersburg .
Bulatov V.L. a vascular surgeon of clinic of FGBU "Scientific Research Institute of Experimental Medicine" RAMS, Saint- Petersburg, a researcher at the laboratory of biogerontology of Saint-Petersburg Institute of Bioregulation and Gerontology.
Tsarev O.I. MD, a vascular surgeon of clinic of FGBU "Scientific Research Institute of Experimental Medicine" RAMS, Saint- Petersburg .
Khmelniker S.M. MD, deputy chief physician of MBY "Municiple Clinical Hospital ¹ 14", Yekaterinburg .
Rosuhovsky D.A. PhD, a head of the department of vascular surgery of clinic of FGBU "Scientific Research Institute of Experimental Medicine" RAMS, Saint- Petersburg.

O.I. MIMINOSHVILI1,2 , V.N. PSHENICHNYY1,2, Y.V. RODIN1, V.Y. VESELY2, Y.V. BISTROVA2, A.O. KOVALCHUK1

PREDICTING THE OUTCOME OF INFRAINGUINAL REVASCULARIZATION IN CRITICAL LIMB ISCHEMIA ACCORDING TO TRANSCUTANEOUS OXIMETRY

SE "Institute of Emergency and Restorative Surgery named after V.K.Gusak", Donetsk1 ,
Donetsk National Medical University named after M.Gorky2
The Ukraine

Objectives. To elaborate the prognostic criteria of infrainguinal reconstructive surgeries in patients with the lower limb critical ischemia using functional tests at transcutaneous oximetry.
Methods. 75 patients with atherosclerotic artery occlusions in the femoral-popliteal segment were engaged into the research. Two-level arterial reconstructions were performed in 19 cases, infrainguinal reconstructions – in 37 and lumbar sympathectomy – in 19. In the preoperative period all patients underwent transcutaneous oximetry using the apparatus “Radiometer” (Denmark) with positional functional test.
Results. It has been revealed that in 88% of patients the lower limbs chronic critical ischemia was caused by the combined affection of several arterial segments including aorthal-inguinal, femoral-popliteal and tibial-pedal segments in various combinations. 70% of the operated patients has not received distinct angiographic information about the state of both dorsal and plantar arterial arch of the foot.
The favorable operative result has been attained in 40 cases. In 35 patients positive clinical and haemodinamic effect hasn’t been reached. The initial basal transcutaneous oxygen pressure (tcPo2) in the skin of the operated patients with favorable and unfavorable postoperative results has not significantly differed (7,4±2,6 vs 8,2±1,4, p=0,2). The value of orthostatic Po2 Hg growth more than 20 mm Hg permitted to predict reliably the favorable outcomes of the infrainguinal reconstructions (ð=0,001), lumbar sympathectomy (ð=0,01), but it appeared to be inadequate in two-level arterial reconstructions of the aorthal-inguinal and femoral-popliteal lower limb segments (ð=0,1). According to the orthostatic test of transcutaneous oximetry the negative prediction of surgical treatment turned out to be true in 84,4% of the operated patients and positive prediction – in 87,5 %.
Conclusions. The microcirculation analysis by means of transcutaneous oximetry allows predicting the treatment outcome and thus to choose the optimal method of the critical limb ischemia.

Keywords: chronic critical limb ischemia, reconstructive surgery, transcutaneous oximetry, prediction
p. 45 – 49 of the original issue
References
  1. Pokrovskii AV, Dan VN, Chupin AV, Kharazov AF. Mozhno li predskazat' iskhod rekonstruktivnoi operatsii u bol'nykh s ishemiei nizhnikh konechnostei na osnovanii dooperatsionnykh issledovanii? [Is it possible to predict the outcome of reconstructive surgery in patients with lower limb ischemia on the basis of preoperative studies?] Angiol i Sosud Khirurgiia. 2002;8(3):102–09.
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  5. Ubbink DT, Tulevski II, de Graaff JC, Legemate DA, Jacobs MJ. Optimisation of the non-invasive assessment of critical limb ischaemia requiring invasive treatment. Eur J Vasc Endovasc Surg. 2000 Feb;19(2):131–37.
  6. Kislov EE, Panfilov SD, Zoloev GK, Dedikova TN, Koval' OA. Sravnitel'naia otsenka metodov prognozirovaniia effektivnosti poiasnichnoi simpatektomii u patsientov s kriticheskoi ishemiei nizhnikh konechnostei. [Comparative evaluation of methods for predicting the effectiveness of lumbar sympathectomy in patients with critical ischemia of the lower limbs]. Angiol i Sosud Khirurgiia. 2009;15(1):138–41.
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  8. Gavrilenko AV, Omarzhanov OA, Abramian AV. Mikrotsirkuliatsiia u bol'nykh s khronicheskoi ishemiei nizhnikh konechnostei [Microcirculation in patients with chronic lower limb ischemia]. Angiol i Sosud Khirurgiia. 2003;9(2):130–35.
  9. de Graaff JC, Ubbink DT, Legemate DA, Tijssen JG, Jacobs MJ. Evaluation of toe pressure and transcutaneous oxygen measurements in management of chronic critical leg ischemia: a diagnostic randomized clinical trial. J Vasc Surg. 2003 Sep;38(3):528–34.
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  11. Gusak VK, Pshenichnyi VN. Sposob diagnostiki prokhodimosti bertsovo-stopnogo arterial'nogo segmenta [A method of diagnosing of tibia Iambic arterial segment permeability]. Patent na izobretenie - SU 1811372 A3 ot 23.04.93 A61B5/00, G01N33/483 (biul.¹15). patentoobladatel': Donets gos med institut im M Gor'kogo.
  12. Kozlov VI, Azizov GA. Patofiziologicheskaia kharakteristika rasstroistv mikrotsirkuliatsii pri khronicheskoi arterial'noi ishemii nizhnikh konechnostei [Pathophysiological characteristics of microcirculation in chronic arterial ischemia of the lower limbs]. Angiol i Sosud Khirurgiia. 2007;1(13):17–23.
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  14. Scheffler A, Eggert S, Rieger H. Influence of clinical findings, positional manoeuvres, and systolic ankle arterial pressure on transcutaneous oxygen tension in peripheral arterial occlusive disease. Eur J Clin Invest. 1992 Jun;22(6):420–26.
Address for correspondence:
83045, Ukraina, g. Donetsk, Leninskii pr., d. 47, Donetskii gosudarstvennyi meditsinskii universitet, kafedra khirurgii im. V.M. Bogoslavskogo,
e-mail: choice@online.ua,
Pshenichnyi Vladimir Nikolaevich
Information about the authors:
Miminoshvili O.I. MD, professor, a head of the department of surgery named after V.M. Bogoslavsky of Donetsk National Medical University named after M. Gorky, deputy director of the SE "Institute of Emergency and Reconstructive Surgery named after V.K. Gusak".
Pshenichnyy V.N. PhD, An associate professor of surgery named after V.M. Bogoslavsky of Donetsk National Medical University named after M. Gorky, deputy director of the SE "Institute of Emergency and Reconstructive Surgery named after V.K. Gusak".
Rodin Y.V. MD, a head of the chair of vascular surgery of SE "Institute of Emergency and Reconstructive Surgery named after V.K. Gusak".
Vesely V.Y. PhD, associate professor of the chair of surgery named by V.M. Bogoslavsky of Donetsk National Medical University named after M. Gorky.
Bistrova Y.V. An assistant of the chair of Infectious diseases of Donetsk National Medical University named after M. Gorky.
Kovalchuk A.O. A cardiovascular surgeon of SE “Institute of Emergency and Reconstructive Surgery named after V.K. Gusak".

