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Year 2016 Vol. 24 No 5

SCIENTIFIC PUBLICATIONS
EXPERIMENTAL SURGERY

T.O. PAVLUT 1, T.B. MELIK-KASUMOV 1, I.P. ZHAVORONOK 1, O.A. ANTIPOVA 1, E.I. PEHTEREVA 1, S.A. NOVAKOVSKAYA 1, A.I. VASILKEVICH 2, M.A. KISEL 2, A.Y. MOLCHANOVA 1

THE EFFECT OF N-PALMITOYLETHANOLAMINE AND N-STEAROYLETHANOLAMINE IN LIPOSOMES ON THE HEALING OF EXPERIMENTAL SKIN WOUNDS

SRE " Institute of Physiology, NAS of Belarus"1,
SRE "Institute of Bioorganic Chemistry", NAS of Belarus"2,
Minsk,
The Republic of Belarus

Objectives. To study wound-healing properties of N-palmitoylethanolamine and N-stearoylethanolamine in liposomes and to compare their action with the drug has also proven to be effective and safe.
Methods. The wound-healing effects of N-palmitoylethanolamine and N-stearoylethanolamine were studied on white male rats (n=214) with three types of skin wounds: incision, excision and burn wounds. To study each type of wounds the animals were divided into groups: control (untreated wounds), negative control (or solvent), positive control (Methyluracil ointment), N-palmitoylethanolamine and N-stearoylethanolamine. The general state of animals was monitored daily; all wounds were photographed and then treated with tested substances. In wound model treatment was continued till the complete healing with registration of the date of healing. Conclusion was made according to visual observation, computer planimetry and morphological studies data.
Results. The application of both of N-acylethanolamines has not reduced the healing time of incision wounds which lasted during 8-10 days. Excision wound completely healed (in control group) within 21-25 days and 22-25 days in treating with N-stearoylethanolamine. In contrast, daily application of palmitoylethanolamine on the surface of excision wound has shorten the healing up to 18-19 days (p<0,05). Thermal burns of IIIA degree healed in control rats within 30-32 days. Use of both of N-acylethanolamines reduced this period up to 27-28 days, as for N-stearoylethanolamine the changes were statistically reliable (p<0,05).
Conclusion. N-palmitoylethanolamine and N-stearoylethanolamine in liposomes stimulate the regeneration of experimental skin wounds. Palmitoylethanolamine accelerates excision skin wounds healing whereas N-stearoylethanolamine healing of burns. N-acylethanolamines seems to be promising as a base for wound-healing agents. Further research in this direction could be a scientific background for new drugs development.

Keywords: acylethanolamine, liposome, skin wounds, regeneration, epidermis, derma, wound-healing properties, new drugs development
p. 425-435 of the original issue
References
  1. Molchanova AIu. Endokannabinoidnaia sistema: fiziologiia, patofiziologiia, terapevticheskii potentsial [Endocannabinoid system: physiology, pathophysiology, therapeutic potential]. Minsk, RB: Bel Navuka; 2015. 211 p.
  2. Kaliuzhnaia LD, Gorbenko AV. Agonisty kannabinoidnykh retseptorov v dermatologii – novaia tekhnologiia korrektsii zuda i vospaleniia v kozhe [Agonists of cannabinoid receptor in dermatology - new technology of correction of skin itchy and inflammation]. Ukr Zhurn Dermatolog³¿ Venerolog³¿ Kosmetolog³¿. 2011;4(43):17-27.
  3. Tromza VE, Nikiforova IN. Farmakologicheskie svoistva kannabinoidov. Izv Nats Akad Nauk Belarusi [The pharmacological properties of cannabinoids]. Ser Med Nauk. 2010;(1):112-19.
  4. Bíró T, Tóth BI, Haskó G, Paus R, Pacher Pál. The endocannabinoid system of the skin in health and disease: novel perspectives and therapeutic opportunities. Trends Pharmacol Sci. 2009 Aug;30(8):411-20. doi: 10.1016/j.tips.2009.05.004.
  5. Lambert DM, Vandevoorde S, Jonsson KO, Fowler CJ. The palmitoylethanolamide family: a new class of anti-inflammatory agents? Curr Med Chem. 2002 Mar;9(6):663-74. doi: 10.2174/0929867023370707.
  6. Berdyshev AG, Gulaia NM, Chumak AA, Kindruk NL. Vliianie N-stearoiletanolamina na soderzhanie svobodnykh aminokislot v krovi i pecheni krys pri eksperimental'nom ozhoge [Effect of N-stearoylethanolamine on the concentration of free amino acids in the blood and liver of rats with experimental burns]. Biomed Khimiia. 2011;57(4):446-54. doi: 10.18097/pbmc20115704446.
  7. Zhukov OD, Berdishev AG, Kosiakova GV, Kl³mashevs'kii VM, Gor³d'ko TM, Meged' OF, i dr. Vpliv N-stearo¿letanolam³na na r³ven' 11-oksikortikostero¿d³v, tsitok³n³v IL-1β, IL-6 i TNFα v shchur³v za nespetsif³chnogo zapalennia, pri term³chnomu op³ku shk³ri. [Effect of N-stearoylethanolamine on the level of 11 glucocorticoids, cytokines IL-1β, IL-6 and TNFα in rats with non-specific inflammation in thermal skin burns]. Ukr Biochem J [Elektronnyi resurs]. 2014 [data dostupa: 26.02.2016];86(3):88-97. Rezhim dostupa: http://nbuv.gov.ua/UJRN/BioChem_2014_86_3_12.
  8. Allen TM, Cullis PR. Liposomal drug delivery systems: from concept to clinical applications. Adv Drug Deliv Rev. 2013 Jan;65(1):36-48. doi: 10.1016/j.addr.2012.09.037.
  9. Pattni BS, Chupin VV, Torchilin VP. New developments in liposomal drug delivery. Chem Rev. 2015;115(19):10938-966. doi: 10.1021/acs.chemrev.5b00046.
  10. Frolova NI, Mel'nikova TI, Buriakina AV, Vishnevskaia EK, Avenirova EL, Sivak KV, i dr. Metodicheskie podkhody k eksperimental'nomu izucheniiu dermatotropnykh sredstv [Methodological approaches to the experimental study of dermotropic drugs]. Eksperim i Klin Farmakologiia. 2009;72(5):56-60.
  11. Kumar V, Khan AA, Nagarajan K. Animal models evaluation of wound healing activity. Int Bul Drug Res. 2013;3(5):93-107.
  12. Eliseev VG, Subbotin MIa, Afanas'ev IuA, Kotovskii EF. Osnovy gistologii i gistologicheskoi tekhniki [Fundamentals of histology and histological techniques]. 2 izd. Moscow, RF: Meditsina; 1967. 268 p.
  13. Nesterova IuV, Povet'eva TN, Nagorniak IuG, Perova AV, Andreeva TI, Rosliakova EP, i dr. Mekhanizmy vliianiia kompleksnykh i vydelennykh veshchestv iz zhivokosti vysokoi na reparativnuiu aktivnost' tkanei v eksperimente [Mechanisms of influence of complex and isolated compounds from larkspur high on reparative tissue activity in the experiment] Eksperim i Klin Farmakologiia. 2009;72(3):40-43.
  14. Plecheva DV, Alekhin EK. Stimuliatsiia reparativnoi regeneratsii kozhi krys oksimetiluratsilom [Stimulation of reparative regeneration of the skin of rats by oxymetiluratsilom]. Eksperim i Klin Farmakologiia. 2004;67(5):63-66.
Address for correspondence:
220072, Republic of Belarus, Minsk, Akademicheskaia st., 28,
Institute of Physiology, National Academy of Sciences of Belarus
laboratory of modulation of
body functions.
Phone: +375 29 568-33-82
E-mail: tanja281286@mail.ru
Pavlut Tatjana Olegovna
Information about the authors:
Pavlut T.O. Researcher, laboratory of modulation of the body functions. "Institute of Physiology", NAS of Belarus".
Melik-Kasumov T.B. PhD (Physiology), Senior Researcher, laboratory of modulation of the body functions, "Institute of Physiology", NAS of Belarus".
Zhavoronok I.P. PhD (Physiology), Researcher, laboratory of modulation of the body functions, "Institute of Physiology", NAS of Belarus.
Antipova O.A. Junior researcher, laboratory of modulation of the body functions", Institute of Physiology", NAS of Belarus.
Pehtereva E.I. Junior researcher, laboratory of modulation of the body functions" Institute of Physiology", NAS of Belarus.
Novakovskaya S.A. PhD (Morphology), Head of laboratory "Center of light and electronic microscopy", "Institute of Physiology", NAS of Belarus. Vasilkevich A.I. Researcher, laboratory of lipids chemistry, "Institute of Bioorganic Chemistry", NAS of Belarus.
Kisel M.A. Dr.Sci. (Chemistry), professor, Head of laboratory of lipids chemistry, "Institute of Bioorganic Chemistry", NAS of Belarus
Molchanova A.Yu. PhD (Physiology), Head of laboratory of modulation of the body functions, "Institute of Physiology", NAS of Belarus".

