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Year 2021 Vol. 29 No 5

SCIENTIFIC PUBLICATIONS
EXPERIMENTAL SURGERY

A.-M. YEROFEYEVA, I. ZHAVARANAK, O. ANTIPOVA, N. SCHASTNAYA, I. SIAMIONIK, S. RJABCEVA, A. MOLCHANOVA

ASSESMENT OF ANTI-NOCICEPTIVE ACTIONS OF ADIPOSE-DERIVED MESEMCHYMAL STEM CELLS IN EXPERIMENTAL PERIPHERAL NEUROPATHIC PAIN

Institute of Physiology NAS of Belarus, Minsk,
The Republic of Belarus

Objective. To estimate an anti-nociceptive and regenerative potential of adipose-derived mesenchymal stem cells in experimental post-traumatic neuropathy in rats.
Methods. Neuropathic pain was induced by axotomy technique in rat left hind paw (Wistar rats (n=113)). The respective group of subjects received ADMSCs dose of 1×106 cells/kg and 2×106 cells/kg into the site of sciatic nerve injury at 2 regimens: single (7th day post-surgery) and twice (7th and 14th day post-surgery). Nociceptive responses, as well as histological changes of sciatic nerve and perineural tissue were assessed in dynamics.
Results. Sciatic nerve axotomy led to a significant increase of mechanical nociceptive sensitivity of ipsilateral hind paw by 7th day, as well as to fibrotic changes of peri- and epineural areas of damaged nerve fibers and to denervation of surrounding muscle tissue and fascia. Local administration of ADMSCs effectively abolished mechanical hyperalgesia by 14th day after first injection at all regimens tested. Among tested regimens, the most pronounced anti-nociceptive and regenerative effects were induced by single injection of ADMSCs (1×106 cells/kg). As the dose and frequency of ADMSCs administration elevated, their reparative and anti-inflammatory properties reduced.
Conclusion. Obtained results testify anti-nociceptive potential of ADMSCs and feasibility of its further investigation on the experimental models of neuropathy.

Keywords: mesenchymal stem cells, adipose tissue, neuropathy, pain, sciatic nerve, hyperalgesia
p. 527-534 of the original issue
References
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  7. Yekkirala AS, Roberson DP, Bean BP, Woolf CJ. Breaking barriers to novel analgesic drug development. Nat Rev Drug Discov. 2017 Aug;16(8):545-64. doi: 10.1038/nrd.2017.87
  8. Han Y, Li X, Zhang Y, Han Y, Chang F, Ding J. Mesenchymal Stem Cells for Regenerative Medicine. Cells. 2019 Aug 13;8(8):886. doi: 10.3390/cells8080886
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Address for correspondence:
220072, Republic of Belarus,
Minsk, Akademicheskaya Str., 28,
Institute of Physiology NAS of Belarus,
the Laboratory for Modulation of Body Functions,
e-mail: amyerofeyeva@zoho.eu,
Yerofeyeva Anna-Maria V.
Information about the authors:
Yerofeyeva Anna-Maria V., Post-Graduate Student, Junior Researcher of the Laboratory for Modulation of Body Functions, Institute of Physiology NAS of Belarus, Minsk, Republic of Belarus.
https://orcid.org/0000-0002-9407-9295
Zhavaranak Irina P., PhD, Senior Researcher of the Laboratory for Modulation of Body Functions, Institute of Physiology NAS of Belarus, Minsk, Republic of Belarus.
http://orcid.org/0000-0001-9982-0719
Antipova Olga A., Researcher of the Laboratory for Modulation of Body Functions, Institute of Physiology NAS of Belarus, Minsk, Republic of Belarus.
http://orcid.org/0000-0002-5418-0874
Schastnaya Nadezhda I., Researcher of the Laboratory for Modulation of Body Functions, Institute of Physiology NAS of Belarus, Minsk, Republic of Belarus.
http://orcid.org/0000-0003-1786-5185
Siamionik Irina A., PhD, Senior Researcher of the Center for Light and Electron Microscopy, Institute of Physiology NAS of Belarus, Minsk, Republic of Belarus.
https://orcid.org/0000-0002-7520-1945
Rjabceva Svetlana N., PhD, Head of the Laboratory, Leading Researcher of the Center for Light and Electron Microscopy, Institute of Physiology NAS of Belarus, Minsk, Republic of Belarus.
https://orcid.org/0000-0001-5960-3656
Molchanova Alla Yu., PhD, Head of the Laboratory, Leading Researcher, the Laboratory for Modulation of Body Functions, Institute of Physiology NAS of Belarus, Minsk, Republic of Belarus.
https://orcid.org/0000-0001-5053-6602

GENERAL & SPECIAL SURGERY

E.L. KALMYKOV 1, W. AHMAD 1, I.A. SUCHKOV 2, R.E. KALININ 2, O. NEMATZODA 3, A.D. GAIBOV 4, D.D. SULTANOV 4, P. MAJD 1, J. BRUNKWALL 1

DEMOGRAPHIC DIFFERENCES IN PATIENTS WITH ABDOMINAL AORTIC ANEURYSM IN DIFFERENT COUNTRIES: GERMANY, TAJIKISTAN AND RUSSIAN FEDERATION

Cologne University Clinic 1, Cologne,
Germany,
I.P. Pavlov Ryazan State Medical University 2, Ryazan,
Russian Federation,
Republican Scientific Center for Cardiovascular Surgery of the Ministry of Health and Social Protection of the Population 3, Dushanbe,
Avicenna Tajik State Medical University 4, Dushanbe,
Republic of Tajikistan

Objective. To compare the demographics, comorbidities and risk factors in patients with abdominal aortic aneurysm (AAA) treated in three different communities; Germany, Tajikistan and Russian Federation.
Methods. A retrospective comparative study including patients with an infrarenal AAA who were treated with either endovascular aneurysm repair (EVAR) or open repair (2011-2015) in Cologne, Dushanbe and Ryazan was done. A total number of 711 patients, 499 from Cologne, 46 from Dushanbe and 166 from Ryazan were included in the study. Demographic data including age, gender, body mass index (BMI), comorbidities (diabetes, coronary artery disease (CAD)), hypertension, cerebrovascular disease, chronic obstructive pulmonary disease (COPD, smoking), actual treatment as well as the diameter of the abdominal aorta were collected, retrospectively.
Results. There was no statistically significant difference in AAA prevalence with respect to gender between the study centers. Similarly, the BMI did not differ significantly between these 3 centers. Though, the patients from Cologne were older than those from Dushanbe and Ryazan. Moreover, the number of patients treated due to ruptured aneurysm was significantly lower in Cologne in comparison to the other two centers (P<.05). The AAA-diameter of patients in Ryazan and Dushanbe was greater than that found in Cologne. Regarding the actual medication that patients were presented with, antiplatelet-aggregation medication, statin and beta blockers were used significantly more often in Cologne. Patients from Tajikistan had COPD more often than patients from the other centers.
Conclusion. The prevalence of comorbidities, risk factors as well as medication in patients with infrarenal abdominal aortic aneurysm is different in the various geographical regions.