A.B. LARICHEV1, E.J. POKROVSKIJ2, A.A. DYLENOK1

THE TREATMENT RESULTS OF GENERALIZED PURULENT PERITONITIS WITH DECOMPENSATION OF MULTIPLE ORGAN DYSFUNCTION

SBEE HPE "Yaroslavl State Medical Academy"1,
SBEE HPE "Ivanovo State Medical Academy"2,
The Russian Federation

Objectives. To estimate efficiency of a complex surgical treatment of patients with the generalized purulent peritonitis in the stage of decompensation of multiple organ dysfunction.
Methods. The analysis of treatment results of 98 patients with the urgent abdominal pathology, complicated by the generalized purulent peritonitis with the multiorgan dysfunction decompensation is presented in this paper. Operative intervention including liquidation of a source of peritonitis, nasogastrointestinal intubation and peritoneal lavage in a series of staged remedial relaparotomies. Extra corporal methods of detoxification was presented by hemo- and lymph sorption. Efficiency of medical actions was estimated by means of physical, clinical-laboratory, biochemical and special methods of investigation (bacteriological, gas-liquid chromatography, computer phonoenterography, cystomanometry).
Results. Despite of absoluteness of indications for the staged sanitation of the abdominal cavity and extra corporal detoxification, decompensation of vital systems essentially limited its application. Taking into account the severity of patients’ condition the sanitation actions “under the program” having low chances for success were realized in 43 patients. Expressed adhesion process in the abdominal cavity, massive deposition of fibrin and stable intestinal paresis didn’t permit to perform video laparoscopic sanitation. Presence of intoxication on the insufficient efficiency background of primary intracorporeal resuscitative actions in the abdominal sphere, supplemented by a series of staged sanitation relaparotomies incapable to eliminate endotoxemia have defined the indications for lymph- and hemosorption. The enumerated measures were accompanied by a high lethality (77,4%).
Conclusions. At treatment of patients with generalized purulent peritonitis in the stage of multiorgan dysfunction decompensation, traditional surgery doesn’t stop the progressing of the pathological process. More aggressive approach to the given disease is associated with the problem of possible failure of the functional status of vital systems. Often observable extreme degree of the cardiovascular insufficiency does not allow realizing the potential of staged sanitations of the abdominal cavity “under the program”, including video laparoscopy technique as well as limits essentially clinical opportunities of extra corporal methods of detoxification.

Keywords: peritonitis, multiorgan dysfunction, treatment
p. 50 – 57 of the original issue
References
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Address for correspondence:
150000, Rossiiskaia Federatsiia, g. Iaroslavl', ul. Revoliutsionnaia, d. 5, GBOU VPO Iaroslavskaia gosudarstvennaia meditsinskaia akademiia, kafedra obshchei khirurgii,
e-mail: larich-ab@mail.ru,
Larichev Andrei Borisovich
Information about the authors:
Larichev A.B. MD, professor, a head of department of general surgery SEI HPE "Yaroslavl State Medical Academy".
Pokrovskij E.J. PhD, an associate professor, a head of department of surgery hospital SEI HPE "Ivanovo State Medical Academy".
Dylenok A.A. a graduate student, a chair of general surgery SEI HPE "Yaroslavl State Medical Academy".

Y.P. ORLOV1, V.N. LUKACH1, A.V. GLUSCHENKO1,2

REAMBERIN IN THE INTENSIVE THERAPY PROGRAM IN PATIENTS WITH GENERALIZED PERITONITIS

SBEE HPE "Omsk State Medical Academy"1,
Omsk Municipal Clinical Emergency Hospital2,
The Russian Federation