S.V. IVANOV, 1 V.A. LAZARENKO1, I.S. IVANOV1, A.V. IVANOV1, A.V. TSUKANOV1, Y.P. ROZBERG1 , L.P. POPOVA2, D.V. TARABRIN1, Y.G. OBYEDKOV1

MORPHOLOGICAL FEATURES OF PARAPROSTHESIS CAPSULE DURING IMPLANTATION OF POLYPROPYLENE AND COMPOSITE ENDOPROSTHESIS AGAINST OROTIC ACID USE IN THE EXPERIMENT

SBEE HPE "Kursk State Medical University" Russian Ministry of Health,
BME "Kursk Regional Clinical Hospital",
Kursk.
The Russian Federation

Objectives. To compare dynamics of connective tissue capsule formation around the polypropylene endoprosthesis and self-expandable prosthesis on the background of the drug stimulating collagen synthesis in experiment.
Methods. The experimental study was performed on mature syngeneic albino mice, (n=185, average weight 45-50 g.). All the animals were divided into 4 series, depending on the application of the endoprosthesis and orotic acid. The number of fibroblast cells, lymphocytes, macrophages and neutrophils was counted in the studied histological preparations of abdominal wall with a fragment of the endoprosthesis, stained with hematoxylin and eosin. The regenerative processes and the capsule paraprotesis formation were evaluated on the basis of the ratio of the cells.
Results. In addition of orotic acid to the animal feed ration the relative amount of fibroblasts was higher in 1,43 and 1,06 fold after implantation of polypropylene and the composite endoprosthesis compared with series without drug application. Dynamics of relative increase of mechanocytes amount in a capsule in implantation of the composite endoprosthesis within 30, 60 and 90 days, was greater than the values in a studied similar series with a polypropylene graft in 1,03, 1,14 and 1,10 fold, respectively.
The obtained findings testified about better biocompatibility of the composite endopropthesis consisting of a polypropylene and polylactic acid, manifested by early proliferation.
Conclusion. The application of a new synthetic composite endoprosthesis consisting of polypropylene and polylactic acid in combination with orotic acid is considered to reduce the intensity of aseptic inflammation in the site of implantation and to optimize collagenogenesis of paraprotesis capsule.

Keywords: orotic acid, polypropylene, polylactic acid, fibroblasts, biocompatibility, ventral hernia, collagen
p. 436-443 of the original issue
References
  1. Grigoriuk AA, Kovalev VA, Gorelik MZ. Plastika posleoperatsionnykh ventral'nykh gryzh polipropilenovym implantatom: eksperimental'noe i klinicheskoe issledovanie [Plastic of postoperative ventral hernias by polypropylene implants: an experimental and clinical study]. Tikhookean Med Zhurn. 2006; (1):46-48.
  2. Rutenburg GM, Bogdanov DIu, Chistiakov AA, Omel"cheiko VA. Vozmozhnosti primeneniia razlichnykh variantov khirurgicheskogo lecheniia posleoperatsionnykh ventral'nykh gryzh [Possibilities of application of various variants of surgical treatment of postoperative ventral hernias]. Gerniologiia. 2005;(4):3-8.
  3. Veligotskii NN, Komarchuk VV, Komarchuk EV, Kasumba K. Khirurgicheskoe lechenie gryzh na fone displazii soedinitel'noi tkani [Surgical treatment of hernias in the background of connective tissue dysplasia]. Ukr Zhurn Xipypgii. 2011;(3):236-39.
  4. Henriksen NA, Yadete DH, Sorensen LT, Agren MS, Jorgensen LN. Connective tissue alteration in abdominal wall hernia. Br J Surg. 2011 Feb;98(2):210-9. doi: 10.1002/bjs.7339.
  5. Moger CJ, Arkill KP, Barrett R, Bleuet P, Ellis RE, Green EM, et al. Cartilage collagen matrix reorientation and displacement in response to surface loading. J Biomech Eng. 2009 Mar;131(3):031008. doi: 10.1115/1.3049478.
  6. Galimov OV, Musin RZ. Primenenie “stimuliatora regeneratsii” pri khirurgicheskom lechenii posleoperatsionnykh ventral'nykh gryzh [The use of "stimulator of regeneration" in the surgical treatment of postoperative ventral hernias]. Vestn Khirurgii im II Grekova. 2001;160(4):84-86.
  7. Wess TJ, Orgel JP. Changes in collagen structure: drying, dehydrothermal treatment and relation to long term deterioration. Thermochim Acta. 2000 Dec;365(1-2):119-28. doi: 10.1016/S0040-6031(00)00619-5.
  8. Smirnova ED, Protasov AV, Shukhtin NIu, Titarov DL, Navid MN. Allogernioplastika s ispol'zovaniem bezfiksatsionnogo implanta Parietene ProGrip [Alloherniaplasty with fixation-free implant Parietene ProGrip]. Izv Tul gos un-ta Estestv nauki. 2011;(1):265-72.
  9. Gromova OA, Torshin IIu, Kalacheva AG, Fedotova LE, Gromov AN, Rudakov KV. Khemoinformatsionnyi analiz molekuly orotovoi kisloty ukazyvaet na protivovospalitel'nye, neiroprotektornye i kardioprotektornye svoistva liganda magniia [Chemoinformation analysis orotic acid molecule indicates the anti-inflammatory, neuroprotective and cardioprotective properties of magnesium ligand]. Farmateka. 2013;(13):95-104.
  10. Korzhevskii DE, Giliarov AV. Osnovy gistologicheskoi tekhniki [Basics of histologic techniques]. S-Petersburg, RF: SpetsLit; 2010. 96 p.
  11. Avtandilov GG. Meditsinskaia morfometriia [Medical morphometry]: ruk. Moscow, RF: Meditsina; 1990. 384 p.
Address for correspondence:
305041, Russian Federation, Kursk,
Karl Marx st., 3, Kursk State Medical University,
department N1of surgical diseases.
Tel: +7 (4742) 35-36-90
E-mail: ivanov.is@mail.ru
Ivanov Ilya Sergeevich
Information about the authors:
Ivanov S.V. MD, Professor, Head of department N1 of surgical diseases, SBEE HPE "Kursk State Medical University".
Lazarenko V.A. MD, Professor, Rector, SBEE HPE "Kursk State Medical University".
Ivanov I.S. MD, Professor of department N1 of surgical diseases, SBEE HPE "Kursk State Medical University".
Ivanov A.V. MD, Professor, Head of department of histology, cytology and embryology, SBEE HPE "Kursk State Medical University".
Tsukanov A.V. PhD, Ass. Professor of department N1of surgical diseases, SBEE HPE "Kursk State Medical University".
Rozberg E.P. MD, Ass. Professor of department N1 of surgical diseases, SBEE HPE "Kursk State Medical University".
Popova L.P. Physician-cytologist, BME "Kursk Regional Clinical Hospital".
Tarabarin D.V. Assistant of department N1 of surgical diseases, SBEE HPE "Kursk State Medical University".
Obyedkov E.G. Assistant of department N1 of surgical diseases.SBEE HPE "Kursk State Medical University".

GENERAL & SPECIAL SURGERY

S.V. SHALASHOV 1, L.K. KULIKOV 2, E.A. SEMENISHCHEVA1, I.A. EGOROV 1, A.L. MIKHAYLOV 1, E.M. YURKIN 1

A COMPARATIVE ANALYSIS OF RESULTS OF I.L. LICHTENSHTEIN TECHNIQUE AND CS-INGUINAL HERNIAPLASTY

NME "Railways Clinical Hospital on the station Irkutsk-Passazhirsky" of JSC "Russian Railways"1,
SBEE APE "Irkutsk State Medical Academy of Post-graduate Education"2,
Irkutsk.
The Russian Federation

Objectives. To conduct the comparative analysis of the results of I.L. Lichtenshtein and CS-inguinal herniaplasty.
Methods. 172 patients were enrolled into the study. 88 patients underwent I.L.Lichtenstein inguinal hernia repair and were included in the clinical comparison group (CCG). 84 patients were operated on using the proposed «combined seam» (CS-plasty) technique and composed the basic group (BG).
Results. When performing hernia repair by I.L. Lichtenstein (CCG), the duration of surgery was 50,2±13,2 min. CS-plasty lasted for 40,3 (±12,1) minutes in BG. The early incisional period was without complications both in BG and in CCG. Treatment results were followed for 84 BG patients and 85 CCG patients within the period from 12 months to 2 years. A lot more severe and long-lasting pain manifestations in early postoperative period in CCG in comparison with those in BG were registerted. Clinically significant pain syndroms occurred in nine cases in CCG at time of hospital discharge, in other words on 7th days after repair. There were no such pain manifestations in BG. Chronic pain was marked twice in CCG, no other complications were noted. Chronic pain lasted for up to 1 year and required anti-inflammatory therapy and physiotherapy. There were no delayed complications in BG. No recurrences occurred in both groups within the observed period.
Conclusion. CS-inguinal herniaplasty has many merits of existing «non-tension» methods. The presented plasty method is considered to be easy and allows eliminating inguinal hernia quickly and reliably. Pain manifestations are less marked in the operative zone after CS-inguinal herniaplasty in comparison with I.L. Lichtenstein technique and no cases of chronic pains were registered.

