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Khirurgii

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Year 2015 Vol. 23 No 6

SCIENTIFIC PUBLICATIONS
EXPERIMENTAL SURGERY

A.V. BURAVSKY, E.V. BARANOV, S.I. TRETYAK, M.K. NEDZVED

EVALUATION OF EFFECT OF LOCAL LIGHT-EMITTING DIODE PHOTOTHERAPY ON EXPERIMENTAL WOUNDS

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

Objectives. To evaluate the effects of local light-emitting diode phototherapy (LED) on experimental wounds.
Methods. The study was performed on 102 white inbred rats with experimental purulent (Staphylococcus aureus, Pseudomonas aeruginosa) wounds (6 subgroups with 17 animals in each). The rats in both control subgroups were not treated. Systemic antibiotic therapy was applied in the first and second subgroups of the main group; in the subgroups three and four of the main group (without antibiotic therapy) the local LED phototherapy were used sequentially: at first the antimicrobial photodynamic therapy with "Ointment Photolon" photosensitizer and emission wavelength λ1=(0,405±0,002) µm was applied, then the photoregulation by λ2=(0,630±0,03) µm was used. Conclusion about the impact of the local LED phototherapy on experimental wounds healing was made by comparing the results of visual observation, computer planimetry, histological and microbiological investigations in groups.
Results. The local application of unpolarized LED light λ1=(0,405±0,002) µm and medicinal agent «Ointment Photolon» led to the most significant reduction of the total wound microorganisms number in a short term, and the completion of the first phase of wound healing process by the seventh day of experiment. Stimulation of wound reparative processes was caused by local use of polarized LED phototherapy λ2=(0,630±0,03) µm after the inflammatory phase; this results in the activation of growth and maturation of granulation tissue formation as well as intensification of the epithelialization occurred from the edges of the wound.
Conclusion. The use of the local LED phototherapy with the selected parameters, taking into account the phase of experimental wound healing process resulted in the term reduction of healing no less than 5 days in vivo. The obtained results are considered to use a guide intended to develop treatment methods for designing clinical practice.

Keywords: light-emitting diode radiation, phototherapy, photosensitizer, wound process, epithelialization, granulation tissue
p. 601-611 of the original issue
References
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  3. Ishchuk AV. Fotodinamicheskaia terapiia: istoriia razvitiia metoda i ego prakticheskoe primenenie v lechenii gnoinykh ran i troficheskikh iazv nizhnikh konechnostei [Photodynamic therapy: history of development of the method and its practical application in the treatment of purulent wounds and trophic ulcers of the lower extremities]. Med Zhurn. 2007;(4):120-25.
  4. Klebanov GI, Shuraeva NIu, Chichuk TV, Osipov AN, Rudenko TG, Shekhter AB, Vladimirov IuA. Sravnitel'noe issledovanie deistviia lazernogo i svetodiodnogo izlucheniia na zazhivlenie ran i funktsional'nuiu aktivnost' kletok ranevogo ekssudata [A comparative study of the laser and the LED light on wound healing and the functional activity of the cells of the wound exudate]. Biofizika. 2005;50(6):1137-44.
  5. Whinfield AL, Aitkenhead I.The light revival: does phototherapy promote wound healing? A review. Foot (Edinb). 2009 Jun;19(2):117-24. doi: 10.1016/j.foot.2009.01.004.
  6. Dai T, Huang YY, Hamblin MR. Photodynamic therapy for localized infections – state of the art.Photodiagnosis Photodyn Ther. 2009 Sep–Dec; 6(3-4): 170-88. doi: 10.1016/j.pdpdt.2009.10.008
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  8. Stranadko EF, Kuleshov IIu, Karakhanov GI. Fotodinamicheskoe vozdeistvie na patogennye mikroorganizmy. Sovremennoe sostoianie problemy antimikrobnoi fotodinamicheskoi terapii [The photodynamic effect on pathogens. The current state of the problem of antimicrobial photodynamic therapy]. Lazer Meditsina. 2010;(2):52-56.
  9. Soyer T, Ayva S, Aliefendioğlu D, Aktuna Z, Aslan MK, Senyücel MF, Cakmak M.Effect of phototherapy on growth factor levels in neonatal rat skin. J Pediatr Surg. 2011 Nov;46(11):2128-31. doi: 10.1016/j.jpedsurg.2011.06.012.
  10. Yeh NG. Wu CH, Cheng TC. Light–emitting diodes – their potential in biomedical applications Renewable and Sustainable Energy Reviews. 2010; 14(8):2161-66. doi: 10.1016/j.rser.2010.02.015.
  11. Shumilin AG./red. Kompleks fototerapevticheskii Kalendula [Complex phototherapy Calendula]. Katalog vysokotekhnologichnykh tovarov RB. Minsk, RB: GU BelISA. 2014;(7):232.
  12. Shliakhtin SV, Trukhacheva TV. Vozmozhnosti i perspektivy ispol'zovaniia proizvodnykh khlorofilla dlia sozdaniia effektivnykh i bezopasnykh fotosensibilizatorov dlia fotodinamicheskoi terapii [Opportunities and prospects of chlorophyll derivatives to create safe and effective photosensitizers for photodynamic therapy]. Vestn Farmatsii. 2010;(2):87-106.
  13. Mbene AB, Houreld NN, Abrahamse H. DNA damage after phototherapy in wounded fibroblast cells irradiated with 16 J/cm(2). J Photochem Photobiol B. 2009 Feb 9;94(2):131-7. doi: 10.1016/j.jphotobiol.2008.11.002.
  14. Buravskii AV, Baranov EV, Tret'iak SI, Skorokhod GA, Slabko IN. Eksperimental'noe obosnovanie effektivnosti lokal'noi antimikrobnoi fotodinamicheskoi terapii (in vitro) [Experimental evaluation of the effectiveness of local antimicrobial photodynamic therapy (in vitro)]. Med Panorama. 2013;4(139):10-16.
  15. Buravskii AV, Baranov EV, Tret'iak SI, Kvacheva ZB, Vladimirskaia AM. Vliianie poliarizovannogo svetodiodnogo izlucheniia na mitoticheskuiu aktivnost' kul'tivirovannykh fibroblastov kozhi krysy [Effect of polarized LED light on mitotic activity of cultured skin fibroblasts of rat]. Med Panorama. 2014;4(148):24-28.
Address for correspondence:
220116, Republic of Belarus,
Minsk, pr. Dzerzhinskogo, d. 83,
UO "Belorusskiy gosudarstvennyiy
meditsinskiy universitet",
2-ya kafedra hirurgicheskih bolezney,
tel. mob. 375 29 622-57-81,
e-mail: buravskyav@mail.ru,
Buravsky Aleksandr Vladimirovich
Information about the authors:
Buravsky A.V. An assistant of the 2nd chair of surgical diseases of EE "Belarusian State Medical University".
Baranov E.V. PhD, an associate professor of the 2nd chair of surgical diseases of EE "Belarusian State Medical University".
Tretyak S.I. A Corresponding Member of the NAS of Belarus, Minsk, Belarus, MD, professor, a head of the 2nd chair of surgical diseases of EE "Belarusian State Medical University".
Nedzved M.K. MD, professor of the pathological anatomy chair of EE "Belarusian State Medical University"

V.V. BESCHASNOV 1, S.G. IZMAYLOV1, M.V. BAGRYANTSEV 1, N.Y. ORLINSKAYA 1, Å.Å. LUKOYANYCHEV 1, À.À. MIRONOV 1,2

ACTIVITY OF REPARATIVE REGENERATIVE PROCESSES IN TERMS OF LOCAL PERIWOUND CIRCULATORY HYPOXIA

SBEE HPE "Nizny Novgorod State Medical Academy" 1,
FSAEE HE "Nizhy Novgorod State University Named after N.I. Lobachevsky" 2,
The Russian Federation

Objectives. To study the impact of local circulatory compensated hypoxia, occurring in the extensible flap in skin extension on the activity of the reparative regenerative processes in the area surrounding the wound.
Methods. The experiment was carried out on 18 white outbred rats. An oval skin wound was made in the upper part of the animals’ back. In the study group the skin of periwound area was being stretched by means of special device during 5 days; in the control group all wounds were well healed with no case of any external factors. The condition of the skin edges in the extension area was controlled by laser Doppler flowmetry: microcirculation index was reduced by no more than 50% from the original one. Activity of tissue regeneration was monitored by immunohistochemical studies of the granulation tissue from the expetrimental wound and extensible skin.
Results. An increased proliferative activity of the cells was registered in the granulation tissue in the primary defect zone in the skin extension of the periwound area compared to the control: after 3 days of skin stretching the percent of Ki-67-immunopositive cells was 57% (51; 60), and in the control group – 34% (30; 42) (p=0,016) in the granulation tissue of the wound defect of the study group. On the 5th day of modeling of local circulatory hypoxia the statistically significant differences remained on the basis of this criterion – 61% (55; 66) in the study group, compared to 42% (39; 50) in the control group (p=0,032). The statistically significant differences between the activity of regenerative hypertrophic processes have been revealed in the immunohistochemical analysis of tissue samples of the extensible flap in the study and control groups.
Conclusion. Local compensated hypoxia of the periwound area stimulates proliferative processes not only in the extensible flap, but also in the area of the primary wound defect. The obtained new data essentially specify effect of hypoxia on the body contributing the search of methods to control the degree of hypoxia in the extensible flap and new surgical methods affected on the process of regenerative hypertrophy.