Objectives. To determine reamberin efficiency in the intensive therapy program of generalized peritonitis (GP) for correction of the rheological disorders, providing of effective oxygen supply to tissues, restoration of oxidative phosphorylation and tissue reparation.
Methods. 24 patients with GP were included in the study (severe abdominal sepsis) due to destructive appendicitis, perforated gastric and duodenal ulcers. 2 groups were formed in the postoperative period. The main group (n=12) consisted of 6 men (aged of 31,4±3,3 years (M±σ)) and 6 women (aged 32,4±2,4 years (M±σ)) with GP (according to Mannheim scale 30,4±2,1 scores (M±σ)) where reamberin was used in the program of the infusion therapy. The comparison group (n=12) consisted of 4 men (34,3±3,1 years scores (M±σ)) and 8 women (31,4±2,6 years (M±σ)) with GP (according to Mannheim scale 30,1±3,2 year scores (M±σ)) where reamberin was not used.
Results. The use of reamberin in patients with GP reduces (60%) intensity of processes of free radical oxidation (FRO) and lipid peroxidation (LP) (reduction of MD (malonic dialdehyde in 2-fold), reduces the tissue hypoxia (in 3,8-fold). It generally contributes to the reduction of mortality, the terms of vasopressor support (in 1,5-fold), artificial pulmonary ventilation (APV) and decrease the hospitalization period of patients at the Intensive Care Unit (in 1,2-fold).
Conclusions. The conducted study confirms the efficiency of reamberin use in patients with GP due to its elimination of metabolic acidosis, improving the rheological properties of the blood and oxygen supply to the tissues at the expense of normalizing of the red blood cells volume, restoration of microcirculation, intestinal motility, realize an earlier enteral nutrition, improving of reparative processes and suturing of the laparotomic wound in the early postoperative period.

Keywords: reamberin, generalized peritonitis, intensive therapy, correction of rheological disorders, free radical oxidation, lipid peroxidation
p. 58 – 64 of the original issue
References
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  2. Mal'tseva IV, Urazova OI, Novitskii VV, Shipulin VM, Chumakova SP, Khokhlov OA, Odintsova SE, Korchagina MV. Vliianie agregatsii eritrotsitov na vyrazhennost' vnutrisosudistogo gemoliza pri operatsiiakh v usloviiakh iskusstvennogo krovoobrashcheniia [Effect of red blood cell aggregation on the expression of intravascular hemolysis during operations under artificial circulation]. Gematol i Transfuziol. 2011;56(6):28–32.
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  9. Akman T, Akarsu M, Akpinar H, Resmi H, Taylan E. Erythrocyte deformability and oxidative stress in inflammatory bowel disease. Dig Dis Sci. 2012 Feb;57(2):458-64.
  10. Swihart AH, Mikrut JM, Ketterson JB, Macdonald RC. Atomic force microscopy of the erythrocyte membrane skeleton. J Microsc. 2001 Dec;204(Pt 3):212–25.
  11. Arslan M, Metin Comu F, Kucuk A, Ozturk L, Yaylak F. Dexmedetomidine protects against lipid peroxidation and erythrocyte deformability alterations in experimental hepatic ischemia reperfusion injury. Libyan J Med. 2012;7.
  12. Wang X, Wu Z, Song G, Wang H, Long M, Cai S. Effects of oxidative damage of membrane protein thiol groups on erythrocyte membrane viscoelasticities. Clin Hemorheol Microcirc. 1999;21(2):137–46.
  13. Kosinets VA. Primenenie reamberina v korrektsii funktsional'noi aktivnosti enterotsitov pri eksperimental'nom peritonite [Application reamberine in the correction of functional activity of enterocytes in experimental peritonitis] Eksperim i Klin Farmakol. 2010;73(2):35–38.
  14. Orlov IuP, Lukach VN, Filippov SI, Glushchenko AV, Maliuk AI, Pritykina TV, Parkhomenko KK, Petrova IuV. Effektivnost' i bezopasnost' sbalansirovannogo rastvora s antioksidantnoi napravlennost'iu reamberin v intensivnoi terapii peritonita i ostroi kishechnoi neprokhodimosti [The efficacy and safety of a balanced solution with the antioxidant oriented reamberin in intensive care of peritonitis and acute intestinal obstruction]. Khirurgiia Zhurn im NI Pirogova. 2012;(2):64–69.
  15. Dinkla S, Wessels K, Verdurmen WP, Tomelleri C, Cluitmans JC, Fransen J, Fuchs B, Schiller J, Joosten I, Brock R, Bosman GJ. Functional consequences of sphingomyelinase-induced changes in erythrocyte membrane structure. Cell Death Dis. 2012 Oct 18;3:e410.
Address for correspondence:
644119, Rossiiskaia Federatsiia, g. Omsk, ul. Pereleta d. 9, GKB ¹ 1, GBOU VPO Omskaia gosudarstvennaia meditsinskaia akademiia, kafedra anesteziologii i reanimatologii,
e-mail: orlov-up@mail.ru,
Orlov Yurii Petrovich
Information about the authors:
Orlov Y.P. MD, professor of the chair of anesthesiology and critical care medicine of SEI HPE "Omsk State Medical Academy".
Lukach V.N. An Honored Worker of Higher School, MD, a head of the department of anesthesiology and intensive care of SEI HPE "Omsk State Medical Academy".
Gluschenko A.V. PhD, an assistant of the chair of anesthesiology and intensive care of SEI HPE "Omsk State Medical Academy", a head of the intensive care unit for septic patients of Omsk Municipal Clinical Emergency Hospital.

ONCOLOGY

V.V. KHAZIEV

THYROID CANCER IN THE STRUCTURE OF EUTHYROID SINGLE-NODULAR PATHOLOGY

SE "Institute of Endocrine Pathology Problems named after V.Y.Danilevsky of National Academy of Medical Sciences of the Ukraine", Kharkov,
The Ukraine