Keywords: inguinal hernia, Lichtenstein technique, surgery, repair with the mesh, CS-plasty, chronic pain, recurrences
p. 444-450 of the original issue
References
  1. Jenkins JT, O'Dwyer PJ. Inguinal hernias. BMJ. 2008 Feb 2;336(7638):269-72. doi: 10.1136/bmj.39450.428275.AD.
  2. Shliakhovskii IA, Chekmazov IA. Sovremennye aspekty khirurgicheskogo lecheniia gryzh briushnoi stenki [Modern aspects of surgical treatment of abdominal wall hernias]. Abdomin Khirurgiia. 2002;04(7):44-47.
  3. Köninger JS, Oster M, Butters M. Management of inguinal hernia – a comparison of current methods. Chirurg. 1998 Dec;69(12):1340-4. [Article in German]
  4. Timoshin AD, Iurasov AV, Shestakov AL. Khirurgicheskoe lechenie pakhovykh i posleoperatsionnykh gryzh briushnoi stenki [Surgical treatment of inguinal and postoperative abdominal wall hernias]. Moscow, RF: Triada-Kh, 2003. 144 p.
  5. Tabbara M, Genser L, Bossi M, Barat M, Polliand C, Carandina S, et al. Inguinal hernia repair using self-adhering sutureless mesh: Adhesix™: a 3-year follow-up with low chronic pain and recurrence rate. Am Surg. 2016 Feb;82(2):112-16.
  6. Hallén M, Sandblom G, Nordin P, Gunnarsson U, Kvist U, Westerdahl J. Male infertility after mesh hernia repair: a prospective study. Surgery. 2011 Feb;149(2):179-84. doi: 10.1016/j.surg.2010.04.027.
  7. Bendavid R. Dysejaculation. Hernia. 2009;(1):24.
  8. Fitzgibbons RJ. Can we be sure polypropylene mesh causes infertility? Ann Surg. 2005 Apr;241(4):559-61. doi: 10.1097/01.sla.0000157210.80440.b7PMCID: PMC1357058.
  9. Chernousov A, Khorobrykh T, Siniakin S, Vychuzhanin D, Belousov A. Khronicheskaia posleoperatsionnaia pakhovaia bol' [Chronic postoperative groin pain]. Vrach. 2015;(7):34-37.
  10. Nienhuijs S, Staal E, Strobbe L, Rosman C, Groenewoud H, Bleichrodt R. Chronic pain after mesh repair of inguinal hernia: a systematic review. Am J Surg. 2007 Sep;194(3):394-400.
  11. Sajid MS, Leaver C, Baig MK, Sains P. Systematic review and meta-analysis of the use of lightweight versus heavyweight mesh in open inguinal hernia repair. Br J Surg. 2012 Jan;99(1):29-37. doi: 10.1002/bjs.7718.
  12. Koch CA, Greenlee SM, Larson DR, Harrington JR, Farley DR. Randomized prospective study of totally extraperitoneal inguinal hernia repair: fixation versus no fixation of mesh. JSLS. 2006 Oct-Dec;10(4):457-60.
  13. Petri A, Sebin K. Nagliadnaia statistika v meditsine. Leonova VP, per. s angl. Moscow, RF: GEOTAR-MED; 2003. 144 p.
  14. Nyhus LM. Classification of groin hernia: milestones. Hernia. 2004 May;8(2):87-8.
  15. Shalashov SV, Kulikov LK, red. Pakhovye gryzhi u vzroslykh [Inguinal hernias in adults]: ruk dlia vrachei. Novosibirsk, RF: Nauka; 2011. 136 p.
  16. Shalashov SV, Egorov IA, Zakharov AG, Mikhailov AL, Iurkin EM. Sposob plastiki pri pakhovykh gryzhakh [A method of inguinal hernias plastics]. Patent ¹2371106 Ros Federatsii. 27.10.2009.
  17. Kharchenko IuA. Adekvatnaia otsenka boli – zalog ee uspeshnogo lecheniia [Adequate assessment of pain - the key to its successful treatment]. Universum: Meditsina i Farmakologiia [Elektronnyi resurs]. 2014 [data dostupa: 2016 iiun' 26];(4). Rezhim dostupa: http://7universum.com/ru/med/archive/item/1229.
  18. Kalantarov TK, Vakulin GV, Melkanian AG, Begun MS. Vozmozhnosti «svobodnoi ot natiazheniia» plastiki briushnoi stenki pri ustranenii pakhovoi gryzhi [Features of "tension-free" plastic abdominal wall while eliminating inguinal hernia]. Vestn Nats Med-Khirurg Tsentra im NI Pirogova. 2011;6(3):38-40.
Address for correspondence:
664013, Russian Federation,
Irkutsk, Obraztsov st., 27,
Road Clinical Hospital Art.
Irkutsk-Passenger JSC Russian Railways, department of surgical diseases.
Tel: +7 (950) 069 35 67
E-mail: Sersha62@gmail.com
Shalashov Sergey Vladimirovich
Information about the authors:
Shalashov S.V. PhD, Surgeon of department of surgical diseases, NME "Railways Clinical Hospital on the station Irkutsk-Passazhirsky" of JSC "Russian Railways".
Kulikov L.K. MD, Professor of department of surgical diseases, SBEE APE "Irkutsk State Medical Academy of Post-graduate Education".
Semenishcheva E.A. PhD, Chief Physician, NME "Railways Clinical Hospital on the station Irkutsk-Passazhirsky” of JSC "Russian Railways".
Egorov I.A. Head of department of surgical diseases, NME "Railways Clinical Hospital on the station Irkutsk-Passazhirsky" of JSC "Russian Railways",
Mikhaylov A.L. Surgeon of surgical department., NME "Railways Clinical Hospital on the station Irkutsk-Passazhirsky" of JSC "Russian Railways".
Yurkin E.M. Surgeon of department of surgical diseases, NME “Railways Clinical Hospital on the station Irkutsk-Passazhirsky” of JSC “Russian Railways”.

V.V. BOIKO, V.A. PRASOL, K.V. MIASOIEDOV

APPLICATION OF HYDRAULIC DISOBLITERATION METHOD IN TREATMENT OF PATIENTS WITH LOWER LIMBS CRITICAL ISCHEMIA

Kharkov National Medical University,
Kharkov,
Ukraine

Objectives. To estimate the significance of hydraulic dissection of arteries in treatment of patients with chronic critical limb ischemia as a potential method of artery disobliteration.
Methods. 20 amputated specimens of the arteries isolated from the lower extremity in patients with critical limb ischemia were studied. Hydraulic dissection of the arterial wall, affected by atherosclerosis was performed to disobliterate its lumen. To perform this technique the isotonic fluid was injected sub-adventitially to separate obstructing substrate from the residual wall in the arterial lumen. After atherosclerotic plague separation the last one was extracted via the longitudinal arteriotomy.
Results. The hydraulic disobliteration was completed on the segments of femoral and popliteal arteries over 5±2,1 cm, this index made up 3±1,7 cm on the tibial arteries. In 17 cases the plague was completely separated from the wall and extracted via a arteriotomy orifice as a single conglomerate. At the same time the plague was extracted via the arteriotomy orifice sized 1,5±0,8 cm. Extracted substrate was an atherosclerotic plaque in conjunction with media portion, had a smooth surface and it became thinner in a site of natural reduction of the stenotic lesion. In 3 cases the mechanical endarterectomy was required to perform caused to the fragmentation of the obturating substrate to add the purposed method. Throughout the whole disobliterated site no intima fragments were not detected in macroscopical study of residual wall.
Conclusion. The technique of hydraulic endarterectomy allows to perform dissection of the arterial wall, thereby to separate obstructive substrate from the arterial wall and to extract it in sufficient volume as along the affected segment, as throughout the depth of the arterial wall lesions from the lumen. This technique involves no special equipment to introduce liquid agent into the subadventitial space.