Keywords: hypoxia, wound, skin, stretching, proliferative processes, regeneration, hypertrophy
p. 612-618 of the original issue
References
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  2. Yıldırım AO, Eryılmaz M, Kaldırıım U, Eyi YE, Tuncer SK, Eroğlu M, Durusu M, Topal T, Kurt B, Dilmen S, Bilgiç S, Serdar M. Effectiveness of hyperbaric oxygen and ozone applications in tissue healing in generated soft tissue trauma model in rats: an experimental study. Ulus Travma Acil Cerrahi Derg. 2014 May;20(3):167-75. doi: 10.5505/tjtes.2014.09465.
  3. Lokmic Z, Musyoka J, Hewitson TD, Darby IA. Hypoxia and hypoxia signaling in tissue repair and fibrosis. International review of cell and molecular biology. 2012;(296):139-85. doi: 10.1016/B978-0-12-394307-1.00003-5.
  4. Krock BL, Skuli N, Simon MC. Hypoxia-induced angiogenesis: good and evil Hypoxia-induced angiogenesis: good and evil. Cancer 2011 Dec;2(12):1117-33.
  5. Asmis R, Qiao M, Zhao Q.Low flow oxygenation of full-excisional skin wounds on diabetic mice improves wound healing by accelerating wound closure and reepithelialization. Int Wound J. 2010 Oct;7(5):349-57. doi: 10.1111/j.1742-481X.2010.00716.x.
  6. Rusakov VI. Reguliatsiia vospaleniia i regeneratsii v khirurgii [Regulation of inflammation and regeneration in Surgery]. Tashkent, Uzbekistan: Meditsinazh; 1970. 376 p.
  7. Sano H, Ichioka S, Sekiya N. Influence of oxygen on wound healing dynamics: assessment in a novel wound mouse model under a variable oxygen environment. PLoS ONE 7(11): e50212. DOI:10.1371/journal.pone.0050212.
  8. Semenza GL, Wang GL. A nuclear factor induced by hypoxia via de novo protein synthesis binds to the human erythropoietin gene enhancer at a site required for transcriptional activation. J of mol cell biology. 1992; (12)12:5447-54.
  9. Ruas JL, Lendahl U, Poellinger L. Modulation of vascular gene expression by hypoxia. Current Opinion in Lipidology. 2007Oct;18(5):508-14.
    doi: 10.1097/MOL.0b013e3282efe49d.
  10. Pokrovskii AV, Chupin AV. Opredelenie stepeni narusheniia regional'noi mikrotsirkuliatsii nizhnikh konechnostei [Determination of the degree of regional microcirculation disturbances of the lower extremities]. Vrach. 1994;(1):28.
  11. Stupin VA, Goriunov SV, Prividentsev AI. Metabolicheskaia terapiia pri sindrome diabeticheskoi stopy [Metabolic therapy for diabetic foot syndrome]. Khirurgiia. 2013;(10):25-31.
Address for correspondence:
603093, Russian Federation,
Nizhniy Novgorod, ul. Rodionova, d. 167,
GBOU VPO "Nizhegorodskaya gosudarstvennaya
meditsinskaya akademiya",
kafedra khirurgicheskih bolezney,
tel. 790 43-90-56-82,
e-mail: lancet2003@list.ru,
Beschastnov Vladimir Viktorovich
Information about the authors:
Beschastnov V.V. MD, an associate professor of the chair of surgical diseases of SBEE HPE "Nizhny Novgorod State Medical Academy".
Izmaylov S.G. MD, professor of the chair of surgical diseases of SBEE HPE "Nizhny Novgorod State Medical Academy".
Bagryantsev M.V. A post-graduate student of the chair of surgical diseases of SBEE HPE "Nizhny Novgorod State Medical Academy".
Orlinskaya N.Y. MD, professor of the pathological anatomy chair of SBEE HPE "Nizhny Novgorod State Medical Academy".
Lukoyanychev E.E. PhD, a lecturer of surgical diseases of SBEE HPE "Nizhny Novgorod State Medical Academy".
Mironov A.A. PhD, an associate professor of the chair of nanotechnologies of the Institute of biology and biomedicine of FSAEE HE "Nizhny Novgorod State University named after N.I. Lobachevsky", a senior researcher of the department of neurophysiology and experimental modeling of Central Scientific Research Laboratory.

GENERAL & SPECIAL SURGERY

A.V. CHERNYH, E.I. ZAKURDAEV, E.F. CHEREDNIKOV

ON THE POSSIBILITY OF DETERMINING MESH PROSTHESIS SIZE OF THE PREOPERATIVE INGUINAL HERNIA REPAIR

SBEE HPE "Voronezh State Medical University named after N.N. Burdenko",
The Russian Federation

Objectives. To develop the regression equations to predict the linear dimensions of an inguinal gap according anthropometric parameters of the anterior abdominal wall.
Methods. In the topographic and anatomic study the anthropometric parameters of anterior abdominal wall (the interspinal line, length of inguinal ligament, hypogastrium height) and the linear dimensions of inguinal gap (height, length) were studied on cadavers (n=123). Prior hernia repair the linear sizes of an inguinal gap with the use of the regression equations and within an operative intervention in 30 patients with inguinal hernias were determined during the clinical trials.
Results. In anatomic study it was established that the interosseus line made up 27,2±0,3 cm, the length of inguinal ligament – 14,2±0,2 cm, the height of hypogastric area – 7,7±0,15 cm, the height of inguinal gap – 1,6±0,4 cm and the length – 5,3±0,8 cm. Using correlation analysis a strong reliable correlation between the height of the inguinal gap, interosseus line (r=-0,7; p<0,01) and a height of hypogastric region (r=0,8; p<0,01) was determined. In turn, between the height of inguinal gap and the length of inguinal ligament as well as between the length of inguinal gap and the length of inguinal ligament an average reliable correlation – r =-0,5 (p<0,05) was been registered.
On the basis of the obtained data the regression equations of forecasting of the linear dimensions of inguinal gap using anthropometric parameters of anterior abdominal wall were suggested: a=1,98+0,06×x1-0,14×x2+0,15×x3, b=7,91-0,18×x2 (a – a height of inguinal gap, b – a length of inguinal gap, x1 – a the interspinal line, x2 – a length of inguinal ligament, x3 – height of hypogastric area). In a clinical study it was established the absence of statistically significant differences between the linear dimensions of the inguinal gap obtained before the hernia repair using proposed regression equations and measured during an operative intervention (p=0,82).
Conclusion. The proposed regression equations allow predicting the linear dimensions of the inguinal gap using anthropometric parameters of the anterior abdominal wall and can be useful in choosing the optimal size of the mesh prosthesis at the preoperative stage of inguinal hernia repair.

Keywords: inguinal hernia, mesh hernia repair, chronic groin pain, linear dimensions, inguinal gap, regression equations, operative intervention
p. 619-623 of the original issue
References
  1. Volod'kin VV, Miadelets OD, Kharkevich NG. Makromikroskopicheskie osobennosti pakhovoi oblasti i vozmozhnye prichiny retsidiva pakhovykh gryzh [Macromicroscopic features of the groin, and the possible causes of recurrent inguinal hernias]. Novosti Khirurgii. 2006;14(2):7-12.
  2. Koshelev PI, Glukhov AA, Khussain M, Leibovich BE. Innovatsionnye puti sovershenstvovaniia metodov nenatiazhnoi gernioplastiki [Innovative ways to improve methods of pull hernioplastics]. Sistem Analiz i Upr v Biomed Sistemakh. 2007;6(2):528-32.
  3. Emel'ianov SI, Protasov AV, Rutenburg GM. Endoskopicheskaia khirurgiia pakhovykh i bedrennykh gryzh [Endoscopic surgery of inguinal and femoral hernias]. Saint-Petersburg, RF: Foliant; 2000. 176 p.
  4. Bezhin AI, Dolzhikov A.A., Plotnikov RV, Netiaga AA, Zhukovskii VA Sravnitel'noe eksperimental'noe izuchenie novykh polivinilidenftoridnykh endoprotezov s karbinovym pokrytiem dlia gernioplastiki [Comparative experimental study of new young polyvinylidene fluoride with carbon-coated implants for hernia repair]. Sistem Analiz i Upr v Biomed Sistemakh. 2006;5(4):802-806.
  5. Chernykh AV, Liubykh EN, Vitchinkin VG, Zakurdaev EI. Anatomicheskoe obosnovanie modifikatsii oposredovannoi plastiki pakhovogo kanala [The anatomical study mediated modification of plastic inguinal canal]. Novosti Khirurgii. 2014;22(4):403-407.
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  7. Szopinski J, Dabrowiecki S, Pierscinski S, Jackowski M, Jaworski Z, Szuflet M. Desarda Versus Lichtenstein Technique for Primary Inguinal Hernia Treatment: 3-Year Results of a Randomized Clinical Trial. World J Surg. 2012 May; 36(5): 984–992. doi: 10.1007/s00268-012-1508-1 PMCID: PMC3321139.
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  9. Olcucuoglu E, Kulacoglu H, Ensari CO, Yavuz A, Albayrak A, Ergul Z, Evirgen O. Fibrin sealant effects on the ilioinguinal nerve. J Invest Surg. 2011;24(6):267-72. doi: 10.3109/08941939.2011.590268.
  10. Porrero JL, Castillo MJ, Pérez-Zapata A, Alonso MT, Cano-Valderrama O, Quirós E, Villar S, Ramos B, Sánchez-Cabezudo C, Bonachia O, Marcos A, Pérez B. Randomised clinical trial: conventional Lichtenstein vs. hernioplasty with self-adhesive mesh in bilateral inguinal hernia surgery. Hernia. 2014 Nov 4.
  11. Rabe R, Yacapin CP, Buckley BS, Faylona JM. Repeated in vivo inguinal measurements to estimate a single optimal mesh size for inguinal herniorrhaphy. BMC Surg. 2012 Oct 2;12:19. doi: 10.1186/1471-2482-12-19.
Address for correspondence:
394036, Russian Federation,
Voronezh, ul. Studencheskaya, d. 10,
GBOU VPO "Voronezhskiy gosudarstvennyiy
meditsinskiy universitet
imeni N.N. Burdenko",
kafedra operativnoy khirurgii s
topograficheskoy anatomiey,
tel.: 7 (951) 566-43-61,
e-mail: ezakurdaev@rambler.ru,
Zakurdaev Evgeniy Ivanovich
Information about the authors:
Chernyh A.V. MD, professor, First Vice-Rector, a head of the operative surgery chair with topographic anatomy of SBEE HPE "Voronezh State Medical University named after N.N. Burdenko".
Zakurdaev E.I. PhD, an assistant of the operative surgery chair with topographic anatomy of SBEE HPE "Voronezh State Medical University named after N.N. Burdenko".
Cherednikov E.F. MD, professor, a head of the faculty surgery of SBEE HPE "Voronezh State Medical University named after N.N. Burdenko".