Objectives. To carry out a retrospective analysis of the thyroid cancer prevalence in patients operated on for thyroid nodular pathology.
Methods. To investigate the prevalence peculiarities of various forms of the single-nodular pathology and thyroid cancer during 1985-2010 yrs. 25000 patients with different forms of nodular pathology were selected and 5350 case-histories of patients with clinically and morphologically confirmed single-focal benign or malignant lesion without autoimmune process and disturbances of the thyroid function have been analyzed. The building of logarithmic trend line with the calculation of the coefficient of determination R2 (regression analysis) has been used to identify tendency data and prognostication.
Results. High frequency of thyroid cancer in euthyroid single-nodular pathology has been detected. Patients with the single-nodular goiter made up 87,33%, with the thyroid cancer – 12,67% (ratio 7:1). The overall ratio of male/female for the single-nodular goiter composed 1:11,73 and 1: 3,89 for thyroid cancer. A highly reliable tendency of increase in the proportion of males among patients with the single-nodular euthyroid goiters and thyroid cancer was revealed in the period of 1985-2010 yrs. Single colloidal structures (64,77%) and follicular adenomas (24,55%) dominated in the pathologic structure of benign single-nodular growth. Single-nodular malignant pathology was presented by papillary (65,19%) and follicular carcinomas (29,79%) in the majority of cases. Forms of thyroid cancer without damaging of the lymphatic system and distant metastases made up 76,84% summarily.
Conclusions. High frequency of thyroid cancer in patients with single-nodular pathology and the prevalence of “small” forms demonstrate the need to regard the presence of nodular growth as a cancer risk factor especially in men.

Keywords: thyroid gland, nodular goiter, thyroid cancer
p. 65 – 70 of the original issue
References
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  4. Mel'nichenko GA, Troshina EA, Vanushko VE, Rumiantsev PO, Platonova NM, Kavtaradze SR. Spornye voprosy lecheniia differentsirovannogo raka shchitovidnoi zhelezy [Controversial issues of treatment of differentiated thyroid cancer]. Problem Endokrinol. 2008;54(2):14–22.
  5. Rumiantsev PO, Il'in AA, Rumiantseva UV, Saenko VA. Rak shchitovidnoi zhelezy. Sovremennye podkhody k diagnostike i lecheniiu [Current approaches to diagnosis and treatment]. Moscow, RF: GEOTAR¬Media, 2009. 448 p.
  6. Tuttle RM, Ball DW, Byrd D, Dilawari RA, Doherty GM, Duh QY, Ehya H, Farrar WB, Haddad RI, Kandeel F, Kloos RT, Kopp P, Lamonica DM, Loree TR, Lydiatt WM, McCaffrey JC, Olson JA Jr, Parks L, Ridge JA, Shah JP, Sherman SI, Sturgeon C, Waguespack SG, Wang TN, Wirth LJ; Thyroid carcinoma. J Natl Compr Canc Netw. 2010 Nov;8(11):1228–74.
  7. Shaha AR. Controversies in the management of thyroid nodule. Laryngoscope. 2000 Feb;110(2 Pt 1):183–93.
  8. Gharib H, Papini E, Valcavi R, Baskin HJ, Crescenzi A, Dottorini ME, Duick DS, Guglielmi R, Hamilton CR Jr, Zeiger MA, Zini M; American Association of Clinical Endocrinologists and Associazione Medici Endocrinologi medical guidelines for clinical practice for the diagnosis and management of thyroid nodules. Endocr Pract. 2006 Jan-Feb(12)1:63–102.
  9. Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, Mazzaferri EL, McIver B, Pacini F, Schlumberger M, Sherman SI, Steward DL, Tuttle RM. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009 Nov;19(11):1167–214.
Address for correspondence:
61002, Ukraina, g. Kharkov, ul. Artema, d. 10, GU Institut problem endokrinnoi patologii im. V. Ia. Danilevskogo Natsional'noi Akademii meditsinskikh nauk Ukrainy, otdelenie endokrinnoi 61002, Ukraina, g. Kharkov, ul. Artema, d. 10, GU Institut problem endokrinnoi patologii im. V. Ia. Danilevskogo Natsional'noi Akademii meditsinskikh nauk Ukrainy, otdelenie endokrinnoi khirurgii i ginekologii,
e-mail: khaziev@mail.ru,
Khaziev Vadim Vital'evich
Information about the authors:
Khaziev V.V. PhD, a head of the division of endocrine surgery and gynecology of SE "Institute of endocrine pathology named after V.J. Danilevsky of National Academy of Sciences of Ukraine".

A.V. RUSIN1,2, V.I. RUSIN1, O.M. ODOSHEVSKAYA1, O.T. DEVINYAK1

SOME PROBLEMS OF BREAST CANCER SCREENING DEMONSTRATED BY THE EXAMPLE OF TRANSCARPATHIAN REGION

SHEE ”Uzhgorod National University”1
Transcarpathian Regional Clinical Oncologic Hospital2, Uzhgorod,
The Ukraine

Objectives. To identify the level of breast cancer knowledge among Transcarpathian women, factors influencing on the conversance, predictors for breast self-examination. To study and analyze the main motivation for passing a special examination of the mammary glands, untimely consult physician.
Methods. The article suggests the research results of knowledge level as well as attitude to breast cancer on the basis of surveys of 100 women (aged 29-82 years) without any complaints and history of breast cancer. The main characteristics were: age, residence, nationality, education level, marital status. Statistical analysis of data was carried in the environment for statistical computations R.
Results. 100 women have been interviewed, most of them – the married Ukrainians with the secondary education. 85% of the surveyed women had insufficient or inadequate knowledge about breast cancer. Chance to demonstrate high knowledge among residents of the urban area is 4-fold higher than for rural ones. Statistically significant predictors of performing breast self-examination are considered to be the levels of knowledge about breast cancer and education. Convincing argument in favor of the medical examination of the mammary glands should be recommendations made by physicians. The main obstacle to pass the regular examination is the lack of mandatory preventive medical inspection and misgiving to know the diagnosis.
Conclusions. To improve the diagnosis of breast cancer the public health authorities should strengthen advocacy effort work at the regional level and implementation of pilot screening programs.