Keywords: endarterectomy, arterial wall, plaques, critical ischemia, hydraulic dissection, atherosclerosis, disobliteration
p. 451-456 of the original issue
References
  1. Aho PS, Venermo M. Hybrid procedures as a novel technique in the treatment of critical limb ischemia. Scand J Surg. 2012;101(2):107-13.
  2. Sheng N, Chiriano J, Teruya TH, Abou-Zamzam AM, Bianchi C. Evaluation of superficial femoral artery remote endarterectomy for treatment of critical limb ischemia in patients with limited autogenous conduit. Ann Vasc Surg. 2014 Jan;28(1):262.e1-7. doi: 10.1016/j.avsg.2013.01.023.
  3. Stanley JC, Veith F, Wakefield TW, eds. Current therapy in vascular and endovascular surgery. 5th ed. Saunders; 2014. 1040 p.
  4. Antoniou GA, Koutsias S, Antoniou SA, Giannoukas AD. Remote endarterectomy for long segment superficial femoral artery occlusive disease. A systematic review. Eur J Vasc Endovasc Surg. 2008 Sep;36(3):310-18. doi: 10.1016/j.ejvs.2008.04.005.
  5. Taylor RS. Gas endarterectomy. Techniques, applications, and initial results. Lancet. 1967 Aug 5;2(7510):281-83.
  6. Baron HC, Schwarz AW, Cabaluna W, Rodrigues RJ. Gas endarterectomy in the treatment of the ischemic lower extremity. Arch Surg. 1969 Jun;98(6):754-57
Address for correspondence:
61022, Ukraine, Kharkiv,
pr. Nauka, 4, Kharkiv National Medical University, department of surgery N1.
Tel: + 380950111141
E-mail: vonmiasoiedov@gmail.com Myasoedov Kirill Valerevich
Information about the authors:
Boiko V.V. MD, Professor, Head of department N1 of surgical diseases, Kharkov National Medical University.
Prasol V.A. MD, Professor of department N1 of surgical diseases, Kharkov National Medical University,
Miasoiedov K.V. Post-graduate student of department N1 of surgical diseases, Kharkov National Medical University.

S.M. SMOTRIN 1, A.I. ASLAUSKI 1, V.D. MELAMED 1, P.V. GRAKOVICH 2

SORPTION-DRAINAGE DEVICES IN COMPLEX TREATMENT OF PURULENT WOUNDS AND SOFT TISSUE ABSCESSES OF SOFT TISSUES

EE "Grodno State Medical University"1
SNE "V.A. Belyi Metal Polymer Research Institute"2,
National Academy
of Sciences of Belarus,
Grodno.
The Republic of Belarus

Objectives. To evaluate the efficacy of sorption-drainage devices based on carbon fiber sorbent "Karbopon-B-Aktive" in the complex treatment of purulent wounds and soft tissue abscesses.
Methods. The study included the patients (n=218) with soft tissue abscesses and purulent wounds. The control group consisted of 103 patients, and the experimental group – of 115. Two subgroups were formed in the control group – "Control-1" and "Control-2". The subgroup "Control-1" consisted of 62 patients. The abscess cavity was drained with wet-drying gauzes. The subgroup "Control-2" included 41 patients. In those patients purulent cavities were drained by PVC-tubes.
74 patients of the experimental group ("Experience-1") with the size of a purulent cavity up to 30 cm³ drainage was carried out by the sorption-drainage device (CDD), and in 41 patients with the size of purulent cavity more than 30 cm³ ("Experience-2") the sorption-active drainage system (SADS ) was applied. The groups were comparable in age, gender, form and severity of the disease. Efficacy of treatment was assessed according to clinical, laboratory and microbiological studied materials.
Results. In the groups “Experience-1" and "Experience-2" on the 3rd day of studies, scant purulent exudate was observed in 98,4% and 60% of patients, respectively, and in "Control-1" and "Control 2" groups- in only 13,2% and 2,5% of patients. On the day 7th day of the studies the purulent exudate from the wounds in the patients of "Experience-1" and "Experience-2" was not registered. In the control groups purulent exudate from the wound remained. At the same time in both experimental groups more rapid positive dynamics of clinical indices of blood, LII, LIS, characterizing the severity of the inflammatory process was observed.
Conclusion. The sorption-drainage device (CDD) and sorption-active drainage system (SADS) facilitate the rapid purification of wounds from pus, reduce the intoxication syndrome and shorten the hospitalization period.

Keywords: sorption-drainage devices, sorption-active drainage system, purulent wounds, purification, intoxication syndrome, duration of treatment, clinical efficacy
p. 457-464 of the original issue
References
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  7. Oslavskij AI, Smotrin SM, Prokopchik NI, Zhmakin AI. Vlijanie uglevoloknistyh sorbentov na zazhivlenie jeksperimental'nyh ran [Effect of carbon fiber sorbents on the healing of experimental wounds]. Zhurn Grodn gos med un-ta. 2013;(1):73-79.
  8. Smotrin SM, Oslavskij AI, Grakovich PN, Kuznecov AG. Sorbcionno-drenazhnoe ustrojstvo dlja gnojnyh ran i polostej [Sorption-drainage device for septic wounds and cavities]. Patent ¹ 7187 Resp Belarus', MPK A61M27/00. 2011 Apr 30.
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  10. Ostrovskij VK, Mashhenko AV, Jangolenko DV. Pokazateli krovi i lejkocitarnogo indeksa intoksikacii pri vospalitel'nyh, gnojnyh ignojno-destruktivnyh zabolevanijah [Indices of blood and leukocyte index of intoxication in inflammatory, purulent-destructive diseases]. Klin Lab Diagnostika. 2006;(6):50-53.
  11. Modificirovannaja licevaja shkala boli (FPS-R) [Modified facial pain scale (FPS-R)] [Jelektronnyjresurs]. Mode of access: live.com.ua/health/shkaly-ocenki-boli-u-vzroslyh_80316i15959.html.
Address for correspondence:
230009, Republic of Belarus,
Grodno, Gorky st., 80,
Grodno State Medical University,
department N2 of surgical diseases.
Tel:+ 375 29 781-00-78
E-mail: s.smotrin@mail.ru
Smotrin Sergei Mikhailovich
Information about the authors:
Smotrin S.M. MD, Professor of department N2 of surgical diseases, Grodno State Medical University,
Aslausli A.I. Assistant department N2 of surgical diseases, Grodno State Medical University,
Melamed V.D. PhD, Ass. Professor of department N2 of surgical diseases, Grodno State Medical University,
Grakovich P.N. PhD, Leading Researcher, V.A. Belyi Metal Polymer Research Institute, National Academy of Sciences of Belarus.

A.A. DMITRIYENKO 1, V.V. ANICHKIN 2, M.F. KUREK 2, A.Y. MAKANIN 1

ACUTE PHASE OF CHARCOT OSTEOARTHROPATHY IN PATIENTS WITH NEUROISCHEMIC FORM OF DIABETIC FOOT SYNDROME

SME "Gomel City Clinical Hospital N3"1,
EE "Gomel State Medical University"2
Gomel,
The Republic of Belarus

Objectives. To study the possibility of the development of the acute phase of Charcot osteoarthropathy in patients with neuroischemic form of diabetic foot syndrome (DFS).
Methods. Medical case-histories of patients (n=39) with the acute phase of diabetic Charcot osteoarthropathy, being treated at Gomel Regional Centre «Diabetic Foot» in 2011-2015 had been analyzed. Osteoarthropathy diagnostic was based on the results of radiological and histological studies. Neuropathy diagnostic was based on the assessment of reducing the levels of tactile, pain, foot temperature and vibration sensitivity. Macroangiopathy was diagnosed in the absence of pulsations at the level of the ankle joint and foot dorsal artery. In this case, changes in the blood flow in the main arteries were refined according to the result of Doppler ultrasound. In some cases multispiral CT and selective angiography of the lower limbs vessels were used.
Results. In the majority of patients (n=33, 85%) Charcot osteoarthropathy developed against the background of peripheral neuropathy without disturbing the main blood flow in the lower limbs. In 6 patients (15%) an acute phase of Charcot osteoarthropathy developed against the background of the previously diagnosed neuroischemic form of DFS. In this group (n=6) all patients (3 females, 3 males, mean age 65 years and mean duration of diabetes 15.6 years) suffered from diabetes mellitus type 2.
Conclusion. The value of the vascular component in the origin and course of the disease needs to be further studied specifically both to clarify the essence of ongoing pathological changes in the limbs on the affected side and to determine the treatment tactics of this severe disease and its complications. Process of arteriovenous shunting in the tissues of the affected lower limb appears the mechanism could be mediated by the development of bone and joint destruction in DFS.