A.V. STAKANOV 1, À.Å. MURONOV 1, S.Y. EFANOV 2

HYPERBARIC OXYGEN THERAPY OF ACUTE COLONIC OBSTRUCTION

SBEE HPE "Kuban State Medical University" 1
SBEE HPE "Rostov State Medical University"2,
The Russian Federation

Objectives. To evaluate the effectiveness of hyperbaric oxygen therapy in patients after elimination of acute colonic obstruction.
Methods. The study enrolled 263 patients with acute colonic obstruction (ACO). All patients were divided into two groups: I – comparison group with basic therapy (n=118) and II – main group (n = 145), where in the postoperative period starting from the 2nd-3rd days hyperbaric oxygen therapy (HBO) was applied together with a standard therapy. The primary surgeries were: a bowel resection, laparotomy, applying of colo- (ceco-, transverso-, sigmo-) stomy, nasointestinal intubation of the small intestine and stomach. Patient’ gender and age characteristics as well as the severity of the early perioperative period estimated according to the dynamic APACHE III scale had no differences. The duration of operations, anesthetic treatment and stay in the intensive care unit are comparable. The presence of comorbidities in patients of both groups is without any significant differences.
Results. In the postoperative period the use of HBO reduces the incidence of postoperative complications, significantly reducing the pneumonia percentage by 9,7%, acute respiratory distress syndrome (ARDS), delirium – by 7,5%, paresis of the gastrointestinal tract for more than 3 days by 5,8%, septic complications by 3,5%. The development of acute kidney injury, left ventricular failure, postoperative myocardial infarction, as well as hypotension requiring vasoactive support, occurred in a comparable number of observations. Complications associated with pulmonary embolism, brain ischemia, acute gastrointestinal bleeding were considered to be similar in both groups. Medical and economic feasibility of HBO application in complex therapy in case of acute colonic obstruction (ACO) is based on statistical trends reducing the length of hospital stay by two days, the need for reoperation – by 3,5%, in-hospital mortality rate – by 3,1%.
Conclusion. The performed study gives the opportunity to recommend the use of hyperbaric oxygen therapy after elimination of acute colonic obstruction.

Keywords: hyperbaric oxygen therapy, abdominal surgery, acute colonic obstruction, hospitalization, complications, postoperative period, mortality rate
p. 624-630 of the original issue
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  13. Gomon NL, Shlapak IP. Mul'timodal'naia kombinirovannaia anesteziia/analgeziia v komplekse lecheniia khirurgicheskikh patsientov abdominal'nogo profilia [Multimodal combined anesthesia / analgesia in the complex treatment of surgical patients abdominal profile]. Novosti Khirurgii. 2014;22(6):721-26.
  14. Fukami Y, Kurumiya Y, Mizuno K, Sekoguchi E, Kobayashi S. Clinical effect of hyperbaric oxygen therapy in adhesive postoperative small bowel obstruction. Br J Surg. 2014 Mar;101(4):433-7. doi: 10.1002/bjs.9389.
  15. Zabolotskikh IB, Rudometkin SG, Trembach NV. Profilaktika deliriia u geriatricheskikh bol'nykh posle obshirnykh abdominal'nykh operatsii [Prevention of delirium in geriatric patients after major abdominal surgery]. Vestn Anesteziologii i Reanimatologii. 2013;10.(1):3-8.
Address for correspondence:
344010, Russian Federation,
Rostov-na-Donu, pr. Voroshilovskiy, d. 105,
GBOU VPO "Rostovskiy gosudarstvennyiy meditsinskiy universitet"
kafedra obschey khirurgii,
tel. mob. 7 903 406-00-97, e-mail: efanov_su@mail.ru,
Efanov Sergey Yurevich
Information about the authors:
Stakanov A.V. PhD, an applicant for Doctor’s degree of anesthesiology, reanimatology and transfusion chair of the advanced training faculty and retraining of specialists of SBEE HPE "Kuban State Medical University" of the Ministry of Health of Russia.
Muronov A.E. PhD, an associate professor of anesthesiology, reanimatology and transfusion chair of the advanced training faculty and retraining of specialists of SBEE HPE "Kuban State Medical University" of the Ministry of Health of Russia.
Efanov S.Y. PhD, an assistant of the general surgery chair of SBEE HPE "Rostov State Medical University".

N. TORMA 1, I.I. KOPOLOVETS 2, V. SIHOTSKÝ 3, 4, M. KUBÍKOVÁ 3, 4,M. FRANKOVIČOVÁ 3, 4

SURGICAL TREATMENT OF ATHEROSCLEROTIC STENOSIS OF CAROTID ARTERIES IN COMBINATION WITH PATHOLOGICAL TORTUOSITY OF THE INTERNAL CAROTID ARTERY FOR ISCHEMIC STROKE PREVENTION

Vascular Center "IMEA ÑÑ", Kosice1,
The Slovak Republic
HSEE "Uzhgorod National University"2,
Ukraine
East Slovak Institute of Cardiovascular Diseases "VUSCH"3,
P.I. Safarik University, medical faculty, Kosice4,
The Slovak Republic

Objectives. To investigate the results of surgical treatment of patients with pathological tortuosity of the internal carotid artery.
Methods. The results of surgical treatment of patients (n=97) with pathological tortuosity (PT) of internal carotid artery (ICA) in combination with atherosclerotic stenosis have been presented. The results of treatment depending on the degree of deformation, atherosclerotic damage localization and clinical symptomatology have been analyzed. The patients were divided into 3 groups depending on etiopathogenetical factors, clinical manifestations and patients’ examination results. In those groups the patients didn’t differ in their age and sex characteristics.
Group I (n=18) – the patients with pathological tortuosity of internal carotid artery (PT ICA) without atherosclerotic stenosis of carotid arteries;
Group II (n=36) – the patients with pathological tortuosity of internal carotid artery and asymptomatic atherosclerotic stenosis;
Group III (n=43) – the patients with pathological tortuosity of internal carotid artery and symptomatic atherosclerotic stenosis.
Results. No reliable statistic difference was revealed in comparison with the surgical treatment results of CA atherosclerotic stenosis in combination with ICA pathological tortuosity in the groups represented in the investigation (≥0,05). The optimal method of treatment of ICA pathological tortuosity is considered to be a surgical reconstruction. Surgical tactics means resection of excessive ICA length with further reimplantation or transposition, and in case of atherosclerotic stenosis – performing eversion endarterectomy.
In group I the patients (n=11; 61,1%) showed specific symptoms of cerebral ischemic regression typical for PT ICA; in the group II (n=21; 58,3%); in group III (n=16; 37,2%).
Conclusion. Surgical correction in symptomatic patients is a successful method of treatment of cerebral insufficiency and ischemic stroke prevention. Early good and satisfactory results of surgical treatment of pathological tortuosity of the internal carotid artery accounted for 100% in group I; 97,2% – in group II and 95,3% – in group III.