Keywords: abdominal aortic aneurysm, ruptured aneurysm, risk factors, demographic differences, mortality, endovascular treatment
p. 535-541 of the original issue
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  6. Wanhainen A, Verzini F, Van Herzeele I, Allaire E, Bown M, Cohnert T, Dick F, van Herwaarden J, Karkos C, Koelemay M, Kölbel T, Loftus I, Mani K, Melissano G, Powell J, Szeberin Z, Esvs Guidelines Committee, de Borst GJ, Chakfe N, Debus S, Hinchliffe R, Kakkos S, Koncar I, Kolh P, Lindholt JS, de Vega M, Vermassen F, Document Reviewers, Björck M, Cheng S, Dalman R, Davidovic L, Donas K, Earnshaw J, Eckstein HH, Golledge J, Haulon S, Mastracci T, Naylor R, Ricco JB, Verhagen H. Editor’s Choice – European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms. Eur J Vasc Endovasc Surg. 2019 Jan;57(1):8-93. doi: 10.1016/j.ejvs.2018.09.020
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Address for correspondence:
Clinic of Vascular and Endovascular Surgery,
Helios University Clinic. Wuppertal, Germany, Heusener Street 40,
42283, Wuppertal,
e-mail: egan0428@mail.ru,
Kalmykov Egan L.
Information about the authors:
Kalmykov Egan L., PhD, Vascular Surgeon, Clinic of Vascular and Endovascular Surgery, Helios University Clinic. Wuppertal, Germany.
https://orcid.org/0000-0001-6784-2243
Ahmad Wael, Doctor of Medicine, Department of Vascular and Endovascular Surgery, University Clinics, University of Cologne, Cologne, Germany.
https://orcid.org/0000-0001-5090-3468
Suchkov Igor A., MD, Professor, Vice-Rector for Research and Innovative Development, Professor of the Department of Cardiovascular, X-ray Endovascular, Operatives and Topographic Anatomy, I.P. Pavlov Ryazan State Medical University, Ryazan, Russian Federation
https://orcid.org/0000-0002-1292-5452
Kalinin Roman E., MD, Professor, Rector, Head of the Department of Cardiovascular, X-ray Endovascular, Operatives and Topographic Anatomy, I.P. Pavlov Ryazan State Medical University, Ryazan, Russian Federation
https://orcid.org/0000-0002-0817-9573

Nematzoda Okildzhon, PhD, Leading Researcher, Republican Scientific Center for Cardiovascular Surgery of the Ministry of Health and Social Protection of the Population, Dushanbe, Republic of Tajikistan.
https://orcid.org/0000-0001-7602-7611.

Gaibov Alidzhon D., Corresponding Member of AMS of RT, MD, Professor of the Department of Surgical Diseases No2, Avicenna Tajik State Medical University, Republican Scientific Center for Cardiovascular Surgery of the Ministry of Health and Social Protection of the Population, Dushanbe, Republic of Tajikistan.
https://orcid.org/0000-0002-7767-2556
Sultanov Dzhavili D., MD, Professor of the Department of Surgical Diseases No2, Avicenna Tajik State Medical University Dushanbe, Republic of Tajikistan.
https://orcid.org/0000-0001-7935-7763
Majd Payman, Doctor of medicine, Clinic of Vascular and Endovascular Surgery, Cologne University Clinic, Cologne, Germany.
https://orcid.org/0000-0002-5835-8318
Brunkwall Jan, Professor, Clinic of Vascular and Endovascular Surgery, Cologne University Clinic, Cologne, Germany.
https://orcid.org/0000-0003-3082-6009

I.V. KOLOSOVYCH, I.V. HANOL

PURULENT SEPTIC COMPLICATIONS OF ACUTE PANCREATITIS AND THEIR PATHOGENETIC RELATIONSHIP WITH HELICOBACTER PYLORI

A.A. Bogomolets National Medical University, Kiev,
Ukraine

Objective. To study of the role of Helicobacter pylori as an etiological factor of acute pancreatitis and a marker of the development of its purulent-septic complications.
Ìethods. The study was conducted in the period of 2015-2020; patients with acute pancreatitis (n=124) were divided into 2 groups: the main group (66 patients with moderate severity and severe course) and the comparison group (58 patients with a mild form). All patients underwent a screening study of Helicobacter pylori in feces and serological blood test to detect antibodies, namely immunoglobulin M to Helicobacter pylori (determination of the phase of the disease – acute or chronic). In 39 (31.5%) patients of the main group, a bacteriological study of biological and biopsy specimens of antral mucous membrane were taken and examined histologically for organisms.
The selection of antibiotics for treatment was carried out taking into account the infection of patients with Helicobacter pylori and was performed using the author’s method, the effectiveness of treatment was controlled microbiologically.
Results. The positive result of the express test was in 66 (100%) patients of the main group and in 39 (67.2%) patients in the comparison group. During serological examination, a positive result was obtained: 24 hours after hospitalization – in 8 (13.8%) patients in the comparison group, in 23 (34.8%) patients in the main group; after 7 days – in 9 (15.5%) patients and 42 (63.3%) patients, respectively. Helicobacter pylori is sensitive to the majority of antibiotics used to treat purulent-septic complications of acute pancreatitis; after finishing the course of antibiotic therapy, eradication was achieved in 37 (94.9%) patients of the main group.
Conclusion. Positive results of a serological study of Íelicobacter pylori after 7 days from the moment of hospitalization were more common in patients of the main group (63.3%) in relation to the comparison group (15.5%) (χ2=28.9, p<0.001), which gives grounds to consider bacteria, as one of the markers of the development of purulent-septic complications of acute pancreatitis.

Keywords: Helicobacter pylori, acute pancreatitis, etiology, purulent-septic complications, diagnosis, treatment
p. 542-548 of the original issue
References
  1. Rasslan R, Novo FC, Rocha MC, Bitran A, Rocha MS, Bernini CO, Rasslan S, Utiyama EM. Pancreatic necrosis and gas in the retroperitoneum: treatment with antibiotics alone. Clinics (Sao Paulo). 2017 Feb;72(2):87-94. Published online 2017 Feb. doi: 10.6061/clinics/2017(02)04
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  12. Khan J, Pelli H, Lappalainen-Lehto R, Järvinen S, Sand J, Nordback I. Helicobacter pylori in alcohol induced acute pancreatitis. Scand J Surg. 2009;98(4):221-24. doi: 10.1177/145749690909800405
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Address for correspondence:
01601, Ukraine, Kiev,
Blvd T.Shevcheko, 13,
A.A. Bogomolets National
Medical University,
the Surgery Department No 2?
tel.: +380 (67) 698 86 17,
e-mail:ganoli@ukr.net,
Hanol Ihor V.
Information about the authors:
Kolosovych Ihor V., MD, Professor, Head of the surgery Department No2, A.A. Bogomolets National Medical University, Kiev, Ukrainå.
https://orcid.org/0000-0002-2031-4897
Hanol Ihor V., PhD, Associate Professor of the Surgery Department No2, A.A. Bogomolets National Medical University, Kiev, Ukrainå.
https://orcid.org/0000-0002-3470-2102