Keywords: Charcot osteoarthropathy, neuroischemic form, diabetic foot syndrome, arteriovenous shunting, Doppler ultrasound, main blood flow, affected lower limb
p. 465-472 of the original issue
References
  1. Galstian GR, Kaminarskaia IuA. Patogenez osteoartropatii Sharko: rol' perifericheskoi nervnoi sistemy [The pathogenesis of Charcot osteoarthropathy: the role of the peripheral nervous system]. Endokrin Khirurgiia. 2014;(4):5-14.
  2. Milne TE, Rogers JR., Kinnear EM, Boyle FM. Developing an evidence-based clinical pathway for the assessment, diagnosis and management of acute Charcot Neuro-Arthropathy: a systematic review. J Foot Ankle Res [Electronic resource]. 2013 Jul [cited 2015 Nov 20];6(1):30. Avaiable from: http://www.jfootankleres.com/content/6/1/30.
  3. Ul'ianova IN, Tokmakova AIu, Iaroslavtseva MV, Il'in AV, Galstian GR. Diabeticheskaia osteoartropatiia: sovremennye metody terapii [Diabetic osteoarthropathy: current methods of treatment]. Sakhar Diabet. 2010;(4):70-73.
  4. Udovichenko OV, Grekova NM. Diabeticheskaia stopa [Diabetic foot]. Moscow, RF: Prakt Meditsina; 2010. 272 p.
  5. Mezhdunarodnoe soglashenie po diabeticheskoi stope [International agreement on the diabetic foot]. Moscow, RF: Bereg; 2000. 96 p.
  6. Frykberg RG, Zgonis T, Armstrong DG, Driver VR, Giurini JM, Kravitz SR, at al. Diabetic foot disorders. A clinical practice guideline (2006 revision). J Foot Ankle Surg. 2006 Sep-Oct;45(5 Suppl):S1-66.
  7. Luther M. Critical limb ischemia in diabetes: definition, assessment, prognosis. Vasa. 2001;30(Suppl 58):21-27. doi: 10.1024/0301-1526.30.S58.21.
  8. Hinchliffe RJ, Andros G, Apelqvist J, Bakker K, Friederichs S, Lammer J, et al. A systematic review of the effectiveness of revascularization of the ulcerated foot in patients with diabetes and peripheral arterial disease. Diabetes Metab Res Rev. 2012 Feb;28(Suppl 1):179-17. doi: 10.1002/dmrr.2249.
  9. Apelqvist JA, Lepäntalo MJ. The ulcerated leg: when to revascularize. Diabetes Metab Res Rev. 2012 Feb;28(Suppl 1):30-5. doi: 10.1002/dmrr.2259.
  10. Peripheral arterial disease in people with diabetes. Diabetes Care. 2003 Dec; 26(12):3333-41. doi: 10.2337/diacare.26.12.3333.
  11. Norgren L, Hiatt W, Dormandy J, Nehler MR, Harris KA, Fowkes FG, et al. Inter-society consensus for the management of peripheral arterial disease (TASC II). Eur J Vasc Endovasc Surg. 2007;33(Suppl 1):1-75.
Address for correspondence:
246000, Republic of Belarus, Gomel, Ilich st., 286,
Gomel City Clinical Hospital ¹3, department ¹3 of surgical diseases.
Tel. +375 44 780-19-50
E-mail: dmitrienko-83@mail.ru Dmitrienko Anatoly Anatolevich
Information about the authors:
Dmitriyenko A.A. Deputy Chief Physician, SME "Gomel City Clinical Hospital N3".
Anichkin V.V. MD, Professor of department N3 of surgical diseases, EE "Gomel State Medical University".
Kurek M.F. PhD, Ass. Professor of department N1 of surgical diseases, EE "Gomel State Medical University".
Makanin A.Y. Head of department N3 of surgical diseases, SME "Gomel City Clinical Hospital ¹3".

TRANSPLANTOLOGY

G.P. KOTELNIKOV, Y.V. LARTSEV, D.S. KUDASHEV, S.D. ZUEV-RATNIKOV, I. S. SHORIN

MOSAIC CHONDROPLASTY OF FULL-THICKNESS DEFECTS OF KNEE ARTICULAR SURFACES IN ITS DESTRUCTIVE DYSTROPHIC LESIONS

SBEE HPE "Samara State Medical University",
Samara.
The Russian Federation

Objectives. The improvement of the operative treatment results of patients with full-thickness destructive and dystrophic defects of the articular cartilage of the knee joint based on a new method of chondroplasty application.
Methods. The patients were divided into two clinical groups according the method of the operative treatment. The patients (n=34, 49%) were enrolled into the first group. They were operated on using Hangody’s mosaic chondroplasty technique (1992). The patients of the second group (n=35, 51%) subjected to a proposed mosaic chondroplasty based on the use of bone spongy autograft taken extra-articularly as a plastic material for defect replacement. Comparative evaluation of operative treatment results of the indicated clinical groups of patients was carried out 3, 6 and 36 months after the operation. Treatment response was assessed according the indicators WOMAC-index, Lequesne index, parameteres of the functional electromyography, stabilometry and podometry that allowed calculating integral indicators Õâi and using it in the mathematical models of the system (clinical and functional status of the lower limb) and analyse them.
Results. Comparative analysis of the mathematical models (clinical and functional status of the knee) demonstrated more expressed clinical remission and functional recovery of the lower limb comparing to the Hangody’s method within 3-6 months after the operation.However, if in those terms a clear trend of reduction of integral indicator Õâi with its striving to the value, corresponded to norm, the reversed increasing of Õâi value identical for both groups was observed later in terms of 36 months after the operation. It testifies the regression of the achieved compensation and is considered to be an unfavorable criterion of prognosis of the pathological process progression.
Conclusion. The proposed method of chondroplasty of the articular cartilage defects of the knee joint provided significantly greater structural and functional recovery of the knee and and may be recommended for clinical use.

Keywords: knee joint, hyaline cartilage defect, destructive-dystrophic diseases, stabilometry, chondroplasty
p. 473-481 of the original issue
References
  1. Korzh NA, Golovakha ML, Orlianskii V. Povrezhdeniia khriashcha kolennogo sustava: monografiia [Injuries of the knee cartilage: a monograph]. Zaporozh'e, Ukraina: Prosvita; 2013. 128 p.
  2. Kotel'nikov GP, Lartsev IuV. Osteoartroz [Osteoarthritis]: ruk. Moscow, RF: GEOTAR-Media; 2009. 208p.
  3. Steinwachs MR, Kreuz PC, Guhlke-Steinwachs U, Niemeyer P. Current treatment for cartilage damage in the patellofemoral joint. Orthopade. 2008 Sep;37(9):841-47. doi: 10.1007/s00132-008-1290-9. [Article in German]
  4. Kushner FD, Skott VN, Skuderi ZhR. Khirurgiia kolennogo sustava [Surgery of the knee joint]. Krasenkov PV, per. s angl. Moscow, RF: Med lit; 2014. 274 p.
  5. Aaron RK, Skolnick AH, Reinert SE, Ciombor DM. Arthroscopic débridement for osteoarthritis of the knee. J Bone Joint Surg Am. 2006 May;88(5):936-43.
  6. Goldring SR. Role of bone in osteoarthritis pathogenesis. Med Clin North Am. 2009 Jan;93(1):25-35, xv. doi: 10.1016/j.mcna.2008.09.006.
  7. Bielby RC, Boccaccini AR, Polak JM, Buttery LD. In vitro differentiation and in vivo mineralization of osteogenic cells derived from human embryonic stem cells. Tissue Eng. 2004 Sep-Oct;10(9-10):1518-25.
  8. Bae DK, Yoon KH, Song SJ. Cartilage healing after microfracture in osteoarthritic knees. Arthroscopy. 2006 Apr;22(4):367-74.
  9. Malanin DA, Pisarev VB, Novochadov VV. Vosstanovlenie povrezhdenii khriashcha v kolennom sustave: eksperimental'nye i klinicheskie aspekty [Restoration of damaged cartilage in the knee joint: experimental and clinical aspects]. Volgograd, RF; 2010. 455 p.
  10. Wright TM, Maher SA. Current and novel approaches to treating chondral lesions. J Bone Joint Surg Am. 2009 Feb;91(Suppl 1):120-5. doi: 10.2106/JBJS.H.01390.
  11. Eismont OL, Borisov AV, Maliuk BV, Bukach DV. Artroskopicheskaia diagnostika i lechenie lokal'nykh povrezhdenii sustavnogo khriashcha kolennogo sustava [Arthroscopic diagnosis and treatment of local injuries the articular cartilage of the knee joint]. Ortopediia Travmatologiia i Protezirovanie. 2007;(2):111-14.
  12. Bhattacharjee A, McCarthy HS, Tins B, Roberts S, Kuiper JH, Harrison PE, et al. Autologous Bone Plug Supplemented With Autologous Chondrocyte Implantation in Osteochondral Defects of the Knee. Am J Sports Med. 2016 May;44(5):1249-59. doi: 10.1177/0363546516631739.
  13. Kotel'nikov GP, Lartsev IuV, Smirnitskii AM. Sposob autoplastiki sustavnykh poverkhnostei kolennogo sustava [A method autoplasty articular surfaces of the knee joint]. Patent RF ¹ 2239377. 10.11.2004.
  14. Orlianskii V, Golovakha MV, Shabus R. Korrigiruiushchie osteotomii v oblasti kolennogo sustava [Corrective osteotomy of the knee joint]. Dnepropetrovsk, Ukraina: Porogi; 2009. 160 p.
  15. Preston CF, Fulkerson EW, Meislin R, Di Cesare PE. Osteotomy about the knee: applications, techniques, and results. J Knee Surg. 2005 Oct;18(4):258-72.
Address for correspondence:
443099, Russian Federation, Samara,
Chapaevskaya st., 89, Samara State Medical University,
department of traumatology, orthopedics and
extreme surgery named after Academician AF Krasnov.
Tel: +79276076209
E-mail: dr.kudashev@gmail.com
Kudashev Dmitry Sergeevich
Information about the authors:
Kotelnikov G.P. MD, Academician of RAS, Professor, Head of department of traumatology, orthopedics and extreme surgery named after Academician of RAS Krasnov A.F. SBEE HPE "Samara State Medical University".
Lartsev Y.V. MD, Professor of department of traumatology, orthopedics and extreme surgery named after Academician of RAS Krasnov A.F., Head, department N2 of traumatology-orthopedics SBEE HPE "Samara State Medical University".
Kudashev D.S. PhD, traumatologist-orthopedist SBEE HPE "Samara State Medical University", department N2 of traumatology-orthopedics, Assistant of department of traumatology, orthopedics and extreme surgery named after Academician of RAS Krasnov A.F.
Zuev-Ratnikov S.D. PhD, traumatologist-orthopedist, SBEE HPE "Samara State Medical University", department N2 of traumatology-orthopedics of clinics, Assistant of department of traumatology, orthopedics and extreme surgery named after Academician of RAS Krasnov A.F.
Shorin I.S. Post-graduate student, SBEE HPE "Samara State Medical University", department of traumatology, orthopedics and extreme surgery named after Academician of RAS Krasnov A.F.