Keywords: carotid arteries atherosclerosis, kinking, coiling, ischemic stroke, etiopathogenetical factors, cerebral insufficiency, surgical treatment
p. 631-636 of the original issue
References
  1. Pokrovskii AV, Beloiartsev DF, Adyrkhaev ZA, Timina IE, Losik IA. Otdalennye rezul'taty rekonstruktivnykh operatsii pri patologicheskoi deformatsii vnutrennei sonnoi arterii [Long-term results of reconstructive surgery for pathological deformation of the internal carotid artery]. Angiologiia i Sosud Khirurgiia. 2012;(18)1:92-104.
  2. Beigelman R, Izaguirre AM, Robles M, Grana D, Ambrosio G, Milei J. Kinking of carotid arteries is not a mechanism of cerebral ischemia: A functional evaluation by Doppler echography International angiology: J of Intern Union of Angiology. 2011;30(4):342-48.
  3. Rodin IV. Gemodinamicheskie vzgliady na patologicheskuiu izvitost' sonnykh arterii [Hemodynamic views on pathological tortuosity of the carotid arteries]. Novoe v Angiologii Sosud Khirurgii. 2005;(2):150-52.
  4. Ballotta E, Thiene G , Baracchini C, Ermani M, Militello C, Giuseppe Da Giau, Barbon B, Angelini A. Surgical vs medical treatment for isolated internal carotid artery elongation with coiling or kinking in symptomatic patients: A prospective randomized clinical study. J Vasc Surg. 2005;(42):838-46.
  5. Molčan T. Chirurgická liečba cerebrovaskulárnej insuficiencie Via Pract. 2006;3(5):234-38.
  6. Kalitko IM, VI, Kovalenko NIu, Berezova IV, Kazantseva, V.V. Shebriakov, V.P. Kochubei, T.N. Beliakova Diagnostika i khirurgicheskoe lechenie patologicheskoi izvitosti vnutrennikh sonnykh arterii [Diagnosis and surgical treatment of pathological tortuosity of the internal carotid arteries]. Angiologiia i Sosud Khirurgiia. 2007;(13)2:89-94.
  7. Stanciulescu R, Ispas A, Filipoiu F, Bordei P, Galaman L, La Marca G. Anatomical variations of the carotid arteries: kinking, coiling, and tortuosity. Anatomical and functional considerations. IJAE. 2010;(115):161-68
  8. Radak Dj. Babić S, Tanasković S, Matić P, Sotirović V. Are the carotid kinking and coiling underestimated entities? Vojnosanitetski pregled. Military-medical and pharmaceutical review. 2012;69(7):616-19. DOI: 10.2298/VSP110722001R.
  9. Mumoli N, Marco C. Asymptomatic carotid kinking. Circulation Journal. 2008;72(4);682-83.
  10. Rusin V², Korsak VV, Butsko ЄS. Sindrom obkradannia pri patolog³¿ sudin dugi aorti [Steal syndrome in the pathology of the aortic arch vessels]. Uzhgorod, Ukraina: Karpati; 2011. 208 p.
  11. Togay-Isikay' C, Kim J, Betterman K, Andrews C, Meads D, Tesh P, Tegeler C, Oztuna D. Carotid artery tortuosity, kinking, coiling : stroke risk factor, marker, or curiosity? Acta Neurol. Belg. 2005;(105):68-72.
  12. Poorthuis MH, Brand EC, Toorop RJ, Moll FL, de Borst GJ. Posterior transverse plication of the internal carotid artery to correct for kinking. J Vasc Surg. 2014 Apr; 59(4): 968-77.
  13. YK, Zhong T, Li L, Wang J, Chen Y, Zhou H. Significant Association between Carotid Artery Kinking and Leukoaraiosis in Middle-Aged and Elderly Chinese Patients. Journal of Stroke and Cerebrovascular Diseases. 2015;24(5):1025-1031. doi: 10.1016/j.jstrokecerebrovasdis.2014.12.030.
Address for correspondence:
88000, Uzhgorod, Ukraine,
ul. Universitetskaya d.10,
VGUZ "Uzhgorodskiy natsionalnyiy universitet",
tel.mob.: 38050558-82-11,
e-mail: i.kopolovets@gmail.com,
Kopolovets Ivan Ivanovich
Information about the authors:
Torma N. PhD, vascular surgeon, "IMEA ÑÑ".
Kopolovets I.I. PhD, a researcher of HSEE "Uzhgorod National University".
Sihotský V. PhD, P.I. Safarik University, medical faculty, Deputy Head of the Vascular Surgery Clinic for teaching.
Kubíková M. PhD, a head of the Vascular Surgery Department, P.I. Safarik University, medical faculty.
Frankovičová M. PhD, professor, a head of the Vascular Surgery Clinic, P.I. Safarik University, medical faculty.

B.S. SUKOVATYKH1, L.N. BELIKOV2, M.B. SUKOVATYKH1, D.V. SIDOROV1, E.B. INOCHODOVA

FEMOROPOPLITEAL BYPASS BY FREE AUTOVENOUS GRAFT BELOW THE KNEE-JOINT SLOT IN THE TREATMENT OF CRITICAL LIMB ISCHEMIA

SBEE HPE "Kursk State Medical University" 1,
RBME "Kursk City Clinical Emergency Hospital" 2,
The Russian Federation

Objectives. To optimize treatment results of patients with critical ischemia of lower extremities caused by occlusive and stenotic lesions of the femoral-popliteal arterial segment by means of the femoral popliteal bypass surgery.
Methods. The analysis of complex examination and treatment of patients (n=60) with critical ischemia of lower extremities with atherosclerotic lession was done. The ischemia was caused by atherosclerotic occlusion of a femoral-popliteo-tibial segment. There were 55 males and 5 females; age of the patients ranged between 52-78 years. All patients were divided into two groups depending on the technique of femoral-popliteal bypass grafting. Each group consisted of 30 patients. The patients (the 1st group, control) were treated by common bypass graft using reverse greater saphenous vein. The patients of the 2nd group was underwent to the operation made according to the original technology using free venous graft with destruction of the venous valves without vein reversion.
Results. An advantage of the technique is that it permits to increase the volume blood flow in 1,5 fold, magisterial blood flow in 1,6 fold, microcirculation in 1,3 fold, volume blood flow via graft in 4,75 fold in the early incisional period, to decreases the incidence of early postoperative complications by 23,4%: graft thrombosis – by 6,7%, wound contamination – by 13,2%, lymphorrhea – by 3,3%. In the late incisional period it managed to reduce the quantity of late graft thrombosis by 40%, to improve long-term vein graft patency in 2,6 fold and quality of life by 10,6% (physical component ) and by 4,3% (mental one). In 2 years after operation the graft has been functioning in 36,7% of patients (the 1st group) and 83,3% of patients (the 2nd group). It allowed saving an extremity in 60% (the 1st group) and in 90% (the 2nd group) of patients.
Conclusion. The technique of femoro-popliteal bypass grafting using free venous graft with destroyed valves is considered to be pathogenetically justified and permits optimizing treatment results.