N.I. TROITSKAYA, K.G. SHAPOVALOV, V.A. MUDROV

THE PREVALENCE OF GENETIC POLYMORPHISMS FOR REGULATION OF VASCULAR TONE, PLATELET RECEPTORS, VASCULAR WALL REMODELING AND PROTHROMBOTIC FACTORS IN DIABETIC FOOT SYNDROME

Chita State Medical Academy, Chita,
The Russian Federation

Objective. To analyze the frequency of occurrence of eNOS 786C>T, END1 Lys198Ash, ITGB3 1565T>C (Leu33Pro), F5 1691G>A, F2 20210G>A, MMP9 8202A>G, MTHFRA 1298 C,VEGFA 634C>G gene polymorphisms in diabetic foot syndrome.
Methods. The study included patients (n=198) with uncomplicated diabetes mellitus and patients (n=199) with the development of diabetic foot syndrome. Genotyping of the studied gene polymorphisms was performed by the polymerase chain reaction method.
Results. In patients with uncomplicated diabetes mellitus and in patients with diabetic foot, no significant differences were found in the frequency of occurrence of polymorphisms 786C>T of the eNOS3 gene, Lys198Ash of the END1 gene, 1691G>A of the F5 gene, 20210G>A of the F2 gene, 8202A>G of the MMP9 gene, 634C> G of the VEGFA gene and their allelic variants. Associative relationship between the polymorphisms of the NOS 786C>T, END1 Lys198Ash, F5 1691G>A, F2 20210G>A, MMP9 8202A>G, VEGFA 634C>G genes and the development of diabetic foot syndrome was not found. With the development of a diabetic foot, a heterozygous variant of the 1565TÑ polymorphism of the ITGB3 gene was more common than in uncomplicated diabetes mellitus (37.7% and 28.3%, respectively (χ²=6.243, p=0.045)). The risk of developing a diabetic foot with the carriage of this polymorphism is 1.5 times higher than with other variants of gene polymorphism ((OR=1.534 (95% Cl 1.006 – 2.338), p<0.05). Polymorphism 1298 AS of the MTHFR gene was more often detected in the group of patients with uncomplicated diabetes mellitus than in the group with the development of diabetic foot (45.4% and 29.1%), (χ²=11.55, p=0.004).
Conclusion. The development of diabetic foot syndrome is associated with the carriage of the heterozygous 1565TÑ polymorphism of the ITGB3 gene, in which the likelihood of developing this complication increases 1.5 fold. In diabetes mellitus without complications, a more frequent carriage of the heterozygous polymorphism 1298 AC of the MTHFR gene was revealed, which may have a protective effect against the development of diabetic foot syndrome.

Keywords: diabetic foot, gene polymorphism, vascular tone, platelet receptors, remodeling, prothrombotic factors
p. 549-557 of the original issue
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  8. Šeruga M, Kariž S, Makuc J, Završnik M, Cilenšek I, Gazdikova K, Caprnda M, Kruzliak P, Petrovič D. Endothelin-1 Gene Polymorphisms rs5370, rs1476046, and rs3087459 are not Associated with Diabetic Nephropathy in Caucasians with Type 2 Diabetes Mellitus. Folia Med (Plovdiv). 2017 Sep 1;59(3):261-69. doi: 10.1515/folmed-2017-0033
  9. Yakovleva EV, Konyashina NI, Gorgidze LA, Surin VL, Pshenichnikova OS, Polevodova OA, Spirin MV, Galstyan GM, Zozulya NI. Congenital factor V deficiency: case reports. Russian Journal of Hematology and Transfusiology. 2019;64(4):489–503. (In Russ.) doi: 10.35754/0234-5730-2019-64-4-489-503 (In Russ.)
  10. Bogatyreva KB, Azova MM, Aghajanyan AV, Leila V. Tskhovrebova LV, Ait AA, Shugushev ZKh. Association of the ITGB3 gene T1565C polymorphism with the development of atherosclerosis and in-stent restenosis in patients with stable coronary artery disease. Nauchnye Rezul’taty Biomed Issledovanii. 2018;4(4):3-9. doi: 10.18413/2313-8955 (In Russ.)
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  14. Moll S, Varga EA. Homocysteine and MTHFR Mutations. Circulation. 2015 Jul 7;132(1):e6-9. doi: 10.1161/CIRCULATIONAHA.114.013311
  15. Singh K, Agrawal NK, Gupta SK, Singh K. A functional single nucleotide polymorphism -1562C>T in the matrix metalloproteinase-9 promoter is associated with type 2 diabetes and diabetic foot ulcers. Int J Low Extrem Wounds. 2013 Sep;12(3):199-204. doi: 10.1177/1534734613493289
  16. Bitsadze VO. Samburova NV, Makatsanya NA. Mishchenko AL. Folate deficiency in obstetrics and the problem of its correction. Akusherstvo Ginekologiia i Reproduktsiia. 2016;10(1)1:38-48. doi: 10.17749/2313-7347.2015.10.1.038-048 (In Russ.)
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  18. Rusanov AV, Chumachenko IaD, Dubovik EI, Garbuzova VIu, Ataman AV. Analysis of the association between C936T VEGFA gene polymorphism and diabetic foot syndrome in the Ukrainian population. Research Results in Biomedicine. 2019;5(2):34-43. DOI: 10.18413/2658-6533-2019-5-2-0-4 (In Russ.).
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Address for correspondence:
672000, Russian Federation,
Chita, Gorkii Str., 39à,
Chita State Medical Academy,
Department of Hospital Surgery,
tel.: +7 924 38045 38,
e-mail: troicachita@mail.ru,
Troitskaya Natalia I.
Information about the authors:
Troitskaya Natalia I., PhD, Assistant of the Department of Hospital Surgery, Chita State Medical Academy, Chita, Russian Federation.
https://orcid.org/0000-0002-8973-753X
Shapovalov Konstantin G., MD, Professor, Head of the Department of Anesthesiology, Resuscitation and Intensive Care, Chita State Medical Academy, Chita, Russian Federation.
https://orcid.org/ 0000-0002-3485-5176
Mudrov Viktor A., PhD, Associate Professor of the Department of Obstetrics and Gynecology of the Medical and Dental Faculties, Chita State Medical Academy, Chita, Russian Federation.
https://orcid.org/0000-0002-5961-5400

N.V. LEBEDEV 1, S. B. AGRBA 2, V.S. POPOV 1, A.E. KLIMOV 1, G.T. SVANADZE 1

PROGNOSIS FOR SECONDARY PERITONITIS OUTCOME

Peoples’ Friendship University of Russia (RUDN University),
Burdenko National Medical Research Center of Neurosurgery, Moscow,
The Russian Federation