Keywords: breast cancer, screening, survey, breast self examinations
p. 71 – 79 of the original issue
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  9. Vysotskaia IV. Vozmozhnosti uluchsheniia skrininga raka molochnoi zhelezy [Opportunities of improvement of breast cancer screening]. Opukholi Zhen Reprodukt Sistem. 2010;(4):28–32.
  10. R Core Team (2012). R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria.
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  12. Sdvizhkov AM, Borisov VI, Vasil'eva ID, Evtiagin VV, Kropacheva TD, Svichkar' IP. Opyt provedeniia mammograficheskogo skrininga v Moskve [Experience of mammography screening conduction in Moscow]. Ross Onkol Zhurnal. 2009;(4):33–36.
  13. Tu SP, Reisch LM, Taplin SH, Kreuter W, Elmore JG. Breast self-examination: self-reported frequency, quality, and associated outcomes. J Cancer Educ. 2006 Fall;21(3):175–81.
  14. Informatsiia o blagotvoritel'noi programme AVON Vmeste protiv raka grudi [Information about the philanthropic program of AVON Together against breast cancer] http://www.avonprotyraku.org.ua/ua/about-progam
  15. Parsa P, Kandiah M, Abdul Rahman H, Zulkefli NM. Barriers for breast cancer screening among Asian women: a mini literature review. Asian Pac J Cancer Prev. 2006 Oct-Dec;7(4):509–14.
Address for correspondence:
88014, Ukraina, g. Uzhgorod, ul. Brodlakovicha, d. 2, Zakarpatskii oblastnoi klinicheskii onkologicheskii dispanser,
e-mail: alyelya@mail.ru,
Odoshevskaia Elena Mikhailovna
Information about the authors:
Rusin A.V. MD, professor, a head of the chair of oncology with the courses of radiation medicine and intensive care of medical faculty of SHEE "Uzhgorod National University", a chief physician of Transcarpathian regional clinical oncology center.
Rusin V.I. MD, professor, a head of the chair of surgical diseases of medical faculty of SHEE "Uzhgorod National University".
Odoshevskaya E.M. A post-graduate of the chair of oncology, radiation medicine and critical care of medical faculty of SHEE "Uzhgorod National University".
Devinyak O.T. An assistant of the chair of pharmaceutical sciences of medical faculty of SHEE "Uzhgorod National University".

ANESTHESIOLOGY-REANIMATOLOGY

Z.V. KOKHAN, A.V. MAROCHKOV, A.V. BRUKHNOU, V.G. PIACHERSKI

ON THE POSSIBILITY OF IDENTIFYING THE PROPER INJECTION NEEDLE POSITION AT THE SCIATIC NERVE BLOCKADE

ME "Mogilev Regional Hospital"
The Republic of Belarus

Objectives. The determination of the possibility of creating the technology of the injection needle introduction in the paranervous space in relation to the sciatic nerve based on the measurement of interstitial pressure.
Methods. A prospective analysis of 22 blockades of the sciatic nerve performed with the measurement of interstitial pressure has been carried out. Blockade of the sciatic nerve was performed using the combination of 1% lidocaine solution (10 ml) and a 0,75% solution of ropivacaine (10 ml). The local anesthetic (20 ml) was injected with the dispenser (300 ml per hour). The interstitial pressure while moving the injection needle into the tissues and at reaching the paranervous space was measured.
Results. While evaluating the obtained data it was found out that there are no significant differences between three groups of interstitial pressure values at the injection of a mixture of local anesthetics intramuscularly (ð>0,05). After hitting the tip of the injection needle into the paranervous space a sharp decline of the interstitial pressure up to the value of 40 (35,45) mm Hg was observed. After nonparametric dispersive analysis, statistically significant differences between the mean pressure values in the paranervous space and pressure during intramuscular injection (p <0,05) were obtained. After verification of the injection needle tip position the introduction of the local anesthetics mixture was continued. Simultaneously with the introduction of local anesthetics the pressure monitoring in the paranervous space was conducted as well as the registration of values after each injected milliliter up to the finishing the mixture introduction in the calculated dose. Statistical analysis of the pressure values in the paranervous space revealed no significant differences between the data measured with each milliliter at the mixture titration (ð>0,05).
Conclusions. The identification method of paranervous space surrounded the sciatic nerve based on the interstitial pressure measurement may be used at the sciatic nerve blockade in clinical practice.

Keywords: regional anesthesia, blockade of the sciatic nerve, measurement of interstitial pressure, mixture of local anestheticss
p. 80 – 85 of the original issue
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  1. Malroj M. Regional Anaesthesia: Illustrated Practice Book. 3rd Edition, Wolters Kluwer/LippincottWilliams & Wilkins, Philadelphia, 2002, p. 333.
  2. Marochkov AV, Bordilovskii AN, Evseenko AI. Effektivnost' i bezopasnost' regionarnoi anestezii perefericheskikh nervov i spletenii [The efficacy and safety of regional anesthesia of peripheral nerve and plexus]. Novosti Khirurgii. 2007;15(4):96–102.
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  8. Hadzic A, Dilberovic F, Shah S, Kulenovic A, Kapur E, Zaciragic A, Cosovic E, Vuckovic I, Divanovic KA, Mornjakovic Z, Thys DM, Santos AC. Combination of intraneural injection and high injection pressure leads to fascicular injury and neurologic deficits in dogs. Reg Anesth Pain Med. 2004 Sep-Oct;29(5):417–23.
  9. The BSmart™ is the first objective injection monitor for use in regional anesthesia. Ectronic resource http://www.concertmedical.com/regional.html
Address for correspondence:
212002, Respublika Belarus', g. Mogilev, ul. B. Biruli, d. 12, UZ Mogilevskaia oblastnaia bol'nitsa, otdelenie anesteziologii i reanimatsii,
e-mail: coxann@yandex.ru,
Kokhan Zakhar Viktorovich
Information about the authors:
Kokhan Z.V. A physician anesthesiologist-resuscitator of department of anesthesiology and critical care of EPH "Mogilev Regional Hospital".
Marochkov A.V. MD, professor, a head of the department of anesthesiology and critical care of EPH "Mogilev Regional Hospita".
Brukhnou A.V. A physician anesthesiologist-resuscitator of department of anesthesiology and critical care of EPH "Mogilev Regional Hospital".
Piacherski V.G. A physician anesthesiologist-resuscitator of department of anesthesiology and critical care of EPH "Mogilev Regional Hospital".