Keywords: atherosclerosis, autovein, below-knee femoro-popliteal bypasses grafting, volume blood flow, long-term vein graft patency, graft thrombosis, incisional period
p. 637-643 of the original issue
References
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  3. Pereira CE, Ajbers M, Romiti M, Sao Paulo. Meta-analysis of femoropopliteal bypas grafts for lower extremity arterial insufficiency. J Vasc Surg. 2006 Sept;(44)3:510-17. doi: 10.1016/j.jvs.2006.04.054
  4. Bradbury AW, Adam DJ, Bell J, Forbes JF, Fowkes FGR., Gillespie I, Ruckley CV, Raab GM. Bypass versus Angioplasty in Severe Ischaemia of the Leg (BASIL) trial: Analysis of amputation free and overall survival by treatment received. J. Vasc. Surg. 2010 May;51 (Suppl. S):18-31. doi: 10.1016/j.jvs.2010.01.074.
  5. Conte MS. Bypass versus Angioplasty in Severe Ischaemia of the Leg (BASIL) and the (hoped for) dawn of evidence-based treatment for advanced limb ischemia. J Vasc Surg. 2010;(51) (Suppl. S):69-75. DOI: 10.1016/j.jvs.2010.02.001.
  6. Haruguchi H, Teraoka S. Intimal hyperplasia and hemodynamic factors in arterial bypass and arteriovenous grafts: a review. J Artif Organs. 2003;6(4):227-35.
  7. Asher E./red. Sosudistaia khirurgiia po Khaimovichu [Vascular surgery in the manner of Haimovich]. V 2-kh t.; A.V. Pokrovskii / red. Per s ang pod. 5-e izd. Moscow, RF: BINOM. Laboratoriia Znanii. 2010;(1):644.
  8. Diagnostika i lechenie patsientov s kriticheskoi ishemiei nizhnikh konechnostei [Diagnosis and treatment of patients with critical limb ischemia]. Moscow, RF: Meditsina; 2002. 40 p.
  9. Hill BB, Arko FR, Faruqi RM, Zarins CK, Fogarty TJ. Over-the-wire inversion saphenectomy: a simple minimally invasive vein harvesting technique for arterial bypass. J Endovasc Ther. 2005;(12):394-400.
  10. Ishii Y. Minimum internal diameter of the greater saphenous vein is an important determinant of successful femorodistal bypass grafting that is independent of the quality of the runoff. Vascular. 2004 Jul-Aug;12 (4):225-32.
  11. Schanzer A, Hevelone N, Owens CD, Belkin M, Bandyk DF, Clowes AW, Moneta GL.. Technical factors affecting autogenous vein graft failure: observations from a large multicenter trial. J Vasc Surg. 2007;(46)6:1180-90.
  12. Karruthers TH, Varber A. Ñîâðåìåííîå ñîñòîÿíèå ïðîáëåìû ïîä ïàõîâîé êðèòè÷åñêîé èøåìèåé êîíå÷íîñòåé. Àíãèîëîãèÿ è Ñîñóä Õèðóðãèÿ. 2013;19(2):129-33.
  13. Matiushkin AV, Lobachev AA, Korotkov IN. Metody uluchsheniia otdalennykh rezul'tatov ispol'zovaniia sinteticheskogo proteza pri bedrenno-distal'no-podkolennom i bertsovom shuntirovanii [Methods to improve long-term results using a synthetic prosthesis at the distal femoral-popliteal and tibial-artery bypass]. Vestn Eksperim i Klin Khirurgii. 2011;(4)3:424-30.
  14. Gavrilenko AV, Kotov AE, Murav'eva IaIu, Kochetov SV, Alikin EIu. Takticheskie oshibki v lechenii bol'nykh s kriticheskoi ishemiei nizhnikh konechnostei pri porazhenii arterii bedra i goleni [Tactical mistakes in the treatment of patients with critical limb ischemia with the defeat of the arteries femur and tibia]. Khirurgiia. Zhurn im NI Pirogova. 2011;(5):10-14.
  15. Gavrilenko AV, Kochetov SV, Kotov AE, Murav'eva IaIu, Piven' AV. Khirurgicheskoe lechenie bol'nykh s kriticheskoi ishemiei nizhnikh konechnostei v zavisimosti ot spektra vegetiruiushchei flory [Surgical treatment of patients with critical ischemia of the lower limbs, depending on the spectrum of flora vegetating]. Khirurgiia. Zhurn im NI Pirogova. 2012;(2):19-25.
Address for correspondence:
305041 Russian Federation,
Kursk, ul. K.Marksa, d. 3,
GBOU VPO "Kurskiy
gosudarstvennyiy
meditsinskiy universitet",
kafedra obschey khirurgii,
tel. office 8 4712 52-98-62,
e-mail: SukovatykhBS@kursksmu.net,
Sukovatykh Boris Semenovich
Information about the authors:
Sukovatykh B.S. MD, professor, a head of the general surgery chair of SBEE HPE "Kursk State Medical University".
Belikov L.N. MD, a head of the vascular department of RBME "Kursk City Clinical Emergency Hospital".
Sukovatykh M.B. PhD, an associate professor of the general surgery chair of SBEE HPE "Kursk State Medical University".
Sidorov D.V. A clinical intern, applicant of the general surgery chair of SBEE HPE "Kursk State Medical University".
Inochodova E.B. A specialist of ultrasound diagnostics of RBME "Kursk City Clinical Emergency Hospital".

M.B. EKTOVA1, E.P. BURLEVA 1, S.J. MEDVEDEVA 2, V.A. BAGIN 3

A COMPARATIVE ASSESSMENT OF THE SKIN AND WALL RESTRUCTURING OF THE SAPHENOUS VEIN IN CHRONIC VENOUS DISEASE CLASSES C1 AND C2

SBEE HPE "Ural State Medical University"1,
FSBES "Institute of Immunology and Physiology of Ural Branch of RAS",2
MAE "Municipal Hospital ¹ 40"3, Yekaterinburg,
The Russian Federation

Objectives. To perform a comparative study of the skin and wall restructuring of great saphenous vein (GSV) in chronic venous diseases classes of C1 and C2 (CVD).
Methods. Tissue samples were harvested from the leg muscles of women died due to injuries. Group 1 consisted of normal samples (n=10). Groups 2 and 3 had visual signs of CVD classes C1 (n=10) and C2 (n=10). After tissue staining and description the epidermal thickness, proportion of elastic fibers (EF) and collagen fibers (CF) in the reticular dermis and the GSV media were determined. Agranulocytes, granulocytes, and mast cells (MC) were counted and optical density of MC was determined.
Results. Structural changes in the skin and GSV wall in groups C1 and C2 were of the same type with some differences. In group C1 a focal structural disorganization of EF and CF in the GSV wall with predominant changes of the endothelium without perivasculitis manifestations was observed. In group C2 the changes in the EF and CF were diffuse, involving endothelium and subendothelial structures and the media.
Perivasculitis phenomena were revealed in the skin and adventitia vessels. The number of cells involved in the chronic inflammatory process (agranulocytes, granulocytes, and mast cells) was greater in classes C1 and C2 compared to normal. A significant increase of the optical density of MC indicates to their potential to participate in modulating granulocytes and agranulocytes reactivity.
Conclusion. The chronic venous diseases classes C1 and C2 are the similar variants of genetically determined dysplasia of the connective tissue. The received data target at the implementation of a comprehensive approach in the treatment of chronic venous diseases class C1 patients.

Keywords: chronic venous diseases, C1 and C2 classes, pathomorphology of the skin and great saphenous vein wall, granulocytes, agranulocytes, reactivity, dysplasia of the connective tissue, mast cells
p. 644-650 of the original issue
References
  1. Larin SI, Zamechnik TV. Sravnenie klinicheskikh i ul'trazvukovykh dannykh s gistomorfologicheskoi strukturoi bol'shoi podkozhnoi veny u patsientov s varikoznoi bolezn'iu [Comparison of clinical and ultrasound data histomorphological structure of the great saphenous vein in patients with varicose veins]. Flebologiia. 2011;(3):16-20.
  2. Sushkou SA, Miadelets OD, Korobov GD. Sravnitel'nyi analiz morfologicheskikh izmenenii v glubokikh venakh pri raznykh formakh varikoznoi bolezni [Comparative analysis of morphological changes in the deep veins in various forms of varicose veins]. Flebologiia. 2012;(3):46-51.
  3. Tsukanov IT, Tsukanov AIu, Vasilevich VV, Bazhenov VN, Pritykina TV. Sravnitel'noe issledovanie morfologii ven, soderzhaniia tkanevykh gormonov rosta i metabolitov soedinitel'noi tkani pri varikoznym sindrome [A comparative study of the morphology of the veins, the content of tissue growth hormones and metabolites of connective tissue in varicose syndrome]. Flebologiia. 2008;(1):14-20.
  4. Janowski K, Sopiński M, Topol M. Changes in the wall of the great saphenous vein at consecutive stages in patients suffering from chronic vein disease of the lower limbs. Folia Morphol (Warsz). 2007 Aug;66(3):185-9.
  5. Lim CS, Davies AH. Pathogenesis of primary varicose veins. Br J Surg. 2009 Nov;96(11):1231-42. doi: 10.1002/bjs.6798.
  6. Svistunov AA, Tsarev OA, Masliakova GN, Mashchenko IuV. Klinicheskoe techenie varikoznoi bolezni u bol'nykh s razlichnoi stepen'iu vyrazhennosti displazii soedinitel'noi tkani [The clinical course of varicose veins in patients with varying degrees of severity of connective tissue dysplasia]. Saratov Nauch-Med Zhurn. 2009;5(2):261-66.
  7. Shval'b PG, Shval'b AP, Kachinskii AE. Morfologicheskie osnovy klinicheskoi klassifikatsii CEAP i ikh terapevticheskoe znachenie [Morphological bases CEAP clinical classification and therapeutic value]. Flebologiia. 2012;(3):10-14.
  8. Perrin M, Ramelet AA. Pharmacological treatment of primary chronic venous disease: rationale, results and unanswered questions. Eur J Vasc Endovasc Surg. 2011 Jan;41(1):117-25. doi: 10.1016/j.ejvs.2010.09.025.
  9. John JB, Schmid-Schönbein GW, Philip D, Smith CD, Andrew N, Nicolaides MS, Boisseau MR, Bo E. Chronic Venous Disease. N Engl J Med 2006; 355:488-498August 3, 2006 doi: 10.1056/NEJMra055289.
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  11. Nicolaides A, Kakkos S, Eklof B, Perrin M, Nelzen O, Neglen P, Partsch H, Rybak Z.Management of chronic venous disorders of the lower limbs Guidelines according to scientific evidence. Intern Angiology 2014 April;33(2):87-208.
  12. Shevchenko IuL, Stoiko IuM, Gudymovich VG, Nikitina AM, Trifonov SI. Disfunktsiia endoteliia u bol'nykh khronicheskoi venoznoi nedostatochnost'iu nizhnikh konechnostei i vozmozhnosti ee korrektsii [Endothelial dysfunction in patients with chronic venous insufficiency of the lower limbs and the possibility of its correction]. Angiol i Sosud Khirurgiia. 2010;16(4):99-104.
  13. Shevchenko IuL, Stoiko IuM, Gudymovich VG, Batrashov VA, Iudaev SS, Astashev PE, Nikitina AM. Endotelii-zavisimye faktory patogeneza retsidiva varikoznoi bolezni - diagnosticheskaia kontseptsiia i lechebnaia taktika [The endothelium-dependent factor in the pathogenesis of recurrence of varicose veins - the concept of diagnostic and treatment tactics]. Angiol i Sosud Khirurgiia. 2013;19(3):20-24.
  14. Pascual G, Mendieta C, García-Honduvilla N, Corrales C, Bellón JM, Buján J. TGF-beta1 upregulation in the aging varicose vein. J Vasc Res. 2007;44(3):192-201.
  15. Pocock ES, Alsaigh T, Mazor R, Schmid-Schönbein GW. Cellular and molecular basis of Venous insufficiency. Vasc Cell. 2014 Dec 12;6(1):24. doi: 10.1186/s13221-014-0024-5. eCollection 2014.
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Address for correspondence:
620102, Russian Federation,
Ekaterinburg, ul. Volgogradskaya, d. 189,
MAU "Gorodskaya klinicheskaya bolnitsa ¹ 40",
tel: 7 912 600-300-8,
7 (343) 240-14-16,
e-mail: burleva@gkb40.ur.ru,
Burleva Elena Pavlovna
Information about the authors:
Ektova M.V. A post-graduate student of the general surgery chair of SBEE HPE "Ural State Medical University", director of the medical center "AngioLine".
Burleva E.P. MD, professor of the general surgery chair of SBEE HPE "Ural State Medical University".
Medvedeva S.J. PhD, a head of the laboratory of morphology and biochemistry of FSBES "Institute of immunology and physiology of Ural branch of RAS".
Bagin V.A. PhD, a head of the Intensive Care Unit ¹ 5 of MAE "Municipal Hospital ¹ 40".