Objectives. To develop a new system for predicting the outcome of secondary peritonitis and analyze its accuracy in comparison with the most common analogous systems.
Methods. The study is based on the analysis of treatment results in patients (n=352) with secondary peritonitis. At admission sepsis was diagnosed in 15 (4.3%) patients, septic shock – in 4 (1.1%) persons. There were the following main causes of death in the mortality structure: purulent intoxication and/or sepsis – 51 cases (87.9%), cancer intoxication – 4 (6.9%) cases, acute cardiovascular failure – 3 cases (5.2%). The efficacy of the Mantheim Peritoneal Index (MPI), WSES prognostic score, APACHE-II scale, gSOFA score and Peritonitis Prediction System (PPS) developed by the authors were analyzed. The likelihood of the effect of 85 clinical and laboratory parameters on the outcome of patients with secondary peritonitis using nonparametric methods of statistical research (Fisher’s test, Mann-Whitney test, Chi-square with Yates correction) have been analyzed. Criteria predictively associated with lethal outcome (p <0.05) were selected, they were included in the PPS scale. To compare the predictive value of peritonitis prediction systems, ROC analysis was used with the construction of ROC curves for each of the systems.
Results. The most important criteria in predicting fatal outcome are the patient’s age, the presence of malignant tumor, the exudate nature, sepsis (septic shock), and also polyorganic insufficiency which is not associated with developed peritonitis. To assess the prognostic value of peritonitis prediction systems, ROC curve analysis was used. The greatest accuracy in terms of predicting mortality in patients with generalized secondary peritonitis is possessed by PPS (AUC 0.942), minimal – APACHEII (AUC 0.840).
Conclusion. APACHEII, MPI, WSESSSS and PPS systems can be considered as reliable in predicting mortality in patients with peritonitis. The greatest accuracy in predicting fatal outcome in patients with generalized secondary peritonitis had PPS (94%).

Keywords: peritonitis, abdominal sepsis, multiple organ dysfunction, prognosis
p. 558-564 of the original issue
References
  1. Tolonen M, Coccolini F, Ansaloni L, Sartelli M, Roberts DJ, McKee JL, Leppaniemi A, Doig CJ, Catena F, Fabian T, Jenne CN, Chiara O, Kubes P, Kluger Y, Fraga GP, Pereira BM, Diaz JJ, Sugrue M, Moore EE, Ren J, Ball CG, Coimbra R, Dixon E, Biffl W, MacLean A, McBeth PB, Posadas-Calleja JG, Di Saverio S, Xiao J, Kirkpatrick AW. Getting the invite list right: a discussion of sepsis severity scoring systems in severe complicated intra-abdominal sepsis and randomized trial inclusion criteria. World J Emerg Surg. 2018 Apr;13(1):1-11. doi: 10.1186/s13017-018-0177-2. eCollection 2018.
  2. Sartelli M, Catena F, Abu-Zidan FM, Ansaloni L, Biffl WL, Boermeester MA, Ceresoli M, Chiara O, Coccolini F, De Waele JJ, Di Saverio S, Eckmann C, Fraga G, Giannella M, Girardis M, Griffiths EA, Kashuk JL, Kirkpatrick A, Khokha V, Kluger Y, Labricciosa FM, Leppäniemi A, Vitt Maier R, May AK, Malangoni M, Martin-Loeches I, Mazuski JE, Montravers P, Peitzman A, Tavares Pereira BM, Reis T, Sakakushev B, Sganga G, Soreide K, Sugrue M, Ulrych J, Vincent J-L, Viale P, Moore EE. Management of intra-abdominal infections: recommendations by the WSES 2016 consensus conference. World J Emerg Surg. 2017;12(1):2-31. doi: 10.1186/s13017-017-0132-7
  3. Tolonen M, Sallinen V, Mentula P, Leppäniemi A. Preoperative prognostic factors for severe diffuse secondary peritonitis: a retrospective study. Langenbecks Arch Surg. 2016 Aug;401(5):611-17. doi: 10.1007/s00423-016-1454-8
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  5. Kirkpatrick AW, Coccolini F, Ansaloni L, Roberts DJ, Tolonen M, McKee JL, Leppaniemi A, Faris P, Doig CJ, Catena F, Fabian T, Jenne CN, Chiara O, Kubes P, Manns B, Kluger Y, Fraga GP, Pereira BM, Diaz JJ, Sugrue M, Moore EE, Ren J, Ball CG, Coimbra R, Balogh ZJ, Abu-Zidan FM, Dixon E, Biffl W, MacLean A, Ball I, Drover J, McBeth PB, Posadas-Calleja JG, Parry NG, Di Saverio S, Ordonez CA, Xiao J, Sartelli M; Closed Or Open after Laparotomy (COOL) after Source Control for Severe Complicated Intra-Abdominal Sepsis Investigators. Closed Or Open after Source Control Laparotomy for Severe Complicated Intra-Abdominal Sepsis (the COOL trial): study protocol for a randomized controlled trial. World J Emerg Surg. 2018 Jun 22;13:26. doi: 10.1186/s13017-018-0183-4. eCollection 2018.
  6. Savel’ev VS, Gel’fand BR. (red). Abdominal’naia khirurgicheskaia infektsiia. Natsional’nye rekomendatsii. Moscow, RF: Borges; 2011. 98 p. http://infectology.ucoz.ru/_ld/1/151-_.pdf (In Russ.)
  7. Linder MM, Wacha H, Feldmann U, Wesch G, Streifensand RA, Gundlach E. The Mannheim peritonitis index. An instrument for the intraoperative prognosis of peritonitis. Chirurg. 1987 Feb;58(2):84-92.
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Address for correspondence:
117198, Russian Federation,
Moscow, South-Western Administrative District,
Obruchevsky district, Miklukho-Maklay Str., 6, Peoples’ Friendship University of Russia ,
the Department of Faculty Surgery,
tel.: 8 917-598-9015,
e-mail: nickl55@mail.ru,
Lebedev Nikolay V.
Information about the authors:
Lebedev Nikolay V., MD, Professor, the Department of Faculty Surgery, Peoples’ Friendship University of Russia, Moscow, Russian Federation.
https://orcid.org/0000-0002-7745-1390
Agrba Sariya B., Post-Graduate Student, Burdenko National Medical Research Center of Neurosurgery, Moscow, Russian Federation.
https://orcid.org/0000-0003-1668-6409
Popov Vasily S., PhD, Assistant, the Department of Faculty Surgery, Peoples’ Friendship University of Russia, Moscow, Russian Federation.
https://orcid.org/0000-0001-7415-6794
Klimov Alexey E., MD, Professor, Head of the Department of Faculty Surgery. Peoples’ Friendship University of Russia, Moscow, Russian Federation.
https://orcid.org/0000-0002-0001-8003
Svanadze Giorgy T., Post-Graduate Student of the Department of Faculty Surgery, Peoples’ Friendship University of Russia, Moscow, Russian Federation.
https://orcid.org /0000-0002-5420-475X

PEDIATRIC SURGERY

R.V. ZHEZHERA

THE EFFECTIVENESS OF SPLENORENAL SHUNT IN TREATMENT OF PREHEPATIC PORTAL HYPERTENSION IN CHILDREN

Bogomolets National Medical University,
National Children’s Specialized Hospital “Okhmatdet”, Kiev,
Ukraine