OTORHINOLORYNGOLOGY

V.P. SITNIKOV1, EL-REFAI HOSSAM1, E.S. YADCHENCKO2, A.P. LI3

OPTION OF SUBCORTICAL CONSERVATIVE RADICAL OPERATION OF THE EAR

EE "Gomel State Medical University"1,
The Republic of Belarus,
NEE "Kazakhstan-Russian MedicaL University"2,
The Republic of Kazakhstan

Objectives. To improve the efficiency of radical operation of the ear by forming a small trepanation cavity and development of acceleration method of epidermization.
Methods. For period of 2011-2013 yrs. the surgical treatment have been carried out in 26 patients with attico-antral types of chronic suppurative otitis media. Depending on the applied surgical techniques the patients were divided into two groups. The main group of patients (14) were subjected to the subcortical conservative sparing radical operation on the middle ear with the antral drainage according to the worked out methodology. Patients of the control group (12) underwent the classic transcortical conservative sparing radical operation.
Results. In 12 (85,7%) patients of the main group a complete epidermization of small trepanation cavities was registered on the 18th days after surgery, in the control one – in 5 (41,6%) cases. In a year 22 patients have been reexamined: 12 patients of the main group, 10 – of the control one. Recurrence wasn’t observed in 11 (91,6%) patients of the main group. In the control group otorrhea and incomplete cavity epidermization were found in 5 (50%) patients. Aural function in the main group remained on the initial level or improved on 10-15 dB in 8 (57,1%) patients. In the control group the initial aural level was registered only in 2 (20%) patients, whereas in 8 (80%) cases it has worsened.
Conclusions. Option of subcortical conservative sparing radical operation of the ear with subcortical approach and the formation of a small trepanation cavity allows achieving a stable morphological and functional effect in the long-term period in 92,8% of patients.

Keywords: chronic suppurative otitis media, subcortical conservative radical operation on middle ear, antrodrainage
p. 86 – 90 of the original issue
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Address for correspondence:
246050, Respublika Belarus', g. Gomel', ul. Lange, d. 5, UO Gomel'skii gosudarstvennyi meditsinskii universitet, kafedra otorinolaringologii s kursom oftal'mologii,
e-mail: drhossam64@mail.ru,
El'-Refai Khusam
Information about the authors:
Sitnikov V.P. MD, professor, a scientific consultant of EE "Gomel State Medical University".
El-Refai Hossam. PhD, an associate professor of otorhinolaryngology with the course of ophthalmology of EE "Gomel State Medical University".
Yadchencko E.S. An assistant of the chair of otorhinolaryngology with the course of ophthalmology of EE "Gomel State Medical University".
Li A.P. A postgraduate of the chair of otorhinolaryngology of NEE "Kazakhstan-Russian Medical University".

REVIEWS

E.L. KALMYKOV1, A.D. GAIBOV1, M.S. INOYATOV2

ENDOVENOUS LASER TREATMENT OF VARICOSE VEIN DISEASE

Avicenna Tajik State Medical University, Dushanbe1,
SE "Center of Cardiovascular Surgery of Sughd Province", Khujand2,
The Republic of Tajikistan

The literature review is devoted to the analysis of the treatment results of varicose vein disease using endovasal laser treatment (EVLT). The current data on EVLT effectiveness in the dependence on the wavelength, the energy used as well as the advantages and disadvantages compared with radiofrequency ablation (RFA), sclerotherapy, phlebectomy are presented in the comparative aspect.
The success of the EVLT composes 93-100%. When comparing the results of the laser application with different wavelength and energy, the incidence of severe complications (deep vein thrombosis, thrombophlebitis, pulmonary thromboembolism (PTE)) makes up from 0,1 to 2,4%.
In analyzing the literature no evidence of wavelength affection on the clinical outcome has been revealed. A number of authors have shown the correlation of the EVLT effectiveness and the power of laser energy.
Comparison of the results of EVLT and RFA application showed that despite of better tolerability of RFA the long-term results are inferior to EVLT in the early postoperative period. However, confirmation of this phenomenon requires the further investigation. Comparison of the results of the EVLT and stem sclerotherapy application has also shown highly contradictory results, however, the short- and long-term results after EVLT are better than after the stem sclerotherapy. Despite on the effectiveness of EVLT and stripping of the great superficial veins, the patient’s quality of life and regression of clinical symptoms in the early postoperative period are better in EVLT but in the future the results are comparable.
Thus, the literature review has shown the safety and high efficiency of EVLT of varicose veins as well as the need of further results investigation of the EVLT in clinical practice.

Keywords: varicose veins, endovasal laser treatment, venous insufficiency, sclerotherapy, radiofrequency ablation, stripping
p. 91 – 100 of the original issue
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Address for correspondence:
734003, Respublika Tadzhikistan, g. Dushanbe, ul. Rudaki, d. 139, Tadzhikskii gosudarstvennyi meditsinskii universitet imeni Abuali ibni Sino, kafedra khirurgicheskikh boleznei ¹2,
e-mail: egan0428@mail.ru
Kalmykov Egan Leonidovich
Information about the authors:
Kalmykov E.L. An assistant of the chair of surgical diseases ¹ 2 of the Avicenna Tajik State Medical University.
Gaibov A.D. A corresponding member of Academy of Medical Sciences of the Republic of Tajikistan, professor of the chair of surgical diseases ¹ 2 of Avicenna Tajik State Medical University.
Inoyatov M.S. A head of the department of vascular surgery of SE "Center for cardiovascular surgery of Sughd province", Khujand.