NEUROSURGERY

E.L. TSITKO, O.S. GOVRUSHKO, A.A. LITVIN, E.V. TSITKO

POSSIBILITY OF FRAMELESS NEURONAVIGATION IN PLANNING AND MONITORING DURING A SURGICAL INTERVENTION OF LUMBAR HERNIATED INTERVERTEBRAL DISC

ME "Gomel Regional Clinical Hospital"
Gomel.
The Republic of Belarus

Objectives. To study the application efficiency of frameless Brainlab neuronavigation in the surgical treatment of lumbar herniated intervertebral disc.
Methods. The study included patients (n=24) with osteochondrosis stage III. According to the level of destruction the degenerative disc changes were diagnosed at L4-L5 and L5-S1 (16 (66,7%) and 8 (33,3%), respectively. The caudal displacement of sequestration in 9 (37,5%) patients and 2 (8,3%) cranial displacement of sequestration was noted according to the computed tomography (CT) or magnetic resonance imaging (MRI) of the lumbar region. In all cases the interlaminar removing of the fragments of the fallen pulposus nucleus was performed with the revision of intervertebral gap in 18 (75%) patients and in 6 (25%) – with the puncture laser nucleoplasty (PLN) by the holmium laser. Planning and intraoperative monitoring during the surgery stages carried out by neuronavigation station BrainLab (Germany).
Results. Dynamic control of intervention by means of intraoperative navigation provided validity of decompression of the spinal root, radical removal of nucleus pulposus sequesters, and also permitted to prevent the damage of the vertebral end-plates and ventral portions of the fibrous ring due to the possibility of a clear positioning of the optical fiber in the disc cavity at PLN. Using PLN provides «intradiscal decompression» and fibrotization of the nucleus pulposus residues. A statistically significant positive dynamics of pain syndrome intensity according to visual analog scale (VAS) in patients (Z=4,28; p<0,001) as well as a significant improvement in life quality (Oswestry questionnaire) (Z=4,28; p<0,001) in the incisional period had been established.
Conclusion. High efficiency (91,7%) of the navigation system application in the preoperative planning and intraoperative monitoring during the surgical treatment of sequestered hernias has been established. Combination of the controlled navigation microsurgical discectomy and PLN appears promising method of surgical exposure aimed at eliminating direct causes of compression of the spine root and the prevention of postoperative complications.

Keywords: neuronavigation, microsurgical discectomy, intervertebral disc hernia, laser nucleoplasty, lumbar osteochondrosis, prevention, postoperative complications
p. 482-488 of the original issue
References
  1. Akshulakov SK, Kerimbaev TT, Aleinikov VG, Urunbaev EA, Kisaev EV, Sansyzbaev AB, i dr. Sovremennye problemy khirurgicheskogo lecheniia degenerativno-distroficheskikh zabolevanii pozvonochnika [Current problems in the surgical treatment of degenerative diseases of the spine]. Neirokhirurgiia i Nevrologiia Kazakhstana. 2013; 1 (30): 7-16.
  2. Azizov MZh, Simonovich AE, Nuraliev KhA. Rezul'taty analiza diskektomii u bol'nykh s poiasnichnym osteokhondrozom [The results of the analysis of discectomy in patients with lumbar osteochondrosis]. Genii Ortopedii. 2010;(1):59-63.
  3. Chan C, Peng P. Failed back surgery syndrome. Pain Medicine. 2011;12: 577-606.
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  5. Maslov LB, Saboneev NA. Razrabotka realistichnykh modelei uprugikh elementov oporno-dvigatel'nogo apparata cheloveka [Development of realistic models of the elastic elements of the locomotor apparatus of man]. Vestnik IGEU. 2008;(3): 1-6.
  6. Gladkov AV, Sivets IuV, Avdeeva KIu. Novyi podkhod v ispol'zovanii matematicheskogo apparata v postroenii trekhmernoi modeli pozvonochnika [A new approach of mathematical apparatus use in the construction of three-dimensional model of the spine]. Khirurgiia Pozvonochnika. 2005;(1):100-104.
  7. Dreischarf M, Zander T, Shirazi-Adl A, Puttlitz CM, Adam CJ, Chen CS, et al. Comparison of eight published static finite element models of the intact lumbar spine: predictive power of models improves when combined together. J Biomech. 2014 Jun 3;47(8):1757-66. doi: 10.1016/j.jbiomech.2014.04.002.
  8. Ben-Hatira F, Saidane K, Mrabet A. A finite element modeling of the human lumbar unit including the spinal cord. J Biomed Sci Eng. 2012;5(3):146-52. doi: 10.4236/jbise.2012.53019.
  9. Dreischarf M, Schmidt H, Putzier M, Zander T. Biomechanics of the L5-S1 motion segment after total disc replacement - Influence of iatrogenic distraction, implant positioning and preoperative disc height on the range of motion and loading of facet joints. J Biomech. 2015 Sep 18;48(12):3283-91. doi: 10.1016/j.jbiomech.2015.06.023.
  10. Usikov VD, Ptashnikov DA, Mikhailov DA. The use of low-invasive surgery in treatment of degenerative dystrophic spine diseases. Travmatologiia i Ortopediia Rossii. 2009;(3):78-84.
  11. Borshchenko IA, Migachev SL, Dreval' ON, Baskov AV. Opyt chreskozhnoi endoskopicheskoi poiasnichnoi diskektomii [Experience of percutaneous endoscopic lumbar discectomy. Results and prospects]. Rezul'taty i perspektivy. Neirokhirurgiia. 2009;(4):25-34.
  12. Ruetten S, Komp M, Merk H, Godolias G. Full-endoscopic interlaminar and transforaminal lumbar discectomy versus conventional microsurgical technique: a prospective, randomized, controlled study. Spine (Phila Pa 1976). 2008 Apr 20;33(9):931-9. doi: 10.1097/BRS.0b013e31816c8af7.
Address for correspondence:
246012, Republic of Belarus,
Gomel, Brothers Lizyukova st., 5,
Gomel Regional Clinical Hospital.
neurosurgical department N1.
Tel: +375 232 48-55-66
E-mail: fedor30@tut.by
Evgeny Leonidovich Tsitko
Information about the authors:
Tsitko E.L. PhD, Neurosurgeon, ME "Gomel Regional Clinical Hospital".
Govrushko O.S. Head of neurosurgical department N1, ME "Gomel Regional Clinical Hospital".
Litvin A.A. PhD, Ass. Professor, Deputy Chief Physician (Surgery), ME "Gomel Regional Clinical Hospital".
Tsitko E.V. PhD, Deputy Chief Physician (Polyclinic work), ME "Gomel Regional Clinical Hospital".