Objective. To evaluate the results of treatment of prehepatic portal hypertension (PPH) in children by method of side-to-side splenorenal bypass.
Methods. A retrospective, monocentric analysis of 114 patients with prehepatic portal hypertension was carried out in the period from 2000 to 2018. The age of the patients was from 6 months up to 18 years, the average age 10,1±3,8 years (M±σ). All patients underwent side-to-side splenorenal shunt. In the postoperative period, on the 7th day, ultrasound examination of the abdominal organs with Doppler sonography (US) was performed to assess the volume of the spleen, the rate of portohepatic perfusion, the rate of blood flow along the side-to-side splenorenal shunt, as well as to assess its diameter. Control US was performed after the 1st, 3rd, 6th, 12th months; to assess the regression of esophageal and gastric varicose veins, the control esophagogastroduodenoscopy (EYD) was performed after 3rd , 6th, 12th months and then once a year. Subsequently, the control examination of the patients was carried out once a year. The follow-up was 2-18 years.
Results. Out of 114 patients who underwent side – to – side splenorenal shunt, 5 (4,4%) patients had recurrent bleeding from the esophageal variceal vein at the follow-up period (2-18 years). One patient had intra-abdominal arrosive bleeding from side-to-side splenorenal shunt provoked by severe postoperative pancreatitis. The average diameter of the shunt was 12±1.9 mm. The spleen volume decreased by 39.7±10.3%. Portohepatic perfusion reduced by 39% in comparison with the indicators before surgery. The blood flow rate along the side –to-side splenorenal shunt was 2403±557.3 ml/min. in 95,4% of patients the regression of variceal vein was noted. Hypersplenism syndrome was arrested in 73.6% of children.
Conclusion. Side -to- side splenorenal shunt is considered to be an effective method of portal decompression with the effectiveness in preventing both esophageal and gastric variceal veins bleeding in 95,4% of patients.

Keywords: portal hypertension, prehepatic type, splenorenal bypass, children, variceal veins, gastrointestinal bleeding
p. 565-572 of the original issue
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Address for correspondence:
01135, Ukraine,
Kiev, st. V. Chornovol 28/1,
National Children’s Specialized Hospital “Okhmatdet”,
Department of Urgent Surgery,
tel.: +38 067 270-93-23,
e-mail: roman.zhezhera83@gmail.com,
Zhezhera Roman V.
Information about the authors:
Zhezhera Roman V., Graduate Student of the Department of Pediatric Surgery, Bogomolets National Medical University, Pediatric Surgeon of the Department of Urgent Surgery, National Children’s Specialized Hospital “Okchmatdet”.
https://orcid.org/0000-0003-3000-0821

M.G. MELNYCHENKO, A.A. KVASHNINA, P.B. ANTONENKO, K.A.ANTONENKO

PREDICTING THE RISK OF DEVELOPING ABDOMINAL ADHESIONS IN CHILDREN DEPENDING ON ACETYLATION GENOTYPE

Odessa National Medical University, Odessa,
Ukraine

Objective. To determine the predictive value of the genetic polymorphism of the N-arylacetyltransferase-2 (NAT-2) gene for assessing the risk of postoperative adhesive intestinal obstruction in children.
Methods. In all children (36 children with adhesive intestinal obstruction (main group) and 35 planned patients (comparative group)) the acetylation genotype was studied by detecting point mutations of the NAT-2 gene using allele-specific amplification method with analysis of a polymerase chain reaction-restriction fragment length polymorphism.
Results. The study of the frequency of mutations at position 481 revealed the greatest diversity of the studied variants of genotypes: 33.3% of the children of the main group were homozygous for the wild-type gene, 44.4% were heterozygotes, 22.2% of patients had a homozygous mutant gene. According to the NAT-2 * 6A genotype (G 590 – A), the majority of patients (55.6%) were heterozygotes, 44.4% were homozygotes with the wild-type of the gene. Not a single case of mutation at position 857 has been identified. Among the children of the main group, the share of «fast» acetylators was 69.4%, in the comparison group – 40.0% (χ2=6.215; p=0.013). The development of postoperative adhesive intestinal obstruction in children with the “fast” acetylation genotype occurred in the absence of clinical and anamnestic risk factors and was characterized by a greater severity and prevalence of intra-abdominal adhesive process (PAI was (14.8±1.8) and (8.1±2.4 ), respectively).
Conclusion. The risk of developing postoperative adhesive complications in children can be done preventively by determining the genetic polymorphism of the N-acetyltransferase-2 gene. The risk group for developing adhesive intestinal obstruction is made up of children who are the carriers of NAT-2 alleles and correspond to the genotype of «fast» and «moderate» acetylation. Children who are «fast» acetylators have a more pronounced intra-abdominal adhesion process and a higher risk of complications associated with excessive adhesion even in the absence of other risk factors.

Keywords: adhesive obstruction, adhesions, genetic polymorphism, acetylation genotype, prediction
p. 573-580 of the original issue
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Address for correspondence:
65000, Ukraine,
Odessa, Valikhovsky Lane, 2,
Odessa National Medical University,
Pediatric Surgery Department,
tel. +38050 197-61-85,
e-mail: marina_gm@i.ua,
Melnychenko Maryna G.
Information about the authors:
Melnychenko Maryna G., MD, Professor of the Pediatric Surgery Department, Odessa National Medical University, Odessa, Ukraine.
https://orcid.org/0000-0001-9066-4801
Kvashnina Anastasiia A., Postgraduate Student of the Pediatric Surgery Department, Odessa National Medical University, Odessa, Ukraine.
https://orcid.org/0000-0003-3704-2047
Antonenko Petr B., MD, Professor of the Department of Pharmacology and Pharmacognosy, Odessa National Medical University, Odessa, Ukraine.
https://orcid.org/0000-0002-9697-1615
Antonenko Kateryna A, PhD, Assistant of the Department of Pharmacology and Pharmacognosy, Odessa National Medical University, Odessa, Ukraine.
https://orcid.org/0000-0001-9707-3676

TRAUMATOLOGY AND ORTHOPEDICS

O.O. KOSTRUB 1, IU.V. POLIACHENKO 1, M.A. GERASIMENKO 2, V.V. KOTIUK 1, R.I. BLONSKII 1, V.B. MAZEVYCH 1, N.S. VADZYUK 1

ANTEROLATERAL LIGAMENT AS ROTATION STABILISER OF KNEE- JOINT. THE ROLE OF MRT AND ULTRASONOGRAPHY IN UNDERSTANDING ITS ANATOMY AND IN SELECTING SURGICAL TREATMENT STRATEGY FOR ITS INJURIES

Institute of Traumatology and Orthopedics of NAMS of Ukraine 1, Kiev, Ukraine
Republican Scientific and Practical Center of Traumatology and Orthopedics 2, Minsk
The Republic of Belarus

Objective. To assess the variability of the anterolateral ligament according to MRT and ultrasonography data and to coordinate it with surgical treatment strategy for its injuries.
Methods. The anterolateral ligament was analyzed on 100 series of MRI images of knee joints without traumatic pathology on Philips Achieva 1.5 T tomograph using the standard research protocol in three mutually perpendicular planes and 150 series of MRT images of knee joints with injuries and without injuries of the anterolateral ligament obtained on different tomographs from 0.2 to 3 Tesla. The quality of visualization of anterolateral ligament separate portions, the number of layers, and the contact with the joint capsule were evaluated. Both knee joints were analyzed by ultrasonography in 30 patients with anterior cruciate ligament injuries of one of the knee-joint and in 30 patients with intact knee-joints.
Results. During the studies in the identification of anterolateral ligament with magnetic resonance tomography (MRT 1.5T) it was revealed at least partially in 92% of cases (in 68% as a two-layer structure; in 24% as a single-layer structure; in 14% as a thickening of the capsule or in 10% as a separate extracapsular structure), ultrasound examination – in 100% (the structure was not determined, however, in 26.67% of patients without clinically pronounced pathology of the knee-joint and significant trauma in anamnesis ultrasound scan revealed a violation of the integrity of the cortical layer at the tibial attachment site),
Conclusion. According to MRT and ultrasonography data, the anterolateral ligament is a constant structure of the knee-joint, but very variable in its anatomical parameters, which in some cases may be poorly visualized on MRT, may have a two-layer structure, may be located either extracapsular or as a thickening of the knee-joint capsule. The variability of its anatomical structure makes it impossible to make the theoretical substantiation of the advantages of one separate method of its restoration, but, on the contrary, justifies a differentiated approach to the selection of optimal surgical treatment.