F.P. KAPSARGIN, E.V. DYABKIN, A.G. BEREZHNOY

THE MODERN SURGICAL APPROACHES TO THE TREATMENT OF UROLITHIASIS

SBEE HPE "Krasnoyarsk State Medical University named after professor V.F. Voyno-Yasenetsky",
The Russian Federation

The article presents the review of studies devoted to urolithiasis which is considered as one of the most common diseases in everyday urological practice. According to most researchers in recent years the disease develops in not less than 1-3% of the world population and characterized by the endemic spread. The importance of the problem is due to the fact that the disease is more common among people of the most productive age (20-50 years). Currently, the most of the stones are removed by applying the minimally invasive methods, but in the certain situations (large stones) the operative treatment is indicated. In each situation several treatment options are studied and the most appropriate one for each patient is chosen. The literature analysis shows that the achievements of the last decade have been directed primarily at optimizing the properties of endoscopic equipment with the reduction of tool diameter, improvement of the optical resolution and durability of flexible tools as well as the improving disintegration technique of stones. Current approaches and widespread application of extracorporeal shock-wave lithotripsy (ESWL), ureterorenoscopy (URS), contact lithotripsy (CLT) with minimally invasive percutaneous nephrolitholapaxy (PNL) allow a manifold increasing of the level of treatment, reducing the risk of complications as well as improving the of patients’ quality of life. A marked tendency of combination of minimally invasive technique of lithoextraction with remote techniques of stones fragmentation has been traced. Taking into account the high prevalence of urolithiasis, frequent recurrences as well as general social significance of the problem the continuation of active experimental researches to identify the pathogenetic mechanisms of stone formation, methods of prevention it of stone formation and minimization of invasive methods to remove stones of the urinary tract should be considered the priority trend.

Keywords: urolithiasis, kidney, surgical treatment, shock-wave lithotripsy, ureterorenoscopy, contact lithotripsy, percutaneous nephrolitholapaxy
p. 101 – 106 of the original issue
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Address for correspondence:
660022, Rossiiskaia Federatsiia, g. Krasnoiarsk, ul. Partizana Zhelezniaka, d. 1, GBOU VPO "Krasnoiarskii gosudarstvennyi meditsinskii universitet imeni professora V.F. Voino-Iasenetskogo", kafedra obshchei khirurgii,
e-mail: dyabkyn@mail.ru,
Diabkin Evgenii Vladimirovich
Information about the authors:
Kapsargin F.P. MD, a head of the chair of urology, andrology and sexology of IPO SEI HPE "Krasnoyarsk State Medical University named after professor V.F. Voyno-Yasenetsky".
Dyabkin E.V. PhD, an assistant of the chair of general surgery of SEI HPE "Krasnoyarsk State Medical University named after professor V.F. Voyno-Yasenetsky".
Berezhnoy A.G. PhD, an assistant of the chair of urology, andrology and sexology of IPO SEI HPE "Krasnoyarsk State Medical University named after professor V.F. Voyno-Yasenetsky".

CASE REPORTS

V.D. LUTSENKO1,2, V.I. SHUTOV1,2, O.A. ZAMULIN2, A.G. ZHARKO3, S.V. ZHARKO3

A RARE CLINICAL CASE: A FOREIGN BODY IN THE THYROID GLAND

"Belgorod State National Research University"1
MBEPH "Municipal Hospital ¹2"2, Belgorod,
RSBEPH "Belgorod Regional Hospital of Saint Ioasaf" 3,.
The Russian Federation

Objectives. To describe a casuistic case as well as to assess the effectiveness of the chosen tactics of treatment a patient with a foreign body in the thyroid gland.
Methods. The patient with a foreign body in the right lobe of the thyroid gland (fish bone) was under our observation. The patient has not applied for medical help on the 5th day. At hospitalization the patient had the symptoms of acute thyroiditis.
Results. Complex examination (fibrogastroscopy, ultrasound, spiral computed tomography) has been conducted. As the result a foreign body in the right lobe of the thyroid gland was detected. Initially, it was decided to carry out a conservative tactics: massive antibiotic, anti-inflammatory therapy, and then in the cold period the patient underwent the surgical intervention (hemithyroidectomy). The patient was discharged on 7th days after the surgery.
Conclusions. We should recommend the following treatment tactics of patient with foreign bodies in the thyroid gland: if septic complications are absent, treatment is carried out in two stages: the first – a conservative stage, the second – surgery. In à case of septic complications development the urgent surgery with simultaneous massive antibacterial therapy is indicated.

Keywords: thyroid gland, foreign body, fish bone
p. 107 – 110 of the original issue
References
  1. Bobrov VM, Shushkov PV, Neobychnye inorodnye tela glotki i pishchevoda [Unusual foreign bodies in the pharynx and esophagus]. Vestn Otorinolaringol. 2006;(4):78–79.
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Address for correspondence:
308036, Rossiiskaia Federatsiia, g. Belgorod, ul. Gubkina, d. 46, MBUZ Gorodskaia bol'nitsa ¹2 g. Belgorod,
e-mail: lutsenko@gb2bel.ru,
Lutsenko Vladimir Dmitrievich
Information about the authors:
Lutsenko V.D. MD, professor, a head of the chair of general surgery with the course of operative surgery and topographic anatomy of FSAEI HPE "Belgorod State National Research University", the chief physician of MBEPH "Miniciple Hospital ¹ 2", Belgorod.
Shutov V.I. PhD, an assistant of the chair of general surgery with the course of operative surgery and topographic anatomy of FSAEI HPE "Belgorod State National Research University", a physician-otolaryngologist of a department of otorhinolaryngology MBEPH "Miniciple Hospital ¹ 2", Belgorod.
Zamulin O.A. A deputy of chief physician of MBEPH "Miniciple Hospital ¹ 2", Belgorod.
Zharko A.G. A surgeon of RSBEPH "Belgorod Regional Hospital of Saint Ioasaf".
Zharko S.V. PhD, a surgeon of RSBEPH "Belgorod Regional Hospital of Saint Ioasaf".