TRAUMATOLOGY & ORTHOPEDICS

A.A. ZYKIN, N.A. TENILIN, A.A. KORYTKIN, S.A. GERASIMOV

A NEW METHOD FOR OSTEOTOMY OF THE TIBIA FOR AXIAL DEFORMITY CORRECTION OF THE LOWER EXTREMITIES

FSBE "Privolzhsky Federal Research Medical Centre" of the Ministry of Health of the Russian Federation
The Russian Federation

Objectives. To develop a new method of osteotomy of the tibia for axial deformity correction of the lower extremities and to evaluate the results of its application in patients with gonarthrosis at the front deformities greater than 15 degrees.
Methods. The treatment results of 27 patients (aged up to 60 yrs) with gonarthrosis stage II-III who were underwent to corrective osteotomy near the knee joint have been studied. The method of corrective tibia osteotomy was applied in 13 patients (48%) with gonarthrosis stage II-III at a varus deformity of the lower extremities exceeding 15 degrees. The treatment results of the patients with knee gonarthrosis stage II-III assessed using a 100-point Josef and Kaufman scale. The results were evaluated within the monitoring periods of 3, 6, 12, 18 and 24 months.
Results. By using an in-house developed method the high values on the scale of Joseph & Kaufman (61 to 84,5 points) have been obtained corresponding to the results of analogous opening-wedge osteotomies (p>0,1 within a 24-month monitoring period). The best results after 6 months of monitoring were registered in the group of patients operated on by a new technique (p<0,037). The proposed method retaining all the advantages of high osteotomy (rapid and lower impact of consolidation) eliminates the tension of the patellar ligament, allows correcting the axial deformity of an axis shift of more than 15 degrees and ultimately permits patients quickly begin restoring the initial level of physical activity.
Conclusion. The proposed method of corrective osteotomy may be recommended for the normalization of the mechanical axis of a lower extremity in patients with knee gonarthrosis stage II-III and front deformities exceeding 15 degrees. This technique was applied for treatment of 13 patients with obtaining good results.

Keywords: knee joint, gonarthrosis, axial strain, corrective osteotomy, high tibial osteotomy, stages, physical activity
p. 651-657 of the original issue
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  6. Miuller B. Vysokaia osteotomiia bol'shebertsovoi kosti: usloviia, pokazaniia, tekhnika, problemy, rezul'taty [High tibial osteotomy: the conditions, indications, techniques, problems and results]. Margo Anterior. 2003;(1-2):2-10.
    7. LI>Sangkaew Ñ, Piyapittayanun P.Boomerang proximal tibial osteotomy for the treatment of severe varus gonarthrosis. Int Orthop. 2013 Jun; 37(6): 1055–1061. Published online 2013 Feb 12. doi: 10.1007/s00264-013-1802-z PMCID: PMC3664149.
  7. Fraitzl ÑR, Flören M, Reichel H. Kniegelenk - Arthrose und Arthritis Orthopädie und Unfallchirurgie up2date 2008;3(3):155-76. doi: 10.1055/s-2008-1077323.
  8. Efe T, Ahmed1 G, Heyse1 TJ, Boudriot U, Timmesfeld N, Fuchs-Winkelmann S, Ishaque B , Lakemeier S, Schofer MD. Closing-wedge high tibial osteotomy: survival and risk factor analysis at long-term follow up BMC Musculoskeletal Disorders 2011, 12:46. DOI: 10.1186/1471-2474-12-46.
  9. Niemeyer P, Schmal H, Hauschild O, von Heyden J, Südkamp NP, Köstler W. Open-wedge osteotomy using an internal plate fixator in patients with medial-compartment gonarthritis and varus malalignment: 3-year results with regard to preoperative arthroscopic and radiographic findings. Arthroscopy. 2010 Dec;26(12):1607-16. doi: 10.1016/j.arthro.2010.05.006.
  10. Lobenhoffer P, Agneskirchner JD. Improvements in surgical technique of valgus high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc. 2003 May;11(3):132-38.
  11. Esenkaya K, Akan UK. Proximal tibial osteotomies for the medial compartment arthrosis of the knee: a historical journey. Strat Traum Limb Recon. 2012;(7):13–21.
  12. Uquillas C, Rossy W, Nathasingh CK, Strauss E, Jazrawi L, Gonzalez-Lomas G. Osteotomies about the knee: AAOS exhibit selection. J Bone Joint Surg Am. 2014 Dec 17;96(24):e199. doi: 10.2106/JBJS.N.00270.
  13. Makushin VD, Chegurov OK, Kazantsev VI. O roli vnutrikostnoi gipertenzii v geneze bolevogo sindroma pri gonartroze [On the role of intraosseous hypertension in the genesis of pain in gonarthrosis]. Genii Ortopedii. 2000(2):52-55.
  14. Portner O. High Tibial Valgus Osteotomy: Closing, Opening or Combined? Patellar Height as a Determining Factor Clin Orthop Relat Res. 2014 Nov; 472(11): 3432–3440. Published online 2014 Jul 29. doi: 10.1007/s11999-014-3821-5 PMCID: PMC4182389
Address for correspondence:
603155, Russian Federation,
Nizhny Novgorod, Verhnevolzhskaya naberezhnaya, d. 18,
FGBU "Privolzhskiy federalnyiy meditsinskiy
issledovatelskiy tsentr", tel.: 831 436-01-60,
e-mail: dr.zykin@mail.ru,
Zykin Andrey Anatolevich
Information about the authors:
Zykin A.A. A junior researcher of the orthopedics department (the adults) of FSBE "Privolzhsky Federal Research Medical Centre" of the Ministry of Health of the Russian Federation.
Tenilin N.A. MD, a leading researcher of pediatric orthopedics department of FSBE "Privolzhsky Federal Research Medical Centre" of the Ministry of Health of the Russian Federation.
Korytkin A.A. PhD, a head of the orthopedics department (the adults) of FSBE "Privolzhsky Federal Research Medical Centre" of the Ministry of Health of the Russian Federation.
Gerasimov S.A. A traumatologist-orthopedist of the orthopedics department (the adults) of FSBE "Privolzhsky Federal Research Medical Centre" of the Ministry of Health of the Russian Federation.

ONCOLOGY

I.A. ILYIN, V.T. MALKEVICH

COMPARATIVE EVALUATION OF DIRECT TREATMENT RESULTS OF ESOPHAGEAL CANCER IN DIFFERENT TYPES OF SURGICAL INTERVENTIONS

SE "N.N. Alexandrov National Cancer Centre of Belarus", Minsk,
The Republic of Belarus

Objectives. To determine an optimal type of surgical treatment of patients suffering from esophageal cancer and to carry out comparative analysis of the main types of surgical procedures.
Methods. From 1990 to 2010 yrs. the radical surgeries in patients (n=347) with esophageal cancer have been performed in the "N.N. Alexandrov National Cancer Centre of Belarus". Three groups of patients were compiled. The 1st group (n=255) – the patients underwent to two-level transthoracic esophagectomy. The 2nd group (n=60) – three-level transthoracic esophagectomy. The 3rd group (n=32) – transhiatal esophagectomy.
Results. In total cohort the post-operative complications were observed in 34,6% of patients. 30-day postoperative mortality was 12,1%, hospital mortality – 13,5% and 60-day one – 15,3%. Cervical esophageal anastomosis leak was dominated in the 2nd and 3rd groups – 21,7% and 18,8%, respectively (p<0,001). The application of a wide gastric pedicle (n=57) with anastomosis in the cervical region the incidence of graft necrosis and anastomotic leak was 19,3%, which was lower in comparison with a narrow gastric pedicle (n=35) where those complications occurred in 48,6% of cases (p=0,006). At the same time hospital mortality was 5,3% and 2,9%, respectively (p=0,982). In esophagoplasty by narrow pedicle stalk (n=53) necrosis developed in 9,3% (p=0,938). 12,5% of the patients out of the 255 patients with localized intrapleural anastomosis died, while in the cervical localization (n=92) mortality was 16,3% (p=0,469).
Conclusion. In the cases of mid- and lower-thoracic esophageal cancer the two-level access to organs of abdominal and pleural cavities with application of intrapleural esophageal anastomosis and three-level access with cervical anastomosis for upper thoracic cancer are considered to be optimal. As for transhiatal access this technique seems to be less traumatic and made similar results with the direct ones of other types of surgical procedures.