Keywords: anterolateral ligament, anterolateral complex, knee joint, rotational instability, MRT, ultrasonography, surgical treatment
p. 581-589 of the original issue
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Address for correspondence:
01601 Ukraine,
Kiev, Bulvarno-Kudryavskaya Str., 27,
Institute of Traumatology and Orthopedics,
the Department of Sports and Ballet Trauma
of NAMS of Ukraine,
tel. +38(068)321 42 87.
e-mail: kotyuk_v@ukr.net
Kotiuk Viktor V.
Information about the authors:
Kostrub Oleksandr O., MD, Professor, Head of the Department of Sports and Ballet Trauma, Institute of Traumatology and Orthopedics of NAMS of Ukraine, Kiev, Ukraine.
https://orcid.org/0000-0001-7925-9362
Poliachenko Iurii V., MD, Professor, Acting Director of Institute of Traumatology and Orthopedics of NAMS of Ukraine, Kiev, Ukraine
https://orcid.org/0000-0003-1814-4240
Gerasimenko Mikhail A., MD, Professor, Director of Republican Scientific and Practical Center of Traumatology and Orthopedics, Minsk, Republic of Belarus
https://orcid.org/0000-0003-2270-1193
Kotiuk Viktor V., PhD, Senior Researcher of the Department of Sports and Ballet Trauma, Institute of Traumatology and Orthopedics of NAMS of Ukraine, Kiev, Ukraine.
https://orcid.org/0000-0001-8837-8603
Blonskii Roman I., MD, Leading Researcher of the Department of Sports and Ballet Trauma, Institute of Traumatology and Orthopedics of NAMS of Ukraine, Kiev, Ukraine.
https://orcid.org/0000-0003-2310-6345
Mazevych Vadym B., Researcher of the Diagnostics Department, Institute of Traumatology and Orthopedics of NAMS of Ukraine, Kiev, Ukraine.
https://orcid.org/0000-0002-3617-5043
Vadzyuk Nazar S., PhD, Senior Researcher of the Department of Sports and Ballet Trauma, Institute of Traumatology and Orthopedics of NAMS of Ukraine, Kiev, Ukraine.
https://orcid.org/0000-0002-3398-1285

ANESTHESIOLOGY-REANIMATOLOGY

K.V. BODYAKOV, A.V. MAROCHKOV, A.S. KYLIK, V.A. DUDKO, A.L. LIPNITSKI

SPECIFICITY OF USING TRANEXAMIC ACID IN PATIENTS WITH CARDIAC SURGERY

Mogilev Regional Hospital, Mogivev,
The Republic of Belarus

Objective. To evaluate the efficacy of tranexamic acid (ÒÀ) in cardiac surgery patients undergoing the open-heart surgery under conditions of artificial blood circulation (ÀBC) by determining the volume of perioperative blood loss using the hemoglobin balance method.
Methods. A pilot non-randomized prospective clinical trial was conducted. To determine the effectiveness of TÀ use, 2 groups of patients were formed: the 1st group, without TÀ application (n=40), the 2nd group – with TÀ application intraoperatively (n=40). In group 2, prior to sternotomy, intravenous bolus injection of TA (1000 mg (20 ml of 5% solution)) was performed and further titration of TA through a syringe dispenser was continued at a rate of 4 ml/hour (200 mg/hour) until the end of the operation.The volume of intraoperative blood-loss was assessed by the hemoglobin balance method. A special protocol was developed to control the volume of postoperative blood loss.
Results. The volume of circulating blood (VCB) calculated by Nadler’s formula for the first group was 5433.2 (5008.5; 5768.2) ml, for the second – 5214.0 (4944.1; 5546.8) ml. In the first group of patients who did not receive TA during open- heart surgery, the volume of blood loss was 1460.6 (1196.8; 1725.8) ml or 26.9 % of the average circulating blood volume (CBV), and in the second group of patients who received TA intraoperatively – 1090.7 (882.3; 1468.6) ml or 20.9% of the CBV (p<0,001).
Conclusion. The application of TÀ in cardiac surgery patients during open-heart surgery with ABC according to the developed algorithm (1000 mg/bolus, titration during surgery-200 mg/h) for the purpose of blood saving the volume of blood-loss was reduced by 25.3% compared to the control group.

Keywords: cardiac surgery, tranexamic acid, blood loss, hemoglobin balance, extracorporeal circulation
p. 590-597 of the original issue
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Address for correspondence:
212016, Republic of Belarus,
Mogilev, Belynitskogii-Biruli Str.,
Mogilev Regional Hospital, Intensive Care
Unit of the Center of Cardiovascular Surgery,
tel/fax +375 222 62-90-75,
e-mail: kirill_bodyakov@mail.ru,
Bodyakov Kirill V.
Information about the authors:
Bodyakov Kirill V., Anaesthesiologist of the Intensive Care Unit of the Center of Cardiovascular Surgery, Mogilev Regional Hospital, Mogilev, Republic of Belarus.
https://orcid.org/0000-0003-4639-4079
Marochkov Alexey V., MD, Professor, Anaesthesiologist of the Intensive Care Unit, Mogilev Regional Hospital, Mogilev, Republic of Belarus.
https://orcid.org/0000-0001-5092-8315
Kylik Anatoly S., Cardiac Surgeon, Head Physician, Mogilev Regional Hospital, Mogilev, Republic of Belarus.
https://orcid.org/0000-0001-6663-3802
Dudko Vladimir A., Head of the Intensive Care Unit of the Center of Cardiovascular Surgery, Mogilev Regional Hospital, Mogilev, Republic of Belarus.
https://orcid.org/0000-0002-5959-5454
Lipnitski Artur L., PhD, Head of the Department for Coordinating the Collection of Organs and Tissues for Transplantation, Mogilev Regional Hospital, Mogilev, Republic of Belarus.
https://orcid.org/0000-0002-2556-4801

REVIEWS

K.V. NIKITSINA 1, G.V. ILUKEVICH 2

MULTIPLE ORGAN DYSFUNCTION SYNDROME IN ACUTE NECROTIZING PANCREATITIS

Vitebsk State Medical University 1,Vitebsk,
Belarusian Medical Academy of Postgraduate Education 2, Minsk
The Republic of Belarus