EXCHANGE OF EXPERIENCE

M.H. MALIKOV, U.A. KURBANOV, A.A. DAVLATOV, I.N. KHVAN

THE TRANSPLANTATION OF TISSUE COMPLEX IN A CASE OF LOSS OF THE UPPER LIMB MUSCLE FUNCTION

Avicenna Tajik State Medical University, Dushanbe
The Republic of Tajikistan

Objectives. To analyze the experience of restoration of the loss of hand muscle function in patients with severe outcomes of the upper limb traumas who have undergone free muscle transplantation.
Methods. In the Tajikistan Republican Scientific Center of the cardiovascular surgery the muscular grafts were transplanted on the upper limb in 61 patients with sever outcomes of the upper limb trauma. Prior surgeries such as interventions on the vessels of the forearm, reconstruction and neurolysis of the nervous trunks, arthrodesis of the wrist joint and opponentodesis of the thumb have been performed in patients before the transplantation of complex tissues. Plastic surgery was carried out 6 months after orthopedic and neurologic preparation of the limb. Musculus latissimus dorsi flap was used in 42 cases, musculus latissimus dorsi flap with the fascia of the serratus anterior muscle flap – in 16 and soft thigh muscle flap – in 3 ones. The long-term results from 4 months of 10 yeans of the flap transplantation have been studied in 32 patients.
Results. In the recent postoperative period the blood circulation disturbance of the tissue complex developed in 7 operated patients. Necrosis of the muscular transplants occurred in 3 cases (5%). Starting from the 4th month the first voluntary contractions of the transplanted muscular grafts have appeared; maximal regeneration continued within one year and further. In 16 patients in saving the function of own hand muscles except restoration of the cylindrical and spherical grip some fine movements of affected fingers became possible. In studying the degree and force of contraction of transplanted muscular graft it was found out that the force of the flap contraction of the musculus latissimus dorsi in complex with serratus muscle was much more effective in comparison with the other tissue complexes.
Conclusions. Severe outcomes of the upper limb traumas demand on the application of the multi-step complex reconstructions. At present free microsurgical transplantation of the muscular grafts is considered to be the better alternative in à case of loss of the upper limb function.

Keywords: upper limb, trauma outcome, restorative surgery, muscular grafts, Volkmann’s contracture, thoracodorsal flap
p. 111 - 116 of the original issue
References
  1. Milanov NO, Antokhii NI, Trofimov EI, Gainullin PM. Povtornye operatsii po povodu sosudistykh oslozhnenii pri peresadke torakodorsal'nykh loskutov [Repeated surgery of vascular complications in transplantation of thoracodorsal grafts]. Khirurgiia. Zhurn im NI Pirogova.1989;(6):105–107.
  2. Trofimov EI, Gurdzhidze TIu, Suvorov NA, Mekhtikhanova GM. Ustranenie defektov i rubtsovykh deformatsii distal'nykh otdelov konechnostei svobodnymi mikrokhirurgicheskimi autotransplantatami [Elimination of defects and scar deformities of the distal parts of the limbs by free microsurgical autografts]. Ann Plast Rekonstrukt i Estet Khirurgii. 2010;(2):66–72.
  3. Duymaz A, Karabekmez FE, Keskin M, Tosun Z, Savaci N. The reconstruction of soft tissue defects in the elbow area: a treatment algorithm proposal. Ulus Travma Acil Cerrahi Derg. 2009 Nov;15(6):591–98.
  4. Tikhilov RM, Kochish AIu, Rodomanova LA, Kutianov DI, Afanas'ev AO. Vozmozhnosti sovremennykh metodov rekonstruktivno-plasticheskoi khirurgii v lechenii bol'nykh s obshirnymi posttravmaticheskimi defektami tkanei konechnostei [The capabilities of modern methods of reconstructive surgery in the treatment of patients with extensive post-traumatic defects of the extremity tissues]. Travmatol i Ortoped Rossii. 2011;60(2):164–70.
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  8. Milanov NO, Eiubov Iu.Sh. Autodermoplastika pri zakrytii defektov donorskoi oblasti posle vziatiia svobodnykh revaskuliariziruemykh autotransplantatov [Autodermoplastics at the closure of the defects of the donor area after the capture of free revascular autografts]. Khirurgiia. 2004;(8):13–16.
  9. Mikhailov IA, Iudenich AA, Moroz VIu. Otsenka sostoianiia sosudistoi nozhki pri mikrokhirurgicheskoi tkanevoi autotransplantatsii [Assessment of the vascular pedicle at microsurgical tissue transplantation]. Angiol i Sosud Khirurgiia. 2008;(3)14:118–23.
  10. Yan H, Zhang F, Akdemir O, Songcharoen S, Jones NI, Angel M, Brook D. Clinical applications of venous flaps in the reconstruction of hands and fingers. Arch Orthop Trauma Surg. 2011 Jan;131(1):65–74.
Address for correspondence:
734003, Respublika Tadzhikistan, g. Dushanbe, ulitsa Sanoi, d. 33. Respublikanskii nauchnyi tsentr serdechno-sosudistoi khirurgii Ministerstva zdravookhraneniia Respubliki Tadzhikistan, otdelenie rekonstruktivnoi i plasticheskoi mikrokhirurgii,
e-mail: malikovm@yahoo.com,
Malikov Mirzobadal Khalifaevich
Information about the authors:
Malikov M.H. PhD, an associate professor of the chair of surgical diseases ¹ 2 of Avicenna Tajik State Medical University, a microsurgeon of the chair of plastic and reconstructive microsurgery of the Republican Scientific Center for Cardiovascular Surgery .
Kurbanov U.A. MD, director of Avicenna Tajik State Medical University.
Davlatov A.A. PhD, a head of the department of plastic and reconstructive microsurgery of the Republican scientific center for cardiovascular surgery
Khvan I.N. PhD, an associate professor of the chair of surgical diseases ¹ 2 of Avicenna Tajik State Medical University.
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