Keywords: esophageal cancer, two-level esophageal resection, three-level transthoracic esophagectomy, transhiatal esophagectomy, cervical anastomosis, necrosis, anastomotic failure
p. 658-665 of the original issue
References
  1. Shah SV, Chheda YP, Pillai SK, Shah SV. Total oesophagectomy for squamous cell carcinoma with or without standard two field node dissection – a prospective study. Indian J Surg Oncol. 2013 Dec; 4(4):336–40. doi: 10.1007/s13193-013-0264-5 PMCID: PMC3890016
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Address for correspondence:
223040, Republic of Belarus,
Minskaya oblast, Minskiy rayon,
agrogorodok "Lesnoy" 2,
GU "RNPTs onkologii i meditsinskoy radiologii im. N.N. Aleksandrova", khirurgicheskiy otdel,
tel. mob.: 375 44 713-59-56,
e-mail: ileus@tut.by,
Ilyin Ilya Anatolevich
Information about the authors:
Ilyin I.A. PhD, a senior researcher of the surgical department of SE "N.N. Alexandrov National Cancer Centre of Belarus",
Malkevich V.T. MD, a head of the oncologic thoracic department of SE "N.N. Alexandrov National Cancer Centre of Belarus".

ANESTHESIOLOGY-REANIMATOLOGY

V.V. YASKEVICH¹, A.V. MAROCHKOV²

PARAVERTEBRAL BLOCKS AS A COMPONENT OF ANESTHETIC MANAGEMENT OF BREAST CANCER SURGERY

ME "Bobruisk Interdistrict Oncologic Dispensary"¹,
ME "Mogilev regional hospital"²,
The Republic of Belarus

Objectives. Increase of efficiency and safety of the multicomponent balanced endotracheal anesthesia in the combination with paravertebral block for surgical interventions in patients with breast cancer.
Methods. Two groups of patients were formed. In the 1st group (n=30) the multicomponent balanced endotracheal anesthesia was applied. In the 2nd group (n=27) the multicomponent balanced endotracheal anesthesia with paravertebral block (PVB) was applied. Paravertebral block was performed under ultrasound-guided surgery navigation at the Th1, Th2, Th3, Th4, Th5 and Th6 levels. At each level 1,5 mL of a local anesthetic (0,75% ropivacaine solution) was injected to patients, the total volume was 9 mL. In five cases the block was performed using 2 mL of a local anesthetic (0,75% ropivacaine solution) at each level and the total volume of 12 mL.
Results. During the operation the patients of the 1st group required more fentanyl than did those in the 2nd group; so as in the 1st group droperidol consumption was more than in the 2nd group. Neither pneumothorax nor any other complications were encountered after PVB. Postoperative reduced need for analgesics in patients of the 2nd group was marked only in the first day after surgery.
Conclusion. The present method of the spinal nerves PVB at the level Th1-Th6 with small doses of local anesthetic (administered ropivacaine at 0,75% (1,5 mL) at the level) as a component of the combined anesthesia for breast cancer surgery in the volume of radical mastectomy gives safe and effective pain relief. This method reduces the risk of systemic toxicity of local anesthetics. Application of small doses of local anesthetics for thoracic paravertebral block has been show to reduce patient need for analgesics in the first day after surgery.

Keywords: paravertebral block, breast cancer, mastectomy, breast surgery, surgical anaesthesia, ropivacaine solution, safe and effective pain relief
p. 666-672 of the original issue
References
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  11. Marochkov AV, Iakimov DA. Izmerenie ostroi boli v klinicheskoi praktike [Measurement of acute pain in clinical practice]: monografiia. Mogilev, RB: MGU im AA Kuleshova. 2011. 188 p.
  12. Pei L, Zhou Y, Tan G, Mao F, Yang D, Guan J, Lin Y, Wang X, Zhang Y, Zhang X, Shen S, Xu Z, Sun Q, Huang Y. Ultrasound-Assisted Thoracic Paravertebral Block Reduces Intraoperative Opioid Requirement and Improves Analgesia after Breast Cancer Surgery: A randomized, controlled, single-center trial. Outcomes Research Consortium. PLoS One. 2015 Nov 20;10(11):e0142249. doi: 10.1371/journal.pone.0142249. eCollection 2015.
  13. Schnobel A, Reichl SU, Kranke P, Pogatzki-Zohn EM, Zahn PK. Efficacy and safety of paravertebral blocks in breast surgery: a meta-analysis of randomized controlled trials. Br J Anaesth. 201O.105:842 - 52; doi: 10.1093/bja/aeq265.
  14. Naja Z, Lonnqvist PA. Somatic paravertebral nerve blockade. Incidence of failed block and complications. Anaesthesia 2001;56:1184-88. doi: 10.1111/j.1365-2044.2001.2084-2.x.
Address for correspondence:
213825, Republic of Belarus,
Mogilevskaya oblast,
Bobruysk, per. Sosnovyiy, d. 40,
UZ "Bobruyskiy mezhrayonnyiy
onkologicheskiy dispanser",
tel.mob.: 375 029 601-94-21,
e-mail: varera@tut.by,
Yaskevich Valeriy Viktorovich
Information about the authors:
Yaskevich V.V. An anesthesiologist-resuscitator of ME "Bobruisk Interdistrict Oncologic Dispensary".
Marochkov A.V. MD, a head of the anesthesia and resuscitation unit of ME "Mogilev regional hospital".

REVIEWS

À.À. GLUKHOV 1, M.V. ARALOVA2

PATHOPHYSIOLOGY OF PERSISTENT CHRONIC WOUNDS AND CURRENT METHODS OF STIMULATION OF WOUND PROCESS

SBEE HPE "Voronezh State Medical University named after N.N. Burdenko",1
BEH "Voronezh regional clinical hospital N1"2,
The Russian Federation

Treatment of persistent chronic wounds completely differented in the etiology, pathogenesis, clinical pictures so far represents one of the most difficult issues of surgery. At the cellular and subcellular levels they are characterized by existence of a chronic inflammation and signs of all 3 phases of wound process simultaneously. In the article the difficult intercellular and cellular matrix interactions, mediators and regulators the reparative processes, participation of separate cellular elements during various temporary periods in normal and pathological healing, the factors modeling wound process are described. The current data of morphology of tissue regeneration obtained by electron microscopy, immunohistochemical researches, an autoradiography allowing the physicians of surgical specialties to provide the effective search of radical and rational methods of treatment of this problem are presented. The wide range of the new directions of tissue and genetic engineering, the cellular therapy used in practical medicine: the preparations of collagen, agents on the basis of negatively charged inert polystyrene microspheres, use of platelet-rich plasma and the preparations containing growth factors, including an endothelium of vessels, techniques of cultivation of fibroblasts, keratinocytes, epidermal cells have been described. The new technologies which are passing still laboratory researches, but having great clinical prospects are specified.

Keywords: persistent chronic wounds, pathogenesis, wound process, trophic ulcers, local treatment, new methods, perspectives
p. 673-679 of the original issue
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  37. Glukhov AA, Zuikova AA, Petrova TN, Andreev AA, Ostroushko AP. Kliniko-patogeneticheskoe obosnovanie primeneniia antimikoticheskikh sredstv v kompleksnom lechenii patsientov s sindromom diabeticheskoi stopy [Clinico-pathogenetic substantiation of application of antifungal agents in treatment of patients with diabetic foot syndrome]. Vestn Eksperiment i Klin Khirurgii. 2012;(5)4:639-43.
Address for correspondence:
396310, Rossiiskaia Federatsiia, g. Voronezh, Moskovskii prospekt, d. 151, "Voronezhskaia oblastnaia klinicheskaia bol'nitsa ¹1" otdelenie ambulatorno-poliklinicheskoi khirurgii, tel. rab.: 8 803 854 05 43,
e-mail: Mashaaralova@mail.ru,
Aralova Mariia Valer'evna
Information about the authors:
Glukhov A.A., MD, professor, a head of the department of general surgery Medical University "Voronezh State Medical University named after N.N. Burdenko".
Aralova M.V. PhD, a head of the department of outpatient surgery BEH "Voronezh regional clinical hospital N1".