UROLOGY

R.N. FOMKIN, T.V. SHATYLKO

PSA NADIR AS A BASIC PREDICTOR OF LOCALIZED PROSTATE CANCER RECURRENCE AFTER HIFU-ABLATION

SBEE HPE "Saratov State Medical University named after V.I. Razumovsky",
Research Institute of Fundamental and Clinical Uronephrology,
Saratov.
The Russian Federation

Objectives. To assess whether prostate-specific antigen (PSA) nadir is an independent predictor of recurrence and disease-free survival after high-intensity focused ultrasound (HIFU) in localized prostate cancer, using ASTRO new criteria.
Methods. Clinical cases of patients (n=103) after HIFU-ablation (Ablatherm, France) with the localized prostate cancer without previous hormonal therapy were analyzed, retrospectively. Patients were observed regularly at control visits every 3 months. Recurrence was defined by the revised ASTRO criteria (PSA 2 ng/ml or more above the nadir, positive biopsy, appointment of rescue therapy). The patients were divided into three groups depending on the level of PSA nadir: Group I – 0,2 ng/ml or less; group II, – 0,21-1 ng/ml; Group III – more than 1 ng/ml. Relapse-free survival was calculated using the method of mortality tables. The log rank test was used to compare the constructed Kaplan-Meier curves.
Results. Median follow-up was 4,9 (3-8,6) years. The average time to reach PSA nadir was 6,4±5,1 months. PSA nadir of 0,2 ng/ml or less was achieved in 64% of patients, 0,21-1 ng/ml – 22,3% of the patients more than 1 ng/ml – 13,6%. The recurrence rate was 4,5%, 30,4% and 100%, respectively (p<0,001) in those groups. Five-year actuarial disease-free survival in those groups was 95%, 55% and 0%, respectively (p<0,001).
Conclusion. The level of PSA nadir after HIFU-ablation correlates with a high degree of statistical significance with the probability of recurrence and disease-free survival, which can be applied in a real clinical practice. Promising oncological result may be expected in case of reaching PSA nadir 0,2 ng/mL or less.

Keywords: HIFU, PSA, biochemical recurrence, nadir, predictor of recurrence, mortality
p. 489-496 of the original issue
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  6. Lee HM, Hong JH, Choi HY. High-intensity focused ultrasound therapy for clinically localized prostate cancer. Prostate Cancer Prostatic Dis. 2006;9(4):439-43.
  7. Blana A, Brown SC, Chaussy C, Conti GN, Eastham JA, Ganzer R, et al. High-intensity focused ultrasound for prostate cancer: comparative definitions of biochemical failure. BJU Int. 2009 Oct;104(8):1058-62. doi: 10.1111/j.1464-410X.2009.08518.x.
  8. Ganzer R, Robertson CN, Ward JF, Brown SC, Conti GN, Murat FJ, et al. Correlation of prostate-specific antigen nadir and biochemical failure after high-intensity focused ultrasound of localized prostate cancer based on the Stuttgart failure criteria - analysis from the @-Registry. BJU Int. 2011 Oct;108(8 Pt 2):E196-201. doi: 10.1111/j.1464-410X.2011.10091.x.
  9. Zelefsky MJ, Kuban DA, Levy LB, Potters L, Beyer DC, Blasko JC, et al. Multi-institutional analysis of long-term outcome for stages T1-T2 prostate cancer treated with permanent seed implantation. Int J Radiat Oncol Biol Phys. 2007 Feb 1;67(2):327-33.
  10. Poissonnier L, Chapelon JY, Rouvière O, Curiel L, Bouvier R, Martin X, et al. Control of prostate cancer by transrectal HIFU in 227 patients. Eur Urol. 2007 Feb;51(2):381-87.
  11. Berge V, Baco E, Dahl AA, Karlsen SJ. Health-related quality of life after salvage high-intensity focused ultrasound (HIFU) treatment for locally radiorecurrent prostate cancer. Int J Urol. 2011 Sep;18(9):646-51. doi: 10.1111/j.1442-2042.2011.02815.x.
Address for correspondence:
410054, the Russian Federation,
Saratov, Bolshaya Sadovaya st., 137/7.
Clinical Hospital named after SR Mirotvortseva SSMU,
department of urology,
Research Institute for Fundamental and Clinical Uronephrology.
Tel: +7 927 123-38-01
E-mail: rnfomkin@mail.ru
Fomkin Roman Nikolaevich
Information about the authors:
Fomkin R.N. PhD, Ass. Professor of department of urology, SBEE HPE "Saratov State Medical University named after V.I.Razumovsky", Senior Researcher, Research Institute of Fundamental and Clinical Uronephrology.
Shatylko T.V. Post-graduate student, SBEE HPE "Saratov State Medical University named after V.I.Razumovsky", Research Institute of Fundamental and Clinical Uronephrology.

REVIEWS

A.I. CHERNOOKOV1, M.M. KARAPETYAN2, V.V. BAGDASAROV1, H.A. BAGDASAROVA1, M.V. KOSACHENCO2, A.P. MOISEEV1

COLORECTAL STENTING IN TREATMENT OF MALIGNANT LARGE BOWEL OBSTRUCTION

SBEE HPE "I.M. Sechenov First Moscow State Medical University"1,
SBME "City Clinical Hospital named after S.S.Judin of Moscow Health Care Department"2.
Moscow.
The Russian Federation

Review the recent literature data for colonic stenting application in patients with malignant large bowel obstruction has been analyzed. Colorectal stent application is considered to be a real alternative for the emergency surgery. First of all stent is performed for temporary colonic decompression as a bridge to the surgery followed by a delayed radical operation in resectable cases. The second indication – stents are being increasingly used to solve malignant large bowel obstruction (unresectable and / or metastatic cancer). The placement of colorectal stents has been carried out with endoscopic guidance, fluoroscopy guidance, or a combined technique. The average clinical effectiveness of stenting is 80-90%. The effectiveness of stenting is affected by the extent of tumor stricture, patient’s status, and experience of endoscopist, cancer localization and the source of tumor. In the case of a complete obstruction the outcomes of stenting are worse compared with a subtotal obstruction. “A bridge to the surgery” approach improves immediate outcomes of management in patients with malignant large bowel obstruction compared with emergency surgical interventions. The optimal time until elective radical surgery is 5-10 days after stent insertion. The long-term oncologic outcomes of a bridge method are insufficiently studied. The stent insertion may affect negatively on 5-year overall survival and cancer recurrence rate. In patients with unresectable and/or metastatic cancer, complicated by malignant large bowel obstruction, the stenting improves the quality of life, reduces the hospitalization time. The complications of colorectal stenting include stent-induced colonic perforation, colonic re-obstruction, stents migration, inadequate colonic decompression, pain, bleeding. Further individualisation of treatment tactics of malignant large bowel obstruction should be carefully considered the advantages and disadvantages of colonic stenting.

Keywords: colorectal cancer, colorectal stenting, colonic perforation, malignant large bowel obstruction, self-expandable metallic stents, hospitalization time, quality of life
p. 497-507 of the original issue
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Address for correspondence:
119991, Russian Federation, Moscow, Trubetskaya st., 8/2.
First Moscow State Medical University named after IM Sechenov,
department N2 of hospital surgery.
Tel:. +7-985-167-43-66
E-mail: sanpali4@yandex.ru
Moiseev Aleksandr Pavlovich
Information about the authors:
Chernookov A.I. MD, Professor, Head of department N2 of hospital surgery, SBEE HPE "I.M.Sechenov First State Medical University".
Karapetyan M.M. PHD, Head of surgical department, SBME "City Clinical Hospital named after S.S.Judin".
Bagdasarov V.V. MD, Professor of department ¹ 2 of hospital surgery, SBEE HPE "I.M.Sechenov First State Medical University".
Bagdasarova E.A. MD, Professor of department N 2 of hospital surgery, SBEE HPE "I.M.Sechenov First State Medical University".
Kosachenco M.V. Surgeon of Moscow Health Care department., SBME "City Clinical Hospital named after S.S.Judin".
Moiseev A.P. Post-graduate student of department N2 of hospital surgery, SBEE HPE "I.M.Sechenov First State Medical University",

CASE REPORTS

Z.S. FAIZIEV1, T.G. GULMURADOV1, E.L. KALMYKOV1,2, H.Z. FAIZIEV3, H.S. MUKHAMADIEVA1

A RARE CASE OF SURGICAL TREATMENT OF FEMALE PATIENT WITH BOUVERET SYNDROME

Republican Scientific Center of Cardiovascular Surgery1,
Tajik National Research Center for transplantation of organs and human tissue2,
Avicenna Tajik State Medical University3,
Dushanbe,
The Republic of Tadzhikistan

Bouveret’s syndrome is characterized by gastric outlet obstruction due to a gallstone in the duodenum, usually in association with a cholecystoduodenal fistula and occurs in 0.3-0.5% cases of gallstone complications. The purpose of this article is to demonstrate a rare presentation of gastric outlet obstruction caused by a gallstone. During the ultrasound study the hyperechoic formation with clear contours intensive acoustic track (dimensions 4,5×3,2 cm) below the projection of the gallbladder was visualized. The diameter of the duct of Wirsung averaged 3 mm. Sonographic signs in portal hypertension were not observed. The presence of calculus (sized 4,5×3,2 cm) occupying the entire lumen of the duodenal bulb and vesico-duodenal fistula was diagnosed during endoscopy and radiologic examination. The attempts to remove the stone endoscopically failed due to the large diameter. It was therefore decided to perform an open surgery. Laparotomy and gastrotomy on the border of gastric antrum and the stomach body extending 3,5 cm. were performed; a huge gallstone was extracted. Taking into consideration a severe infiltration of hepatoduodenal region with the involvement of the hepatic angle of the transverse colon and omentum as well as the risk of possible conflict with vascular secretory pedicle of hepatic gate, the removal of the biliary fistula with cholecystectomy was not carried out. The insicional period proceeded without any complications. Within 5 months of observation the patient’s condition was satisfactory, the complaints were not registered.