Acute necrotizing pancreatitis (ANP) is associated with significantly higher morbidity and mortality. It is still difficult for the surgeon to choose and schedule the most appropriate treatment. In the early phase of the disease, surgical activity is considered to be ineffective and is associated with high risks. The only chance to save the patient is to conduct the intensive therapy in the intensive care unit, based on current pathogenetic approaches. The present review analyzed the current understanding of the pathogenesis of multiple organ dysfunction syndrome (MODS) in acute necrotizing pancreatitis. Òhe role of inflammatory mediators, cytokines, biogenic amines, bradykinins, and lipid peroxidation products in the development of organ hypoperfusion is reflected. It is shown that the violation of the intestinal barrier function with the translocation of microorganisms exacerbates endogenous intoxication and contributes to the development of MODS. The endothelial dysfunction that develops in acute necrotizing pancreatitis has a significant effect on hemostasis. The literature analysis revealed the contradictory data on the functional activity of the coagulation and anticoagulation systems at different stages of the disease. The mechanisms of development of intra-abdominal hypertension and its multisystem negative impact are reflected. There are still controversial question of appropriate timing and indications for surgical decompression.
The analysis of the available literature data showed the need for further study of the mechanisms of multiple organ dysfunction development in acute necrotizing pancreatitis to work out new pathogenetically justified methods of its intensive therapy with an assessment of their effectiveness.

Keywords: acute necrotizing pancreatitis, multiple organ failure, endogenous intoxication, systemic inflammatory reaction, intra-abdominal hypertension, changes in hemostasis
p. 598-606 of the original issue
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Address for correspondence:
210023, Republic of Belarus,
Vitebsk, Frunze Avenue, 27,
Vitebsk State Medical University,
the Department of Anesthesiology and Resuscitation with the Course of Advanced Training and Retraining
tel. mobilr: +375 (33) 316-10-25,
e-mail: katarinaanaest@gmail.com,
Nikitina Ekaterina V.
Information about the authors:
Nikitsina Katsiaryna V., PhD, Associate Professor, Head of the Department of Anesthesiology and Resuscitation with the Course of Advanced Training and Retraining, Vitebsk State Medical University, Vitebsk, Republic of Belarus.
https://orcid.org/0000-0003-4744-6838
Ilukevich Georgy V., MD, Professor, Head of the Department of Anesthesiology and Resuscitation, Belarusian Medical Academy of Postgraduate Education, Minsk, Republic of Belarus.
https://orcid.org/0000-0002-3474-621X

D.K. MUKHABBATOV, M.K. GULOV, S.G. ALI-ZADE, F.H. NOZIMOV

APPLICATION OF INTESTINAL AUTOTRANSPLANTATION IN TREATMENT OF SURGICAL DISEASES OF THE ABDOMINAL CAVITY

Avicenna Tajik State Medical University, Dushanbe,
The Republic of Tajikistan

This review is devoted to the relevance of the problem and the assessment of potential surgical indications, surgical methods and clinical results in the intestinal autotransplantation. Radical resection of the neoplasm is performed. Currently, the main indications for performing intestinal autotransplantation are considered neoplasms of the pancreas, mesenteric and retroperitoneal space with the involvement of the superior mesenteric vessels in the process. Preliminary results demonstrate that radical resection can be effective in carefully selected patients. Although perioperative morbidity and mortality are relatively high, the literature describes some cases with long patient survival, especially when performing radical resection of a benign tumor or a tumor of potential low malignant. However, early tumor recurrence remains a serious problem in patients with a high-grade tumor, especially with pancreatic ductal adenocarcinoma (PDAC). It should be noted that when using intestinal autotransplantation, it is possible to perform a radical resection of the organ in patients with separate neoplasms in the abdominal cavity and the involvement of the main mesenteric vessels in the process. However, this aggressive method is associated with significant operational risk and should be only performed in specialized centers. The additional combination therapies have to be developed to optimize the clinical outcome and prolong the survival of patients with pancreatic cancer.

Keywords: autologous transplantation, intestines, abdominal cavity, pancreatic cancer, mesenteric tumors
p. 607-616 of the original issue
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Address for correspondence:
734003, Republic of Tajikistan,
Dushanbe, Rudaki Avenue, 139.
Avicenna Tajik State Medical University,
the Department of Surgical Diseases No1,
tel.: +992 928-21-77-55,
e-mail: suhrob_a@mail.ru,
Ali-Zade Sukhrob G.
Information about the authors:
Mukhabbatov Dzhiyonkhon K., MD, Professor of the Department of General Surgery No1, Avicenna Tajik State Medical University, Dushanbe, Republic of Tajikistan.
https://0000-0002-2100-310X
Gulov Makhmadshokh K., MD, Professor of the Department of General Surgery No1, Avicenna Tajik State Medical University, Dushanbe, Republic of Tajikistan.
https://0000-0001-5151-937X
Ali-Zade Sukhrob G., PhD, Associate Professor of the Department of Surgical Diseases No1, Avicenna Tajik State Medical University, Dushanbe, Republic of Tajikistan.
https://0000-0002-2456-7509
Nozimov Farkhod H., PhD, Assistant of the Department of General Surgery No1, Avicenna Tajik State Medical University, Dushanbe, Republic of Tajikistan.
https://0000-0001-5428-1811

K.F. CHERNOUSOV, R.V. KARPOVA, K.S. RUSSKOVA

SURGICAL OPTIONS FOR NONPARASITIC SPLENIC CYSTS

I.M. Sechenov First Moscow State Medical University, Moscow,
The Russian Federation

Nonparasitic splenic cysts (NPSCs) are uncommon lesions of the spleen, clinically, they may be asymptomatic. Their classification includes two basic groups: the true cysts or primary cysts and false or pseudo cysts based on the presence or absence of an epithelial lining. The need for surgery of nonparasitic cysts is due to the development of complications: suppuration, hemorrhage into the cavity of the cyst and its rupture. Historically, the conventional surgical method was splenectomy, however, complete removal of the organ, especially at a young age, often led to life-threatening infectious complications. Spleen-preserving surgery is considered to be an alternative to classical splenectomy: partial resection of the spleen and fenestration with excision of extra-hepatic cyst wall. However, as clinical practice has shown, these methods can be effectively used exclusively for the treatment of superficial cysts, and during the operation the ruptures of the capsule of the pathological focus with bleeding are observed. According to the general tendency in surgery to reduce the traumatization all patients were worked up with an ultrasound and X-Ray examination of the abdomen to look for the size and location of the splenic cysts. These operations include: drainage with sclerosing of the cyst and deepithelialization with superselective arterial embolization of the feeding vascular pedicle of the pathological focus. The study of these techniques revealed their weak points: the recurrence rate of cysts after sclerosis was 30-50%, and the use of embolizing agents in 50% of cases is complicated by ischemia of an organ segment with possible formation of an infarction zone in the early postoperative period. Nowadays the most promising method is considered to be a microwave ablation. Its thermal effect creates coagulation necrosis of the pathological focus and surrounding tissues with minimal toxic effects. This approach decidedly requires further research.