A.A. TRETYAKOV1, S.V. PETROV1, A.N. NEVEROV1, A.F. SHCHETININ1

TREATMENT OF PURULENT WOUNDS

SBEE HPE "Orenburg State Medical University"1
The Russian Federation

The number of patients with acute purulent diseases of the soft tissues hasn’t reduced and tends to rise, accounting for 35-40% of all surgical patients. The success of the surgical treatment of acute purulent diseases of soft tissues depends on radical surgical aids, performed with adequate anesthesia. Drainage of wound fluid is an factor important to successful wound healing in the incisional period. The use of antibiotics is included in a comprehensive treatment of patients with acute purulent surgical infection. The development of current methods of active treatment is related to the revision of the main points of the classical incision-drainage method and changing the very nature of the operation itself. They envisage a targeted radical surgery in the site of supportive focus to provide the effective and adequate drainage so as completely different, more aggressive therapy of purulent wounds in the inflammatory and regeneration phases. Any drainage system requires some special conditions. The necessity for early and rapid closing of purulent wound led to the search and creation of conditions for sutures and skin plasty. A new perspective way to overcome antibiotic resistance is considered to use probiotics. Another new direction in solving the issue of the treatment of chronic inflammatory processes of different localization is the inclusion of neuropeptides such as hypothalamic nanopeptid (oxytocin) in a comprehensive treatment.

Keywords: purulent wounds, surgical treatment, treatment tactics, drainage, resistance to antibiotics, probiotics, neuropeptides
p. 680-687 of the original issue
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Address for correspondence:
460000, Russian Federation,
Orenburg, ul. Sovetskaya d. 6,
GBOU VPO "Orenburgskiy gosudarstvennyiy
meditsinskiy universitet",
kafedra khirurgii IPO,
tel. office: 7 3532 34-92-71,
mob. 7 922 625-2531,
e-mail: k_hirurg@orgma.ru,
Petrov Sergey Valentinovich
Information about the authors:
Tretyakov A.A. MD, professor, a head of the surgery chair of "Orenburg State Medical University".
Petrov S.V. PhD, an assistant of the surgery chair of "Orenburg State Medical University".
Neverov A.N. PhD, an associate professor of the surgery chair of "Orenburg State Medical University".
Shchetinin A.F. PhD, an associate professor of the surgery chair of "Orenburg State Medical University".

CASE REPORTS

S.I. KIRILENKO, S.A. KRYZH, A.A. LITVIN, V.V. ROZHIN

DYSPHAGIA AS A RESULT OF ESOPHAGEAL COMPRESSION BY THE CERVICAL OSTEOPHYTES

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

Three clinical cases of a rare cause of dysphagia: esophageal compression by cervical osteophytes are presented to pay attention of physicians.
The patients were being treated at the trauma and orthopedic department of ME Gomel "Regional Clinical Hospital" in the period from 01.08.2013 to 01.08.2014. Swallowing problems are a common complaint among pastients.
The decisive methods of instrumental diagnostics were the radiography and computed tomography of the cervical spine. No any deviations were revealed during laboratory investigation. All patients were operated on after complete and comprehensive diagnostics. In two patients the compression of the esophagus and the larynx by the osteophytes was observed, and in one of them - by the osteophytes and sclerous tissues; there were no complications during the operation, throughout the postoperative period. All patients were discharged on the 3rd-4th days after the surgery and began to work in a one-month period. In the case of dysphagia resulting from esophageal compression caused by cervical osteophytes, radiography is the best modality for characterizing suspected lesions. The only radical method for treating severe dysphagia due to the esophageal compression by the cervical osteophytes is considered to be a resection.

Keywords: dysphagia, osteophytes, compression, radiography and computed tomography, cervical vertebra, esophagus, resection
p. 688-692 of the original issue
References
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Address for correspondence:
210023, Republic of Belarus,
Gomel, ul. Bratev Lizyukovyih, d. 5,
UZ "Gomelskaya oblastnaya klinicheskaya bolnitsa",
travmatologo-ortopedicheskoe otdelenie,
tel. office: 375 232 48-55-54,
e-mail: ortoped74.@bk.ru,
Kirilenko Sergey Ivanovich
Information about the authors:
Kirilenko S.I. PhD, a traumatologist-orthopedist of ME "Gomel Regional Clinical Hospital".
Litvin A.A. PhD, Deputy Chief on Surgery of ME "Gomel Regional Clinical Hospital".
Kryzh S.A. An anesthesiologist-resuscitator of ME "Gomel Regional Clinical Hospital".
Rozhin V.V. A traumatologist-orthopedist of ME "Gomel Regional Clinical Hospital".

EXCHANGE OF EXPERIENCE

A.M. TYSHCHENKO1, E.V. MUSHENKO1, R.M. SMACHYLO2

CHANGES IN TREATMENT TACTICS OF ACUTE PANCREATITIS ACCORDING TO REVISED ATLANTA CLASSIFICATION - 2012

SE "V.T. Zaytsev Institute of General and Urgent Surgery of National AMS of Ukraine" 1, Kharkov
Kharkov National Medical University2
Ukraine

Objectives. To study the results of surgical treatment of patients with acute pancreatitis according to suggested tactical approach taking into consideration the revised Atlanta Classification – 2012.
Methods. During the period of 2005-2013 yrs. the (n=121) patients with destructive pancreatitis had underwent surgical treatment in GI "V.T. Zaytsev Institute of General and Urgent Surgery of National AMS of Ukraine"; they were subjected to surgical interventions different by volume. Standard laboratory methods as well as ultrasound examination and computed tomography were used for preoperative examination. 269 operations were performed on 121 patients; minimally invasive interventions or their combinations were used in 87,0% cases.
Results. Intraoperative complications developed in 2,6% of patients and they were revealed and treated during the operation. Early postoperative complications developed in 43,8% of patients; the most frequent of them were: postoperative wounds suppuration in 43 patients, intestinal and pancreatic fistulas in 4 and 5 cases, respectively, arrosive bleeding and multiple organ failure – in 6 and 9 cases, respectively.
Mortality rate made up 21,5%. The most often causes of death were: intoxication – 38,5%, multiple organ failure – 23,1%, fulminant pancreatitis – 15,4%, arrosive bleeding – 11,5%.
Late postoperative complications developed in 23,6% of survivors. Among them: ventral hernias were detected in 10 patients, mechanical jaundice – in 2 cases, forming of pancreatic pseudocysts – in 2 cases, duodenal obstruction – in 2 patients, abscess of spleen – in 2 cases.
Conclusion. Staged surgical approach using minimally invasive technologies in treatment of patients with necrotizing pancreatitis permits to decrease the number of intra- and postoperative complication as well as mortality rate in this group of patients.

Keywords: revised Atlanta Classification of acute pancreatitis, acute pancreatitis, necrotizing pancreatitis, surgical treatment, necrosectomy, complication, mortality rate
p. 693-701 of the original issue
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Address for correspondence:
61103, Ukraine,
Harkov, v'ezd Balakireva, d. 1,
GU "Institut obschey i neotlozhnoy khirurgii im. V.T. Zaytseva NAMN Ukrainyi",
tel. office: 38-057-349-41-50,
e-mail: dr_mushenko@mail.ru,
Mushenko Evgeniy Vladimirovich
Information about the authors:
Tyshchenko A.M. MD, professor, a head of the department of hepatic surgery and biliary ducts of SE "V.T Zaytsev Institute of General and Urgent Surgery of National AMS of Ukraine".
Mushenko E.V. PhD, a researcher of the department of diseases of the esophagus and digestive tract of SE" V.T. Zaytsev Institute of General and Urgent Surgery of National AMS of Ukraine".
Smachylo R.M. PhD, an associate professor of the surgery chair ¹1 of Kharkov National Medical University

SCIENTIFIC CONGRESSES & CONFERENCES

S.A. SUSHKOU, Y.S. NEBYLITSIN

SLAVIC VENOUS FORUM VITEBSK, MAY, 28-29, 2015

On the 28-29th of May, 2015, the International Congress "Slavic Venous Forum" took place in Vitebsk, the Republic of Belarus. Surgeons from 19 countries – Belarus, Russia, Ukraine, France, Great Britain, Denmark, Cyprus, Switzerland, Poland, Slovakia, Lithuania, Latvia, Estonia, Azerbaijan, Armenia, Georgia, Kazakhstan, Uzbekistan and Tajikistan took part in the Congress.
The total number of the Congress participants exceeded 700 physicians of different specialties: vascular surgeons, phlebologists, lymphologists, surgeons, oncologists, trauma orthopedists, obstetricians, medical sonographers. During the Congress the following important questions of phlebology were being discussed: current approaches to the treatment of chronic venous diseases, venous thromboembolic complications, issues and solutions, innovative methods of venous diseases treatment, complex treatment of patients with trophic ulcers of venous etiology, acute venous thrombosis, strategy and tactics of surgical treatment, aesthetic phlebology, endothelial dysfunction in diseases of veins and lymphatic vessels. The article provides the information on reports, presented at the Congress concerning the directions of the study in the field of phlebology, which are being carried out in clinics of Belarus, Russia, Ukraine, Poland, Slovakia, Latvia, Lithuania and Estonia. The reports devoted to various aspects of current phlebology, from various methods of conservative and surgical treatment of deep venous thrombosis, pulmonary embolism to the problems of prevention and treatment of chronic venous disease were presented at the Congress. A comprehensive discussion of the reports permitted to identify the main trends in the research and practice of the member state of Congress.

Keywords: Slavic Venous Forum, congress, phlebology, chronic venous diseases, deep venous thrombosis, trophic ulcers, phlebological patients
p. 702-714 of the original issue
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