Keywords: Bouveret syndrome, gastric outlet obstruction, gall bladder, stone, fistula, cholecystectomy, complaints
p. 508-512 of the original issue
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Address for correspondence:
734000, Republic of Tajikistan,
Dushanbe, Mayakovsky st., 2,
Tajik National Research Center for transplantation of organs and human tissue,
of the Health Ministry of Human
and Social Protection, the Republic of Tajikistan.
Tel: +992 90 811 00 18
E-mail. egan0428@mail.ru
Kalmykov Egan Leonidovich
Information about the authors:
Faiziev Z.S. PhD, Leading Researcher of Republican Scientific Center of Cardiovascular Surgery of the Ministry of Health and Social Protection of Population of the Republic of Tadzhikistan.
Gulmuradov T.G. MD, Professor, Corresponding member of Academy of Science, Head of department of cardiovascular surgery of Tajik Institute of Postgraduate Medical Training,
Kalmykov E.L. PhD, Deputy Director (Science) of Tajik National Research Center for Transplantation Organ and Human Tissues of the Ministry of Health and Social Protection of Population of the Republic of Tadzhikistan.
Faiziev H.Z. Post-graduate student of department N2 of surgical diseases, Avicenna Tajik State Medical University.
Mukhamadieva H.S. Radiologist, Republican Scientific Center of Cardiovascular Surgery of the Ministry of Health and Social Protection of Population of the Republic of Tadzhikistan.

E.P. KULIKOV1, Y.D. KAMINSKY1,2, I.I. VINOGRADOV2, M. Y. HOLCHEV2, S.V. KLEVTSOVA1

POSSIBILITIES OF SURGICAL TREATMENT OF RECURRENT RETROPERITONEAL LIPOSARCOMAS

SPEE HPE "Ryazan State Medical University named after academician I.P. Pavlov"1
SBE "Ryazan Regional Clinical Oncologic Center"2,
Ryazan.
The Russian Federation

The case report of the recurrent retroperitoneal liposarcoma is presented as well as the tactics of management patients with this pathology by the example of a certain clinical situation.The peculiarity of the clinical example of the presented patient is a long anamnesis of liposarcoma with the multiple recurrent course. At the time of admission to Ryazan Regional Clinical Oncology Center, the patient had the fifth recurrence of liposarcoma. During the period from 2009 to 2015 the patient underwent five operations on the primary tumor and its recurrences and 11 courses of chemotherapy. In July, 2015 the patient underwent the 6th operation to remove the recurrent tumors of the retroperitoneal space and the course of adjuvant intraperitoneal chemotherapy with cisplatin. The patient was discharged from the hospital to be dynamically observed. The next control examination (10 months later) showed no signs of disease recurrence according to clinical and ultrasound criteria.
There is no consensus regarding management of patients with recurrent retroperitoneal non-organic tumors and they classified as the patients for whom today clearly defined treatment has not been established. However, the surgery remains the most successful treatment method of patients with recurrent retroperitoneal tumors and the presented clinical example demonstrates that the complete surgical resection is the only potential curative treatment modality (with maximal degree of cytoreduction).

Keywords: the extra-organ retroperitoneal tumors, retroperitoneal liposarcoma, recurrence, surgical treatment, ultrasound, chemotherapy, cytoreduction.
p. 513-518 of the original issue
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Address for correspondence:
390046, Russian Federation, Ryazan, Sport st., 13,
Ryazan Regional Clinical Oncology Center,
Department of Oncology with a course of radiation diagnosis FADE.
Tel: (4912) 44-88-25
E-mail: klevcovasveta1@rambler.ru
Klevtsova Svetlana Vladimirovna
Information about the authors:
Kulikov E.P. MD, Professor, Honored physician of RF, Head of department of oncology with the course of radiation diagnostics FADE., SPEE HPE
"Ryazan State Medical University named after academician I.P. Pavlov".
Kaminsky Y.D. PhD, Ass. Professor of department of oncology with the course of radiation diagnostics FADE, SPEE HPE "Ryazan State Medical University named after academician I.P. Pavlov".
Vinogradov I.I. PhD, Assistant of department of pathologic anatomy with the course of forensic medicine, SPEE HPE "Ryazan State Medical University named after academician I.P. Pavlov", pathologist of SBE "Ryazan Regional Clinical Oncologic Center".
Holchev M.Y. Physician of X-ray unit, SBE "Ryazan Regional Clinical Oncologic Center".
Klevtsova S.V. Intern, SPEE HPE "Ryazan State Medical University named after academician I.P. Pavlov", department of oncology with the course of radiation diagnostics FADE.

EXCHANGE OF EXPERIENCE

K.V. PUCHKOV1,2, D.A. KHUBEZOV2,3, D.K. PUCHKOV2,3, R.V. LUKANIN3

LAPAROSCOPIC RIGHT HEMICOLECTOMY WITH SPECIMEN EXTRACTION ACCORDING TO NOSE METHOD

ANCO "Center of Clinical and Experimental Surgery"1, Moscow,
SBEE HPE "Ryazan State Medical University Named after Academician I.P. Pavlov"2,
SBE RR "Ryazan Regional Clinical Hospital",
Ryazan.
The Russian Federation

Objectives. To evaluate the immediate and long-term results of surgical treatment of patients with simultaneous diseases of the abdominal and pelvic organs after laparoscopic right hemicolectomy with the specimen extraction transvaginelly according to the natural orifice organs specimen extraction (NOSE) method.
Methods. The article details the first clinical case: the patient with the tumour of the colon and uterus myoma nodes, and therefore, she was subjected to a simultaneous laparoscopic operation – hysterectomy, right hemicolectomy with extraction of resected specimen transvaginally with intracorporal anastomosis fistulization. At the first stage hysterectomy was performed, right hemicolectomy was carried out using the original combined latero-medial technique. Within 3 years 5 similar surgical procedures had been done and the results are presented in this article.
Results. Mean operative time was 133+12,9 min. Intraoperative blood loss did not exceed 90-100 ml. The length of the vascular pedicle (indersected iliac colic artery) was 9±1 cm. The fascia of colon was saved in all 5 cases. No intraoperative complication was observed. Postoperative complications were registered in 2 cases: the development of functional complication – dyspareunia was noted in 1 case. The development of this complication was associated with the violation of treatment guidelines – abstinence from sexual intercourse after an operation is advisable for 2 months. This complication was cured with vaginal suppositories within 2 weeks after the first symptoms appearance. One case of acute urinary retention was observed on the second day after surgery (after the urinary catheter removal). There was a need to set a urinary catheter within 12 hours. The level of postoperative pain ranged from 0 to 1.
Conclusion. Transvaginal access is considered to be an ideal way to extract the resected specimen due to anatomical and physiological features of the given area during the colon operations.

Keywords: laparoscopy, laparoscopic hemicolectomy, NOSE, intracorporeal interintestinal anastomosis formation, transvaginal access, postoperative pain, complication
p. 519-524 of the original issue
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Address for correspondence:
390026, Russian Federation, Ryazan, Vyisokovoltnaya st.,
9, Ryazan State Medical University named by Academician I.P. Pavlov,
department of surgery with the course of endosurgery FAPE.
Tel: +7 (952) 122-81-85
E-mail: puchkovdk@mail.ru
Puchkov Dmitry Konstantinovich
Information about the authors:
Puchkov K.V. MD, Professor, Director, ANCO "Center of Clinical and Experimental Surgery", Moscow, Professor of department of surgery with the course of endosurgery FAPE, SBEE HPE "Ryazan State Medical University named after Academician I.P.Pavlov", Professor of department of obstetrics and gynaecology, SBEE APE "Russian Medical Academy of Post-graduate Education".
Khubezov D.A. MD, Professor, Head of department of surgery with the course of endosurgery FAPE, SBEE HPE "Ryazan State Medical University named after Academician I.P.Pavlov", Head of department of coloproctology, SBE RR "Ryazan Regional Clinical Hospital".
Puchkov D.K. Assistant of department of surgery with the course of endosurgery FAPE, SBEE HPE "Ryazan State Medical University named after Academician I.P.Pavlov", Coloproctologist of department of coloproctology, SBE RR "Ryazan Regional Clinical Hospital".
Lukanin R.V. Coloproctologist of department of coloproctology, SBE RR "Ryazan Regional Clinical Hospital".
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