Keywords: splenic cyst, splenectomy, navigational surgery, percutaneous puncture, artery embolization, microwave ablation
p. 617-623 of the original issue
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Address for correspondence:
119435, Russian Federation,
Moscow, Bolshaya Pirogovskaya str., 6-1,
I.M. Sechenov First Moscow State Medical University,
the Department of Faculty Surgery No1,
tel. +7 916 478-37-65,
e-mail: kirill_chernousov@bk.ru,
Chernousov Kirill F.
Information about the authors:
Karpova Radmila V., MD, Professor of the Department of Faculty Surgery No1, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
https://orcid.org/0000-0003-0608-9846
Chernousov Kirill F., Post-Graduate Student, the Department of Faculty Surgery No1, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
https://orcid.org/0000-0002-1751-4601
Russkova Ksenia S., a 6th-Year Student, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
https://orcid.org/0000-0003-2150-7567

CASE REPORTS

S.A. PLAKSIN

CYSTIC PULMONARY HAMARTOMA MANIFESTING AS SPONTANEOUS PNEUMOTHORAX

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

Cystic hamartoma refers to rare benign lung tumors. The literature describes 17 cases of this disease. The tumor may look like multiple bilateral cysts or a solitary single-chamber or multi-chamber cyst of a large size, which makes it difficult to diagnose. The disease can be complicated by spontaneous pneumothorax. The cyst itself often looks like a pneumothorax. An observation of a 52-year-old man complaining of chest pain and shortness of breath is presents. On the x-ray, the left lung is compressed with air, which is regarded as a spontaneous pneumothorax. Two-day drainage did not give any results. The video-assisted thoracoscopic surgery technique was performed and a large air cyst was detected. A conversion to a thoracotomy was made. A cyst of 20×15 cm size originated from the lower lobe, the lung was in atelectasis. Cyst resection and lung decortication were performed. Histological examination of the cyst wall revealed a hamartoma of the lung. The postoperative period was uneventful. Differential diagnosis of cystic hamartoma is conducting with lymphangioleiomyomatosis, air cysts, extrapulmonary sequestration, echinococcal cysts, and lung cancer. Indications for surgery are the following: chest pain, shortness of breath, pneumothorax, and hemoptysis. In a unilateral process, a cyst resection or lobectomy have to be performed. Cystic pulmonary hamartoma should be included in the differential diagnostic range in patients with recurrent spontaneous pneumothorax, hemoptysis, single and multiple lung cysts. It is impossible to determine the diagnosis without a biopsy and histological examination.

Keywords: cystic lung hamartoma, spontaneous pneumothorax, air lung cyst, benign lung tumors, videothoracoscopy
p. 624-628 of the original issue
References
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Address for correspondence:
614990, Russian Federation,
Perm, Petropavlovskaya Str., 26,
E.A. Vagner Perm State Medical University,
the Surgery Department with the Course
of Cardiovascular Surgery
and Interventional Cardiology
tel. +7 342 239-29-72,
e-mail: splaksin@mail.ru,
Plaksin Sergei A.
Information about the authors:
Plaksin Sergei A., MD, Professor of the Surgery Department with the Course of Cardiovascular Surgery and Interventional Cardiology
E.A.Vagner Perm State Medical University, Perm, Russian Federation.
http://orcid.org/0000-0001-8108-1655

D.K. GUSCHIN, S.S. VOLKOV, A.V. SHCHERBAK, M.M. ZELENIKIN

EFFECTIVE CORRECTION OF THE COMMON ATRIOVENTRICULAR CANAL WITH TETRALOGY OF FALLOT AND HYPOPLASIA OF THE RIGHT VENTRICLE IN A CHILD

A.N. Bakoulev National Medical Research Center for Cardiovascular Surgery of the Ministry of Health of the Russian Federation, Moscow,
The Russian Federation

The paper presents a description of a case of successful one and a half ventricular correction of a complex congenital cardiac anomalies, including the common atrioventricular canal, tetralogy of Fallot, and hypoplasia of the right ventricle in a child (2 year and 4 months). A rare congenital anomaly characterized by a combination of intracardiac defects, required an innovative surgical approach, the exclusivity of this clinical case has determined.
The surgical strategy of complete atrioventricular canal defect is determined by a number of factors. One of the most important is balance between right and left ventricular outputs. The balanced type with adequate development of the ventricles involves the biventricular repair performance. Unbalanced atrioventricular canal defects include a hypoplastic ventricle. Reconstructive surgery for one hypoplastic ventricle is oriented towards the degree of hypoplasia. In particular, a mild right ventricular hypoplasia allows perfoming biventricular radical operation while a severe degree suggests univentricular repair. In case of borderline, moderate degree of hypoplastic right ventricle the one and half ventricle repair can be carried out. Another important point is the presence of concomitant pulmonic stenosis required the choice of optimal method and material for reconstruction which is not always obvious and often it is the subject of debates. This report presents a description of the diagnostic stages with an emphasis on determining the type of balance of the common atrioventricular canal, the degree of hypoplasia of the right ventricle, the approach to choosing the optimal method for correcting the defect in general and the material for reconstructing the outflow pathway from the right ventricle in particular, as well as the subsequent successful correction of congenital multicomponent cardiac abnormalities in a young patient.

Keywords: young children, complete atrioventricular canal defect, tetralogy of Fallot, one and half ventricle repair, pulmonary allograft
p. 629-635 of the original issue
References
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Address for correspondence:
121552, The Russian Federation,
Moscow, Rublevskoe Highway, 135,
A.N. Bakoulev National Medical
Research Center for Cardiovascular Surgery,
Surgery Department of Young Children
With Congenital Heart Diseases,
Tel. mobile: +79260310316,
e-mail: medikum@inbox.ru,
Dmitry K. Guschin
Information about the authors:
Guschin Dmitriy K., Researcher, Cardiovascular Surgeon of the Department of Congenital Heart Diseases Surgery in Young Children, À.N. Bakoulev National Medical Research Center for Cardiovascular Surgery of the Ministry of Health of the Russian Federation, Moscow, the Russian Federation.
http://orcid.org/0000-0002-0925-6526.
Volkov Sergey S., PhD, Senior Researcher, Cardiovascular Surgeon of the Department of Congenital Heart Diseases Surgery in Young Children, À.N. Bakoulev National Medical Research Center for Cardiovascular Surgery of the Ministry of Health of the Russian Federation, Moscow, the Russian Federation.
http://orcid.org/0000-0003-2005-4957.
Shcherbak Anastasia V., Cardiovascular Surgeon of the Department of Congenital Heart Diseases Surgery in Young Children, À.N. Bakoulev National Medical Research Center for Cardiovascular Surgery of the Ministry of Health of the Russian Federation, Moscow, the Russian Federation.
http://orcid.org/0000-0002-0723-9028.
Zelenikin Mikhail M., MD, Professor, Chief of the Department of Congenital Heart Diseases Surgery in Young Children,À.N. Bakoulev National Medical Research Center for Cardiovascular Surgery of the Ministry of Health of the Russian Federation, Moscow, the Russian Federation. http://orcid.org/0000-0002-1298-2940.
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